Job Summary
The Sr Analyst, Encounters is responsible for monitoring inbound and outbound encounter processes and ensuring timely, accurate, and complete encounter submissions for moderate- to high-complexity markets or states. Performs data analysis using internal and external sources, analyzes processes and provides recommendations for improvement to decision-makers. At the direction of the Manager, Encounters, collaborates with cross-functional teams to identify and resolve root causes of issues that impact encounters and identify improvements to operational performance.
Job Duties
- Monitors inbound and outbound encounters submissions and responses, interprets outcomes, and takes swift action to remediate errors
- Routinely reviews submission results and analyzes encounter pend and rejection inventory, and works with other areas including IT, health plan, claims, provider, enrollment, regulators, and external vendors, as needed, to remediate encounter errors and ensure timely, accurate, and complete encounter submissions
- Owns and maintains encounter submission criteria, maintains submission schedule, central documentation of market nuances, compliance, and regulatory requirements for primary market or state
- Responsible for maintaining market or state-specific KPIs, and reports monthly and quarterly results
- Understands and communicates financial and performance impacts related to encounter submissions
- Assists with preparing portions of materials and information for Monthly Governance and Operations Reviews
- Performs root cause analysis of claims and encounter data and develops recommendations based on data and industry knowledge. Collaborates across departments to design and implement systems changes to meet encounter data processing and submission goals.
- Writes business requirements for system updates to resolve errors and optimize encounter performance
- Participates in and/or leads projects to address corrections, changes, and updates to ensure encounter submissions acceptance.
- Develops basic reports and distributes to appropriate departments for error resolution, follow up, and performance monitoring.
- Understands provider, member, and, inbound claims data compliance in relation to encounters submission requirements
- Monitors vendor encounter submissions, contractual compliance, and SLAs
Job Qualifications
REQUIRED EDUCATION:
High School Diploma or GED
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
- 5-7 years of experience in billing, claims, encounters, and data analysis
- 5 years or more of managed care experience
- Knowledge of advanced data analysis techniques
- Skilled with writing basic to advanced SQL queries
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
PREFERRED EDUCATION:
Bachelor’s Degree or equivalent work experience
PREFERRED EXPERIENCE:
- Claims processing, provider contacting, health data analysis and reporting, project management, working with various levels of management throughout multiple organizations
- Managed care experience
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
Certified Professional Coder (CPC)
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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