ALTA IT Services, LLC · 1 day ago
Encounters System Analyst
United States
Contract
Remote
Senior Level
5+ years expALTA IT Services, LLC is a leader in delivering outsourced services and workforce solutions. They are seeking an Encounters System Analyst III who will be responsible for compiling and analyzing Encounters data, understanding its financial and clinical impact, and ensuring Service Level Agreements are met.
ConsultingInformation TechnologyStaffing Agency
Responsibilities
Compile and analyze 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 achieve
Provide analytical support and leadership for Claims Encounters Regulatory Data projects
Responsible for reviewing Encounter rejections and providing resolution of minor to complex data issues or process changes
Provide Claims Encounter Subject Matter Expertise (SME) for both CMS and State agencies and internal impacted organizations (IT, Claims, New Business, Enrollment, etc.)
Build, sustain and leverage relationships with persons within his/her responsibility to constantly allow for continuous improvement of the Encounter Data business process
Direct responsibility for the design, testing and delivery of supporting processes to the business
Lead the claims data processes to ensure accuracy and compliance with CMS and state agencies
Provide support for other key claims data management and readiness to state and governing entities
Understand the Claims Encounter Data requirements in detail to enable one to lead 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
Responsible for Claims Encounters regulatory reporting
Provide critical reporting and analysis of functional performance, and make recommendations for enhancements, cost savings initiatives and process improvements
Prepare and monitor various management and oversight metrics and reports as required
Lead Claims Encounter initiatives such as working with IT and others internal departments to automate Claims Encounters functions; improve regulatory report development with SIS
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
Required
Bachelor's degree or equivalent years of relevant work experience is required
Minimum of five (5) years of managed healthcare, claims, or managed care regulated environment experience is required
Minimum of five (5) years of experience using at least two of the following tools is required: SQL, SAS, SSIS, MySQL, ORACLE, R, or PowerBI
Knowledge of relational databases (SQL Server, Oracle, etc.)
Experience with SQL Server - 2016 or newer
Strong database querying, data analysis and trending skills
Demonstrated understanding of claims operations specifically related encounters
Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding
Knowledge of Claims IT processes/systems
Knowledge of claims analytic processes/systems
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
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
Experience with 837O files to States and/or CMS (MA EDS) preferred
Experience with 835 files preferred
Benefits
Health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.
Company
ALTA IT Services, LLC
ALTA IT Services, LLC combines experience and expertise to deliver IT talent that meets and exceeds the expectations of our clients.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2015-12-18Acquired
Leadership Team
Bonnie Wells
Senior Business Development Manager - Strategic Staffing Partner
Company data provided by crunchbase