Encounters Technical Lead

Job not on LinkedIn

🔥 14 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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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Oversee end-to-end encounters data management, including ingestion, cleansing, transformation, and integration • Develop and implement best practices for encounters data processing • Establish data integration processes with internal and external stakeholders • Coordinate with IT teams and vendors to ensure accurate data exchange between systems and platforms • Design, develop, and optimize encounter data models • Monitor encounters data process performance and implement optimization measures • Provide technical expertise and guidance in encounters data management and analysis • Set technical objectives and expectations and lead delivery of high-quality solutions • Collaborate across teams, prioritize 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 • Support analytics teams with data requirements, analytical models, and reports • Ensure compliance with regulatory requirements, guidelines, and contractual obligations for CMS encounter submissions and response files • Work on a computer in a remote environment

🎯 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 • Experience with Medicare and Medicaid products • Working knowledge of claims, utilization management, member, and/or provider data • Proficient with Microsoft Office • Proficiency in data integration tools and techniques • Strong knowledge of database management systems, including SQL and NoSQL • Knowledge of data modeling, ETL processes, and data warehousing concepts • Proven experience in leading technical projects • Ability to analyze complex data sets, identify patterns, and derive actionable insights • Ability to identify and resolve technical issues in a timely manner • Strong interpersonal and communication skills to collaborate with cross-functional stakeholders • Ability to work independently and in a team environment • Preferred: Master’s Degree; five (5) years of encounter data management experience; knowledge of CMS EDPS data files; ICD Diagnosis, CPT, UB, and HCFA coding; CMS Medicare Regulatory Reporting; SAS, Tableau, or Power BI • Must possess current understanding of how Medicare STARS, HEDIS, and NCQA affect the Plan

🏖️ Benefits

• Full-time position • Remote work environment