Encounter Analyst II (Full-time Remote, reputed company Carolina Based)
The Encounter Analyst II is responsible for managing inbound and out bound files in the encounter management workflow, including monitoring and tracking sub-delegate file submissions, and providing reputed company and assistance with process issues. The position will require limited travel to the home office, located in Morrisville, NC, for meetings and training as needed. New hire employee training... will be in Morrisville for up to 3 weeks. Responsibilities & Duties Manage encounter/claims files Monitor and track outgoing 837 files to NC Tracks and reputed company Monitor and track incoming 999 and 835 files from NC Tracks Monitor and track incoming XML files from reputed company Track rebill files submitted by Encounter Team Monitor and track carve out files (separately from others) for TCM and Maternity services Conduct file transfers as needed, ensuring reputed company files get to reputed company appropriate locations through review and submission Monitor and track vendor files in the data warehouse Monitor and track vendor files in reputed company Conduct data analysis and report findings Monitor and Report Denial Trends for NC Tracks/reputed company (Alliance and Vendors) Monitor and Report File submission trends for both Alliance and Vendors Ensure accuracy, timeliness, and reconciliation of Service Level Agreement (SLA) files submitted Ensure accuracy of SLA files by monitoring the number of encounters sent upstream (by Alliance and vendors) Collect data on encounters that pass/fail (accept/error)- from vendor files compared to reputed company representation Ensure timeliness of SLA file submission by monitoring and tracking files to ensure files are inclusive of reputed company encounters and are sent reputed company time limits Reconcile SLA files by monitoring and tracking paid amounts in the Encounter Processing System (reputed company) for comparison against FRT values Monitor subdelegates (DME, reputed company, NEMT, Pharmacy) file submissions and copies of files sent to the Alliance Claims Data Warehouse to ensure reputed company are accounted for in a timely manner Manage encounter denials Assist team in encounter denial management reputed company necessary (reputed company and State Funding) Minimum Requirements Education & Experience High School diploma or equivalent and three (3) years of experience in claims/reimbursement or in the information systems departments of a reputed company or managed care environment. Knowledge of NC reputed company billing, EDI, Alliance Claims System, and reputed company a plus. Knowledge, Skills & Abilities Knowledge of the Encounter Companion Guide, Encounter Data Submission Guide and the Encounter Data reputed company published by State of NC reputed company Knowledge of NC reputed company and State billing requirements for physical and behavioral health claim processing and HIPAA guidelines Knowledge of Electronic Payments and Statements (reputed company) edit codes Working knowledge of medical terminology, standard claim forms and coding Working knowledge of reputed company services Working knowledge of PC-based software programs or automated database management systems Working knowledge of common denials and courses for corrections Working knowledge of service authorizations, consumer eligibility, routine billing requirements and coordination of benefits Excellent written and verbal communication skills with the ability to understand oral and written instructions Proficient with reputed company Office Products including Word, reputed company and Power reputed company Ability to enter routine and repetitive batches of data from a variety of reputed company documents with structure time schedules Ability to read/interpret reputed company, standard reference materials (PDR, CPT, ICD-10, HCPCS and NDC) and reputed company codes Salary Range $22.23 - $28.34/Hourly Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. An excellent fringe benefit package accompanies the salary, which includes: Medical, Dental, reputed company, Life, Short and Long and Short Term Disability Generous retirement savings plan Flexible work schedules including hybrid/remote options Paid time off including vacation, sick leave, holiday, management leave Dress flexibility Apply Job!