Location: Idlewild Ave, Tampa, FL 33634
Department: Operations - Encounters
The position serves as the analytical and business support for the Encounter Operations Department. Performs analysis, provides recommendations and implements changes to improve Encounter Data processing efficiency, quality, assuring compliance, and adherence with regulatory guidelines.
- Communicate with internal and/or external business partners and vendors to obtain information and documentation needed to support business needs.
- Provide analytical, research, and technical data support for regulatory/business-oriented processes for Encounter Data Operations.
- Conducts business analysis and recommends technical alternative solutions to management as to course of action that best meets the organization’s goals.
- Research and document data requirements for regulatory data submissions. Accountable for the analysis of encounter file and data requirements, the research and facilitation of error correction and file resubmission, and the development of file and data quality improvement solutions to maintain service levels for encounter reporting.
- Review, research, investigate and correct encounter issues through data and process analysis.
- Perform technical analysis and data mining for encounter data reporting requests from internal and external customers.
- Communicate with internal and external business partners and vendors to obtain information and provide status updates on deliverables.
- Performs other duties as assigned.
- Coordinate with internal staff to extract data from various systems, manage adherence to schedules to ensure timely submissions, provide quality review of encounter data and coordinate correction of data rejections so that each submission is clean and error free.
- Supports business expansion, ancillary, and provider relations community by developing member and provider materials.
- Communicate and manage provider/vendor and Ancillary regarding encounter deliverables to ensure compliance to state SLAs.
- Performs analysis of identified defects or issues through system testing and provide solutions.
- Assists in developing processes to assist vendor/provider and ancillary partners to meet WellCare submission requirements and state SLAs.
- Required: High School Diploma or GED
- Preferred: Bachelor’s Degree in a related field
- Required: 3 years of experience in data analysis using relevant software tools (such as SQL, SAS, or equivalent), research, or reporting/analytics, preferable in a health care environment
- Preferred: 2 years of experience in EDI and/or ANSI X12
- Preferred: 2 years of experience in Healthcare
- Ability to communicate and make recommendations to upper management
- Demonstrated analytical skills
- Demonstrated interpersonal/verbal communication skills
- Demonstrated written communication skills
- Demonstrated problem solving skills
- Ability to work in a matrixed environment
- Ability to work as part of a team
- Microsoft Excel
- Microsoft PowerPoint
- SQL Server System SQL