Job Description

Location: Health Choice Management Co.
Posted Date: 3/20/2020
The Encounter Lead is able to oversee all processes associated with submission, pending and editing and adjusting all Encounter submissions for all lines-of-business accurately and timely in order to meet regulatory requirements. Assists in training of Resolution Center Coordinators in Encounter processing to ensure optimal skill set, as well as adherence to policies and procedures.
  • Ensures and works, as required, all pended Encounters timely and accurately
  • Ensures work distribution to Resolution Center Coordinators
  • Understands Encounter submission process and keeps updated
  • Understands Encounter submission and acceptance regulatory requirements, inclusive of first-pass acceptance
  • Assists in training of Resolution Center Coordinators
  • Assists in the development and maintenance of training materials
  • Develops and maintains relationships with New Day claims processing
  • Identifies root cause resolution to errors and works with appropriate leaders to change process and/or train staff as needed
  • Brings appropriate escalated issues to leadership
  • Identify issues for process improvement

Education:

  • High school or GED
  • College preferred

Years of Experience:

  • 3+ years in claims processing, inclusive of UB and HCFA 1500s

Specialized Knowledge:

  • Medicaid policies and procedures
  • AHCCCS policies and systems
  • Medicare policies and procedures
  • ICD10/CPT/HCPC CODING
  • Computer skills, inclusive of Microsoft suite and proprietary systems
  • Ability to lead a team
  • Ability to think analytically and make independent decisions

Application Instructions

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