Encounter Data Management Lead

Kentucky, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Candidates must have a minimum of 5 years of technical experience in CAS or X12 with knowledge of EDI formats like 834, 835, 837, 270/271, and 277. Experience working in an SQL environment with SSMS, 2+ years of project leadership, and demonstrated experience building presentations based on analytics are required. Strong knowledge of Cloud Technologies (Azure Synapse Analytics), Databricks, and Power Platform (Power BI, Power Automate, Power Apps) is also necessary, along with knowledge of process improvement, healthcare industry regulations, and managing change. Excellent communication and collaboration skills are essential, and a Bachelor's degree is preferred. Experience with state or federal encounter data submission portals and data quality assurance processes is a plus.

Responsibilities

The Encounter Data Management Lead will support the Encounter Data Management team by ensuring the accurate, timely, and complete submission of encounter data to Medicaid, Medicare, and DSNP states. This role involves managing inventory, ensuring compliance adherence, and solving complex business challenges. Key responsibilities include partnering with teams on new state implementations, conducting annual state contract reviews, analyzing new regulatory requirements, and developing compliance and operational processes. The Lead will analyze data to ensure encounter submissions meet compliance standards, develop tools to enhance acceptance rates, and work on strategic initiatives. They will also troubleshoot submission errors and potentially work with external vendors.

Skills

CAS

X12

EDI

834

835

837

270/271

277

SQL

SSMS

Project Leadership

Data Analytics

Presentation

Cloud Technologies

Azure Synapse Analytics

Databricks

Power Platform

Power BI

Power Automate

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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