Encounter Data Submissions Program Manager

Location: Remote within the United States; Arlington, Virginia

What you will do

• Design and implement an end-to-end Encounter Data Submission and Reconciliation program, including program guides and standard operating procedures.
• Establish Alternate Submission Method (ASM) processes with eligible payers and support practice adoption.
• Create and transmit ASM files, maintain payer-specific templates and submission methods, and track annual CMS and payer deadlines.
• Reconcile ASM submissions with payer and CMS encounter data files and oversee daily submission and reconciliation processes.
• Integrate accepted diagnosis data into risk reporting dashboards and monitor diagnosis submission and truncation trends.
• Evaluate ASM process ROI and collaborate with senior leadership and legal partners on compliance related to diagnosis submissions.

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 in a payer, vendor, or provider organization.
• At least 1 year of X-12 837 data knowledge.
• Strong analytical skills and the ability to interpret complex data sets and present insights to senior leadership.
• Working knowledge of SQL, including writing, creating, or running queries.
• Proficiency with Microsoft Office, collaboration tools such as SharePoint, and project management software such as Jira or Smartsheet.

Nice to have

• Business Process Reengineering experience or familiarity with BPR methodologies.
• Medicare claims experience.
• Understanding of relational databases.
• Excellent written, verbal, communication, and presentation skills.

Culture & Benefits

• Full-time remote work within the United States.
• Inclusive and diverse work environment.
• Equal opportunity employment based on merit, qualifications, performance, and business needs.
• Work primarily involves prolonged periods of sitting at a desk and using a computer.