Encounters Technical Lead

🔥 17 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

🧑‍💻 Full-stack Engineer

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Peak Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.

📋 Description

• Oversee end-to-end encounters data management, including ingestion, cleansing, transformation, and integration • Develop and implement best practices for encounters data processing • Collaborate with internal and external stakeholders to establish effective data integration processes • Coordinate with IT teams and vendors to ensure accurate data exchange between systems and platforms • Design and develop encounter data models aligned with industry standards and organizational requirements • Optimize data models for efficient data retrieval and analysis • Establish monitoring mechanisms for encounters data process performance and efficiency • Identify optimization opportunities and implement measures to enhance system performance • Provide technical expertise and guidance in encounters data management and analysis • Set technical objectives and expectations and lead delivery of high-quality solutions • Prioritize cross-functional demands, synthesize information, and generate meaningful conclusions • Develop and implement team training programs • Implement quality assurance processes and conduct regular audits for data accuracy and integrity • Identify and resolve data-related issues with cross-functional teams • Use advanced analytics to extract insights from encounter data • Work with analytics teams to define data requirements and support analytical models and reports • Ensure compliance with regulatory requirements, guidelines, and contractual obligations for CMS EDPS encounter submissions and response files

🎯 Requirements

• Bachelor’s Degree in Healthcare Administration, Business Administration, Finance, Economics, Information Systems, or a closely related field • Four (4) years of experience in encounter data management, risk adjustment, or related field within the healthcare industry • Four (4) years of experience working with claims data to evaluate reimbursement changes, payment discrepancies, medical expense opportunities, quality outcomes and risk • Strong knowledge of CMS’ Encounter Data Processing System (EDPS) data files (837P, 837I, 277CA, MAO-001, MAO-002, MAO-004) • Knowledge and understanding of ICD Diagnosis, CPT, UB, and HCFA coding • Understanding of CMS Medicare Regulatory Reporting • Current understanding of how Medicare STARS, HEDIS, and NCQA compliance and quality programs affect the Plan • Experience with Medicare and Medicaid products • Working knowledge of claims, utilization management, member, and/or provider data • Proficiency in data integration tools and techniques, database management systems (SQL, NoSQL), data modeling, ETL processes, and data warehousing concepts • Experience with data visualization and analytics tools such as SAS, Tableau, and Power BI preferred • Proven experience leading technical projects • Proficient with Microsoft Office • Ability to analyze complex data sets, identify patterns, and derive actionable insights • Bachelor’s degree is required; Master’s degree is preferred