Encounter Data Management Professional

Become a part of our caring community and help us put health first

Humana's Encounter Data Management (EDM) team is looking for an Encounter Data Management Professional with medical claims and data analysis experience to ensure accurate submissions to Medicaid and Medicare. If you enjoy digging in and solving detailed problems, you can use your skills to identify complex errors and problems within the encounter process between Humana and CMS. Using data analysis, claims research, and other resources, you can ensure data integrity for Medicare/Medicaid claims errors and enhance the encounter acceptance rate.

You will report to one of the supervisors of EDM on this impactful and growing team.

• You should understand that this is a production-focused role and that performance will be subject to regular quality reviews

• Ensure encounter submissions meet all compliance standards through careful analysis

• Look for long-term improvements of encounter submission processes

• Develop tools to enhance the encounter acceptance rate by Medicaid/Medicare

• Maintain partnerships with any departments that are required to make changes to decrease the amount of errors

• Communicate with leadership to highlight results from changes made by the impacted department

• You may work on additional projects, stretch assignments or additional responsibilities

• Bachelor's degree or 2 years or more of medical claims experience

• Experience solving problems using analysis and review

• Experience managing multiple tasks and deadlines

• Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel

• Previous encounter submissions experience

• Prior internship or experience in healthcare data management, claims processing, or actuarial services

• Working knowledge of Microsoft SQL or SAS

• Understanding of healthcare encounter data and basic knowledge of claims submission and reconciliation processes

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.

• Satellite, cellular and microwave connection only if approved by leadership.

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

As part of our candidate screening for this opportunity, we will use an interviewing platform called Hire Vue to enhance our hiring process. Hire Vue allows us to quickly connect and gain valuable information from you about your relevant experience at a time that is best for your schedule.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

40

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

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…