Encounter Validation AnalystPrimary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix, DE-Newark, FL-Jacksonville Apply
- Candidate is responsible for the creation and submission of encounter data to State and federal entities in accordance with regulatory and contractual requirements for accuracy and timeliness
- Resolves problems in a timely and effective manner
- Uses designated systems to obtain information
- Understands the impact of actions on system primarily used/maintained
- Understands relationships of designated systems
- Analyzes and verifies system results to ensure accuracy, accountability and financial data integrity
- Possesses working knowledge of functions of other units in department
- Responds to and resolves customer inquiries and complaints (internal as well as external), both verbal and written correspondence within established unit time frames
- Analyzes and resolves system error conditions within established unit time frames
- Participates as a member of a project team
- Analyzes and recommends solutions to nonstandard requests and requirements from plan sponsors and areas within and outside the area
- Processes customer new business and other transactions and records in appropriate systems
- Uses system produced data to prepare management level reports
- Oversight for reporting on 1-3 Medicaid plans
- Monitor, review, research, reconcile and balance designated Aetna system activity
- Excellent verbal and written communication skills.
- Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook) and Internet Explorer.
- Strong organizational skills.3-5 years of data interpretation and analysis experience.
- Basic programming skills (e.g., to run extracts).
- Healthcare background.Demonstrated skill in data gathering, interpretation & data presentation.Familiarity with databases and comfortable generating reports
- Strong 837 experience required
- Background in claims, root cause analysis and / or health care data
- Strong critical thinking skills
- Strong analytical skills
- Strong organizational skills including the ability to manage tasks with competing priorities
- Familiarity with SQL along with other HIPAA transactions and code sets helpful
- High School Diploma or GED equivalent required.Technical certification or equivalent work experience
- Candidate should be familiar with HIPAA transaction sets, claims processing and encounters
- Should have ability to move multiple projects forward simultaneously and be responsible for the results even when others are directly accountable for the outcome.
- Ability to establish effective business relationships with internal and external constituents a must
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