Encounters Technical Lead

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OtherTechnical Lead

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Quick Summary

Key Responsibilities

The statements described here are intended to describe the general nature of work being performed by people assigned to this position.

Requirements Summary

EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Bachelor’s Degree in Healthcare Administration, Business Administration, Finance, Economics, Information Systems,

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OtherTechnical Lead

About the Role

~1 min read

Come join Peak Health to help launch a Medicare Advantage plan. We are seeking a highly skilled and experienced professional to join our organization as an Encounters Technical Lead. Reporting to the Manager, Encounters & Risk Adjustment, the Encounters Technical Lead will play a pivotal role in our organization by overseeing the technical aspects of encounters data management and analysis. This role requires a strong understanding of healthcare encounters data, as well as expertise in data integration, data modeling, and data analytics. The successful candidate will collaborate closely with cross-functional teams to ensure accurate and efficient processing of encounters data.

Requirements

~1 min read

1. Bachelor’s Degree in Healthcare Administration, Business Administration, Finance, Economics, Information Systems, or a closely related field

1. Master’s Degree in Healthcare Administration, Business Administration, Finance, Economics, Information Systems, or a closely related field

1. Four (4) years of experience in encounter data management, risk adjustment, or related field within the healthcare industry.

2. Four (4) years of experience working with claims data to evaluate reimbursement changes, payment discrepancies, medical expense opportunities, quality outcomes and risk.

1. Five (5) years of experience in encounter data management or related field within the healthcare industry.

2. Strong knowledge of CMS’ Encounter Data Processing System (EDPS) data files (837P, 837I, 277CA, MAO-001, MAO-002, MAO-004)

3. Knowledge of ICD Diagnosis, CPT, UB, HCFA coding and understanding

4. Understanding of CMS Medicare Regulatory Reporting

Responsibilities

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1. Strategic thinking

2. Excellent written an oral communication

3. Demonstrated ability to analyze complex data sets, identify patterns, and derive actionable insights. Familiarity with statistical analysis and machine learning techniques is a plus.

4. Exceptional problem-solving and critical-thinking abilities, with a keen attention to detail. Ability to identify and resolve technical issues in a timely manner.

5. Attention to detail

6. Experience with Medicare and Medicaid products

7. Working knowledge of claims, utilization management, member, and/or provider data

8. Effective time management and organizational skills. Flexibility to adapt to changing priorities and business needs. Ability to thrive in a fast-paced and dynamic environment.

9. Work independently as well as in a team environment

10. Proficient with Microsoft Office

11. Proficiency in data integration tools and techniques. Strong knowledge of database management systems (e.g., SQL, NoSQL), data modeling, ETL processes, and data warehousing concepts. Experience with data visualization and analytics tools (e.g., SAS, Tableau, Power BI) is preferred.

12. Proven experience in leading technical projects. Strong interpersonal and communication skills to effectively collaborate with cross-functional stakeholders.

Day (United States of America)

United States of America (Exempt)

2903 PHH Operational and Provider Analytics