RA Encounter Data System Senior Analyst
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Job Location:
Grand Rapids, MI - USA
Monthly Salary:
Not Disclosed
Posted on:
19 hours ago
Vacancies:
1 Vacancy
Job Summary
Job Summary
The Risk Adjustment (RA) Senior Encounter Data Systems Analyst plays a key role within the Risk Adjustment (RA) Encounters team managing and enhancing the full lifecycle of the Encounter Data Submission process across all applicable lines of business. This position requires deep knowledge of regulatory requirements and strong technical and analytical skills to ensure accurate compliant data submissions. The role involves evaluating upstream business processes conducting advanced root cause analysis and supporting other analysts through knowledge sharing and guidance on documentation troubleshooting and data quality practices.
As a business owner of the Encounter Data Submission system this analyst is responsible for translating business needs into clear actionable requirements. This includes developing and maintaining Business Requirements Documents (BRDs) Functional Requirements Documents (FRDs) and Business Requirements Mapping Documents (BRMDs) that trace data from intake through business logic to mandated outputs. The role also manages routine and ad-hoc processing investigates and resolves internal and government edits maintains application and database servers supports software upgrades and performs user acceptance and unit testing.
The position works closely with cross-functional teams and external vendors to resolve pended transactions document incidents and improve data quality and operational efficiency. Proficiency in SQL data querying and reporting is essential along with a solid understanding of HIPAA 5010 EDI formats (837P 837I 837D) 999 277 MAO-002 XML and ACA Encounter Data structures. This role requires the ability to clearly communicate complex findings and recommendations to both technical and non-technical stakeholders including senior leadership.
Essential Functions
Serves as the business product owner for the Encounter Data Submission system overseeing the routine and ad-hoc creation and submission of encounter data across all domains including Enrollment Medical Claims Pharmacy and Chart Review.
Leads comprehensive reconciliation efforts and root cause analysis for data system issues and submission incidents including internal and external (government) edit rejections.
Manages relationships with cross-functional teams to ensure accurate and timely resolution of Encounter Data Submission issues; reviews and updates documentation for upstream business processes that impact data inputs.
Acts as Encounters Subject Matter Expert with the Encounter Data Submission system IT vendor reviewing incident reports contributing to backlog refinement and supporting release management activities.
Designs and develops operational reports to support full-cycle reconciliation of encounter data including source inputs data batches file submissions and response files. Creates dashboards and executive-level reporting to communicate key encounter data metrics and performance indicators to senior leadership.
Plans tests and supports ETL processes including the design of table structures and data workflows to support encounter data ingestion and transformation.
Identifies and assesses the impact of incidents within the core Encounter Data Submission system; collaborates with IT vendors to refine backlog items and implement new market or regulatory submission requirements. Supports system integration efforts by leading data validation testing and implementation of new functionality or submission requirements.
Troubleshoots and resolves production issues related to encounter data and supporting applications ensuring minimal disruption to submission processes. Evaluates and advises on short-term workaround strategies to address Encounter Data Submission issues while long-term solutions are developed.
Qualifications
Required
Bachelors Degree or equivalent in business liberal arts computer science application programming software development information systems database administration mathematics engineering or other related field or equivalent work experience
3 years of relevant experience in the Encounter Data Processing of outbound and response transaction: State 837 Edge XML CMS EDPS 837 MMP ect field or
5 years of relevant experience IT systems databases analytics or related encounter data submission and resolution experience. Preferably with large complex data sources
About Corewell Health
As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement - to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!
Optional identity theft protection home and auto insurance pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Priority Health - 1231 E Beltline Ave NE - Grand RapidsDepartment Name
Risk Adjustment Executive - PH Managed BenefitsEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
9 a.m. to 5 p.m.Days Worked
Monday to FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.
An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Required Experience:
Senior IC
Key Skills
- Databases
- Data Analytics
- Microsoft Access
- SQL
- Power BI
- R
- Tableau
- Data Management
- Data Mining
- SAS
- Data Analysis Skills
- Analytics
About Company
Corewell Health is committed to granting equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status
