It’s more than MANAGING enrollment data integrity.
It’s about ENABLING plans to collect government subsidies and continue to provide affordable, quality insurance to all Americans…
A simple mission for a complex problem
✅ OPPORTUNITY
We help capture millions in missed subsidy revenue in the door that you are entitled to that would otherwise be written off.
✅ RISK MITIGATION
We reduce your financial risk profile by conducting a two-sided review of A/R and A/P to address reporting and compliance requirements.
Encore has been at the forefront of understanding Affordable Care Act (ACA) and Medicare Advantage (MA) policy change impacts on the industry, and our team has provided consulting experience related to ACA/MA for over a decade.
We understand the importance of membership data integrity on timely and accurate advance premium tax credit (APTC) payments.
We help health plans navigate the complexity of member data management, applying our reconciliation expertise to create actionable insights that fix operational issues and automate payment disputes.
The Encore Integrity team can help you align your health plan data with the Exchange and reduce the need for manual intervention.
APTC Revenue Growth
✅ EFFICIENCY
We expedite member reconciliation by fixing operational issues and creating a seamless financial close experience.
Encore analyzes your member data to review the entire member lifecycle from initial enrollment to termination. We can help you pinpoint the root cause – and a resolution – to any outstanding APTC balances.
Why Us?
We have subject matter expertise in enrollment data processes and reconciliation across Federal and State-Based Exchanges.
We have in-depth industry experience standing up financial reconciliation controls and analytics at health plans.
We know what it takes to get paid timely and accurately.
SIMPLER
We eliminate the complexity of the reconciliation process by consolidating the dozens of data inputs into a single data layer.
FASTER
We identify data discrepancies at the earliest possible time to ensure accurate data transmission and timely subsidy payments.
TRANSPARENT
No more black boxes: for any existing A/R, we accurately identify and enable client recovery opportunities.
How it Works
Team
Jessica Dye | jdye@encoreintegrity.com
Ms. Dye has experience developing corporate strategies and initiatives that adapt to policy changes. She provides end-to-end support for risk adjustment, data management, value-based payments, and operational strategies for all lines of business.
Ms. Dye has led health plan efforts to implement commercial operations, risk adjustment, enrollment, and financial reconciliations, along with technical enterprise-wide warehouse development. She has been instrumental in developing technical solutions to support health plans handle large data sets associated with enrollment processing, monthly reconciliations, and various other regulatory requirements. She has held positions of accountability for Medicare Advantage, Managed Medicaid, and Commercial risk adjustment operations and data submissions. Her responsibilities have included vendor selection and oversight, analytical specifications for interventions such as retrospective and prospective, provider education, data integrity and reconciliation for data submissions, and RADV (Risk Adjustment Data Validation) audit processes. She was also a cofounder and chief strategy officer of a healthcare software company that focused on the development of applications to support value-based services, data management, and chart storage.
In addition to health plan and vendor positions held, Ms. Dye provides industry insights through conference presentations, webinars, cowriting white papers, and general advisory services. For almost two decades, she has focused on public-private healthcare market interactions in the context of ongoing analysis of key financial and public policy trends as they impact profitability and compliance processes in the industry. She is passionate about the healthcare industry and delivering quality care to all members.
Peter Hess | phess@encoreintegrity.com
Mr. Hess has extensive health plan experience developing data architecture and strategies to automate end-to-end financial reconciliation. He has created and managed a health plan’s financial audit controls to ensure accurate billing and minimization of aged accounts receivables. In his past work, he has stood up reconciliation monitoring and analytics, ensuring timely and accurate payment of billions of dollars in annual premiums from federal marketplace and state-based exchanges. He has led company-wide data transformation for financial and risk reporting systems. Mr. Hess has led data integrations with several partner plans and vendors, developing testing processes to meet system requirements for all parties.
In addition to health plan experience, Mr. Hess has provided economic consulting services in antitrust and across the healthcare industry. He has prepared expert reports and white paper submissions to regulatory agencies such as the DOJ, FTC, and Canadian Competition Bureau.