for the Encounters Analyst position
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Phoenix - WellCare
Location: E Camelback Rd, Phoenix, AZ 85016
Department: Operations - Claims, Medicaid
Reports to: Manager, Encounter Operations
The Encounters Analyst is responsible for ensuring that services provided to health plan members and billed by providers to the health plan are submitted to AHCCCS and CMS accurately and timely, with minimal errors in order that health plan medical expense on file at AHCCCS and CMS is complete and up to date. This position analyzes, researches, root causes and corrects errors within as short of time as possible in order to provide an accurate picture of medical expense and avoid penalties from the State.
- Analyzes, researches encounter errors, identifies root causes and makes recommendations for resolution
- Researches and documents all encounter errors in established database(s)
- Communicates with and provides clear, detailed, effective documentation to other departments within the organization on issues causing encounter pends/denials and potential solutions.
- Communicates regularly with management on issues discovered through research efforts
- Handles reversals/ recoupments resulting from encounter errors
- Assists Encounter Manager or Sr. Encounter Analyst in producing monthly summary reports identifying adjudication errors
- Keeps up-to-date on current claims processing procedures and guidelines
- Other duties as assigned
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