Be an early applicantLess than 25 applicants

Company

Humana · 3 hours ago

Manager, Encounter Data Management

United States

Full-time

Remote

Mid, Senior Level

$77K/yr - $106K/yr

3+ years exp

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Health CareHealth Insurance

H1B Sponsor Likely

U.S. Citizen Only

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Responsibilities

Develop business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare.

Ensure encounter submissions meet or exceed all compliance standards via analysis of data.

Develop tools to enhance the encounter acceptance rate by Medicaid/Medicare.

Look for long term improvements of encounter submission processes.

Make decisions related to resources, approach, and tactical operations for projects and initiatives.

Collaborate across departments and conduct briefings and area meetings.

Maintain frequent contact with other managers across the department.

Lead a team of associates to develop efficient business processes for Error Corrections associates.

Ensure successful submission and reconciliation of encounter submissions across multiple Medicare/Medicaid trading partners.

Play a key role in influencing departmental strategy and establish team as subject matter experts.

Communicate objectives and accomplishments to upper management.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Medicare claims processingMedicaid claims processingData analysisLeadership experienceMicrosoft OfficeSQLSix Sigma certificationX-12 data knowledgeEdifecs knowledgeHERO applications knowledgeFast-paced environment experience

Required

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

Preferred

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

Company

Humana

Glassdoor

3.8

Humana is a health insurance provider for individuals, families, and businesses.

Founded in 1964

Louisville, Kentucky, USA

10,001+ employees

http://www.humana.com

H1B Sponsorship

Humana has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2023 (217)

2022 (257)

2021 (258)

2020 (107)