Senior Encounters Analyst

South Florida Community Care Network LLC • Sunrise, FL

7d • $78,000 - $82,000

About The Position

Community Care Plan is seeking a Senior Encounters Analyst to serve as the business lead for encounters operations across our Medicaid and Marketplace lines of business. This is a highly visible role that sits at the intersection of Finance, IT, Quality, Risk Adjustment, and Operations. If you're passionate about healthcare data, process improvement, analytics, and solving complex challenges, this is an opportunity to shape how encounter data is collected, validated, reported, and leveraged across the organization. Your work will directly influence regulatory compliance, financial performance, risk adjustment outcomes, and strategic decision-making.

Requirements

• Bachelor's degree in a related field
• 2+ years of experience working in a healthcare data environment, preferably within a health plan
• Experience with encounter data, healthcare claims, or healthcare reporting
• Strong SQL skills and experience analyzing large datasets
• Experience developing dashboards and reporting solutions using Power BI
• Strong analytical, problem-solving, and decision-making skills
• Ability to communicate complex technical concepts to business leaders and non-technical stakeholders
• Proven success collaborating across departments and with external partners
• Knowledge of SQL and visual basic

Nice To Haves

• Experience supporting Medicaid and/or ACA Marketplace lines of business
• Knowledge of encounter submission and validation processes
• Familiarity with risk adjustment, quality reporting, or healthcare regulatory reporting
• Experience working with healthcare compliance and state or federal reporting requirements
• Some prior knowledge of encounters creation and submission for Florida Medicaid and Marketplace.
• Ability to summarize and clearly articulate data; create dashboards in a Power BI environment.
• Strong organizational and project management skills to effectively prioritize tasks, meet deadlines, and coordinate cross-functional teams in delivering encounters projects and reports.
• Ability to assess and manage risks inherent in health insurance products, including experience with risk mitigation strategies and decision-making under uncertainty.
• Strong written and verbal communication skills to effectively convey complex IT processes to non-technical stakeholders, including senior management, regulators, and business partners.
• Ability to identify challenges and develop creative solutions to complex IT problems.

Responsibilities

• Conduct end to end validation of current encounters creation and submission processes.
• Serve as business lead for implementation of new encounters process for Marketplace line of business.
• Collaborate with risk adjustment, quality, IT and external partners to design processes and dashboards for complete, accurate and timely encounters reporting.
• Work with finance to reduce/eliminate any penalties related to encounters submissions.
• Develop project plan and budget for any new workflows or resources required to optimize encounters reporting.
• Ensure encounters processes and dashboards support accurate risk adjustment, quality and financial metrics.
• Provide encounter data for any and all state and federal agency requirements.
• Perform root cause analysis on encounter errors and work cross-functionally with claims, IT, provider operations, and various partners in care to implement corrections.
• Document standard operating procedures (SOPs) and maintain up-to-date process guides.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior