Under minimal supervision supports the continuous evaluation of the Department in alignment with Denver Health's financial, strategic, and operational initiatives and projects. Evaluates business processes, anticipates opportunities and challenges, identifies areas for improvement and makes data-driven recommendations. Coordinates and performs duties related to data acquisition and analysis for multiple projects simultaneously.
The Encounter Data Analyst evaluates encounter data and identifies errors created by operational claims and eligibility processes. This position will research, analyze, summarize and categorize all types of encounters based on response files from the HCPF and CMS, as appropriate. This position also works closely with other internal departments, delegated vendors and government agencies to monitor and communicate that encounter data is submitted and processed appropriately.
The Encounter Data Analyst will need to understand the overall data; process flows and provider data used with Medicare and Medicaid to work with internal teams and delegated entities to create targeted and ongoing reports to track and monitor data accuracy and timeliness. This position will also support Denver Health Medical Plan teams in working collaboratively with partners to improve overall encounter, member and provider data quality.
1.Research and analyze Encounter Edits or Rejections to identify trends and root cause.
2.Provide EDI interpretation and assist with decision making for the Government Operations team. Review and work the weekly encounter reports, and work with PBM on final resolution.
3.Contribute to establishing and/or revising claims research policies and procedures and look for ways to improve processes.
4.Collaborate with other departments, vendors and delegates to identify missing data, errors or other anomalies; works with them to correct these encounter data errors, gather necessary information and provide guidance on regulatory reporting needs.
5.Work with minimal supervision under tight timelines while maintaining compliance at the company and government regulatory agency level.
6.Manage monthly and quarterly reports from the HCPF within contracted timelines.
7.Work miscellaneous HCPF requests and/or reports as applicable.
8.Summarize large volumes of encounter data in analytical reports that include tables and graphs for management review and use.
9.Assist in development of reports and projects, including documenting methodology and protocols.
10.Analyze existing and proposed business requirements.
11.Work with Vendor, Products and Configuration, and Data teams as applicable to diagnose and resolve configuration and set up issues. Act as liaison between Encounter Operations team and IT work streams.
12.Work with the Provider Operations and Service teams specific to claims based issues, provider setup and Medicaid enrollment.
13.Understand core business functions at an intermediate level.
14.Participate in Encounter work groups, across departments and participate or lead other standing or ad hoc workgroups as needed.
15.Coordinate with vendors and delegates to act as a primary contact for Encounter Data related questions, requirements, policy changes and expectations.
16.Understand end-to-end processing of Medicare Encounter Data requirements and processing and work with Risk team as applicable
17.Other duties as assigned.
1. Two (2) years in data analysis, process improvement, or project management required.
Knowledge, Skills and Abilities
1. Must be able to work independently and meet schedules and deadlines. Ability to handle multiple tasks, simultaneously.
2. Exceptional ability to gather, understand, and utilize data to inform decisions and make recommendations. Excellent communication skills and ability to summarize detailed information in an organized, concise manner.
3. Strong analytical and problem-solving skills and ability to compile, categorize, calculate, audit, and/or verify data.
4. Project management skills, including the ability to manage several projects simultaneously while remaining flexible with changing priorities. Strong ability and comfort in presenting data, recommendations, and proposals to a wide variety of audiences and levels of leadership (both written and verbally).
Computers and Technology
1. Intermediate proficiency with Microsoft Office, specifically Excel required
2. Knowledge of relational databases (Microsoft SQL Server) and proficiency in SQL preferred
3. Healthcare encounter data experience, including 835/837/999 and EDI work, claims adjudication experience with working knowledge of Government requirements preferred.
4. Coding experience preferred.
5. Demonstrated ability to conduct detailed research of claims, system, reports, and similar required.
6. Understand HCPF/CMS regulations and contract requirements specific to Encounter Data and claims processing.
7. Ability to review, analyze and resolve data from Vendor, HCPF, CVS and QNXT.
8. Knowledge of Medicare, Medicaid, and commercial fee-for-service schedules, and industry regulations issued by the Center of Medicare and Medicaid Services ("CMS") and the Colorado Department of Health Care, Policy & Financing ("HCPF") and the Colorado Division of Insurance.
9. Knowledge of all claims forms and coding types, including UB-04, CMS 1500, ICD-10, HCPC, Revenue Codes and NDC coding,HIPPA, HEDIS, NCQA.
10. Intermediate knowledge of the Government Programs (Medicare/Medicaid) structure, medical coding and medical terminology required.
11. Knowledge of claims and provider networks required. Intermediate understanding of EDI and industry standard X12 specifications and requirements.
12. QNXT preferred.
1. Bachelor's Degree required. Concentration in business administration, finance, health care, or economics preferred.
Location Denver Health Medical Plan
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, efficient, high-quality academic health care system that is considered a model for the nation. The Denver Health system includes the Rocky Mountain Regional Level I Trauma Center, a 525-bed acute care medical center, Denver's 911 emergency medical response system, 8 family health centers, 15 school-based health centers, the Rocky Mountain Poison and Drug Center, the Denver Public Health Department, an HMO, and The Denver Health Foundation.
As Colorado's primary safety net institution, Denver Health is a mission-driven organization that has provided more than $3.3 billion in care for the uninsured in the last ten years. Denver Health is a leader in performance and quality improvements and remains financially secure, in part, due to its nationally recognized implementation of lean principles in healthcare. Denver Health is a major resource to the community, serving approximately 185,000 individuals and 67,000 children a year.
Located just south of downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
"Denver Health is committed to provide equal treatment and equal employment opportunities to all applicants and employees. Denver Health is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class."
Internal Number: 3639
About Denver Health
Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation’s leaders in medicine.