Knowledge/Skills/Abilities
The Encounter Analyst is responsible for analyzing complex encounter inbound/outbound process issues, using data from internal and external sources to provide insight to decision-makers.
• Monitors inbound and outbound encounter process. Identifies and interprets encounter data, submission requirements and performance metrics.
• Performs root cause analysis of claims/encounters processing and submission issues; 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.
• Develops various reports (i.e. exception reports, standard reports and performance reports) and distributes them to appropriate departments for error resolution, follow up and performance monitoring.
• Participates in the workgroup to resolve encounter data and process issues.
• Monitors provider compliance with policies, procedures and regulations for the coding of encounters.
• Develops programs to address provider data and performance gaps.
Required Education
High School Diploma or GED
Required Experience
3-5 Years of Billing, Claims, and Encounter experience
Preferred Education
College Degree or equivalent work experience of 3+ years with claims and/or encounter processing
Preferred Experience
Managed care experience
Preferred License, Certification, Association
Certified Procedural 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.
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