A leading Managed Care Company based out of Dayton, OH is looking for a fully remote Encounters System Analyst for a 3 month contract opportunity. The Encounters Systems Analyst II is responsible for performing analysis of Encounters data and understanding the financial and clinical impact of changes and decisions to the business process to ensure that the Service Level Agreements are achieved.
Essential Functions:
* Perform analysis of Encounter data.
* Understand the financial and clinical impact of changes and decisions to the business process to ensure that the Service Level Agreements (SLAs) are achieved
* Support for Regulatory Data projects
* Responsible for reviewing Encounter rejections and providing resolution of minor to complex data issues or process changes
* Support for testing and delivering process to business.
* Participate in claims data processes to ensure accuracy and compliance with CMS and state agencies
* Participate in the key claims data management and readiness to state and governing entities
* Understand the Claims Encounter Data requirements in detail to enable one to support efforts to ensure claims data submissions achieve the required SLAs through requested changes internally and externally
* Recognize inconsistencies and gaps to improve productivity, accuracy and data usability and streamlining procedures and policies
* Provide support of vendors, managing SLA's, regulatory requirements and contractual metrics
* Contribute to and/or develop user stories or provide user story guidance for sprint planning
* Understanding of how claims payment methodologies, adjudication processing and State Encounter regulations interrelate to maintain compliant Encounter reconciliation processes and SLA's
* Perform any other job duties as requested
* 2+ years of managed healthcare, claims, or managed care regulated environment experience
* 837 and 835 files within Encounters
* Bachelor's degree
* SQL
Level III/IIII will be expected to have at least 3 years using Encounters.
Entry Level can be >1 years
* Master's Degree, preferably a concentration in Healthcare Analytics or Data Science
* Edifecs knowledge
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.