Centers Plan for Healthy Living

Encounter Reporting & Claims Data Analyst

US-NY-Staten Island
3 months ago
ID
2017-1215
# of Openings
1
Category
Claims

Overview

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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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