Encounter Data Sr. Business Analyst - Remote
About The Position
We are seeking an experienced senior analyst who will guide end-to-end improvements in encounter data operations, using technical strategies to optimize efficiency in the Finance department. You will use your existing Microsoft SQL skills to write queries to generate reports according to health plan requirements. Must be proficient in developing ad hoc scripts to support evolving business needs. Collaborates directly with internal and external partners to review and solve errors to meet service level agreements. Responsible for the timely analysis and resolution of rejected encounters for both clearinghouse and direct encounter submissions. Ensures all corrections align with health plan industry standards and guidelines established by CMS and DHCS. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Requirements
- 5+ years of experience in Microsoft SQL query development and reporting
- 2+ years of experience within the healthcare data environment – (e.g. encounters, eligibility, provider, claims)
- EDI 837 production support and maintenance experience including editing and correcting X12 837 transactions for resubmission to trading partners
- EDI testing and validation experience
- Experience using Microsoft Office, Excel (e.g. dashboards, pivot tables, formulas, v-lookup)
- Ability to travel up to 10%
- Working with Encounter Management systems and/or Claims Payment systems and their associated HIPAA X12 EDI 837 Claims and 277 Acknowledgment transactions
- Strategic, data-driven analyst who not only solves problems at their root but builds sustainable solutions to prevent them from happening again
Nice To Haves
- Proven knowledge about importance of encounter data reporting and impact on revenue
- Demonstrated understanding of claims billing cycle and reimbursement process a plus
- Based in Southern California
Responsibilities
- Monitor daily end-to-end encounter submissions from in-house system to health plans
- Correct rejected encounters in accordance with CMS and DHCS claims processing guidelines and industry standards
- Write and generate reconciliation reports as required by health plans
- Proficient in developing ad hoc scripts to provide insight and analysis for leadership
- Proactive in analyzing trends of rejected encounters; conducting root cause analysis and scope to prioritize escalations
- Manage key relationships with health plans, clearinghouses, and internal stakeholders to drive effective prevention, resolution, and escalation of encounter errors
- Resource for EDI validation as required for 837 resubmissions or user testing
- Prepare and update department documentation and training materials
- Lead special projects and additional responsibilities as needed
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
