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Encounter Data Management, Medicaid Research Professional
Location
United States
Posted
20 days ago
Salary
$65K - $88.6K / year
Seniority
Junior
Job Description
Encounter Data Management, Medicaid Research Professional
Humana
• 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.
Job 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
