Humana is looking to solve the problem of ensuring data integrity for claims errors and improving the encounter submission process to Medicaid/Medicare.
Requirements
- proficient in Microsoft Office, including Word, PowerPoint, Outlook, and Excel
- X12 experience
- prior health insurance industry experience
- working knowledge of Microsoft SQL or SAS
- experience with claims processing
- root cause analysis and resolution experience
- strong analytical and critical thinking abilities
Responsibilities
- develops business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare
- ensures encounter submissions meet or exceed all compliance standards via analysis of data
- develops tools to enhance the encounter acceptance rate by Medicaid/Medicare
- looks for long term improvements of encounter submission processes
- analyzes data to identify root causes of claims errors
- resolves claims errors through root cause analysis
- documents processes clearly and thoroughly for future reference
Other
- Bachelor's degree in business, Finance, Accounting, Operations or other related fields
- excellent communication skills
- ability to manage multiple priorities with attention to detail
- travel requirements: occasional travel to Humana's offices for training or meetings may be required
- work-at-home requirements: must have a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
