BendRecruiter Since 2001
the smart solution for Bend jobs

Encounter Data Analyst

Company: PacificSource Health Plans
Location: Bend
Posted on: January 9, 2021

Job Description:

Looking for a way to make an impact and help people?Join PacificSource and help our members access quality, affordable care!PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.Position Overview: Review, analyze and adjust hospital and professional claims as necessary for Encounter resolution. Research Encounter Edit, identify trends and resolve root cause, which need a higher level of adjudicator expertise, EDI interpretation and decision making for Government lines of business. Contribute to establishing and/or revising claims research policies and procedures and look for ways to improve processes. Work with external vendors contracted for EDI transmissions. Participate in Encounter work groups, across departments and participate or lead other standing or ad hoc workgroups as needed.Essential Responsibilities:

  • Analyze weekly Encounter pend/rejection reports, drilling down to root cause, system improvement opportunities and/or EDI transaction errors.
    • Review data for trends
    • Adjust claims as needed for pend resolution
    • Collect data and present findings to the Government Encounter team
    • Work cooperatively with internal departments and external vendors to review research to appropriately resolve Encounter errors based on PacificSource policy and procedures and applicable laws governing claims processing.
    • Work independently under time pressure and maintain company compliance by resolving and processing claims within the established by regulatory agencies and the plan timelines, and according to the processes established by the plan.
    • Manage quarterly OHA required Sterilization Consent Audit within timeframe provided.
      • Request medical records as applicable
      • Adjust claims as necessary
      • Search internal systems for Consent form on file
      • Process OHA Deceased Client Report (DCR) within 14 day timeframe.
        • Adjust claims as necessary
        • Process OHA Client Not Enrolled report within timeframe provided.
          • Adjust claims as necessary
          • Work miscellaneous OHA requests and/or reports as applicable to Encounter Data.
          • Review and resolve claim and system edits using multiple systems, processes and procedures.
          • Responsible for entering detailed system notes to record pertinent information involving a claim adjustment.
          • Document and report issues that affect claims processing or accuracy to the Government Operations Manager.Supporting Responsibilities:
            • Develop and track project plans for large upcoming projects that affect multiple areas.
            • Ability to judge severity of problems and the need to escalate to management or employ external services.
            • Maintain professional, service oriented relationships.
            • Demonstrate ability to organize and prioritize work.
            • Provide Claims processing assistance to the Claims Department when available.
            • Report pertinent information back to the Claims Leadership Team.
            • Perform other duties as assigned.Work Experience: Minimum five years claims adjudication experience with strong knowledge of Government requirements or equivalent work experience in a related health field. Coding experience is required. EDI knowledge is preferred.Education, Certificates, Licenses: High school diploma or equivalent required.Knowledge: Intermediate proficiency in Microsoft Office Applications including Word and Excel. Basic knowledge of medical terminology and medical coding preferred. Knowledge of claims and provider network preferred. Intermediate knowledge of Government Programs (Medicare/Medicaid) structure preferred. Intermediate understanding of EDI files and 5010 requirements. Excellent Time Management, Critical Thinking and Research skills preferred.Competencies
              • Adaptability
              • Building Customer Loyalty
              • Building Strategic Work Relationships
              • Building Trust
              • Continuous Improvement
              • Contributing to Team Success
              • Planning and Organizing
              • Work StandardsEnvironment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.Our Values
                • We are committed to doing the right thing.
                • We are one team working toward a common goal.
                • We are each responsible for customer service.
                • We practice open communication at all levels of the company to foster individual, team and company growth.
                • We actively participate in efforts to improve our many communities-internally and externally.
                • We encourage creativity, innovation, and the pursuit of excellence.
                • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Keywords: PacificSource Health Plans, Bend , Encounter Data Analyst, Professions , Bend, Oregon

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Professions Jobs


CDL Class A OTR Company Drivers Sign-On Bonus $1,000
Description: br br br CDL Class A OTR Company Drivers Sign-On Bonus 1,000 br Call 844 802-4392 Today br br Herrington Transportation, Inc is a growing trucking company that was founded in 2002. We (more...)
Company: Herrington Transportation
Location: Creswell
Posted on: 01/21/2021

92G Food Service Specialist
Description: AGE REQUIREMENTS: Must be between the ages of 17 and 35 br br It takes energy to keep the Army National Guard marching on, and that's where you take the lead. As a Food Service Specialist for the (more...)
Company: Army National Guard
Location: Eugene
Posted on: 01/21/2021

CDL Dedicated Drivers - Local & Regional Routes - Springfield, OR $5K Sign-On Bonus!
Description: br br Dedicated Truck Drivers Wanted Earn up to 80K PLUS up to 5K Sign-On Bonus br We are looking for Class A drivers who want to be part of a safe, highly motivated and exciting team. Is Work (more...)
Company: CRST Dedicated West
Location: Cheshire
Posted on: 01/21/2021


Delivery Driver - Flexible Schedule
Description: Job DescriptionDeliver with Uber. Earn on your schedule. Work on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends--it's up to you. Earn Good Money. You'll
Company: Uber Eats
Location: Sweet Home
Posted on: 01/21/2021

Class A Drivers
Description: br br br Class A Drivers br Call 888 991-1477 X 245 or Apply Online Below br br Certified Freight Logistics has hauled refrigerated products on the West Coast since 1928. We are a third-generation (more...)
Company: CFL - Certified Freight Logistics
Location: Creswell
Posted on: 01/21/2021

OTR Class A CDL Company Truck Driver
Description: br br OVER THE ROAD CLASS A CDL COMPANY TRUCK DRIVER br br CALL 866 404-6935 br Major Pay Increases in the First Year OTR - CDL A Truck Drivers are the backbone of May Trucking Company. (more...)
Company: May Trucking
Location: Creswell
Posted on: 01/21/2021

OTR CDL A Van or Hopper Company Driver
Description: Job Description: br AHEAD OF THE CURVE At H M Trucking, we know what it takes to get ahead of the curve and stay there. Whatever lies ahead for you make sure H M Trucking is with you every step and (more...)
Company: H & M Trucking Inc
Location: Junction City
Posted on: 01/21/2021

Delivery Driver - Uber Eats
Description: Job DescriptionDeliver with Uber. Earn on your schedule. Work on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends it's up to you. Earn Good Money. You'll
Company: Uber Eats
Location: Sweet Home
Posted on: 01/21/2021

Non-CDL Hostler
Description: br Non-CDL Hostler - Halsey, OR - HOME DAILY br br Apply Online Below br or Give Us a Call Today: 866
Company: CWT- Driver Advocates
Location: Junction City
Posted on: 01/21/2021

CDL Dedicated Drivers - Local & Regional Routes - Springfield, OR $5K Sign-On Bonus!
Description: br br Dedicated Truck Drivers Wanted Earn up to 80K PLUS up to 5K Sign-On Bonus br We are looking for Class A drivers who want to be part of a safe, highly motivated and exciting team. Is Work (more...)
Company: CRST Dedicated West
Location: Fall Creek
Posted on: 01/21/2021

Log In or Create An Account

Get the latest Oregon jobs by following @recnetOR on Twitter!

Bend RSS job feeds