Encounter Data Manager – Facets

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Oversee the complete encounter submission processes, ensuring adherence to CMS and state Medicaid regulations.

• Monitor, assess, and resolve errors in encounter submissions through automated workflows and root cause analysis.

• Guarantee the accuracy, completeness, and timely submission of encounter data to optimize acceptance rates and reduce rejections.

• Configure and validate components within Facets related to claims, benefits, pricing, and rules to ensure correct adjudication outcomes.

• Align encounter data processes with claims adjudication logic, as well as 837/835 transaction flows and EDI processing.

• Diagnose configuration and data issues affecting claims processing, encounters, and regulatory submissions.

• Validate and reconcile data across various systems to ensure precise encounter submissions and mitigate financial risks.

• Identify gaps in data, mismatches, or risks of revenue leakage associated with Medicare Advantage and Medicaid.

• Implement enhancements to boost acceptance rates of encounters and decrease the need for resubmissions.

• Assist in testing cycles (UAT, regression, validation) for new configurations or system improvements.

⛳️ Requirements

• A minimum of 5 years of experience in healthcare payer environments (Medicare and Medicaid).

• At least 5 years of practical experience with Facets (TriZetto) and EDM across claims and configuration modules.

• Extensive experience with 837/835 transactions and EDI processing.

• Proficient in encounter data submissions and reconciliation.

• Familiarity with claims payment systems.

• Knowledge of claims adjudication processes.

• Experience in consulting or client-facing roles.

• Strong communication skills to engage with both technical and non-technical staff.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage for employees and their dependents.

• A 401(k) plan with a generous employer matching contribution.

• An employee stock purchase program.

• A generous Paid Time Off policy.

• Paid parental leave and adoption assistance.

• A wellness program aimed at supporting the overall well-being of employees.