Job Description

1. Sustains strong knowledge of encounter system processes within HMSA and external partners.
2. Coordinates and reconciles data exchange with external entities, monitoring quality.
3. Researches complex claim-member-provider scenarios to determine root cause of data submission errors.
4. Coordinates activities with internal staff to optimize encounter submission processes.
5. Actively participates in the planning, implementation, and testing of projects to increase the scope or efficacy of encounters submission.
6. Analyzes project objectives, data sources, and methodology.
7. Provides data to support financial reporting.
8. Monitors government/vendor requirements changes. Determines and communicates impact.
9. Ensures submission methodologies are compliant with published guidance.

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