Encounter Data Management Professional

Become a part of our caring community and help us put health first
 The Encounter Data Management Professional develops business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid. Ensures encounter submissions meet or exceed all compliance standards via analysis of data and develops tools to enhance the encounter acceptance rate by Medicaid. Looks for long term improvements of encounter submission processes. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

The Encounter Data Management Professional works to develop efficient business processes for Error Corrections associates to ensure successful submission and reconciliation of encounter submissions to Medicaid trading partners. Ensures Medicaid encounter submissions meet or exceed all compliance standards via analysis of data, and consults on development of tools to enhance the encounter acceptance rate for Medicaid trading partners. Conducts research on various Medicaid encounter issues, tests submissions, tracks outcomes and acts as a subject matter expert for Medicaid encounter submissions and looks for long term improvements for error corrections processes. Exercises considerable latitude in determining objectives and approaches to assignments and is able to effectively communicate objectives and accomplishments to leaders.

• Serves as a subject matter expert for error corrections teams for multiple Medicaid States
• Conducts research and testing for resolution of claim errors
• Tracks test cases and reports on outcomes of test cases
• Drafts error correction processes for production associates to utilize
• Analyzes and trends data of error correction inventory, research root causes for inventory spikes and dips
• Consults with internal business partners regarding error correction inventory, successes, and areas of opportunity

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree in Business, Finance, Accounting, Operations or other related fields or 2 years or more of CAS claims experience
• 2 years or more experience with Medicare/Medicaid claims processing, auditing, or researching experience
• 2 years' experience with analyzing and visualizing large data sets
• Advance Excel experience creating formulas and pivot tables
• Strong analysis, critical thinking, and analytical problem-solving skills
• Ability to manage multiple tasks and deadlines with attention to detail
• Excellent communication skills
• Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint and Outlook

Preferred Qualifications

• Prior experience delivering presentations
• Comprehensive knowledge of other Payer Platform Experience
• Working knowledge of SQL writing and creating queries (ORACLE, Microsoft SQL Server)
• 1+ years of X-12 data knowledge
• Sig Sigma certification a plus

Additional Information

For local applicants, this position will be required to be onsite a minimum of once per month for collaborative meetings if local to Louisville.

Work-At-Home Requirements

• WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• 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

Interview Process

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$57,700 - $79,500 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of 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.
About us
 Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.