Humana

Encounter Data Management Lead

Louisiana, United States

Not SpecifiedCompensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries

Position Overview

  • Location Type: Remote (with occasional travel)
  • Job Type: Full-time
  • Salary: $94,900 - $130,500 per year

The Encounter Data Management Lead develops business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid. This role ensures encounter submissions meet or exceed all compliance standards through data analysis and develops tools to enhance the encounter acceptance rate by Medicaid, focusing on long-term improvements. The Lead advises executives on functional strategies and exercises independent judgment on complex issues with minimal supervision. This position is responsible for ensuring data integrity for claims errors and works on problems of diverse scope and complexity.

Location Requirement

  • Candidates must be currently residing in Louisiana.

Required Qualifications

  • 2 or more years of experience with encounter data submissions or related Medicaid experience.
  • 2 or more years of project leadership experience.
  • Prior demonstrated experience with process improvements.
  • Ability to manage multiple tasks and deadlines with attention to detail.
  • Excellent communication skills.
  • Ability to operate under tight deadlines.
  • Demonstrated problem-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.
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Preferred Qualifications

  • Master's Degree in Business Administration or a related field.
  • Certification in Six Sigma or Project Management.
  • Prior leadership experience over direct reports.
  • Prior experience in a healthcare or insurance setting.

Work-At-Home Requirements

  • Must have the ability to provide a high-speed DSL or cable modem for a home office.
  • A minimum speed of 25Mbps download x 10Mbps upload is required.
  • Satellite and Wireless Internet service are NOT allowed.
  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information is required.
  • Associates or contractors residing and working from home in California will be provided payment for their internet expense.

Interview Format

  • The hiring process utilizes HireVue, a third-party vendor, for interviews.
  • Selected candidates may be invited to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview via phone, expected to take 10-15 minutes.

Responsibilities

  • Develop business processes for successful submission and reconciliation of encounter submissions to Medicaid.
  • Ensure encounter submissions meet or exceed compliance standards through data analysis.
  • Develop tools to enhance the encounter acceptance rate by Medicaid.
  • Identify and implement long-term improvements for encounter submission processes.
  • Advise executives on functional strategies concerning encounter data management.
  • Exercise independent judgment and decision-making on complex job-related tasks.
  • Ensure data integrity for claims errors.
  • Manage multiple tasks and deadlines with a high degree of accuracy.
  • Collaborate with multiple departments to achieve objectives.
  • Deliver presentations to senior leadership.

Additional Information

  • This position is eligible for a bonus.
  • Occasional travel to Humana's offices for training or meetings may be required.

Skills

Encounter Data Submissions
Medicaid
Process Improvements
Data Analysis
Project Leadership
Problem Solving
Communication
Microsoft Office

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.
Rising medical costs and tightening Medicare reimbursements may strain financial performance.
Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.
The company emphasizes inclusivity, offering free language interpreter services for accessibility.
Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.
The company is the first insurer to cover TMS therapy for adolescent depression.
Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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