View all jobs

Encounter Data Integrity (EDI) Program Manager

Phoenix, AZ · Information Technology
Encounter Data Integrity (EDI) Program Manager- Health Plan
Phoenix, AZ

EDI Program Manager Job Summary:
  • Responsible for all roles within encounter data, including, analytics to identify errors in encounter data and find solutions
  • Work within the quality management department under the umbrella of risk adjustment team
  • Maintain superior understanding of complex Encounter Data Integrity (EDI) opportunities around eligibility, claim status, encounters, response files, and risk adjustment data files
  • Managing EDI operations within production and test environments while proactively prioritizing encounters with incremental HCC value
  • Submit encounter data to CMS in both test and production environments
  • Work with encounter vendor (if applicable) to validate submissions and quality of submissions
  • Technical experience of healthcare data and industry driven changes including EDI and Healthcare X 12 transactions
  • Provide excellent communication to internal and external teams
  • Manage multiple tasks simultaneously in a demanding, fast-paced environment
  • Intermediate understanding of CMS HCC regulations and methodology
  • Maintain knowledge of current Medicare Managed Care Manual 
EDI Program Manager  Background:
  • Bachelor’s degree in Computer Science, Information Systems, Mathematics, Economics, or Business Administration
  • 5 years of technical development experience in business intelligence, data analysis, reporting, data engineering, data science, or informatics within healthcare industry
  • Excellent understanding of the CMS cross-walk of ICD diagnosis codes to Hierarchical Condition Category (HCC) codes and impact of diagnosis coding on risk adjustment payment model
  • 2 years of experience with intermediate to advanced level SQL
  • Advanced proficiency with MS Excel and Access including ability to create macros, pivot tables, charts, VLOOKUP, and work across multiple worksheets and workbooks to combine data.

480.646.3275 (CALL – TEXT – FAX)
See the latest @
CareNational Media!
Powered by