Long Beach, CA, USA
Encounters data is essential for monitoring and measuring managed care quality, finance, utilization and compliancy with state and contractual requirements. It is a critical source of information for rate setting, HEDIS score and risk adjustment.
The Encounter team is responsible for receiving, capturing, validating, tracking submission, reconciling response files and error correcting rejections of encounters data rendered to members. The Encounters Analyst will be supporting the Claims and Encounters business unit as the expert to review internal and external rejections, identify the root cause of the rejection, provide detailed analysis of the root cause, provide recommendations and error correction of data. A strong understanding of the system and state regulation to collect and validate data required to improve submission of encounters reporting is highly recommended.
Key Tasks and Responsibilities:
- Manage and monitor encounters submission, acceptance, rejection and response file inventory.
- Evaluate and conduct root cause analysis of internal and external errors.
- Manage and maintain requirement changes to ensure system validation rules and edits are up-to-date.
- Monitor and track inventory progress; remediate issues, produce progress reports and communicate to executive team.
- Support the capturing and updating of required data elements in various Itineris modules.
- Provide monthly summary report to executive team.
- Define solution approach to implement business objectives.
- Formulate business analysis plan to define specific list of deliverables, milestones and timelines.
- Elicit and discover necessary information to process and remediate errors based on state regulations.
- Support technical implementation by reviewing solution designs to ensure requirements meet contractual and state mandates.
Education & Training:
- Required: High School Diploma or GED.
- Preferred: Bachelor Degree in Business, Health Administration, Computer Science or equivalent work experience.
Knowledge and Experience:
- 1-3 years of Itineris experience.
- Strong knowledge of Itineris trips, contact, 834 and reservation modules.
- Microsoft Excel, Word, FileMaker.
- Strong written and verbal communication.
- Exceptional analytical skills.
- Ability to communication and make recommendation for organization process improvement.
- Strong problem-solving skills.
Working Conditions :
- This is a Full time hourly position. Benefits after 60 days include medical, dental, vision, voluntary life and 401(k)
- No travel is required.
- This position requires working on a sitting position working on a computer and operating a keyboard and a mouse as well as other office equipment like phones and printers, and filing documents.
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