Encounter Data Manager

Job Summary

A company is looking for an Encounter Data Manager (EDM) with expertise in Facets.

Key Responsibilities

• Lead end-to-end encounter submission processes, ensuring compliance with CMS and state Medicaid guidelines
• Monitor, analyze, and resolve encounter submission errors using automated workflows and root cause analysis
• Configure and validate Facets components across claims, benefits, pricing, and rules to ensure proper adjudication outcomes

Required Qualifications

• 5+ years of healthcare payer experience (Medicare and Medicaid)
• 5+ years of hands-on experience with Facets (TriZetto) and EDM across claims and configuration modules
• Strong experience with 837/835 transactions and EDI processing
• Proven ability to analyze and resolve complex data and configuration issues
• Experience working in consulting or client-facing environments