The DSNP Encounters Data Management Lead supports the Encounter Data Management team within the Healthcare Quality Reporting and Improvement organization (HQRI). This support includes submission of encounter data to Medicaid, Medicare, and DSNP states and will require the ability to manage inventory, ensure compliance adherence, and solve complex business challenges ranging from moderate to substantial.
The Lead, Encounter Data Management will support the effectiveness and efficiency of encounter data management submissions by ensuring inventory is processed accurately, timely and with completeness. In addition, this role will need partnering with multiple teams and leaders on new state implementations, conduct annual state contract reviews, analyze new regulatory requirements, and support the development of compliance and operational processes.
The Lead, Encounter Data Management Lead will identify and analyze inventory and will ensure encounter submissions meet or exceed all compliance standards via analysis of data and develop tools to enhance the encounter acceptance rate by Medicaid, Medicare, and DSNP. This role will work on strategic initiatives and will need to solve problems of diverse scope and complexity ranging from moderate to substantial. This role will utilize various tools, technologies, applications, and data resources.
Use your skills to make an impact
Required Qualifications
- Minimum 5 years of technical experience in CAS or X12, including working knowledge of EDI formats: 834, 835, 837, 270/271, 277, etc.
- Experienced working in an SQL environment with comprehensive knowledge of SSMS
- 2 or more years of project leadership experience
- Demonstrated experience building and presenting story-driven presentations based on analytics
- Strong working knowledge of Cloud Technologies (Azure Synapse Analytics), Databricks and Power Platform (Power BI, Power Automate, & Power Apps)
- Knowledgeable in process improvement and metrics development
- Knowledgeable in regulations governing health care industries or related adjacent industries
- Ability to be creative, anticipate and be proactive around the next steps in large initiatives simultaneously
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences and business outcome.
- 2 + years' experience in managing change by leading and energizing others, modeling adaptability, and inspiring strong organizational performance through periods of transformation, ambiguity, and complexity.
- Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences
- Highly collaborative mindset and excellent relationship-building skills, including the ability to engage many diverse stakeholders and SMEs and win their co-ownership in the outcome
- Collaborative with adjacent business intelligence and data science teams to drive results
Preferred Qualifications
- Bachelor's Degree
- Comprehensive knowledge of advanced analytic and experience with Python, Databricks or other statistical software
- Experience managing large-scale projects or leading cross-functional teams, preferably in healthcare data management.
- Experience with state or federal encounter data submission portals (e.g., CMS, state Medicaid portals) and troubleshooting submission errors.
- Proven track record in implementing or overseeing data quality assurance processes and tools.
- Experience working with external vendors, technology partners, or third-party administrators in a data exchange environment.
Additional Information
Work-At-Home Requirements:
- 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 for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions, and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round.
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
Top Skills
What We Do
At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
