• Bachelor’s degree in computer science, information technology, business, or a related field, and five years of experience, or an equivalent combination of education and experience required

• Five or more years of experience with CMS processes in a Medicare or managed care environment

• Must have 3-5 years of experience with Encounter submission (837 I, P, 999 and 277) to/from CMS is required

• Advanced proficiency with SQL, SSIS package, data visualization tools, and Microsoft Office

• Knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-10 coding standards, and revenue/HCPCS coding

• Extensive experience with claims encounter strategies and processes

• Knowledge of claims payment methodologies, adjudication processing, and Federal encounter regulations

• Knowledge of encounter regulatory reporting and compliance requirements

• Previous vendor management experience

• Ability to research and resolve encounter issues

• Understanding of the health care model, capitation, and other managed care IPA and provider reimbursement methodologies

• Excellent communication, interpersonal, analytical, and problem-resolutions skills

• Ability to modify and adapt operational procedures to changing operational needs

• Strong leadership, critical thinking, and prioritizing abilities

• Ability to develop, implement, and evaluate methods and systems to improve efficiency

• Ability to articulate ideas to both technical and non-technical staff