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The position serves as the analytical and business support for the Encounter Operations Department. Performs analysis, provides recommendations and implements changes to improve Encounter Data processing efficiency, quality, assuring compliance, and adherence with regulatory guidelines.
Communicate with internal and/or external business partners and vendors to obtain information and documentation needed to support business needs.
Provide analytical, research, and technical data support for regulatory/business-oriented processes for Encounter Data Operations.
Conducts business analysis and recommends technical alternative solutions to management as to course of action that best meets the organization's goals.
Research and document data requirements for regulatory data submissions. Accountable for the analysis of encounter file and data requirements, the research and facilitation of error correction and file resubmission, and the development of file and data quality improvement solutions to maintain service levels for encounter reporting.
Review, research, investigate and correct encounter issues through data and process analysis.
Perform technical analysis and data mining for encounter data reporting requests from internal and external customers.
Communicate with internal and external business partners and vendors to obtain information and provide status updates on deliverables.
Performs other duties as assigned.
Coordinate with internal staff to extract data from various systems, manage adherence to schedules to ensure timely submissions, provide quality review of encounter data and coordinate correction of data rejections so that each submission is clean and error free.
Supports business expansion, ancillary, and provider relations community by developing member and provider materials.
Communicate and manage provider/vendor and Ancillary regarding encounter deliverables to ensure compliance to state SLAs.
Performs analysis of identified defects or issues through system testing and provide solutions.
Assists in developing processes to assist vendor/provider and ancillary partners to meet Wellcare submission requirements and state SLAs.
Preferred A Bachelor's Degree in a related field
Required 3 years of experience in Data analysis using relevant software tools (such as SQL, SAS, or equivalent), research, or reporting/analytics, preferable in a health care environment
Preferred 2 years of experience in pharmacy background/knowledge of PBM
Intermediate Ability to communicate and make recommendations to upper management
Advanced Demonstrated analytical skills
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Demonstrated written communication skills
Intermediate Demonstrated problem solving skills
Intermediate Ability to work in a matrixed environment
Intermediate Ability to work as part of a team
Licenses and Certifications: A license in one of the following is required: Technical Skills: