Health Information Management Professional

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

Responsibilities

The Health Information Management Professional 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

• Experience with analyzing and visualizing large data sets and presenting information to leaders
• Ability to manage multiple tasks and deadlines with attention to detail
• Bachelor's degree or 3+ years of related work experience in SQL writing and creating queries (ORACLE, Microsoft SQL Server, Netezza, Databricks)
• 1+ years of Medical claims experience (auditing, processing, loading, etc...)
• Strong analysis, critical thinking, and analytical problem solving skills
• Excellent written and verbal communication skills
• Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel

Work-At-Home Requirements

• Satellite and Wireless Internet service is NOT allowed for this role.
• WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Preferred Qualifications

• Master's Degree in Business Administration or a related field
• Prior experience in a fast paced insurance or health care setting
• CAS Auditing, Claims Adjudication or other Payer Platform Experience
• Sig Sigma certification a plus
• Prior experience with Medicare and Medicaid programs
• 1+ years of X-12 data knowledge

Additional Information

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from [email protected] with instructions to add the information into the application at Humana’s secure website.

Vaccination Policy

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

40