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Encounters Analyst Job

Full Job Title: Encounters Analyst

Job Number: 1705228

Location: Phoenix, AZ

Date Posted: 11-3-2017

This position is forCare1st Health Plan in Phoenix, AZ, a WellCare Healthplans, Inc. company.

The Encounter 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.

Department:ArizonaEncounters-Medicaid

Reports to: Mgr, Encounter Operations

Location: E Camelback Rd, Phoenix AZ 85016

Job Type: Hourly/Non-exempt


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 A High School diploma or GED
Candidate Experience:
  • Required 2 years of experience in Encounters area and/or claims processing and/or claims billing in processing multiple claim types (i.e. HCFA, UB, Dental and Drug)
Candidate Skills:
  • Beginner Understanding of AHCCCS and CMS rules/regulations including encounter process
  • Intermediate 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
  • Intermediate Other Demonstrated detail orientation
  • Beginner Other Demonstrated research skills
  • Beginner Other Ability to effectively identify the root cause of issues and provide recommendations for improvement
  • Intermediate Demonstrated organizational skills
  • Intermediate Ability to work independently
  • Intermediate Ability to work as part of a team
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Demonstrated written communication skills
  • Intermediate Demonstrated interpersonal/verbal communication skills

Technical Skills:

  • Required Intermediate Microsoft Outlook Microsoft Office
  • Preferred Intermediate Microsoft Excel
  • Preferred Intermediate Microsoft Word

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Last Updated On: 12/9/2015