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Insight Global · 1 day ago

Encounters System Analyst

United States

Contract

Remote

Mid Level

$30/hr - $34/hr

Insight Global is seeking an Encounters Systems Analyst responsible for compiling and analyzing Encounters data to understand its financial and clinical impact. This role focuses on new implementation and encounter data reporting requirements, ensuring Service Level Agreements are met.

EmploymentHuman ResourcesRecruitingSales

H1B Sponsor Likely

Hiring Manager

Ashlee Gagliardo

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 achieved

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 CareSource 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

SQL ServerClaims Encounter ExpertiseData AnalysisRelational DatabasesCodingBilling KnowledgeClaims IT ProcessesRelationship ManagementCommunicationProblem Solving

Required

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 achieved