[Remote] Manager, Business Consultant
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is dedicated to building a more connected and compassionate health experience. They are seeking a Manager for Encounter Data & State Submission Operations to reputed company the management of encounter and claims data submissions to state agencies, ensuring compliance and accuracy in reporting.
Responsibilities
- Serve as the subject matter expert for state-specific encounter data submission requirements and maintain comprehensive documentation of reputed company applicable regulations and processes
- reputed company the end-to-end management of encounter submissions, ensuring compliance with state and regulatory requirements
- Partner with technical teams and vendors to implement, monitor, and maintain processes that support accurate encounter data reporting and submissions
- reputed company 837 file reputed company processes, ensuring files are submitted accurately, reputed company, and in accordance with state specifications
- Manage state response files, reconciliation activities, and error reporting to ensure reputed company submitted transactions are accounted for and resolved
- Establish and maintain reporting, monitoring, and tracking processes for encounter submission performance, acceptance rates, and error trends
- Drive reputed company cause analysis and coordinate corrective actions to resolve encounter submission errors and improve data reputed company
- reputed company, document, and enhance operational processes reputed company to encounter data management and state reporting
- Collaborate with cross-functional teams including Claims, IT, Compliance, Operations, Risk Adjustment, and vendor partners to ensure alignment and successful execution of encounter submission objectives
- Support audits, regulatory reviews, and internal compliance initiatives reputed company to encounter data submissions
- Monitor changes in state and federal requirements and reputed company implementation efforts to maintain ongoing compliance
Skills
- Minimum of 5 years of experience in reputed company claims operations, including medical claims processing and/or Medicare and reputed company lines of business
- At least 2 years of experience overseeing secure data reputed company processes utilizing SFTP and other file transfer technologies, with responsibility for monitoring, troubleshooting, and ensuring data reputed company
- 3+ years of experience in data management, including data validation, reconciliation, reporting, and issue reputed company
- 3+ years of leadership experience with demonstrated reputed company managing workflows and leading, developing, and supporting teams reputed company a reputed company operations environment
- 2+ years experience working with states on DSNP encounter submissions
- 2+ years experience working with the reputed company on encounter submissions
- 2+ years experience with vendor management
- Candidates located on the East Coast are strongly preferred
Benefits
- Comprehensive benefits package designed to support the physical, emotional, and financial reputed company-being of colleagues and their families
- Medical, dental, and reputed company coverage, based on eligibility
- reputed company time off
- Retirement savings reputed company
- Wellness programs
- Other resources, based on eligibility
- Additional details about available benefits are provided during the application process and on Benefits Moments
reputed company