What are the responsibilities and job description for the Data Encounter Specialist position at Regal Medical Group?
Job Description
MUST BE ABLE TO WORK FULLY ONSITE IN NORTHRIDGE, CA.
Position Summary :
The Encounter Data Specialist works with internal stakeholders, external clients to identify 5010 requirements. This position is responsible for analyzing and correcting rejected encounters in a timely manner for Clearing House and Direct submitters. This position is accountable to ensure that encounters are corrected according to Health Plan industry standards and guidelines set by CMS and DHCS.
Essential Duties and Responsibilities include the following :
- Correct rejected encounters , follow CMS and DHCS Claims processing guidelines and industry standard in correcting rejected encounters.
- Conduct Root Cause analyst for encounter errors, meet with departments to go over processes or programming to minimize root cause.
- Understand the entry of claims system support tables and processes to ensure our groups are meeting 5010 requirements and general data maintenance for eligibility, providers, fee sets, and benefits or any other areas that require knowledge in making decisions.
- Create and maintain an encounter error.
- Analyze trends of rejected.
- Establish and maintain strong relationships with Health Plans, Encounter Clearing Houses, and internal stakeholders to fix, prevent, and to obtain extra support in resolving encounter errors.
- Educate internal stakeholders regarding regulator changes for encounters.
- Lead and attend meetings as required.
- Provides training to staff in encounter corrections.
- Adhere to Data integrity policies for all system.
- All other duties as directed by management.
The pay range for this position at commencement of employment is expected to be between $25 - $27 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and / or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department / team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
Full Time Position Benefits :
The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness :
Savings and Retirement :
Other Benefits :
Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.
Requirements
Education and / or Experience :
Salary : $25 - $27
