Remote or Bloomfield, CT
$162,366 yearly est.
_Medicaid Claims & Encounters Senior Advisor position_ is the _encounters_ subject matter expert and responsible for working with IT and Claims and other operational areas, to ensure the accurate, timely and efficient submission of claims and encounters.
Works with IT and business leadership (corporate and market based) to effectively provide access to information and data to maintain business lead by the organization of state and federal regulatory reporting.
Together with internal functional partners, ensure we meet or exceed Medicaid and Medicare claims and Encounter requirements related to the State of Texas Medicaid and MMP programs and internal goals. Perform various analysis and interpretation to link business needs and objectives for assigned function by:
+ Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems.
+ Ensuring Encounter submissions meet state requirements. Perform necessary data pulls and analytics to pre-determine failures in encounter data extracted from claims system.
+ Identify and analyze user requirements, procedures, and problems to improve existing processes.
+ Ensure BA’s and other analysts processing files are keeping up to date, informed of changes and following through with them.
+ Complete the monitoring of submission, transmission and acceptance rates and provide reporting around each as required.
+ Reviewing, researching, investigating and correcting encounter issues through data and process analysis.
+ Where process or system changes are necessary, develop short and/or long-term resolutions by identifying root causes using data files, provider files, diagnosis files, etc.
+ Develop collaborative relationships with internal partners to ensure Encounter goals are met; includes partnering with functional teams (e.g., Provider Data, Claims, etc.) accountable for issues impacting Encounters.
+ Resolve issues and problems by conferring with those internal and external clients as necessary.
+ Support internal and external partners for reporting requirements.
+ Analyze the integrity of data, diagnose issues and test changes.
+ Participates in change management procedures to support accurate data documentation and process flow supporting the reporting requirements.
+ Develop and maintain all Encounter reporting technical documentation.
+ Maintain Encounter reporting describing results against internal goals; presenting results and issue updates
+ Develop, share, and incorporate organizational best practices into business applications
+ Develop relationships with state partners to research issues.
+ Regularly (Quarterly) review processes and work collaboratively with other BA’s and other analysts to improve automation and accuracy of submissions.
+ Identify trends / issues / deficiencies regarding monthly submission files and feedback files; oversee or resolve errors by working with other key departments; determine whether there is a need for process improvement or modification to ensure proper submission of all encounters; document testing; maintain record / file of all these interactions and of any changes.
+ Serves as Medicare and Medicaid Encounter Subject Matter Expert (SME) for state of Texas and other states acquired as necessary.
+ Support management requests for reporting based on various performance measures/data within the organization
+ Lead system testing to validate the rollout of new functionality.
+ Ability to perform some travel.
+ Other duties as assigned by supervisor/organizational leadership.
+ Maintain professional contact with other departments as needed; attend interdepartmental meetings.
+ Bachelor’s degree preferred or equivalent experience.
+ 4+ years of business process analysis, preferably in healthcare (i.e. documenting business process, gathering requirements) or claims payment/analysis experience.
+ Experience with encounters or claims business analysis experience in healthcare, preferably managed care or Medicaid Advanced knowledge of Microsoft Applications, including Excel and Access preferred.
+ Experience in benefits, pricing, contracting or claims and knowledge of provider reimbursement methodologies. Knowledge of managed care information or claims payment systems preferred.
+ Previous structured testing experience preferred. Compliance Coding/Prepay Compliance (Payment Integrity).
+ Knowledge of HIPAA transactions (i.e. 837, I, P, 999, 824, 277,820, 834) and SQL Scripting preferred.
+ Experience managing projects with a high reliance on technology.
+ Experience in Project Management
This position is not eligible to be performed in Colorado.
Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.
When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response._