Business Encounter Data Analyst

Overview

It's an exciting time to join the Well Sense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Business Encounter Data Analyst is responsible for compiling and analyzing encounter data and understanding the claim impact of changes and decisions to the business process to ensure that CMS and State Service Level Agreements (SLAs) are achieved. This individual will support the encounter data lifecycle process working closely with business and technical resources as well as document and illustrate business requirements, processes, and deficiencies across the organization, our vendors, and our regulators.

• Full-time remote work
• Competitive salaries
• Excellent benefits

• Understand the claims encounter data requirements in detail to ensure claims data is complete, accurate, and timely.
• Review encounter rejections and provide resolution of minor to complex data/system issues or processes.
• Develop and maintain supporting business processes and workflows.
• Recognize inconsistencies and gaps to improve productivity, accuracy and data usability and streamline procedures and policies.
• Provide critical analysis of functional performance and make recommendations for enhancements and process improvements.
• Build, sustain and leverage relationships to enable continuous improvement of the encounter data business process.
• Provide encounter data support to vendors and ensure understanding of regulatory encounter requirements.
• Participate in claims encounter initiatives such as working with IT and other internal departments to automate claims encounters functions.
• Understand how claims payment methodologies, adjudication processing and CMS and State encounter regulations interrelate to maintain compliant encounter reconciliation processes and SLAs.
• Stay current with the needs and operations of the regulatory deliverables.
• Interact with business stakeholders, internal and external as appropriate, to understand new business requirements and enhancement requests.
• Provide business encounter subject matter expertise for internal departments and both CMS and State agencies.
• Performance for timely and accurate reviews must meet or exceed internal, CMS, and State SLA requirements.
• Other duties as assigned

• Supervision Exercised: None
• Supervision Received: Indirect supervision is received weekly

• Education Required: Bachelor's Degree in a related field or the equivalent combination of training and experience.
• Education Preferred: AHIMA or other nationally recognized Coding/Billing Certification.

• Experience
  
  Required:
  
  5 or more years experience in a fast paced, managed healthcare environment.
• 5 or more years experience with encounter data operations, claims processing, and/or provider billing.
• 3 or more years of claim coding and billing processes, including CPT, ICD-10 and HCPCS coding.
• Advanced knowledge of HIPAA regulations and 837 EDI standards.
• Experience working with Medicaid, Medicare or commercial encounter, coding and/or regulatory guidelines.

• Edifecs encounter data software.
• Cognizant Facets claim adjudication system.
• Experience with industry standard payment rules and methods.

• Successful completion of pre-employment background check

• Effective collaborative and proven process improvement skills.
• Good communication skills, both oral and written, ability to interact well with others at all levels, strong organizational skills, strong customer service skills and orientation.
• A strong working knowledge of Microsoft Office products.
• Independent thinker and problem solver with an analytical mind and the ability to solve complex data and workflow issues.
• Detail oriented.

• Compensation Range: $64,000 - $93,000

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an…