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Claims Management - PK- Data Submission Coordinator

Tabula Rasa Healthcare Saint Louis ,MO
  • Posted: over a month ago
  • Full-Time
  • Benefits: life_insurance, medical, vision, 401k, dental
Job Description
PK- Data Submission Coordinator

 

Peak TPA (Peak), a Tabula Rasa Healthcare company, helps PACE organizations manage the business functions that drive the major sources of reimbursement revenue and utilization costs. Peak provides services that optimize financial management and fulfill regulatory requirements for health plan functions. Peak is committed to the PACE model of care and thus to the success of the sponsoring organizations.

Peak is seeking a detail-oriented, knowledgeable team member to fill the role of Data Submission Coordinator.
 

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 pharmacy files into PACElogic
    System monthly – all clients

  • Submit PDE file to CMS monthly – all
    clients

  • Correct PDE files & re-submit to CMS
    as needed – all clients

  • Submit PDE return files to PDAC – all
    clients

  • Create PDE status report – all clients

  • Correct PDE data necessary based on
    results of audit

 

  • P2P

  • Check P2P reports monthly – all clients

  • Complete P2P approval form as needed – all
    clients

  • Reserve

  • Complete Part D reserve worksheet monthly
    – all clients

  • TrOOP

  • Calculate TrOOP for all disenrollments
    monthly – all clients

  • Generate & mail TrOOP notification
    monthly – all clients

  • Place TrOOP notification on FTP site – all
    clients

  • Part D Audit

  • Review all Part A stays for clients and
    validate no drugs were filled under Medicare Part D during the stays – all
    clients

     

Encounter Reporting

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

 

Risk Adjustment

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

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; ensures customer satisfaction by understanding and
    applying the Customer Service Policy, Procedure and Standards; 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: Minimal travel, less than 10% is
expected for this position. For remote positions, travel is required for
initial training and for necessary, subsequent training. Travel may also be
required for company events.

 

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 highly 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 meet attendance requirements to effectively fulfill all position
         functions.
  • 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
  • Occasionally exert up to 20 pounds of force to
         lift, carry, push, pull or move objects
  • 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 professional or 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

  

Company Description
TRHC provides patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize medication regimens. We improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. We deliver our solutions through a comprehensive suite of technology-enabled products and services for medication risk management and risk adjustment.

Tabula Rasa Healthcare

Why Work Here?

Growing company with casual environment, generous benefits and growth opportunities!

TRHC provides patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize medication regimens. We improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. We deliver our solutions through a comprehensive suite of technology-enabled products and services for medication risk management and risk adjustment.

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