tango is a leader in the home health management industry and is preparing for significant growth! Our mission is to deliver innovative, home-based, post-acute solutions through proprietary technology and proven processes. We partner with health plans to provide a comprehensive suite of products and services designed to manage the total cost of care.
We are currently looking for a Manager, Encounters to join our growing team!
Position Description:
Manages encounter data processing, compliance, and submissions. This role oversees the end-to-end encounter file management process, including generation, validation, submission, and regulatory compliance activities. The Manager – Encounters ensures timely and accurate encounter data submission to health plans and regulatory bodies.
Office Location:
** Remote **
Responsibilities include, but are not limited to the following:
- Direct encounter file generation, scrubbing (utilizing Optum Integrity or similar tools), submission, and correction workflows.
- Familiarity with breaking down companion guides, working closely with Operations Specialist on configuration of new health plan 837I, 837P encounter files and creating test files with health plan provider and member test data while participating on implementation calls and collaborating with implementation managers.
- Monitor and manage response files from health plans; troubleshoot and resolve submission issues.
- Drive monthly health plan meetings and coordinate regulatory attestations and submissions.
- Partner with Claims Operations and Finance to ensure accurate and timely data submission.
- Maintain thorough, compliant documentation of all encounter processes, submissions, and audit trails.
- Identify process improvement opportunities and recommend enhancements to encounter workflows.
- Ensure compliance with health plan contracts, regulatory requirements, and organizational policies.
- Support audits and provide detailed encounter documentation as needed for regulatory reviews.
Responsibilities:
- Bachelor's degree or equivalent work experience
- 5+ years in claims, encounter management, or health plan operations
- Advanced knowledge of encounter submissions, health plan compliance, and file integrity processes
- Strong understanding of EDI standards and data validation protocols
- Proficiency with encounter management systems and data scrubbing tools
- Excellent organizational and communication skills
Personal Proven Attributes:
- Detail-oriented with strong attention to accuracy and compliance
- Proactive problem-solver with ability to work independently and collaboratively
- Strong organizational skills with ability to manage multiple submissions and timelines
- Reliable and accountable with commitment to quality and deadline adherence
- Strong communication and coordination skills with internal and external stakeholders
- Initiative-driven with ability to identify and recommend process improvements
- Professional demeanor and ability to maintain confidentiality of sensitive health plan data
tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.