Encounters Business Consultant

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is invested in your future!

Job Summary

This position is responsible for being a lead subject matter expert (SME) within HCSC's government performance risk adjustment encounters team. This role will be an SME in encounter operational management and analytics activities/functions. Operational and analytical areas include but are not limited to encounter data management, submissions, reject remediation, data reconciliation, performance management, presenting to internal/external entities, vendor management, as well as, interfacing with federal regulatory agencies if/when applicable. This individual must have strong experience in day to day Medicare and/or Medicaid risk adjustment related risk adjustment encounter operations and related activities.

Please note: This is a hybrid role and will work in the office three days a week.

Required Job Qualifications:

• Bachelors or Advanced degree (or 5 years' experience in lieu of degree) in Business Administration, Finance, Statistics, Healthcare Administration

• 5+ years' experience working in Healthcare industry in Medicaid and/or Medicare Encounter operations, risk adjustment or related healthcare operations.

• Advanced knowledge in query design/development (e.g. SAS, SQL, etc.) and relational database understanding

• Knowledge of Medicare and/or Medicaid Encounter Data System and understanding of 837-5010 and/or other standard encounter data file formats

• Strong experience working with healthcare data specific to risk adjustment and/or related functions

• Proficient/advanced in MS Office (Excel, PowerPoint, Access, etc.) to derive effective presentations & exhibits for leadership

• Strong interpersonal, organizational, communication, and workflow skills

• Willingness and ability to travel approximately up to 25%

Preferred Job Qualifications:

• Experience with risk adjustment encounter file preparation and remediation (e.g. 837 5010 files, RAPS returns/submission files, EDPS MAO-002, 277CA, and/or 999 file, MAO-004, PDE, or EDGE files etc.

• Experience with Medicare and/or Medicaid risk adjustment encounter management, reporting and requirements from either a payer or vendor a big plus

• Advanced knowledge of Medicare and/or Medicaid risk adjustment encounter functions, regulations, and other related activities

• Experience with databases as well as interpretation and manipulation of related healthcare data (e.g. claims, enrollment data etc.)

• Knowledge of encounters within other lines of business including Exchange/ACA, Medicaid, and/or Medicare Advantage

• Knowledge of HCC coding, risk adjustments concepts, medical record review project management, encounter data management, compliance audit concepts

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.