Encounter Data Management Professional

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

Encounter Data Management Professional is responsible for ensuring accurate submission and reconciliation of encounter data to Medicaid and Medicare through effective business processes. Ensures claims submissions meet or exceed all compliance standards via analysis of data and develops tools to enhance the encounter acceptance rate by Medicaid/Medicare. Looks for long-term improvements of claims submission processes. Takes ownership by applying professional standards, regulations, and strategies within their work area.

Independently sets priorities and makes decisions on work approach while following established direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

Humana’s Encounter Data Management (EDM) team is seeking an Encounter Data Management Professional that has experience with business processing and data entry to join working remote (anywhere in the U.S.). As the Encounter Data Management Professional, you will identify complex errors and problems within the encounter process between Humana and CMS using data analysis, claims research, and other resources to provide insight and ensure data integrity for Medicare/Medicaid claims errors.

• Develop business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare
• Applicants should understand that this is a production-focused role and that performance will be subject to regular quality reviews
• Ensure encounter submissions meet or exceed all compliance standards via analysis of data
• Develop tools to enhance the encounter acceptance rate by Medicaid/Medicare
• Look for long-term improvements of encounter submission processes
• Maintain partnership with departments and communicate with the leadership of those departments to highlight impacts that will result in change by the responsible department that ultimately will decrease the amount of errors
• May be assigned additional projects, stretch assignments and/or additional duties

• Bachelor’s degree or 2 years or more of medical claims experience
• Strong analysis, critical thinking, and analytical problem-solving skills
• Ability to manage multiple tasks and deadlines with attention to detail
• Excellent verbal and written communication skills
• 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.
• Strong analytical, organizational, and communication skills

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 recommended; 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

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan…