• Manager, Encounters

    Job Locations US-VA-Glen Allen
    Job ID
    2018-5076
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    This position is responsible for managing multiple lines of business operated in partnership between Virginia Premier Health Plan (VPHP) and The Department of Medical Assistance Services (DMAS - VA Medicaid). This position will be responsible for the prompt and accurate reporting of encounters in accordance with DMAS contractual guidelines and internal goals. This position is a hands-on management position and is involved in supporting strategy within the Claims Department for ongoing and future operations.

    Responsibilities

    • Leading a team diverse team of business analysts and support staff in all aspects of the Encounters process, including but not limited to:
      • Preparation of 837P, 837I, 837D and NCPDP encounter files for electronic file transfer and processing.
      • Pres-submission evaluation and correction of critical business errors.
      • Timely, accurate, and complete submission of all contractually defined Encounter files.
      • Remediation against standard and proprietary response files.
    • Enforcement of existing and developing standards of timely, accurate and complete submissions of all encounter files in accordance with contractual obligations.
    • Definition, documentation and ongoing maintenance of processes of all major processes.
    • Hiring, training, retraining a team of exempt and non-exempt employees.
    • Analysis of encounters submissions and error reporting data, and development of solutions for mitigating current errors and reducing future occurrences.
    • Analysis and preparation of statistical and analytical reports
    • Coordination of file mapping changes, files submissions, and error remediation efforts with supplemental benefits subcontractors
    • Development of an in-depth understanding of the correlation between encounters and other operational areas with Virginia Premier.
    • Serve as systems support liaison for claims processing and encounters software solutions, including system upgrades, testing and claims logic configuration changes.
    • Development and maintenance of consistent levels of communication with peers and Management within the Claims Department to ensure smooth end-to-end operations.
    • Miscellaneous duties/activities as directed

     

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Bachelors Degree Required, preferably in Business or Health Care Administration

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Knowledge of HIPAA 837 and NCPDP formats preferred
    • Knowledge of QNXT and IDX claims processing system
    • Solid SQL Database query experience
    • State regulatory Medicaid requirements
    • Strong data analytical and problem-solving skills
    • Knowledge of claims software editing programs
    • Knowledge of CPT-4 coding, ICD-9 and ICD-10     

    WORK BACKGROUND/EXPERIENCE

    • Minimum 3 years in a supervisory or leadership capacity
    • Minimum 1 – 2 years in a healthcare setting
    • Experience in quality improvement techniques, such as Six Sigma, beneficial

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position

     

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

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