Encounter Data Management Professional

Humana

1d • $59,300 - $80,900 • Remote

About The Position

The 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. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities and follows direction. You will follow established policies, procedures, and regulatory guidelines while applying judgment to routine issues.
This is a remote position.
Humana's Encounter Data Management (EDM) team is looking for an Encounter Data Management Professional with experience in business processes and data entry. You will analyze encounter data, research claims issues, and identify complex errors within the encounter submission process between Humana and CMS. Your work will help ensure the accuracy and integrity of Medicare and Medicaid claims data. You will report to a supervisor.

Requirements

• 2+ years of relevant business processing or data entry experience.
• 1+ year of experience analyzing or reconciling data.
• Experience using Excel (can maintain complex spreadsheets) and other data analysis.
• Experience working with DOS-based or legacy systems.

Nice To Haves

• Prior health insurance industry experience
• Working knowledge of Microsoft SQL or SAS
• Medicare or Medicaid experience

Responsibilities

• Analyze encounter data to identify errors, discrepancies, and trends.
• Support submission and reconciliation processes for Medicare and Medicaid.
• Research claims and related data to resolve processing issues.
• Identify opportunities to improve encounter acceptance rates and reduce errors.
• Communicate findings and process impacts with business partners.
• Support compliance with established encounter submission requirements.
• Participate in projects and process improvement programs.

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: No Education Listed