Humana
Join our dedicated community and prioritize health!
The Encounter Data Integrity Specialist is crucial in maintaining data accuracy and addressing claim discrepancies. This role involves a variety of tasks that often require individual interpretation and decision-making to determine the best course of action.
The specialist will create and refine business processes to ensure timely and accurate submission and reconciliation of encounter data to Medicaid and Medicare. You will analyze data to ensure compliance with established standards and develop tools to enhance the acceptance rate for encounter submissions, focusing on long-term improvements in submission processes. An understanding of departmental and organizational strategies is essential, as well as the ability to operate autonomously while following established guidelines.
Utilize your skills to make a positive impact!
Key Qualifications:
1 - 5 years of experience in claims processing or auditing
At least 1 year of experience conducting thorough root cause analysis and resolution
Ability to document project processes clearly and in detail for future reference
Strong analytical, critical thinking, and problem-solving skills to tackle complex challenges
Proven experience managing multiple tasks while meeting deadlines accurately
Exceptional written and verbal communication skills, capable of conveying complex information effectively
Comprehensive knowledge of Microsoft Office Suite, including Word, PowerPoint, Outlook, and Excel
Preferred Qualifications: Bachelor's degree in Business, Finance, Accounting, Operations, or a related field
Experience in Encounter Submission
Familiarity with CAS and Edifecs
Knowledge of X12 standards
Prior experience in the health insurance sector
Working knowledge of Microsoft SQL or SAS
Additional Information: Interview Process: We will implement an innovative interview technology provided by HireVue. Selected candidates will be invited to complete a pre-recorded Voice Interview or an SMS Text Messaging interview. The pre-recorded interview will involve responding to a series of questions via phone, anticipated to take about 10-15 minutes. Work-At-Home Requirements: Must provide high-speed DSL or cable modem for a home office. California residents will receive internet expense reimbursement.
A minimum speed of 25mbps download and 10mbps upload is required.
Satellite and wireless internet services are not permitted for this role.
A dedicated space free from interruptions to safeguard member PHI / HIPAA information
Travel: This is a remote position; however, occasional travel to Humana’s offices for training or meetings may be required. Scheduled Weekly Hours:
40 Compensation: The pay range reflects a good faith estimate of starting base pay and may vary based on location and individual experience.
$65,000 - $88,600 per year.
This role is eligible for a bonus incentive plan based on performance. Benefits Overview: Humana provides competitive benefits focusing on whole-person well-being, including medical, dental, and vision coverage, a 401(k) savings plan, generous paid time off, short- and long-term disability, life insurance, and numerous other opportunities. Application Deadline:
09-25-2025 About Us: Humana Inc. is dedicated to placing health first for our teammates, customers, and communities we serve. We aim to facilitate access to care and services for all, enhancing the quality of life for individuals, including those with Medicare and Medicaid. Equal Opportunity Employer: Humana does not discriminate against any employee or applicant based on various protected categories. We promote affirmative action to employ individuals with disabilities or protected veteran status.
At least 1 year of experience conducting thorough root cause analysis and resolution
Ability to document project processes clearly and in detail for future reference
Strong analytical, critical thinking, and problem-solving skills to tackle complex challenges
Proven experience managing multiple tasks while meeting deadlines accurately
Exceptional written and verbal communication skills, capable of conveying complex information effectively
Comprehensive knowledge of Microsoft Office Suite, including Word, PowerPoint, Outlook, and Excel
Preferred Qualifications: Bachelor's degree in Business, Finance, Accounting, Operations, or a related field
Experience in Encounter Submission
Familiarity with CAS and Edifecs
Knowledge of X12 standards
Prior experience in the health insurance sector
Working knowledge of Microsoft SQL or SAS
Additional Information: Interview Process: We will implement an innovative interview technology provided by HireVue. Selected candidates will be invited to complete a pre-recorded Voice Interview or an SMS Text Messaging interview. The pre-recorded interview will involve responding to a series of questions via phone, anticipated to take about 10-15 minutes. Work-At-Home Requirements: Must provide high-speed DSL or cable modem for a home office. California residents will receive internet expense reimbursement.
A minimum speed of 25mbps download and 10mbps upload is required.
Satellite and wireless internet services are not permitted for this role.
A dedicated space free from interruptions to safeguard member PHI / HIPAA information
Travel: This is a remote position; however, occasional travel to Humana’s offices for training or meetings may be required. Scheduled Weekly Hours:
40 Compensation: The pay range reflects a good faith estimate of starting base pay and may vary based on location and individual experience.
$65,000 - $88,600 per year.
This role is eligible for a bonus incentive plan based on performance. Benefits Overview: Humana provides competitive benefits focusing on whole-person well-being, including medical, dental, and vision coverage, a 401(k) savings plan, generous paid time off, short- and long-term disability, life insurance, and numerous other opportunities. Application Deadline:
09-25-2025 About Us: Humana Inc. is dedicated to placing health first for our teammates, customers, and communities we serve. We aim to facilitate access to care and services for all, enhancing the quality of life for individuals, including those with Medicare and Medicaid. Equal Opportunity Employer: Humana does not discriminate against any employee or applicant based on various protected categories. We promote affirmative action to employ individuals with disabilities or protected veteran status.