Senior Encounter Data Management Professional

Humana Inc.

Job Overview

Location

Remote Nationwide

Job Type

Full-time

Full Job Description

📋 Description

• The Senior Encounter Data Management Professional at Humana Inc. plays a critical role in ensuring the accuracy, compliance, and efficiency of encounter data submissions to Medicare and Medicaid trading partners, directly impacting reimbursement integrity and regulatory adherence for one of the nation’s largest healthcare providers.
• This role leads a small team of 2-5 associates responsible for error correction processes, develops and refines business workflows to improve encounter acceptance rates, and drives long-term process improvements through data analysis, tool development, and cross-functional collaboration.
• As a subject matter expert, the professional serves as the primary liaison between encounter submissions teams, internal business partners, and external trading partners, facilitating meetings, presenting performance summaries, and leading special projects to resolve complex data discrepancies.
• The position operates with significant autonomy, requiring independent decision-making on moderately complex to complex technical and procedural issues, while influencing departmental strategy and communicating objectives and outcomes to senior leadership.
• Day-to-day responsibilities include analyzing large datasets to identify trends and root causes of submission errors, developing and maintaining tools (including SQL queries and Excel-based solutions) to enhance data quality, providing training and mentorship to direct reports and production staff, and ensuring all processes meet HIPAA and CMS compliance standards.
• The role involves managing multiple priorities and deadlines in a fast-paced healthcare environment, with a strong emphasis on attention to detail, proactive problem-solving, and continuous improvement of error correction workflows.
• The professional contributes to organizational goals by identifying process inefficiencies, partnering with stakeholders to implement enhancements, and measuring the impact of changes on encounter acceptance rates and operational efficiency.
• Working remotely nationwide, the role requires a dedicated, secure home office environment to protect protected health information (PHI), with specific technical requirements for internet connectivity and workspace setup to ensure data security and optimal performance.
• This position offers the opportunity to deepen expertise in healthcare data management, Medicare/Medicaid encounter standards (including X-12 and CAS/CI), and healthcare analytics, while developing leadership and project management skills in a mission-driven organization focused on improving health outcomes for vulnerable populations.

🎯 Requirements

• 3+ years of experience in Medicare and/or Medicaid claims processing or auditing
• Experience analyzing and visualizing large data sets
• Proficiency in Microsoft Office applications, including intermediate Excel skills
• Ability to manage multiple tasks and deadlines with strong attention to detail
• Excellent verbal and written communication skills
• Self-starter with proven ability to work independently

🏖️ Benefits

• Competitive annual salary range of $78,400 - $107,800, plus eligibility for performance-based bonus incentives
• Comprehensive benefits package including medical, dental, vision, 401(k) retirement savings, paid time off, parental and caregiver leave, disability coverage, and life insurance
• Remote work flexibility with nationwide eligibility, supported by a dedicated home office setup and potential internet expense reimbursement (particularly for California residents)
• Access to professional development opportunities and exposure to healthcare data standards, project management, and process improvement methodologies
• Opportunity to influence departmental strategy and lead a small team in a stable, mission-driven healthcare organization committed to health equity and quality care

Skills & Technologies

Senior

Remote

$78k-107k

Degree Required

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Humana Inc.

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About Humana Inc.

Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.

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