Encounter Data Management Professional

Work at Home - Kentucky

Applications have closed
Become a part of our caring community and help us put health first
 The Encounter Data Management Professional ensures data integrity for claims errors. The Encounter Data Management Professional work various tasks or assignments involving Medicare and/or Medicaid encounters.

Do you have an analytical mindset? Do you find yourself researching to find the root cause of a problem? If so, this position is for you! The Encounter Data Management Professional will identify complex errors and problems within the encounter process between Humana and CMS and Duals Medicaid using data analysis, claims research, and other resources to provide insight. Encounter Data Management Professional ensures encounter submissions meet or exceed all compliance standards and develop new strategies and processes that decreases the amount of errors that come back from CMS and Medicaid trading partners. Partnership with departments and communication 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. Being able to make decisions regarding own work approach/priorities and follows direction. The work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

This is a remote position.


Use your skills to make an impact

Required Qualifications

  • Prior health insurance industry experience
  • CAS, processing and/or auditing experience
  • 3 + or more years of claims experience
  • 2 + years Medicaid/Medicare experience
  • Strong analysis, critical thinking, and analytical problem solving skills
  • Ability to manage multiple tasks and deadlines with attention to detail
  • Excellent communication skills
  • Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel

Preferred Qualifications

  • Bachelor's degree or equivalent experience
  • Working knowledge of Microsoft SQL or SAS
  • 1 + year of Edifecs, eHub and Humana image view station, associate Remittance Inquiry and CMS.gov enterprise portal

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


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.


$47,700 - $65,600 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.
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 because he or she is a protected veteran. 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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Tags: Data analysis Data management Excel Research SAS SQL

Perks/benefits: Competitive pay Flex hours Health care Insurance Medical leave Parental leave

Regions: Remote/Anywhere North America
Country: United States

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