Encounter Data Submissions Program Manager
Aledade, Inc.
full-time
Posted on:
Location Type: Remote
Location: Virginia • United States
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About the role
- 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
Requirements
- 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)
Benefits
- Flexible work schedules and the ability to work remotely are available for many roles
- Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners
- Robust time-off plan (21 days of PTO in your first year)
- Two paid volunteer days and 11 paid holidays
- 12 weeks paid parental leave for all new parents
- Six weeks paid sabbatical after six years of service
- Educational Assistant Program and Clinical Employee Reimbursement Program
- 401(k) with up to 4% match
- Stock options
- And much more!
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
X-12 837 data knowledgeSQLdata analysisrisk adjustmentprogram documentationSOP developmentdata reconciliationdiagnosis submissionCDI chart auditsROI evaluation
Soft Skills
analytical skillscommunicationcollaborationpresentation skillsproblem-solvingattention to detailorganizational skillsleadershipinterpersonal skillsadaptability