Encounter Data Program Lead: ROI & Reconciliation (Remote)

Aledade PBC; United States; Remote; USD 110,000 - 150,000; Full time

Benefits offered by this job

401(k) with match

Stock options

Job summary

Aledade PBC is seeking a data-driven Manager to lead the Encounter Data Submissions Program. You will design and implement an end-to-end submission and reconciliation program, develop SOPs, and drive ROI improvements across ASM workstreams to enhance data accuracy and efficiency.

You will oversee daily EDS and reconciliation processes, ensuring accurate submission of encounter data to payers and CMS, while collaborating with legal and senior leadership to maintain compliance.

Qualifications

• 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 with a Payer, Vendor or Provider Organization
• 1+ years of X-12 837 data knowledge
• Strong analytical skills with a proven ability to interpret complex data sets and identify key insights
• Ability to develop and present information to Senior Leadership
• Working knowledge of SQL: writing, creating and/or running queries
• Proficiency in using common business software such as Microsoft Office Suite (Word, Excel, PowerPoint), collaboration tools (SharePoint), and project management software (Jira, Smartsheet)

Responsibilities

• Assist in the development of programming documentation and SOPs, to include routine maintenance and update of program documents
• Create and transmit ASM files to all relevant payers on an established cadence
• Reconcile ASM record submissions with payer and CMS EDS files
• Provide ongoing monitoring of provider diagnosis submission and truncation trends
• Collaborate with senior leadership and legal partners to ensure continued compliance with regulatory requirements pertaining to submission of “add” and “delete” diagnoses
• Develop a process to identify and submit diagnoses appropriately identified through routine CDI chart audits
• Conduct annual ROI evaluation of ASM processes to include both submission of “dropped” diagnoses, and retrospective chart audit projects
• Other duties as assigned.

Skills

Analytical skills

Presentation skills

SQL

MS Office proficiency

Education

Bachelor’s degree in Business, Finance, IT, Analytics, Operations, or related field

Tools

SharePoint

Jira

Smartsheet

Microsoft Office Suite

Job description

Aledade PBC is seeking a data-driven Manager to lead the Encounter Data Submissions Program. You will design and implement an end-to-end submission and reconciliation program, develop SOPs, and drive ROI improvements across ASM workstreams to enhance data accuracy and efficiency.

You will oversee daily EDS and reconciliation processes, ensuring accurate submission of encounter data to payers and CMS, while collaborating with legal and senior leadership to maintain compliance.