Encounter Submissions Management Communicates with LOB leads and Governance Finance Director on the necessary information and context for strategic business decision making. Establishes schedule for meetings and delivera…
Skills: Encounter Submissions Management, Program Management, Team Leadership, Data Reconciliation, Risk Adjustment
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Full-time
bachelor degree
Posted 61d ago
~40 hrs/week
Responsibilities
Manage encounter submissions across three lines of business, ensuring data accuracy for risk adjustments and government requirements. Lead the encounter submission team and vendors while driving continuous improvement in financial reporting and revenue optimization.
Requirements
Requires a bachelor's degree and four years of related experience, including at least one year of supervisory or management experience. Must possess strong analytical skills, proficiency in Microsoft Office, and knowledge of information systems.
Full job description
Encounter Submissions Management
Communicates with LOB leads and Governance Finance Director on the necessary information and context for strategic business decision making.
Establishes schedule for meetings and deliverables to complete needs of all 3 lines of business encounter submissions.
Supports audits of encounter data and minimizes risks of findings from submission activities.
Ensures encounter submission data is meeting requirements for risk adjustments as set by relevant government entities.
Manages implementation of new solutions as needed.
Oversees data reconciliation and research. Resolves issues with encounter data reported through vendor partners recommending or implementing corrective actions.
Analyzes project objectives, data sources, methodology, and data summaries and findings.
Responsible for production, delivery, and efficacy review of reports for internal and external audiences.
Coordinates and prioritizes activities with internal and external staff for implementation and monitors work for accuracy.
Program and Team Management
Coordinates work of the encounters submission workgroup, ES team, and ES vendor(s).
Provides guidance and development to team members.
Responsible for performance management and staffing.
Builds business case for additional resourcing needs.
Delegates some leadership to senior analysts and oversees outcomes and communication.
Continuous Improvement
Develops strategies to improve encounter submission passthrough and communication of opportunities to business owners.
Creates culture of continuous improvement and a working environment to support encounter submissions, financial analysis, and reporting for Government Finance.
Subject Matter Expertise
Monitors and evaluates changes in the external/internal environment, making changes to staffing and workflows to adapt.
Forecasts gaps in SME and requests investments in internal or external resourcing.
Develops and implement changes to processes and procedures that optimize revenue.
Documentation
Ensures complete documentation of program policies and procedures.
Performs all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid
Qualifications
Bachelor's degree and four years of related experience; or an equivalent combination of education and related work experience.
One year of supervisory or management experience.
Effective verbal and written communication skills.
Proven success with system implementation and analytical work.
Intermediate working knowledge of Microsoft Office applications, including but not limited to Outlook, Word, and Excel.
Improving the lives of our members and the health of Hawaii. #hmsahawaii #teamhmsa
Industry
Insurance
Company size
1,001-5,000 employees
Founded
1938
Headquarters
Honolulu, Hawaii
LinkedIn followers
10,962
The Hawaii Medical Service Association (HMSA), an independent licensee of the Blue Cross and Blue Shield Association, is a reliable name in Hawaii health care. Established in 1938, we are the largest and most experienced provider of health care coverage in the state. Over half of Hawaii’s population have chosen HMSA for their health care coverage.
We are dedicated to providing quality, affordable health plans; employee benefit services; and worksite wellness programs. HMSA also offers a variety of programs, services and support to help improve the health and well-being of our members and community.
Offices: 818 Keeaumoku Street, Honolulu, Hawaii 96814, US
Improving the lives of our members and the health of Hawaii. #hmsahawaii #teamhmsa
Industry
Insurance
Company size
1,001-5,000 employees
Founded
1938
Headquarters
Honolulu, Hawaii
LinkedIn followers
10,962
The Hawaii Medical Service Association (HMSA), an independent licensee of the Blue Cross and Blue Shield Association, is a reliable name in Hawaii health care. Established in 1938, we are the largest and most experienced provider of health care coverage in the state. Over half of Hawaii’s population have chosen HMSA for their health care coverage.
We are dedicated to providing quality, affordable health plans; employee benefit services; and worksite wellness programs. HMSA also offers a variety of programs, services and support to help improve the health and well-being of our members and community.
Offices: 818 Keeaumoku Street, Honolulu, Hawaii 96814, US