Senior Analyst, Encounters

Job Description

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 :

PREFERRED EXPERIENCE :

2-4 years of experience working on projects

Experience managing projects, communicating statuses and risks, and facilitating calls with cross-functional teams

Claims processing, provider contacting, health data analysis and reporting, project management, working with various levels of management throughout multiple organizations

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :

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 : $77,969 - $141,371 / ANNUAL