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.

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

• Must have the ability to provide a high-speed DSL or cable modem for a home office.
• 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. 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.

Scheduled Weekly Hours

40

Pay Range

$65,000 - $88,600 per year. This job is eligible for a bonus incentive plan.

Description of Benefits

Humana offers competitive benefits including medical, dental, vision, 401(k) retirement savings plan, paid time off, and more.

Application Deadline

07-07-2026

About us

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.

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.