Support encounter data reporting processes for EDPS, RAPS and the EDGE server, including tracking, reporting, and resolving rejections
Conduct gap analysis and data validation, identifying possible issues in data submission and determining financial impact.
Analyze and reconcile claims and encounter data which will include 837 EDI encounter files for EDPS, RAPS and Edge Server submission files
Perform research in the encounter management system and liaison with the CSSC Helpdesk for exception resolution
Be comfortable with raw data files in their native format and accessing these through various servers
Partner with Product Support Engineers and development teams as necessary
Assist development team with performance analysis and testing during release cycles for service packs, hot fixes etc
Answer email and phone requests for help from customers
Collaborate in virtual teamwork with other Product Support staff
Host online troubleshooting and investigation sessions on customer’s production environments
Deliver a consistent, responsive and satisfying customer experience with each contact
Collect all necessary problem details from customers to be able to effectively see the problem to resolution
Successfully reproduce customer issues in a controlled test environment
Follow standard operational procedures for case management
Continuously improve troubleshooting skills, product expertise, and knowledge on related technical topics
Perform ACA and MA Submissions for Clients
Understand RAPS and EDPS filtering logic which CMS uses for Risk Adjustment and/or Risk Score calculations
Monitor CMS data submission deadlines for both MA and ACA lines of business

Requirements

Bachelor’s Degree in Health IT/Informatics/Management Information Systems or related field required
2+ years of professional experience in Risk Adjustment data management
Understanding of claims data, encounter response files, 837 EDI encounter files, EDGE/MA billing & business rules as well as MA filtering logic for EDPS
Experience with CMS Submissions Process and EDI transactions
Excellent time management and organizational skills necessary
Prior experience troubleshooting performance problems that may have many underlying causes such as Disk, Database, Network, Messaging and other platform / 3rd party solutions
Experience with managing product back end and webservices
Ability to guide customers remotely through complex, multi-server deployments and upgrades for enterprise products
Familiarity with EDI Standards such as X12, EDIFACT, HL7, NCPDP and knowledge of HIPAA transactions
Prior knowledge of 837’s along with various loops and segments and an understanding of the requirements set forth by CMS for EDPS submission files
Working knowledge in SQL scripts is a plus
Good written and verbal skills.
Knowledge in CMS model changes is a plus
Knowledge in CMS Risk Score and Risk Adjustment methodologies is a plus
Knowledge in Medicaid is a plus

Benefits

Health insurance
401(k) matching
Paid time off
Flexible work arrangements
Professional development opportunities

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

837 EDI encounter filesCMS submissions processSQL scriptsEDI standardsRisk Adjustment data managementData validationClaims data analysisPerformance analysisTroubleshootingData reconciliation

Soft Skills

Time managementOrganizational skillsCustomer experienceCommunication skillsProblem-solvingCollaborationRemote guidanceContinuous improvementAttention to detailVirtual teamwork

Certifications

Bachelor’s Degree in Health ITBachelor’s Degree in InformaticsBachelor’s Degree in Management Information Systems