Encounter Data Submissions Program Manager

🔥 13 hours ago

🦀 Maryland, Virginia – Remote

🦀 Maryland – Remote ⚔️ Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Program Manager

👻 Ghost score 10%

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Aledade, Inc.

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2014

🏥 Healthcare

⚕️ Healthcare Insurance

🏢 Enterprise

Healthcare • Healthcare Insurance • Enterprise

Aledade, Inc. is a public benefit corporation that operates as the largest network of independent primary care practices in the United States. The company specializes in Accountable Care Organizations (ACOs), which help primary care practices and health centers improve patient outcomes and generate sustainable revenue through value-based care solutions. Aledade offers data insights, support, and business solutions to achieve sustainability and clinical autonomy. It collaborates with a wide range of healthcare providers, including primary care practices, community health centers, and network ACOs, ensuring improved quality of care and patient satisfaction. With operations in 45 states and affiliations with over 20,000 clinicians serving more than 2. 5 million patients, Aledade is committed to reducing care fragmentation and enhancing the overall quality of life for clinicians and patients alike.

📋 Description

• Assist in developing an end-to-end Encounter Data Submission and Reconciliation program • Create, maintain, and update program documentation and Standard Operating Procedures • Identify and establish Alternate Submission Method (ASM) processes with eligible payers • Support efforts to increase practice opt-in to ASM processes • Create and transmit ASM files to relevant payers on an established cadence • Maintain annual CMS and payer submission deadlines • Maintain and update payer-specific ASM templates and submission methods annually • Reconcile ASM record submissions with payer and CMS EDS files • Establish routine reconciliation processes with payer and CMS files • Integrate accepted ASM diagnosis data into existing risk reporting dashboards • Monitor provider diagnosis submission and truncation trends • Develop monitoring processes for dropped diagnosis and truncation dashboards • Collaborate with senior leadership and legal partners to ensure regulatory compliance • Develop processes to identify and submit diagnoses from CDI chart audits • Conduct annual ROI evaluations of ASM processes • Oversee daily EDS and reconciliation processes after program establishment • Ensure clinical encounter data is accurately captured, validated, and submitted to payers and CMS

🎯 Requirements

• Bachelor's degree in Business, Finance, Information Technology, Analytics, Operations, or a related field • 4+ years of experience with Medicare Advantage or ACA encounter data processes and/or risk adjustment experience with a Payer, Vendor or Provider Organization • 1+ years of X-12 837 data knowledge • Strong analytical skills with a proven ability to interpret complex data sets and identify key insights • Ability to develop and present information to Senior Leadership • Working knowledge of SQL: writing, creating and/or running queries • Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint), collaboration tools (e.g., SharePoint), and project management software (e.g., Jira, Smartsheet) • Excellent written and verbal communication and presentation skills • Familiarity with Business Process Reengineering (BPR) principles and methodologies • Medicare claims experience • Fundamental understanding of relational databases • Prolonged periods of sitting at a desk and working on a computer

🏖️ Benefits

• Flexible work schedules and the ability to work remotely are available for many roles • Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners • Robust time-off plan (21 days of PTO in your first year) • Two paid volunteer days and 11 paid holidays • 12 weeks paid parental leave for all new parents • Six weeks paid sabbatical after six years of service • Educational Assistant Program and Clinical Employee Reimbursement Program • 401(k) with up to 4% match • Stock options • Equal opportunity employment and commitment to a diverse, inclusive workplace