Aimed at senior-level data analysts who excel in cross-functional collaboration and have a background in managed care or healthcare claims processing.
Derived from job-description analysis by Serendipath's career intelligence engine.
Original posting from Molina Healthcare
JOB DESCRIPTION Job Summary Provides senior level analyst support for encounters activities including monitoring inbound and outbound encounters processes and ensuring timely, accurate and complete encounter submissions for moderate to high complexity markets or states. Facilitates data and process analysis, collaborates with cross-functional teams to identify and resolve root-causes of issues that impact encounters, and provides recommendations for improvements to enhance operational performance.
Essential Job Duties
- Monitors inbound and outbound encounters submissions and responses, interprets outcomes and takes swift action to remediate errors.
- Routinely reviews submission results, analyzes encounter pend and rejection inventory, and works with other areas including information technology, health plan, claims, provider, enrollment, regulators and external vendors, to remediate encounter errors and ensure timely, accurate and complete encounter submissions.
- Performs data analysis using internal and external sources, analyzes processes and provides recommendations for improvement to decision-makers.
- Maintains encounter submission criteria, and maintains submission schedule, central documentation of market nuances, compliance, and regulatory requirements for primary markets or states.
- Maintains market or state specific key performance indicators (KPIs), and reports monthly and quarterly results.
- Understands and communicates financial and performance impacts related to encounter submissions.
- Assists with preparing portions of materials and information for monthly governance and operations reviews.
- Performs root-cause analysis of claims and encounter data and develops recommendations based on data and industry knowledge.
- Collaborates across departments to design and implement systems changes to meet encounter data processing and submission goals..
- Participates in and/or leads projects to address corrections, changes, and updates to ensure encounter submissions acceptance.
- Develops basic reports and distributes to appropriate departments for error resolution, follow-up, and performance monitoring.
- Understands provider, member, and inbound claims data compliance in relation to encounters submission requirements.
- Monitors vendor encounter submissions, contractual compliance, and service level agreements (SLAs).Communicate encounter issues, risks, and status updates to cross-functional stakeholders.
Communicate encounter issues, risks, and status updates to cross-functional stakeholders.
Develop, execute, and monitor unit testing plans to ensure accurate encounter processing.
Facilitate coordination between vendors, IT, and business partners to support encounter initiatives
Writes business and functional requirements for new system implementations and program updates.
Required Qualifications
- At least 3 years of experience in billing, claims, encounters, and/or data analysis, preferably in an analyst capacity in a managed care setting, or equivalent combination of relevant education and experience.
- Experience with data analysis techniques.
- Skilled with writing basic to advanced queries.
- Strong organizational and time management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
- Ability to work cross-collaboratively across teams/functions.
- Strong verbal and written communication skills.
- Microsoft Office suite and applicable software program(s) proficiency.
Preferred Qualifications
- Experience in claims processing, provider contacting, health data analysis and reporting, and project management.
- Experience working with various levels of leadership in a highly matrixed organization.
- Certified Professional Coder (CPC).
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Source: Molina Healthcare careers