Search jobs > Chicago, IL > Remote > Analyst

Encounters Business Analyst

Health Care Service Corporation
Chicago Illinois HQ
$53.5K-$118.1K a year
Remote
Full-time

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

Job Purpose :

This position is responsible for aiding HCSC’s IFM risk adjustment operational management and analytics activities and functions.

Operational areas include but are not limited to data management, data submissions, reject remediation, data reconciliation, data reporting and analytics, performance management, vendor management, as well as, interfacing with federal regulatory agencies if / when applicable.

Job Responsibilities :

  • Acts as lead in various activities such as risk adjustment encounter data collection, processing, submission, small / medium / large projects, report generation, and data reconciliation efforts ensuring that data is processed and submitted according to State and / or CMS guidelines and requirements.
  • Conducts business analysis and recommends solutions to leadership
  • Analyze encounter data to identify trends, and conduct root cause analysis; develop improvement plans, organize cross-functional teams and develop high-quality output for internal and external constituents to address identified issues
  • Provides guidance and training to other staff members as needed
  • Monitors vendor performance and guiding them through issues, areas for improvement, and priorities
  • Create reports, insights and analytics in support of the business.
  • Create specifications for reports and analysis based on business needs; possibly providing consultation to users and working on cross-functional teams to address business issues.
  • Produce datasets and reports for analysis using system reporting tools; possibly performing research and assisting in analyzing data related to the division’s strategic initiatives and broader research needs.
  • Partners with vendors, team members, provider groups, etc. to ensure all CMS and / or State guidelines for risk adjustment data capture and contractual service level agreements are met.
  • Serves as a Subject Matter Expert for other departments, providers, projects, and committees
  • Performs any other job-related duties as assigned.Required Job Qualifications : *Bachelors or Advanced degree (or 4 years’ experience in lieu of degree) in Business Administration, Finance, Statistics, Healthcare Administration *3-5 years’ experience working in Healthcare industry in Medicaid and / or Medicare Encounter operations, risk adjustment or related operations.
  • Experienced in query design / development (e.g. SAS, SQL, etc.) and / or relational database understanding*Knowledge of Medicare and / or Medicaid Encounter Data System and understanding of 837-5010 and / or other standard encounter file formats *Experience working with healthcare data specific to risk adjustment and / or related functions*Proficient / advanced in MS Office (Excel, PowerPoint, Access, etc.

to derive effective presentations & exhibits for leadership*Strong interpersonal, organizational, communication, and workflow skills*Willingness and ability to travel approximately up to 25Preferred Job Qualifications : *Experience with risk adjustment encounter file preparation and remediation (e.

g. 837 5010 files, RAPS returns / submission files, EDPS MAO-002, 277CA, and / or 999 file, MAO-004, or EDGE files etc.*Experience with Medicare and / or Medicaid risk adjustment encounter management, reporting and requirements from either a payer or vendor a big plus*Knowledge of and experience in Medicare and / or Medicaid risk adjustment functions, regulations, and other related activities*Experience with databases as well as interpretation and manipulation of related healthcare data (e.

g. claims, enrollment data etc.)*Knowledge of encounters within other lines of business including Exchange / ACA, Medicaid, and / or Medicare Advantage*Knowledge of HCC coding, risk adjustments

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement :

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$53,500.00 - $118,100.00

5 hours ago
Related jobs
Health Care Service Corporation
Chicago, Illinois
Remote

Create specifications for reports and analysis based on business needs; possibly providing consultation to users and working on cross-functional teams to address business issues. Knowledge of encounters within other lines of business including Exchange/ACA, Medicaid, and/or Medicare Advantage*Knowle...

Promoted
PMI (Project Management Institute)
Chicago, Illinois

Strong project management skills, with the ability to manage multiple concurrent projects and priorities. Strong project management skills, with the ability to manage multiple concurrent projects and priorities. Managing the logistics, resources, and operational support needed to execute critical pr...

Promoted
SOURCE ALLIANCE NETWORK
Chicago, Illinois

This will allow the Logistics Data Analyst to become proficient and further develop skills in transportation and data analysis applications needed to perform the required tasks. Additionally, the Logistics Data Analyst will be expected to perform various mathematical calculations to determine how da...

Promoted
Hexaware Technologies
Chicago, Illinois

The ServiceNow Project Manager would be a self-driven individual who would be accountable for managing & driving end-to-end ServiceNow project, assess ServiceNow capabilities and lead the Product roadmap aligned to client strategic objectives. Accountable for end-to-end delivery of overall project a...

Promoted
US Tech Solutions
Chicago, Illinois

A Technical Business Analyst is responsible for gathering and documenting requirements, conducting business and systems analysis, creating specifications for systems to meet business requirements, and overseeing the implementation of these systems. The key responsibilities include analyzing business...

Promoted
TAG - The Aspen Group
Chicago, Illinois

We are looking to hire a positive, proactive IT project manager to manage project teams and ensure IT projects are completed on time and on cost. A project manager will need to communicate with stakeholders during all phases of the project and must close each project efficiently with documented sign...

Promoted
The Judge Group
Chicago, Illinois

Our client is currently seeking a Business Intelligence Analyst. The ideal person is someone who can work in a fast paced environment, is able to self-direct, collaborate and deliver on critical Business Intelligence projects. Your work will be influential in the business decisions they make which m...

Promoted
Confidential
Chicago, Illinois
Remote

Experienced in detailed project planning, project governance, capacity planning, and project budgeting. We are looking for an Implementation-heavy Project Manager (Remote eligible) able to work on EST time zone and spearhead SaaS implementations for our Healthcare clients. Professional experience wi...

Promoted
Flexport
Chicago, Illinois

Data Analyst, BI Engineer, Product Analyst, or similar role. Ready to tackle global challenges that impact business, society, and the environment? Come join us. Meet with stakeholders - from business and product - to understand OKR requirements and convert them into analytical solutions. Improve ope...

Promoted
Accenture
Chicago, Illinois

In addition to delivering innovative solutions for Accenture's clients, you will work with a highly skilled, diverse network of people across Accenture businesses who are using the latest emerging technologies to address today's biggest business challenges. As a Business Analyst, you will be respons...