Encounter Data Management Professional

Humana

2d•Remote

About The Position

Become a part of our caring community and help us put health first Encounter Data Management Professional is responsible for ensuring accurate submission and reconciliation of encounter data to Medicaid and Medicare through effective business processes. Ensures claims 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 claims submission processes. Takes ownership by applying professional standards, regulations, and strategies within their work area. Independently sets priorities and makes decisions on work approach while following established direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. Humana’s Encounter Data Management (EDM) team is seeking an Encounter Data Management Professional that has experience with business processing and data entry to join working remote (anywhere in the U.S.). As the Encounter Data Management Professional, you will identify complex errors and problems within the encounter process between Humana and CMS using data analysis, claims research, and other resources to provide insight and ensure data integrity for Medicare/Medicaid claims errors. Key Role Functions Develop business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare Applicants should understand that this is a production-focused role and that performance will be subject to regular quality reviews Ensure encounter submissions meet or exceed all compliance standards via analysis of data Develop tools to enhance the encounter acceptance rate by Medicaid/Medicare Look for long-term improvements of encounter submission processes Maintain partnership with departments and communicate 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 May be assigned additional projects, stretch assignments and/or additional duties Use your skills to make an impact

Requirements

Bachelor’s degree or 2 years or more of medical claims experience
Strong analysis, critical thinking, and analytical problem-solving skills
Ability to manage multiple tasks and deadlines with attention to detail
Excellent verbal and written communication skills
Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel

Nice To Haves

Previous encounter submissions experience
Prior internship or experience in healthcare data management, claims processing, or actuarial services
Working knowledge of Microsoft SQL or SAS
Understanding of healthcare encounter data and basic knowledge of claims submission and reconciliation processes.
Strong analytical, organizational, and communication skills

Responsibilities

Develop business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare
Ensure encounter submissions meet or exceed all compliance standards via analysis of data
Develop tools to enhance the encounter acceptance rate by Medicaid/Medicare
Look for long-term improvements of encounter submission processes
Maintain partnership with departments and communicate 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
May be assigned additional projects, stretch assignments and/or additional duties