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✓Coordinate testing with trading partners and certification authorities.
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140administration roles open in CA
Full employer posting
- Description In this role, you will serve as a liaison between business stakeholders and Application/IT teams, translating business needs into requirements and supporting system solutions for encounter data operations. You will:
- Gather and document business and functional requirements, process flows, business cases, system specifications, test cases, and other SDLC materials.
- Analyze data, business processes, electronic transactions, and file exchanges to identify system gaps and opportunities to improve processes.
- Coordinate testing with trading partners and certification authorities.
- Support the design, development, testing, and implementation of software and Tapestry ISS enhancements.
- Develop and maintain interface documentation, policies, and procedures.
- Investigate operational issues and variances, prepare stakeholder reports, and present findings and recommendations to leadership.
- Support internal and external audits, quality control, regulatory requirements, and operational standards. Salary Range: $82,434 - $171,779/annually Note: This posted position is 1 of 2 positions available for hire. All applicants will apply through this requisition and if selected will be hired into one of the available positions. Qualifications We’re seeking a self-motivated and results-driven individual with:
- Bachelor’s degree in business, information systems, healthcare, or a related field required
- 5 or more years of experience managing enrollment, claims, or encounters in a Medicare or managed care environment required
- 5 or more years of experience with CMS processes required
- Computer proficiency with Microsoft Office, SQL, and data visualization tools
- Knowledge of encounter regulatory reporting and compliance requirements
- Experience managing vendors to contractual requirements
- Ability to research and resolve encounter issues
- Understanding of the healthcare model, capitation, and other managed care IPA and provider reimbursement methodologies
- Knowledge of physician/facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue and HCPCS coding
- Strong leadership, interpersonal, analytical, problem-solving, and prioritizing skills
- Excellent oral and written communication skills
- Ability to develop, implement, and evaluate methods and systems to improve efficiency
- Ability to work well independently as well as part of a team
About the role
In this role, you will serve as a liaison between business stakeholders and Application/IT teams, translating business needs into requirements and supporting system solutions for encounter data operations.