Senior Encounter Data & State Submissions Manager

CVS Health Corporation; Maryland; Hybrid; USD 60,000 - 133,000; Full time

Benefits offered by this job

Comprehensive benefits package

Job summary

CVS Health Corporation is seeking a Manager, Encounter Data & State Submission Operations for a remote-based role. Lead end-to-end submission of encounter and claims data to state agencies, ensuring accuracy and timeliness while partnering with Claims, IT, Compliance, and external vendors.

The role requires deep knowledge of the 837 standard, DSNP state requirements, data validation, reconciliation, and secure data transfer.

Qualifications

• 5+ years in healthcare claims operations (Medicare/Medicaid)
• 2+ years overseeing secure data transmission (SFTP)
• 3+ years data management: validation, reconciliation, reporting
• 3+ years leadership in healthcare operations/team management

Responsibilities

• Serve as SME for state-specific encounter data submission requirements and maintain regulatory docs
• Lead end-to-end management of encounter submissions for state compliance
• Collaborate with IT and vendors to implement and monitor encounter data reporting processes
• Oversee 837 file transmission to ensure accurate, timely submissions per state specifications
• Manage state response files, reconciliation activities, and error reporting
• Establish reporting, monitoring, and tracking for submission performance and error trends
• Drive root cause analysis and corrective actions to resolve submission issues
• Coordinate with Claims, IT, Compliance, Operations, Risk Adjustment, and vendors
• Support audits, regulatory reviews and internal compliance initiatives

Skills

Healthcare claims operations

Data leadership

Regulatory compliance

Education

Bachelor's degree preferred

Tools

SFTP

Data reconciliation tools

Reporting tools

Job description

CVS Health Corporation is seeking a Manager, Encounter Data & State Submission Operations for a remote-based role. Lead end-to-end submission of encounter and claims data to state agencies, ensuring accuracy and timeliness while partnering with Claims, IT, Compliance, and external vendors.

The role requires deep knowledge of the 837 standard, DSNP state requirements, data validation, reconciliation, and secure data transfer.