Become a part of our caring community and help us put health first
 

The Supervisor, Encounter Data Management 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. Decisions are typically related to schedule, plans and daily operations. Performs escalated or more complex work of a similar nature and supervises a group of typically support and technical associates; coordinates and provides day-to-day oversight to associates. Ensures consistency in execution across team. Holds team members accountable for following established policies.

The Supervisor, Encounter Data Management ensures data integrity for claims errors. The Supervisor, Encounter Data Management works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of variable factors to solve basic problems; collaborates with management and top professionals/specialists in selection of methods, techniques, and analytical approach.

Use your skills to make an impact
 

Required Qualifications

• 2+ years Medicare and/or Medicaid claims processing experience
• Internal and external error claims processing
• 2+ years of formal or informal leadership experience
• 1+ years' experience working in CAS, Edifecs, Optum and similar DOS 835/837 warehouse systems
• Ability to manage multiple tasks and operate under tight deadlines with attention to detail.
• Excellent communication skills
• Demonstrated problems solving skills; ability to give direction and make sound business decisions.
• Self-starter, ability to work independently.
• 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

• Bachelor's Degree
• 1+ years’ experience in encounter submissions background
• Working knowledge of SQL writing, creating, and/or running queries
• Certification in Six Sigma or Project Management
• Prior Experience in healthcare or insurance setting

Additional Information

Interview Format

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.

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

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay 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.

 

$59,300 - $80,900 per year

 

This 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”) offe