Manager, Encounter Data Management
Humana Inc, Jacksonville, FL, United States
Job Overview
The Manager, Encounter Data Management develops business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare and ensures compliance with all standards. This role leads a team of associates who develop efficient processes for Error Corrections, enhances encounter acceptance rates, and seeks long‑term improvements and automation. The Manager makes decisions on resources, approach, and operations for day‑to‑day focus, collaborates across departments, conducts briefings and area meetings, and communicates accomplishments to upper management.
Use your skills to make an impact
The Manager demonstrates leadership, problem‑solving, presentation to senior leadership, and excellent communication while managing multiple tasks and deadlines.
Required Qualifications
Bachelor's degree in Business, Finance, Operations or other related fields or 3+ years of 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 Microsoft Office applications, including Word, PowerPoint, Outlook, and intermediate Excel skills
Preferred Qualifications
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
Work‑At‑Home Requirements
Must have a high‑speed DSL or cable modem for a home office; staff in California will receive payment for internet expense
Minimum standard speed: 25 Mbps download x 10 Mbps upload
Satellite and wireless Internet service not allowed
Dedicated space free from ongoing interruptions to protect PHI/HIPAA information
Interview Format
The hiring process includes a pre‑recorded voice interview and/or an SMS text‑messaging interview with a third‑party vendor. Participation may take approximately 10–15 minutes.
Travel
Occasional travel to Humana offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
$86,300 – $118,700 per year, with potential bonus incentive plan based on performance.
Description of Benefits
Humana offers competitive benefits, including medical, dental, vision, 401(k), paid time off, short‑term and long‑term disability, life insurance, and more.
Equal Opportunity Employer
Humana does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. The company takes affirmative action in accordance with Section 503 of the Rehabilitation Act and VEVRAA. All employment decisions are based on valid job requirements. Humana complies with all applicable federal civil rights laws and provides free language interpreter services.
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The Manager, Encounter Data Management develops business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare and ensures compliance with all standards. This role leads a team of associates who develop efficient processes for Error Corrections, enhances encounter acceptance rates, and seeks long‑term improvements and automation. The Manager makes decisions on resources, approach, and operations for day‑to‑day focus, collaborates across departments, conducts briefings and area meetings, and communicates accomplishments to upper management.
Use your skills to make an impact
The Manager demonstrates leadership, problem‑solving, presentation to senior leadership, and excellent communication while managing multiple tasks and deadlines.
Required Qualifications
Bachelor's degree in Business, Finance, Operations or other related fields or 3+ years of 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 Microsoft Office applications, including Word, PowerPoint, Outlook, and intermediate Excel skills
Preferred Qualifications
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
Work‑At‑Home Requirements
Must have a high‑speed DSL or cable modem for a home office; staff in California will receive payment for internet expense
Minimum standard speed: 25 Mbps download x 10 Mbps upload
Satellite and wireless Internet service not allowed
Dedicated space free from ongoing interruptions to protect PHI/HIPAA information
Interview Format
The hiring process includes a pre‑recorded voice interview and/or an SMS text‑messaging interview with a third‑party vendor. Participation may take approximately 10–15 minutes.
Travel
Occasional travel to Humana offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
$86,300 – $118,700 per year, with potential bonus incentive plan based on performance.
Description of Benefits
Humana offers competitive benefits, including medical, dental, vision, 401(k), paid time off, short‑term and long‑term disability, life insurance, and more.
Equal Opportunity Employer
Humana does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. The company takes affirmative action in accordance with Section 503 of the Rehabilitation Act and VEVRAA. All employment decisions are based on valid job requirements. Humana complies with all applicable federal civil rights laws and provides free language interpreter services.
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