Network Encounter Data Specialist at Magellan Health Services inc

Posted in General Business 5 days ago.

Type: Full-Time
Location: Albuquerque, New Mexico





Job Description:

This position is responsible for accurate and timely research of all encounter dispute types, timely processing of adjustments and acts as liaison between providers and internal claims departments. If adjustments are warranted and modification to the claim is determined to be required, acting within established parameters, this role requests the appropriate corrections into the claims system.
Responds to technical and claims inquiries from the client entailing the review of encounter records that were not accepted. Determines where the submission is failing in certain circumstances and defines the error codes associated with potential encounter issues


  • Analyzes complex encounter inbound and outbound process issues.

  • Uses data from internal and external sources to provide insight to decision-makers.

  • Performs root cause analysis of Claims/Encounters processing and submission issues.

  • Identifies system errors and develops recommendations based on data and industry knowledge.

  • Collaborates across departments to design and implement systems changes to meet encounter data processing and submission goals.

  • Participates in the workgroup to resolve encounter data and process issues.

  • Monitor's provider compliance with policies, procedures, and regulations for the coding of encounters.

  • Develops programs to address provider data and performance gaps.


Other Job Requirements

Responsibilities


  • 2+ years of claims and encounter transaction research experience.

  • Ability to deal with many functional areas of an organization.

  • Excellent verbal and written communication skills.

  • Excellent research and analytical skills.

  • Ability to identify encounter/claims processing and policy issues as they apply to corporate and contract policies.

  • Strong spreadsheet and word processing skills.


General Job Information

Title
Network Encounter Data Specialist

Grade
19

Work Experience
Claims

Education
GED (Required), High School (Required)

License and Certifications - Required

License and Certifications - Preferred

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their
position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.





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