Business Rules & Encounters Analyst

Cbhphilly; Philadelphia, Northern (Philadelphia County, KY); Hybrid; USD 67,000 - 68,000; Full time

Job summary

CBH Philadelphia is seeking a Business Rule Management Analyst at our Philadelphia location. The role ensures compliant submission of encounter data to the State, maintains the claims adjudication system, and translates business requirements into system functionality.

The ideal candidate will have 3+ years in Claims or Behavioral Health, strong analytical skills, and proficiency with Excel and Word. Knowledge of HIPAA EDI 5010 is a plus, with a focus on accuracy and process improvement.

Qualifications

• At least 3 years of experience in Claims or Behavioral Health.
• Proficient in Excel and Word.
• Knowledge of HIPAA EDI 5010 transaction sets.

Responsibilities

• Monitor and ensure accurate, timely, and compliant submission of encounter data.
• Analyze encounter errors and perform root-cause analysis to identify discrepancies.
• Translate business requirements into system rules and configurations.
• Maintain and document business rules, configurations, testing, and implementations.

Skills

Analytical skills

Excel

Word

HIPAA EDI 5010

Job description

CBH Philadelphia is seeking a Business Rule Management Analyst at our Philadelphia location. The role ensures compliant submission of encounter data to the State, maintains the claims adjudication system, and translates business requirements into system functionality.

The ideal candidate will have 3+ years in Claims or Behavioral Health, strong analytical skills, and proficiency with Excel and Word. Knowledge of HIPAA EDI 5010 is a plus, with a focus on accuracy and process improvement.