Senior Medicare Encounters Data Analyst

Molina Healthcare; United States; On-site; USD 90,000 - 120,000; Full time

Job summary

Molina Healthcare is seeking a Sr Analyst, Encounters to monitor and improve encounter submissions across markets. You will analyze data, identify root causes, and collaborate with IT, health plan, claims, and provider teams to remediate issues.

The role involves maintaining submission criteria, KPIs, and preparing materials for governance reviews, with a focus on timely and accurate processing and regulatory compliance.

Qualifications

• 3+ years of experience in billing, claims, encounters, and/or data analysis
• Experience with data analysis techniques
• Skilled with writing basic to advanced queries (SQL)
• Strong organizational and time management skills
• Ability to work cross-collaboratively across teams/functions
• Strong verbal and written communication skills
• Proficiency with Microsoft Office and applicable software programs

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, coordinating with IT, health plan, claims, provider, enrollment, regulators, and vendors
• Owns and maintains encounter submission criteria, submission schedule, and market-specific documentation
• Maintains market/state KPIs and reports monthly and quarterly results
• Understands and communicates financial and performance impacts related to encounter submissions
• Assists with materials for Monthly Governance and Operations Reviews
• Performs root cause analysis of claims and encounter data and designs system changes
• Writes business requirements for system updates to resolve errors
• Participates in/returns leadership on projects addressing corrections and updates for encounter submissions
• Develops basic reports for error resolution, follow-up, and performance monitoring
• Understands data compliance for encounters submission
• Monitors vendor encounter submissions, contractual compliance, and SLAs

Skills

Data analysis

SQL queries

Organizational skills

Cross-functional collaboration

Communication (verbal/written)

Microsoft Office

Tools

SQL

Microsoft Office

Job description

Molina Healthcare is seeking a Sr Analyst, Encounters to monitor and improve encounter submissions across markets. You will analyze data, identify root causes, and collaborate with IT, health plan, claims, and provider teams to remediate issues.

The role involves maintaining submission criteria, KPIs, and preparing materials for governance reviews, with a focus on timely and accurate processing and regulatory compliance.