Senior Encounter Data Management Professional

Description

The Senior Encounter Data Management Professional develops business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare. Ensures encounter submissions meet or exceed all compliance standards via pulling and analysis of data and develops tools to enhance the encounter acceptance rate by Medicaid/Medicare. Looks for long term improvements of encounter submission processes. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Responsibilities

The Senior Encounter Data Management Professional ensures data integrity for claims errors. This would be accomplished by doing end to end analysis of encounter submissions to identify new data and methods for long term resolution. The Senior Encounter Data Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Role will include data pulling, data analysis, requirements review and creation, data validation.

This is a remote position

#LI-Remote

Required Qualifications

• 3+ years of requirements writing or UAT validations
• 3+ years of SQL data pulling and data analysis
• 3+ years of claims/encounter processing
• Prior experience in a fast-paced insurance or health care setting
• Ability to manage multiple tasks and deadlines with attention to detail
• Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel

Preferred Qualifications

• Bachelor's degree in Business, Finance, Operations or other related fields
• CAS or MTV experience

• X12 Experience

• Prior demonstrated experience with project management
• Prior experience with Medicare and Medicaid programs
• Six Sigma certification a plus

Additional Information

Why Humana?  You'll experience the following perks as a full-time Humana employee:

Compensation and Financial Security — Our pay philosophy is designed to motivate and reward associates for their skills and contributions to the company. We provide options to help you plan for your future and protect your assets: Competitive base pay, Recognition pay, 401(k) retirement savings plan (125% match for the first 6% contributed by an associate), etc.

Your Whole Health — Humana's health products and services are designed to encourage personal wellness and smart healthcare decisions for you and your family: Medical, dental, and vision benefits, Health plan incentives, Paternity leave, etc.

Work Perks — Humana knows your life extends outside of work. We have many options to support your interests and needs. Some departments have the flexibility to allow associates to work from home, and we offer all associates: Paid time off, holidays, volunteer time, jury duty pay, Associate charity matching program, Discount programs with major retailers, etc.

Grow With Us — Humana provides growth and career opportunities that can help you develop your skills and build your future with the organization: Internal and external learning events, Tuition assistance, Inclusion and diversity training, etc.

Social Security Task:

Alert: Humana values personal identity protection.  Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file.  When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.  

Interview Format:

As part of our hiring process for this opportunity, you may be utilizing our interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Modern Hire interview.  In this interview, you will receive a set of interview questions over your phone and you will provide recorded or text message responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours