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

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 ensures data integrity for claims errors that result from the data exchange between Humana and its trading partners, Medicare and Medicaid. The Senior Encounter Data Management Professional will act as liaison between department leadership, trading partner owners, and the error resolution team ensuring timely correction of any issues. Additionally the Senior Encounter Data Management Professional is tasked with problem-solving and clearing roadblocks to any issue that prevents Humana from submitting encounter data information to its trading partners in a timely manner. This involves moderately complex to complex issues where the analysis fo situations or data requires an in-depth evaluation of variable factors.

Use your skills to make an impact
 

Required Qualifications

• 5 or more years of related experience
• 3 years of medical claims or encounter data management experience
• Prior experience in a fast-paced insurance or health care setting
• Prior experience with Medicare and Medicaid programs
• Ability to manage multiple tasks and deadlines with attention to detail
• Excellent communication skills
• Self-starter, ability to work independently
• Ability to manage multiple priorities simultaneously
• Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel

Preferred Qualifications

• Bachelor's degree in business, Finance, Operations or other related fields
• Prior demonstrated experience with project management

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 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.

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.

 

$78,400 - $107,800 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”) 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