Experienced Encounter Analyst II – Remote Opportunity for a Detail-Oriented Professional in Healthcare Claims and Reimbursement

Introduction to Our Company and the Role

Are you a detail-oriented and organized individual with a passion for working in the healthcare industry? Do you have experience in claims and reimbursement, and are you looking for a new challenge? Our company is a leading provider of healthcare services, and we are seeking an experienced Encounter Analyst II to join our team. As an Encounter Analyst II, you will play a critical role in managing inbound and outbound files in the encounter management workflow, ensuring accuracy, timeliness, and reconciliation of Service Level Agreement (SLA) files submitted. This is a remote opportunity, offering a fantastic work environment and a competitive salary.

Key Responsibilities and Duties

In this role, you will be responsible for a range of tasks, including:

• Managing encounter/claims files, including monitoring and tracking outgoing 837 files to NC Tracks and EPS, and incoming 999 and 835 files from NC Tracks
• Conducting data analysis and reporting findings, including monitoring and reporting denial trends for NC Tracks/EPS (Alliance and Vendors), and monitoring and reporting file submission trends for both Alliance and Vendors
• Ensuring accuracy, timeliness, and reconciliation of SLA files submitted, including collecting data on encounters that pass/fail (accept/error) from vendor files compared to EPS representation
• Managing encounter denials, including assisting the team in encounter denial management when necessary (Medicaid and State Funding)
• Conducting file transfers as needed, ensuring all files get to all appropriate locations through review and submission
• Monitoring and tracking vendor files in the data warehouse and EPS

Essential Qualifications and Experience

To be successful in this role, you will need:

• A High School diploma or equivalent, and three (3) years of experience in claims/reimbursement or in the information systems departments of a healthcare or managed care environment
• Knowledge of NC Medicaid billing, EDI, Alliance Claims System, and EPS (a plus)
• Knowledge of the Encounter Companion Guide, Encounter Data Submission Guide, and the Encounter Data Manual published by the State of NC Department of Health and Human Services
• Knowledge of NC Medicaid and State billing requirements for physical and behavioral health claim processing and HIPAA guidelines
• Working knowledge of medical terminology, standard claim forms, and coding
• Working knowledge of healthcare services
• Working knowledge of PC-based software programs or automated database management systems
• Excellent written and verbal communication skills, with the ability to understand oral and written instructions
• Proficient with Microsoft Office Products, including Word, Excel, and PowerPoint

Preferred Qualifications and Skills

While not essential, the following qualifications and skills are preferred:

• Experience working with Electronic Payments and Statements (EPS) edit codes
• Knowledge of common denials and courses for corrections
• Knowledge of service authorizations, consumer eligibility, routine billing requirements, and coordination of benefits
• Ability to enter routine and repetitive batches of data from a variety of source documents with structured time schedules
• Ability to read/interpret contracts, standard reference materials (PDR, CPT, ICD-10, HCPCS, and NDC), and revenue codes

Career Growth Opportunities and Learning Benefits

As an Encounter Analyst II, you will have the opportunity to develop your skills and knowledge in a range of areas, including:

• Claims and reimbursement processes
• Data analysis and reporting
• Encounter management workflow
• NC Medicaid billing and EDI
• Alliance Claims System and EPS

You will also have access to training and development opportunities, including new hire employee training, which will be held in Morrisville, NC, for up to 3 weeks.

Work Environment and Company Culture

Our company offers a fantastic work environment, with a range of benefits, including:

• Remote work options
• Flexible work schedules, including hybrid/remote options
• Dress flexibility
• Paid time off, including vacation, sick leave, holiday, and management leave
• A generous retirement savings plan
• Medical, Dental, Vision, Life, Short and Long Term Disability benefits

We are committed to creating a positive and inclusive work environment, where our employees can thrive and grow.

Compensation, Perks, and Benefits

The salary range for this role is $22.23 - $28.34 per hour, depending on experience and qualifications. In addition to your salary, you will also receive a range of benefits, including:

• Medical, Dental, Vision, Life, Short and Long Term Disability benefits
• A generous retirement savings plan
• Flexible work schedules, including hybrid/remote options
• Paid time off, including vacation, sick leave, holiday, and management leave
• Dress flexibility

Conclusion and Call to Action

If you are a motivated and detail-oriented individual, with a passion for working in the healthcare industry, we encourage you to apply for this exciting opportunity. As an Encounter Analyst II, you will play a critical role in our team, and will have the opportunity to develop your skills and knowledge in a range of areas. Don't miss out on this chance to join our team and take your career to the next level. Click the apply now button to start your application today!