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Senior Encounter Data Analyst

Company: Medica Health Plans
Location: Minnetonka
Posted on: January 9, 2021

Job Description:

Medica's Senior Encounter Data Analyst will be responsible for supporting ACA encounter data submissions to the Center for Medicare & Medicaid Services (CMS). This individual will be working closely with several internal business units on a day-to-day basis. Coordinate with enrollment & billing and claims operations teams to identify, escalate and resolve data issues appropriately. Work with Medica IT to ensure completion of EDGE Server upgrades when needed. Perform routine data reconciliations to ensure data submission integrity. Monitor & track encounter metrics to ensure timely submissions. Responsible for maintenance of existing reports and development of new reports as needed. Stay informed on CMS risk adjustment updates, determine impact to existing processes. Collaborate with Compliance & Health Services on all internal and CMS regulated audits (RADV). Act as a liaison between Health Services and external vendors to ensure smooth audit completion.Required Qualifications -

  • Bachelor's degree or equivalent experience in healthcare related field
  • 5+ years of related work experience beyond degree
  • Basic understanding of Health Insurance and life cycle of a claim
  • Proficient in at least one data reporting tools (e.g. SAS, SQL)
  • Excellent analytical and problem solving abilities
  • Previous experience working in health care/health insurance sector
  • Strong communication, documentation, project management skills
  • Proficient in Microsoft Excel, PowerPoint and Word
  • Experience with developing detailed documentation of policies and procedures
  • Strong interpersonal and communication skills with an ability to work collaboratively with both internal and external stakeholdersPreferred skills or experience -
    • ACA, Risk Adjustment, and Provider knowledge a plus
    • Direct encounters experience
    • ACA RADV experienceEqual Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

Keywords: Medica Health Plans, Minnetonka , Senior Encounter Data Analyst, Professions , Minnetonka, Minnesota

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