Encounter Data Submissions Program Manager

Remote · Arlington · 1+ years experience · Full-time · Remote · Posted Oct 1, 2026

At a glance

The Encounter Data Submissions Program Manager will lead the design and implementation of an end-to-end Encounter Data Submission and Reconciliation program.
This role involves creating program guides and standard operating procedures while evaluating the ROI of Alternate Submission Method (ASM) workstreams.
The manager will oversee daily EDS and reconciliation processes to ensure clinical encounter data is accurately captured, validated, and submitted to payers and CMS.

Assist in the development of programming documentation and SOPs, including routine maintenance and updates.
Identify and establish ASM processes with additional eligible payers.
Provide support to CSO in efforts to increase practice opt-in to ASM processes.
Create and transmit ASM files to all relevant payers on an established cadence.
Maintain annual CMS and payer submission deadlines.
Reconcile ASM record submissions with payer and CMS EDS files.
Integrate accepted ASM submitted diagnosis data into existing risk reporting dashboards.
Provide ongoing monitoring of provider diagnosis submission and truncation trends.
Collaborate with senior leadership and legal partners to ensure compliance with regulatory requirements.
Conduct annual ROI evaluation of ASM processes.

Bachelor's degree in Business, Finance, Information Technology, Analytics, Operations, or a related field.
4+ years of experience with Medicare Advantage or ACA encounter data processes and/or risk adjustment experience.
1+ years of X-12 837 data knowledge.
Strong analytical skills with a proven ability to interpret complex data sets.
Ability to develop and present information to Senior Leadership.
Working knowledge of SQL: writing, creating and/or running queries.
Proficiency in Microsoft Office Suite, SharePoint, and project management software like Jira or Smartsheet.
Excellent communication and presentation skills.
Familiarity with Business Process Reengineering (BPR) principles.
Fundamental understanding of relational databases.

Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners
21 days of PTO in the first year
Two paid volunteer days
11 paid holidays
12 weeks paid parental leave
Six weeks paid sabbatical after six years of service
Educational Assistant Program
Clinical Employee Reimbursement Program
401(k) with up to 4% match
Stock options