Encounters Technical Lead

Peak Health

. Oversee end-to-end encounters data management, including ingestion, cleansing, transformation, and integration .

Posted 9/22/2026full-timeRemote • United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in encounters data management, including ingestion, cleansing, transformation, and integration, while ensuring compliance with CMS regulatory requirements. Proficient in data modeling, analytics, and leading cross-functional teams to optimize data processes and deliver high-quality solutions.

Highest-signal resume keywords

Encounter Data ManagementCMS Encounter Data Processing System (EDPS)Data Integration Tools and TechniquesData Visualization and Analytics ToolsRegulatory Compliance in Healthcare

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data ModelingETL ProcessesDatabase Management Systems (SQL, NoSQL)Advanced AnalyticsClaims Data AnalysisICD Diagnosis CodingCPT CodingUB CodingData Warehousing ConceptsQuality Assurance Processes

Soft Skills

CollaborationProblem-SolvingLeadershipTraining DevelopmentCommunication

Tools & Technologies

SASTableauPower BIMicrosoft Office

Industry Keywords

Healthcare AdministrationRisk AdjustmentMedicareMedicaidHEDISNCQAMedicare STARSClaims DataPayment DiscrepanciesQuality Outcomes

Tech Stack

Tools & technologies

ETLNoSQLSQLTableau

About the role

Key responsibilities & impact

Oversee end-to-end encounters data management, including ingestion, cleansing, transformation, and integration
Develop and implement best practices for encounters data processing
Collaborate with internal and external stakeholders to establish effective data integration processes
Coordinate with IT teams and vendors to ensure accurate data exchange between systems and platforms
Design and develop encounter data models aligned with industry standards and organizational requirements
Optimize data models for efficient data retrieval and analysis
Establish monitoring mechanisms for encounters data process performance and efficiency
Identify optimization opportunities and implement measures to enhance system performance
Provide technical expertise and guidance in encounters data management and analysis
Set technical objectives and expectations and lead delivery of high-quality solutions
Prioritize cross-functional demands, synthesize information, and generate meaningful conclusions
Develop and implement team training programs
Implement quality assurance processes and conduct regular audits for data accuracy and integrity
Identify and resolve data-related issues with cross-functional teams
Use advanced analytics to extract insights from encounter data
Work with analytics teams to define data requirements and support analytical models and reports
Ensure compliance with regulatory requirements, guidelines, and contractual obligations for CMS EDPS encounter submissions and response files

Requirements

What you’ll need

Bachelor’s Degree in Healthcare Administration, Business Administration, Finance, Economics, Information Systems, or a closely related field
Four (4) years of experience in encounter data management, risk adjustment, or related field within the healthcare industry
Four (4) years of experience working with claims data to evaluate reimbursement changes, payment discrepancies, medical expense opportunities, quality outcomes and risk
Strong knowledge of CMS’ Encounter Data Processing System (EDPS) data files (837P, 837I, 277CA, MAO-001, MAO-002, MAO-004)
Knowledge and understanding of ICD Diagnosis, CPT, UB, and HCFA coding
Understanding of CMS Medicare Regulatory Reporting
Current understanding of how Medicare STARS, HEDIS, and NCQA compliance and quality programs affect the Plan
Experience with Medicare and Medicaid products
Working knowledge of claims, utilization management, member, and/or provider data
Proficiency in data integration tools and techniques, database management systems (SQL, NoSQL), data modeling, ETL processes, and data warehousing concepts
Experience with data visualization and analytics tools such as SAS, Tableau, and Power BI preferred
Proven experience leading technical projects
Proficient with Microsoft Office
Ability to analyze complex data sets, identify patterns, and derive actionable insights
Bachelor’s degree is required; Master’s degree is preferred