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.

Bachelors 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