Manager, Encounters

Job Summary

The Manager of Encounter Data is responsible for coaching staff to ensure all are equipped with today’s business knowledge, state of art techniques and preparation to take on challenges and changes. The position requires communicating with Centers for Medicare and Medicaid Services (CMS), The California Department of Health Care Services (DHCS) and other government agencies, understanding contract obligations, requirements of encounter data extraction and submission.

In addition, this individual oversees the department which is responsible for providing guidance and rules to L.A. Care’s sub-contractors on encounter data requirements which include, but are not limited to, drafting and distributing L.A. Care companion guides, technical bulletins and internal encounter data policies and procedures.

The Manager of Encounter Data and their team is responsible for providing guidance and rules to IT encounter data team on data structures, mappings and source code changes to ensure data quality and process efficiency as well as coordinating with other departments on new lines of business set up, new vendor set up, encounter rules and logic implementation and testing. The Manager will manage all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

Duties

Effectively train staff to ensure they are equipped with up to date business knowledge, state of art techniques and an open mind to take any new challenge and changes. Develop goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.

Serve as the primary lead for managing the process of encounter data management submissions, including the ongoing approval of both routine and ad hoc encounter data submissions from LA Care to state and federal agencies.

Serve as analytical resource for root cause analysis and issue resolution on issues relating to data submissions. Devise action plans to address encounter data that is either rejected by the agencies or delayed by LA Care prior to submission.

Providing guidance, instructions, requirements and rules to Plan Partners, Vendors and Clearing house on encounter data submission. Write and publish L.A. Care Health Insurance Portability and Accountability Act Companion Guides, L.A. Care Technical Bulletins for Medi-Cal, Covered California, Cal Medi-connect line of businesses.

Contribute to development of business requirements, functional requirements, process flows, reference materials, user guides and code release artifacts as appropriate. Develop and maintain detailed documentation that provides traceability for all encounter data back to its source, including both internal and external vendor data. Developing internal policies and procedure to ensure encounter data process are effective and efficient.

Develop and maintain positive working relationship with Plan Partners, Physician Provider Group (PPGs), vendors and encounter clearing house. Open communication with government agencies such as DHCS and CMS on regulatory requirements and issues.

Actively participate in projects designed to create record of reference systems for key enterprise data. Define and adhere to standard metadata naming conventions, as dictated by L.A. Care policy and procedure. Assist in creating data models for existing databases and systems to support the design and deployment of new systems for managing encounter data.

Perform other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:
At least 5-7 years of related experience relating to Medicare/Medicaid data operations, encounter data operations. 

At least 3-4 years of supervisory/ management experience in healthcare or managed care industry.

Experience with BI reporting tools.

Knowledge and experience in Claims processing and Enrollment, Healthcare I.T. projects and/or file exchanges with government agencies.

Related experience in business analysis/data analysis.

Equivalency:  Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

Skills

Required:
Knowledge of relational databases, programing language, source code and database structures.

Extensive knowledge of encounter data process and flows.

Proficiency in Microsoft Word, Excel and Access.

Strong analytical, organizational, and interpersonal communication skills.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information