Aledade - Encounter Data Submissions Program Manager
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Requirements
• 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 • 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) • Excellent communication and presentation skills, both written and verbal • Business Process Reengineering (BPR): Familiarity with BPR principles and methodologies to radically redesign business processes for improved performance, efficiency, and customer satisfaction • Medicare claims experience • Fundamental understanding of relational databases • Prolonged periods of sitting at a desk and working on a computer.
Responsibilities
• 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