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CenCal Health · 1 month ago

Medicare Encounter Data Analyst

United States

Full-time

Remote

Entry, Mid Level

$76K/yr - $111K/yr

2+ years exp

CenCal Health is a healthcare organization focused on providing quality services. The Medicare Encounter Data Analyst is responsible for data collection, analysis, and reporting to support the Claims Operations team, ensuring the accuracy and compliance of encounter data processing.

Health CareInsuranceNon Profit

Responsibilities

Adhere to regulatory and internal guidelines in conjunction with CenCal Health policies and procedures as they apply to both internal and external encounter reporting

Perform data analysis of submitted encounter data files from external entities and produce regular reports of findings

Measure Encounter data accuracy file submissions and correction timeliness against established contractual obligations, based on findings, make recommended procedural changes to ensure these guidelines are met

Monitor and analyze encounter data reporting of encounter data

Maintain a thorough knowledge of CenCal Health’s encounter data reporting requirements

Analyze, interpret, and summarize encounter data for development of solutions for reducing and mitigating errors

Analyze existing and future encounter submission regulatory guidelines to ensure compliance with system editing logic

Work in conjunction with the IT department on encounter data issues and process development related to successful encounter management

Work cooperatively on ongoing Encounter Data Process Improvement projects with other CenCal Health departments as well as external vendors and Provider Community

Develop system Change Forms (SCFs) to improve Encounter Data Quality and prevent rejections

Assist with monitoring and oversight and ensure contractual obligations of our outsourced Encounter data processing vendor requirements are met. Assist with the plan and develop changes when necessary. Recommend corrective action to resolve processing and data issues

Review, manage and process encounter data for the supplemental file program, including error review and resubmission when necessary

Management of downstream delegate (VTS) encounter data including working with Vendor, sharing errors from CMS, then receiving and resubmitting the corrections provided by Vendor back to CMS

Maintain spreadsheets for reporting of encounter related projects both within the department as well as companywide and with the outsourced vendor

Review each error received from CMS and make corrections; develop new processes to prevent future errors

Work with IT to correct encounter data errors during pre-submission review

Work with internal staff and/or create process improvements to prevent encounter data errors

Develop and report on Encounter Data for Claims Quality Committee (CQC), Delegation Oversite Committee and delegated vendors (VTS) JOC meetings

Manage encounter data counts/charts for ECM/CS program

Attend internal and external meetings when necessary

Adhere to all CenCal Health employee policies and procedures, and meet required performance standards

Other duties as assigned

Qualification

Claims/Encounter Data KnowledgeData Analysis MethodsMedicare D-SNP KnowledgeCognizant EDM ExperienceMS Office ProficiencySQL ProficiencyCMS Regulations KnowledgeAnalytical SkillsHealthcare System ConfigurationDatabase Systems FamiliarityQNXT ExperienceMedicare Claims ProcessingProblem-Solving SkillsCommunication SkillsTeam Player

Required

Knowledge of the Medicare D-SNP program

Strong knowledge in dual eligible encounter processing (Medi-Cal and Medicare D-SNP)

Cognizant EDM application system experience

Two-three (2-3) years in data analysis in a managed health care environment; claims experience is highly desirable

Any combination of education, training and experience that would provide an equivalent background

Experience in healthcare system configuration

Experience in analysis

Must be proficient in the MS Suite of software and have intermediate-advances skills in Excel

Familiarity with database systems

Technical knowledge related to claims/encounter data including understanding of primary coding systems (e.g., CPT/HCPCS, ICD-10, NDC)

Ability to diagnose problems with EDI processes by working effectively with internal departments and third parties

Assist in the formulation of policies and procedures related to the encounter data process; understand and interpret policies, procedures and regulations

Proficient in use of MS Office applications, Excel, and Word and/or SQL

Knowledge of data analysis methods used in the encounter/claim submission process

Knowledge of CMS and Medi-Cal program guidelines, regulations and data reporting requirements desired

Analytical and problem-solving skills

Excellent verbal and written communication skills

Team player who builds effective working relationships