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The Encounter Data Management Professional develops business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare. Ensures encounter 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 encounter submission processes. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities and follows direction. You will follow established policies, procedures, and regulatory guidelines while applying judgment to routine issues.
This is a remote position.
Humana's Encounter Data Management (EDM) team is looking for an Encounter Data Management Professional with experience in business processes and data entry. You will analyze encounter data, research claims issues, and identify complex errors within the encounter submission process between Humana and CMS. Your work will help ensure the accuracy and integrity of Medicare and Medicaid claims data. You will report to a supervisor.
Main Responsibilities
Analyze encounter data to identify errors, discrepancies, and trends.
Support submission and reconciliation processes for Medicare and Medicaid.
Research claims and related data to resolve processing issues.
Identify opportunities to improve encounter acceptance rates and reduce errors.
Communicate findings and process impacts with business partners.
Support compliance with established encounter submission requirements.
Participate in projects and process improvement programs.
Use your skills to make an impact
Required Qualifications
2+ years of relevant business processing or data entry experience.
1+ year of experience analyzing or reconciling data.
Experience using Excel (can maintain complex spreadsheets) and other data analysis.
Experience working with DOS-based or legacy systems.
Preferred Qualifications
Prior health insurance industry experience
Working knowledge of Microsoft SQL or SAS
Medicare or Medicaid experience
Work at Home Requirements: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. 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.
$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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 08-27-2026
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
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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Questions:
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Please answer the questions below.
- Have you ever worked for Humana Inc. and/or its affiliates and subsidiaries (collectively “Humana”) before as an Associate, Intern, or Contractor/Temporary Worker?
- Yes
- No
- Are you legally authorized to work in the United States?
- Yes
- No
- Will you now or in the future require immigration sponsorship by our company to attain or maintain your employment eligibility (e.g., H-1B, E-3, TN, 0-1, STEM OPT, or any immigration work authorization requiring a written submission from the company to a government agency)?
- Yes
- No
- Do you reside in the location for this job posting or within commutable distance?
- Yes
- No
- What are your salary expectations for this job?
- Please explain your reason for leaving your current or last position.
- Have you ever been employed by the Federal Government, a contractor (including subsidiaries, parents, and affiliates) that performed work for the Defense Health Agency – DHA, served in the Military, and/or were a Political Appointee?