[Remote] Encounter Data Management Lead at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Junior (1 to 2 years), Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Minimum of 2 years’ professional experience in Medicaid data management, healthcare operations
Ability to monitor product performance, resolve production environment issues, and communicate timely updates to business stakeholders
Strong ability to facilitate effective meetings, lead collaborative discussions, and clearly communicate project status, issues, and solutions to business stakeholders
Knowledge in Agile ceremonies, including backlog refinement, sprint planning, and Program Increment (PI) planning
Proficiency in Azure DevOps, including experience reviewing high level testing activities
Demonstrated ability to lead cross-functional collaboration and foster effective team engagement
Exceptional interpersonal and relationship-building skills, with the ability to engage and influence diverse stakeholders, including technical teams and business partners
Ability to translate complex data findings into clear, actionable business recommendations for non-technical audiences
Experience delivering professional presentations, reports, and documentation to support cross-functional initiatives and decision-making
Experience using SQL and data analytics tools to track, trend, and resolve data issues
Demonstrated authority to define product direction, with a consistent focus on advancing key business objectives
Ability to provide a high-speed DSL or cable modem for a home office (minimum 25 Mbps download x 10 Mbps upload; no satellite or wireless internet)
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Preferred Qualifications
Lean or Six Sigma certification
Hands-on experience in encounter data submissions
Background in Medicare and/or Medicaid product management or support
Familiarity with Claims Adjudication Systems (CAS)
Knowledge of X12 transaction sets and standards
Proficiency in SQL for data analysis and management

Responsibilities

Ensuring the accurate and timely submission of encounter data to Medicaid, Medicare, and DSNP states, while maintaining adherence to all regulatory requirements
Ensuring the integrity and accuracy of Medicaid and Medicare encounter data across multiple trading partners
Collaborating with Product Owners and business contract owners to facilitate accurate and compliant encounter data submissions
Managing the resolution of complex data issues while supporting business contract teams across multiple trading partners
Utilizing strong analytical skills and attention to detail
Collaborating effectively with cross-functional teams to drive process improvements and enhance communication and collaboration across the organization

Skills

Key technologies and capabilities for this role

Medicaid data managementMedicare encounter dataAzure DevOpsAgile ceremoniesSprint planningPI planningHealthcare operationsData integrityStakeholder communicationCross-functional collaboration

Questions & Answers

Common questions about this position

What experience is required for the Encounter Data Management Lead role?

Minimum of 2 years’ professional experience in Medicaid data management or healthcare operations is required, along with proficiency in SQL and data analytics tools, knowledge of Agile ceremonies, and strong cross-functional collaboration skills.

Is this a remote position, and what are the work-at-home requirements?

The role supports work-at-home with requirements including the ability to provide a high-speed DSL or cable modem for a home office; associates or contractors must live and work from home in the state.

What is the salary or compensation for this position?

This information is not specified in the job description.

What preferred qualifications would make me stand out for this role?

Preferred qualifications include Lean or Six Sigma certification, hands-on experience in encounter data submissions, background in Medicare/Medicaid product management, familiarity with Claims Adjudication Systems (CAS), knowledge of X12 transaction sets, and proficiency in SQL.

What collaboration skills are emphasized for this position?

The role requires exceptional interpersonal and relationship-building skills, the ability to lead cross-functional collaboration, facilitate effective meetings, and communicate complex data findings to non-technical audiences.

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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