Encounter Data Management Lead
HumanaSalary not specified
Full Time
Senior (5 to 8 years)
Not SpecifiedCompensation
Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
- 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
- Strong command of SQL; experience with Snowflake database (desired)
- Minimum of five years of substantive health care experience, operational experience or other consulting experience (desired)
Responsibilities
- 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
Skills
Key technologies and capabilities for this role
Questions & Answers
Common questions about this position
What is the salary range for the Risk Adjustment Encounter Submissions Manager role?
The salary range is $76,000 - $126,000 per year. Additional compensation details will be provided by the talent partner once the interview process begins.
Is this position remote?
Yes, this is a remote position.
What are the required skills and experience for this role?
Required qualifications include a Bachelor’s degree in healthcare, data analytics, or related field (advanced degree preferred), excellent communication and interpersonal skills, strong attention to detail and organizational skills, ability to take initiative in a fast-paced environment, and strong analytical skills for interpreting complex data.
What is the team structure for the Risk Adjustment Encounter Submissions team?
The team includes a Director of Encounter Submissions, an Encounter Submissions Manager, and close partnership with Risk Adjustment focused data scientists and software engineers.
What makes a strong candidate for this position?
Strong candidates will have at least five years of substantive healthcare, operational, or consulting experience, a strong command of SQL with Snowflake experience, and the ability to establish and improve operational processes.
Devoted Health
Medicare Advantage plans with personalized support
About Devoted Health
Devoted Health provides Medicare Advantage plans aimed at simplifying and making healthcare more affordable for seniors aged 65 and older. Their plans include services like provider and pharmacy searches, prescription drug coverage, and preventive care rewards. Members pay premiums for these plans, and the company may also receive government payments for managing Medicare benefits. What sets Devoted Health apart from competitors is their high level of customer service, featuring Devoted Health Guides who assist members in navigating their healthcare options and addressing common issues with traditional insurance. Additionally, they promote preventive care through the Devoted Dollars program, which rewards members for engaging in health activities. The goal of Devoted Health is to create a more compassionate and accessible healthcare experience for its members.
Waltham, MassachusettsHeadquarters
2017Year Founded
$2,194.5MTotal Funding
SERIES_ECompany Stage
HealthcareIndustries
1,001-5,000Employees
Benefits
Comprehensive health plan
401(k) retirement plan
Generous vacation and holiday time
Lyra mental health resources
Time off to vote
Risks
Increased competition from Medicare Advantage providers like Clover Health and Oscar Health.
Potential regulatory changes affecting Medicare Advantage plans by CMS.
Rising healthcare costs could impact the affordability of Devoted Health's plans.
Differentiation
Devoted Health offers personalized assistance through Devoted Health Guides for member support.
The company emphasizes preventive care with its Devoted Dollars rewards program.
Devoted Health integrates virtual and in-home care with top local providers.
Upsides
Devoted Health raised $287 million in Series E funding in 2024.
The company expanded Medicare Advantage plans to eight new states in 2023.
Devoted Health achieved a 5-star Medicare Advantage rating in Ohio in 2023.
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