Encounter Data Submissions Program Manager

Why consider this job opportunity

• Flexible work schedules with the ability to work remotely
• Health, dental, and vision insurance paid up to 80% for employees, dependents, and domestic partners
• Robust time‑off plan including 21 days of PTO in your first year
• 12 weeks paid parental leave for all new parents and a six‑week paid sabbatical after six years of service
• Opportunity to work in a collaborative, inclusive, and mission‑driven environment
• 401(k) with up to 4% match and stock options

• Assist in the development of programming documentation and standard operating procedures (SOPs)
• Identify and establish Alternate Submission Method (ASM) processes with eligible payers
• Create and transmit ASM files to relevant payers on an established schedule
• Maintain annual CMS and payer submission deadlines, ensuring compliance with regulatory requirements
• Conduct annual ROI evaluations of ASM processes and monitor provider diagnosis submission trends

• 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
• 1+ years of knowledge in X-12 837 data
• Strong analytical skills with the ability to interpret complex data sets
• Proficiency in common business software such as Microsoft Office Suite and project management tools

• Excellent written and verbal communication and presentation skills
• Familiarity with Business Process Reengineering (BPR) principles
• Experience with Medicare claims
• Fundamental understanding of relational databases

#Healthcare Services #Remote Work #Career Opportunity #Health Insurance #Diversity And Inclusion

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