Encounter Data Management Professional

Humana

1d • Remote

About The Position

Humana's Encounter Data Management (EDM) team is looking for an Encounter Data Management Professional with medical claims and data analysis experience to ensure accurate submissions to Medicaid and Medicare. If you enjoy digging in and solving detailed problems, you can use your skills to identify complex errors and problems within the encounter process between Humana and CMS. Using data analysis, claims research, and other resources, you can ensure data integrity for Medicare/Medicaid claims errors and enhance the encounter acceptance rate. You will report to one of the supervisors of EDM on this impactful and growing team. Main Responsibilities You should understand that this is a production-focused role and that performance will be subject to regular quality reviews

Requirements

• Bachelor's degree or 2 years or more of medical claims experience
• Experience solving problems using analysis and review
• Experience managing multiple tasks and deadlines
• 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

Responsibilities

• Ensure encounter submissions meet all compliance standards through careful analysis
• Look for long-term improvements of encounter submission processes
• Develop tools to enhance the encounter acceptance rate by Medicaid/Medicare
• Maintain partnerships with any departments that are required to make changes to decrease the amount of errors
• Communicate with leadership to highlight results from changes made by the impacted department
• You may work on additional projects, stretch assignments or additional responsibilities

Benefits

• Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
• Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level