Encounter Data Manager (EDM) - Healthcare Consulting

Duration:: 6-12 months

Contract Terms: W2, 1099 & C2C Available

Rate: Commensurate with experience

Start: Mid to late February

Remote

MUST HAVE EXPERIENCE WORKING SPECIFICALLY WITH TRIZETTO and their ENCOUNTER DATA MANAGEMENT HEALTHCARE PRODUCT SOLUTION.

This is NOT a Manager position. Only apply if you have direct experience with TriZetto/Cognizant and their Encounter Data Management platform.

Job Summary:

The Encounter Data Manager is responsible for supporting TriZetto’s Encounter Data Management (EDM) solutions, ensuring compliance with submission requirements, enhancing client revenue streams, and minimizing operational overhead. This role requires in-depth expertise in 837 claims, QNXT or Facets, and encounter submissions to support our clients in meeting regulatory compliance expectations, improving data accuracy, and resolving submission errors effectively. The ideal candidate will leverage advanced technology to capture and validate data from multiple sources, identify potential financial mismatches, and mitigate revenue loss risks for Medicare/Medicaid submissions. With a focus on automation and workflow optimization, the Encounter Data Manager will drive efficiency, error resolution, and increased acceptance rates for encounters.

Key Responsibilities:

• Encounter Data Management:
• • Oversee and manage the end-to-end submission of encounter data to ensure compliance with CMS and state Medicaid guidelines.
  • Monitor and resolve submission errors, leveraging automated workflows for timely resolutions.
• Data Accuracy and Integrity:
• • Capture and validate accurate data from multiple sources to ensure complete and compliant submissions.
  • Implement strategies to reduce costs associated with inaccurate or incomplete data.
• Compliance and Revenue Optimization:
• • Identify and address potential financial mismatches and revenue risks from CMS for Medicare and Medicaid programs.
  • Ensure compliance with regulatory requirements and submission standards.
• Workflow Automation:
• • Utilize automated workflow tools to enhance operational efficiency and control error resolution processes.
  • Continuously optimize workflows to improve acceptance rates for encounters.
• Client Support and Collaboration:
• • Collaborate with internal teams and clients to address challenges and deliver effective solutions.
  • Provide training and support for clients to help them meet applicable compliance expectations.

Qualifications:

• Bachelor’s degree in Healthcare Administration, Information Systems, Business, or a related field (or equivalent experience).
• Familiarity with TriZetto’s Encounter Data Management (EDM) solutions or similar platforms.
• 3-5 years of 837 claims and encounter data submissions for Medicare and Medicaid experience.
• 3+ years of QNXT or Facets experience.
• Experience working with CMS and state Medicaid compliance requirements.
• Experience with automated workflow tools and error resolution processes.
• Excellent analytical and problem-solving skills.
• Strong communication and collaboration abilities.

Preferred Skills:

• Experience in healthcare revenue cycle management.
• Technical expertise in data validation and reporting tools.