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 execute best practices for processing encounters data.

• Develop data integration protocols with both internal and external partners.

• Collaborate with IT teams and vendors to guarantee precise data exchange across systems and platforms.

• Design, create, and refine encounter data models.

• Monitor the efficiency of encounters data processes and implement optimization strategies.

• Offer technical expertise and guidance in encounters data management and analysis.

• Define technical goals and expectations, driving the delivery of high-quality solutions.

• Work collaboratively across teams, prioritize requests, synthesize information, and draw meaningful conclusions.

• Create and implement training programs for the team.

• Establish quality assurance measures and perform regular audits to ensure data accuracy and integrity.

• Detect and resolve data-related challenges in collaboration with cross-functional teams.

• Utilize advanced analytics to derive insights from encounter data.

• Assist analytics teams with data requirements, analytical models, and reporting.

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

• Operate in a remote work setting on a computer.

⛳️ Requirements

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

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

• Four (4) years of experience analyzing claims data to assess reimbursement changes, payment discrepancies, medical expense opportunities, quality outcomes, and risk.

• Familiarity with Medicare and Medicaid products.

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

• Proficient in Microsoft Office applications.

• Expertise in data integration tools and methodologies.

• In-depth knowledge of database management systems, including SQL and NoSQL.

• Understanding of data modeling, ETL processes, and data warehousing principles.

• Demonstrated experience in leading technical projects.

• Capability to analyze complex data sets, recognize patterns, and extract actionable insights.

• Ability to promptly identify and resolve technical issues.

• Excellent interpersonal and communication skills for collaborating with cross-functional stakeholders.

• Capacity to work both independently and as part of a team.

• Preferred qualifications: Master’s Degree; five (5) years of experience in encounter data management; familiarity with CMS EDPS data files; knowledge of ICD Diagnosis, CPT, UB, and HCFA coding; understanding of CMS Medicare Regulatory Reporting; experience with SAS, Tableau, or Power BI.

• Must have a current understanding of how Medicare STARS, HEDIS, and NCQA impact the Plan.

🏝️ Benefits

• Full-time employment opportunity.

• Flexible remote work environment.