Note: The job is a remote job and is open to candidates in USA. Molina Healthcare is seeking a Senior Analyst, Encounters to monitor and improve encounter submission processes for moderate- to high-complexity Medicare markets or states. The role analyzes encounter, claims, and related data, resolves root causes of submission errors, maintains performance metrics and compliance documentation, and collaborates with cross-functional teams and vendors on operational improvements.
Responsibilities
- Monitors inbound and outbound encounters submissions and responses, interprets outcomes, and takes swift action to remediate errors
- Routinely reviews submission results and analyzes encounter pend and rejection inventory, and works with other areas including IT, health plan, claims, provider, enrollment, regulators, and external vendors, as needed, to remediate encounter errors and ensure timely, accurate, and complete encounter submissions
- Owns and maintains encounter submission criteria, maintains submission schedule, central documentation of market nuances, compliance, and regulatory requirements for primary market or state
- Responsible for maintaining market or state-specific 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
- Writes business requirements for system updates to resolve errors and optimize encounter performance
- 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 SLAs
Skills
- 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
- Claims processing, provider contacting, health data analysis and reporting, project management, working with various levels of management throughout multiple organizations
- Managed care experience
- 5-7 years of experience in billing, claims, encounters, and data analysis
- 5 years or more of managed care experience
- Knowledge of advanced data analysis techniques
- Skilled with writing basic to advanced SQL queries
- Certified Professional Coder (CPC)
Company Overview
Company H1B Sponsorship