Data Coordinator Jobs

Summary: Under the supervision of the Regulatory Manager, the Data Submission Coordinator is responsible for submitting Risk Adjustment Data, PDE, and Encounter data for all clients. The Data Submission Coordinator is also responsible for the reporting and regulatory functions as described below.

Essential Functions:

• TrOOP
• Review all Part A stays for clients and validate no drugs were filled under Medicare Part D during the stays
• Check P2P reports monthly
• Part D Audit
• PDE
• Generate & mail TrOOP notification monthly
• Correct PDE files & re-submit to CMS as needed
• Create PDE status report
• Place TrOOP notification on FTP site
• Complete P2P approval form as needed
• Complete Part D reserve worksheet monthly
• P2P
• Correct PDE data necessary based on results of audit
• Reserve
• Calculate TrOOP for all disenrollments monthly
• Medicare Part D
• Submit PDE return files to PDAC
• Import/Enter pharmacy files into PACElogic System monthly
• Submit PDE file to CMS monthly

Encounter Reporting

• Follow-up and correct errors on encounter data submissions as required
• Complete monthly status report of encounter reporting

Risk Adjustment

• Submit RAPS file monthly
• Place RAPS return files on FTP site
• Enter coding received from clients
• Correct RAPS files & re-submit to CMS as needed
• Create RAPS status report
• Submit RAPS return files, HCC, RxHCC reports to PDAC –

Additional Functions:

• Maintains knowledge and understanding of current Medicare regulations related to PACE health plan management
• Maintains courteous, helpful and professional behavior on the job; displays a willingness and ability to be responsive in a warm and caring manner to all customer groups; consistently cooperates and supports organization in problem solving issues; will support the success of the entire team; establishes and maintains effective working relationships with co-workers
• Establishes and maintains effective working relationships with co-workers
• Communicates clearly and concisely, with sensitivity to the needs of others
• Track all regulatory submissions and dates for clients
• Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
• Follows all Policies and Procedures and HIPAA regulations
• Maintains a safe working environment

Knowledge, Skills and Abilities:

• Two years of health insurance claims processing or claims billing experience preferred. Prior experience working with RAPS, PDE and Encounter Data is strongly preferred.
• Ability to work independently with minimal supervision
• Ability to independently follow through on projects
• Ability to communicate professionally, clearly and effectively, verbally and in writing
• Ability to consistently multitask
• Ability to prioritize effectively
• Skilled in data analysis and problem solving using defined methodologies
• Knowledge and experience using current computer technology, and a strong knowledge of Excel and Microsoft Word.
• Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency
• Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels
• Education/Experience – Educational requirements include a high school diploma or equivalent.

Physical Demands & Requirements:

• Remain stationary for extended periods of time
• Occasional reaching to retrieve shelved items
• Communicate by way of the telephone with participants, customers, vendors and staff
• Operate a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer
• Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy

Work Environment:

• No substantial exposure to adverse environmental conditions is expected
• Moderate pressure to meet scheduled appointments and deadlines
• Potential for occasional verbal aggression by clients and vendors
• This job operates in a home office environment with a conversational noise level.