Analyst, Encounters (EST Time zone) - REMOTE
Passport Health Plan by Molina Healthcare Louisville, Kentucky; Lexington-Fayette, Kentucky; Bowling Green, Kentucky; Owensboro, Kentucky; Covington, Kentucky; Georgetown, Kentucky; Richmond, Kentucky; Florence, Kentucky; Nicholasville, Kentucky Job ID 2027831Passport Health Plan by Molina Healthcare has a mission to provide quality health care to those who need it, no matter their circumstances. Today, Molina health plans serve 3,331,000 members across the country through government-funded programs. Each day, we work to earn the trust our partners and members put in us, so they can lean on Molina. Together, Passport Health Plan and Molina share a commitment to improving the health and quality of life of our members across the Commonwealth of Kentucky.
- Full Time, Part Time
- Level: All Levels
- Travel: Occassional
Success Profile
What makes you successful at Passport Health Plan by Molina Healthcare? Check out the traits we’re looking for and see if you're the right fit!
- Compassionate
- Consultive
- Patient
- Problem-Solver
- Sincere
- Relationship Expertise
Benefits
-
Insurance
Medical · Dental · Vision
Group & Voluntary Life Insurance
Aflac · Pet Health · Identity Theft
Auto & Home Insurance -
Savings
Flexible Spending Accounts
401K · Roth 401K
Employee Stock Purchase Plan -
Career Growth
Continuing Education Units
Education Reimbursement -
Time Off
Paid Time Off
Volunteer Time Off
Company Holidays -
Additional Perks
Legal Assistance Plan
Employee Assistance & Well Being Programs
Employee Perks Platform
Rideshare Portal
Responsibilities
Job Summary
The Analyst, Encounters is responsible for monitoring inbound and outbound encounters processes and ensuring timely, accurate, and complete encounter submissions for low- to moderate-complexity markets or states. Performs data analysis using internal and external sources, analyzes processes and provides recommendations for improvement to decision-makers. At the direction of the Manager, Encounters, collaborates with cross-functional teams to identify and resolve root causes of issues that impact encounters and identify improvements to operational performance.
Job Duties
- Monitors inbound and outbound encounters submissions and responses, interprets outcomes, and takes swift action to remediate errors
- Routinely reviews submission results and analyzes pend and rejection inventory, and works with other areas as needed to remediate encounter errors and to ensure timely, accurate, and complete submissions
- Owns and maintains encounter submission criteria, maintains submission schedule, central documentation of market nuances, compliance, and regulatory requirements for primary market or state
- Understands market or state-specific KPIs and financial and performance impacts related to encounter submissions
- Assists with preparing portions of materials and information for Monthly Governance and Operations Reviews
- Performs root cause analysis of claims and encounters data and develops recommendations based on data and industry knowledge. Collaborates across departments to design and implement systems changes to meet encounter data processing and submission goals.
- Writes business requirements for system updates to resolve errors and optimize encounter performance
- Participates in workgroups to resolve encounter data and process issues
- Develops basic reports and distributes to appropriate departments for error resolution, follow up, and performance monitoring
- Understands provider, member, and inbound claims data compliance in relation to encounters submission requirements
- Maintains awareness of vendor encounter submission requirements and status
Job Qualifications
REQUIRED EDUCATION:
High School Diploma or GED
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
- 3-5 years of experience in billing, claims, encounters, and data analysis
- Knowledge of basic data analysis techniques
- Skilled with running basic SQL queries
PREFERRED EDUCATION:
Bachelor’s Degree or equivalent work experience
PREFERRED EXPERIENCE:
Managed care experience
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
Certified Professional Coder (CPC)
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $49,430.25 - $107,098.87 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 09/05/2024ABOUT OUR LOCATION
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