Manager, Clinical Data Management

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

📋 Description

• Manage the comprehensive strategy, priorities, and operations for the submission of accurate and compliant encounter data to payers and CMS.

• Generate and send ASM files on scheduled cycles, ensuring adherence to payer-specific templates and submission methods each year.

• Implement reconciliation processes to monitor diagnoses from documentation to acceptance, assess gaps, and pinpoint any dropped or truncated records.

• Conduct root-cause analysis and corrective action in collaboration with internal teams, vendors, and payers regarding rejected or dropped diagnoses.

• Collaborate with operations leadership on strategy, chart selection, and annual assessments for retrospective chart reviews.

• Track submission metrics and acceptance rates, applying data scrubbing and business rules to comply with regulatory standards and meet CMS/payer deadlines.

• Work alongside leadership and legal teams to ensure adherence to workflows for adding and deleting diagnoses.

• Create and sustain process documentation, SOPs, and regular workflow updates.

• Identify tools and long-term strategies to enhance encounter acceptance rates, reduce manual efforts, and broaden ASM processes across eligible payers.

• Assess annual ROI for submission and audit processes and refine workflows to enhance financial performance.

• Drive cross-functional initiatives to address data flow challenges and implement system updates.

• Integrate accepted diagnosis data from ASM submissions into current risk reporting dashboards and generate recurring reports for leadership.

• Take ownership of ASM valuation and financial outcomes, collaborating with Data and Analytics on metric definitions and data quality.

⛳️ Requirements

• A Bachelor’s degree in Business, Finance, IT, Healthcare Analytics, or Operations.

• Over 6 years of experience with Medicare Advantage or ACA encounter data processes, and/or risk adjustment experience within a payer, vendor, or Value-Based Care organization.

• At least 3 years of program or project management experience, including responsibility for complex, multi-stakeholder initiatives.

• A minimum of 2 years of practical knowledge with X12 837 transaction sets.

• Familiarity with CMS EDPS experience (MAO-002/MAO-004 reports).

• Strong analytical skills with the capacity to interpret complex datasets and extract actionable insights.

• Outstanding written and verbal communication abilities, with experience in developing and presenting critical information to executive leadership.

• Practical knowledge of SQL, including the ability to write, modify, and execute queries.

• Proficiency in Google Workspace, project tracking tools like Jira or Smartsheet, and business intelligence or dashboard platforms.

• Understanding of Business Process Reengineering principles and methodologies.

• Experience in chart selection or targeting strategies for retrospective chart reviews.

• Basic understanding of relational databases.

• Ability to sit at a desk and work on a computer for extended periods.

🏝️ Benefits

• Flexible work schedules and remote work options are available for many positions.

• Health, dental, and vision insurance covered up to 80% for employees, dependents, and domestic partners.

• 21 days of PTO in the first year.

• Two paid volunteer days.

• 11 paid holidays.

• 12 weeks of paid parental leave for all new parents.

• Six weeks of paid sabbatical after six years of service.

• Educational Assistance Program.

• Clinical Employee Reimbursement Program.

• 401(k) with up to 4% matching.

• Stock options.