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Evolent is looking for Business analyst - Encouters to join the team in Chicago to manage day to day operations for a state’ Medicaid encounters on behalf of Evolent clients.
Medicaid Encounter Operations, Health Plan Services (HPS) is responsible for managing day to day operations for a state’ Medicaid encounters on behalf of Evolent clients. Operational areas of responsibility include encounter data management, submissions, reject remediation, and client/internal reporting as well as coordination/reconciliation with state regulatory bodies.
You should be be experienced in managing day to day encounter operations around state Medicaid encounter submissions. This position will report to the Director or Associate Director of Encounter Operations and is located in the Chicago, IL area.
What You’ll Be Doing:
The Business Analyst will be
- Responsible for timely, complete, and accurate encounter data submissions that meet or exceed state and/or federal requirements
- Work with HPS Business Operations and IT Engineering to implement a strategic approach to encounter data management encompassing internal and external data sources, technical infrastructure, process automation, and issue/reject remediation workflow
- Identify, develop and drive initiatives to increase the Encounter Operations function regulatory compliance levels, productivity/efficiency, process consistency, and long-term scalability
- Oversee the on-boarding of new encounter clients to include requirements gathering/documentation and coordination with HPS Implementation, Business Operations, and/or HPS Engineering teams (as required)
- Develop and execute action plans to respond to new encounter regulatory requirements
- Efficiently and effectively manage internal and external escalations
- Data management and analysis reporing utilizing SQL, Microstrategy and similar reporting tools
- Medicaid Encounterr management and processing utilizing EDIFECS Encounter Management platform
- Data movement and transformation utiizing Move-IT and SSIS and SFTP protocols , processes and tools
The Experience You’ll Need (Required):
- Bachelor’s degree in Healthcare Management, Computer Science or another technology/business field of study
- Understanding and experience with standard claim Electronic Data Interchange file formats and protocols such as 837I, 835, 277, 999 among othersHands-on experience with EDI X12 837 transaction set.
- Experience Monitoring, troubleshooting, and correcting EDI transactions in Encounter Management Platform.
- Excellent analytical and problem-solving skills in Healthcare data operations, specifically with Claims and Encounters data.
- Experience working with TPA and establishing Third Party Vendors EDI contractors – Encounter Data submission.
- Experience working with Request Management tools like HP QC, ReqPro, JIRA, or similar industry standard tools.
- Ability to perform typical business analyst duties such as requirements gathering, solution design, testing to meet business needs.
- End to End knowledge of Healthcare Payer data operations.
- Experience working in Government Programs – Medicaid/Medicare.
- Strong SQL Server Management Studio experience or similar products.
- Experience in healthcare payer systems required and knowledge of Medicaid products and programs preferred
Finishing Touches (Preferred):
- 3-5 yrs experience in leading Medicaid encounter operations, Indiana Medicaid a plus
- Process orientation with strong organizational/leadership and analytic skills (troubleshooting, attention to detail)
- Strong verbal and written communication skills for internal and external (clients, state bodies, vendors)
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.