ABOUT US

Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources

Position Summary

Under the general direction of the SVP, Payer Services, the Director of Encounters Analytics is responsible for the strategy, design, and management of the team that will implement companywide initiatives impacting Encounters Accuracy & Completeness (i.e., Encounter Production, Audit, Production Vendor Oversight) for all lines of business. The Director is the senior executive accountable for daily operational oversight of the Encounter and Analytics teams, which monitor, and report encounter data capture in all core systems of all ILS’s entities and clients throughout their service areas. In this role, the Director mobilizes resources across the organization to establish an Encounters Center of Excellence.

Essential Functions

1. Conduct interviews and hiring of direct reports. Complete a 90-day introductory and annual performance evaluation of each direct report. Facilitate professional growth and improved proficiency of staff who are direct and indirect reports through mentoring and training. Conduct ongoing performance management of each direct report; establishes performance goals; and measures performance against goals. 
2. Oversee and manage the operations and data governance of ILS’s encounters analytics functions to ensure all submissions meet client and regulatory expectations. Monitor and align operational goals with client and agency contractual compliance standards and SLAs.
3. Chair a cross-functional Encounter Oversight Committee that includes representation from Medical Economics, Compliance, and Finance. Work with IT and business leadership (corporate and market based) to effectively provide access to information and data needed to manage the business. Effectively communicate risks, requirements, and best strategies for data/encounter gaps. 
4. Manage key relationships with external clients and vendors for effective metrics and reporting. Resolve escalated issues and problems by conferring and collaborating with internal and external clients. Represent ILS and the encounter management function in external settings, including with regulators. 
5. Implement data improvements using industry best practices and proposed solutions for an improved data governance strategy. Foster and champion improvements and changes needed for upstream systems needed to enhance encounter performance. 
6. Centralize and automate standardized resources, requirements, operating procedures, reporting, and encounter transformation. Manage workflow across team members efficiently. Lead projects with varying degree of complexity with overlapping timelines.
7. Oversee and manage the integrity of data, diagnosing issues and validating and documenting all improvements/changes in reporting and analysis.
8. Improve submission accuracy for frequent occurring error codes and create systemic improvements. Develop reports for internal and external customers for error identification, follow-up and performance monitoring.
9. Increase the volume of encounters received from providers, implement processes to monitor rejected encounters to correct and resubmit where applicable; reconcile data with regulatory systems.
10. Identify trends / issues / deficiencies regarding monthly submission files and feedback files; oversee or resolve errors by working with other key departments; determine whether there is a need for process improvement or modification to ensure proper submission of all encounters; document testing; maintain record / file of all these interactions and of any changes.
11. Oversee and manage the integrity of data, diagnosing issues and test and validation of all improvements/changes in reporting and analysis to support clients and ILS core business(s).
12. Participates and directs change management procedures to support accurate data documentation and process flow supporting the reporting requirements.
13. Support management requests for various performance measures and other necessary actions as assigned.
14. Perform other duties as required or assigned.

Education and Experience

• Bachelor’s degree or equivalent combination of education and experience; advanced degree or additional relevant training preferred.
• 5 or more years demonstrated management of programing and analytical staff.
• Claims processing, provider contracting or data management, health data and financial analysis reporting, project management experience with knowledge or working experience with Edifecs (Encounter Management System) preferred.
• Statistical analysis or data analysis experience, preferably in a healthcare setting.
• Medicare and Medicaid managed care experience required. 

Required Skills

• Proficiency with Encounter, 837/EDI Transactions.
• Proficiency with various data mining, reporting, and reconciliation tools and methodologies.
• Advanced systems and software knowledge in MS Office tools, and SQL.
• Demonstrated leadership ability to drive results that are aligned with organizational goals.
• Ability to shift priorities when necessary to support urgent business needs.
• Proactive, assertive, and creative approach to problem-solving.
• Hands-on approach, with high attention to detail and accuracy.
• Ability to translate complex analytic concepts for non-analytic audiences.

EEO STATEMENT 

In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.