Encounters Analyst
1 month ago
Summary
The Analyst, Encounter is responsible for the creation and auditing of all monthly and ad hoc outbound encounter reporting as well as analysis of inbound Health plan provided reports. Under the supervision of the Encounters Lead and Supervisor, the role performs data analysis and works with contracted provider offices/clinics to meet compliance thresholds when identified deficiencies are noted.
Duties and Responsibilities
· Support the encounter submission of encounter data to contracted health plans as required by reporting schedule.
· Review extracted data for quality and accuracy as well as submission timeliness.
· Review internal and externally discovered errors while working with other departments, contracted providers, and Health Plans to enhance the quality of data submissions.
· Monitor and reconcile submitted encounters against clearinghouse and health plan response files to ensure timely resolution of submission gaps.
· Create and maintain internal health plan maps (as applicable), to adhere to companion guide updates and ANSI X12 standards.
· Create monthly/quarterly and/or ad hoc reports to assist providers/vendors on submission gaps and coordinate corrective action plans as needed.
· Other special projects as requested by team leadership.
Minimum Job Requirements
· High School Diploma or equivalent required, bachelor’s degree preferred.
· Five years’ experience working at a health plan or managed care organization in either EDI or a related department.
· Ability to analyze large data sets and document the results.
· Proficiency in MS Office suite of products (Excel, Word, PowerPoint, Outlook).
· Knowledge of ANSI X12 EDI implementation and industry companion guides, as well as CMS 1500 and UB04 forms, ICD-10 diagnoses, and CPT/HCPCS procedure codes.
Skill and Abilities
· Excellent verbal, written, communication and organizational skills.
· Ability to analyze clinical data, prepare written reports and plans, make informed decisions, take appropriate action, and follow through within scope of responsibility.
· Analytical and detail-oriented with excellent project management skills.
· Ability to work well with others in a professional, team-oriented environment.
· EZ-CAP® knowledge a plus.
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