Encounters Technical Lead

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

📋 Description

• Manage the complete lifecycle of encounters data, encompassing ingestion, cleansing, transformation, and integration.

• Create and enforce best practices for processing encounters data.

• Work collaboratively with both internal and external stakeholders to develop efficient data integration workflows.

• Liaise with IT teams and vendors to ensure precise data exchange across different systems and platforms.

• Design and develop encounter data models that meet industry standards and align with organizational needs.

• Enhance data models for improved data retrieval and analysis efficiency.

• Create monitoring systems to track the performance and efficiency of encounters data processes.

• Recognize opportunities for optimization and execute strategies to boost system performance.

• Provide technical expertise and support in encounters data management and analysis.

• Establish technical goals and expectations, guiding the delivery of high-quality solutions.

• Balance cross-functional demands, consolidate information, and draw meaningful insights.

• Create and implement training programs for the team.

• Apply quality assurance practices and perform regular audits to ensure data accuracy and integrity.

• Identify and address data-related challenges in collaboration with cross-functional teams.

• Utilize advanced analytics to extract valuable insights from encounter data.

• Collaborate with analytics teams to define data needs and support the development of analytical models and reports.

• Ensure adherence to regulatory requirements, guidelines, and contractual obligations for CMS EDPS encounter submissions and response files.

⛳️ Requirements

• A Bachelor’s Degree in Healthcare Administration, Business Administration, Finance, Economics, Information Systems, or a closely related discipline.

• At least four (4) years of experience in encounter data management, risk adjustment, or a related area within the healthcare sector.

• A minimum of four (4) years of experience working with claims data to assess reimbursement changes, payment discrepancies, medical expense opportunities, quality outcomes, and risk.

• Strong familiarity with CMS’ Encounter Data Processing System (EDPS) data files (837P, 837I, 277CA, MAO-001, MAO-002, MAO-004).

• Knowledge of ICD Diagnosis, CPT, UB, and HCFA coding.

• Understanding of CMS Medicare Regulatory Reporting.

• Current insight into how Medicare STARS, HEDIS, and NCQA compliance and quality programs impact the Plan.

• Experience with Medicare and Medicaid products.

• Practical knowledge of claims, utilization management, member, and/or provider data.

• Proficiency in data integration tools and techniques, database management systems (SQL, NoSQL), data modeling, ETL processes, and data warehousing principles.

• Experience with data visualization and analytics tools such as SAS, Tableau, and Power BI is preferred.

• Demonstrated experience in leading technical projects.

• Proficient in Microsoft Office.

• Capability to analyze complex datasets, identify trends, and extract actionable insights.

• Bachelor’s degree is mandatory; a Master’s degree is preferred.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health benefits including medical, dental, and vision coverage.

• Opportunities for professional development and continued education.

• Flexible work environment and work-life balance initiatives.

• Retirement savings plan with company match.

• Paid time off and holiday leave.