Analyst, Encounters (PST hours)

Job Description

***This remote position will have standard PST business hours**

Job Summary

The Analyst, Encounters is responsible for monitoring inbound and outbound encounters processes and ensuring timely, accurate, and complete encounter submissions for low- to moderate-complexity markets or states. Performs data analysis using internal and external sources using SQL programming, analyzes processes and provides recommendations for improvement to decision-makers. At the direction of the Manager, Encounters, collaborates with cross-functional teams to identify and resolve root causes of issues that impact encounters and identify improvements to operational performance.

Job Duties

• Monitors inbound and outbound encounters submissions and responses, interprets outcomes, and takes swift action to remediate errors
• Routinely reviews submission results and analyzes pend and rejection inventory by using SQL programming, and works with other areas as needed to remediate encounter errors and to ensure timely, accurate, and complete submissions
• Owns and maintains encounter submission criteria, maintains submission schedule, central documentation of market nuances, compliance, and regulatory requirements for primary market or state
• Understands market or state-specific KPIs and 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 encounters 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.
• Writes business requirements for system updates to resolve errors and optimize encounter performance
• Participates in workgroups to resolve encounter data and process issues
• 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
• Maintains awareness of vendor encounter submission requirements and status

Job Qualifications

REQUIRED EDUCATION:

High School Diploma or GED

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 3-5 years of experience in billing, claims, encounters, and data analysis
• Knowledge of basic data analysis techniques
• Skilled with running basic SQL queries

PREFERRED EDUCATION:

Bachelor’s Degree or equivalent work experience

PREFERRED EXPERIENCE:

Managed care experience

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

Certified Professional Coder (CPC)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.