Manager, Encounter Data Management

Humana

2d • Remote

About The Position

Become a part of our caring community The Manager, Encounter Data Management 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. Looks for long term improvements of encounter submission processes. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department. The Manager, Encounter Data Management leads a team of associates who develop efficient business processes for Error Corrections associates and ensures successful submission and reconciliation of encounter submissions across multiple Medicare/Medicaid trading partners. Ensures Medicare/Medicaid encounter submissions meet or exceed all compliance standards via analysis of data and develops tools to enhance the encounter acceptance rate for Medicare/Medicaid trading partners. Looks for long term improvements and/or automation for error corrections processes. Plays a key role in influencing departmental strategy, makes decisions on resources, approach and operations of day-to-day focus, and establishes team as subject matter experts when it is related to the resolution of error. Exercises considerable latitude in determining objectives to exceed goals and can effectively communicate objectives and accomplishments to upper management. Use your skills to make an impact

Requirements

• Bachelor's degree in Business, Finance, Operations or other related fields or 3+ years with Medicare and/or Medicaid claims processing or auditing experience
• 2+ years of leadership, coaching and/or team leadership experience
• Demonstrated problems solving skills; ability to give direction and make sound business decisions
• Ability to develop and present information to senior leadership
• Excellent communication skills
• Experience with analyzing and visualizing large data sets
• Ability to manage multiple tasks and deadlines with attention to detail
• Prior experience in a fast-paced insurance or health care setting
• Self-starter, ability to work independently
• Ability to manage multiple priorities simultaneously
• Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Intermediate Excel skills
• WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office.
• 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

Nice To Haves

• Working knowledge of Edifecs and HERO applications
• 1+ years' experience working in CAS and CI
• Working knowledge of SQL writing, creating, and/or running queries (ORACLE, Microsoft SQL Server)
• 1+ years of X-12 data knowledge
• Six Sigma certification

Responsibilities

• 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
• Develops tools to enhance the encounter acceptance rate by Medicaid/Medicare.
• Looks for long term improvements of encounter submission processes.
• Leads a team of associates who develop efficient business processes for Error Corrections associates and ensures successful submission and reconciliation of encounter submissions across multiple Medicare/Medicaid trading partners.
• Plays a key role in influencing departmental strategy
• Makes decisions on resources, approach and operations of day-to-day focus, and establishes team as subject matter experts when it is related to the resolution of error.
• Exercises considerable latitude in determining objectives to exceed goals and can effectively communicate objectives and accomplishments to upper management.

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees