Supervisor, Encounter Data Management

Accountabilities:

• • Oversee business processes supporting the successful submission and reconciliation of Medicaid and Medicare encounter data, ensuring submissions meet applicable compliance and quality standards.
  • Analyze encounter and claims data to identify errors, trends, root causes, and opportunities to improve acceptance rates and operational performance.
  • Develop and enhance tools, reporting, and processes that improve the quality, accuracy, and efficiency of encounter submissions.
  • Supervise support and technical associates, providing day-to-day direction, coaching, guidance, and performance oversight.
  • Ensure consistent execution of established processes and policies across the team while maintaining accountability for quality and compliance.
  • Manage schedules, operational plans, daily priorities, and workflow decisions to support business objectives.
  • Investigate and resolve escalated and complex issues, coordinating with relevant teams to identify effective and sustainable solutions.
  • Collaborate with multiple departments and stakeholders to improve encounter data processes and address operational challenges.
  • Prepare and deliver presentations, findings, and recommendations to senior leadership.
  • Identify opportunities for long-term process enhancements and contribute to initiatives focused on operational excellence and continuous improvement.

  Requirements:

  • At least 2 years of experience in Medicare and/or Medicaid claims processing, including experience handling internal and external claim-processing errors.
  • At least 2 years of formal or informal leadership experience, with a demonstrated ability to provide direction, guidance, coaching, and oversight.
  • At least 1 year of experience working with CAS, Edifecs, Optum, or similar DOS 835/837 warehouse systems.
  • At least 2 years of advanced Microsoft Excel experience, including VLOOKUPs, pivot tables, and the ability to create macros.
  • At least 1 year of SQL experience, including the ability to run queries and use data to support operational analysis.
  • Strong analytical and problem-solving skills, with the ability to identify trends, investigate complex issues, and translate findings into practical recommendations.
  • Strong communication and presentation skills, including the ability to communicate effectively with senior leadership and cross-functional stakeholders.
  • Demonstrated ability to collaborate across multiple departments and build productive working relationships.
  • A bachelor’s degree is preferred, particularly in a relevant business, healthcare, analytics, or technical discipline.
  • Experience specifically focused on encounter submissions is preferred.
  • Six Sigma or Project Management certification is a plus.
  • Prior experience in healthcare or insurance environments is preferred.
  • For remote work, candidates must have a dedicated workspace that protects confidential member and healthcare information and an internet connection capable of at least 25 Mbps download and 10 Mbps upload speeds.
  • Occasional travel to company offices for training or meetings may be required.

  Benefits:

  • Salary: $65,000–$88,600 per year, with actual compensation varying based on location, experience, skills, education, certifications, and other relevant factors.
  • Bonus opportunity: Eligibility for a bonus incentive plan based on individual and/or organizational performance.
  • Work arrangement: Fully remote position with nationwide availability.
  • Healthcare: Medical, dental, and vision coverage supporting employees and their families.
  • Retirement: 401(k) retirement savings plan.
  • Paid time off: Paid time off, company holidays, and personal holidays.
  • Family support: Paid parental and caregiver leave.
  • Protection benefits: Short-term and long-term disability coverage and life insurance.
  • Well-being: Additional programs and resources designed to support personal wellness and informed healthcare decisions.
  • Schedule: Full-time position with a standard 40-hour workweek.