Encounter Manager

Location
Norfolk, VA
Salary
Competitive
Posted
Sep 09, 2019
Closes
Nov 12, 2019
Ref
128503BR
Function
Other
Industry
Healthcare
Hours
Full Time
The Manager is responsible for ensuring the timely, accurate and complete submissions of encounter data, including medical, behavioral health and subcontractor claims, to DMAS for all populations in Virginia Medicaid. Will work with a dedicated group of representatives (Encounter Team) from Information Technology, Claims, Business Systems Integration, the business owners for vendors and other stakeholders across Optima to ensure that all aspects of the encounter process is meeting contractual requirements. The position leads a cross-departmental workgroup and oversees efforts to analyze, trend, root cause and correct all encounter errors in a timely, effective manner. Manager will ensure that the encounter process meets compliance requirements, appropriately captures and submits all paid claims and applicable denied claims and will ensures audits are conducted to validate encounter data submitted is accurate and complete based on the. Will be the primary liaison with DMAS regarding encounters, encounter testing, encounter audits, encounter compliance and corrective action plans. This position will report to the Dir of Government Programs Operations. Position will have oversight and responsibility for the management of the encounter process.

Qualifications

Education Level
Bachelor's Level Degree

Experience
Required: Related - 5 years

Preferred: None, unless noted in the "Other" section below

License
None, unless noted in the "Other" section below

Skills
Required:

Preferred: None, unless noted in the "Other" section below

Other
5-years experience in business analysis, encounters claims submission processing and reconciliation in managed care for medical and/or pharmacy claim required. Experience working in all 837 files and NCPDP submissions formats, Medicaid and/or Medicare encounter technical manual specifications required. Demonstrated experience leading a technical team in the implementation of an encounter manual. Experience both managing and auditing to ensure compliance preferred. Experience working with clients such as state Medicaid and federal Medicare encounters leadership preferred.

Bachelor's degree preferred. Eight (8) years total commensurate experience will be considered in lieu of education.

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