Senior Encounter Data Management Professional

Humana

2d • Remote

About The Position

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. The Senior Encounter Data Management Professional leads a team of 2-5 associates who develop efficient business processes for Error Corrections associates to ensure successful submission and reconciliation of encounter submissions to Medicare/Medicaid trading partners. Ensures Medicare/Medicaid encounter submissions meet or exceed all compliance standards via analysis of data and develops tools to enhance the encounter acceptance rate for Medicare/Medicaid trading partners. Looks for long term improvements for error corrections processes. Plays a key role in influencing departmental strategy and makes decisions on moderately complex to complex issues regarding resolution of error corrections. Exercises considerable latitude in determining objectives and approaches to assignments and can effectively communicate objectives and accomplishments to upper management. Serves as a subject matter expert for error corrections teams for Medicare/Medicaid trading partners Facilitates regular collaborative meetings with Encounter Submissions teams, providing status updates on inventory, outstanding concerns, systems issues, and more Presents summary of inventory, successes, and areas of concerns to internal business partners Serves as a point of contact for special projects for Medicare/Medicaid encounters Identifies opportunities for process improvements and works with internal business partners to implement new processes and/or enhancements to existing processes Provides ongoing support and training to direct reports and production associates Use your skills to make an impact

Requirements

• 3 years or greater with Medicare and/or Medicaid claims processing or auditing experience
• Experience with analyzing and visualizing large data sets
• Prior experience in a fast-paced insurance or health care setting
• Ability to manage multiple tasks and deadlines with attention to detail
• Excellent communication skills
• Self-starter, ability to work independently
• Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Intermediate Excel skills
• 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, Operations or other related fields
• Prior demonstrated experience with project management
• Working knowledge of SQL writing, creating, and/or running queries (ORACLE, Microsoft SQL Server)
• 1+ years experience working in CAS and CI
• 1+ years of X-12 data knowledge
• Six Sigma certification

Responsibilities

• 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
• Develops tools to enhance the encounter acceptance rate by Medicaid/Medicare.
• Looks for long term improvements of encounter submission processes.
• Leads a team of 2-5 associates who develop efficient business processes for Error Corrections associates to ensure successful submission and reconciliation of encounter submissions to Medicare/Medicaid trading partners.
• Plays a key role in influencing departmental strategy and makes decisions on moderately complex to complex issues regarding resolution of error corrections.
• Serves as a subject matter expert for error corrections teams for Medicare/Medicaid trading partners
• Facilitates regular collaborative meetings with Encounter Submissions teams, providing status updates on inventory, outstanding concerns, systems issues, and more
• Presents summary of inventory, successes, and areas of concerns to internal business partners
• Serves as a point of contact for special projects for Medicare/Medicaid encounters
• Identifies opportunities for process improvements and works with internal business partners to implement new processes and/or enhancements to existing processes
• Provides ongoing support and training to direct reports and production associates

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: Mid Level
• Number of Employees: 5,001-10,000 employees