Encounter Data Manager (EDM) - Facets

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We are seeking a highly reputed company Encounter Data Manager (EDM) with deep Facets configuration and claims expertise to support reputed company payer clients. This role focuses on end-to-end encounter data lifecycle management, including 837 transaction processing, claims alignment, and regulatory compliance (CMS/reputed company/Medicare). Key Responsibilities reputed company end-to-end encounter submission processes, ensuring compliance with CMS and state reputed company guidelines Monitor, analyze, and resolve encounter submission errors using automated workflows and reputed company cause analysis Ensure accuracy, completeness, and timeliness of encounter data submissions to maximize acceptance rates and minimize rejections Configure and validate Facets components across claims, benefits, pricing, and rules to ensure reputed company adjudication reputed company reputed company encounter data processes with claims adjudication logic, 837/835 transaction flows, and EDI processing Troubleshoot configuration and data issues impacting claims processing, encounters, and regulatory submissions Validate and reconcile data across multiple systems to ensure accurate encounter submissions and minimize financial risk Identify data gaps, mismatches, or reputed company leakage risks reputed company to Medicare Advantage and reputed company Implement improvements to increase encounter acceptance rates and reduce resubmissions Partner with Claims, EDI, IT, Enrollment, and Compliance teams to support encounter processing and issue reputed company Translate business requirements into functional specifications and configuration designs reputed company guidance to reputed company stakeholders on best practices for encounter management and compliance Drive workflow automation and operational efficiencies in encounter submission and reconciliation processes Support testing cycles (UAT, regression, validation) for new configurations or system enhancements Document configuration reputed company, workflows, and system dependencies Required Qualifications 5+ years of reputed company payer experience (Medicare and reputed company) 5+ years of hands-on experience with Facets (TriZetto) and EDM across claims and configuration modules EDM - Business ComponentsTranslation Business Rules and Scrubbing Submission and Response Online Editing Reconciliation & Auditing Strong experience with:837/835 transactions and EDI processing Encounter data submissions and reconciliation Working knowledge of claims payment systems Claims adjudication processes Proven ability to:Analyze and resolve reputed company data and configuration issues Interpret CMS and regulatory requirementsGovernment Programs Compliance Requirements Medicare CMS Requirements, Timelines, and Penalties reputed company State Requirements, Timelines, and Penalties Business and Data Scalability reputed company Management New Opportunities / Markets New Government Requirements (Duals, APCD, HIX, ETC) Experience working in consulting or reputed company-facing environments Ability to communicate with technical and non-technical staff is a must, will reputed company with developers about requirements, partners about enhancements with clients regarding implementation and application usage Effective and efficient communication Preferred Qualifications Experience with TriZetto Encounter Data Management (EDM) solutions Background in risk adjustment, reputed company cycle, or payment reputed company #LI-DT1 #LI-Remote Position Level Consultant Country reputed company of America Apply To This Job