Senior Encounter Data Management Professional

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Candidates must possess at least 5 years of experience in claims operations, with proven ability in analyzing, reconciling, and manipulating data sets. Proficiency in writing and executing data pulls using relational databases like Microsoft SQL and Access is required, along with experience in creating data visualizations and using reporting applications such as Microsoft PowerPoint and Power BI. Prior experience in a fast-paced insurance or healthcare setting and the ability to manage multiple tasks with attention to detail are essential. A Bachelor's degree in Business, Finance, Operations, or a related field is preferred, as is prior project management experience and familiarity with Medicare and Medicaid programs. Six Sigma certification is a plus.

Responsibilities

The Senior Encounter Data Management Professional is responsible for developing business processes to ensure the successful submission and reconciliation of encounter data to Medicaid/Medicare, meeting or exceeding compliance standards through data analysis. This role involves developing tools to improve the encounter acceptance rate, identifying long-term improvements for submission processes, and ensuring data integrity for claims errors. The professional will handle moderately complex to complex issues, performing analysis without direction and exercising considerable latitude in determining objectives and approaches.

Skills

Claims Operations

Data Analysis

Data Reconciliation

SQL

Microsoft Access

Data Visualization

Power BI

Microsoft PowerPoint

Project Management

Medicare

Medicaid

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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