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Risk Adjustment Encounter Submissions Manager

2 weeks ago

Waltham, Massachusetts, United States Devoted Health Services Full time

Job Description

A bit about the Risk Adjustment Encounter Submissions team:

The Risk Adjustment Encounter Submissions team is one of the 5 functional areas in Devoted's Risk Adjustment Department and is responsible for ensuring the timely and accurate submission of risk adjustment encounter data to CMS. Risk Adjustment Encounter Submissions work collaboratively with the other functional areas of the Risk Adjustment department, other departments across the organization, and external provider partners to continuously improve the accuracy of the data we submit to CMS.

The Risk Adjustment Encounter Submissions team includes:

  • Director of Encounter Submissions

  • Encounter Submissions Manager

  • Close partnership with Risk Adjustment focused data scientists and software engineers

A bit about this role: 

The Risk Adjustment Encounter Submissions Manager supports the department by reviewing internally and externally sourced encounter data, identifying opportunities for improving day-to-day submissions operations and creating recommendations for implementation. This role also supports ongoing successful submissions of all ADDs and DELETEs to the Encounter Data Processing System (EDPS).

Your Responsibilities and Impact will include:

  • Review and monitor encounter data submissions for accuracy and completeness, identifying discrepancies and potential areas for improvement.

  • Collaborate with cross-functional teams to implement and monitor corrective actions

  • Develop and maintain documentation of submission processes, including troubleshooting and resolution strategies for data submission errors.

  • Educate and train stakeholders on policies, procedures, and best practices related to encounter data submissions.

  • Stay up-to-date on regulatory changes and industry best practices affecting risk adjustment and encounter data submissions.
     

Required skills and experience:

  • Bachelor's degree in healthcare, data analytics, or a related field; advanced degree preferred.

  • Excellent communication and interpersonal skills, with a collaborative approach to problem-solving.

  • Strong attention to detail and organizational skills to manage multiple priorities effectively.

  • Ability to take initiative and drive projects forward in a fast-paced environment.

  • Strong analytical skills with a proven ability to interpret complex data sets and identify key insights.

  • Ability to establish and improve operational processes

Desired skills and experience:

  • Strong command of SQL; experience with Snowflake database

  • Minimum of five years of substantive health care experience, operational experience or other consulting experience.

#LI-Remote

#LI-DS1

Salary Range:  $76,000 - $126,000 per year

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

  • Employer sponsored health, dental and vision plan with low or no premium

  • Generous paid time off

  • $100 monthly mobile or internet stipend

  • Stock options for all employees

  • Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

  • Parental leave program

  • 401K program

  • And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted's mission to treat our members like family.  We are committed to a diverse and vibrant workforce. 

At Devoted Health, we're on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That's why we're gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted's Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.