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Title

Data Submission Coordinator 

Description

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, knowledgable 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

  • < >

    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

  • < >

    Check P2P reports monthly - all clients

  • Complete P2P approval form as needed - all clients

  • < >

    Complete Part D reserve worksheet monthly - all clients

  • < >

    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.

 
Position Requirements

Knowledge, Skills and Abilities:

  • Education/Experience – Educational requirements include a high school diploma or equivalent. Three years of billing and coding 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
  • Potential for occasional verbal aggression by clients and vendors
 
Full-Time/Part-Time Full-Time  
Shift Days  
Position Data Submission Coordinator  
Post Internal Days 0  
Number of Openings 3  
Location Peak Health Plan Management- St Louis, MO  
About the Organization  
EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.  
Cell None Specified 

HoursPerWk None Specified 

supervisorUID None Specified 

This position is currently accepting applications.

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