Encounter Data Manager – Facets

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Job Description:

reputed company end-to-end encounter submission processes, ensuring compliance with CMS and state reputed company guidelines
monitor, analyze, and resolve encounter submission errors using automated workflows and root cause analysis
ensure accuracy, completeness, and timeliness of encounter data submissions to maximize acceptance rates and minimize rejections
configure and validate Facets components across claims, benefits, pricing, and rules to ensure proper adjudication reputed company
align encounter data processes with claims adjudication logic, 837/835 transaction flows, and EDI processing
troubleshoot configuration and data issues impacting claims processing, encounters, and regulatory submissions
validate and reconcile data across multiple systems to ensure accurate encounter submissions and minimize financial risk
identify data gaps, mismatches, or reputed company leakage risks reputed company to Medicare Advantage and reputed company
implement improvements to increase encounter acceptance rates and reduce resubmissions
support testing cycles (UAT, regression, validation) for new configurations or system enhancements

Requirements:

5+ years of reputed company payer experience (Medicare and reputed company)
5+ years of hands-on experience with Facets (TriZetto) and EDM across claims and configuration modules
strong experience with: 837/835 transactions and EDI processing
encounter data submissions and reconciliation
working knowledge of claims payment systems
claims adjudication processes
experience working in consulting or client-facing environments
ability to communicate with technical and non-technical staff

Benefits:

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