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Humana HQRI Medicare Submissions Senior Professional in Indianapolis, Indiana

Description

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.

Responsibilities

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.

Required Qualifications

  • 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

Preferred Qualifications

  • 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

  • EDW knowledge

  • 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

Additional Information

Scheduled Weekly Hours

40

About Us

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.

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

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