Job Summary This position is responsible for the creation and submission of Medicare Encounter (EDPS) Data to CMS as well as applicable state entities, and any Risk Adjustment related EDGE Server data submission, reconciliation, reporting and error resolution as needed to support the Medicare and ACA Line of Business. Reconciliation, tracking, and reporting of all CMS Response Files to ensure complete, accurate, and timely submission. Maintaining internal software, servers, and databases to support operations and reporting. Managing internal and contracted staff. Manage software and system upgrades. Responsible for the oversight of activities that ensure regulatory compliance related to risk adjustment operations. Essential Functions + Creation and Submission of Medicare Encounter Data (EDPS) to both CMS and State Entities. + Creation and Submission of EDGE Server Data for submission to CMS/HHS. + Maintaining and reconciling vendor software for EDPS. + Managing software upgradesMaintaining internal databases for reporting and analysis across the organizationManaging internal staff + Managing contracted staffReporting and identifying trends related to Medicare and ACA data submissionCreation of productivity reports, key performance indicators, dashboards, and other reporting as needed + Participate in various Government, Vendor or other entity hosted webinars, training, and conferencesMonitor Federal and State Guidance to ensure compliance with Risk Adjustment requirements. + Develop and maintain internal Standard Operating Procedures (SOPs) and documentation as necessaryManage and own other special projects as assigned + Reporting and Monitoring of submitted data in support of the Medicare and ACA Line of Business. Qualifications + Required - Bachelor's Degree in business, finance, economics, mathematics, healthcare administration, statistics, information systems, or closely related discipline. + Required - 7 years of relevant experience + Required - 2 years of relevant experience with Encounter Data Physical Demands + Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs + Waist to Waist > 5 lbs: Seldom up to 10 lbs + Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs + Waist to Overhead > 5 lbs: Seldom up to 10 lbs + Bilateral Carry > 5 lbs: Seldom up to 10 lbs + Unilateral Carry > 5 lbs: Seldom up to 10 lbs + Pushing Force > 5 lbs: Seldom up to 10 lbs + Pulling Force > 5 lbs: Seldom up to 10 lbs + Sitting: Frequently + Standing: Occasionally + Walking: Occasionally + Forward Bend - Standing: Seldom + Forward Bend - Sitting: Occasionally + Trunk Rotation - Standing: Seldom + Trunk Rotation - Sitting: Occasionally + Reach - Above Shoulder: Seldom + Reach - at Shoulder or Below: Seldom + Handling: Occasionally + Forceful Grip > 5 lbs: Seldom + Forceful Pinch > 2 lbs: Seldom + Finger/Hand Dexterity: Frequently How Corewell Health cares for you + Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here (https://careers.corewellhealth.org/us/en/benefits-new) . + On-demand pay program powered by Payactiv + Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! + Optional identity theft protection, home and auto insurance, pet insurance + Traditional and Roth retirement options with service contribution and match savings + Eligibility for benefits is determined by employment type and status Primary Location SITE - Priority Health - 1231 E Beltline - Grand Rapids Department Name Risk Adjustment Executive Employment Type Full time Shift Day (United States of America) Weekly Scheduled Hours 40 Hours of Work 8 a.m. to 5 p.m. Days Worked Monday to Friday Weekend Frequency N/A CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only. Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief. Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team. You may request assistance in completing the application process by calling 616.486.7447.