Responsible for day-to-day operations as related to encounter data submission. Must coordinate extraction and submission of files to multiple health plans via clearinghouses or direct. Perform analysis on data submitted and work with contracted provider offices/clinics to meet compliance thresholds when identified deficiencies are noted.
Duties and Responsibilities
- Support the processes related to the submission of encounter data to contracted health plans as required by their reporting schedule.
- Extract data and review it for quality and accuracy as well as submission timeliness.
- Responsible for handling both internal and external errors generated in the encounter submission process; this will entail working with other departments and contracted providers to enhance the quality of data submission.
- Accurately monitor and reconcile submitted encounters against clearinghouse and health plan response files to ensure timely resolution of submission gaps.
- Create map changes in EZ-NET EDI programs as applicable to match new companion guides.
- Create quarterly reports to assist providers/vendors on submission gaps; coordinate corrective action plan as needed.
- Streamline analysis as needed.
- Other special projects as requested by management.
- Ability to analyze large data sets and assist in the documentation of results.
- Experience with MS Excel functions that includes working with large data sets and creating standardized reports and graphs.
- Ability to communicate and work with outside vendors.
- Knowledge of X12 EDI implementation and companion guides is a must.
- Knowledge of the CMS 1500 and UB04 is required but not mandatory.
Minimum Job Requirements
- Two years’ experience working at a health plan or managed care organization in EDI or related departments.
Knowledge, Skills and Abilities Required
- Effective verbal and written communication skills and effective interpersonal skills.
- Ability to write clear concise narratives and statistical reports.
- Proficiency level in MS-Excel 2013 or higher.
- Ability to analyze clinical data, prepare written reports and plans, make informed decisions, take appropriate action and follow through within scope of responsibility.
- Analytical and detail oriented with excellent project management skills.
- Ability to work well with others in a professional, team-oriented environment.
- Ability to analyze, interpret and prepare reports.
- Experience with encounter data submissions.
- EZ-CAP® knowledge a plus.