Alliance Health · 7 hours ago
Encounter Analyst I (Full-time Remote, North Carolina Based)
United States
Full-time
Remote
Mid Level
$20.32/hr - $25.91/hr
4+ years expAlliance Health is a company focused on healthcare claims processing, and they are seeking an Encounter Analyst I to review and monitor adjudicated claims. The role involves researching encounter denials, ensuring service level agreements are maintained, and collaborating with internal and external stakeholders to resolve claims issues.
Health Care
Responsibilities
Research and Resolve Encounter Denials
Research upstream encounter denials
Determine if claim processed appropriately in ACS
Rebill encounter denial when appropriate
Research State initiated encounter recoupments
Ensure Service Level Agreement (SLA) Maintenance
SLAs: Accuracy, Timeliness, and Reconciliation
Accuracy: Review and be aware of number of denied encounters weekly
Timeliness: Research and resolve 98% of encounter denials within 30 days
Reconciliation: Assist in researching discrepancies
Manage Encounter Denials and Recoupments
Utilize the A/R system to manage encounter denials and recoupments
Document current status of denials and recoupments
Process and Reconcile Claims
Ensure appropriate coordination of benefits has occurred utilizing billing and payment policies and procedures, review & analyze claims adjudications to identify system issue and provider errors
Maintain knowledge of current adjudication edits
Provide Feedback on Process Improvement
Provide information and feedback to the system team to support development of system enhancements in a structured manner aimed to eliminate system settings and or processes that contribute to poor results
Maintain processes that are consistent with and compliant to CMS, state, federal and best practice standards, regulations and guidelines
Communicate and Collaborate with Internal and External Stakeholders
Communicate and conduct liaison work across multiple departments to resolve claims denials/issues
Communicate with DMH/DHB when appropriate to resolve complex encounter denials/issues
Demonstrate professional and timely communication
Qualification
Required
Graduation from high school or equivalent
(4) four years of experience processing healthcare claims
High level knowledge of healthcare services and systems
Knowledge of complex claim denials and sources for correction
Knowledge of Medicaid and State funding rules
Knowledge of laws, legal codes, precedents, government regulations, and MCO policies and procedures
Microsoft Office (Excel, Word, Outlook) skills
Professional written and oral communication for sharing technical information
Ability to independently identify necessary tasks and initiate action
Ability to independently find answers to complex issues
Ability to analyze large quantities of data
Ability to solicit cooperation from persons and departments throughout the organization
Ability to work independently and as part of a team
Ability to demonstrate professional conduct in all situations
Ability to take initiative and lead others
Preferred
Experience With Medicaid And IPRS
Benefits
Medical
Dental
Vision
Life
Long Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
Dress flexibility
Company
Alliance Health
Alliance Health is the managed care organization for publicly funded behavioral healthcare services.
Founded in 2012Fayetteville, North Carolina, USA
1001-5000 employees
H1B Sponsorship
Alliance Health 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 (2)
2022 (1)
Funding
Current Stage
Late StageLeadership Team
Kelly Goodfellow
Executive Vice President, Chief Financial Officer
Recent News
Company data provided by crunchbase