[Remote] Claims Encounter Data Analyst

Note: The job is a remote job and is open to candidates in USA. CenCal Health is seeking a Claims Encounter Data Analyst responsible for providing analytical and reporting support to the Claims Operations, Outsourced Vendors, and IT support teams. The role involves validating and analyzing encounter data to ensure compliance, accuracy, and ongoing process improvement.ResponsibilitiesAdhere to regulatory and internal guidelines in conjunction with CenCal Health policies and procedures as they apply to both internal and external encounter reportingPerform data analysis of submitted encounter data files from external entities and produce regular reports of findingsWork in conjunction with outside vendors on claim file submission rejections to assure corrections are made so that clean data is being submitted prior to each load into the Caradigm systemMonitor and analyze encounter data reporting of encounter dataMaintain a thorough knowledge of CenCal Healths encounter data reporting requirementsAnalyze, interpret, and summarize encounter data for development of solutions for reducing and mitigating errorsAnalyze existing and future encounter submission regulatory guidelines to ensure compliance with system editing logicWork in conjunction with the IT department on encounter data issues and process development related to successful encounter managementWork in conjunction with outside vendors on encounter data issues and develop a process to assure quality data is being providedWork cooperatively on ongoing Encounter Data Process Improvement projects with other CenCal Health departments as well as external vendors and Provider CommunityMaintain spreadsheets for reporting of encounter related projects both within the department as well as company wideRecommend corrective action to resolve processing and data issuesPerform other duties as assignedSkillsExperience with EDI 837 transactions for claims and encountersTechnical knowledge related to claims/encounter data including understanding of coding systems (e.g. CPT/HCPCS, ICD-9/10, NDC)Ability to diagnose problems with EDI processes by working effectively with internal departments and third partiesAssist in the formulation of policies and procedures related to the encounter data process; understand and interpret policies, procedures and regulationsProficient use of MS Access, Excel and Word and/or SQLKnowledge of data analysis methods used in the encounter/claim submission processKnowledge of Medi-Cal program guidelines, regulations and data reporting requirementsAnalytical and problem solving skillsExcellent verbal and written communication skillsTeam player who builds effective working relationshipsAbility to work independentlyAbility to attend meetings and participate in small teams effectivelyDetail orientedBachelor's Degree in Health Care Administration, Business Administration or related fields preferredTwo Three (2-3) years in data analysis in a managed health care environment; claims experience is highly desirableAny combination of education, training and experience that would provide the knowledge and abilities listedExperience in healthcare system configurationExperience in analysisMust be proficient in the MS Suite of software and have intermediate-advances skills in ExcelFamiliarity with database systemsMust be experience in Oracle database systemsBachelor's Degree in Health Care Administration, Business Administration or related fieldsCompany OverviewCenCal Health focuses on the improvement of the well-being of the communities with various social services and health plans. It was founded in 1983, and is headquartered in Santa Barbara, California, USA, with a workforce of 201-500 employees. Its website is https://www.cencalhealth.org.