Encounter Data Management Professional
HumanaFull Time
Entry Level & New Grad
Candidates should have proven experience in healthcare data submissions, medical record management, or health information operations, preferably within a Medicare Advantage or risk adjustment audit setting. Strong attention to detail and the ability to perform meticulous quality assurance under time-sensitive conditions are essential. Proficiency with SQL, Looker, or other BI/database query tools is a plus for analyzing and validating submission data. The role requires the ability to troubleshoot technical submission errors and collaborate effectively with IT and technical teams. Strong organizational skills and experience managing high-volume workflows with compressed timelines are necessary. Experience collaborating with offshore resources or distributed teams, along with excellent communication and collaboration skills for cross-functional teamwork, is also required. A Bachelor's degree in Healthcare Administration or Health Information Management is desired.
The Senior Data Submissions Operations Associate will own the end-to-end audit file submission process, including file validation, coversheet completion, and final upload via the CMS portal. This role involves coordinating and directing day-to-day work activities of assigned team members for submission-related tasks, ensuring priorities, timelines, and quality standards are met. Responsibilities include conducting detailed quality assurance checks on all files to ensure alignment with CMS specifications, monitoring and triaging submission feedback, and routing issues to appropriate teams. The associate will maintain meticulous tracking of submission status, metadata, and resolution notes in internal audit logs. They will partner closely with internal Tech and IT Submission teams to resolve system issues, optimize processes, and manage secure file transfers. Additionally, the role includes preparing and delivering submission metrics, error trends, and resolution summaries for RADV operations reporting, and documenting and updating standard operating procedures for submission, QA, and feedback resolution.
Medicare Advantage plans with personalized support
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.