Manager, Clinical Data Management
New
A
AledadeHealthcare data
Remote, United StatesFull-TimeManager
Salary not disclosed
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Job Details
- Experience
- 6+ years of experience with Medicare Advantage or ACA encounter data processes, and/or risk adjustment experience; 3+ years of program or project management experience; 2+ years of working knowledge with X12 837 transaction sets
- Required Skills
- SQLJiraGoogle Workspace
Requirements
- Bachelor’s degree in Business, Finance, IT, Healthcare Analytics, or Operations.
- 6+ years of experience with Medicare Advantage or ACA encounter data processes, and/or risk adjustment within a payer, vendor, or Value Based Care organization.
- 3+ years of program or project management experience, including ownership of complex, multi-stakeholder initiatives.
- 2+ years of working knowledge with X12 837 transaction sets.
- Working knowledge of CMS EDPS experience, including MAO-002 and MAO-004 reports.
- Working knowledge of SQL, including writing, modifying, and executing queries.
- Strong analytical capabilities and ability to interpret complex datasets and synthesize actionable insights.
- Written and verbal communication skills, including experience developing and presenting key information to executive leadership.
- Proficiency in Google Workspace, project tracking software such as Jira or Smartsheet, and business intelligence or dashboard platforms.
- Familiarity with Business Process Reengineering principles and methodologies is preferred.
- Experience with chart selection or targeting strategies for retrospective chart review is preferred.
- Fundamental understanding of relational databases is preferred.
Responsibilities
- Oversee strategy, priorities, and operations for accurate and compliant encounter data submission to payers and CMS.
- Create and transmit ASM files on established cadences, maintaining payer-specific templates and submission methods.
- Establish reconciliation processes to track diagnoses from documentation through acceptance and identify gaps or dropped records.
- Lead root-cause analysis and corrective action for rejected or dropped diagnoses across internal teams, vendors, and payers.
- Partner with operations leadership on strategy, chart selection, and annual evaluation for retrospective chart review.
- Monitor submission metrics and acceptance rates, applying data scrubs and business rules to meet regulatory standards and deadlines.
- Develop and maintain process documentation, SOPs, and workflow updates.
- Identify tools and strategies to improve encounter acceptance rates, reduce manual effort, and expand ASM processes across eligible payers.
- Integrate accepted ASM diagnosis data into risk reporting dashboards and build recurring leadership reports.
- Own ASM valuation and financial results, partnering with Data and Analytics on metric definitions and data quality.
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