The Encounter Data Management Lead supports the Encounter Data Management team within the Healthcare Quality Reporting and Improvement (HQRI) organization. This position is responsible for ensuring the accurate and timely submission of encounter data to Medicaid, Medicare, and DSNP states, while maintaining adherence to all regulatory requirements. The Lead utilizes strong analytical skills and attention to detail and collaborates effectively with cross-functional teams to drive process improvements and enhance communication and collaboration across the organization.
The Encounter Data Management Lead is responsible for ensuring the integrity and accuracy of Medicaid and Medicare encounter data across multiple trading partners. This role collaborates with Product Owners and business contract owners to facilitate accurate and compliant encounter data submissions. The Lead manages the resolution of complex data issues while supporting business contract teams across multiple trading partners.
Use your skills to make an impact
Required Qualifications
- Minimum of 2 years’ professional experience in Medicaid data management, healthcare operations
- Ability to monitor product performance, resolve production environment issues, and communicate timely updates to business stakeholders.
- Strong ability to facilitate effective meetings, lead collaborative discussions, and clearly communicate project status, issues, and solutions to business stakeholders.
- Knowledge in Agile ceremonies, including backlog refinement, sprint planning, and Program Increment (PI) planning.
- Proficiency in Azure DevOps, including experience reviewing high level testing activities.
- Demonstrated ability to lead cross-functional collaboration and foster effective team engagement.
- Exceptional interpersonal and relationship-building skills, with the ability to engage and influence diverse stakeholders, including technical teams and business partners.
- Ability to translate complex data findings into clear, actionable business recommendations for non-technical audiences.
- Experience delivering professional presentations, reports, and documentation to support cross-functional initiatives and decision-making.
- Experience using SQL and data analytics tools to track, trend, and resolve data issues.
- Demonstrated authority to define product direction, with a consistent focus on advancing key business objectives.
Preferred Qualifications
- Lean or Six Sigma certification.
- Hands-on experience in encounter data submissions
- Background in Medicare and/or Medicaid product management or support.
- Familiarity with Claims Adjudication Systems (CAS).
- Knowledge of X12 transaction sets and standards.
- Proficiency in SQL for data analysis and management.
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, 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
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.Application Deadline: 12-15-2025About 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.
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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.
