Nov 10, 2019

Encounters Data Analyst

  • Professional Diversity Network
  • Tampa, FL, USA
Full-Time Information Technology (IT)

Job Description

WellCare Health Plans

The position serves as the analytical and business support for the Encounter Operations Department. Performs analysis, provides recommendations and implements changes to improve Encounter Data processing efficiency, quality, assuring compliance, and adherence with regulatory guidelines.

Reports to: Sr Mgr, Encounters

Department: Ops-Encounters

Position Location: West Idlewild, Tampa, FL 33634

Essential Functions:

  • Communicate with internal and/or external business partners and vendors to obtain information and documentation needed to support business needs.
  • Provide analytical, research, and technical data support for regulatory/business-oriented processes for Encounter Data Operations.
  • Conducts business analysis and recommends technical alternative solutions to management as to course of action that best meets the organization's goals.
  • Research and document data requirements for regulatory data submissions. Accountable for the analysis of encounter file and data requirements, the research and facilitation of error correction and file resubmission, and the development of file and data quality improvement solutions to maintain service levels for encounter reporting.
  • Review, research, investigate and correct encounter issues through data and process analysis.
  • Perform technical analysis and data mining for encounter data reporting requests from internal and external customers.
  • Communicate with internal and external business partners and vendors to obtain information and provide status updates on deliverables.
  • Performs other duties as assigned.
Additional Responsibilities:
  • Coordinate with internal staff to extract data from various systems, manage adherence to schedules to ensure timely submissions, provide quality review of encounter data and coordinate correction of data rejections so that each submission is clean and error free.
  • Supports business expansion, ancillary, and provider relations community by developing member and provider materials.
  • Communicate and manage provider/vendor and Ancillary regarding encounter deliverables to ensure compliance to state SLAs.
  • Performs analysis of identified defects or issues through system testing and provide solutions.
  • Assists in developing processes to assist vendor/provider and ancillary partners to meet Wellcare submission requirements and state SLAs.

Candidate Education:

  • Preferred A Bachelor's Degree in a related field
Candidate Experience:
  • Required 3 years of experience in Data analysis using relevant software tools (such as SQL, SAS, or equivalent), research, or reporting/analytics, preferable in a health care environment
  • Preferred 2 years of experience in pharmacy background/knowledge of PBM
Candidate Skills:
  • Intermediate Ability to communicate and make recommendations to upper management
  • Advanced Demonstrated analytical skills
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Intermediate Demonstrated written communication skills
  • Intermediate Demonstrated problem solving skills
  • Intermediate Ability to work in a matrixed environment
  • Intermediate Ability to work as part of a team
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Advanced Microsoft Excel
  • Required Intermediate Microsoft PowerPoint
  • Preferred Intermediate SQL Server System SQL

About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.



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