Claims Encounter Data Analyst

CenCal Health•Santa Barbara, CA

1d•$78,454 - $113,758•Onsite

About The Position

The Encounter Data Quality Analyst is responsible for providing analytical and reporting support to the Claims Operations, Outsourced Vendors and IT support team related to the processing and delivery of encounter data. Validates and analyzes reports and logs related to the processing of 837 transactions to ensure compliance, accuracy, completion and timeliness, as well as ongoing process improvement.

Requirements

Experience with EDI 837 transactions for claims and encounters
Technical knowledge related to claims/encounter data including understanding of coding systems (e.g. CPT/HCPCS, ICD-9/10, NDC)
Ability to diagnose problems with EDI processes by working effectively with internal departments and third parties
Assist in the formulation of policies and procedures related to the encounter data process; understand and interpret policies, procedures and regulations
Proficient use of MS Access, Excel and Word and/or SQL
Knowledge of data analysis methods used in the encounter/claim submission process
Knowledge of Medi-Cal program guidelines, regulations and data reporting requirements
Analytical and problem solving skills
Excellent verbal and written communication skills
Team player who builds effective working relationships
Ability to work independently
Ability to attend meetings and participate in small teams effectively
Detail oriented
Two Three (2-3) years in data analysis in a managed health care environment; claims experience is highly desirable
Any combination of education, training and experience that would provide the knowledge and abilities listed
Must be proficient in the MS Suite of software and have intermediate-advances skills in Excel
Familiarity with database systems
Must be experience in Oracle database systems

Nice To Haves

Bachelor's Degree in Health Care Administration, Business Administration or related fields preferred
Experience in healthcare system configuration
Experience in analysis

Responsibilities

Adhere to regulatory and internal guidelines in conjunction with CenCal Health policies and procedures as they apply to both internal and external encounter reporting
Perform data analysis of submitted encounter data files from external entities and produce regular reports of findings
Work in conjunction with outside vendors on claim file submission rejections to assure corrections are made so that clean data is being submitted prior to each load into the Caradigm system
Monitor and analyze encounter data reporting of encounter data
Maintain a thorough knowledge of CenCal Healths encounter data reporting requirements
Analyze, interpret, and summarize encounter data for development of solutions for reducing and mitigating errors
Analyze existing and future encounter submission regulatory guidelines to ensure compliance with system editing logic
Work in conjunction with the IT department on encounter data issues and process development related to successful encounter management
Work in conjunction with outside vendors on encounter data issues and develop a process to assure quality data is being provided
Work cooperatively on ongoing Encounter Data Process Improvement projects with other CenCal Health departments as well as external vendors and Provider Community
Maintain spreadsheets for reporting of encounter related projects both within the department as well as company wide
Recommend corrective action to resolve processing and data issues
Perform other duties as assigned