Encounters System Analyst

Job Title: Encounters System Analyst
Location: Remote

Type: Contract
Contractor Work Model: Remote

Title: Encounters System Analyst
ALTA is supporting an 8-month contract opportunity working 100% remote.

ALTA IT Services is a wholly owned subsidiary of System One, a leading provider of specialized workforce solutions and integrated services. ALTA is an established leader in IT Staffing and Services, for both government and commercial enterprises across the United States, specializing in Program & Project Management, Application Development, Cybersecurity, Data & Advanced Analytics, and Agile Transformation Services.

The Encounters System Analyst IV is responsible for overall State and Federal(CMS) level Encounters SLA's and key KPI's set forth internally. The position requires advanced knowledge of Encounters end to end process and hands on remediation activities to resolve internal and State/CMS rejections.

Essential Qualifications:

• Comprehensive knowledge of healthcare EDI transactions: Familiarity with 837 Institutional/Professional/Dental, and response transactions such as 835, 277U, 999, and TA1.
• Experience with healthcare program implementations: Previous experience with Marketplace, Medicaid, or MMP markets, with Nevada Medicaid implementation experience preferred .
• Data validation expertise: Proficient in validating internally generated data and vendor-submitted data to ensure quality assurance before submission to the state.
• Vendor collaboration: Skilled in managing vendors and providing guidance on encounter-related aspects.
• Encounter rejection resolution: Previous experience resolving encounter rejections is highly desirable.
• Documentation analysis and solution development: Ability to review state documentation, propose implementation strategies, and engage internal IT and cross-functional teams to execute solutions.
• Stakeholder communication: Experienced in representing the organization during vendor and state calls, providing project updates, and maintaining clear communication.
• SQL proficiency: Capable of running SQL queries to support software quality assurance (SQA), generate summary reports, and manually create X12 data for testing or proof-of-concept validations.
• Knowledge of Medicaid programs and EDI standards: Familiarity with CMS/state Medicaid programs, including a strong understanding of the 5010 837 Implementation Guide and state-specific companion guides.
• Strong communication and documentation skills: Excellent written and verbal communication skills are highly valued.

Nice to Have:

• Enterprise Data Warehouse (EDW) experience : Previous experience extracting data from an EDW and providing requirements/validation on EDW data is a plus.
• State SLA reporting: Understanding state Service Level Agreements (SLAs) such as accuracy, completeness, timeliness, and throughput, with experience creating dashboard reports for SLA metrics.
• NCPDP transaction management: Previous experience managing NCPDP transactions is an advantage but not required.
• Claims adjudication systems: Knowledge of FACETS or similar claims adjudication systems.
• EDIFECS expertise: Familiarity with the EDIFECS Encounter Management system.

System One, and its subsidiaries including Joul, ALTA IT Services, and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

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Ref: #860-IT Cincinnati