Encounter Data Submissions Program Manager (copy)

3 hours, 39 minutes ago
Full-time
Mid Level
Project and Program Management
Aledade

Aledade

Aledade collaborates with independent practices, health centers, and clinics to establish and manage Accountable Care Organizations (ACOs) that prioritize primary care, enabling physicians to enhance patient care while maintaining their independence in...

Health Care Providers & Services
1K-5K
Founded 2014
$686M raised

Description

  • Develop, maintain, and update program documentation, guides, and standard operating procedures.
  • Establish Alternate Submission Method (ASM) processes with eligible payers and support practice adoption.
  • Create and transmit ASM files to payers according to established schedules.
  • Maintain annual CMS and payer submission deadlines, templates, and submission methods.
  • Reconcile ASM records with payer and CMS encounter data files.
  • Integrate accepted diagnosis data into risk reporting dashboards.
  • Monitor provider diagnosis submissions, dropped diagnoses, and truncation trends to identify errors.
  • Develop processes for submitting diagnoses identified through clinical documentation improvement chart audits.
  • Collaborate with senior leadership and legal partners to maintain compliance with diagnosis add/delete regulations.
  • Evaluate ASM return on investment annually, including dropped-diagnosis submissions and retrospective chart audit projects.

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.
  • 1+ year of X-12 837 data knowledge.
  • Strong analytical skills and the ability to interpret complex data sets.
  • Ability to develop and present information to senior leadership.
  • Working knowledge of SQL, including writing, creating, or running queries.
  • Proficiency with Microsoft Office, SharePoint, and project management tools such as Jira or Smartsheet.
  • Excellent written and verbal communication and presentation skills.
  • Familiarity with business process reengineering principles and methodologies (preferred).
  • Medicare claims experience and an understanding of relational databases (preferred).

Benefits

  • Remote work from anywhere in the US with flexible work schedules.
  • Health, dental, and vision insurance covered up to 80%.
  • 21 days of PTO in the first year, plus 11 paid holidays and two paid volunteer days.
  • 12 weeks of paid parental leave for all new parents.
  • Six-week paid sabbatical after six years of service.
  • Educational assistance and clinical employee reimbursement programs.
  • 401(k) with up to a 4% company match.
  • Stock options.

Interested in this position?

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