Senior Analyst, Encounters (Medicare)

Molina Healthcare; Northern (KY); Hybrid; USD 54,000 - 118,000; Full time

Job summary

Molina Healthcare is seeking a Sr Analyst, Encounters to monitor inbound and outbound encounter submissions and ensure timely, accurate submission across moderate- to high-complexity markets. You will perform data analysis, identify root causes, and collaborate with IT, health plan, claims, and providers to implement improvements.

The role emphasizes KPI tracking, reporting, and cross-functional coordination to maintain compliance and optimize performance within the organization.

Qualifications

• At least 3 years of experience in billing, claims, encounters, and/or data analysis.
• Experience with data analysis techniques.
• Skilled with writing basic to advanced queries.
• Strong organizational and time management skills.
• Ability to work cross-collaboratively across teams/functions.
• Strong verbal and written communication skills.
• Microsoft Office suite proficiency.

Responsibilities

• Monitors inbound and outbound encounters submissions and responses, interprets outcomes, and takes swift action to remediate errors.
• Routinely reviews submission results and analyzes encounter pend and rejection inventory, and works with IT, health plan, claims, provider, enrollment, regulators, and external vendors to remediate errors and ensure timely, accurate, and complete encounter submissions.
• Owns and maintains encounter submission criteria, maintains submission schedule, central documentation of market nuances, compliance, and regulatory requirements for primary market or state.
• Responsible for maintaining market or state-specific KPIs, and reports monthly and quarterly results.
• Understands and communicates financial and performance impacts related to encounter submissions.
• Assists with preparing portions of materials for Monthly Governance and Operations Reviews.
• Performs root cause analysis of claims and encounter data and develops recommendations based on data and industry knowledge; collaborates to design and implement systems changes.
• Writes business requirements for system updates to resolve errors and optimize encounter performance.
• Participates in and/or leads projects to address corrections, changes, and updates to ensure encounter submissions acceptance.
• Develops basic reports and distributes to appropriate departments for error resolution, follow up, and performance monitoring.
• Understands provider, member, and inbound claims data compliance in relation to encounters submission requirements.
• Monitors vendor encounter submissions, contractual compliance, and SLAs.

Skills

Data analysis

SQL queries

Organizational skills

Cross-functional collaboration

MS Office

Tools

SQL

Microsoft Office

Job description

JOB DESCRIPTION

Job Summary

The Sr Analyst, Encounters is responsible for monitoring inbound and outbound encounter processes and ensuring timely, accurate, and complete encounter submissions for moderate- to high-complexity markets or states. Performs data analysis using internal and external sources, analyzes processes and provides recommendations for improvement to decision-makers. At the direction of the Manager, Encounters, collaborates with cross-functional teams to identify and resolve root causes of issues that impact encounters and identify improvements to operational performance.

Job Duties

• Monitors inbound and outbound encounters submissions and responses, interprets outcomes, and takes swift action to remediate errors
• Routinely reviews submission results and analyzes encounter pend and rejection inventory, and works with other areas including IT, health plan, claims, provider, enrollment, regulators, and external vendors, as needed, to remediate encounter errors and ensure timely, accurate, and complete encounter submissions
• Owns and maintains encounter submission criteria, maintains submission schedule, central documentation of market nuances, compliance, and regulatory requirements for primary market or state
• Responsible for maintaining market or state-specific KPIs, and reports monthly and quarterly results
• Understands and communicates financial and performance impacts related to encounter submissions
• Assists with preparing portions of materials and information for Monthly Governance and Operations Reviews
• Performs root cause analysis of claims and encounter data and develops recommendations based on data and industry knowledge. Collaborates across departments to design and implement systems changes to meet encounter data processing and submission goals.
• Writes business requirements for system updates to resolve errors and optimize encounter performance
• Participates in and/or leads projects to address corrections, changes, and updates to ensure encounter submissions acceptance.
• Develops basic reports and distributes to appropriate departments for error resolution, follow up, and performance monitoring.
• Understands provider, member, and, inbound claims data compliance in relation to encounters submission requirements
• Monitors vendor encounter submissions, contractual compliance, and SLAs

Required Qualifications

• At least 3 years of experience in billing, claims, encounters, and/or data analysis, preferably in an analyst capacity in a managed care setting, or equivalent combination of relevant education and experience.
• Experience with data analysis techniques.
• Skilled with writing basic to advanced queries.
• Strong organizational and time management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Ability to work cross-collaboratively across teams/functions.
• Strong verbal and written communication skills.
• Microsoft Office suite and applicable software program(s) proficiency.

PREFERRED EXPERIENCE

• Claims processing, provider contacting, health data analysis and reporting, project management, working with various levels of management throughout multiple organizations
• Managed care experience
• 5-7 years of experience in billing, claims, encounters, and data analysis
• 5 years or more of managed care experienceknowledge of advanced data analysis techniquesCertainly, it should be
  five years or more, but previously I've applied as clicking a measure founded with 500 IT gating data too. Sounding it: But is the user a digital platform rather than 37 offered? Probably we want to elaborate more about each variable and ...
• Knowledge of advanced data analysis techniques
• Skilled with writing basic to advanced SQL queries

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION

Certified Professional Coder (CPC)

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $54,373.27 - $117,808.76 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.