Associate VP, Encounters Submissions
Humana Inc, Lincoln, NE, United States
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The Associate Vice President (AVP) Encounters Submissions is responsible for the integrity, accuracy, and timeliness of submitting encounter data to Centers for Medicare and Medicaid Services (CMS) and/or Medicaid State Agencies for all Medicare, D‑SNP, and Medicaid contracts. The AVP is accountable for working collaboratively across the enterprise and with multiple external partners to ensure robust processes, procedures, analytics, and technology capabilities are implemented to achieve critical compliance requirements.
The Associate Vice President Encounters Submissions leads a large-scale operation of ~220 associates focused on the successful submission of encounters data to CMS and Medicaid State Agencies. The AVP will be responsible for driving all operational activities required to achieve CMS and state specific metrics—including submission timeliness and accuracy, rate setting, kick payments, and audit-related requirements. Success in this role includes building a strong culture of teamwork, accountability, process improvement, innovation, and compliance.
Responsibilities:
Ensures encounter data submissions continuously meet or exceed all compliance and operational standards/requirements.
Accountable for operational implementation of new Medicaid and D‑SNP contracts’ encounters submissions. Partners with Corporate Medicaid to support RFP process for Medicaid state expansions, including proactive communication and escalation of requirements that create operational challenges.
Leads/influences across all levels of the enterprise to develop and implement a transformational 5‑year strategy.
Fosters trusted relationships with enterprise partners to ensure end‑to‑end processes are optimized and communications/escalations occur timely and effectively.
Product ownership of multiple systems/platforms in collaboration with IT leadership, business technology and analytics teams, and external vendors.
Communicates to senior leaders (SVP+) regularly on operational performance, risks, and opportunities.
Continuously identifies and implements levers for risk mitigation, improved control environment, and cost optimization.
Builds a strong culture of teamwork, accountability, process improvement and efficiency, and compliance mindset to drive overall team success and engagement.
Use your skills to make an impact Required Qualifications
Bachelor's degree.
Medicare Advantage/Medicaid‑specific industry knowledge and experience.
7+ years of management experience.
3+ years of experience managing large‑scale operational processes with ambitious compliance standards.
Demonstrated outcomes implementing process reengineering, automation, advanced analytics, and technology stacks to achieve operational excellence.
Experience optimizing processes via a robust control environment.
Enterprise‑thinker who can drive innovation outside of silos.
Best in class communication skills; ability to educate and influence executive level (SVP+) leaders.
Demonstrated experience in leading large organizations while optimizing organizational design and infusing talent development best practices.
Comfort making quick decisions based on quantitative and qualitative insights.
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The Associate Vice President Encounters Submissions leads a large-scale operation of ~220 associates focused on the successful submission of encounters data to CMS and Medicaid State Agencies. The AVP will be responsible for driving all operational activities required to achieve CMS and state specific metrics—including submission timeliness and accuracy, rate setting, kick payments, and audit-related requirements. Success in this role includes building a strong culture of teamwork, accountability, process improvement, innovation, and compliance.
Responsibilities:
Ensures encounter data submissions continuously meet or exceed all compliance and operational standards/requirements.
Accountable for operational implementation of new Medicaid and D‑SNP contracts’ encounters submissions. Partners with Corporate Medicaid to support RFP process for Medicaid state expansions, including proactive communication and escalation of requirements that create operational challenges.
Leads/influences across all levels of the enterprise to develop and implement a transformational 5‑year strategy.
Fosters trusted relationships with enterprise partners to ensure end‑to‑end processes are optimized and communications/escalations occur timely and effectively.
Product ownership of multiple systems/platforms in collaboration with IT leadership, business technology and analytics teams, and external vendors.
Communicates to senior leaders (SVP+) regularly on operational performance, risks, and opportunities.
Continuously identifies and implements levers for risk mitigation, improved control environment, and cost optimization.
Builds a strong culture of teamwork, accountability, process improvement and efficiency, and compliance mindset to drive overall team success and engagement.
Use your skills to make an impact Required Qualifications
Bachelor's degree.
Medicare Advantage/Medicaid‑specific industry knowledge and experience.
7+ years of management experience.
3+ years of experience managing large‑scale operational processes with ambitious compliance standards.
Demonstrated outcomes implementing process reengineering, automation, advanced analytics, and technology stacks to achieve operational excellence.
Experience optimizing processes via a robust control environment.
Enterprise‑thinker who can drive innovation outside of silos.
Best in class communication skills; ability to educate and influence executive level (SVP+) leaders.
Demonstrated experience in leading large organizations while optimizing organizational design and infusing talent development best practices.
Comfort making quick decisions based on quantitative and qualitative insights.
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