Encounter Data Management Medicaid Research Professional

Humana

1d • $65,000 - $88,600 • Remote

About The Position

Become a part of our caring community The Encounter Data Management Medicaid Research Professional ensures accurate and compliant Medicare and Medicaid encounter submissions. You will use data analysis and process improvement techniques to increase submission acceptance rates and operational efficiency. Work independently on routine to moderately complex issues and support departmental goals through process improvement. The Encounter Data Management Medicaid Research Professional supports encounter data integrity by managing claims and encounter data errors. You will work independently to identify issues, recommend solutions, and ensure compliance with Medicaid data submission requirements. Assignments are varied and require. You will report to the Senior Encounter Data Management Professional and be a part of the Encounters Submissions team. Use your skills to make an impact Manage and analyze large datasets related to Medicaid claims and encounter data to identify trends and patterns. Maintain data quality control processes to ensure accuracy and completeness of data. Collaborate with teams to design and implement data management solutions. Conduct data validation and quality assurance activities to ensure data integrity. Develop and maintain documentation of data management processes. Demonstrated attention to detail, consistently meeting established quality standards Use your skills to make an impact

Requirements

• 1+ year of experience in medical claims adjudication, claims auditing, or encounter submissions.
• Ability to accurately resolve claims issues and meet established deadlines.
• 1+ year of experience conducting root cause analysis and implementing resolutions.
• 1+ year of experience documenting processes, procedures, and findings accurately and thoroughly.
• Must have the ability to provide a high-speed DSL or cable modem for a home office.
• 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.

Nice To Haves

• Bachelor's degree in business, Finance, Accounting, Operations or other related fields
• Experience identifying, researching, and resolving Medicaid claims and encounter data errors
• Prior health insurance industry experience
• Working knowledge of Microsoft SQL or SAS

Responsibilities

• Manage and analyze large datasets related to Medicaid claims and encounter data to identify trends and patterns.
• Maintain data quality control processes to ensure accuracy and completeness of data.
• Collaborate with teams to design and implement data management solutions.
• Conduct data validation and quality assurance activities to ensure data integrity.
• Develop and maintain documentation of data management processes.
• Demonstrated attention to detail, consistently meeting established quality standards

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree