Encounter Data Manager & QNXT SME

Description:
We are seeking a seasoned and hands-on Encounter Data Manager & QNXT SME to lead our encounter submission, validation, reconciliation, and compliance workflows. This role will partner closely with Claims, Provider Data, IT, Analytics, and Regulatory teams to ensure accurate, complete, and timely encounter reporting to state and federal agencies. This role will support managing EDM implementation, developing UAT test cases, determining UAT data needs, executing UAT test cases, and related activities.

What You Will Do:

• Own the full lifecycle ofencounter data: extraction, validation, error resolution, resubmission, reconciliation, and reporting.
• Configure, maintain, and troubleshoot QNXT modules and schema relevant to claims / encounter workflows (e.g. claims staging, mapping, adjustments).
• Serve as the subject matter expert (SME) on state/federal encounter specifications (e.g. Medi-Cal / DHCS, CMS, etc.).
• Design and enforce business rules / data scrubs to prevent invalid encounters from being submitted.
• Lead root cause analysis for rejected or failed encounters; coordinate with upstream teams (claims, provider data, eligibility) to resolve systemic issues.
• Monitor encounter acceptance rates, error trends, and performance KPIs; provide insights to leadership.
• Maintain documentation: policies, procedures, data dictionary, mappings, interfaces, and change logs.
• Coordinate with IT on extract / transform / load (ETL), data pipelines, and system interfaces between QNXT and encounter systems (e.g. Edifecs or a custom tool).
• Test system changes, releases, and patches related to QNXT / encounter workflows; validate backward compatibility.
• Developing UAT test cases, determining UAT data needs, and executing UAT test cases.
• Train and mentor junior staff involved in encounter processing.
• Stay abreast of regulatory changes and ensure our encounter workflows remain compliant.
• Assist in audits, state reviews, and regulatory reporting as needed.

What You Will Bring:

• Experience with Encounter Data Manager (EDM) required. Financial Reconciliation Manager (FDR) highly preferred.
• Experience with Cognizant Trizetto Elements Suite required.
• Experience with support managing EDM implementation, developing UAT test cases, determining UAT data needs, executing UAT test cases, and related activities required.
• Expertise working with QNXT.
• Expertise knowledge of CMS and DHCS encounter data guidelines.
• Experience in a health plan environment.
• Prior experience leading or mentoring an encounter or claims operations team
• Certification(s) in healthcare data / HIT / analytics
• Familiarity with vendor systems, regulatory audits, and contract models

About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do - provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That's Impresiv!