Encounters Analyst Manager (Remote Option)

Position eligible for – 

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

See attachment for additional details. 

Office Location:  Available for the Gastonia, NC location; Remote Option

Projected Hiring Range:  Depending on Experience
Closing Date:  Open Until Filled

Primary Purpose of Position: The Encounters Analysts Manager ensures accurate and timely submission of encounter data, maintains regulatory compliance, and oversees data quality. They analyze data to identify trends and gaps, collaborate with cross-functional teams to improve processes, and resolve issues related to data submissions. They will maintain high data integrity and support informed decision-making across the company.  

Role and Responsibilities: 

1. Encounter Data Management & Submission:
   • Create and manage submission schedules.
   • Ensure timely and accurate delivery of encounter data.
   • Process supplemental chart review files and integrate them into the workflow 
2. Analytics & Issue Resolution:
   • Analyze metric deviations and perform root cause analysis.
   • Investigate schedule failures and collaborate with technical teams to resolve issues.
   • Research and documents encounter errors, applying statistical and trend analysis 
3. Testing & System Support:
   • Provide User Acceptance Testing (UAT) support during software upgrades and new releases.
   • Coordinate release management activities and validate new software or product enhancements 
4. Process Documentation & Compliance:
   • Document and monitor the end-to-end encounter lifecycle.
   • Ensure compliance with process requirements, training mandates, and regulatory guidelines.
   • Develop and maintain Standard Operating Procedures (SOPs), training manuals, and knowledge management databases 
5. Engagement & Reporting:
   • Respond to internal and external customer queries related to submissions and remediations.
   • Create and deliver status reports to IT leadership.
   • Manage escalations and ensure timely resolution 
6. Performance & Quality Assurance:
   • Achieve individual and team Service Level Agreement (SLA) targets.
   • Maintain high levels of productivity, accuracy, and turnaround time.
   • Minimize rework and ensure no findings in audit

Team Leadership & Management: 

7. Lead and manage a team of analysts, providing guidance, support, and mentorship.
   • Conduct regular team meetings to discuss progress, challenges, and strategies for improvement.
8. Foster a collaborative and productive work environment, encouraging professional development and growth.
9. Evaluate team performance and provide constructive feedback to ensure high standards of work.

• Perform internal and customer training as needed and provide technical support and guidance.
• Lead the IT Encounters Analyst team in support of the Edifecs application, encounter analysis and best practices and recommendations.
• Responsible for creating and implementing processes to analyze encounters, analyze encounter errors, and ensure the errors are addressed by the appropriate teams.
• Develop and refine workflows to improve data accuracy and submission timeliness.
• Collaborate with IT, claims, and provider relations teams to resolve data discrepancies.
• Lead root cause analysis and implement long-term solutions for recurring issues.
• Oversee the collection, validation, and submission of encounter data to regulatory bodies (e.g., CMS, state Medicaid agencies).
• Ensure compliance with all applicable regulations, including HIPAA and state-specific requirements.
• Perform other related duties as assigned or requested.

Knowledge, Skills, and Abilities:  

Knowledge: 

1. Healthcare Regulations and Compliance: Understanding healthcare laws, regulations, and compliance requirements.
2. Data Analysis: Proficiency in data analysis techniques and tools, including statistical software and databases.
3. Healthcare Systems: Familiarity with healthcare management systems and electronic health records (EHR).

Skills: 

1. Analytical Skills: Ability to analyze complex data sets to identify trends and insights.
2. Communication: Strong verbal and written communication skills to effectively convey findings and recommendations.
3. Project Management: Competence in managing projects, including planning, execution, and monitoring.
4. Problem-Solving: Ability to identify issues and develop effective solutions.

Abilities: 

1. Attention to Detail: High level of accuracy and attention to detail in data analysis and reporting.
2. Critical Thinking: Ability to think critically and make informed decisions based on data.
3. Adaptability: Flexibility to adapt to changing regulations and healthcare environments.
4. Team Collaboration: Ability to work effectively in a team and collaborate with various stakeholders.
5. Demonstrated technical aptitude through strong analytical skills, problem identification and resolution, organizational skills, creativity, and critical thinking.
6. Collaborative, ability to manage multiple tasks at once, and meet deadlines.
7. Ability to effectively communicate with providers, external partners, management, and end users both within and external to the organization.
8. Excellent time management skills and customer service skills.
9. Experience working with relational databases writing SQL, Stored Procedure, and reports.
10. Strong knowledge of encounter data claims processing, and regulatory reporting requirements.
11. Attention to detail and accuracy of facts and documentation.
12. Proficiency in MS Office
13. Experience in performing internal and customer training and providing technical support and guidance.
14. Experience in analyzing and reporting interface transaction statistics and performance metrics.
15. Experience in coordinating and facilitating internal and external support teams and third-party vendors.
16. Experience in supporting project management activities and following established best practices and procedures.
17. Knowledge of the principles and practices of data exchange, data quality, and data security.
18. Excellent verbal and written communication, collaboration, and problem-solving skills.
19. Knowledge and familiarity working in healthcare software; using SQL, EDI, FHIR, Json, XML, or other related integration protocols or toolsets.
20. Ability to work independently and as part of a team in a fast-paced and dynamic environment.
21. Ability to work under time constraints and other demands.

Education/Experience Required: 

Education: 

• Bachelor's Degree in one of the following fields
  • Computer Science
  • Information Systems
  • Business Administration
  • Healthcare Administration

Experience: 

• Experience with Medicaid/Medicare encounter submissions
• Experience with EDI formats (e.g., 837, 999, 277CA, TA1, etc).
• 5+ years of experience in a technical support and customer-service oriented environment.
• 5+ years of experience working with encounters (managing, analyzing, troubleshooting and submitting encounters)
• 5+ years of experience in a supervisory role

Note: Equivalent years of relevant work experience can sometimes substitute for formal education 

Preferred Qualifications: (all Education and Experience qualifications above plus the following) 

1. Master's Degree in one of the above-mentioned professional fields or closely related field
2. 10+ years of encounters experience