The DSNP Encounters Data Management Lead supports the Encounter Data Management team within the Healthcare Quality Reporting and Improvement organization (HQRI). This support includes submission of encounter data to Medicaid, Medicare, and DSNP states and will require the ability to manage inventory, ensure compliance adherence, and solve complex business challenges ranging from moderate to substantial.
Requirements
- Minimum 5 years of technical experience in CAS or X12, including working knowledge of EDI formats: 834, 835, 837, 270/271, 277, etc.
- Experienced working in an SQL environment with comprehensive knowledge of SSMS
- Demonstrated experience building and presenting story-driven presentations based on analytics
- Strong working knowledge of Cloud Technologies (Azure Synapse Analytics), Databricks and Power Platform (Power BI, Power Automate, & Power Apps)
- Knowledgeable in process improvement and metrics development
- Comprehensive knowledge of advanced analytic and experience with Python, Databricks or other statistical software
- Experience with state or federal encounter data submission portals (e.g., CMS, state Medicaid portals) and troubleshooting submission errors.
Responsibilities
- supports the Encounter Data Management team within the Healthcare Quality Reporting and Improvement organization (HQRI).
- submission of encounter data to Medicaid, Medicare, and DSNP states
- manage inventory, ensure compliance adherence, and solve complex business challenges ranging from moderate to substantial.
- support the effectiveness and efficiency of encounter data management submissions by ensuring inventory is processed accurately, timely and with completeness.
- partnering with multiple teams and leaders on new state implementations, conduct annual state contract reviews, analyze new regulatory requirements, and support the development of compliance and operational processes.
- identify and analyze inventory and will ensure encounter submissions meet or exceed all compliance standards via analysis of data and develop tools to enhance the encounter acceptance rate by Medicaid, Medicare, and DSNP.
- solve problems of diverse scope and complexity ranging from moderate to substantial.
Other
- 2 or more years of project leadership experience
- Ability to be creative, anticipate and be proactive around the next steps in large initiatives simultaneously
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences and business outcome.
- 2 + years' experience in managing change by leading and energizing others, modeling adaptability, and inspiring strong organizational performance through periods of transformation, ambiguity, and complexity.
- Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences
