Encounter Data Submissions Program Manager (copy)

Assist in the development of programming documentation and SOPs, to include routine maintenance and update of program documents

Identify and establish ASM process with additional eligible payers

Provide support to CSO in efforts to increase practice “opt-in” to ASM processes

Create and transmit ASM files to all relevant payers on an established cadence

Maintain annual CMS and payer submission deadlines

Maintain and update payer specific ASM templates annually

Maintain and update payer specific submission methods annually

Reconcile ASM record submissions with payer and CMS EDS files

Establish routine reconciliation process with payer and CMS files

Integrate accepted ASM submitted diagnosis data into existing risk reporting dashboards

Provide ongoing monitoring of provider diagnosis submission and truncation trends

Develop process for consistent monitoring of existing dropped diagnosis and truncation dashboards for early identification of diagnosis submission errors

Collaborate with senior leadership and legal partners to ensure continued compliance with regulatory requirements pertaining to submission of “add” and “delete” diagnoses

Develop a process to identify and submit diagnoses appropriately identified through routine CDI chart audits.

Conduct annual ROI evaluation of ASM processes to include both submission of “dropped” diagnoses, and retrospective chart audit projects

Other duties as assigned.

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 with a proven ability 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

Software Proficiency: Proficiency in using common business software such as Microsoft Office Suite (Word, Excel, PowerPoint), collaboration tools (e.g., SharePoint ), and project management software (e.g., Jira, Smartsheet )

Excellent communication and presentation skills, both written and verbal

Business Process Reengineering (BPR): Familiarity with BPR principles and methodologies to radically redesign business processes for improved performance, efficiency, and customer satisfaction

Medicare claims experience

Fundamental understanding of relational databases

Prolonged periods of sitting at a desk and working on a computer.