Become a part of our caring community and help us put health firstThe Encounter Data Management Professional will report to the Senior Encounter Data Management Professional. They will develop business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare and ensure encounter submissions meet or exceed all compliance standards. They will develop tools to enhance the encounter acceptance rate by Medicaid/Medicare and look for long-term improvements of encounter submission processes.
The Encounter Data Management Professional will:
- Collaborate with internal operations, DHS, and IT to process Encounter Claims work for WI Market including CMS
- Complete additional Encounter claims reporting for Long Term Care lines
- Oversee the process to ensure CFO receives monthly encounter submission reports for contractual attestation process
- Participate in State Long Term Care encounters project, to include regular meetings with DHS
- Participate in Market Encounter Data Management Workgroup, including all teams involved in Encounter Data Management resolution needs (Network Development, Operations, and IT) with support of AD, BI
- Participate in end to end with Encounter Data Management for WI Market
- Participate in audits related to Encounter Data Management for WI Market
- Be the Subject Matter Expert for Encounter Data management for all lines of business, specializing in Family Care
- Navigate the ForwardHealth portal and associated systems to support encounter data management
- Communicate complex encounter error resolutions to partners and team members
- Help develop policies and procedures for Encounter Data Management for WI Market
- Work schedule will be Monday-Friday 8:00am - 5:00pm CST
Use your skills to make an impact Required Qualifications- 1 or more years of related experience
- Prior financial reporting experience
- Strong analysis, critical thinking, and analytical problem-solving skills
- Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel
Preferred Qualifications- Bachelor's degree in Business, Finance, Accounting, Operations or other related fields
- Prior health insurance industry experience
- Working knowledge of Microsoft SQL or SAS
Additional Information
WAH Internet StatementTo 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 can be used 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 business requirements for their position/job. Work from 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 Hours40
Pay RangeThe 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 BenefitsHumana, 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 usHumana 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 EmployerIt 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.
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