JobsUSAEncounter Data Management Specialist
Company : Humana
Location : Denver, CO
Posted Date : 15 September 2025
Job Details
Join Our Compassionate Community and Prioritize Health
As an Encounter Data Management Specialist, you will play a vital role in ensuring the accuracy, timeliness, and completeness of DSNP encounter submissions through thorough research and analysis.
Your expertise in processes, policies, and compliance guidelines will be critical in supporting operational and compliance key performance indicators. You'll collaborate with cross-functional teams, aiding the product management group in analyzing business processes, troubleshooting errors, and creating tickets for issue resolution.
You will oversee encounter processing, perform analytics, and research the encounter submission inventory, demonstrating independent judgment and decision-making in a dynamic environment.
Leverage Your Skills to Make a Difference
Required Qualifications
- At least 1 year of experience in medical claims payment and processing
- At least 1 year of experience analyzing and researching medical claims
- Proficient in Microsoft Office (Word, Excel, Access, PowerPoint)
- Working knowledge of SQL
- Familiarity with EDI X12 formats (837P/I/D, 999, 277, 835, 270/271, 834)
- Ability to identify process gaps and propose independent solutions
- Self-starter with initiative to drive projects and properly escalate issues
- Strong analytical skills with experience in resolving complex data issues
- Proven decision-making skills in ambiguous situations using available data
- Creative and proactive in managing tasks and inventory
- Dedicated to improving business outcomes through continuous improvement
- Excellent oral and written communication skills
- Collaborative with strong relationship-building and stakeholder engagement abilities
- Familiarity with healthcare industry regulations or related sectors
Preferred Qualifications
- In-depth knowledge of Medicare, Medicaid, and DSNP encounter processes and policies
- Experience with advanced analytics, Python, and DataBricks
- Understanding of Cloud Technologies (Azure Synapse Analytics) and Power Platform (Power BI)
- Experience in creating pivot tables and presenting data within Excel
Additional Information
Work-At-Home Requirements:
- Must have a high-speed DSL or cable modem for a home office setup.
- California-based associates or contractors will receive internet expense reimbursement.
- A minimum standard speed of 25x10 (25mbps download x 10mbps upload) is required.
- Satellite and wireless internet service is not permitted for this role.
- A dedicated workspace free from ongoing interruptions to protect member PHI/HIPAA information.
Interview Process:
As part of our hiring procedure, we will utilize an engaging interviewing platform called HireVue, enabling us to connect quickly with you regarding your relevant skills and experience at your convenience. If selected, you will receive an invitation to complete a HireVue assessment, consisting of a set of questions requiring your responses. Expect this to take about 15-20 minutes. Your answers will be reviewed to determine if you move forward in the hiring process.
Travel: Though this is a remote position, occasional travel to Humana's offices for training or meetings may be necessary.
Scheduled Weekly Hours: 40
Compensation: The estimated pay range for this full-time position is $65,000 - $88,600 per year, possibly varying based on geographic location and individual qualifications. This role may also include eligibility for a bonus incentive plan linked to company and/or individual performance.
Benefits Overview: Humana, Inc. offers a competitive benefits package supporting overall well-being, including medical, dental, and vision benefits, a 401(k) retirement savings plan, various time off options, and additional opportunities for life insurance, disability coverage, and more.
Application Deadline:
About Us: Humana Inc. is dedicated to prioritizing health for our team members, customers, and communities. Through our Humana insurance services and CenterWell healthcare services, we strive to assist millions in attaining their best health.
Equal Opportunity Employer: Humana does not discriminate against any employee or applicant for employment based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status, and actively takes measures to employ and advance individuals with disabilities or veteran status.
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