Job Description

Job Description

Job Summary
The Senior Encounter Analyst is responsible for analyzing complex encounter process issues, using data from internal and external sources to provide insight to decision-makers and monitoring claims & encounters processes, including collaborating with cross-functional teams at the direction of the Manager, Encounters, to prevent encounter rejections via root cause analysis and resolution.

Knowledge/Skills/Abilities
• Monitors inbound and outbound encounter process. Identifies and interprets encounter data, submission requirements and performance metrics.
• Performs root cause analysis of claims/encounters processing and submission issues; develops recommendations based on data and industry knowledge. Collaborates across departments to design and implement systems changes to meet encounter data processing and submission goals.
• Monitors State, Federal and/or third party agency submissions, contractual compliance and SLAs.
• Participates and/or leads projects to address corrections, changes, and updates to assure encounter submission acceptance.
• Participates in the workgroup to resolve encounter data and process issues.
• Monitors provider and vendor compliance with policies, procedures and regulations for the coding of encounters.
• Develops programs to address data and performance gaps and process improvement.

Job Qualifications

Required Education
High School Diploma or GED

Required Experience
3-5 Years of Billing, Claims, and Encounter experience
5 years or more of managed care experience

Preferred Education
College Degree or equivalent work experience of 5-7 years with claims and/or encounter processing.

Preferred Experience
Encounter 837 submission and response file processing, Claims processing, Health data analytics and reporting, project management, working with various levels of management throughout multiple organizations
Excel and SQL proficiency.

X12 knowledge.

Edifecs knowledge.

Preferred License, Certification, Association
Certified Procedural Coder (CPC)

Pay Range: $60,415 - $117,809 a year*

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.