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. Looking for long-term improvements of encounter submission processes. Begins to influence department’s strategy. Make 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 work with department leadership, trading partner owners, and the error resolution team to ensure timely improvements are made regarding Error Submission issues/errors.   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.  Must analyze data, trends, system limitations and create long-term improvements and see them through implementation to drive the needed change to improve Encounter Submissions.   This involves moderately complex to complex issues where analyzing situations or data requires an in-depth evaluation of variable factors. 

 

Use your skills to make an impact
 

Required Qualifications

• 5 years of medical claims processing/auditing or encounter data management experience 

• Demonstrated deep dive research and analysis skills 

• Prior experience in a fast-paced insurance or health care setting 

• Demonstrated experience working with Medicare and Medicaid programs 

• Ability to manage multiple tasks and deadlines with attention to detail 

• Self-starter, ability to work independently 

Preferred Qualifications

• Bachelor's degree in business, Finance, Operations or other related fields 

• 1+ years of leadership, coaching and/or team leadership experience 

• 1+ years of leadership, coaching and/or team leadership experience 

• Demonstrated experience in managing projects effectively 

• Medical claims experience 

Additional Information

This position may be required to be onsite a minimum of once per month for collaborative meetings if local to Louisville.

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. Yo