Senior Health Information Management Professional

Profile

Description

The Senior Health Information Management Professional manages the process of Prescription Drug Event (PDE) error resolution, which includes partnering with Humana Pharmacy Solutions business areas and PDE stakeholders for process improvement. The Senior Health Information Management Professional works assignments frequently requiring interpretation and independent determination of appropriate courses of action.

Responsibilities

The Senior Health Information Management Professional develops business processes to ensure successful resolution of Prescription Drug Event (PDE) errors. The role applies knowledge of pharmacy claims processing and systems, which includes Microsoft Excel, Microsoft Access, RxNova, EDW, and PL/SQL Developer. Identifies opportunities for process improvements for the prevention of PDE errors by collaborating with Pharmacy and Eligibility teams. Have a working knowledge of CMS guidance in order to determine proper resolution of errors. Requires interpretation and independent determination of appropriate courses of action for each error category. Coordinates rework file submissions and PDE recycle requests with several internal and external business areas including SS&C, Eligibility, Finance, and Humana IT.

The role is responsible for the strategy and execution of initiatives to meet business goals. Knowledge sharing and providing guidance to Pharmacy business areas and PDE stakeholders. Makes decisions regarding own work methods in ambiguous situations and requires minimal direction.

Responsibilities include (but not limited to):

Tracking of all PDE file activity submitted to SS&C, Humana's claims processing vendor.

Tracking of acceptance and error rates from CMS response files.

Create and provide monthly data pulls and reporting to leadership, which includes financial impact by error type, weekly and YTD comparison.

Tracking of rework and recycle submissions to ensure PDE submissions are sent to CMS.

Research PDE errors utilizing Humana and SS&C tools to determine business areas to assist with root cause and resolution.

Facilitate monthly touchpoints with internal business partners who collaborate on PDE error resolution.

Collaborate with pharmacy teams, enrollment/eligibility, finance, and SS&C partners on error resolution and root cause.

Facilitate the PDE Deletion process, as needed, by gathering requests, obtaining stakeholder approvals, and tracking deletion activity.

Document and maintain process flows and work instructions.

Maintain department, CMS, and Compliance timelines.

Ensure timely responses from business partners to meet CMS deadlines.

Required Qualifications

4 years related experience

Pharmacy claims experience

Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and Access

Excellent communication skills, both oral and written, and ability to adapt your communication style for the audience

Ability to work with large data sets and data manipulation

Ability to simultaneously manage multiple priorities and deadlines with attention to detail

Preferred Qualifications

Prescription Drug Event (PDE) knowledge

Familiarity with Humana and SS&C operating systems, specifically PL/SQL Developer, EDW, and RxNova.

Additional Information

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected, you will receive correspondence inviting you to participate in a Modern Hire assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed and you will subsequently be informed if you will be moving forward to next round.

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 Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com