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Encounter Claims Data Analyst

5.00 to 7.00 Years   Pune   07 Jul, 2020
Valence Health
Job LocationPune
EducationNot Mentioned
SalaryNot Disclosed
IndustryMedical / Healthcare
Functional AreaSales / BD
EmploymentTypeFull-time

Job Description

Position summary

  • Responsible for timely, complete, and accurate encounter data submissions that meet or exceed state and/or federal requirements
  • Work with HPS Business Operations and IT Engineering to implement a strategic approach to encounter data management encompassing internal and external data sources, technical infrastructure, process automation, and issue/reject remediation workflow
  • Identify, develop and drive initiatives to increase the Encounter Operations function regulatory compliance levels, productivity/efficiency, process consistency, and long - term scalability
  • Oversee the on - boarding of new encounter clients to include requirements gathering/documentation and coordination with HPS Implementation, Business Operations, and/or HPS Engineering teams (as required)
  • Develop and execute action plans to respond to new encounter regulatory requirements
  • Efficiently and effectively manage internal and external escalations
  • Data management and analysis reporting utilizing SQL, MicroStrategy and similar reporting tools
  • Encounter management and processing utilizing Encounter Management platform

Essential functions

  • Experience working in Client facing engagements and act as key Stakeholder in the TPA functions related to Encounter Management and Reporting.
  • Experience working among Payer & Provider Community to facilitate implementation of improvements of State/Federal Managed Care Programs or similar Care Coordination programs.
  • Ability to manage and track the implementation of tasks, operational improvements and enhancements in order to meet Client specific goals.
  • Experience in Executive level clear and concise project status and data management reporting.
  • Experience working in vertically aligned cross functional teams to identify interdependencies to support program implementation and enhancements.
  • Experience with mentoring and training other Business Analyst to support ongoing operations.
  • Understanding and experience with standard claim Electronic Data Interchange file formats and protocols such as 837I, 835, 277, 999 among others
  • Hands - on experience with EDI X12 837 transaction set in the context of CMS EDGE data submission
  • Excellent analytical and problem - solving skills in Healthcare data operations, specifically with Claims/Configuration and Encounters data
  • Strong SQL Server Management Studio experience or similar products

Academic Qualification

  • Bachelor s degree in Healthcare Management, Computer Science or another technology/business field of study.
,

Keyskills :
sqldata analysismicrosoft excelcustomer relationsreportingsql server management studioelectronic data interchangesql servermanaged caredata managementreporting toolsversion controlcustomer servicecomputer sciencebusiness analysisserver mana

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