It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
Job Summary:
The Business Encounter Data Analyst is responsible for compiling and analyzing encounter data and understanding the claim impact of changes and decision to the business process to ensure that CMS and State Service Level Agreements (SLAs) are achieved. This individual will support the encounter data lifecycle process working closely with business and technical resources as well as document and illustrate business requirements, processes, and deficiencies across the organization, our vendors, and our regulators.
Our Investment in You:
* Full-time remote work
* Competitive salaries
* Excellent benefits
Key Functions/Responsibilities:
Supervision Exercised:
* None
Supervision Received:
* Indirect supervision is received weekly
Qualifications:
Education Required:
Education Preferred:
* AHIMA or other nationally recognized Coding/Billing Certification.
Experience Required:
* 5 or more years experience in a fast paced, managed healthcare environment.
* 5 or more years experience with encounter data operations, claims processing, and/or provider billing.
* 3 or more years of claim coding and billing processes, including CPT, ICD-10 and HCPCS coding.
* Advanced knowledge of HIPAA transaction regulations and 837 EDI standards.
* Experience working with Medicaid, Medicare or commercial encounter, coding and/or regulatory guidelines.
Experience Preferred/Desirable:
* Edifecs encounter data software.
* Cognizant Facets claim adjudication system.
* Experience with industry standard payment rules and methods.
Required Licensure, Certification or Conditions of Employment:
* Successful completion of pre-employment background check
Competencies, Skills, and Attributes:
Working Conditions and Physical Effort:
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees