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Posted 2w ago

Claims Encounter Data Analyst

@ CenCal Health
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Santa Barbara, California, United States
$78k-$114k/yrRemoteFull Time
Responsibilities:analyzing data, validating encounters, reporting findings
Requirements Summary:Experience with EDI 837 transactions, claims/encounter coding (CPT/HCPCS, ICD-9/10, NDC), MS Access/Excel/Word and/or SQL, Oracle and Caradigm familiarity, 2+ years data analysis in managed care preferred, strong analytical and communication skills.
Technical Tools Mentioned:EDI 837, CPT, HCPCS, ICD-9, ICD-10, NDC, Microsoft Access, Microsoft Excel, Microsoft Word, SQL, Oracle, Caradigm
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Job Description

Salary Range: $78,454.00 - $113,758.00

The Encounter Data Quality Analyst is responsible for providing analytical and reporting support to the Claims Operations, Outsourced Vendors and IT support team related to the processing and delivery of encounter data. Validates and analyzes reports and logs related to the processing of 837 transactions to ensure compliance, accuracy, completion and timeliness, as well as ongoing process improvement. Position reports to the Associate Director of Claims.

Duties and Responsibilities 

  • Adhere to regulatory and internal guidelines in conjunction with CenCal Health policies and procedures as they apply to both internal and external encounter reporting
  • Perform data analysis of submitted encounter data files from external entities and produce regular reports of findings
  • Work in conjunction with outside vendors on claim file submission rejections to assure corrections are made so that clean data is being submitted prior to each load into the Caradigm system
  • Monitor and analyze encounter data reporting of encounter data 
  • Maintain a thorough knowledge of CenCal Healths encounter data reporting requirements 
  • Analyze, interpret, and summarize encounter data for development of solutions for reducing and mitigating errors
  • Analyze existing and future encounter submission regulatory guidelines to ensure compliance with system editing logic
  • Work in conjunction with the IT department on encounter data issues and process development related to successful encounter management
  • Work in conjunction with outside vendors on encounter data issues and develop a process to assure quality data is being provided
  • Work cooperatively on ongoing Encounter Data Process Improvement projects with other CenCal Health departments as well as external vendors and Provider Community
  • Maintain spreadsheets for reporting of encounter related projects both within the department as well as company wide
  • Recommend corrective action to resolve processing and data issues
  • Perform other duties as assigned