Manager, Business Consultant
Core
Lead end-to-end management of encounter and claims data submissions to state agencies, ensuring accuracy, compliance, and timeliness for Dual Special Needs Plans.
Role type
Manager, Healthcare Claims Operations & State Submission
Builds
Accurate encounter data reporting and submissions to state agencies
Domain
Healthcare, Insurance, Claims Processing
Required skills
Healthcare claims processing, Medicare/Medicaid operations, 837 claims transaction standard, state-specific submission requirements, secure data transmission (SFTP), data validation and reconciliation, root cause analysis, vendor management, regulatory compliance monitoring
Preferred skills
DSNP encounter submissions, Florida state encounter submissions, East Coast location
Technologies
SFTP, 837 file transmission
Responsibilities
Serve as subject matter expert for state-specific encounter data submission requirements; Lead end-to-end management of encounter submissions ensuring compliance; Partner with technical teams and vendors to implement and monitor submission processes; Oversee 837 file transmission and manage state response files/reconciliation; Establish reporting and tracking processes for submission performance; Drive root cause analysis for submission errors; Monitor changes in state and federal requirements and lead implementation efforts.
Seniority
Manager, hands-on leadership