Eligibility & Encounters Data Analyst (Accountable Care)

Stanford Health Care - ValleyCare; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider is seeking an Eligibility & Encounters Data Analyst to maintain data integrity for ACO members. This role involves collaborating with vendors, verifying eligibility, and ensuring accurate encounter data processing. Ideal candidates will have strong communication skills and relevant experience in health-related fields. Join us to make a difference in patient care and operational efficiency.

Qualifications

• 3-5 years in health-related fields, including Eligibility Data and Encounters.
• Knowledge of Electronic Data Interchange processes.

Responsibilities

• Verify eligibility using Health Plan websites or by calling eligibility contacts.
• Track encounter reject records for reporting.

Skills

Communication

Organizational Skills

Problem-Solving

Education

Associate Degree

Tools

Microsoft Office Suite

EPIC

Tapestry

Job description

Eligibility & Encounters Data Analyst (Accountable Care) page is loaded

Eligibility & Encounters Data Analyst (Accountable Care)

Apply remote type Remote locations Remote - USA time type Full time posted on Posted 2 Days Ago job requisition id R2547479

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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview

Under the direction of ACO Operations Management, the Eligibility and Enrollment (E&E) Data Analyst performs specialized functions to maintain eligibility data integrity for ACO members and collaborate closely with Team Lead and/or Manager on work assignment prioritization and maintain assigned process and procedure documents. The E&E Data Analyst is an intermediate level in the Eligibility and Enrollment job series. The analyst coordinates with third-party vendors to ensure Tapestry Encounter data rejects are processed accurately. Strong knowledge of Commercial and Managed Care plans is required.

Locations
Stanford Health Care

What you will do

• Eligibility:
• Verify eligibility using Health Plan websites or by calling the eligibility contact number.
• Create or update Member records in Tapestry with accurate notations.
• Create or update Member coverage details in Tapestry.
• Identify non-member claims and document each case clearly to support the mail-back notification process.
• Collaborate with Decision Support for root cause analysis and resolution.
• Assist in creating and maintaining procedure documents.

• Encounters:
• Navigate fluently in Clearing House and third-party vendor portals, understanding each portal's functionality.
• Track encounter reject records for reporting.
• Assist in creating and maintaining procedure documents.
• Resolve enrollment system rejections within portals.

• Communication:
• Work with internal teams involved in registration and claims processing.
• Coordinate with external vendors and Health Plans.
• Escalate complex issues to supervisors or management.
• Proactively notify managers of issues or obstacles.
• Use strong writing skills for email communication and internal documentation.
• Communicate effectively verbally.

• Customer Service:
• Respond promptly to emails and calls, maintaining professionalism and confidentiality.

• Operational Efficiency:
• Re-prioritize tasks as needed to adapt to departmental changes.
• Collaborate across departments and outside agencies to meet patient needs.
• Meet or exceed productivity and quality standards.
• Assist with special projects and other duties as assigned.
• Adhere to safety, HIPAA, and compliance policies.

Education Qualifications

• Associate degree or equivalent experience considered.

Experience Qualifications

• 3-5 years in health-related fields, including Eligibility Data and Encounters.
• Knowledge of Electronic Data Interchange processes.
• Claims and Referrals experience preferred.
• EPIC/Tapestry experience preferred.

Required Knowledge, Skills, and Abilities

• Strong communication and interpersonal skills.
• Ability to stay composed during challenging interactions.
• Organizational and prioritization skills.
• Proficiency in Microsoft Office Suite.
• Problem-solving skills.
• Ability to interpret and apply guidelines.

Physical Demands and Work Conditions

• Constant sitting, hand use, and repetitive motions.
• Frequent walking, twisting, turning, and fine manipulation.
• Occasional standing, bending, squatting, climbing, kneeling, crawling, pushing, pulling, reaching, and lifting (up to 20 lbs).

Principles for All Employees

Stanford Health Care emphasizes the C-I-CARE standards to deliver exceptional patient and family experiences, focusing on knowing, guiding, and coordinating care.

Equal Opportunity Employment

Stanford Health Care values diversity and is committed to equal opportunity employment without discrimination based on race, gender, age, disability, or other protected characteristics. All qualified applicants are encouraged to apply.