EDS Submission Supervisor (Encounter Data System Supervisor)

Position: EDS Submission Supervisor

As the leading workforce solutions provider, ManpowerGroup is committed to identifying and securing top-tier talent that aligns seamlessly with our client's organization's goals and values. Our extensive experience in recruitment, combined with a vast network of highly qualified professionals, positions us as the ideal partner to assist in filling the Medical Director role for our client, a market leader health plan insurance company.

Summary: The EDS Submission Supervisor will play a pivotal role in overseeing specific functions related to Encounter Data submissions, contributing to the success of the Risk Adjustment department. This individual will be responsible for line of business oversight, including submission, analysis, and operations related to CMS RAPS and EDPS, CMS EDGE, and other associated initiatives and vendors.

Essential Responsibilities/Accountabilities:

• Supervise accurate and timely submissions of Encounter Data for Medicare Advantage, Commercial, Medicaid, CHP, and related state products, ensuring the accurate receipt of risk-adjusted premium exceeding $1.5 billion.
• Conduct routine balancing and checkpoints to ensure completeness and accuracy of encounter submissions.
• Develop and maintain dashboards detailing encounter submissions, acceptance rates, balancing results, and KPI metrics.
• Collaborate with internal teams, vendors, and regulators, including CMS, HHS, and NYSDOH, to ensure successful Encounter Data submission.
• Coordinate with various departments, including Compliance, Legal, Operations, IT, Finance, Provider Relations, VBP, and Quality.
• Attend and participate in State and Federal regulator forums, meetings, and technical discussions.
• Mentor and develop a small team of data analysts.

Minimum Qualifications:

• Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Information Management, Accounting, Finance, or related field.
• 4 years of experience in the healthcare industry, with 2 years of experience in data analysis.
• Advanced Analytics skills.
• Proficiency in programming languages such as SAS, SQL, R, Python, C/C#, VB.
• Base or Advanced SAS Certifications desirable.
• Experience with EDI Transactions, specifically 837 5010 files.
• Knowledge of RAPS, EDPS, EDGE, and APD submission systems.

Physical Requirements:

• Ability to work in a typical office environment or home office for continuous periods.
• Travel across the Health Plan service region for meetings and/or training as needed.
• Manual dexterity and repetitive motion required.

ManpowerGroup is dedicated to attracting diverse talent to strengthen your workforce. We understand the importance of diversity and inclusion in fostering innovation. Our mission is aligned with your values, aiming to provide leading-edge healthcare insurance and services.

Job Type: Full-time

Salary: From $55,000.00 per year

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Experience level:

• 3 years

Schedule:

• 8 hour shift

Work Location: In person