Encounter Data Management Professional

Become a part of our caring community and help us put health first

Encounter Data Management Professional is responsible for ensuring accurate submission and reconciliation of encounter data to Medicaid and Medicare through effective business processes. Ensures claims submissions meet or exceed all compliance standards via analysis of data and develops tools to enhance the encounter acceptance rate by Medicaid / Medicare. Looks for long-term improvements of claims submission processes. Takes ownership by applying professional standards, regulations, and strategies within their work area. Independently sets priorities and makes decisions on work approach while following established direction. Work is managed and often guided by precedent and / or documented procedures / regulations / professional standards with some interpretation.

Humana's Encounter Data Management (EDM) team is seeking an Encounter Data Management Professional that has experience with business processing and data entry to join working remote (anywhere in the U.S.). As the Encounter Data Management Professional, you will identify complex errors and problems within the encounter process between Humana and CMS using data analysis, claims research, and other resources to provide insight and ensure data integrity for Medicare / Medicaid claims errors.

Key Role Functions

Develop business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid / Medicare

Applicants should understand that this is a production-focused role and that performance will be subject to regular quality reviews

Ensure encounter submissions meet or exceed all compliance standards via analysis of data

Develop tools to enhance the encounter acceptance rate by Medicaid / Medicare

Look for long-term improvements of encounter submission processes

Maintain partnership with departments and communicate with the leadership of those departments to highlight impacts that will result in change by the responsible department that ultimately will decrease the amount of errors

May be assigned additional projects, stretch assignments and / or additional duties

Use your skills to make an impact

Required Qualifications

Experience managing end-to-end business processes in the medical Encounter space

Minimum 1 year of prior financial reporting and / or related finance experience

2 or more years of experience using DOS type systems

Strong analysis, critical thinking, and analytical problem-solving skills

Ability to manage multiple tasks and deadlines with attention to detail

Excellent verbal and written communication skills

Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel

Preferred Qualifications

Prior health insurance industry experience

Working knowledge of Microsoft SQL or SAS

Medicare and / or Medicaid experience

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, 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

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.

$59,300 - $80,900 per year

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 : 11-11-2025

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 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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our