Eligibility & Encounters Data Analyst

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Requirements:

• Three (3) - five (5) years related experience obtained from working in a health or health-related field including experiences in Eligibility Data and Encounters.
• Working knowledge of Electronic Data Interchange processes and procedures.
• Claims and Referrals experience highly preferred.
• EPIC/Tapestry experience highly preferred.
• Strong verbal/written communication and listening skills; including excellent interpersonal skills and telephone communication.
• Ability to maintain composure during challenging interpersonal interactions.
• Ability to effectively organize and prioritize tasks to complete assignments within the time allotted and maintain standard workflow.
• Ability to establish and maintain effective working relationships with co-workers and management.
• Proficiency in the operation of a computer using Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
• Skill in identifying and resolving problems.
• Ability to interpret, adapt and apply guidelines and procedures.

Responsibilities:

• Verify eligibility by utilizing Health Plan websites and/or call Health Plan eligibility contact number.
• Create or update Member record in Tapestry accurately with appropriate notation.
• Create or update Member coverage in Tapestry accurately with appropriate notation.
• Identify non-member claims and document accordingly each case clearly in support of mail back notification process.
• Collaborate with Decision Support per established workflow on root cause analysis and resolution implementation.
• Assist in creation and maintenance of procedure documents.
• Navigate in the Clearing House and third vendor portals fluently and understand functionality of each portal.
• Keep track of encounter reject records for reporting purpose.
• Assist in creation and maintenance of procedure documents.
• Fix and resolve enrollment system rejections in the portals.
• Collaborate with internal customers in the registration and claims payment processes.
• Collaborate with external vendors and Health Plans.
• Escalate complex issues to team leader and/or management.
• Notify department manager proactively with issues, instances of errors or obstacles that prevent successful completion of work.
• Apply strong writing skills in email communication and internal notes/memos.
• Have strong verbal articulation ability.
• Manage email traffic and phone call volume by responding in a timely manner.
• Adhere to professional conduct and exercise reasonable care to maintain member privacy and confidentiality.
• Re-prioritize work regularly to adapt to changes in the department or environment.
• Collaborate with other departments and outside agencies to meet the identified needs of the patient.
• Consistently meet or exceed productivity and quality standards established by Eligibility and Encounter Team Lead and/or Department Manager.
• Assist Department Manager with special projects as needed.
• All other duties as assigned including department-specific functions and responsibilities.
• Performs other duties as assigned and participates in organization projects as assigned.
• Adheres to safety, HIPAA and compliance policies.