Medicare Encounter Data Analyst

4 days ago


Milwaukee, Wisconsin, United States CareOregon Full time
Job Title: Medicare Encounter Data Analyst

CareOregon is seeking a highly skilled Medicare Encounter Data Analyst to join our team. As a key member of our finance department, you will be responsible for leading the process for the end-to-end Encounter Data Processing System (EDPS) data flow and working within CMS guidelines for acceptable data submission.

Key Responsibilities:
  • Ensure accuracy and completeness of data submissions to CMS.
  • Design and develop encounter data controls and internal audit processes with internal signoffs.
  • Provide dashboards, reports, and analysis specific to the complete and accurate submission of encounter data to CMS.
  • Monitor and track Medicare encounter data throughout the entire submission process, ensuring integrity through ongoing reconciliation of EDI, claims, supplemental data, and outgoing 837 file creation to prevent data loss.
  • Identify root cause of data loss and encounter rejections; research return codes and coordinate with IS, claims, enrollment and provider data to enable complete and accurate encounter submissions.
  • Work cross-functionally to interpret, verify, test and correct errors within the encounter data processing system.
  • Maintain business rules and policies and procedures for Medicare encounter data submissions; lead the updating of business rules in response to regulatory changes.
  • Lead and manage the standardization and automation of encounter data table creation and response file loading from CMS.
  • Compile reports for other departments and regulatory agencies.
  • Use statistical software, including SAS and SQL, to retrieve, edit and tabulate data from various databases and files.
  • Participate in cross-departmental encounter data workgroup meetings.
  • Analyze data trends and creates documentation supporting all reports.
  • Advise on and guides process improvements that will optimize the accuracy and completeness of Medicare encounter data submissions.
  • Work with outside vendors as needed.
  • Advise internal customers regarding the availability and utility of data elements for reporting and data set requests, as well as the timing and frequency of reporting and data refresh.
Requirements:
  • Minimum 5 years' experience reporting, analyzing, interpreting, and presenting data; experience analyzing large data files and performing file reconciliations.
  • Minimum 3 years' healthcare, claims, data management, EDI experience.
  • Preferred experience with Medicare Advantage risk adjustment and payment methodologies.
What We Offer:
  • Estimated hiring range $78,270 - $94,710 / year, 5% bonus target, full benefits.
  • Opportunity to work in a fully remote role, but must reside in one of the listed 9 states.

CareOregon is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to building a linguistically and culturally diverse and inclusive work environment.


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