Senior Encounter Data Management Professional

Humana

5d • $78,400 - $107,800 • Remote

About The Position

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.

Requirements

• 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.

Nice To Haves

• 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

Responsibilities

• 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.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree