Become a part of our caring community and help us put health first
The Lead, Data Quality/Integrity understands end-to-end master data processes and flows and uses that knowledge to design and implement master data management solutions. The Lead, Data Quality/Integrity works on problems of diverse scope and complexity ranging from moderate to substantial.
In this key role on the Quality Systems Integration (QSI) team, the QSI Data Quality/Integrity Lead will leverage their expertise in clinical/healthcare data, data exploration, collaboration, and leadership to guide the daily activities of our comprehensive supplemental and lab data connection and processing operations. This role will work to mature existing relationships with key internal and external teams, maintain and mature quality control processes for supplemental and lab data connections, deliver key operational reporting to management, and provide support and leadership on the ground for this team. Additionally, this role will be instrumental in our department's continuous process improvement, operational excellence objectives, and quality management.
Primary Responsibilities:
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Provide expertise, leadership, and positivity while helping the team identify, consult on, develop, and maintain key supplemental data connections
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Engage market and provider offices to establish high value data connections and to educate them on data intake processes and procedures.
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Communicate data processing status and improvement opportunities to management, markets, and other stakeholders.
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Provide operational reporting on progress, challenges, and achievements to management.
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Partner with Medicare Risk Adjustment (MRA) and vendors to establish data feeds for STARs data and maximize the quality of the data procured digitally and manually.
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Support STARs Clinical Team to gather data for pilots and Humana acquisitions.
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Submit FTP requests, approve UAT and postproduction, and partner on most aspects of data acquisition development and deployment of data focused enhancements and functionality.
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Partner with internal HEDIS operations and compliance teams on the maintenance of policies, processes, and procedures in support of the annual HEDIS roadmap.
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Support annual standard and nonstandard supplemental data audit with NCQA and DTS auditor.
Use your skills to make an impact
Required Qualifications
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Bachelor's degree
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Minimum 8 years experience in data focused role utilizing reporting and analytics applications and tools.
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Minimum 6 years experience working with healthcare data and/or lab data experience
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Minimum 5 years experience of data analytics and business intelligence platform to include but not limited to SQL, PowerBI, and others
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Demonstrated ability to articulate ideas effectively in both written and oral forms
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Creative thinking focused on solving problems and identifying simple and innovative solutions
Preferred Qualifications
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Knowledge and experience with HCPCS and CPT codes
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Experience presenting information to executive leadership
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Experience in provider engagement, MRA or STAR
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Familiarity with HEDIS measures
Additional Information
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.
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.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay 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.
$106,900 - $147,000 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.
Application Deadline: 05-18-2025
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.
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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.
