Senior Analyst, Encounters - Remote

Molina Healthcare•United States,

3h•$54,373 - $117,809•Remote

About The Position

Provides senior-level analyst support for encounter activities, including monitoring inbound and outbound encounter processes and ensuring timely, accurate, and complete submissions for moderate- to high-complexity markets or states. Facilitates data and process analysis, collaborates with cross-functional teams to identify and resolve root causes of issues affecting encounters, and recommends improvements to enhance operational performance. The role monitors submission results and responses, analyzes encounter pend and rejection inventory, and works with internal teams and external vendors to resolve errors. It maintains submission criteria, schedules, documentation of market-specific requirements, and performance indicators; analyzes financial and operational impacts; and supports governance and operations reviews. The position also performs root-cause analysis, develops and distributes reports, monitors vendor submissions and contractual performance, and communicates encounter-related issues, risks, and status updates. The analyst collaborates on systems changes and encounter initiatives, participates in or leads projects to improve submission acceptance, develops and monitors unit testing plans, and writes business and functional requirements for system implementations and program updates.

Requirements

At least 3 years of experience in billing, claims, encounters, and/or data analysis, preferably as an analyst in a managed care setting, or an equivalent combination of relevant education and experience.
Experience with data analysis techniques.
Skill writing basic to advanced queries.
Strong organizational and time-management skills, including the ability to manage simultaneous projects and tasks to meet internal deadlines.
Ability to collaborate across teams and functions.
Strong verbal and written communication skills.
Proficiency with Microsoft Office and applicable software programs.

Nice To Haves

Experience in claims processing, provider contacting, health data analysis and reporting, and project management.
Experience working with various levels of leadership in a highly matrixed organization.
Certified Professional Coder (CPC).

Responsibilities

Monitor inbound and outbound encounter submissions and responses, interpret outcomes, and take timely action to remediate errors.
Review submission results and analyze encounter pend and rejection inventory; coordinate with IT, health plans, claims, provider, enrollment, regulators, and external vendors to resolve errors and ensure timely, accurate, and complete submissions.
Perform data and process analysis using internal and external sources and recommend improvements to decision-makers.
Maintain encounter submission criteria, submission schedules, and centralized documentation of market-specific nuances, compliance, and regulatory requirements.
Maintain market- or state-specific KPIs and report monthly and quarterly results.
Understand and communicate the financial and performance impacts of encounter submissions.
Assist in preparing materials and information for monthly governance and operations reviews.
Perform root-cause analysis of claims and encounter data and develop recommendations based on data and industry knowledge.
Collaborate across departments to design and implement system changes that support encounter processing and submission goals.
Participate in or lead projects addressing corrections, changes, and updates to improve encounter submission acceptance.
Develop and distribute basic reports for error resolution, follow-up, and performance monitoring.
Understand provider, member, and inbound claims data compliance as it relates to encounter submission requirements.
Monitor vendor encounter submissions, contractual compliance, and service-level agreements.
Communicate encounter issues, risks, and status updates to cross-functional stakeholders.
Develop, execute, and monitor unit testing plans to ensure accurate encounter processing.
Coordinate vendors, IT, and business partners to support encounter initiatives.
Write business and functional requirements for new system implementations and program updates.