Description
Become a part of our caring community and help us put health first
Become a part of our caring community and help us put health first
The Encounter Data Management Professional will conduct research and analysis to execute accurate, timely, and completeness of DSNP encounter submissions.Encounter Data Management Professional will have comprehensive knowledge of processes, policies and procedures as well as compliance guidelines. Will support achieving operational and compliance key performance indicators. In addition, the associate will participate in cross functional teams and support analyzing business processes, error processing, issues and ticket creations with the product management team.
The Encounter Data Management Professional will support encounter processing, analytics and research of encounter submission inventory. The Encounter Data Management Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Use your skills to make an impact
Required Qualifications
- Minimum 1 year of experience in medical claims payment and processing
- Minimum 1 year of experience analyzing and researching medical claims
- Proficient in Microsoft Office (Word, Excel, Access, PowerPoint)
- Working knowledge of SQL
Demonstrated understanding of healthcare data exchange formats and industry standards (e.g., CSV, XML, JSON, or other structured data)
- Demonstrated ability to identify process gaps and recommend solutions independently
- Self-directed with initiative to drive projects and escalate issues appropriately
- Strong analytical skills with experience resolving complex data issues
- Proven decision-making in ambiguous situations using available data
- Demonstrated creativity and proactive approach to managing tasks and inventory
- Committed to improving business outcomes through continuous improvement
- Proficient in oral and written communication
- Collaborative with strong relationship-building and stakeholder engagement skills
- Familiar with healthcare industry regulations or adjacent sectors
Preferred Qualifications
- Comprehensive knowledge of Medicare, Medicaid, and DSNP encounter processes and policies.
- Familiarity with EDI X12 formats (837P/I/D, 999, 277, 835, 270/271, 834)
- Working knowledge of advanced analytics and experience with Python and DataBricks.
- Working knowledge of Cloud Technologies (Azure Synapse Analytics) and Power Platform (Power BI)
- Experience creating pivot tables and consumable information within Excel
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 for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions, and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
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.
$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.
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
