Remote Encounter Data Submissions Lead

OpenKrill; United States; Remote; USD 110,000 - 140,000; Full time

Benefits offered by this job

Health, dental and vision insurance

401(k) with match

Stock options

PTO and holidays

Job summary

Aledade PBC, a public benefit corporation, seeks an Encounter Data Submissions Program Manager to design and oversee end-to-end EDS and reconciliation programs, create program guides and SOPs, and evaluate ROI of ASM workstreams. This remote-friendly role will collaborate across teams to improve data accuracy and efficiency.

This role will provide ongoing oversight of daily EDS submissions to payers and CMS with integrity, ensuring data captured and reported is reliable and timely.

Qualifications

• Bachelor's degree in a related field.
• 4+ years of experience with Medicare Advantage or ACA encounter data processes and/or risk adjustment.
• 1+ year of X-12 837 data knowledge.
• Strong analytical skills with ability to interpret complex data sets.
• Ability to present information to senior leadership.
• Working knowledge of SQL and data queries.
• Proficiency with Office Suite, SharePoint, Jira, Smartsheet.

Responsibilities

• Assist in developing program documentation and SOPs; maintain/update documents.
• Identify and establish ASM processes with eligible payers.
• Support leadership to increase practice opt-ins to ASM processes.
• Create/transmit ASM files to payers on a cadence.
• Maintain CMS and payer submission deadlines; update templates annually.
• Reconcile ASM submissions with payer and CMS EDS files.
• Ensure compliance with regulatory requirements for diagnoses submissions.
• Oversee daily EDS and reconciliation processes; oversee ROI evaluations.

Skills

Medicare data

Risk adjustment

SQL

Analytics

Leadership presentation

Microsoft Office

Jira

Smartsheet

SharePoint

Education

Bachelor's degree in Business/Finance/IT/Analytics/Operations

Tools

Jira

Smartsheet

SharePoint

Microsoft Office

Job description

Aledade PBC, a public benefit corporation, seeks an Encounter Data Submissions Program Manager to design and oversee end-to-end EDS and reconciliation programs, create program guides and SOPs, and evaluate ROI of ASM workstreams. This remote-friendly role will collaborate across teams to improve data accuracy and efficiency.

This role will provide ongoing oversight of daily EDS submissions to payers and CMS with integrity, ensuring data captured and reported is reliable and timely.