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Job Location: Pune
What You’ll Be Doing:
Position summary
- Responsible for timely, complete, and accurate encounter data submissions that meet or exceed state and/or federal requirements
- Work with HPS Business Operations and IT Engineering to implement a strategic approach to encounter data management encompassing internal and external data sources, technical infrastructure, process automation, and issue/reject remediation workflow
- Identify, develop, and drive initiatives to increase the Encounter Operations function regulatory compliance levels, productivity/efficiency, process consistency, and long-term scalability
- Oversee the on-boarding of new encounter clients to include requirements gathering/documentation and coordination with HPS Implementation, Business Operations, and/or HPS Engineering teams (as required)
- Develop and execute action plans to respond to new encounter regulatory requirements
- Efficiently and effectively manage internal and external escalations
- Data management and analysis reporting utilizing SQL, MicroStrategy and similar reporting tools
- Medicaid Encounter management and processing utilizing Encounter Management platform
- Data movement and transformation utilizing Move-IT and SSIS and SFTP protocols, processes, and tools
Essential Skills Required
- Understanding and experience with standard claim Electronic Data Interchange file formats and protocols such as 837I, 835, 277, 999 among others
- Experience Monitoring, troubleshooting, and correcting EDI transactions in Encounter Management Platform.
- Excellent analytical and problem-solving skills in Healthcare data operations, specifically with Claims and Encounters data.
- Experience working with TPA and establishing Third Party Vendors EDI contractors – Encounter Data submission.
- Experience working with Request Management tools like HP QC, ReqPro, JIRA, or similar industry standard tools.
- Ability to perform typical business analyst duties such as requirements gathering, solution design, testing to meet business needs.
- End to End knowledge of Healthcare Payer data operations.
- Experience working in Government Programs – Medicare/Medicare.
- Strong SQL Server Management Studio experience or similar products.
- 3-5 yrs experience in leading Medicare encounter operations, Illinois or Florida Medicare market experience a plus
- Experience in healthcare payer systems required and knowledge of Medicare products and programs preferred
- Hands on experience on concepts COB, Authorization, Duplicate etc.
- Knowledge on HCFA 1500 and UB 04 images.
Academic Qualification
- Bachelor’s degree in Healthcare Management, Computer Science, or another technology/business field of study.
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