Manager, Encounter Data Process Engineering

$116,200 - $194,600/Yr

Emergent Holdings - Detroit, MI

Full-time - Manager

Detroit, MI

Management of Companies and Enterprises

About the position

The Manager, Encounter Data Process Engineering is responsible for designing, developing, and deploying encounter data specifications in compliance with CMS regulations. This role involves overseeing multiple projects, ensuring appropriate model designs and statistical methods are adopted, and planning programs to improve revenue and efficiency for Medicare Advantage populations. The manager will lead a team of technical developers and analysts to drive strategic results aligned with a multi-billion-dollar annual revenue cycle, requiring advanced knowledge of HIPAA EDI file formats and various technical languages.

Responsibilities

• Oversee Medicare Advantage vendor management for encounter submissions.
• Track and trend EDPS files to maximize acceptance rates with CMS.
• Facilitate error reconciliation with stakeholders.
• Develop technical solutions to automate error reconciliation processes.
• Drive strategic results aligned to risk scores and revenue targets.
• Create visual views to demonstrate EDPS program performance.
• Coordinate with stakeholders to resolve and resubmit claim encounter errors.
• Ensure compliance and timely submission with vendor submitters.
• Achieve a submission acceptance rate of 98% for encounters and supplemental data.
• Plan, organize, and direct activities of the assigned business area.
• Compile and analyze statistics and prepare related reports.
• Manage and develop a team of data engineers and contractors.
• Act as a subject matter expert and educate on data solutions.
• Build and operationalize complex data solutions.
• Develop tests to ensure quality of data processes.
• Design and develop code, scripts, and data pipelines.
• Collaborate with agile team members to meet deadlines.
• Ensure governance, security, and quality standards are followed.
• Mentor and develop leadership talent within the team.

Requirements

• Bachelor's degree in Computer Science, Information Systems, Engineering, Applied Mathematics, or related field; or equivalent training.
• 6 years of data engineering or equivalent experience.
• 2 years of supervisory experience or project lead experience.
• Advanced knowledge of HIPAA EDI file formats and ANSI 837 ASC X12N or Version 5010 Data Models.
• Proficiency in SQL, Oracle, SAS, Tableau/Power BI, Python, and CMS Risk Model Methodology.

Nice-to-haves

• Certification or progress toward certification in relevant fields.
• Experience working with data in an insurance environment.
• Knowledge of Jira project management platform.
• Familiarity with Risk Model Methodology.
• Intermediate knowledge of R, Python, and SSRS.
• Advanced knowledge of Big Data platforms such as Hadoop and DataBricks.
• Familiarity with Java and .Net.
• Advanced knowledge of Cloud Data Platforms such as Snowflake.

Benefits

• Competitive salary range of $116,200 - $194,600 per year.
• Full-time employment with potential for career growth.
• Opportunities for professional development and training.