Manager Encounters Data Submission

Job Summary

This position is responsible for the creation and submission of Medicare Encounter (EDPS) Data to CMS as well as applicable state entities, and any Risk Adjustment related EDGE Server data submission, reconciliation, reporting and error resolution as needed to support the Medicare and ACA Line of Business. Reconciliation, tracking, and reporting of all CMS Response Files to ensure complete, accurate, and timely submission. Maintaining internal software, servers, and databases to support operations and reporting. Managing internal and contracted staff. Manage software and system upgrades. Responsible for the oversight of activities that ensure regulatory compliance related to risk adjustment operations.

Essential Functions

• Creation and Submission of Medicare Encounter Data (EDPS) to both CMS and State Entities.
• Creation and Submission of EDGE Server Data for submission to CMS/HHS.
• Maintaining and reconciling vendor software for EDPS.
• Managing software upgrades
  Maintaining internal databases for reporting and analysis across the organization
  Managing internal staff
• Managing contracted staff
  Reporting and identifying trends related to Medicare and ACA data submission
  Creation of productivity reports, key performance indicators, dashboards, and other reporting as needed
• Participate in various Government, Vendor or other entity hosted webinars, training, and conferences
  Monitor Federal and State Guidance to ensure compliance with Risk Adjustment requirements.
• Develop and maintain internal Standard Operating Procedures (SOPs) and documentation as necessary
  Manage and own other special projects as assigned
• Reporting and Monitoring of submitted data in support of the Medicare and ACA Line of Business.

Qualifications

• Required - Bachelor's Degree in business, finance, economics, mathematics, healthcare administration, statistics, information systems, or closely related discipline.
• Required - 7 years of relevant experience
• Required - 2 years of relevant experience with Encounter Data

Physical Demands

• Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
• Waist to Waist > 5 lbs: Seldom up to 10 lbs
• Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
• Waist to Overhead > 5 lbs: Seldom up to 10 lbs
• Bilateral Carry > 5 lbs: Seldom up to 10 lbs
• Unilateral Carry > 5 lbs: Seldom up to 10 lbs
• Pushing Force > 5 lbs: Seldom up to 10 lbs
• Pulling Force > 5 lbs: Seldom up to 10 lbs
• Sitting: Frequently
• Standing: Occasionally
• Walking: Occasionally
• Forward Bend - Standing: Seldom
• Forward Bend - Sitting: Occasionally
• Trunk Rotation - Standing: Seldom
• Trunk Rotation - Sitting: Occasionally
• Reach - Above Shoulder: Seldom
• Reach - at Shoulder or Below: Seldom
• Handling: Occasionally
• Forceful Grip > 5 lbs: Seldom
• Forceful Pinch > 2 lbs: Seldom
• Finger/Hand Dexterity: Frequently

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

• Optional identity theft protection, home and auto insurance, pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1231 E Beltline - Grand Rapids

Department Name

Risk Adjustment Executive

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 a.m. to 5 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace cat