Encounter Data Management Professional
Role details
Job location
Tech stack
Job description
The Encounter Data Management Professional ensures data integrity for claims errors. The Encounter Data Management Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Encounter Data Management Professional develops business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare. Ensure encounter submissions exceed all compliance standards via and develop tools to enhance the encounter acceptance rate by Medicaid/Medicare. Look for long-term improvements of encounter submission processes. Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. Regarding own work methods, occasionally in, and receive guidance where needed. Follow established guidelines/procedures. You will report to the Manager, Encounter Data Management., As part of our hiring process, we will use 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.
Work-At-Home Requirements:
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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.
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A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
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Satellite and Wireless Internet service is NOT allowed for this role.
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A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Requirements
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1-5+ years of demonstrated experience in claims processing
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Minimum 1 year of experience in root cause analysis and resolution
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Experience with documenting processes thoroughly for future reference
Preferred Qualifications
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Bachelor's degree in business, Finance, Accounting, Operations or other related fields
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X12 experience
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Prior health insurance industry experience
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Working knowledge of Microsoft SQL or SAS
Benefits & conditions
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.
$65,000 - $88,600 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.