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The Encounter Data Management Professional ensures data integrity for claims errors. The Encounter Data Management Professional work various tasks or assignments involving Medicare and/or Medicaid encounters.

The Encounter Data Management Professional ensures data integrity for claims errors. The Encounter Data Management Professional work various tasks or assignments involving Medicare and/or Medicaid encounters.

Responsibilities

Do you have an analytical mindset? Do you find yourself researching to find the root cause of a problem? If so, this position is for you! The Encounter Data Management Professional will identify complex errors and problems within the encounter process between Humana and CMS and Duals Medicaid using data analysis, claims research, and other resources to provide insight. Encounter Data Management Professional ensures encounter submissions meet or exceed all compliance standards and develop new strategies and processes that decreases the amount of errors that come back from CMS and Medicaid trading partners. Partnership with departments and communication with the leadership of those departments to highlight impacts that will result in change by the responsible department that ultimately will decrease the amount of errors. Being able to make decisions regarding own work approach/priorities and follows direction. The work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

 

This is a remote position.

#LI-Remote

Use your skills to make an impact
 

Required Qualifications

• Prior health insurance industry experience
• CAS, processing and/or auditing experience
• 3 + or more years of claims experience
• 2 + years Medicaid/Medicare experience
• Strong analysis, critical thinking, and analytical problem solving skills
• Ability to manage multiple tasks and deadlines with attention to detail
• Excellent communication skills
• Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel

Preferred Qualifications

• Bachelor's degree or equivalent experience
• Working knowledge of Microsoft SQL or SAS
• 1 + year of Edifecs, eHub and Humana image view station, associate Remittance Inquiry and CMS.gov enterprise portal

Additional Information

Work-At-Home Requirements

• WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.  
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

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.

 

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.  

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$47,700 - $65,600 per year