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The Senior Encounter Data 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.The Senior Encounter Data Management Professional leads a team of 2-5 associates who develop efficient business processes for Error Corrections associates to ensure successful submission and reconciliation of encounter submissions to Medicare/Medicaid trading partners. Ensures Medicare/Medicaid encounter submissions meet or exceed all compliance standards via analysis of data and develops tools to enhance the encounter acceptance rate for Medicare/Medicaid trading partners. Looks for long term improvements for error corrections processes. Plays a key role in influencing departmental strategy and makes decisions on moderately complex to complex issues regarding resolution of error corrections. Exercises considerable latitude in determining objectives and approaches to assignments and can effectively communicate objectives and accomplishments to upper management.
- Serves as a subject matter expert for error corrections teams for Medicare/Medicaid trading partners
- Facilitates regular collaborative meetings with Encounter Submissions teams, providing status updates on inventory, outstanding concerns, systems issues, and more
- Presents summary of inventory, successes, and areas of concerns to internal business partners
- Serves as a point of contact for special projects for Medicare/Medicaid encounters
- Identifies opportunities for process improvements and works with internal business partners to implement new processes and/or enhancements to existing processes
- Provides ongoing support and training to direct reports and production associates
Use your skills to make an impact
Required Qualifications
- 3 years or greater with Medicare and/or Medicaid claims processing or auditing experience
- 1+ years of leadership, coaching and/or team leadership experience
- Experience with analyzing and visualizing large data sets
- Prior experience in a fast-paced insurance or health care setting
- Ability to manage multiple tasks and deadlines with attention to detail
- Excellent communication skills
- Self-starter, ability to work independently
- Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Intermediate Excel skills
Preferred Qualifications
- Bachelor's degree in Business, Finance, Operations or other related fields
- Prior demonstrated experience with project management
- Working knowledge of SQL writing, creating, and/or running queries (ORACLE, Microsoft SQL Server)
- 1+ years experience working in CAS and CI
- 1+ years of X-12 data knowledge
- Six Sigma certification
Additional Information
Work-At-Home Requirements
- WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
- A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
- Satellite and Wireless Internet service is NOT allowed for this role.
- A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Interview Process
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
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. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$78,400 - $107,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid 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.Application Deadline: 05-29-2025
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
