MRA Encounter Analyst

People. Passion. Purpose.

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients. We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization, then you should consider joining our team.

Overall Purpose

The primary role of the Risk Adjustment Encounter Analyst (RAA) will be to function as the encounter SME for P3. The RAA implements data analytic reports, as well as analyzes and researches data errors and issues related to CMS submissions. This requires collaboration with internal departments to work toward error resolution and risk outcome improvement. The RAA will own the encounter adjustment workflow associated with regulatory retrospective chart review efforts. The RAA will be responsible for the monitoring and management of the end-to-end data follow of data submissions to vendors and government agencies to mitigate data leakage. This includes identifying root cause and mitigation efforts. The RAA will review and apply all related regulatory requirements to department activities, i.e. audits, changes in rate models, changes in submissions, etc.

The position will also be responsible for the direction and completion of other ad-hoc projects; including data oversight and analyses as needed. The RAA must be a team player with great problem-solving skills and the ability to prioritize deadlines as appropriate.

Essential Functions

• Analyze, prioritize & support resolution of Claims/ Encounter data errors by triaging to the appropriate internal departments for a resolution, and/or work with encounter submissions vendor for resolution
• Work with the Director and Market Risk Adjustment Analysts on monthly operational and performance reporting and dashboards
• Monitor and manage end-to-end data submissions to vendors and government agencies for assigned populations to mitigate data leakage and/or submission errors.
• Cross-train to handle similar tasks across all lines of business

Knowledge, Skills, and Abilities

• Basic to intermediate skill level with Microsoft Excel, SQL & Power Point
• Ability to problem solve

Experience

• Strong claims processing skill, understanding of medical terminology, and familiarity with medical records
• Basic Data Warehouse knowledge and experience with Microsoft SQL
• Strong communication and strong written skills
• Working knowledge of the provider-based healthcare industry, claims processing, provider billing or Risk Adjustment or Medicare Advantage strongly preferred

Education

• BA or BS – Mathematics, Finance, Economics, Management, other