Leader, Encounter Data Federal

Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds-tech people, numbers people, even people people-working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference-it's time to make a healthy career move to MVP!

There are some positions at MVP where your work may require an onsite or community component. When working in an MVP office and/or in the community on behalf of MVP, you must be fully vaccinated against COVID-19, and have received the first booster dose within one month of eligibility.

Full-Time, Exempt

Provides leadership and direction to the Encounter Data Delivery team and Accumulator Services Team, overseeing operations including but not limited to analysis and reconciliation of eligibility, Encounter Data, Prescription Drug Event (PDE) and accumulator processes and reconciliation.

ESSENTIAL JOB FUNCTIONS:

1. Responsible for the accuracy of Federal Programs and ACA data including, but not limited to member eligibility, provider, medical & pharmacy encounters, and payment.
2. Reviews the reconciliation and payment processes, and ensures complete, accurate and timely revenue within federal guidelines.
3. Must constantly monitor the status of new, existing, and previous discrepancies or recovery situations.
4. Actively participates in the development, testing and implementation of file extracts and layouts to meet vendor and regulatory agency requirements.
5. Oversees the extraction, integrity, and submission of data while actively coordinating with other internal departments
6. Leads staff to achieve departmental and organizational objectives.
7. Coordinates all efforts associated with compliance audits and encounter submissions for CMS (The Centers for Medicare and Medicaid Services) regulatory agency.
8. Provides direct oversight of accumulator transactional processing activities and ensures timeliness and accuracy of quality standards.
9. Manages systemic issues and works to resolve them through thoughtful collaboration with all internal areas of the organization.
10. Consistently challenges the status quo in favor of incremental improvement opportunities that could be achieved through new methods

OTHER DUTIES & RESPONSIBILITIES:

1. Supervise staff including interviewing, selection, on-boarding, development and training, performance management, coaching and corrective action.
2. Handle policy and employee issues in conjunction with Human Resources.
3. Lead staff in a manner which supports our Enterprise and Departmental goals and guiding principles.
4. Responsible for communicating organizational information through regular team meetings, one-on-one meetings, and appropriate written and interpersonal communication.
5. Represent the department to internal and external customers.
6. Manage temporary and consulting resources as assigned to meet project needs.
7. Support continuous process improvement and innovation.
8. Limited travel between MVP offices, including overnight travel.
9. Ability to maintain confidentiality and adhere to regulatory compliance issues as they exist and change from time to time.
10. Performs other related duties as assigned.

POSITION QUALIFICATIONS

Minimum Education:

• Bachelor's Degree Health Administration, Accounting, Finance, Business or related field.

Minimum Experience:

• Three years' experience in financial/data analysis of which two years must be in managed care/health insurance/health care industries.
• Working knowledge of Medicare/Medicaid and Managed Care programs highly desired, including, but not limited to CMS/NYS regulations, eligibility requirements, and premium payment methodologies.
• 2 years in a supervisory/leadership role with demonstrated strength in providing guidance, training and process development.

Required Skills:

• Demonstrated experience with large data-sets and analysis.
• Detail oriented and process focused with evidence of driving measurable outcomes within established timelines.
• Excellent Customer Service and written/verbal communication skills.
• Intermediate Microsoft Word.
• Intermediate Excel - Proven ability to create formulas for financial calculations.
• Intermediate Access skills - Proven database development; ability to write queries and create macros.
• Understanding of database concepts, including ability to identify appropriate data fields and build queries to obtain appropriate information.
• Proven ability to pull, analyze, report and provide insight on large sets of data.
• Extensive reading to stay abreast of the frequent changes in federal and/or state regulations.
• Ability to prioritize multiple assignments with attention to details and deadlines.
• Minimal travel required.
• Ability to develop, oversee and enforce best practices.
• Ability to motivate people to perform against defined objectives and to embrace accountability for their performance.
• Team oriented: Comfortable working in a team environment as well as independently and possess a sense of accountability and urgency in completing assignments.

Preferred Skills:

• Working knowledge of Risk Adjustment.
• Working knowledge of regulatory premium payment methodologies.
• Working knowledge of ICD-9, ICD-10, CPT, HCPCS and revenue codes.
• Intermediate SQL skills.
• Knowledge of Centers for Medicare and Medicaid Services (CMS) agency guidelines.
• Knowledge of revenue and data issues relating to CMS/HHS agencies.
• Previous Health Insurance experience.

Physical demands/Working conditions:

• Physical office or work from home setting.
• 40-hour work week with on-call availability as needed.
• Available to travel as needed.

About MVP
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the EEO is the Law Poster and Supplement protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at [email protected]

Please apply and learn more - including how you may become a proud member of our team.

Other details

• Job Family Claims/Operations
• Pay Type Salary

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