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Analyst, Encounters
3 months ago
Job Description
Job Summary
The Analyst, Encounters is responsible for monitoring inbound and outbound encounters processes and ensuring timely, accurate, and complete encounter submissions for low
- to moderate-complexity markets or states. Performs data analysis using internal and external sources, analyzes processes and provides recommendations for improvement to decision-makers. At the direction of the Manager, Encounters, collaborates with cross-functional teams to identify and resolve root causes of issues that impact encounters and identify improvements to operational performance.
Job Duties
Monitors inbound and outbound encounters submissions and responses, interprets outcomes, and takes swift action to remediate errors
Routinely reviews submission results and analyzes pend and rejection inventory, and works with other areas as needed to remediate encounter errors and to ensure timely, accurate, and complete submissions
Owns and maintains encounter submission criteria, maintains submission schedule, central documentation of market nuances, compliance, and regulatory requirements for primary market or state
Understands market or state-specific KPIs and financial and performance impacts related to encounter submissions
Assists with preparing portions of materials and information for Monthly Governance and Operations Reviews
Performs root cause analysis of claims and encounters data and develops recommendations based on data and industry knowledge. Collaborates across departments to design and implement systems changes to meet encounter data processing and submission goals.
Writes business requirements for system updates to resolve errors and optimize encounter performance
Participates in workgroups to resolve encounter data and process issues
Develops basic reports and distributes to appropriate departments for error resolution, follow up, and performance monitoring
Understands provider, member, and inbound claims data compliance in relation to encounters submission requirements
Maintains awareness of vendor encounter submission requirements and status
Job Qualifications
**REQUIRED EDUCATION**:
High School Diploma or GED
**REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES**:
3-5 years of experience in billing, claims, encounters, and data analysis
Knowledge of basic data analysis techniques
Skilled with running basic SQL queries
**PREFERRED EDUCATION**:
Bachelor’s Degree or equivalent work experience
**PREFERRED EXPERIENCE**:
Managed care experience
**PREFERRED LICENSE, CERTIFICATION, ASSOCIATION**:
Certified Professional Coder (CPC)
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
**Pay Range**: $49,430.25 - $107,098.87 / ANNUAL
- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
