Manager, Risk Adjustment Data Reconciliation & Compliance

IEHP; Rancho Cucamonga (CA); Sur place; USD 119 000 - 157 000; Plein temps

Avantages offerts par ce poste

On-site fitness center

Medical Insurance

Dental and Vision

Life insurance

Disability insurance

Career advancement opportunities

Wellness programs

CalPERS retirement

457(b) plan

Résumé du poste

IEHP in Rancho Cucamonga, CA seeks a highly technical Manager of Risk Adjustment Encounter Data Reconciliation to lead the daily, weekly, and monthly data reconciliation lifecycle and ensure complete, accurate submission of encounter data to CMS and state regulators.

You will manage a team, drive error resolution with EDI/837P/835 knowledge, monitor MAO-002 and other reporting, and partner with stakeholders to protect risk score integrity and maintain audit readiness.

Qualifications

• Advanced Excel skills with complex pivot tables and power query.
• Proficiency with healthcare EDI transactions (837P/837I, 835) and data reconciliation.
• Experience leading teams or technical workflows in managed care or encounter data.
• Strong problem-solving and analytical abilities with attention to detail.

Responsabilités

• Oversee daily, weekly, and monthly encounter data reconciliation lifecycles.
• Manage staff performing sweeps and error resolution.
• Track and respond to federal reports (MAO-002, MAO-004, 999) and resolve clearinghouse rejections.
• Collaborate with internal teams to ensure valid HCCs pass checkpoints.
• Protect and maximize risk score integrity and maintain audit readiness.

Connaissances

Advanced Excel

EDI 837/835

Data reconciliation

Leadership

Analytical thinking

Formation

Bachelor's degree

Master's degree preferred

CRC/CPC/CCS-P credential preferred

Outils

Clearinghouse systems

Description du poste

IEHP in Rancho Cucamonga, CA seeks a highly technical Manager of Risk Adjustment Encounter Data Reconciliation to lead the daily, weekly, and monthly data reconciliation lifecycle and ensure complete, accurate submission of encounter data to CMS and state regulators.

You will manage a team, drive error resolution with EDI/837P/835 knowledge, monitor MAO-002 and other reporting, and partner with stakeholders to protect risk score integrity and maintain audit readiness.