Manager, Clinical Data Management
Core
Lead the full lifecycle of Encounter Data Submission and Reconciliation strategy, ensuring accurate tracking, submission, and acceptance of diagnoses by payers and CMS.
Role type
Manager, Clinical Data Management & Process Strategy
Builds
Reliable, compliant, and financially meaningful encounter data for payers and CMS
Domain
Healthcare data, Medicare Advantage, ACA, Risk Adjustment
Required skills
Encounter data submission strategy, Root-cause analysis, Regulatory compliance (CMS/payer), Process documentation, Cross-functional leadership, ROI evaluation, SQL, Data analytics
Preferred skills
Business Process Reengineering (BPR), Retrospective chart review, Relational databases
Technologies
X12 837, CMS EDPS, Google Workspace, Jira, Smartsheet, BI platforms
Responsibilities
Oversee end-to-end strategy for encounter data submission to payers and CMS; Create and transmit ASM files maintaining payer-specific templates; Establish routine reconciliation processes to track diagnoses from documentation to acceptance; Lead root-cause analysis for rejected or dropped diagnoses; Monitor submission metrics and acceptance rates applying data scrubs and business rules; Develop and maintain process documentation, SOPs, and routine workflow updates; Integrate accepted ASM submitted diagnosis data into risk reporting dashboards; Own ASM valuation and financial results.
Seniority
Manager, strategic & operational leadership
