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Encounters Coordinator

Summary

The Encounters Coordinator is responsible for assisting the team with all aspects of encounter data through all contracted health plans that supports the managed care initiatives and processes. This position will also assist in report creation and with the auditing/reconciliation of health plan encounter data submissions. It is responsible in communicating and coordinating with the internal encounters team, IT, clearinghouses and contracted health plans on encounter related efforts.


Duties and Responsibilities

  • Proactively monitor, log and support all EDI encounter data submissions
  • Assist with testing of regulatory upcoming system changes by working closely with IT and the encounters team
  • Monitor and log health plan and clearinghouses rejections on a daily basis, works closely with the team
  • Coordinates encounters team meetings with clearinghouses, health plans, and other internal MPM departments
  • Identifies and resolves health plan and clearinghouse rejects on a daily basis
  • Monitor and log transaction acknowledgments/responses and coordinate remediation efforts with encounters team
  • Runs ‘pre‐error’ audit reports for the Supervisor, Lead and Analyst for possible rejections that could occur
  • Proactively communicates and collaborates with clearinghouses and contracted health plans to reconcile encounter data submission counts
  • Contacts Providers/Clinics as needed to assist with internal efforts of the team on increasing data thresholds
  • Other duties as assigned by direct Supervisor, and/or Manager

Qualifications:

  • High School Diploma (Bachelor’s degree preferred)
  • At least 2 years of Claims experience preferred (not required)
  • Attention to details, in particular as it relates to compliance and accuracy of data
  • Ability to multi‐task in a very fast paced environment; and work with little supervision
  • Effective verbal, written, communication and organizational skills
  • Working knowledge of MS Office suite of products (Excel, Word, PowerPoint, Outlook)

Skills and Ability:

  • Ability to communicate thoughts and ideas effectively and tactfully in both oral and written form
  • Works effectively with individuals and teams while building constructive relationships and maintaining the self-confidence and self‐esteem of others. Must be a team player
  • Assumes responsibility for the accomplishment of goals and objectives by accepting ownership of assignments, adhering to established work schedules, practicing efficient time management to meet quality service goals and support team objectives. Willingness to be held accountable for errors.
  • Exercises sound judgment and decision making by demonstrating the ability to interpret policies and procedures and evaluate alternative courses of action in a positive approach
  • Ability to communicate information and speak clearly about ideas so others will understand; ability to interact with various levels of management and teammates

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Job title: Encounters Coordinator

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