CMS Encounter Data Engineer

Clover Health is a company focused on reinventing health insurance by leveraging data and human empathy to improve healthcare outcomes. The CMS Encounter Data Engineer will manage the end-to-end data flow of submissions to ensure accuracy and compliance, while collaborating with various teams to enhance data quality and operational efficiency.

Responsibilities:

• Be responsible for the monitoring and management of the end to end data flow of data submissions to vendors and government agencies to mitigate data leakage and submission errors
• Own the claim and supplemental submission workflow for CMS EDS submissions
• Develop data pipeline tracking reports and analyze, research, and resolve encounter data errors
• Support the claim and supplemental submission workflow for CMS EDS submissions
• Collaborate closely between the Engineering and Risk Adjustment teams
• Assist with, track, and implement risk adjustment related initiatives and strategies
• Maintain, update, and create policies, procedures, and other documentation around the encounter process

Requirements:

• You have two years experience with Medicare Risk Adjustment, CMS EDS submissions, and healthcare claims data
• You have at least two years of programmers experience using SQL, Python, and R
• You have experience with building operational level dashboards
• You are a self-starter, have a high degree of internal drive and motivation, and desire to execute at a high level
• You are relentlessly focused on serving the needs of diverse business customers