The Role
Analyze encounter system processes, coordinate data exchange with external entities, research claim scenarios, and document processes. Participate in financial data support and compliance monitoring.
Summary Generated by Built In
Job Summary & Responsibilities
- Analyzes encounter system processes within HMSA and external partners.
- Coordinates and reconciles exchange of data with external entities.
- Researches various claim-member-provider scenarios to determine root cause of data submission errors.
- Participates in discussions with internal staff to optimize encounter submission processes.
- Participates in projects to increase the scope or efficacy of encounters submission.
- Provides data to support financial reporting.
- Monitors government/vendor requirements changes.
- Ensures submission methodologies are compliant with published guidance.
- Documents new processes or procedures and updates existing documentation.
- Bachelor's degree and one year related experience; or an equivalent combination of education and experience.
- Conceptual knowledge of claims, health plan financial data, and health industry structure.
- Conceptual knowledge of Medicare Advantage, Medicaid, and/or ACA revenue cycles for payers.
- Intermediate working knowledge of Microsoft Office applications, including but not limited to Word, Excel, Outlook, and PowerPoint.
- Conceptual knowledge of SQL, SAS, or MicroStrategy.
Top Skills
Excel
Microsoft Office (Word
Microstrategy
Outlook
Powerpoint)
SAS
SQL
Am I A Good Fit?
Get Personalized Job Insights.
Our AI-powered fit analysis compares your resume with a job listing so you know if your skills & experience align.
Success! Refresh the page to see how your skills align with this role.
The Company
What We Do
The Hawaii Medical Service Association (HMSA), an independent licensee of the Blue Cross and Blue Shield Association, is a reliable name in Hawaii health care. Established in 1938, we are the largest and most experienced provider of health care coverage in the state. Over half of Hawaii’s population have chosen HMSA for their health care coverage. We are dedicated to providing quality, affordable health plans; employee benefit services; and worksite wellness programs. HMSA also offers a variety of programs, services and support to help improve the health and well-being of our members and community.
