San Francisco, California
Evansville, Indiana, Indiana
Tupelo, Mississippi, Mississippi
Sioux Falls, South Dakota, South Dakota
Johnson City, Tennessee, Tennessee
Posted: 19-Sep-24
Location: Remote,
Salary: Open
Internal Number: 24010904
JOB SUMMARY
The Risk Adjustment Analyst Sr (Texas Medicaid Encounter Analyst) is responsible for monitoring and oversight of the end-to-end encounter management workflow. Supports program management activities around risk adjustment data management and submissions to government agencies such as Centers for Medicare and Medicaid Services (CMS) or Health & Human Services (HHS).
SALARY (BASED OFF OF RELEVANT EXPERIENCE)
The pay range for this position is $36.80 (entry-level qualifications) - $57.03 (highly experienced) The specific rate will depend upon the successful candidate?s specific qualifications and prior experience.
ESSENTIAL FUNCTIONS OF THE ROLE
- Monitors and oversees the end-to-end claims encounter management workflow.
- Analyzes claims and supplemental data to identify reporting gaps, risk gaps, or sources of incorrect and incomplete diagnostic data.
- Performs analysis and reporting activities related to risk score calculation, encounter data submission, chart review programs and audits, and related performance metrics per regulatory and health plan guidelines.
- Using data from internal and external sources, analyzes complex encounter inbound/outbound process issues to provide insight to decision-makers.
- Researches and documents encounter errors in established systems and databases with appropriate statistical trend analysis; performs root cause analysis of encounters processing and submission issues and develops recommendations based on data and industry standards.
- Performs various financial analysis such as revenue forecasting and ROI.
- Contributes to program improvement by designing and implementing business process and system changes, collaborating to resolve encounter data and process issues and managing policy and procedure documentation.
KEY SUCCESS FACTORS - Advanced knowledge of SQL, MS Excel, MS Access, MS Word, MS Visio and MS PowerPoint.
- Using SQL, able to design and run intermediate to complex queries and reports from multiple databases.
- Able to independently gather, interpret and analyze data for the purpose of identifying trends, problems and opportunities for improvement.
- Excellent time management and organizational skills with the ability to handle multiple tasks in a timely and accurate manner.
- Able to work under pressure, adhere to deadlines and know when to escalate information and issues.
- Highly motivated and able to work with minimal guidance, independently and as a team participant.
- Outstanding verbal and written communications skills with the ability to communicate clearly to all levels of an organization.
- Ability to work in a high paced environment independently and with cross functional groups.
- Knowledge of ACA, Medicare, Medicaid, MCO, TPA business requirements preferred.
- Experience with healthcare encounters, enrollment and pharmacy data preferred.
BENEFITS
Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
QUALIFICATIONS
- EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification
- EXPERIENCE - 3 Years of Experience
- Healthcare billing
- Texas Medicaid guidelines/billing knowledge
- Expert in Excel (Pivot tables, importing data, sorting data, etc.)
- Expert with SQL programming