Encounter Analyst II (Full-time Remote, North 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 insight 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 EPS
Monitor and track incoming 999 and 835 files from NC Tracks
Monitor and track incoming XML files from EPS
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 all files get to all appropriate locations through review and submission
Monitor and track vendor files in the data warehouse
Monitor and track vendor files in EPS
Conduct data analysis and report findings
Monitor and Report Denial Trends for NC Tracks/EPS (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 EPS representation
Ensure timeliness of SLA file submission by monitoring and tracking files to ensure files are inclusive of all encounters and are sent within time limits
Reconcile SLA files by monitoring and tracking paid amounts in the Encounter Processing System (EPS) for comparison against FRT values
Monitor subdelegates (DME, Vision, NEMT, Pharmacy) file submissions and copies of files sent to the Alliance Claims Data Warehouse to ensure all are accounted for in a timely manner
Manage encounter denials
Assist team in encounter denial management when necessary (Medicaid 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 healthcare or managed care environment.
Knowledge of NC Medicaid billing, EDI, Alliance Claims System, and EPS a plus.
Knowledge, Skills & Abilities
Knowledge of the Encounter Companion Guide, Encounter Data Submission Guide and the Encounter Data Manual published by State of NC Department of Health and Human Services
Knowledge of NC Medicaid and State billing requirements for physical and behavioral health claim processing and HIPAA guidelines
Knowledge of Electronic Payments and Statements (EPS) edit codes
Working knowledge of medical terminology, standard claim forms and coding
Working knowledge of healthcare 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 Microsoft Office Products including Word, Excel and Power Point
Ability to enter routine and repetitive batches of data from a variety of source documents with structure time schedules
Ability to read/interpret contracts, standard reference materials (PDR, CPT, ICD-10, HCPCS and NDC) and revenue 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, Vision, 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 Now
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 EPS
Monitor and track incoming 999 and 835 files from NC Tracks
Monitor and track incoming XML files from EPS
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 all files get to all appropriate locations through review and submission
Monitor and track vendor files in the data warehouse
Monitor and track vendor files in EPS
Conduct data analysis and report findings
Monitor and Report Denial Trends for NC Tracks/EPS (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 EPS representation
Ensure timeliness of SLA file submission by monitoring and tracking files to ensure files are inclusive of all encounters and are sent within time limits
Reconcile SLA files by monitoring and tracking paid amounts in the Encounter Processing System (EPS) for comparison against FRT values
Monitor subdelegates (DME, Vision, NEMT, Pharmacy) file submissions and copies of files sent to the Alliance Claims Data Warehouse to ensure all are accounted for in a timely manner
Manage encounter denials
Assist team in encounter denial management when necessary (Medicaid 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 healthcare or managed care environment.
Knowledge of NC Medicaid billing, EDI, Alliance Claims System, and EPS a plus.
Knowledge, Skills & Abilities
Knowledge of the Encounter Companion Guide, Encounter Data Submission Guide and the Encounter Data Manual published by State of NC Department of Health and Human Services
Knowledge of NC Medicaid and State billing requirements for physical and behavioral health claim processing and HIPAA guidelines
Knowledge of Electronic Payments and Statements (EPS) edit codes
Working knowledge of medical terminology, standard claim forms and coding
Working knowledge of healthcare 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 Microsoft Office Products including Word, Excel and Power Point
Ability to enter routine and repetitive batches of data from a variety of source documents with structure time schedules
Ability to read/interpret contracts, standard reference materials (PDR, CPT, ICD-10, HCPCS and NDC) and revenue 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, Vision, 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 Now