事件数据提交项目经理
Encounter Data Submissions Program Manager
Encounter Data Submissions Program Manager 将协助开发一个端到端的 Encounter Data Submission 和 Reconciliation 程序，包括创建项目指南和标准操作流程。该项目经理将跨团队协作，更好地理解并评估现有 Alternate Submission Method (ASM) 工作流的 ROI，以及由于流程效率提升和优化带来的潜在 ROI 改进。此外，一旦程序建立，项目经理将负责日常 EDS 和对账流程。
该经理将领导 Aledade 端到端 Encounter Data Submission 和 Reconciliation 程序的设计与实施，包括创建全面的项目指南和标准操作流程。您将作为跨职能领导者，评估现有 Alternate Submission Method (ASM) 工作流的 ROI，并推动直接提升数据准确性和运营效率的流程优化。
一旦程序建立，您将负责日常 EDS 和对账流程的监督，确保临床就诊数据——价值医疗的核心——被准确采集、验证并以完整无缺的方式提交给支付方和 CMS。
我们对地理位置灵活，理想的候选人应能够在全美范围内远程/居家办公。
我们是谁：
Aledade PBC 是一家公共利益公司，致力于赋能医疗保健领域最具变革性的部分——独立初级保健。我们成立于 2014 年，至今已成为全国最大的独立初级保健网络，帮助诊所、健康中心和医疗机构为患者提供更好的护理，并在价值医疗中蓬勃发展。此外，通过在各种健康计划中创建价值医疗合同，我们旨在颠覆传统的按服务收费模式。我们的工作增强了护理连续性，协调了激励机制，确保初级保健医生因他们最擅长的工作——保持患者健康而获得报酬。如果您希望参与创建一个对患者、对诊所、对社会都好的医疗体系，并且渴望加入一个协作、包容、以远程办公为主的文化环境，那么您来对地方了。
对你而言意味着什么？
在 Aledade PBC，您将融入一个富有创造力的文化，由热情解决复杂问题的信念驱动。
查看英文原文
The Encounter Data Submissions Program Manager will assist in the development of an end to end Encounter Data Submission and Reconciliation program, to include creation of program guide and standard operating procedures. The program manager will collaborate across teams to better understand and evaluate ROI of existing Alternate Submission Method (ASM) workstreams, as well as potential ROI improvements as a result of workflow efficiencies and enhancements. Additionally, once established, the program manager will oversee daily EDS and reconciliation processes.
This Manager will lead the design and implementation of Aledade’s end-to-end Encounter Data Submission and Reconciliation program, including the creation of comprehensive program guides and Standard Operating Procedures. You will act as a cross-functional leader, evaluating the ROI of existing Alternate Submission Method (ASM) workstreams and driving workflow enhancements that directly improve data accuracy and operational efficiency.
Once established, you will provide oversight of the daily EDS and reconciliation processes, ensuring that clinical encounter data—the lifeblood of value-based care—is accurately captured, validated, and submitted to payers and CMS with total integrity.
We are flexible with respect to geographic location, and the ideal candidate will be comfortable working remotely/work from home within the US.
Primary Duties
Assist in the development of programming documentation and SOPs, to include routine maintenance and update of program documents
Identify and establish ASM process with additional eligible payers
Provide support to CSO in efforts to increase practice “opt-in” to ASM processes
Create and transmit ASM files to all relevant payers on an established cadence
Maintain annual CMS and payer submission deadlines
Maintain and update payer specific ASM templates annually
Maintain and update payer specific submission methods annually
Reconcile ASM record submissions with payer and CMS EDS files
Establish routine reconciliation process with payer and CMS files
Integrate accepted ASM submitted diagnosis data into existing risk reporting dashboards
Provide ongoing monitoring of provider diagnosis submission and truncation trends
Develop process for consistent monitoring of existing dropped diagnosis and truncation dashboards for early identification of diagnosis submission errors
Collaborate with senior leadership and legal partners to ensure continued compliance with regulatory requirements pertaining to submission of “add” and “delete” diagnoses
Develop a process to identify and submit diagnoses appropriately identified through routine CDI chart audits.
Conduct annual ROI evaluation of ASM processes to include both submission of “dropped” diagnoses, and retrospective chart audit projects
Other duties as assigned.
Minimum Qualifications
Bachelor's degree in Business, Finance, Information Technology, Analytics, Operations, or a related field
4+ years of experience with Medicare Advantage or ACA encounter data processes and/or risk adjustment experience with a Payer, Vendor or Provider Organization
1+ years of X-12 837 data knowledge
Strong analytical skills with a proven ability to interpret complex data sets and identify key insights
Ability to develop and present information to Senior Leadership
Working knowledge of SQL: writing, creating and/or running queries
Software Proficiency: Proficiency in using common business software such as Microsoft Office Suite (Word, Excel, PowerPoint), collaboration tools (e.g., SharePoint), and project management software (e.g., Jira, Smartsheet)
Preferred knowledge, skills, and/or abilities
Excellent communication and presentation skills, both written and verbal
Business Process Reengineering (BPR): Familiarity with BPR principles and methodologies to radically redesign business processes for improved performance, efficiency, and customer satisfaction
Medicare claims experience
Fundamental understanding of relational databases
Physical Requirements
Prolonged periods of sitting at a desk and working on a computer.
Who We Are:
Aledade PBC, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.
What Does This Mean for You?
At Aledade PBC, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.
In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:
Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners
Robust time-off plan (21 days of PTO in your first year)
Two paid volunteer days and 11 paid holidays
12 weeks paid parental leave for all new parents
Six weeks paid sabbatical after six years of service
Educational Assistant Program and Clinical Employee Reimbursement Program
401(k) with up to 4% match
Stock options
And much more!
At Aledade PBC, we don’t just accept differences, we celebrate them! We strive to attract, develop and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.