Encounter Data Management Professional

Candidates must possess a minimum of 1 year of experience in medical claims payment and processing, along with 1 year of experience analyzing and researching medical claims. Proficiency in Microsoft Office (Word, Excel, Access, PowerPoint) and working knowledge of SQL are required. Familiarity with EDI X12 formats (837P/I/D, 999, 277, 835, 270/271, 834) is necessary. Demonstrated ability to independently identify process gaps and recommend solutions, strong analytical skills with experience resolving complex data issues, and proven decision-making in ambiguous situations using available data are essential. Candidates should be self-directed with initiative, demonstrate creativity and a proactive approach, and be committed to improving business outcomes. Proficient oral and written communication skills, along with collaborative and strong relationship-building skills, are also required. Preferred qualifications include comprehensive knowledge of Medicare, Medicaid, and DSNP encounter processes and policies, working knowledge of advanced analytics and experience with Python and DataBricks, and familiarity with Cloud Technologies (Azure Synapse Analytics) and Power Platform (Power BI). Experience creating pivot tables and consumable information within Excel is a plus. For remote work, a high-speed DSL or cable modem (minimum 25mbps download x 10mbps upload) is required, with satellite and wireless internet not permitted.