Job Description:
• Perform analysis of Encounter data
• Understand the financial and clinical impact of changes and decisions to the business process to ensure that the Service Level Agreements (SLAs) are achieved
• Support for Regulatory Data projects
• Responsible for reviewing Encounter rejections and providing resolution of minor to complex data issues or process changes
• Support for Claims Encounter Subject Matter Expertise (SME) for both CMS and State agencies and internal CareSource impacted organizations
• Build, sustain and leverage relationships with persons within his/her area of responsibility to allow for continuous improvement of the Encounter Data business process
• Support for testing and delivering process to business
• Participate in claims data processes to ensure accuracy and compliance with CMS and state agencies
• Participate in the key claims data management and readiness to state and governing entities
• Understand the Claims Encounter Data requirements in detail
Requirements:
• Bachelor’s degree in Science/Arts or equivalent years of relevant work is required
• Master’s Degree in Science/Arts preferred; concentration in Healthcare Analytics or Data Science preferred
• Minimum of one (1) year to two (2) years of managed healthcare, claims, or managed care regulated environment experience is required
• Minimum of one (1) year of experience using at least two of the following tools is required: SQL, SAS, SSIS. MySQL, ORACLE, R, or PowerBI
Benefits:
• Comprehensive total rewards package
• Bonus tied to company and individual performance
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