Manager, Business Consultant

This is a fully remote position, open to applicants in Maryland, +4 more states.

📋 Description

• Act as the subject matter expert regarding state-specific encounter data submission requirements and maintain thorough documentation of all relevant regulations and processes.

• Oversee the complete management of encounter submissions, ensuring adherence to state and regulatory standards.

• Collaborate with technical teams and vendors to implement, monitor, and sustain processes that facilitate accurate encounter data reporting and submissions.

• Supervise the 837 file transmission processes, guaranteeing that files are submitted correctly, punctually, and in alignment with state specifications.

• Manage state response files, reconciliation efforts, and error reporting to ensure all submitted transactions are accounted for and addressed.

• Establish and uphold reporting, monitoring, and tracking processes for encounter submission performance, acceptance rates, and error trends.

• Conduct root cause analysis and coordinate corrective measures to resolve encounter submission errors and enhance data quality.

• Develop, document, and refine operational processes related to encounter data management and state reporting.

• Work alongside cross-functional teams including Claims, IT, Compliance, Operations, Risk Adjustment, and vendor partners to ensure alignment and the successful execution of encounter submission goals.

• Assist in audits, regulatory reviews, and internal compliance initiatives concerning encounter data submissions.

• Keep abreast of changes in state and federal requirements and spearhead implementation efforts to ensure ongoing compliance.

⛳️ Requirements

• A minimum of 5 years of experience in healthcare claims operations.

• At least 2 years of experience managing secure data transmission processes using SFTP and other file transfer technologies.

• Over 3 years of experience in data management, including data validation, reconciliation, reporting, and issue resolution.

• More than 3 years of leadership experience with a proven track record in managing workflows and leading, developing, and supporting teams within a healthcare operations context.

• A bachelor's degree is preferred or a combination of professional work experience and education.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources.