Encounter Data Analyst


Community Health Group is a locally based non-profit health plan that ensures access to high quality, culturally sensitive health care for underserved communities throughout San Diego County. We treat our 300-member, multi-lingual staff like family, encouraging an atmosphere of collaborative teamwork, continuous learning, personal growth, and promotion from within. Recognized as one of the Top Workplaces in San Diego, CHG offers its employees such benefits as tuition reimbursement, a meditation room and yoga classes, a monthly Breakfast With The CEO, and memorable events throughout the year. 

We know that by serving our employees well, they, in turn, will better serve our nearly 300,000+ membership. We have been recognized consistently for the excellence and sensitivity of our customer service by members, physicians, vendors, and a full range of health care providers. We are accredited by the National Committee for Quality Assurance and proud of our continuing company-wide Quality Initiatives.

We are currently recruiting for:

Encounter Data Analyst

POSITION SUMMARY

The Encounter Data Analyst primary responsibilities include all processes and duties that encompass encounter data. The Encounter Data Analyst role is to plan, design, implement, and test the encounter data processes as well as generate, review, analyze, and submit all encounter data for each of Community Health Group’s (CHG) programs and quality initiatives. This position will serve as the lead in managing each encounter data process; including the reporting and tracking of each submission, ensuring data integrity for each submission, and that all regulatory and system updates are implemented efficiently. This role will proactively monitor all regulatory encounter data sites and work closely with EDI and Claims staff to ensure all data is accounted for which will maximize CHG’s revenue.

COMPLIANCE WITH REGULATIONS:

Work closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D), and DHCS.

RESPONSIBILITIES

This position will be involved in multiple activities related to Community Health Group encounter data which include:

  • Analyze, process, and troubleshoot HIPAA/EDI X12 ANSI 5010 healthcare transactions

    • 837

    • 999

    • 277CA

  • Analyze, process, and troubleshoot CMS Encounter Data response files

    • MAO-001

    • MAO-002

    • MAO-004

  • Analyze, process, and troubleshoot DHCS Encounter Data response files

    • EVR

  • Manage all encounter data processes for all Regulatory Agencies

  • Serve as encounter data subject matter expert

  • Expertise in Risk Adjustment Process System (RAPS)

    • Review and submit complete and accurate RAPS files

    • Calculate Risk Scores

    • Expertise in CHG’s RAPS system

  • Expertise in DHCS pharmacy encounter data NCPDP File

  • Expertise in CMS pharmacy encounter data PDE file

  • Manage full cycle Encounter Data process

  • Serve as subject matter expert in new encounter data regulations and quality measurements

  • Attend and participate in all encounter data conferences, workgroups, and webinars

  • Download and track all encounter data specifications

  • Coordinate with EDI Analysts, Software Developers, and Senior level Claims Staff to implement all encounter data updates

  • Develop encounter data reports and deliverables and make recommendations to management

  • Model data using Microsoft SQL Server, Microsoft Excel, and other data warehouse analytical tools

  • Provide ad-hoc SQL data\reports as requested

  • Generate reports in Tableau

  • Keep all EDI Team Members informed of pertinent timelines, plans, and documentation

  • Provide timely communication on status and issues on a weekly basis

  • Document encounter data processes and requirements

  • Perform monthly maintenance system testing

  • Other duties as assigned

Education:                 

  • Bachelor’s Degree in Computer Science, Information Systems, or equivalent experience

Experience/Skills:    

  • Ability to generate SQL scripts
  • Detail oriented is a must
  • Knowledge of relational databases
  • Knowledge of EDI
  • Knowledge of CMS and DHCS companion guides
  • Familiar with Lab and NCPDP data specifications
  • Ability to operate personal computers and other related peripherals
  • Excellent oral and written communication
  • Good analytical, logical, and organization skills
  • Excellent time management; able to work on multiple projects concurrently
  • Ability to adhere to security requirements and confidentiality as required by CHG and the Health Insurance Portability and Accountability Act (HIPAA)

Physical Requirements:   

  • Minimum 30 lb. Lifting.
  • May be required to work evenings and/or weekends.