Join Today: Encounter Analyst II
Invest in your future with this career-defining role as a Encounter Analyst II! The role is situated in Remote, offering a fantastic work environment. This position requires a strong and diverse skillset in relevant areas to drive success. You will be compensated with a competitive salary for your time and effort.
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The Encounter Analyst II is responsible for managing inbound and out bound files in the encounter management workflow, including monitoring and tracking sub-delegate file submissions, and providing insight and assistance with process issues. The position will require limited travel to the home office, located in Morrisville, NC, for meetings and training as needed. New hire employee training... will be in Morrisville for up to 3 weeks. Responsibilities & Duties Manage encounter/claims files  Monitor and track outgoing 837 files to NC Tracks and EPS  Monitor and track incoming 999 and 835 files from NC Tracks  Monitor and track incoming XML files from EPS  Track rebill files submitted by Encounter Team  Monitor and track carve out files (separately from others) for TCM and Maternity services  Conduct file transfers as needed, ensuring all files get to all appropriate locations through review and submission  Monitor and track vendor files in the data warehouse  Monitor and track vendor files in EPS Conduct data analysis and report findings  Monitor and Report Denial Trends for NC Tracks/EPS (Alliance and Vendors)  Monitor and Report File submission trends for both Alliance and Vendors Ensure accuracy, timeliness, and reconciliation of Service Level Agreement (SLA) files submitted  Ensure accuracy of SLA files by monitoring the number of encounters sent upstream (by Alliance and vendors)  Collect data on encounters that pass/fail (accept/error)- from vendor files compared to EPS representation  Ensure timeliness of SLA file submission by monitoring and tracking files to ensure files are inclusive of all encounters and are sent within time limits  Reconcile SLA files by monitoring and tracking paid amounts in the Encounter Processing System (EPS) for comparison against FRT values  Monitor subdelegates (DME, Vision, NEMT, Pharmacy) file submissions and copies of files sent to the Alliance Claims Data Warehouse to ensure all are accounted for in a timely manner Manage encounter denials  Assist team in encounter denial management when necessary (Medicaid and State Funding) Minimum Requirements Education & Experience High School diploma or equivalent and three (3) years of experience in claims/reimbursement or in the information systems departments of a healthcare or managed care environment. Knowledge of NC Medicaid billing, EDI, Alliance Claims System, and EPS a plus. Knowledge, Skills & Abilities  Knowledge of the Encounter Companion Guide, Encounter Data Submission Guide and the Encounter Data Manual published by State of NC Department of Health and Human Services  Knowledge of NC Medicaid and State billing requirements for physical and behavioral health claim processing and HIPAA guidelines  Knowledge of Electronic Payments and Statements (EPS) edit codes  Working knowledge of medical terminology, standard claim forms and coding  Working knowledge of healthcare services  Working knowledge of PC-based software programs or automated database management systems  Working knowledge of common denials and courses for corrections  Working knowledge of service authorizations, consumer eligibility, routine billing requirements and coordination of benefits  Excellent written and verbal communication skills with the ability to understand oral and written instructions  Proficient with Microsoft Office Products including Word, Excel and Power Point  Ability to enter routine and repetitive batches of data from a variety of source documents with structure time schedules  Ability to read/interpret contracts, standard reference materials (PDR, CPT, ICD-10, HCPCS and NDC) and revenue codes Salary Range $22.23 - $28.34/Hourly Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. An excellent fringe benefit package accompanies the salary, which includes:  Medical, Dental, Vision, Life, Short and Long and Short Term Disability  Generous retirement savings plan  Flexible work schedules including hybrid/remote options  Paid time off including vacation, sick leave, holiday, management leave  Dress flexibility Apply Job!Â
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