Encounters Systems Analyst II

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $62.7k - $100.4k / year

⏰ Full Time

🟢 Junior

⚙️ Systems Engineer

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Perform analysis of Encounter data • Understand the financial and clinical impact of changes and decisions to business processes to ensure Service Level Agreements are achieved • Support Regulatory Data projects • Review Encounter rejections and provide resolution of minor to complex data issues or process changes • Provide Claims Encounter subject matter expertise for CMS, state agencies, and internal CareSource organizations • Build and leverage relationships to support continuous improvement of Encounter Data business processes • Support testing and delivery of processes to the business • Participate in claims data processes to ensure accuracy and compliance with CMS and state agencies • Participate in claims data management and readiness for state and governing entities • Support claims data submissions and required SLAs through internal and external changes • Identify inconsistencies and gaps to improve productivity, accuracy, data usability, procedures, and policies • Support Claims Encounters regulatory reporting • Support performance reporting and analysis, recommending enhancements, cost savings initiatives, and process improvements • Monitor management and oversight metrics and reports • Support Claims Encounter initiatives, including automation with IT and improvements to regulatory report development • Support vendors and manage SLAs, regulatory requirements, and contractual metrics • Maintain strategic relationships with internal and external stakeholders • Contribute to or develop user stories and provide user story guidance for sprint planning • Apply knowledge of claims payment methodologies, adjudication processing, and state Encounter regulations to maintain compliant reconciliation processes and SLAs • Perform other duties as requested

🎯 Requirements

• Bachelor’s degree in Science/Arts or equivalent years of relevant work is required • Master’s Degree in Science/Arts is preferred; concentration in Healthcare Analytics or Data Science preferred • Minimum of one (1) year to two (2) years of managed healthcare, claims, or managed care regulated environment experience is required • Minimum of one (1) year of experience using at least two of the following tools is required: SQL, SAS, SSIS, MySQL, ORACLE, R, or PowerBI • Intermediate computer skills • Advanced skills in Excel • Data analysis and trending skills • Demonstrated understanding of claims operations specifically related to encounters • Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding • Knowledge of Claims IT processes/systems and analytic processes • Experience in documentation of business requirements • Advanced working knowledge of managed care and health claims processing and reimbursement methodologies • Excellent written and verbal communication skills required • Ability to work independently and within a team environment • Time management skills; capable of multi-tasking and prioritizing work • Attention to detail • Effective decision-making and problem-solving skills • Critical thinking and listening skills • Licensure and certification: None

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Equal Opportunity Employer environment fostering belonging and supporting individuals of all backgrounds