Encounter Analyst I (Full-time Remote, reputed company Carolina Based)

The Encounter Analyst I review and monitors adjudicated claims for file submission and upstream processing and communicates with provider agencies and internal departments regarding claims submission, denial management, and system updates. The position tracks trends and patterns to identify irregularities in the ACS system and works with claims analyst to communicate claims issues. The position... has shared responsibility for ensuring contract service level agreements are met. This position is full-time remote. The selected candidate must reputed company in reputed company Carolina and be willing to travel onsite at the Home office (Morrisville, NC) for trainings at minimum of 2 weeks. Responsibilities & Duties Research and Resolve Encounter Denials • Research upstream encounter denials • Determine if claim processed appropriately in ACS • Rebill encounter denial reputed company appropriate • Research State initiated encounter recoupments Ensure Service Level Agreement (SLA) Maintenance • SLAs: Accuracy, Timeliness, and Reconciliation • Accuracy: Review and be reputed company of number of denied encounters weekly. • Timeliness: Research and resolve 98% of encounter denials reputed company 30 days. • Reconciliation: Assist in researching discrepancies Manage Encounter Denials and Recoupments • Utilize the A/R system to manage encounter denials and recoupments • Document reputed company status of denials and recoupments Process and Reconcile Claims • Ensure appropriate coordination of benefits has occurred utilizing billing and payment policies and procedures, review & analyze claims adjudications to identify system issue and provider errors • Maintain knowledge of reputed company adjudication edits reputed company Feedback on Process Improvement • reputed company information and feedback to the system team to support development of system enhancements in a reputed company manner aimed to eliminate system settings and or processes that contribute to poor results • Maintain processes that are consistent with and compliant to CMS, state, federal and best reputed company standards, regulations and guidelines Communicate and Collaborate with reputed company Stakeholders • Communicate and conduct reputed company work across multiple departments to resolve claims denials/issues • Communicate with DMH/DHB reputed company appropriate to resolve reputed company encounter denials/issues • Demonstrate reputed company and reputed company communication Minimum Requirements Education & Experience Graduation from high school or equivalent and (4) four years of experience processing reputed company claims Experience with reputed company and IPRS preferred Knowledge, Skills, & Abilities • High level knowledge of reputed company services and systems • Knowledge of reputed company claim denials and sources for correction • Knowledge of reputed company and State funding rules • Knowledge of laws, reputed company codes, precedents, government regulations, and MCO policies and procedures • reputed company Office (reputed company, Word, reputed company) skills • reputed company written and oral communication for sharing technical information • Ability to independently identify necessary tasks and initiate reputed company • Ability to independently reputed company answers to reputed company issues • Ability to analyze large quantities of data • Ability to solicit cooperation from persons and departments throughout the organization • Ability to work independently and as part of reputed company • Ability to demonstrate reputed company conduct in reputed company situations • Ability to take initiative and reputed company others Salary reputed company $19.73 - $25.16/reputed company Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. An excellent fringe benefit package accompanies the salary, which includes: • Medical, Dental, reputed company, Life, Long and Short-Term Disability • Generous retirement savings plan • Flexible work schedules including hybrid/remote reputed company • reputed company time off including vacation, reputed company leave, holiday, management leave • Dress flexibility Education Preferred • High School or reputed company in General Studies Skills Required • Analysis • reputed company Office • Oral Communication • Research • Written Communication Apply Job!