Encounter Data Management Medicaid Research Professional

Become a part of our caring community

The Encounter Data Management Medicaid Research Professional ensures accurate and compliant Medicare and Medicaid encounter submissions. You will use data analysis and process improvement techniques to increase submission acceptance rates and operational efficiency. Work independently on routine to moderately complex issues and support departmental goals through process improvement.The Encounter Data Management Medicaid Research Professional supports encounter data integrity by managing claims and encounter data errors. You will work independently to identify issues, recommend solutions, and ensure compliance with Medicaid data submission

requirements. Assignments are varied and require. You will report to the Senior Encounter Data Management Professional and be a part of the Encounters Submissions team.

Use your skills to make an impact

• Manage and analyze large datasets related to Medicaid claims and encounter data to identify trends and patterns.
• Maintain data quality control processes to ensure accuracy and completeness of data.
• Collaborate with teams to design and implement data management solutions.
• Conduct data validation and quality assurance activities to ensure data integrity.
• Develop and maintain documentation of data management processes.
• Demonstrated attention to detail, consistently meeting established quality standards

Use your skills to make an impact

Required

Qualifications

• 1+ year of experience in medical claims adjudication, claims auditing, or encounter submissions.
• Ability to accurately resolve claims issues and meet established deadlines.
• 1+ year of experience conducting root cause analysis and implementing resolutions.
• 1+ year of experience documenting processes, procedures, and findings accurately and thoroughly.

Preferred

Qualifications

• Bachelor's degree in business, Finance, Accounting, Operations or other related fields

• Experience identifying, researching, and resolving Medicaid claims and encounter data errors

• Prior health insurance industry experience

• Working knowledge of Microsoft SQL or SAS

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.

Work at Home RequirementsTo 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

40Pay 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.$65,000 - $88,600 per yearThis 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 07-07-2026

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.

Apply directly on RemoteJobs.org: https://remotejobs.org/remote-jobs/encounter-data-management-medicaid-research-professional-humana