Job Description

1. Analyzes encounter system processes within HMSA and external partners.
2. Coordinates and reconciles exchange of data with external entities.
3. Researches various claim-member-provider scenarios to determine root cause of data submission errors.
4. Participates in discussions with internal staff to optimize encounter submission processes.
5. Participates in projects to increase the scope or efficacy of encounters submission.
6. Provides data to support financial reporting.
7. Monitors government/vendor requirements changes.
8. Ensures submission methodologies are compliant with published guidance.
9. Documents new processes or procedures and updates existing documentation.

1. Bachelor's degree and one year related experience; or an equivalent combination of education and experience.
2. Conceptual knowledge of claims, health plan financial data, and health industry structure.
3. Conceptual knowledge of Medicare Advantage, Medicaid, and/or ACA revenue cycles for payers.
4. Intermediate working knowledge of Microsoft Office applications, including but not limited to Word, Excel, Outlook, and PowerPoint.
5. Conceptual knowledge of SQL, SAS, or MicroStrategy.