Lead, Encounter Data Management (Remote)

Humana; United States; On-site; USD 65,000 - 89,000; Full time

Job summary

Humana is seeking a Supervisor for Encounter Data Management to lead a team, oversee daily operations, and ensure Medicaid/Medicare submissions meet all compliance standards. You will analyze data, drive process improvements, and develop tools to improve acceptance rates.

The role reports to the Manager, Encounter Data Management and requires collaboration across departments, occasional travel, and a 40-hour work week. Eligible for a bonus plan based on performance.

Qualifications

• 2+ years Medicare and/or Medicaid claims processing experience.
• 2+ years of formal or informal leadership experience.
• 1+ years' experience working in CAS, Edifecs, Optum and similar DOS 835/837 warehouse systems.
• 2 years+ of advanced Microsoft Excel (VLOOKUP, Pivot Tables and ability to create macros).
• 1 year+ SQL experience (running queries).
• Internal and external error claim processing.

Responsibilities

• Supervise a team of support and technical associates; guide daily operations.
• Ensure encounter submissions meet compliance standards through data analysis.
• Develop tools to enhance the encounter acceptance rate by Medicaid/Medicare.
• Hold team members accountable to established policies and ensure consistency across team.
• Report to the Manager, Encounter Data Management and participate in senior leadership presentations.

Skills

Medicare/Medicaid claims processing

Leadership experience

SQL

Advanced Excel

Cas/Edifecs/Optum tools

Presentation to leadership

Education

Bachelor's Degree

Tools

CAS

Edifecs

Optum

DOS 835/837 warehouse systems

Job description

Humana is seeking a Supervisor for Encounter Data Management to lead a team, oversee daily operations, and ensure Medicaid/Medicare submissions meet all compliance standards. You will analyze data, drive process improvements, and develop tools to improve acceptance rates.

The role reports to the Manager, Encounter Data Management and requires collaboration across departments, occasional travel, and a 40-hour work week. Eligible for a bonus plan based on performance.