State Encounter Data & Submissions Manager

Hispanic Alliance for Career Enhancement; Pennsylvania; Hybrid; USD 60,300 - 132,600; Full time

Benefits offered by this job

Benefits package

Bonus eligibility

Job summary

CVS Health is seeking a Manager, Encounter Data & State Submission Operations to lead end-to-end management of encounter and claims data submissions to state agencies. The role requires strong knowledge of 837 transactions and state-specific submission requirements.

Responsibilities include overseeing 837 transmission, data quality, and compliance across multiple states, with collaboration across Claims, IT, Compliance, and vendor partners. A strong leadership track record is essential.

Qualifications

• 5+ years of experience in healthcare claims operations, including medical claims processing and/or Medicare and Medicaid lines of business.
• At least 2 years overseeing secure data transmission processes using SFTP and other file transfer technologies.
• 3+ years in data management including validation, reconciliation, reporting and issue resolution.
• 3+ years of leadership experience managing workflows and teams in a healthcare operations environment.

Responsibilities

• Serve as SME for state-specific encounter data submission requirements and maintain documentation.
• Lead end-to-end management of encounter submissions ensuring compliance with state and regulatory requirements.
• Partner with technical teams and vendors to implement, monitor and maintain processes for accurate encounter data reporting.
• Oversee 837 file transmission processes ensuring timely submissions per state specifications.
• Manage state response files, reconciliation activities and error reporting to resolve issues.
• Establish reporting and monitoring for encounter submission performance, acceptance rates, and error trends.
• Drive root cause analysis and coordinate corrective actions to improve data quality.
• Develop and enhance operational processes related to encounter data management and state reporting.
• Collaborate with Claims, IT, Compliance, Operations, Risk Adjustment and vendors for alignment and execution.

Skills

Healthcare claims processing

Data management

Leadership

Secure data transfer (SFTP)

Education

Bachelor's degree

Job description

CVS Health is seeking a Manager, Encounter Data & State Submission Operations to lead end-to-end management of encounter and claims data submissions to state agencies. The role requires strong knowledge of 837 transactions and state-specific submission requirements.

Responsibilities include overseeing 837 transmission, data quality, and compliance across multiple states, with collaboration across Claims, IT, Compliance, and vendor partners. A strong leadership track record is essential.