Senior Encounters Analyst - Medicare Data & Submissions

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

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.