We are seeking a visionary leader to join our growing team in the Wisconsin Market as a Senior Encounter Data Management Professional. Under the direction of the Associate Director of Business Intelligence, you will take the lead in creating a long-term strategy for the encounter processes. In this role, you will ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare, meeting or exceeding all compliance standards via analysis of data. You will develop tools to enhance the encounter acceptance rate by Medicaid/Medicare as well as looking for improvements of encounter submission processes. This work will be performed without direction and you will be given considerable latitude in determining objectives and approaches to assignments.Leads the Encounter work for WI Market including CMS.Meets regularly with the state to ensure we are processing encounters correctly and timely for all lines of business. Identifies project work including improvements to encounter process and any new state or CMS requirements.Maintains additional encounter reporting for Long Term Care lines of business into AES until sunset by state.Maintains encounter data for reporting across the WI market to provide encounter submission metrics.Lead role in State Long Term Care encounters project - regular meetings with DHS. Leads WI Market Encounter Data Management Workgroup including all business areas involved in Encounter Data Management resolution needs (Network Development, Operations, and IT) with support of AD, BI.Tracks and monitors metrics related to Encounter Data Management, reports issues or non-compliance with state metrics to executive leadership, completes all ESP reporting to Humana, prepares weekly reports for Market.Leads work to support resolution of Incidents and Opportunities identified by the Humana Compliance department. owned by AD, for Encounter Data Management.Guarantees that the existing Encounter Data Management process for the WI Market complies with contractual obligations until the transition to the Edifecs Solution is complete.Tracks submissions to ensure that encounters are generated for all LOB and services. Defines the vision and strategy for upcoming implementation and go-live of Edifecs Solution for Encounter Data Management.Lead for all audits related to Encounter Data Management for WI Market.Partners with Integration Team to develop and plan for transition of Encounter Data Management for Family Care line of business from current vended solution. Develops and maintains all Policies and Procedures for Encounter Data Management for WI Market. Leads/delegates and provides supervision to Encounter Data Management Support Professional.
Use your skills to make an impact
Required Qualifications
Bachelor's degree in Business, Finance, Operations or other related fields5 or more years of related work experience5 or more years of experience in a fast-paced insurance or health care settingComprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and ExcelPreferred Qualifications
Master's Degree in Business Administration or a related fieldPrior demonstrated experience with project managementPrior experience with Medicare and Medicaid programsAdditional Information
Workstyle: HomeTypical Work Days/Hours: Monday – Friday, 8:30 am – 5:00 pm CSTWAH Internet Statement
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.Satellite, cellular and microwave connection can be used only if approved by leadership.Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Benefits
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:
Health benefits effective day 1Paid time off, holidays, volunteer time and jury duty payRecognition pay401(k) retirement savings plan with employer matchTuition assistanceScholarships for eligible dependentsParental and caregiver leaveEmployee charity matching programNetwork Resource Groups (NRGs)Career development opportunitiesHireVue
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
SSN Alert
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Scheduled Weekly Hours
40Pay 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.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.