Analyst, Business Analysis I Encounters Validation Analyst
About The Position
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Analyst, Business Analysis I (Encounter Validation Analyst) is responsible for the creation, submission and tracking of encounter files to State entities in accordance with regulatory and contractual requirements. Validation Analysts also support the team in achieving business results through research and resolution of internal and external encounter edits.
Requirements
- 1+ years’ work experience with HIPAA transaction sets, claims processing and/or encounters
- Problem solving and decision-making skills.
- Strong written and verbal communication skills.
- Strong organizational skills and ability to work as part of a team.
Nice To Haves
- Claims/Encounters experience.
- QNXT or Edifecs experience.
- 1+ years of experience preparing, validating, submitting, loading, and tracking 837 encounter files.
- Experience with Electronic Data Interchange (EDI) files.
Responsibilities
- Prepare, submit and track 837 encounter files according to state and federal regulations.
- Monitor and track State response files.
- Manage vendor files submissions and monitor for accuracy and timeliness.
- Coordinates corrections as needed.
- Complete State attestation reports.
- Assist with testing of related system enhancements and defects.
- Research and resolve encounter related inquiries.
- Assist in correcting both internal and external rejects in an accurate and timely manner.
- Assist in the development of documentation to support encounter validation and team processes.
Benefits
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
