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Humana Senior Health Information Management Professional/ HQRI Medicare Submissions - Office (Louisville, KY) or WAH Nationwide in Bethesda, Maryland


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.

Required Qualifications

  • Bachelor's degree or 5 years of equivalent job 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

  • Medicare and/or Medicare-Medicaid claim processing 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

Additional information

  • Schedule: Monday to Friday from 8 am to 5 pm. S ome additional time is required throughout the year

  • Training: Virtual

  • Work Location (Address): Work at home Nationwide or from an office ( 321 W Main StreetLouisville, KY 40202. Waterfront Plaza 5th floor west)

  • % Travel: Depends on new hire location

Scheduled Weekly Hours