Devoted Health

Senior Data Submissions Operations Associate

United States

Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, HealthcareIndustries

Requirements

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.

Responsibilities

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.

Skills

Data Submission
Healthcare Data
Medical Records
CMS
RADV Audits
Part C Audits
Data Validation
Quality Control
Compliance
Technical Troubleshooting
Data Abstraction
Data Processing Systems

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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