Encounter Data Management Lead

Job Summary

Employment Type: Full time

Become a part of our caring community and help us put health first. The DSNP Encounters Data Management Lead supports the Encounter Data Management team within the Healthcare Quality Reporting and Improvement organization (HQRI). This support includes submission of encounter data to Medicaid, Medicare, and DSNP states and will require the ability to manage inventory, ensure compliance adherence, and solve complex business challenges ranging from moderate to substantial.

The Lead, Encounter Data Management will support the effectiveness and efficiency of encounter data management submissions by ensuring inventory is processed accurately, timely and with completeness. In addition, this role will need partnering with multiple teams and leaders on new state implementations, conduct annual state contract reviews, analyze new regulatory requirements, and support the development of compliance and operational processes.

The Lead, Encounter Data Management Lead will identify and analyze inventory and will ensure encounter submissions meet or exceed all compliance standards via analysis of data and develop tools to enhance the encounter acceptance rate by Medicaid, Medicare, and DSNP. This role will work on strategic initiatives and will need to solve problems of diverse scope and complexity ranging from moderate to substantial. This role will utilize various tools, technologies, applications, and data resources.

Use your skills to make an impact.

Required Qualifications

• Minimum 5 years of technical experience in CAS or X12, including working knowledge of EDI formats: 834, 835, 837, 270/271, 277, etc.
• Experienced working in an SQL environment with comprehensive knowledge of SSMS
• 2 or more years of project leadership experience
• Demonstrated experience building and presenting story-driven presentations based on analytics
• Strong working knowledge of Cloud Technologies (Azure Synapse Analytics), Databricks and Power Platform (Power BI, Power Automate, & Power Apps)
• Knowledgeable in process improvement and metrics development
• Knowledgeable in regulations governing health care industries or related adjacent industries
• Ability to be creative, anticipate and be proactive around the next steps in large initiatives simultaneously
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences and business outcomes.
• 2+ years' experience in managing change by leading and energizing others, modeling adaptability, and inspiring strong organizational performance through periods of transformation, ambiguity, and complexity.
• Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences
• Highly collaborative mindset and excellent relationship-building skills, including the ability to engage many diverse stakeholders and SMEs and win their co-ownership in the outcome
• Collaborative with adjacent business intelligence and data science teams to drive results

Preferred Qualifications

• Bachelor's Degree
• Comprehensive knowledge of advanced analytics and experience with Python, Databricks or other statistical software
• Experience managing large-scale projects or leading cross-functional teams, preferably in healthcare data management.
• Experience with state or federal encounter data submission portals (e.g., CMS, state Medicaid portals) and troubleshooting submission errors.
• Proven track record in implementing or overseeing data quality assurance processes and tools.
• Experience working with external vendors, technology partners, or third-party administrators in a data exchange environment.

Additional Information

Work-At-Home Requirements:

• Must have the ability to provide a high-speed DSL or cable modem for a home office.
• Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum sta