Claims Encounter Analyst

MUST BE ABLE TO WORK FULLY ONSITE IN NORTHRIDGE, CA.

Position Summary:

The Encounter Data Analyst I, interprets results using a variety of techniques, ranging from simple data aggregation via statistical analysis to complex data mining. Designs, develops, implements and maintains business solutions. Works directly with clients and project and business leaders to identify analytical requirements. This position is responsible for analyzing and correcting rejected encounters in a timely manner for Clearing House and Direct submitters. This position is accountable to ensure that encounters are corrected according to Health Plan industry standards and guidelines set by CMS and DHCS.

Essential Duties and Responsibilities include the following:

• Correct rejected encounters , follow CMS and DHCS Claims processing guidelines and industry standard in correcting rejected encounters
• Responsible for the entry of claims system support tables and oversight of processes to ensure our groups are meeting 5010 requirements and required to perform specialized area data entry or general data maintenance for eligibility, providers, fee sets, and benefits or any other areas that require ongoing support.
• Conduct Root Cause analyst for encounter errors, meet with departments to go over processes or programming to minimize root cause.
• Create and maintain an encounter error library.
• Analyze trends of rejected encounters.
• Develop and test internal audit/IDM reports to prevent rejected. Follow through that departments are maintaining audit reports.
• Create policy and procedures to correct rejected encounters.
• Create daily and weekly reports.
• Establish and maintain strong relationships with Health Plans, Encounter Clearing Houses, and internal stakeholders to fix, prevent, and to obtain extra support in resolving encounter errors.
• Educate internal stakeholders regarding regulator changes for encounters.
• Lead and attend meetings as required.
• Provides training to staff member in encounter corrections process.
• Adhere to Data integrity policies for all system configurations.
• Performs other duties as necessary.

The pay range for this position at commencement of employment is expected to be between $27 - $30 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Requirements:

Education and / or Experience:

• Proficiency in Word, Excel, Access, Outlook, EZCAP and Encoder Pro.
• Knowledge of Claim adjudication process (Professional & Institutional) required.
• Knowledge in SQL Server.
• Previous experience in a medical group / healthcare setting.
• Proficiency in running data queries, analyzing and reconciling using multiple data sources.
• Knowledge and experience in Project Management preferred.
• Excellent time management skills.
• Outstanding communication skills.
• Fee schedule knowledge.
• Diagnosis and procedures codes knowledge preferred.
• Understanding of the Health Care industry, benefits, and eligibility processes preferred.
• Medical group or IPA operations and information systems management preferred.
• Ability to be a problem solver.
• A bachelor's degree from a four-college or appropriate industry experience and/or certification preferred.

Compensation: $27 Hr to $30 HR