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CareSource · 1 day ago

Encounters System Analyst II- Vendor

United States

Full-time

Remote

Entry, Mid Level

$63K/yr - $100K/yr

1+ years exp

CareSource is a healthcare management organization seeking an Encounters System Analyst II. This role is responsible for analyzing encounter data and understanding its financial and clinical impact to ensure service level agreements are met, while also supporting regulatory data projects and maintaining relationships with stakeholders.

Health CareMedicalNon Profit

Comp. & Benefits

H1B Sponsor Likely

Responsibilities

Perform analysis of Encounter data. Understand the financial and clinical impact of changes and decisions to the business process to ensure that the Service Level Agreements (SLAs) are achieved

Support for Regulatory Data projects

Responsible for reviewing Encounter rejections and providing resolution of minor to complex data issues or process changes

Support for Claims Encounter Subject Matter Expertise (SME) for both CMS and State agencies and internal CareSource impacted organizations (IT, Claims, New Business, Enrollment, etc.)

Build, sustain and leverage relationships with persons within his/her area of responsibility to allow for continuous improvement of the Encounter Data business process

Support for testing and delivering process to business

Participate in claims data processes to ensure accuracy and compliance with CMS and state agencies

Participate in the key claims data management and readiness to state and governing entities

Understand the Claims Encounter Data requirements in detail to enable one to support efforts to ensure claims data submissions achieve the required SLAs through requested changes internally and externally

Recognize inconsistencies and gaps to improve productivity, accuracy and data usability and streamlining procedures and policies

Support Claims Encounters regulatory reporting

Support for critical reporting and analysis of functional performance, and make recommendations for enhancements, cost savings initiatives and process improvements

Monitor various management and oversight metrics and reports as required

Support Claims Encounter initiatives such as working with IT and others internal departments to automate Claims Encounters functions; improve regulatory report development with reporting department

Provide support of vendors, managing SLA’s, regulatory requirements and contractual metrics

Maintain positive and strategic relationships with internal and external stakeholders

Contribute to and/or develop user stories or provide user story guidance for sprint planning

Understanding of how claims payment methodologies, adjudication processing and State Encounter regulations interrelate to maintain compliant Encounter reconciliation processes and SLA’s

Perform any other job duties as requested

Qualification

SQLData analysisClaims operationsExcelHealthcare AnalyticsCodingBillingCommunication skillsTime managementCritical thinking

Required

Bachelor's degree in Science/Arts or equivalent years of relevant work is required

Minimum of one (1) year to two (2) years of managed healthcare, claims, or managed care regulated environment experience is required

Minimum of one (1) year of experience using at least two of the following tools is required: SQL, SAS, SSIS. MySQL, ORACLE, R, or PowerBI

Intermediate computer skills, Advanced skills in Excel

Data analysis and trending skills

Demonstrated understanding of claims operations specifically related to encounters

Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding

Knowledge of Claims IT processes/systems and analytic processes

Experience in Documentation of business requirements

Advanced working knowledge of managed care and health claims processing and reimbursement methodologies

Excellent communication skills; both written and verbal required

Ability to work independently and within a team environment

Time management skills; capable of multi-tasking and prioritizing work

Attention to detail

Effective decision making / problem solving skills

Critical thinking and listening skills

Preferred

Master's Degree in Science/Arts is preferred; concentration in Healthcare Analytics or Data Science preferred

Edifecs knowledge is preferred

Knowledge of Agile is preferred

Knowledge of Facets is preferred

Experience with 837O files to States and/or CMS (MA EDS) preferred

Experience with 835 files preferred

Benefits

You may qualify for a bonus tied to company and individual performance

Substantial and comprehensive total rewards package

Company

CareSource

Glassdoor3.8

CareSource provides managed care services to Medicaid beneficiaries.

Founded in 1989

Dayton, Ohio, USA

1001-5000 employees

https://www.caresource.com/

H1B Sponsorship

CareSource has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (30)

2024 (39)

2023 (35)

2022 (21)

2021 (37)

2020 (28)