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 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 and works with appropriate parties to reduce and eliminate errors from occurring. The Senior Encounter Data Management Professional analyzes data, puts together presentations, communicates with outside teams to educate around provider billing issues that causes submissions not be accepted by CMS or the state.  Also work assignments involving moderately complex to complex issues where the analysis of the process gaps or problems requires an in-depth evaluation of variable factors including large amounts of data and working with multiple depts to fully uncover the issue at hand and to create a fix that satisfies and improves the encounter submission process and present/report to upper leadership.

This is a remote position.

#LI-Remote

Required Qualifications

• 5 or more years of related healthcare industry experience
• Prior experience in a fast-paced insurance or health care setting
• Ability to manage multiple tasks and deadlines with attention to detail
• Excellent communication and presentation skills
• Proven ability to research and find root cause analysis
• Self-starter, ability to work independently
• Ability to manage multiple priorities simultaneously
• Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel

Preferred Qualifications

• Bachelor's degree in Business, Finance, Operations
• Master's degree in business administration or a related field
• Medical claims/CAS 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 int