Claims Encounter Analyst

Regal Medical Group•Los Angeles, CA

1d•$27 - $30•Onsite

About The Position

The Encounter Data Analyst I, interprets results using a variety of techniques, ranging from simple data aggregation via statistical analysis to complex data mining. Designs, develops, implements and maintains business solutions. Works directly with clients and project and business leaders to identify analytical requirements. This position is 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.

Requirements

Proficiency in Word, Excel, Access, Outlook, EZCAP and Encoder Pro.
Knowledge of Claim adjudication process (Professional & Institutional) required.
Knowledge in SQL Server.
Previous experience in a medical group / healthcare setting.
Proficiency in running data queries, analyzing and reconciling using multiple data sources.
Excellent time management skills.
Outstanding communication skills.
Fee schedule knowledge.
Ability to be a problem solver.
A bachelor’s degree from a four-college or appropriate industry experience and/or certification preferred.

Nice To Haves

Knowledge and experience in Project Management preferred.
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.

Responsibilities

Correct rejected encounters , follow CMS and DHCS Claims processing guidelines and industry standard in correcting rejected encounters
Responsible for the entry of claims system support tables and oversight of processes to ensure our groups are meeting 5010 requirements and required to perform specialized area data entry or general data maintenance for eligibility, providers, fee sets, and benefits or any other areas that require ongoing support.
Conduct Root Cause analyst for encounter errors, meet with departments to go over 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. Follow through that departments are maintaining audit reports.
Create policy and procedures to correct rejected encounters.
Create daily and weekly reports.
Establish and maintain strong relationships with Health Plans, Encounter Clearing Houses, and internal stakeholders to fix, prevent, and to obtain extra support in resolving encounter errors.
Educate internal stakeholders regarding regulator changes for encounters.
Lead and attend meetings as required.
Provides training to staff member in encounter corrections process.
Adhere to Data integrity policies for all system configurations.
Performs other duties as necessary.