• Manager of Encounter Analysis

    Job Locations US-RI-Smithfield
    Req No.
    2018-9572
    Department
    Operations Support
    Type
    Regular Full-Time
  • Overview

    This position is responsible for the oversight and management of a team of analyst responsible for submission of APCD, Encounter, RAPS/EDPS, Edge Server and MMP CMS Reporting.  He/she will lead a team of analyst in the execution of data analysis to examine report data from delegated entities and review data for accuracy.  He/she is responsible for the compliance, oversight and monitoring of timely and accurate submission of data to the Executive Office of Health and Human Services (EOHHS) and CMS. This role requires a strong knowledge of Medicare and Medicaid claims processing. This role also requires a leader with strong leadership, communication and analytical skills who is an expert in the Encounter Submission process. 

    • Serve as a resource in Encounter Data reporting process, including working on monthly data submissions, ad-hoc submissions, tracking, reporting and resolving rejections
    • Serve as a resource and support the monthly Medicare Advantage Encounter Data reporting process (ERI and RAPS system) including working on monthly data submissions, ad-hoc submissions, tracking, reporting and resolving rejections
    • Serve as a resource in the submission of APCD and Edge Server reporting
    • Serve as a resource in facilitating the gathering of submission data from delegated entities
    • Manage a range of moderate to complex activities involving data analysis
    • Perform Data and Statistical Analysis on data provided from delegated entities
    • Contribute to development of business requirements, functional requirements, process flows, reference materials, user guides and code release artifacts as appropriate

    Responsibilities

    • Engage in on-going performance management of staff including coaching, mentoring, development, training and succession planning to include hiring and termination decisions
    • Serves as the subject matter expert and lead on functional deliverables ensuring optimal efficiency in area of responsibility
    • Hands on with more complex assignments, as needed
    • Reviews and approves submission of Encounter data to the EOHHS
    • Oversee the preparation and coordination of reporting data for Edge Server Submissions
    • Reviews and approves submission Medicare Encounter data to CMS using the HPMS module
    • Manages the day-to-day data management activities of RAPS file submission to CMS
    • Manages the oversight and facilitation of EDPS transactions to CMS
    • Manages the data accessibility of RAPS and EDPS for the department and organization
    • Manages the reporting of operational file submissions to CMS
    • Serve as analytical resources for root cause analysis and issue resolution on issues relating to data submissions. Track, analyze and fix errors and rejections that occur that are returned and reprocess where applicable
    • Manages and coordinates the development and implementation of requirements for new vendors (delegated entities)
    • Contributes to development of business requirements, functional requirements, process flows, reference materials, user guides and code release artifacts as appropriate
    • Actively participates in change management activities
    • Actively reviews, tracks, translates and disseminate changes to regulations
    • Manages, participates and coordinates activities during audits of the file submission process both external and internal
    • Ownership of business process audit and developing procedure for the audit process
    • Develop and maintain standards for development of business cases and their documentation
    • Demonstrates a high standard of communication and inter-personal skills
    • Prepare and compile periodic progress reports to the Senior Management Team
    • Other duties as assigned
    • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and  the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

    Qualifications

    Required:

    • Bachelor’s degree in Business or IT-related discipline and/or years of experience and background to equate to the degree in technology or management
    • Five (5)+ years of experience relating to Medicare/Medicaid data operations, Encounter Data, Medicare Claims processing and Enrollment, Healthcare IT projects and/or file exchanges with government agencies in a Pharmacy Benefits Manager (PBM) or Managed Healthcare setting
    • Five (5)+ years of related business analysis/data analysis experience
    • Five (5)+ years of experience of working with EDI, 837I and 837series transactions and Medicare Risk Adjustments (RAPS/EDPS)
    • Two (2) years of supervisory experience
    • Excellent interpersonal skills, including the ability to work across the organization and to interact, influence and negotiate effectively at all levels of management
    • Demonstrated ability to manage multiple priorities simultaneously in a deadline driven environment with accurate resource and time estimates
    • Confident team builder and leader with strong motivational skills. Adept in problem solving and resolving conflict
    • Proficient in MS Project, Excel, PowerPoint and Word, Visio
    • Ability to liaise with business users, developers, stakeholders, analysts and management
    • Strong communication skills, both verbal and written
    • Must have outstanding time management and organizational skills
    • Must be a self-starter and able to work with minimum supervision
    • Solid organization, negotiation, and analysis skills with demonstrated ability to deliver on multiple assignments meet tight deadlines and are effective and decisive under pressure.
    • Ability to liaise with business users, developers, stakeholders, analysts and management.

    Preferred:

    • Extensive experience in an insurance, medical and/or HMO environment using claims processing software
    • Two (2)+ years of project management experience
    • Experience in demonstrating leadership, influence and collaboration in a matrix-managed environment

    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

     

    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org

     

    Neighborhood is an EOE M/F/D/V and an E-Verify Employer

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