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Senior Encounter Data Claims Analyst - IoT BigData Jobs

Senior Encounter Data Claims A...

familycareore FamilyCare Health

Do you know that your work makes a difference? At FamilyCare Health , we touch lives every day. As a Medicare and Medicaid managed care organization, we coordinate medical, behavioral health, and dental care for more than 130,000 Oregonians.

FamilyCare Health is currently seeking a Senior Encounter Data Analyst to monitor the flow of encounter data from the point a file is submitted. This position is responsible for ensuring; timely and accurate encounter data submission, reporting, collaboration with our delegated entities, and state and federal agencies in the process. Additionally, this role participates in claim resolution activities which includes the opening, researching, categorization, documentation and decision making on claims reprocess and reopening requests. The Senior Encounter Data Analyst is expected to take calls and occasionally meet with Providers as it relates to escalated claims issues and accurately identify true claims reconsiderations, claims system configurations issues, contracting issues and Provider billing issues. As well as, monitoring, tracking and analyzing different claim issues and collaborates with other departments to decrease errors by identifying root causes and suggesting system improvements.

Accountabilities:
Manages encounter and RAPS data submission to OHA and CMS, coordinating the submission process with various entities, reconciling and reporting.

Reconciles encounter submission files to financial reports

Analyze encounter errors and rejections, working collaboratively with vendors to correct errors.

Serves as technical lead to the team, helping to develop skills and knowledge while troubleshooting and escalating issues.

Support process improvements and change.

Work in partnership with other departments and outside entities, such as providers, vendors, state and federal agencies regarding claim and encounter issues.

Qualifications:
Bachelor degree or equivalent combination of experience and education.

Three (3) years or more claims analyst experience or experience with medical billing, claim submission and coding required.

Working knowledge of medical terminology as well as ICD-9 / ICD-10, CPT, HCPCS coding.

Three (3) years or more experience working with Medicaid or Oregon Medicaid claims with knowledge of Medicare and Medicaid coverage guidelines.

Knowledge of HIPAA Implementation, ANSI 5010 8937 file format

Previous experience resolving claim rejections.

Previous experience leading and mentoring other in a team environment.

As we connect people to care, our employees are our biggest asset, bringing unique perspectives and experiences to our organization. There's an energy and excitement at FamilyCare Health , a shared mission to improve the lives of others as well as our own. Bring your energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is significantly shaping the way healthcare services are delivered.

When you join our team, we invest in you so you can grow and succeed both in and out of the office.

​ • Earn 4 weeks PTO your first year • Generous healthcare package (you pay $0 – $40 per pay period) • Tuition reimbursement program up to $5,250 per year once eligible • 401K with employer contribution • Paid annual public transit pass • 9 Paid holidays including your birthday plus two paid days to volunteer • Wellness Reimbursement Program up to $200 per year • Convenient location in Portland’s Lloyd District • Voted one of Oregonian's top workplaces 5 years in a row •

Ready for a new Path? Join our team and start doing your life's best work!

FamilyCare is proud to afford equal employment opportunities to all qualified individuals, without regard to their race, color, ancestry, religion, sex, sexual orientation, national origin, age, physical or mental disability, citizenship status, veteran status, gender identity or expression, or any other characteristic or status that is protected by federal, state or local law. To ensure that we continue to hire competent, ethical, and trustworthy individuals, all candidates must successfully complete a thorough background investigation and drug screen prior to receiving any offer of employment from FamilyCare.

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