Job Location: Pune
Itโs Time For A Changeโฆ
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely โ about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of โBeckerโs 150 Great Places to Work in Healthcareโ in 2016, 2017, 2018 and 2019, and one of the โ50 Great Places to Workโ in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If youโre looking for a place where your work can be personally and professionally rewarding, donโt just join a company with a mission. Join a mission with a company behind it.
What Youโll 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 โ 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 โ 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
- Bachelorโs degree in Healthcare Management, Computer Science, or another technology/business field of study.
Submit CV To All Data Science Job Consultants Across India For Free
๐ Explore All Related ITSM Jobs Below! ๐
โ
Select your preferred “Job Category” in the Job Category Filter ๐ฏ
๐ Hit “Search” to find matching jobs ๐ฅ
โ Click the “+” icon that appears just before the company name to see the Job Detail & Apply Link ๐๐ผ

Leave a Reply