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Dahl Consulting
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Enterprise Risk Adjustment Submissions Analyst, Sr
Posted: 11/08/2024
2024-11-08
2025-01-04
Employment Type:
Contract
Category: Information Technology
Job Number: 27334
Job Description
Join this dynamic team! Dahl Consulting is currently partnering with a leader in the health insurance industry. We work one-on-one with great candidates to help connect them with local employment opportunities. This company is hiring a Enterprise Risk Adjustment Submissions Analyst for a contract position. Interested? Get more details below!
As an equal opportunity employer, Dahl Consulting welcomes candidates of all backgrounds and experiences to apply. If this position sounds like the right opportunity for you, we encourage you to take the next step and connect with us. We look forward to meeting you!
- Worksite Location: Eagan, MN
- Responsible for creating and managing data extracts and performing Encounter Data submissions for Medicare, Medicaid, and ACA Commercial programs on an agreed upon schedule
- Review the various submissions reports received and reconcile internal data against data submitted to CMS/DHS/CMS-HHS
- Measure the accuracy and effectiveness of our current data submissions processes
- Assist in the development of recommendations to solve complex problems and issues related to Encounter Data Submissions operations
- Perform root cause analysis to close any potential gap in risk score
- Research, analyze, and interpret Encounter Data and provide technical assistance to team and other departments
- Identify issues to be researched, determining affected areas, estimating the impact, and leading the resolution
- Prepare presentations for report out of findings to leadership
- Independently manage the retrieval and analysis of data on multiple projects with little or no management involvement
- Act as a resource for other members of the department/division on business issues and may be responsible for training and guidance of other employees
- Bachelor’s degree in business or a related field and 5 years of relevant work experience OR 9 years of related work experience in lieu of degree
- Strong knowledge and understating of Claims, Encounters, and Supplemental Data
- Expert knowledge of CMS rules and guidance for all aspects of Risk Adjustment Submissions
- Expert knowledge of initial, mid-year, and final sweep
- Knowledge of the following submission types: accepted, rejected, allowable
- Knowledge of RAPS or EDPS/EDS, CSSC Operations, 837I, 837P, and DME
- Knowledge of CMS Files including: 999, 277CA, MAO-01, MAO-02, MAO-04, MMR, PPR, TRR, DTRRÂ
- Medicare / Medicaid / ACA Commercial Data Submission experience
- Experience extracting data from relational databases and performing data analysis
- Demonstrated ability to handle multiple tasks with competing priorities
- Proficient in Microsoft Office Suite
As an equal opportunity employer, Dahl Consulting welcomes candidates of all backgrounds and experiences to apply. If this position sounds like the right opportunity for you, we encourage you to take the next step and connect with us. We look forward to meeting you!
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Ready to take the next step in your career? Explore exciting job opportunities in the vibrant city of Eagan, Minnesota! Nestled in the Land of 10,000 Lakes, Eagan offers a perfect blend of urban amenities and natural beauty. With easy access to the Mall of America, the stunning Minnesota River Valley, and the picturesque Lebanon Hills Regional Park, Eagan is a haven for outdoor enthusiasts and culture seekers alike. Discover the charm of this bustling city known for its diverse culinary scene, captivating art galleries, and top-notch sports teams like the Minnesota Vikings. Start your job search in Eagan today and unlock endless possibilities for growth and success!