Encounter Data Manager (EDM) - Facets

Huron Consulting Services•Chicago, IL

2d•Remote

About The Position

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients. Joining the Huron team means you’ll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise. Join our team as the expert you are now and create your future. Huron is a global consultancy that helps healthcare organizations drive performance transformation and deliver sustainable growth. We partner with payer organizations to optimize core operations, enhance regulatory compliance, and improve financial outcomes. We are seeking a highly experienced Encounter Data Manager (EDM) with deep Facets configuration and claims expertise to support healthcare payer clients. This role focuses on end-to-end encounter data lifecycle management, including 837 transaction processing, claims alignment, and regulatory compliance (CMS/Medicaid/Medicare).

Requirements

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
EDM - Business Components Translation 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 complex data and configuration issues
Interpret CMS and regulatory requirements
Government Programs Compliance Requirements
Medicare CMS Requirements, Timelines, and Penalties
Medicaid State Requirements, Timelines, and Penalties
Business and Data Scalability
Revenue Management
New Opportunities / Markets
New Government Requirements (Duals, APCD, HIX, ETC)
Experience working in consulting or client-facing environments
Ability to communicate with technical and non-technical staff is a must, will interact with developers about requirements, partners about enhancements with clients regarding implementation and application usage
Effective and efficient communication

Nice To Haves

Experience with TriZetto Encounter Data Management (EDM) solutions
Background in risk adjustment, revenue cycle, or payment integrity

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
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 proper adjudication outcomes
Align 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 revenue leakage risks related to Medicare Advantage and Medicaid
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 resolution
Translate business requirements into functional specifications and configuration designs
Provide guidance to client 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 decisions, workflows, and system dependencies