Job Description

1. Sustains mastery of encounter system processes within HMSA and external partners, for multiple lines of business.
2. Monitors trends in data exchange with external entities and recommends adjustments as needed.
3. Researches highly nuanced claim-member-provider scenarios to determine root cause of data submission errors.
4. Leads collaboration with internal staff to optimize encounter submission processes.
5. Leads the planning, design, implementation, and testing of projects to increase the scope or efficacy of encounters submission.
6. Prioritizes project deliverables to ensure business needs are met.
7. Serves as a resource for colleagues with less experience.
8. Provides data to support financial reporting.
9. Monitors government/vendor requirements changes. Determines and communicates impact, recommends adjustments as needed.

Qualifications

1. Bachelor's degree and four years of 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. 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.