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BSWHP - Tx Medicaid Encounter Analyst

Remote:

Full Remote

Contract:

Full time

Experience:

Mid-level (2-5 years)

Work from:

United States

Offer summary

Qualifications:

Bachelor's degree or equivalent experience, Minimum of 3 years healthcare billing experience, Expert knowledge in Excel and SQL, Understanding of Texas Medicaid guidelines.

Key responsabilities:

Monitor encounter management workflow
Analyze claims data to identify gaps
Perform risk score calculations and reporting
Research and document encounter errors
Contribute to program improvement initiatives

Baylor Scott & White Health Health Care XLarge https://bswhealth.com/

10001 Employees

See more Baylor Scott & White Health offers

Job description

Job Summary

The Risk Adjustment Analyst Sr (Texas Medicaid Encounter Analyst) is responsible for monitoring and oversight of the end-to-end encounter management workflow. Supports program management activities around risk adjustment data management and submissions to government agencies such as Centers for Medicare and Medicaid Services (CMS) or Health & Human Services (HHS).

Salary (based Off Of Relevant Experience)

The pay range for this position is $36.80 (entry-level qualifications) - $57.03 (highly experienced) The specific rate will depend upon the successful candidate’s specific qualifications and prior experience.

Essential Functions Of The Role

Monitors and oversees the end-to-end claims encounter management workflow.
Analyzes claims and supplemental data to identify reporting gaps, risk gaps, or sources of incorrect and incomplete diagnostic data.
Performs analysis and reporting activities related to risk score calculation, encounter data submission, chart review programs and audits, and related performance metrics per regulatory and health plan guidelines.
Using data from internal and external sources, analyzes complex encounter inbound/outbound process issues to provide insight to decision-makers.
Researches and documents encounter errors in established systems and databases with appropriate statistical trend analysis; performs root cause analysis of encounters processing and submission issues and develops recommendations based on data and industry standards.
Performs various financial analysis such as revenue forecasting and ROI.
Contributes to program improvement by designing and implementing business process and system changes, collaborating to resolve encounter data and process issues and managing policy and procedure documentation.

KEY SUCCESS FACTORS

Advanced knowledge of SQL, MS Excel, MS Access, MS Word, MS Visio and MS PowerPoint.
Using SQL, able to design and run intermediate to complex queries and reports from multiple databases.
Able to independently gather, interpret and analyze data for the purpose of identifying trends, problems and opportunities for improvement.
Excellent time management and organizational skills with the ability to handle multiple tasks in a timely and accurate manner.
Able to work under pressure, adhere to deadlines and know when to escalate information and issues.
Highly motivated and able to work with minimal guidance, independently and as a team participant.
Outstanding verbal and written communications skills with the ability to communicate clearly to all levels of an organization.
Ability to work in a high paced environment independently and with cross functional groups.
Knowledge of ACA, Medicare, Medicaid, MCO, TPA business requirements preferred.
Experience with healthcare encounters, enrollment and pharmacy data preferred.

Benefits

Our competitive benefits package includes the following