Supervisor, Encounter Data Management

The Supervisor, Encounter Data Management develops business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare. Ensures encounter submissions meet or exceed all compliance standards via analysis of data, and develop tools to enhance the encounter acceptance rate by Medicaid/Medicare. Looks for long term improvements of encounter submission processes. Makes decisions related to schedules, plans, and daily operations. Handles escalated and complex issues, supervises a team of support and technical associates, and provides day-to-day guidance and oversight.Ensures consistency in execution across team. Holds team members accountable for following established policies. You will report to the Manager, Encounter Data Management.

• Demonstrated; ability to give direction and guidance

• Proven and ability to collaborate with multiple departments

• Deliver presentations to senior leadership, + 2+ years Medicare and/or Medicaid claims processing experience

• Internal and external error claim processing

• 2+ years of formal or informal leadership experience

• 1+ years’ experience working in CAS, Edifecs, Optum and similar DOS 835/837 warehouse systems

• 2 years+ of advanced Microsoft Excel (VLOOKUP, Pivot Tables and ability to create macros)

• 1 year+ SQL experience (running queries)

Preferred Qualifications

• Bachelor’s Degree.

• 1+ years’ experience in encounter submissions background.

• Certification in Six Sigma or Project Management

• Prior Experience in healthcare or insurance setting

Work at Home Requirements: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.