Manager, Clinical Data Management

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🔥 2 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧪 Clinical Research

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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

• Oversee the end-to-end strategy, priorities, and operations for accurate and compliant encounter data submission to payers and CMS • Create and transmit ASM files on established cadences, maintaining payer-specific templates and submission methods annually • Establish reconciliation processes to track diagnoses from documentation to acceptance, quantify gaps, and identify dropped or truncated records • Lead root-cause analysis and corrective action across internal teams, vendors, and payers for rejected or dropped diagnoses • Partner with operations leadership on strategy, chart selection, and annual evaluation for retrospective chart review • Monitor submission metrics and acceptance rates, applying data scrubs and business rules to meet regulatory standards and CMS/payer deadlines • Collaborate with leadership and legal partners to ensure compliance with add and delete diagnosis workflows • Develop and maintain process documentation, SOPs, and routine workflow updates • Identify tools and long-term strategies to improve encounter acceptance rates, minimize manual effort, and expand ASM processes across eligible payers • Evaluate annual ROI across submission and audit processes and optimize workflows to drive financial performance • Lead cross-functional initiatives to resolve data flow issues and implement system updates • Integrate accepted ASM-submitted diagnosis data into existing risk reporting dashboards and build recurring reports for leadership • Own ASM valuation and financial results, partnering with Data and Analytics on metric definitions and data quality

🎯 Requirements

• Bachelor’s degree in Business, Finance, IT, Healthcare Analytics, or Operations • 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 • 3+ years of program or project management experience, including ownership of complex, multi-stakeholder initiatives • 2+ years of working knowledge with X12 837 transaction sets • Working knowledge of CMS EDPS experience (MAO-002/MAO-004 reports) • Strong analytical capabilities with the ability to interpret complex datasets and synthesize actionable insights • Excellent written and verbal communication skills, with experience developing and presenting key information to executive leadership • Working knowledge of SQL, including writing, modifying, and executing queries • Proficiency in Google Workspace, project tracking software such as Jira or Smartsheet, and business intelligence or dashboard platforms • Familiarity with Business Process Reengineering principles and methodologies • Experience with chart selection or targeting strategies for retrospective chart review • 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 • 21 days of PTO in the first year • Two paid volunteer days • 11 paid holidays • 12 weeks paid parental leave for all new parents • Six weeks paid sabbatical after six years of service • Educational Assistant Program • Clinical Employee Reimbursement Program • 401(k) with up to 4% match • Stock options

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