Sr Analyst, Encounters (Remote in Iowa)
Company: Molina Healthcare
Location: Council Bluffs
Posted on: January 18, 2023
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Job Description:
Job Description
Job Summary
The Senior Encounter Analyst is responsible for analyzing complex
encounter process issues, using data from internal and external
sources to provide insight to decision-makers and monitoring claims
& encounters processes, including collaborating with
cross-functional teams at the direction of the Manager, Encounter
Data, to prevent encounter rejections via root cause analysis and
resolution.
- Knowledge/Skills/Abilities
--- Monitors inbound and outbound encounter process. Identifies and
interprets encounter data, submission requirements and performance
metrics.
--- Performs root cause analysis of claims/encounters processing
and submission issues; 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.
--- Develops various reports (i.e. exception reports, standard
reports and performance reports) and distributes them to
appropriate departments for error resolution, follow up and
performance monitoring.
--- Monitors State, Federal and/or third party agency submissions,
contractual compliance and SLAs.
--- Participates and/or leads projects to address corrections,
changes, and updates to assure encounter submission acceptance.
--- Participates in the workgroup to resolve encounter data and
process issues.
--- Monitors provider compliance with policies, procedures and
regulations for the coding of encounters.
--- Develops programs to address provider data and performance
gaps..
- Job Qualifications Required Education
High School Diploma or GED
Required Experience
3-5 Years of Billing, Claims, and Encounter experience
5 years or more of managed care experience
Preferred Education
College Degree or equivalent work experience of 5-7 years with
claims and/or encounter processing.
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 Procedural 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. Pay Range: -$54,922.50 - $107,098.87 a year* *Actual
compensation may vary from posting based on geographic location,
work experience, education and/or skill level. #PJHPO
Keywords: Molina Healthcare, Council Bluffs , Sr Analyst, Encounters (Remote in Iowa), Professions , Council Bluffs, Iowa
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