BSWHP - Tx Medicaid Encounter Analyst

JOB SUMMARY

The Risk Adjustment Analyst Sr (Texas Medicaid Encounter Analyst) is responsible for monitoring and oversight of the end-to-end encounter management workflow. Supports program management activities around risk adjustment data management and submissions to government agencies such as Centers for Medicare and Medicaid Services (CMS) or Health & Human Services (HHS).


SALARY (BASED OFF OF RELEVANT EXPERIENCE)


The pay range for this position is $36.80 (entry-level qualifications) - $57.03 (highly experienced) The specific rate will depend upon the successful candidate's specific qualifications and prior experience.

ESSENTIAL FUNCTIONS OF THE ROLE

• Monitors and oversees the end-to-end claims encounter management workflow.


• Analyzes claims and supplemental data to identify reporting gaps, risk gaps, or sources of incorrect and incomplete diagnostic data.


• Performs analysis and reporting activities related to risk score calculation, encounter data submission, chart review programs and audits, and related performance metrics per regulatory and health plan guidelines.


• Using data from internal and external sources, analyzes complex encounter inbound/outbound process issues to provide insight to decision-makers.


• Researches and documents encounter errors in established systems and databases with appropriate statistical trend analysis; performs root cause analysis of encounters processing and submission issues and develops recommendations based on data and industry standards.


• Performs various financial analysis such as revenue forecasting and ROI.


• Contributes to program improvement by designing and implementing business process and system changes, collaborating to resolve encounter data and process issues and managing policy and procedure documentation.
  
  KEY SUCCESS FACTORS


• Advanced knowledge of SQL, MS Excel, MS Access, MS Word, MS Visio and MS PowerPoint.
  
  
  
  • Using SQL, able to design and run intermediate to complex queries and reports from multiple databases.
  
  
  
  


• Able to independently gather, interpret and analyze data for the purpose of identifying trends, problems and opportunities for improvement.


• Excellent time management and organizational skills with the ability to handle multiple tasks in a timely and accurate manner.


• Able to work under pressure, adhere to deadlines and know when to escalate information and issues.


• Highly motivated and able to work with minimal guidance, independently and as a team participant.


• Outstanding verbal and written communications skills with the ability to communicate clearly to all levels of an organization.


• Ability to work in a high paced environment independently and with cross functional groups.


• Knowledge of ACA, Medicare, Medicaid, MCO, TPA business requirements preferred.


• Experience with healthcare encounters, enrollment and pharmacy data preferred.
  
  BENEFITS
  
  Our competitive benefits package includes the following
  - Immediate eligibility for health and welfare benefits
  - 401(k) savings plan with dollar-for-dollar match up to 5%
  - Tuition Reimbursement
  - PTO accrual beginning Day 1
  Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

• EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification


• EXPERIENCE - 3 Years of Experience
  
  
  
  • Healthcare billing
  
  
  • Texas Medicaid guidelines/billing knowledge
  
  
  • Expert in Excel (Pivot tables, importing data, sorting data, etc.)
  
  
  • Expert with SQL programming