Overview
Remote
$40 - $50
Accepts corp to corp applications
Contract - W2
Contract - 12 Month(s)
No Travel Required
Skills
Oracle
Microsoft SQL Server
Regulatory Reporting
ICD-10
ICD-9
Health Care
HCPCS
EDS
HIS
Job Details
Must have STRONG health care/insurance industry experience!
The Encounters Systems Analyst is responsible for compiling and analyzing Encounters data and understanding the financial and clinical impact of changes and decision to the business process to ensure that Service Level Agreements are achieved. This contractor role will be focusing heavily on new implementation and encounter data reporting requirements and oversight for subcontractor data.
Essential Functions:
Compile and analyze Encounter data. Understand the financial and clinical impact of changes and decisions to the business process to ensure that the Service Level Agreements (SLAs) are achieved
Provide analytical support and leadership for Claims Encounters Regulatory Data projects
Responsible for reviewing Encounter rejections and providing resolution of minor to complex data issues or process changes
Provide Claims Encounter Subject Matter Expertise (SME) for both CMS and State agencies and internal CareSource impacted organizations (IT, Claims, New Business, Enrollment, etc.)
Build, sustain and leverage relationships with persons within his/her responsibility to constantly allow for continuous improvement of the Encounter Data business process
Direct responsibility for the design, testing and delivery of supporting processes to the business
Lead the claims data processes to ensure accuracy and compliance with CMS and state agencies
Provide support for other key claims data management and readiness to state and governing entities
Understand the Claims Encounter Data requirements in detail to enable one to lead efforts to ensure claims data submissions achieve the required SLAs through requested changes internally and externally
Recognize inconsistencies and gaps to improve productivity, accuracy and data usability and streamlining procedures and policies
Responsible for Claims Encounters regulatory reporting
Provide critical reporting and analysis of functional performance, and make recommendations for enhancements, cost savings initiatives and process improvements
Prepare and monitor various management and oversight metrics and reports as required
Lead Claims Encounter initiatives such as working with IT and others internal departments to automate Claims Encounters functions; improve regulatory report development with SIS
Provide support of vendors, managing SLA s, regulatory requirements and contractual metrics
Maintain positive and strategic relationships with internal and external stakeholders
Contribute to and/or develop user stories or provide user story guidance for sprint planning
Understanding of how claims payment methodologies, adjudication processing and State Encounter regulations interrelate to maintain compliant Encounter reconciliation processes and SLA s
Perform any other job duties as requested
Competencies, Knowledge and Skills:
Knowledge of relational databases (SQL Server, Oracle, etc.)
Experience with SQL Server - 2016 or newer
Strong database querying, data analysis and trending skills
Edifecs knowledge is preferred
Demonstrated understanding of claims operations specifically related encounters
Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding
Knowledge of Claims IT processes/systems
Knowledge of claims analytic processes/systems
Advanced working knowledge of managed care and health claims processing and reimbursement methodologies
Experience with 837O files to States and/or CMS (MA EDS) preferred
Experience with 835 files preferred
Excellent communication skills; both written and verbal required
Ability to work independently and within a team environment
Time management skills; capable of multi-tasking and prioritizing work
Attention to detail
Critical thinking and listening skills
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.