Encounter Data & Risk Adjustment Lead

Inland Empire Health Plans; Rancho Cucamonga (CA); On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Competitive salary

On-site fitness center

Medical, dental, vision

Retirement options

Job summary

Inland Empire Health Plans (IEHP) seeks a Manager of Risk Adjustment Encounter Data Reconciliation to lead the data-driven lifecycle for encounter submissions. You will oversee reconciliation processes, error resolution, and regulatory reporting to CMS and State programs, ensuring HCC integrity and audit readiness.

You will mentor staff, coordinate with IT and operations, and drive dashboards and quality controls to prevent data dropouts and safeguard revenue.

Qualifications

• Five+ years in managed care, healthcare EDI data management, or health plan operations with focus on encounter data reconciliation/RAPS processing.
• Three+ years of leadership experience managing teams, projects, or technical workflows.
• Bachelor’s degree required; Master’s preferred; CRC/CPC/CCS-P credentials preferred.

Responsibilities

• Own daily, weekly, and monthly encounter data reconciliation lifecycles; manage sweeps and error resolution staff.
• Track federal response files (999, 227CA, MAO-002) and resolve clearinghouse rejections.
• Partner with internal teams to ensure valid HCCs pass through technical checkpoints; maintain audit readiness.

Skills

Analytical thinking

Leadership

Technical problem solving

Communication

Education

Bachelor’s degree in business/healthcare

Master’s degree preferred

CRC/CPC/CCS-P credential preferred

Tools

EDI 837P/837I

EDI 835

Clearinghouse processes

Job description

Inland Empire Health Plans (IEHP) seeks a Manager of Risk Adjustment Encounter Data Reconciliation to lead the data-driven lifecycle for encounter submissions. You will oversee reconciliation processes, error resolution, and regulatory reporting to CMS and State programs, ensuring HCC integrity and audit readiness.

You will mentor staff, coordinate with IT and operations, and drive dashboards and quality controls to prevent data dropouts and safeguard revenue.