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

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)

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!

Encounter Data Submissions Program Manager

Key skills