Encounter Data Analyst Jobs

ATRIO Health Plans is looking for a motivated and eager Encounter Data Analyst to join their growing team! This a remote opportunity with ATRIO's headquarters based in Oregon (Pacific Standard Time).

Position Summary:

The Encounter Data Analyst, reporting into the VP of Risk Adjustment, will coordinate with submission vendors to ensure accurate and timely encounter/rejection file processing and submission to the Centers for Medicare & Medicaid Services (CMS). This position will utilize their knowledge of the overall claims process to provide input on encounter/rejection opportunities for improvements and to resolve/reduce encounter rejection errors.

Responsibilities:

• Work with internal staff and submission vendors as needed to ensure resolution of errors
• Engage with encounter submission vendors for better understanding of the steps of the data submission process to CMS and error resolution
• Perform review of encounter data feed to vendors to reduce submission errors
• Participate in vendor and internal discussions as subject matter expert and provide input on suggested process improvements
• Interpret and understand CMS encounter data processing system (EDPS) requirements
• Identify trends and suggest and develop efficiencies in the review of reports and other documentation by reviewing procedures and making appropriate suggestions and adjustments to procedures
• Resolve complex encounter errors by analyzing data and related enrollment, claims, and other data sources and determine appropriate action to be taken

Professional Competencies:

• Ability to contribute to team efforts and evaluate processes for potential improvements
• Excellent attention to detail
• High degree of accuracy
• Ability and willingness to work overtime as necessary
• Basic knowledge of Microsoft software (Outlook, Excel, Word and Teams)
• Comprehensive knowledge/understanding of claims processing and resolution
• Comprehensive knowledge/understanding of encounter data processing and error resolution
• Ability to take initiative and show ownership for outcomes
• Knowledge of medical procedures, diagnosis coding, and terminology
• Strong written and verbal communication skills
• Ability to work effectively and prioritize tasks

Required Experience & Education:

• 2 years of experience in Medicare Advantage EDPS processing/resolution preferred
• Must have a firm understanding of 837 specification requirements
• 2 years of prior job-related experience demonstrating strong analytical capabilities
• Payor/health plan experience is required
• Associates degree in business administration/healthcare or equivalent years of related work experience (Bachelor’s degree in related field preferred)