Encounter Validation Analyst

In this role you will create and executes deliverables as part of a team assigned to a business. This position supports the Medicaid Encounter processes including new plan implementations, system upgrades, and regulatory changes by plan. The Analyst is responsible for defining the reporting requirements based on each state specifics and working with Data Base Analysts to ensure the report requirements are met. You will be suing Excel on a regular basis and working with large data files!

If you want the challenge of working in a dynamic environment, this is the position for you. This position will allow you to work with a diverse team of individuals and allow a candidate to acquire a wide variety of knowledge ranging from the inner-workings of an 837 EDI health care claim file to an introduction to the use of SQL. Each day is different from the previous day as there are multiple work streams that need to be managed concurrently.

Fundamental Components


*Candidate is responsible for the creation and submission of encounter data to State entities in accordance with regulatory and contractual requirements for accuracy and timeliness.

*Resolves problems in a timely and effective manner.

*Understands the impact of actions on system primarily used/maintained.

*Understands relationships of designated systems.

*Analyzes and verifies system results to ensure accuracy, accountability and financial data integrity.

*Responds to and resolves customer inquiries and complaints (internal as well as external) both verbal and written correspondence within established unit objectives.

*Analyzes and resolves system error conditions within established unit time frames.

*Participates as a member of a project team.

*Analyzes and recommends solutions to non-standard requests and requirements from plan sponsors and areas within and outside the area.

*Uses system produced data to prepare management level reports.

*Oversight for reporting on a complex Medicaid plan

BACKGROUND/EXPERIENCE

• Technical savvy, strong computer knowledge including experience in Excel is needed!
• Experience in working with large data files in Excel is a huge plus!
• Familiarity with SQL would be helpful.
• Knowledge of 837 institutional and professional file structure is a plus.
• Background in claims, root cause analysis and / or health care is a plus!
• Strong critical thinking skills are needed
• Strong analytical skills are needed
• Strong communication skills are needed
• Strong problem solving skills are needed
• Knowledge of all Microsoft office including Outlook is important.

EDUCATION

The highest level of education desired for candidates in this position is a Bachelor’s degree or equivalent experience.

FUNCTIONAL EXPERIENCES

Functional – Information Technology/Computer operations/1-3 Years

Functional – Information Technology/Research/1-3 Years

Functional – Information Technology/Testing/1-3 Years

Functional – Claims/Reporting & special services/1-3 Years

Functional – Information Management/Business information analysis/1-3 Years

TECHNOLOGY EXPERIENCES

Technical – Database/Microsoft SQL Server/1-3 Years/End User

Technical – Computer Operations/System and Console Operations/1-3 Years/Power User

Technical – Aetna Applications/QNXT/1-3 Years/End User

Technical – System Management/Problem Management/1-3 Years/End User

REQUIRED SKILLS

General Business/Applying Reasoned Judgment/MASTERY

General Business/Communicating for Impact/FOUNDATION

General Business/Maximizing Work Practices/MASTERY

DESIRED SKILLS

General Business/Turning Data into Information/FOUNDATION

Service/Working Across Boundaries/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

ADDITIONAL JOB INFORMATION

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.