Senior Encounter Data Management Professional

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The Senior Encounter Data Management Professional drives encounter data quality, compliance, and operational performance. This role uses data analysis and process improvement strategies to enhance submission accuracy and acceptance rates. The position leads complex initiatives, solves operational challenges, and partners with stakeholders to implement sustainable solutions. Exercises significant independence while contributing to departmental goals and strategy.

The Senior Encounter Data Management Professional leads a team of 2–5 associates and oversees Medicare and Medicaid encounter data operations. This role improves processes, analyzes data to drive submission accuracy and compliance, and develops solutions that increase acceptance rates. The position partners with leadership to resolve complex issues, influence strategy, and deliver operational improvements. Works independently with significant responsibility for priorities and outcomes.

You will report to the Manager, Encounter Data Management to and be a part of Encounter Submissions team.

• Serve as a subject matter expert for Medicare and Medicaid encounter error correction processes.
• Lead recurring meetings with cross-functional partners to review inventory, operational issues, and process updates.
• Present performance results, key accomplishments, and areas of concern to business stakeholders.
• Serve as the primary contact for encounter-related projects and initiatives.
• Identify and implement process improvements to increase efficiency, quality, and compliance.
• Provide coaching, training, and ongoing support to team members and associates.

• 3+ years of experience in Medicare and Medicaid claims, encounters, auditing, or payment integrity operations.
• 2+ years of experience coordinating the work of associates or project teams.
• 2+ years of experience analyzing large datasets and using data to identify trends, resolve issues, and support decisions.
• 3+ years of experience working in a health insurance, managed care, healthcare, or related regulatory environment.
• Demonstrated experience delivering accurate results in a high-volume setting.

• 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.

• To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria.
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

40

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, per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

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…