Data Encounter Analyst
4 weeks ago
The Data Encounter Analyst will be 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.
Key Responsibilities:
Correct rejected encounters, following CMS and DHCS Claims processing guidelines and industry standards
Enter claims system support tables and oversee processes to ensure compliance with 5010 requirements
Perform specialized area data entry or general data maintenance for eligibility, providers, fee sets, and benefits
Conduct root cause analysis for encounter errors, meet with departments to discuss 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 encounters
Create policy and procedures to correct rejected encounters
Establish and maintain strong relationships with Health Plans, Encounter Clearing Houses, and internal stakeholders to resolve encounter errors
Educate internal stakeholders regarding regulator changes for encounters
Lead and attend meetings as required
Provide training to staff members in encounter corrections process
Adhere to Data integrity policies for all system configurations
Requirements:
Proficiency in Word, Excel, Access, Outlook, EZCAP, and Encoder Pro
Knowledge in SQL Server
Proficiency in running data queries, analyzing, and reconciling using multiple data sources
Knowledge and experience in Project Management preferred
Excellent time management skills
Outstanding communication skills
Knowledge of Claim adjudication process (Professional Institutional)
Fee schedule knowledge
Diagnosis and procedures codes knowledge preferred
Understanding of the Health Care industry, benefits, and eligibility processes preferred
Medical group or IPA operations and information systems management preferred
Ability to be a problem solver
Bachelor's degree from a four-year college or appropriate industry experience and/or certification preferred
Why Join Us:
Regal Medical Group offers a fast-paced, exciting, welcoming, and supportive work environment. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
Benefits:
We offer a comprehensive benefits package, including employer-paid comprehensive medical, pharmacy, and dental for employees, vision insurance, zero co-payments for employed physician office visits, flexible spending account, employer-paid life insurance, employee assistance program, behavioral health services, 401k retirement savings plan, income protection insurance, vacation time, company celebrations, employee assistance program, employee referral bonus, tuition reimbursement, license renewal CEU cost reimbursement program, business-casual working environment, sick days, paid holidays, and mileage reimbursement.
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