Required Skills & Experience
- 0-3 years of experience in healthcare operations, EDI analysis, claims processing, claims billing or a related field.
- Strong attention to detail and organizational skills.
- Ability to review data and identify discrepancies or exceptions.
- Basic analytical and problem-solving skills.
- Proficiency in Microsoft Excel, including sorting, filtering, and basic formulas.
- Ability to learn healthcare systems, encounter processing workflows, and reporting tools.
- Strong verbal and written communication skills.
- Ability to manage multiple assignments and meet deadlines.
- Comfortable working with large volumes of data in a fast-paced environment.
- Ability to work independently while collaborating effectively with team members.
Nice to Have Skills & Experience
- Bachelor's degree in Business Administration, Healthcare Administration, Information Systems, Public Health, or a related field.
- Equivalent combination of education and experience may be considered.
- Experience in managed care, health plan operations, or healthcare data environments
- Exposure to healthcare claims, encounters, provider data, or managed care operations.
- Familiarity with Medicare, Medicaid, or Commercial health plan environments.
- Experience working with data quality or operational reporting.
Job Description
The Encounter Business Analyst supports the Encounters Data Management team by reviewing encounter submission rejections, researching data discrepancies, and assisting with correction and resubmission activities. This role is responsible for monitoring encounter submissions, identifying trends in errors and rejections, and partnering with operational and technical teams to ensure issues are addressed appropriately. This position is ideal for an individual who enjoys working with data, investigating issues, and helping improve operational performance within a healthcare environment.
Essential Duties and Responsibilities
- Review, research, and resolve encounter submission rejections and errors.
- Analyze encounter reports to identify trends, recurring issues, and areas requiring follow-up.
- Assist with correction and resubmission efforts to ensure encounter data is accepted and accurately reflected in downstream systems.
- Monitor encounter processing results and track outstanding issues to completion.
- Work with internal departments to obtain information needed to resolve encounter data issues.
- Escalate complex issues to senior analysts or technical teams when appropriate.
- Maintain tracking logs and reports related to encounter rejections, corrections, and resubmissions.
- Perform data validation activities to support data quality and submission accuracy.
- Support reconciliation activities between source data and submitted encounter records.
- Prepare routine reports and summaries for leadership and business partners.
- Participate in process improvement efforts aimed at reducing encounter rejections and improving operational efficiency.
- Assist with testing and validation activities related to system enhancements or process changes. Success Measures
In the first year, the Encounter Business Analyst will:
- Consistently and accurately work assigned encounter rejection inventories.
- Support timely correction and resubmission of encounter records.
- Identify and communicate recurring rejection trends to team leadership.
- Produce accurate operational reports and tracking metrics.
- Develop knowledge of encounter processing requirements and workflows.
- Build effective relationships with operational and technical partners. Ideal Candidate The ideal candidate is detail-oriented, dependable, and comfortable working with large datasets. They enjoy investigating issues, following processes, and helping ensure accurate healthcare data submissions. This individual is not expected to independently solve complex systemic issues but should be able to identify patterns, communicate findings, and support resolution efforts with guidance from senior team members.