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:
Medicare Part D
PDE
Import/Enter pharmacy files into PACElogic System monthly
Submit PDE file to CMS monthly
Correct PDE files & re-submit to CMS as needed
Submit PDE return files to PDAC
Create PDE status report
Correct PDE data necessary based on results of audit
P2P
Check P2P reports monthly
Complete P2P approval form as needed
Reserve
Complete Part D reserve worksheet monthly
TrOOP
Calculate TrOOP for all disenrollments monthly
Generate & mail TrOOP notification monthly
Place TrOOP notification on FTP site
Part D Audit
Review all Part A stays for clients and validate no drugs were filled under Medicare Part D during the stays
Encounter Reporting
- Follow-up and correct errors on encounter data submissions as required
- Complete monthly status report of encounter reporting
Risk Adjustment
Enter coding received from clients
Submit RAPS file monthly
Correct RAPS files & re-submit to CMS as needed
Submit RAPS return files, HCC, RxHCC reports to PDAC –
Place RAPS return files on FTP site
Create RAPS status report
Additional Functions:
· Track all regulatory submissions and dates for clients
· Communicates clearly and concisely, with sensitivity to the needs of others
· 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
· Follows all Policies and Procedures and HIPAA regulations
· Maintains a safe working environment
· Maintains knowledge and understanding of current Medicare regulations related to PACE health plan management
· Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
- Establishes and maintains effective working relationships with co-workers
Supervisory Responsibility: None
Travel: No travel is anticipated for this position
Knowledge, Skills and Abilities:
· Education/Experience – Educational requirements include a high school diploma or equivalent.
· Two years of health insurance claims processing or claims billing experience preferred. Prior experience working with RAPS, PDE and Encounter Data is strongly preferred.
- Knowledge and experience using current computer technology, and a strong knowledge of Excel and Microsoft Word.
- Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels
- Skilled in data analysis and problem solving using defined methodologies
- Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency
- 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 prioritize effectively
· Ability to consistently multitask
Physical Demands & Requirements:
- 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
- Remain stationary for extended periods of time
- Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy
- Occasional reaching to retrieve shelved items
Work Environment:
· This job operates in a home office environment with a conversational noise level.
· 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
Supervised by: Regulatory Manager
Job Type: Full-time
Salary: $23.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- Monday to Friday
Application Question(s):
- Please provide your email and phone number to be contacted.
Education:
- High school or equivalent (Required)
Experience:
- health insurance claims processing: 2 years (Preferred)
- claims billing: 2 years (Preferred)
Work Location: Remote
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