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Manager, Clinical Data Management

13 hours, 42 minutes ago
United States
Full-time
Senior
Operations Manager
Project and Program Management
JIRA SQL
Apply Now
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
1001-5000
Founded 2014
$686M raised
View All Jobs 11

Description

  • Own the end-to-end strategy, priorities, and operations for encounter data submission to payers and CMS.
  • Create and transmit ASM files on established schedules while maintaining payer-specific templates and submission methods.
  • Establish reconciliation processes to track diagnoses from clinical documentation through payer acceptance and identify dropped or truncated records.
  • Lead root-cause analysis and corrective actions for rejected or missing diagnoses with internal teams, vendors, and payers.
  • Partner with operations leadership on strategy, chart selection, and annual evaluation of retrospective chart review initiatives.
  • Monitor submission metrics and acceptance rates, applying data scrubs and business rules to meet regulatory and payer deadlines.
  • Maintain compliance for diagnosis add and delete workflows in partnership with leadership and legal teams.
  • Develop SOPs, process documentation, workflow updates, and long-term improvements that reduce manual effort and increase acceptance rates.
  • Lead cross-functional efforts to resolve data-flow issues, implement system updates, and expand ASM processes across eligible payers.
  • Own ASM valuation and financial results, integrating accepted diagnoses into risk dashboards and recurring leadership reports.

Requirements

  • Bachelor’s degree in Business, Finance, IT, Healthcare Analytics, Operations, or a related field.
  • 6+ years of experience with Medicare Advantage or ACA encounter data processes and/or risk adjustment in a payer, vendor, or value-based care organization.
  • 3+ years of program or project management experience managing complex, multi-stakeholder initiatives.
  • 2+ years of working knowledge of X12 837 transaction sets and CMS EDPS, including MAO-002 and MAO-004 reports.
  • Working knowledge of SQL, including writing, modifying, and executing queries.
  • Strong analytical ability to interpret complex datasets and develop actionable insights.
  • Experience communicating and presenting key information to executive leadership.
  • Proficiency with Google Workspace, project-tracking tools such as Jira or Smartsheet, and business intelligence or dashboard platforms.
  • Familiarity with Business Process Reengineering principles and methodologies (preferred).
  • Experience with retrospective chart-review selection or targeting strategies and relational databases (preferred).

Benefits

  • Flexible schedules and remote-work options for many roles.
  • Health, dental, and vision insurance paid up to 80% for employees, dependents, and domestic partners.
  • 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% employer match.
  • Stock options.

Interested in this position?

Apply directly on the company website

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