[Work From Home] Encounter Analyst II
Quick Overview:Compensation: a competitive salaryLocation: RemoteCompany: WorkwarpPosition: Encounter Analyst IIStart Date: Immediate openings available  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
Education
Required
 High School or better in General Studies
Skills
Required
 Communication
 Microsoft Office Apply Job! Join Our Team!This is a fantastic opportunity to grow your career. If you have the skills and passion we're looking for, please submit your application today.
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
Education
Required
 High School or better in General Studies
Skills
Required
 Communication
 Microsoft Office Apply Job! Join Our Team!This is a fantastic opportunity to grow your career. If you have the skills and passion we're looking for, please submit your application today.
Apply Now