Claire Myers Consulting · 5 days ago
Medicare Encounter Data Analyst
Santa Barbara, CA
Full-time
Onsite
Entry, Mid Level
$76K/yr - $111K/yr
2+ years expClaire Myers Consulting is a healthcare organization dedicated to providing quality services to the Central Coast community. They are seeking a Medicare Encounter Data Analyst who will provide data collection, analytical, reporting, and project management support to the Claims Operations team, ensuring compliance and accuracy in encounter data processing.
ConsultingHuman ResourcesRecruiting
Responsibilities
Ensure adherence to regulatory and internal guidelines in conjunction with company policies and procedures related to encounter reporting
Perform data analysis on submitted encounter data files and produce regular reports of findings
Measure encounter data accuracy, submission, and correction timeliness against contractual obligations; recommend procedural changes as needed
Monitor and analyze encounter data reporting for accuracy and compliance
Maintain in-depth knowledge of encounter data reporting requirements and regulations
Analyze and interpret encounter data to identify errors and develop solutions to mitigate them
Review and analyze encounter submission regulatory guidelines to ensure compliance with system editing logic
Partner with IT on encounter data issues, process development, and system changes to improve encounter management
Collaborate with other departments, vendors, and the provider community on ongoing encounter data process improvement projects
Develop system change forms (SCFs) to improve data quality and reduce rejections
Oversee outsourced vendor encounter data processing, ensuring contractual obligations are met and corrective actions implemented when necessary
Manage downstream delegate (VTS) encounter data, including error review, correction, and resubmission to CMS
Track and maintain encounter-related project reporting for internal teams and external vendors
Review errors received from CMS, make corrections, and develop preventative processes for future accuracy
Develop and present encounter data reports for internal committees and vendor oversight meetings
Support encounter data management for specialized programs (ECM/CS)
Participate in internal and external meetings and maintain compliance with all organizational policies and procedures
Qualification
Required
Strong knowledge of the Medicare D-SNP program and dual-eligible encounter processing (Medi-Cal and Medicare D-SNP)
Hands-on experience with Cognizant EDM application systems
Bachelor's degree in Healthcare Administration, Business Administration, or a related field (or equivalent experience)
2–3 years of experience in data analysis within a managed healthcare environment; claims experience highly desirable
Proficiency in MS Office Suite, with intermediate to advanced Excel skills
Experience with healthcare system configuration, data analysis, and familiarity with database systems
Understanding of primary coding systems (CPT/HCPCS, ICD-10, NDC)
Strong analytical and problem-solving skills
Excellent communication and collaboration abilities
Preferred
Experience with QNXT system preferred
Knowledge of Medicare claims processing in QNXT preferred
Familiarity with CMS and Medi-Cal program regulations and reporting requirements preferred
SQL experience preferred
Company
Claire Myers Consulting
Claire Myers Consulting offers HR services, including talent acquisition, coaching, and consulting for SMBs.
2-10 employees
Funding
Current Stage
Early StageLeadership Team
Claire M. Vitale
Founder
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