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The Associate Vice President (AVP) of Medicare and Medicaid Encounter Submissions is responsible for the integrity, accuracy, and timeliness of submitting encounter data to Centers for Medicare and Medicaid Services (CMS) and/or Medicaid State Agencies for all Medicare, D-SNP, and Medicaid contracts. The AVP is accountable for working collaboratively across the enterprise and with multiple external partners to ensure robust processes, procedures, analytics, and technology capabilities are implemented to achieve critical compliance requirements.

The Associate Vice President (AVP) of Medicare and Medicaid Encounter Submissions leads a large-scale operation of ~220 associates focused on the successful submission of encounters data to CMS and Medicaid State Agencies. The AVP will be responsible for driving all operational activities required to achieve CMS and state specific metrics - to include submission timeliness and accuracy, rate setting, kick payments, and audit-related requirements Success in this role includes building a strong culture of teamwork, accountability, process improvement, innovation, and compliance.

Key expectations and responsibilities of this role include:

+ Ensures encounter data submissions continuously meet or exceed all compliance and operational standards/requirements.

+ Accountable for operational implementation of new Medicaid and D-SNP contracts’ encounters submissions. Partners with Corporate Medicaid to support RFP process for Medicaid state expansions. Includes proactive communication and escalation of requirements that create operational challenges.

+ Leads/influences across all levels of the enterprise to develop and implement a transformational 5-year strategy.

+ Fosters trusted relationships with enterprise partners to ensure end-to-end processes are optimized and communications/escalations occur timely and effectively.

+ Product ownership of multiple systems/platforms in collaboration with IT leadership, HQRI Technology & Analytics, and external partners.

+ Communicates to senior leaders (SVP+) regularly on operational performance, risks, and opportunities.

+ Continuously identifies and implements levers for risk mitigation, improved control environment, and cost optimization.

+ Build a strong culture of teamwork, accountability, process improvement and efficiency, and compliance mindset to drive overall team success and engagement.

Use your skills to make an impact

Required Qualifications

+ Bachelor's degree

+ Medicare Advantage/Medicaid-specific industry knowledge and experience

+ 7+ years of management experience

+ 3+ years of experience managing large-scale operational processes with ambitious compliance standards

+ Demonstrated outcomes implementing process reengineering, automation, advanced analytics, and technology stacks to achieve operational excellence.

+ Experience optimizing processes via a robust control environment

+ Enterprise-thinker who can drive innovation outside of silos

+ Best in class communication skills; ability to educate and influence executive level (SVP+) leaders

+ Demonstrated experience in leading large organizations while optimizing organizational design and infusing talent development best practices.

+ Comfort making quick decisions based on quantitative and qualitative insights

+ Experience managing critical vendor relationships and standing up new vendor contracts/capabilities

Preferred Qualifications

+ Master’s degree in business, technology, or a related field

+ Preference will be given to those in eastern time zone

+ Experience managing large production-oriented teams

+ Experience in claims processing, encounters submissions, or Risk Adjustment

+ Experience with the IT budgeting and prioritization process

+ Experience communicating with regulatory bodies

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.

$150,000 - $206,300 per year

This 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 10-28-2025

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.