Health Care Service Corporation
Encounters Business Analyst
Health Care Service Corporation, Chicago, Illinois, United States, 60290
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.Come join us and be part of a purpose-driven company who is invested in your future!Job Summary
This role will telecommute within the states of IL and TX.This Position Is Responsible For Aiding HCSC Government Programs Risk Adjustment Encounters Operational Management And Analytics Activities And Functions. Operational Areas Include But Are Not Limited To Encounter Data Management, Submissions, Reject Remediation, Data Reconciliation, Performance Management, Vendor Management, As Well As, Interfacing With Federal Regulatory Agencies If/When Applicable.Required Job Qualifications:
Bachelors or Advanced degree (or 4 years’ experience in lieu of degree) in Business Administration, Finance, Statistics, Healthcare Administration.3-5 years’ experience working in Healthcare industry in Medicaid and/or Medicare Encounter operations, risk adjustment or related operations.Experienced in query design/development (e.g. SAS, SQL, etc.) and/or relational database understanding.Knowledge of Medicare and/or Medicaid Encounter Data System and understanding of 837-5010 and/or other standard encounter file formats.Experience working with healthcare data specific to risk adjustment and/or related functions.Proficient/advanced in MS Office (Excel, PowerPoint, Access, etc.) to derive effective presentations & exhibits for leadership.Strong interpersonal, organizational, communication, and workflow skills.Willingness and ability to travel approximately up to 25%.Preferred Job Qualifications:
Experience with risk adjustment encounter file preparation and remediation (e.g. 837 5010 files, RAPS returns/submission files, EDPS MAO-002, 277CA, and/or 999 file, MAO-004, or EDGE files, etc.).Experience with Medicare and/or Medicaid risk adjustment encounter management, reporting and requirements from either a payer or vendor a big plus.Knowledge of and experience in Medicare and/or Medicaid risk adjustment functions, regulations, and other related activities.Experience with databases as well as interpretation and manipulation of related healthcare data (e.g. claims, enrollment data, etc.).Knowledge of encounters within other lines of business including Exchange/ACA, Medicaid, and/or Medicare Advantage.Knowledge of HCC coding, risk adjustments.Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!HCSC Employment Statement:HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
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This role will telecommute within the states of IL and TX.This Position Is Responsible For Aiding HCSC Government Programs Risk Adjustment Encounters Operational Management And Analytics Activities And Functions. Operational Areas Include But Are Not Limited To Encounter Data Management, Submissions, Reject Remediation, Data Reconciliation, Performance Management, Vendor Management, As Well As, Interfacing With Federal Regulatory Agencies If/When Applicable.Required Job Qualifications:
Bachelors or Advanced degree (or 4 years’ experience in lieu of degree) in Business Administration, Finance, Statistics, Healthcare Administration.3-5 years’ experience working in Healthcare industry in Medicaid and/or Medicare Encounter operations, risk adjustment or related operations.Experienced in query design/development (e.g. SAS, SQL, etc.) and/or relational database understanding.Knowledge of Medicare and/or Medicaid Encounter Data System and understanding of 837-5010 and/or other standard encounter file formats.Experience working with healthcare data specific to risk adjustment and/or related functions.Proficient/advanced in MS Office (Excel, PowerPoint, Access, etc.) to derive effective presentations & exhibits for leadership.Strong interpersonal, organizational, communication, and workflow skills.Willingness and ability to travel approximately up to 25%.Preferred Job Qualifications:
Experience with risk adjustment encounter file preparation and remediation (e.g. 837 5010 files, RAPS returns/submission files, EDPS MAO-002, 277CA, and/or 999 file, MAO-004, or EDGE files, etc.).Experience with Medicare and/or Medicaid risk adjustment encounter management, reporting and requirements from either a payer or vendor a big plus.Knowledge of and experience in Medicare and/or Medicaid risk adjustment functions, regulations, and other related activities.Experience with databases as well as interpretation and manipulation of related healthcare data (e.g. claims, enrollment data, etc.).Knowledge of encounters within other lines of business including Exchange/ACA, Medicaid, and/or Medicare Advantage.Knowledge of HCC coding, risk adjustments.Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!HCSC Employment Statement:HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
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