Encounter Data Manager (EDM) - Facets

Huron • Chicago, IL

4d • Remote

About The Position

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

Benefits

• medical, dental, and vision coverage to employees and dependents
• a 401(k) plan with a generous employer match
• an employee stock purchase plan
• a generous Paid Time Off policy
• paid parental leave and adoption assistance
• free annual health screenings and coaching
• bank at work
• on-site workshops
• ongoing programs recognizing major events in the lives of our employees throughout the year

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed