Encounter Data Submissions Lead (Remote)

Lever, Inc.; United States; Remote; USD 120,000 - 170,000; Full time

Job summary

Aledade PBC, a public benefit corporation, is seeking an Encounter Data Submissions Program Manager to oversee the end-to-end submission and reconciliation program, including ROI-driven analysis of ASM workflows and the development of program guides and SOPs.

This cross-functional role partners with senior leadership and legal, ensures data accuracy for CMS and payers, and drives process improvements while supporting remote-work in the United States.

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 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 Microsoft Office Suite, SharePoint, Jira, and Smartsheet

Responsibilities

• Assist in developing program documentation and SOPs, including maintenance of program documents.
• Create and transmit ASM files to payers on an established cadence.
• Reconcile ASM submissions with payer and CMS EDS files.
• Monitor provider diagnosis submission and truncation trends.
• Collaborate with senior leadership and legal partners on regulatory requirements.
• Develop a process to identify diagnoses from routine CDI chart audits.
• Conduct annual ROI evaluation of ASM processes.
• Perform other duties as assigned.

Skills

Strong analytical skills

SQL knowledge

Communication to Senior Leadership

Cross-functional collaboration

Education

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

Tools

Jira

Smartsheet

SharePoint

Microsoft Office

Job description

Aledade PBC, a public benefit corporation, is seeking an Encounter Data Submissions Program Manager to oversee the end-to-end submission and reconciliation program, including ROI-driven analysis of ASM workflows and the development of program guides and SOPs.

This cross-functional role partners with senior leadership and legal, ensures data accuracy for CMS and payers, and drives process improvements while supporting remote-work in the United States.