Encounter Data Submissions Program Manager
New
A
AledadeHealthcare data
Working remotely/work from home within the USFull-TimeManager
Salary not disclosed
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Job Details
- Experience
- 4+ years of experience with Medicare Advantage or ACA encounter data processes and/or risk adjustment experience with a Payer, Vendor or Provider Organization; 1+ years of X-12 837 data knowledge
- Required Skills
- SQLSharePointJiraMicrosoft Office
Requirements
- Bachelor's degree in Business, Finance, Information Technology, Analytics, Operations, or a related field.
- 4+ years of experience with Medicare Advantage or ACA encounter data processes and/or risk adjustment at a payer, vendor, or provider organization.
- 1+ years of X-12 837 data knowledge.
- Strong analytical skills and the ability to interpret complex data sets and identify key insights.
- Ability to develop and present information to senior leadership.
- Working knowledge of SQL, including writing, creating, and/or running queries.
- Proficiency with Microsoft Office Suite, including Word, Excel, and PowerPoint.
- Proficiency with collaboration tools such as SharePoint.
- Proficiency with project management software such as Jira or Smartsheet.
- Preferred: Medicare claims experience and a fundamental understanding of relational databases.
- Preferred: Familiarity with Business Process Reengineering principles and methodologies.
Responsibilities
- Develop the end-to-end Encounter Data Submission and Reconciliation program, including program guides and standard operating procedures.
- Maintain program documentation and SOPs.
- Identify and establish Alternate Submission Method processes with additional eligible payers.
- Support efforts to increase practice opt-in to ASM processes.
- Create and transmit ASM files to relevant payers on an established cadence.
- Maintain annual CMS and payer submission deadlines, templates, and submission methods.
- Reconcile ASM submissions with payer and CMS encounter data files.
- Integrate accepted ASM diagnosis data into existing risk reporting dashboards.
- Monitor provider diagnosis submission and truncation trends and identify errors.
- Evaluate ASM process ROI annually, including dropped diagnoses and retrospective chart audit projects.
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