Encounters Technical Analyst

Description

Encounters Technical Analyst

• Experience working with ANSI x12 EDI standards for health care required. Solid analytical skills with ability to compile data from many sources and formulate plans and recommendations.
• Excellent data manipulation, communication, analytical and statistical skills are required. Must be comfortable with SQL, MS Excel.
• Must have excellent time management and organizational skills with the ability to handle multiple tasks in a timely and accurate manner.
• Ability to work under pressure, adhere to deadlines and know when to escalate information/issues.
• Must have a high level of self-motivation and with little guidance/supervision.
• Must be able to work both independently as well as a team participant.
• Responsible for documenting, monitoring, and analyzing the end-to-end encounter life cycle, inbound and outbound encounter process.
• Identifies and interprets encounter data, submission requirements and performance metrics per the regulatory and health plan guidelines.
• Researches and documents all encounter errors in established systems(s)/database(s) with appropriate statistical and trend analysis
• Performs root cause analysis of claims/encounters processing and submission issues; develops recommendations based on data and industry standards.
• Collaborates across various departments to design and implement any business process and/or systems changes to meet encounter data processing and submission goals.
• Communicates with and provides clear, detailed, effective documentation to other departments within the organization on issues causing encounter pends/denials and potential solutions.
• Collaborates with the Health Plans or Product teams on any encounter related issues
• Develops various encounter related reports (Weekly/Monthly outstanding encounter logs)
• High degree of expertise in SQL store procedures and Encounter analytics skills is essential

Qualifications

Domain Skills

SNo Primary Skill Proficiency Level * Rqrd./Dsrd. 1 Claims NA Desired

* Proficiency Legends

Proficiency Level Generic Reference PL1 The associate has basic awareness and comprehension of the skill and is in the process of acquiring this skill through various channels. PL2 The associate possesses working knowledge of the skill, and can actively and independently apply this skill in engagements and projects. PL3 The associate has comprehensive, in-depth and specialized knowledge of the skill. She / he has extensively demonstrated successful application of the skill in engagements or projects. PL4 The associate can function as a subject matter expert for this skill. The associate is capable of analyzing, evaluating and synthesizing solutions using the skill.