Encounter Data Management Lead
Role details
Job location
Tech stack
Job description
The Encounter Data Management Lead provides strategic oversight of AI-driven reconciliation and automation initiatives to improve data quality and operational efficiency. This role partners across teams to guide model performance, communicate progress, and prioritize enhancements while independently navigating complex challenges.
The Encounter Data Management Lead develops AI tools and business process to reduce/eliminate errors or automate manual steps. Monitor AI reconciliation stats to determine success of AI model. Collaborate on model changes to improve reconciliation success and collaborate on AI automation and systematic automation. Present out to partners on progress of AI modeling, errors that are on the backlog and create roadmap for backlogged work. Exercises independent on complex issues regarding job duties and related tasks, and works, uses requiring analysis of variable factors and determining the best course of action. This position reports to the Director, Encounter Data Management.
Use your skills to make an impact:
- Lead and manage AI-driven reconciliation and automation initiatives to reduce encounter data errors and eliminate manual processes.
- Monitor and evaluate AI reconciliation performance metrics; identify issues and drive targeted model and process enhancements.
- Partner with technical and business stakeholders to communicate AI performance, backlog status, and automation priorities; maintain a remediation roadmap.
- Independently analyze and resolve complex encounter data and automation challenges using sound judgment with minimal supervision; report to the Director, Encounter Data Management., * 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
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Requirements
- 4 or more years of AI modeling experience
- 4 or more years working with encounter data
- 2 or more years of project management experience, * Master's Degree in Business Administration or a related field
- Certification in Six Sigma or Project Management
- Prior Experience in healthcare or insurance setting
Benefits & conditions
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.
$94,900 - $130,500 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
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.
