Encounter Data Operations Lead (DSNP & State Submissions)

CVS Health; Harrisburg (Dauphin County); On-site; USD 60,300 - 132,600; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Job summary

CVS Health is seeking an experienced Manager, Encounter Data & State Submission Operations to lead end-to-end encounter and claims data submissions to state agencies. You will ensure accuracy, timeliness, and regulatory compliance while partnering with internal teams and external vendors.

The role focuses on 837 file transmissions, data quality, and cross-functional collaboration to support DSNP initiatives across multiple states.

Qualifications

• 5+ years in healthcare claims operations.
• 2+ years overseeing secure data transmission (SFTP).
• 3+ years data management: validation, reconciliation, reporting.
• 3+ years leadership in healthcare operations.

Responsibilities

• Serve as SME for state-specific encounter data submission requirements and document regulations.
• Lead end-to-end management of encounter submissions ensuring compliance.
• Collaborate with technical teams and vendors to implement, monitor, and maintain data reporting processes.
• Oversee 837 file transmission to ensure accuracy and timeliness per state specs.
• Manage state response files, reconciliation, and error reporting to resolve issues.
• Establish reporting and monitoring for submission performance and error trends.
• Drive root cause analysis and corrective actions to improve data quality.
• Develop and enhance operational processes for encounter data management and state reporting.
• Coordinate with Claims, IT, Compliance, Operations, Risk Adjustment, and vendors.
• Support audits and regulatory reviews related to encounter data submissions.

Skills

Healthcare claims

Data management

Leadership

Regulatory compliance

Education

Bachelor's degree

Tools

SFTP

Job description

CVS Health is seeking an experienced Manager, Encounter Data & State Submission Operations to lead end-to-end encounter and claims data submissions to state agencies. You will ensure accuracy, timeliness, and regulatory compliance while partnering with internal teams and external vendors.

The role focuses on 837 file transmissions, data quality, and cross-functional collaboration to support DSNP initiatives across multiple states.