Humana
10,000+ employees
Founded 1961
⚕️ Healthcare Insurance
Healthcare Insurance
Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.
Encounter Data Management, Medicaid Research Professional
🔥 4 hours ago
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Humana
10,000+ employees
Founded 1961
⚕️ Healthcare Insurance
Healthcare Insurance
Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.
📋 Description
• Ensure accurate and compliant Medicare and Medicaid encounter submissions. • Use data analysis and process improvement techniques to increase submission acceptance rates and operational efficiency. • Work independently on routine to moderately complex issues and support departmental goals through process improvement. • Support encounter data integrity by managing claims and encounter data errors. • Identify issues, recommend solutions, and ensure compliance with Medicaid data submission requirements. • Manage and analyze large datasets related to Medicaid claims and encounter data to identify trends and patterns. • Maintain data quality control processes to ensure accuracy and completeness of data. • Collaborate with teams to design and implement data management solutions. • Conduct data validation and quality assurance activities to ensure data integrity. • Develop and maintain documentation of data management processes.
🎯 Requirements
• 1+ year of experience in medical claims adjudication, claims auditing, or encounter submissions. • Ability to accurately resolve claims issues and meet established deadlines. • 1+ year of experience conducting root cause analysis and implementing resolutions. • 1+ year of experience documenting processes, procedures, and findings accurately and thoroughly. • Bachelor's degree in business, Finance, Accounting, Operations or other related fields (preferred). • Experience identifying, researching, and resolving Medicaid claims and encounter data errors (preferred). • Prior health insurance industry experience (preferred). • Working knowledge of Microsoft SQL or SAS (preferred).
🏖️ Benefits
• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance
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