WellSense Health Plan · 17 hours ago
Business Encounter Data Analyst
United States
Full-time
Remote
Mid, Senior Level
$64K/yr - $93K/yr
5+ years expWellSense Health Plan is a growing regional health insurance company with a 25-year history of providing health insurance that works for our members. The Business Encounter Data Analyst is responsible for compiling and analyzing encounter data to ensure compliance with CMS and State Service Level Agreements, while working closely with business and technical resources to document and improve business processes.
Hospital & Health Care
Responsibilities
Understand the claims encounter data requirements in detail to ensure claims data is complete, accurate, and timely
Responsible for reviewing encounter rejections and providing resolution of minor to complex data/system issues or processes
Responsible for the development and maintenance of supporting business processes and workflows
Recognize inconsistencies and gaps to improve productivity, accuracy and data usability and streamlining procedures and policies
Provide critical analysis of functional performance, and make recommendations for enhancements, and process improvements
Build, sustain and leverage relationships to constantly allow for continuous improvement of the encounter data business process
Provide encounter data support to vendors and ensure understanding of regulatory encounter requirements
Participate in claims encounter initiatives such as working with IT and others internal departments to automate claims encounters functions
Understanding of how claims payment methodologies, adjudication processing and CMS and State encounter regulations interrelate to maintain compliant encounter reconciliation processes and SLA’s
Stay current with the needs and operations of the regulatory deliverables
Interacts with business stakeholders, internal and external as appropriate, to understand new business requirements and enhancement requests
Provide business encounter subject matter expertise for internal departments and both CMS and State agencies
Performance for timely and accurate reviews must meet or exceed internal, CMS, and State SLA requirements
Other duties as assigned
Qualification
Required
Bachelor's Degree in a related field or the equivalent combination of training and experience
5 or more years experience in a fast paced, managed healthcare environment
5 or more years experience with encounter data operations, claims processing, and/or provider billing
3 or more years of claim coding and billing processes, including CPT, ICD-10 and HCPCS coding
Advanced knowledge of HIPAA regulations and 837 EDI standards
Experience working with Medicaid, Medicare or commercial encounter, coding and/or regulatory guidelines
Successful completion of pre-employment background check
Effective collaborative and proven process improvement skills
Good communication skills, both oral and written, ability to interact well with others at all levels, strong organizational skills, strong customer service skills and orientation
A strong working knowledge of Microsoft Office products
Independent thinker and problem solver with an analytical mind and the ability to solve complex data and workflow issues
Detail oriented
Preferred
AHIMA or other nationally recognized Coding/Billing Certification
Edifecs encounter data software
Cognizant Facets claim adjudication system
Experience with industry standard payment rules and methods
Benefits
Medical
Dental
Vision
Pharmacy
Merit increases
Flexible Spending Accounts
403(b) savings matches
Paid time off
Career advancement opportunities
Resources to support employee and family wellbeing
Company
WellSense Health Plan
A nonprofit health plan serving Medicare, Individual & Family, and Medicaid plan members in Massachusetts & New Hampshire.
1001-5000 employees
H1B Sponsorship
WellSense Health Plan 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 (1)
2024 (8)
2023 (2)
2021 (2)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Heather Thiltgen
President & CEO
Diana Cruz
Chief Operating Officer
Company data provided by crunchbase