Supervisor, Encounter Data Management

This is a fully remote position, open to applicants in United States.

📋 Description

• Create business processes to ensure the effective submission and reconciliation of encounter submissions to Medicaid and Medicare.

• Analyze data to ensure that encounter submissions comply with or surpass regulatory standards.

• Design tools aimed at enhancing the acceptance rate of encounter submissions by Medicaid and Medicare.

• Identify opportunities for long-term enhancements to the encounter submission procedures.

• Make informed decisions regarding schedules, operational plans, and daily activities.

• Address escalated and intricate issues effectively.

• Oversee and mentor support and technical team members.

• Provide ongoing guidance and oversight on a daily basis.

• Ensure uniform execution of tasks across the team.

• Hold team members accountable for adhering to established policies and procedures.

• Offer direction and strategic guidance.

• Collaborate with various departments to achieve common goals.

• Present findings and updates to senior leadership.

• Report directly to the Manager of Encounter Data Management.

⛳️ Requirements

• A minimum of 2 years of experience in processing Medicare and/or Medicaid claims.

• Familiarity with processing internal and external error claims.

• At least 2 years of experience in leadership roles, either formal or informal.

• Over 1 year of experience with CAS, Edifecs, Optum, and similar DOS 835/837 warehouse systems.

• More than 2 years of advanced proficiency in Microsoft Excel, including VLOOKUP, Pivot Tables, and macro creation.

• At least 1 year of SQL experience for running queries.

• A Bachelor's Degree is preferred.

• Over 1 year of experience in encounter submissions is preferred.

• Certification in Six Sigma or Project Management is preferred.

• Prior experience in a healthcare or insurance environment is preferred.

• A minimum home internet speed of 25 Mbps for downloads and 10 Mbps for uploads is required.

• A dedicated workspace that is free from interruptions to safeguard member PHI/HIPAA information is essential.

🏝️ Benefits

• Bonus incentive plan based on personal and/or company performance.

• Comprehensive medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off for personal and vacation days.

• Company-recognized holidays and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability insurance.

• Life insurance coverage.

• Support for whole-person well-being and personal wellness initiatives.

• Occasional travel to Humana offices for training or meetings.