[Hiring] Manager, Encounter Data Management @Humana

Role Description

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.
• Leads a team of associates who develop efficient business processes for Error Corrections associates.
• Ensures successful submission and reconciliation of encounter submissions across multiple Medicare/Medicaid trading partners.
• Plays a key role in influencing departmental strategy and makes decisions on resources, approach, and operations of day-to-day focus.
• Establishes team as subject matter experts related to the resolution of error.
• Exercises considerable latitude in determining objectives to exceed goals and effectively communicates objectives and accomplishments to upper management.

Qualifications

• 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 problem-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.

Requirements

• 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.

Benefits

• 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.

Additional Information

• WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office.
• Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• 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.
• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$86,300 - $118,700 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Application Deadline

04-14-2026