Medicare Encounter Data Analyst

Career Opportunities: Medicare Encounter Data Analyst (24434) Requisition ID 24434 - Posted 07/17/2024 - CareOregon - Full Time - Permanent - Portland - Multi Location (17) Job Description Print Preview Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Medicare Encounter Data Analyst Exemption Status Exempt Department Finance Manager Title Risk Adjustment Manager Direct Reports n/a Requisition 24286 Pay and Benefits Estimated hiring range $78,270 - $94,710 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits. Posting Notes This is a fully remote role, but you must reside in one of the listed 9 states. Job Summary The Medicare Encounter Data Analyst leads the process for the end-to-end Encounter Data Processing System (EDPS) data flow and works within CMS guidelines for acceptable data submission. Using SQL and SAS programs, monitor submissions of core claims and supplemental data and reconcile against CMS response files. This position influences leadership decision making and provides recommendations regarding potential improvements to Encounter Data submissions. Essential Responsibilities Ensure accuracy and completeness of the data submissions to CMS. Design/develop encounter data controls and internal audit processes with internal signoffs. Provide dashboards, reports, and analysis specific to the complete and accurate submission of encounter data to CMS. Monitor and track Medicare encounter data throughout the entire submission process, ensuring integrity through ongoing reconciliation of EDI, claims, supplemental data, and outgoing 837 file creation to prevent data loss. Identify root cause of data loss and encounter rejections; research return codes and coordinate with IS, claims, enrollment and provider data to enable complete and accurate encounter submissions. Work cross-functionally to interpret, verify, test and correct errors within the encounter data processing system. Maintain business rules and policies and procedures for Medicare encounter data submissions; lead the updating of business rules in response to regulatory changes. Lead and manage the standardization and automation of encounter data table creation and response file loading from CMS. Compile reports for other departments and regulatory agencies. Use statistical software, including SAS and SQL, to retrieve, edit and tabulate data from various databases and files. Participate in cross-departmental encounter data workgroup meetings. Analyze data trends and creates documentation supporting all reports. Advise on and guides process improvements that will optimize the accuracy and completeness of Medicare encounter data submissions. Work with outside vendors as needed. Advise internal customers regarding the availability and utility of data elements for reporting and data set requests, as well as the timing and frequency of reporting and data refresh. Organizational Responsibilities Perform work in alignment with the organization's mission, vision and values. Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals. Strive to meet annual business goals in support of the organization's strategic goals. Adhere to the organization's policies, procedures and other relevant compliance needs. Perform other duties as needed. Experience and/or Education Required Minimum 5