Encounter Data and Rules Professional 2

Profile

Description

The Health Information Management Professional 2 ensures data integrity for claims errors. The Health Information Management Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Health Information Management Professional 2 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, and develops tools to enhance the encounter 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. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications

Bachelor's degree in Business, Operations, Computer Science, or other related fields

1 - 5 years of related experience

Strong analysis, critical thinking, and analytical problem solving skills

Ability to manage multiple tasks and deadlines with attention to detail

Excellent communication skills

Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Master's Degree in Business Administration or a related field

Prior health insurance industry experience

Experience working with logic rules

Working knowledge of Microsoft SQL or SAS

Additional Information

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com