Encounter Data Management Lead

Description

The Encounter Data Management Lead 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 pulling, data analysis, and develops tools to enhance the encounter acceptance rate by Medicaid/Medicare. Looks for long term improvements of encounter submission processes. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Responsibilities

The Encounter Data Management Lead ensures data integrity for claims errors. The Encounter Data Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial. This would be accomplished by doing end to end analysis of encounter submissions to identify new data and methods for long term resolution. The lead will oversee business side of release management for multiple IT teams.

This is a remote position.

#LI-Remote

Required Qualifications

• 4+ years of requirements writing or UAT validations
• 4+ of SQL data pulling and data analysis
• 3+ years leading associates
• 3+ years of claims/encounter processing
• Prior demonstrated experience with process improvements
• Ability to manage multiple tasks and deadlines with attention to detail
• Demonstrated problems solving skills; ability to give direction and make sound business decisions
• Proven organizational and prioritization skills and ability to collaborate with multiple departments
• Ability to deliver presentations to senior leadership
• Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel

Preferred Qualifications

• a Bachelor's degree
• CAS or MTV experience
• X12 Experience
• Certification in Six Sigma or Project Management
• Prior Experience in healthcare or insurance setting

Additional Information

Why Humana?  You'll experience the following perks as a full-time Humana employee:

Compensation and Financial Security — Our pay philosophy is designed to motivate and reward associates for their skills and contributions to the company. We provide options to help you plan for your future and protect your assets: Competitive base pay, Recognition pay, 401(k) retirement savings plan (125% match for the first 6% contributed by an associate), etc.

Your Whole Health — Humana's health products and services are designed to encourage personal wellness and smart healthcare decisions for you and your family: Medical, dental, and vision benefits, Health plan incentives, Paternity leave, etc.

Work Perks — Humana knows your life extends outside of work. We have many options to support your interests and needs. Some departments have the flexibility to allow associates to work from home, and we offer all associates: Paid time off, holidays, volunteer time, jury duty pay, Associate charity matching program, Discount programs with major retailers, etc.

Grow With Us — Humana provides growth and career opportunities that can help you develop your skills and build your future with the organization: Internal and external learning events, Tuition assistance, Inclusion and diversity training, etc.

Social Security Task:

Alert: Humana values personal identity protection.  Please be aware that applicants being considered for an interview will 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.  

Interview Format:

As part of our hiring process for this opportunity, you may be utilizing our 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 for a first round interview, you will receive an email correspondence inviting you to participate in a Modern Hire interview.  In this interview, you will receive a set of interview questions over your phone and you will provide recorded or text message responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed, and you will