Centers Plan for Healthy Living

  • Encounter Reporting & Claims Data Analyst

    Job Locations US-NY-Staten Island
    Posted Date 8 months ago(8/22/2017 2:56 PM)
    ID
    2017-1215
    # of Openings
    1
    Category
    Claims
  • Overview

    New CPHL Logo

     

     

    JOB SUMMARY:

     

    Responsible for the timely and accurate submission of claim encounters to Medicaid and Medicare for claims processed on behalf of members enrolled in various Centers Plan for Healthy Living (CPHL) products. Collaborates with vendors to ensure the complete and accurate generation of encounter files. Interacts with various departments within the organization to maintain current on the federal and state requirements for encounter processing.

    Responsibilities

    PRIMARY RESPONSIBILITIES: 

     

    • Execute processes to generate and submit records to NYS DOH and CMS in accordance with required formats and timeframes.
    • When necessary, coordinate the system setup to generate required encounter records and diagnosis data (RAPS), as dictated by the NYS DOH and CMS.
    • Assist in Troubleshooting and resolution of rejected records to ensure the ultimate acceptance of all encounter records.
    • Reconcile source data records to records accepted, to ensure all source data is included in accepted records.
    • Maintain Encounter Tracking Log to record all file generation, submissions, responses, rejections, and resubmissions of Encounter Files and RAPS files to ensure compliance with regulatory standards.
    • Analyze Encounter and RAPS response files to resolve issues and rejections when required.
    • Review and prepare response to Weekly, Monthly, and Quarterly Report Cards issued by NYS and/or CMS.
    • Provides administrative, organization and technical support to the department in the tabulation and analysis of data
    • Provide monthly status reports to management.

    Qualifications

    Education and Experience:

     

    Education

     

    Required: Bachelor’s degree in Computer Science, Business, health-related or related quantitative discipline, or equivalent healthcare experience    

    Preferred:   

     

    Type of Experience                                          

    Required:  Minimum of one year performing encounter data analysis of RAPS, EDPS & APD, in a health care or health plan organization

     

    Preferred:   Prior experience submitting encounter reporting to Medicare or Medicaid, attention to detail, able to export and import data to prepare for submission and analysis, able to prepare summary reports and communicate to management

     

    Specific Technical Skills

    Intermediate level of knowledge with Excel is required

     

          

     

    Knowledge and Skills:

    ·         Effective presentation skills

    ·         Excellent verbal and written communication skills

    ·         Must be able to participate in meetings with all levels of management within the           organization.

    ·         Detail oriented, excellent follow up

    ·         Ability to multi-task in a fast paced environment

    ·         Must be service oriented, quick learner, team player

    ·         Appreciation of cultural diversity and sensitivity toward target population

     

               

     

    Physical Requirements:

    The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

     

    The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification.  They should not be construed as an exhaustive list of all responsibilities, duties and skills required.

     

     

     

     

     

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