Claims Encounters Analyst

Seeking someone with a **strong claims background** (over 4-5 years) and experience processing professional and institutional codes

**Position Summary**:
The Encounter Data Analyst I, interprets results using a variety of techniques, ranging from simple data aggregation via statistical analysis to complex data mining. Designs, develops, implements and maintains business solutions. Works directly with clients and project and business leaders to identify analytical requirements. This position is responsible for analyzing and correcting rejected encounters in a timely manner for Clearing House and Direct submitters. This position is accountable to ensure that encounters are corrected according to Health Plan industry standards and guidelines set by CMS and DHCS.

**Essential Duties and Responsibilities include the following**:

- Correct rejected encounters, follow CMS and DHCS Claims processing guidelines and industry standard in correcting rejected encounters
- Responsible for the entry of claims system support tables and oversight of processes to ensure our groups are meeting 5010 requirements and required to perform specialized area data entry or general data maintenance for eligibility, providers, fee sets, and benefits or any other areas that require ongoing support.
- Conduct Root Cause analyst for encounter errors, meet with departments to go over processes or programming to minimize root cause.
- Create and maintain an encounter error library.
- Analyze trends of rejected encounters.
- Develop and test internal audit/IDM reports to prevent rejected. Follow through that departments are maintaining audit reports.
- Create policy and procedures to correct rejected encounters.
- Create daily and weekly reports.
- Establish and maintain strong relationships with Health Plans, Encounter Clearing Houses, and internal stakeholders to fix, prevent, and to obtain extra support in resolving encounter errors.
- Educate internal stakeholders regarding regulator changes for encounters.
- Lead and attend meetings as required.
- Provides training to staff member in encounter corrections process.
- Adhere to Data integrity policies for all system configurations.
- Performs other duties as necessary.

**Education and / or Experience**:

- Over 4-5 years of claims experience
- Exposure to a variety of claims
- Proficiency in Word, Excel, Access, Outlook, EZCAP and Encoder Pro.
- Proficiency in running data queries, analyzing and reconciling using multiple data sources.
- Fee schedule knowledge.

The pay range for this position at commencement of employment is expected to be between $27 - $30 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Full Application:
**Job Types**: Full-time, Temporary

Pay: $27.00 - $30.00 per hour

**Benefits**:

- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance

Schedule:

- 8 hour shift
- Day shift
- Monday to Friday

Work setting:

- Hybrid work

People with a criminal record are encouraged to apply

Ability to Relocate:

- Northridge, CA 91325: Relocate before starting work (required)

Work Location: Hybrid remote in Northridge, CA 91325