Humana HQRI Medicare Submissions Senior Professional in Phoenix, Arizona
The Senior Health Information Management Professional ensures data integrity for claims errors. The Senior Health Information Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior 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. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
Bachelor’s degree or 5 years of equivalent experience
2 years of SQL experience, Netezza or PL/SQL build and query
Prior experience in a fast paced insurance or health care setting
Prior experience with Medicare and Medicaid programs
Healthcare claims expert
Financial or Metric analysis and reporting experience
Ability to manage multiple tasks and deadlines with attention to detail
Experience leading meetings and department initiatives focused on process improvements
Experience leading successful small teams or successful small team projects
Proven experience investigating / researching problems and identifying root cause analysis along with presenting to leadership using metrics
Excellent communication skills
Self-starter, ability to work independently
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
Master's Degree in Business Administration or a related field
2+ years’ experience pulling big data and developing and presenting data visualizations that enable analysis and decisions
X-12 experience / MRA submission encounter experience
Power BI experience or other dashboard experience
Experience with Tableau or Qlikview
Prior demonstrated experience with project management
Six Sigma certification a plus
Scheduled Weekly Hours
Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
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