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 upgrades
Maintaining internal databases for reporting and analysis across the organization
Managing internal staffManaging contracted staff
Reporting and identifying trends related to Medicare and ACA data submission
Creation of productivity reports, key performance indicators, dashboards, and other reporting as neededParticipate in various Government, Vendor or other entity hosted webinars, training, and conferences
Monitor Federal and State Guidance to ensure compliance with Risk Adjustment requirements.Develop and maintain internal Standard Operating Procedures (SOPs) and documentation as necessary
Manage and own other special projects as assignedReporting 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 experienceRequired - 2 years of relevant experience with Encounter Data

Physical Demands

Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbsWaist to Waist > 5 lbs: Seldom up to 10 lbsWaist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbsWaist to Overhead > 5 lbs: Seldom up to 10 lbsBilateral Carry > 5 lbs: Seldom up to 10 lbsUnilateral Carry > 5 lbs: Seldom up to 10 lbsPushing Force > 5 lbs: Seldom up to 10 lbsPulling Force > 5 lbs: Seldom up to 10 lbsSitting: FrequentlyStanding: OccasionallyWalking: OccasionallyForward Bend - Standing: SeldomForward Bend - Sitting: OccasionallyTrunk Rotation - Standing: SeldomTrunk Rotation - Sitting: OccasionallyReach - Above Shoulder: SeldomReach - at Shoulder or Below: SeldomHandling: OccasionallyForceful Grip > 5 lbs: SeldomForceful Pinch > 2 lbs: SeldomFinger/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.

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

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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.