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Aledade, the largest network of independent primary care in the US, is seeking an Encounter Data Submissions Program Manager to lead the development and oversight of an end-to-end Encounter Data Submission and Reconciliation program. This role is critical to ensuring clinical encounter data—essential for value-based care—is accurately captured, validated, and submitted to payers and CMS with complete integrity.
You will design and implement comprehensive program guides and Standard Operating Procedures for encounter data submissions. As a cross-functional leader, you will evaluate the ROI of existing Alternate Submission Method (ASM) workstreams and drive workflow enhancements that improve data accuracy and operational efficiency. You will oversee daily EDS and reconciliation processes, working closely with senior leadership, legal partners, and clinical teams.
Key responsibilities include: developing and maintaining programming documentation and SOPs; identifying and establishing ASM processes with additional eligible payers; supporting customer success efforts to increase practice opt-in to ASM; creating and transmitting ASM files to payers on established cadences; maintaining annual CMS and payer submission deadlines; reconciling ASM submissions with payer and CMS files; integrating accepted diagnosis data into risk reporting dashboards; monitoring provider diagnosis submission and truncation trends; ensuring regulatory compliance for diagnosis submissions; conducting annual ROI evaluations of ASM processes; and collaborating with leadership on process improvements.
Aledade is a public benefit corporation founded in 2014, operating as a remote-first, collaborative culture focused on transforming independent primary care and value-based care delivery. The company offers flexible work schedules, comprehensive health/dental/vision insurance (80% paid), 21 days PTO in year one, paid parental leave, sabbatical options, and stock options.
REQUIREMENTS:
- Bachelor's degree in Business, Finance, Information Technology, Analytics, Operations, or 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 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
- Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint), collaboration tools (SharePoint), and project management software (Jira, Smartsheet)
PREFERRED:
- Excellent written and verbal communication and presentation skills
- Familiarity with Business Process Reengineering (BPR) principles and methodologies
- Medicare claims experience
- Fundamental understanding of relational databases
