Associate Director - Encounter Data and Risk Adjustment

Overview

Job Summary

The Data Services Healthcare Solutions Associate Director is responsible for providing strategic leadership and direction for the teams working on encounter and risk adjustment data, overseeing the various ETL processes and applications that support the data intake and outputs, providing guidance and solutions for complex coding issues, spec development for new or changing processes, and managing new client process implementation to ensure efficiency and alignment with Data Services’ existing suite of tools and operations. While management of operations and staff is critical to this role, this position involves assisting with the various day-to-day tasks of the staff and reviewing/testing other work to ensure high quality results. This position can be defined as a “working-manager”.

Responsibilities

Work Performed and Job Requirements

• Provide strategic leadership and direction for the Encounter Data and Risk Adjustment data team, ensuring alignment with organizational goals, regulatory requirements, and data integrity standards.
• Manage cross-functional collaboration with internal departments (e.g., Actuarial, IT and other HMA affiliates/departments) and external partners to drive continuous improvement in encounter data accuracy, timeliness, and completeness.
• Own Data Services’ processes related to Encounter Data and Risk Adjustment. This includes understanding process purposes, interdependence, and timing
• Support consulting staff with complex data related questions and troubleshooting issues that involve applying complex SQL coding with healthcare data and risk scoring knowledge.
• Understand claim system adjudication for voiding, replacing and adjusting claims. Apply this knowledge to develop technical specifications and business rules so the Data Services team can create efficient SQL coding and SSIS processes.
• Develop technical specifications and corresponding project plans for changes needed when governmental agencies change encounter requirements.
• Maintain or improve Cirdan’s submission accuracy and low error rates.
• Create complex SQL coding to be used within automated processes.
• Collaborate with and support the data team to investigate and resolve complex data errors, providing guidance on appropriate SQL coding needed for proper resolution.
• Manage Data Services projects to ensure quality and timeliness.
• All other duties as assigned.

Qualifications

Experience

Minimum of 8 years of professional experience in health care data processing and ETL, SQL coding, specification development, project management, and team leadership.

Knowledge, Skills, and Abilities

• Proven strategic and leadership skills
• Expert level with T-SQL, MS SQL (2016 or later), SSIS, and MS Office Suite
• Ability to read and edit VB .NET code to troubleshoot issues and to make updates as needed
• Understanding of CMS EDPS Encounter Submission process and requirements as well as a basic understanding of CMS risk adjustment
• Detailed understanding of healthcare data and claims adjudication
• Strong written and verbal communication skills
• Ability to collaborate effectively and lead a team
• Excellent time management and organizational skills
• Ability to manage multiple projects concurrently and hold team members accountable. While Data Services does not utilize a formal project management framework, this role needs to be comfortable with both a waterfall and agile approach to project management.
• Self-motivation with a curiosity to learn, understand and grow
• Strong attention to detail and quality of work
• Strong problem-solving and analytical abilities

EEO

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

Additional Info

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