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Accounting & Finance WellCare - Finance Careers

Encounters Analyst Job

Full Job Title: Encounters Analyst

Job Number: 1701974

Location: Phoenix, AZ

Date Posted: 10-17-2017

Location: E Camelback Rd, Phoenix, AZ 85016

Department: Operations - Claims, Medicaid

Reports to: Manager, Encounter Operations

The Encounters Analyst is responsible for ensuring that services provided to health plan members and billed by providers to the health plan are submitted to AHCCCS and CMS accurately and timely, with minimal errors in order that health plan medical expense on file at AHCCCS and CMS is complete and up to date. This position analyzes, researches, root causes and corrects errors within as short of time as possible in order to provide an accurate picture of medical expense and avoid penalties from the State.

Essential Functions:

  • Analyzes, researches encounter errors, identifies root causes and makes recommendations for resolution
  • Researches and documents all encounter errors in established database(s)
  • Communicates with and provides clear, detailed, effective documentation to other departments within the organization on issues causing encounter pends/denials and potential solutions.
  • Communicates regularly with management on issues discovered through research efforts
  • Handles reversals/ recoupments resulting from encounter errors
  • Assists Encounter Manager or Sr. Encounter Analyst in producing monthly summary reports identifying adjudication errors
  • Keeps up-to-date on current claims processing procedures and guidelines
  • Other duties as assigned
Candidate Education:
  • Required: High School Diploma or GED
Candidate Experience:
  • Required: 2 years of experience in Encounters, claims processing, and/or claims billing in processing multiple claim types (i.e. HCFA, UB, Dental and Drug)
Candidate Skills:
  • Understanding of AHCCCS and CMS rules/regulations including encounter process
  • Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
  • Knowledge of medical terminology, diagnosis and procedure codes, pricing and provider contracts
  • Demonstrated detail orientation
  • Demonstrated research skills
  • Ability to effectively identify the root cause of issues and provide recommendations for improvement
  • Demonstrated organizational skills
  • Ability to work independently
  • Ability to work as part of a team
  • Ability to work in a fast paced environment with changing priorities
  • Demonstrated written communication skills
  • Demonstrated interpersonal/verbal communication skills

Technical Skills:

  • Microsoft Outlook
  • Microsoft Office
  • Microsoft Excel
  • Microsoft Word


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Last Updated On: 12/9/2015