21 days old

Data Reconciliation Analyst

Umpqua Health
Roseburg, OR 97470
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  • Job Code
    124436849
Full Time - Regular
Roseburg, OR, US


POSITION PURPOSE

Provides oversight and analysis of Health Plan Enrollment and Encounter Data submission/validation functions. Position will support the Director of Customer Care in his/her day-to-day operations in regards to Data Reconciliation and administrative needs.

ESSENTIAL JOB RESPONSIBILITIES

Oversight of 837I and 837P Encounter Data and Pharmacy Encounter Data processes and obtains signature of submission documents.

Response to any Encounter Data OHA memos requesting validation of anomalies/discrepancies at an aggregate level.

Provide oversight of daily and monthly 834 Eligibility Files, and reconciliation of 820 Capitation files against eligibility (perc codes).

Compile, organize and analyze data from various sources to serve as a source to validate Enrollment and Encounter Data.

Identify and correct any Enrollment errors, including potential/missed Enrollments.

Maintain the SFTP sites, compile and store the files posted.

Understand benefit plan coverage, enrollment, claims processing and policies and be able to concisely communicate this information as necessary.

Reviews and processes the monthly/weekly reporting (Case Management Incentive, Membership by Tier, Open-Closed, Newborn, etc.).

Develops, documents and maintains policies and procedures in relation to Data Reconciliation.

Develops reports for administration regarding Enrollment trends and outcomes.

Participates in state conference calls and monthly workgroups in relation to job duties.

Performs internal audits to ensure processes and procedures are being performed properly.

Maintains high level understanding of Medicare and Oregon Health Plan benefits packages.

Comply with organizations internal policies and procedures, Code of Conduct, Compliance Plan, along with applicable Federal, State, and local regulations.

Other duties as assigned.

SUPPORTING JOB RESPONSIBLITIES

Proven strong project management, multi-tasking and presentation skills.

Keep resource information up to date, accurate and organized.

Meets department and company expectations as they pertain to attendance, performance, and values.

Perform duties as assigned.

QUALIFICATIONS

Bachelors degree in related field or equivalent experience, preferred

3-5 years of experience in OHP enrollment and benefits, specifically CCO related, preferred.

Proficient computer skills in MS Word, Excel, PowerPoint, GE Centricity and other medical software.

Excellent verbal and written communication skills as well as, outstanding problem solving, organizational and leadership skills.

Demonstrated ability to successfully work with diverse teams.



PI124436849
Posted: 2020-10-03 Expires: 2020-11-04

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Data Reconciliation Analyst

Umpqua Health
Roseburg, OR 97470

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