Become a part of our caring community and help us put health first
 Become a part of our expanding team in this dynamic new position as an Encounter Data Management Professional 2. In this role you will develop business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare. Through analysis of data, you will ensure encounter submissions meet or exceed all compliance standards. You will develop tools to enhance the standards. counter acceptance rate by Medicaid/Medicare. Looks for long term improvements of encounter submission processes. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

Processes Encounter work for WI Market including CMS.Completes additional encounter reporting for Long Term Care linesOversees the process to ensure CFO receives monthly encounter submission reports for contractual attestation process.Participates in State Long Term Care encounters project - regular meetings with DHS. Participates in Market Encounter Data Management Workgroup including all business areas involved in Encounter Data Management resolution needs (Network Development, Operations, and IT) with support of AD, BIFunctions as a SME and UAT tester to ensure completion of implementation and go-live of Edifecs Solution for Encounter Data Management.Participates in end to end with Encounter Data Management for WI Market and use of Edifecs Solution.Engages in Encounter Data Management for WI Market meets contractual requirements until cut over to Edifecs Solution.Participates in audits related to Encounter Data Management for WI Market.Serves as a SME to provide input to develop a plan to transition of Encounter Data Management for Family Care line of business from current vended solution. Assists in development of Policies and Procedures for Encounter Data Management for WI Market. 
Use your skills to make an impact
 

Required Qualifications

1 or more years of related experiencePrior financial reporting experienceStrong analysis, critical thinking, and analytical problem-solving skillsComprehensive 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 fieldsPrior health insurance industry experienceWorking knowledge of Microsoft SQL or SAS

Additional Information

Workstyle: HomeTypical Work Days/Hours: Monday – Friday, 8:30 am – 5:00 pm CST

WAH Internet Statement

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 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.

Benefits

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 1Paid time off, holidays, volunteer time and jury duty payRecognition pay401(k) retirement savings plan with employer matchTuition assistanceScholarships for eligible dependentsParental and caregiver leaveEmployee charity matching programNetwork Resource Groups (NRGs)Career development opportunities

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

SSN Alert

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.