Under the direction of the Director of Business Intelligence, the Encounter Operations Analyst position is responsible for ensuring that Boston Medical Center Health System’s Encounter Data is prepared and submitted in accordance with State and CMS contractual requirements. Working closely with the leaders of BMCHP/Well Sense business units, vendor management team and IT functions, this role will analyze data lineage, perform defect root cause analysis and overall assume responsibility for managing the IT portion of BMCHP/Well Sense’ encounter IT data lifecycle process.

• Serve as the lead in managing operational aspects of BMCHP’s encounter data process; including the reporting and tracking of each submission, ensuring data integrity for each submission
• Evaluates encounter data and identifies errors created by operational, claims and eligibility processes
• Researches, analyzes, summarizes and categorizes encounter rejects (response files) from NH DHHS, CMS and MassHealth trading partners
• Serve as encounter data subject matter expert for IT
• Works closely with other departments, data stewards, delegated vendors and government agencies to monitor, analyze and communicate aggregate and individual encounter data metrics (completeness, accuracy and timeliness)
• Coordinate with Data Warehouse and EDI developers, Data Quality and Business Analysts, Vendor managers and senior level Claims Staff to implement changes to encounter data “pipeline”.
• Collaborates with Business Intelligence Report Development and Data Warehouse team regarding  requests for new reports and tools to support encounter operations process
• Works collaboratively with Project Managers to perform required project tasks with minimal supervision
• Stays current with the needs and operations of the regulatory deliverables they support; provides recommendations and suggests opportunities to improve reporting solutions.
• Participates in user group forums and knowledge transfer sessions
• Partners with colleagues at and leads discussions with regulatory agencies including DHHS (State of NH), Mass Health (Massachusetts Medicaid) and CMS (Medicare) that pertain to encounter data operational processing and performance

Requirements:

• 3+ years of SQL Programming /Querying experience
• 3+ years of related managed healthcare, or insurance operations experience
• Expertise with relational database concepts, data modeling and OLAP technologies
• Minimum of one year performing encounter data analysis of  RAPS, EDPS & APD or similar, in a health care or health plan organization

Knowledge and Skills:

• Working knowledge of HIPAA/EDI X12 ANSI 5010 standards and EDI file structure required
• Analytical skills necessary to identify important trends, the ability to use technology tools to explore those trends and the judgment to call on internal experts as required.
• Strong knowledge of the healthcare delivery system, managed care and the key attributes of related data (claim type, Revenue Codes, CPT/HCPCS codes, bill type, dates of service, etc.).  Effective collaborative and proven process improvement skills
• Strong analytical, oral and written communication skills; ability to interact within all levels of the organization
• A strong working knowledge of Microsoft Office products
• Detail oriented, excellent proof reading and editing skills

Required Skills Required Experience

• Ability to supervise and evaluate the work of unit employees.
• Knowledge of generally accepted accounting principles and practices.
• Possess strong analytical ability and experience with computer spreadsheet applications.
• Ability to learn Metro policies and procedures.
• Ability to communicate effectively, both orally and in writing.