Encounter Data Analyst

Encounters Data Analyst III is responsible for performing analysis of all data into, out of, and within the Client in support of Encounters Revenue and Remediation efforts.

Expected Skillset:

• Comprehensive knowledge of healthcare EDI transactions : Familiarity with 837 Institutional/Professional/Dental, and response transactions such as 835, 277U, 999, and TA1.
• Experience with healthcare program implementations : Previous experience with Tricare, Marketplace, Medicaid, or MMP markets, with Tricare implementation experience preferred .
• Data validation expertise : Proficient in validating internally generated data and vendor-submitted data to ensure quality assurance before submission to the state.
• Vendor collaboration : Skilled in managing vendors and providing guidance on encounter-related aspects.
• Encounter rejection resolution : Previous experience resolving encounter rejections is highly desirable.
• Documentation analysis and solution development : Ability to review state documentation, propose implementation strategies, and engage internal IT and cross-functional teams to execute solutions.
• Stakeholder communication : Experienced in representing the organization during vendor and state calls, providing project updates, and maintaining clear communication.
• SQL proficiency : Capable of running SQL queries to support software quality assurance (SQA), generate summary reports, and manually create X12 data for testing or proof-of-concept validations.
• Knowledge of Medicaid programs and EDI standards : Familiarity with CMS/state Medicaid programs, including a strong understanding of the 5010 837 Implementation Guide and state-specific companion guides.
• Strong communication and documentation skills : Excellent written and verbal communication skills are highly valued.

Nice to Have:

• Enterprise Data Warehouse (EDW) experience : Previous experience extracting data from an EDW and providing requirements/validation on EDW data is a plus.
• State SLA reporting : Understanding state Service Level Agreements (SLAs) such as accuracy, completeness, timeliness, and throughput, with experience creating dashboard reports for SLA metrics.
• NCPDP transaction management : Previous experience managing NCPDP transactions is an advantage but not required.
• Claims adjudication systems : Knowledge of FACETS or similar claims adjudication systems.
• EDIFECS expertise : Familiarity with the EDIFECS Encounter Management system.