Encounter Data Management Professional

3 weeks ago

Washington, United States Gilbride Management Group (GMG) Full time
About the Role

We are seeking a highly skilled Encounter Data Management Professional to join our team at Gilbride Management Group (GMG). As a key member of our team, you will play a critical role in ensuring data integrity for claims errors.

Key Responsibilities
  • Identify and analyze complex errors and problems within the encounter process between Humana and CMS and Duals Medicaid.
  • Develop and implement new strategies and processes to decrease the amount of errors that come back from CMS and Medicaid trading partners.
  • Collaborate with departments and communicate with leadership to highlight impacts that will result in change and decrease errors.
  • Make decisions regarding own work approach/priorities and follow direction.
Requirements
  • Prior health insurance industry experience.
  • CAS or DOS processing and/or auditing experience.
  • 3 + or more years of claims experience.
  • 2 + years Medicaid/Medicare 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.
Preferred Qualifications
  • Bachelors degree or equivalent experience.
  • Working knowledge of Microsoft SQL or SAS.
  • 1 + year of Edifecs, eHub and Humana image view station, associate Remittance Inquiry and enterprise portal.
Work Environment

This is a remote work opportunity, and you will be required to have a high-speed DSL or cable modem for a home office. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information is also required.

Interview Process

We will be using an exciting interviewing technology provided by HireVue, a third-party vendor. 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.

Benefits

Gilbride Management Group (GMG) offers competitive benefits that support whole-person well-being. Associate benefits include medical, dental and vision benefits, 401(k) retirement savings plan, time off, company and personal holidays, volunteer time off, paid parental and caregiver leave, short-term and long-term disability, life insurance and many other opportunities.

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