Encounter Claims Data Analyst
No of yrs. of exp
5 to 7 years
No of Positions
It’s Time For A Change…
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
- 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 reporting utilizing SQL, MicroStrategy and similar reporting tools
- Encounter management and processing utilizing Encounter Management platform
- Experience working in Client facing engagements and act as key Stakeholder in the TPA functions related to Encounter Management and Reporting.
- Experience working among Payer & Provider Community to facilitate implementation of improvements of State/Federal Managed Care Programs or similar Care Coordination programs.
- Ability to manage and track the implementation of tasks, operational improvements and enhancements in order to meet Client specific goals.
- Experience in Executive level clear and concise project status and data management reporting.
- Experience working in vertically aligned cross functional teams to identify interdependencies to support program implementation and enhancements.
- Experience with mentoring and training other Business Analyst to support ongoing operations.
- Understanding and experience with standard claim Electronic Data Interchange file formats and protocols such as 837I, 835, 277, 999 among others
- Hands-on experience with EDI X12 837 transaction set in the context of CMS EDGE data submission
- Excellent analytical and problem-solving skills in Healthcare data operations, specifically with Claims/Configuration and Encounters data
- Strong SQL Server Management Studio experience or similar products
- Bachelor’s degree in Healthcare Management, Computer Science or another technology/business field of study.