Revenue and Regulatory Data Manager

Minneapolis, Minnesota
Oct 02, 2020
Jan 26, 2021
Employment Status
Full Time
Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.

UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.


Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.

At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.




UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.


Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 11 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.


Position Description

This position is responsible to manage and report Encounter data submissions and reconciliations across all lines of business. Collaborate with analytics staff on designing financial models to project and report on key risk adjustment and revenue metrics. Oversee reporting and data sharing for encounter submissions for UCare, our Delegates and BPO relationships. Partner across company to develop innovative solutions to challenging business, contractual and regulatory requirements. Collaborate with Encounter Scrum team, Revenue team, and Compliance to ensure accuracy and completeness of data. Maintain reporting of overall encounter submissions, acceptance rates, and reconciliation. Manage and maintain an understanding of key variables impacting UCare revenues including enrollment, encounter data submission timing and status, and on-going risk adjustment activities.

• Manage revenue and risk adjustment analytics and reporting incorporating encounter data, current risk scores, revenue rates, and expected adjustments from revenue management and vendor activities.

• Maintain understanding of encounter submission requirements (DHS, CMS, MDH & Exchange). Gather and translate regulatory, contractual, and business requirements into project or service requests, depending on the scope of the issue being addressed. Work with Delegates and Information Technology (IT) to ensure submission process is compliant and deadlines met.

• Maintain a strong understanding of UCare revenue sources and payment processes. Monitor and analyze changes due to CMS guidance, DHS guidance, Health Insurance Exchange, or other modifications to payment models and payment processes impacting UCare. Lead encounters process across all lines of business including DHS, CMS (RAPS and EDPS) and Commercial Exchange (Edge Server).

• Collaborate with compliance team for mandatory audits (RADV, IVA, etc.) and internal reviews (provider, condition specific, vendor, etc.).

• Communicate the importance of risk adjustment payment methodologies and DHS payment & risk adjustment methodologies including encounter data requirements and working collaboratively with internal areas including IT.

• Represent Health Care Economics on UCare cross-departmental projects and workgroups as an active contributor and supporting resource.

• Ad Hoc analysis and department support as needed.

• Manage, develop, train, and monitor a growing team of analysts. Write and conduct performance evaluations. Ensure the quality and accuracy of Analysts' work. Interview and select Data and Financial Analysts.

• Monitor measures of success for each encounter submission by submitter. Regularly report status of current operations and measures as well future projects to leadership.

• Maintain a high-level understanding of risk adjustment methodologies, including CMS HCC, HHS HCC, EDGE, and CDPS, and how it relates to encounter submissions and revenue.

• Other projects and duties as assigned.


B.A./B.S. in Finance or Economics related field.

Required Experience

Three years of supervisory experience. Strong financial analytics background and technical skills.

Preferred Experience

Financial Analysis experience. Knowledge using SQL, SAS, or other statistical software. Healthcare industry experience.


The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

JOB POST DATE: 10/01/2020

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