Encounter Analyst I (Full-time Remote, North Carolina Based)

The Encounter Analyst I reviews and monitors adjudicated claims for file submission and upstream processing and communicates with provider agencies and internal departments regarding claims submission, denial management, and system updates. The position tracks trends and patterns to identify irregularities in the ACS system and works with claims analyst to communicate claims issues. The position has shared responsibility for ensuring contract service level agreements are met.

This position is fulltime remote. Selected candidate must reside in North Carolina. Some travel for onsite meetings to the Home office may be required.

Responsibilities & Duties

Research and Resolve Encounter Denials

• Research upstream encounter denials
• Determine if claim processed appropriately in ACS
• Rebill encounter denial when appropriate
• Research State initiated encounter recoupments

Ensure Service Level Agreement (SLA) Maintenance

Manage Encounter Denials and Recoupments

Process and Reconcile Claims

Provide Feedback on Process Improvement

Communicate and Collaborate with Internal and External Stakeholders

Minimum Requirements

Education & Experience

Graduation from high school or equivalent and (4) four years of experience processing healthcare claims

Experience with Medicaid and IPRS preferred

Knowledge, Skills, & Abilities

Salary Range

$20.32 - $25.91 / Hourly

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.

An excellent fringe benefit package accompanies the salary, which includes :

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.