Reveleer is a healthcare-focused, technology-driven workflow, data, and analytics company that uses natural language processing (NLP) and artificial intelligence (AI) to empower health plans and risk-bearing providers with control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the Reveleer platform allows plans to independently execute and manage every aspect of enrollment, provider outreach, data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology and robust data sets, Reveleer’s end-to-end platform enables health plans to confidently plan and execute programs for more value and improved outcomes.

Responsibilities:

• Ensure accuracy and completeness of data submissions to CMS
• Provide reports and analysis specific to the encounter data submissions to CMS
• Identify root cause of data loss and encounter rejections and co-ordinate with internal teams to enable complete and accurate submissions
• Work with other teams to verify, test and correct error within the encounter data system
• Monitor and track encounter data through out the process and ensure data integrity through ongoing end-to-end reconciliation
• Must be able to perform UAT and setup best practices for the function
• Participate in cross-team encounter data workgroup meetings
• Analyze trends and create documentation supporting all reports
• Track CMS timelines for submissions and work with internal teams to meet the deadlines
• Maintain thorough documentation of RCAs and be able to train other members on team
• Customer Success Partnership: Work closely with the Customer Success team to ensure that technical operations support client satisfaction and retention. Lead the technical response to any client issues, driving quick resolutions and maintaining trust

Qualifications:

• Minimum 5 years of healthcare Claims data management and EDI experience.
• Strong understanding of Medicare Programs
• Minimum 5 years’ experience working with Medicare Encounter Data and Risk adjustment Methodology
• In-depth knowledge and experience of SQL and any standard ETL tool.
• Strong Knowledge of X12 EDI files
• Knowledge of ICD10 codes, CPT/HCPCS, revenue codes, UB04 and CMS1500 claim submissions and electronic claim submissions.
• Ability to independently gather, interpret and analyze data
• Ability to extract data from multiple source using software tools
• Ability to understand, interpret, create, execute complex queries and reports
• Excellent written and verbal communication skills