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ManagerFull-time
Salary Range
$115,600 - $156,400 /year
This salary is estimated based on similar roles. The actual salary may vary.
About the Role
We are seeking an Encounter Data Submissions Program Manager to assist in developing an end-to-end Encounter Data Submission and Reconciliation program. This role involves creating program guides and standard operating procedures, collaborating across teams to evaluate ROI of existing workstreams, and overseeing daily EDS and reconciliation processes.
Key Responsibilities
- →Assist in the development of programming documentation and SOPs, including routine maintenance and updates
- →Identify and establish ASM processes with additional eligible payers
- →Provide support to CSO in 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
- →Maintain and update payer-specific ASM templates and submission methods annually
- →Reconcile ASM record submissions with payer and CMS EDS files
- →Establish routine reconciliation processes with payer and CMS files
- →Integrate accepted ASM submitted diagnosis data into existing risk reporting dashboards
- →Provide ongoing monitoring of provider diagnosis submission and truncation trends
- →Develop processes for consistent monitoring of existing dropped diagnosis and truncation dashboards
- →Collaborate with senior leadership and legal partners to ensure compliance with regulatory requirements
- →Develop processes to identify and submit diagnoses appropriately identified through routine CDI chart audits
- →Conduct annual ROI evaluations of ASM processes
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 experience
- ✓1+ years of X-12 837 data knowledge
- ✓Strong analytical skills with the ability to interpret complex data sets
- ✓Ability to develop and present information to Senior Leadership
- ✓Working knowledge of SQL
- ✓Proficiency in Microsoft Office Suite, SharePoint, Jira, and Smartsheet
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