Business Encounter Data Analyst
WellSense Health Plan
- New Hampshire Massachusetts
- Permanent
- Full-time
- Understand the claims encounter data requirements in detail to ensure claims data is complete, accurate, and timely.
- Responsible for reviewing encounter rejections and providing resolution of minor to complex data/system issues or processes.
- Responsible for the development and maintenance of supporting business processes and workflows.
- Recognize inconsistencies and gaps to improve productivity, accuracy and data usability and streamlining procedures and policies.
- Provide critical analysis of functional performance, and make recommendations for enhancements, and process improvements.
- Build, sustain and leverage relationships to constantly allow for continuous improvement of the encounter data business process.
- Provide encounter data support to vendors and ensure understanding of regulatory encounter requirements.
- Participate in claims encounter initiatives such as working with IT and other internal departments to automate claims encounters functions.
- Understanding of how claims payment methodologies, adjudication processing and CMS and State encounter regulations interrelate to maintain compliant encounter reconciliation processes and SLA’s.
- Stay current with the needs and operations of the regulatory deliverables.
- Interacts with business stakeholders, internal and external as appropriate, to understand new business requirements and enhancement requests.
- Provide business encounter subject matter expertise for internal departments and both CMS and State agencies.
- Performance for timely and accurate reviews must meet or exceed internal, CMS, and State SLA requirements.
- Other duties as assigned.
- Bachelor's Degree in a related field or the equivalent combination of training and experience
- Effective collaborative and proven process improvement skills.
- Good communication skills, both oral and written, ability to interact well with others at all levels, strong organizational skills, strong customer service skills and orientation.
- A strong working knowledge of Microsoft Office products.
- Independent thinker and problem solver with an analytical mind and the ability to solve complex data and workflow issues.
- Detail oriented.
- Time management skills; capable of multi-tasking and prioritizing work.
- Regular and reliable attendance is an essential function of the position.
- Work is normally performed in a typical interior/office work environment.
- No or very limited physical effort required. No or very limited exposure to physical risk.