Aledade, Inc.

With Primary Care. For Primary Care.

Encounter Data Submissions Program Manager

Program ManagerProgram ManagerFull TimeRemoteTeam 501-1,000Since 2014H1B No SponsorCompany SiteLinkedIn

Location

Virginia

Posted

23 days ago

Salary

Not specified

Bachelor Degree4 yrs expEnglishAssemblySQL

Job Description

• Assist in the development of programming documentation and SOPs, to include routine maintenance and update of program documents • Identify and establish ASM process with additional eligible payers • Provide support to CSO in efforts to increase practice “opt-in” to ASM processes • Create and transmit ASM files to all relevant payers on an established cadence • Maintain annual CMS and payer submission deadlines • Maintain and update payer specific ASM templates annually • Maintain and update payer specific submission methods annually • Reconcile ASM record submissions with payer and CMS EDS files • Establish routine reconciliation process with payer and CMS files • Integrate accepted ASM submitted diagnosis data into existing risk reporting dashboards • Provide ongoing monitoring of provider diagnosis submission and truncation trends • Develop process for consistent monitoring of existing dropped diagnosis and truncation dashboards for early identification of diagnosis submission errors • Collaborate with senior leadership and legal partners to ensure continued compliance with regulatory requirements pertaining to submission of “add” and “delete” diagnoses • Develop a process to identify and submit diagnoses appropriately identified through routine CDI chart audits. • Conduct annual ROI evaluation of ASM processes to include both submission of “dropped” diagnoses, and retrospective chart audit projects

Job 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
  • Software Proficiency: Proficiency in using common business software such as Microsoft Office Suite (Word, Excel, PowerPoint), collaboration tools (e.g., SharePoint), and project management software (e.g., Jira, Smartsheet)

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
  • And much more!

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