Encounters Analyst (Remote) at Partners Health Management

Encounters Analyst (Remote) at Partners Health Management

Competitive Compensation & Benefits Package

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

Office Location

Flexible for any of Partners' NC locations; Remote Option.

Projected Hiring Range

Depending on Experience

Closing Date

Open Until Filled

Primary Purpose of Position

The Encounter Analyst is responsible for managing inbound and outbound files in the encounter management workflow, including monitoring and tracking sub-delegate file submissions, and providing insight and assistance with process issues.

Role and Responsibilities

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 (Partners and Vendors)
• Monitor and report file submission trends for both Partners and Vendor

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 Partners 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 sub-delegates’ (DME, Vision, NEMT, Pharmacy) file submissions and copies of files sent to the Partners Claims Data Warehouse to ensure all are accounted for in a timely manner
• Complete dashboards for file certification

Knowledge, Skills, and Abilities

• Ability to analyze, interpret and prepare reports
• Analytical and detail oriented with excellent project management skills
• Knowledge of X12 EDI implementation and companion guides is a must
• Ability to write clear concise narratives and statistical reports
• Proficiency level in Microsoft Office 2016 or higher applications that include Excel, Word, PowerPoint, etc.
• Effective, easy to understand verbal, written and interpersonal communication skills
• Experience with MS Excel functions including working with large data sets and creating standardized reports/graphs
• Knowledge of the UB04 and HCFA 1500 required but not mandatory
• Ability to work well with others in a professional, team-oriented environment
• Two years’ experience working at a health plan or managed care organization in EDI or related departments
• Experience with encounter data submissions
• Ability to analyze large data sets and assist in the documentation of results
• Ability to communicate and work with outside vendors

Education/Experience Required

• Bachelor's Degree required, ideally in a healthcare or technical related field
• Minimum of two years of experience in a technical support and customer-service oriented environment
• Minimum of two years of experience working with interfaces
• One (1) or more years’ experience in Medicaid, Medicare, Commercial, and related encounters submission, health care, and risk adjustment required
• Three (3) or more years’ experience managing and reporting on progress of department initiatives required
• Knowledge of Medicaid, Medicare, Commercial, and related encounters or claims lifecycle
• Proven ability to communicate Medicaid, Medicare, Commercial, and/or related encounters or claims accuracy and reconciliation

Education/Experience Preferred

• Knowledge of NC EPS is plus
• Knowledge of PowerBI or similar data analysis is preferred
• Knowledge of the X12 837i, 837P and 835 is preferred

Licensure/Certification Requirements

N/A

Seniority Level

• Mid-Senior level

Employment Type

• Full-time

Job Function

• Business Development and Sales
• Hospitals and Health Care