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/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. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

The Encounter Data Management Professional ensures data integrity for claims errors. The Encounter Data Management Professional work various tasks or assignments involving Medicare and/or Medicaid encounters.

Do you have an analytical mindset? Do you find yourself researching to find the root cause of a problem? If so, this position is for you!

The Encounter Data Management Professional will identify complex errors and problems within the encounter process between Humana and CMS and Duals Medicaid using data analysis, claims research, and other resources to provide insight. Encounter Data Management Professional ensures encounter submissions meet or exceed all compliance standards and develop new strategies and processes that decreases the number of errors that come back from CMS and Medicaid trading partners.

Partnership with departments and communication with the leadership of those departments to highlight impacts that will result in change by the responsible department that ultimately will decrease the number of errors. Being able to make decisions regarding own work approach/priorities and follows direction. The work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

 

Use your skills to make an impact
 

Required Qualifications

• Prior health insurance industry experience
• CAS, processing and/or auditing experience
• 3 + or more years of claims experience
• 2 + years Medicaid/Medicare experience
• Demonstrated experience in analysis, critical thinking, and analytical problem-solving skills
• Ability to manage multiple tasks and deadlines with attention to detail
• Proficient communication skills
• Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel

Preferred Qualifications

• Bachelor's degree
• Working knowledge of Microsoft SQL or SAS
• 1 + year of Edifecs, eHub and Humana image view station, associate Remittance Inquiry and CMS.gov enterprise portal

Additional Information

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 Format

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.

 

$59,300 - $80,900 per year

 

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.

Application Deadline: 03-23-2025

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.