Expert Analyst

<strong>Working at Advantasure is more than a job &mdash; you&rsquo;re part of a team that is becoming the country&rsquo;s leading healthcare solutions provider.<br /></strong><br /><strong>A career at Advantasure means you&rsquo;ll be part of one of the most dynamic, diversified and innovative healthcare companies in the nation. You&rsquo;ll be helping our clients make their members healthier &mdash; and our communities a better place to call home.</strong>

United States, USA


<p class="p1"><strong>At Advantasure, we partner with healthcare clients to simplify their operations and accelerate their business success. Powered by our broad expertise and a comprehensive suite of product and service solutions, we help health plans effectively navigate the complexity of healthcare.</strong></p>

keywords: summary,job description,work environment,analysis,collaboration,other duties,education & experience,knowledge,skills


Competitive Compensation and Benefits Package

Overview: <br />The role of the Expert Analyst on the Medicare Advantage Submissions team is to help maximize risk scores and revenue associated with the submission of Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS) data to CMS for all full-service Medicare Advantage clients including both MI plans (PPO &amp; HMO), clients on the business process as a service (BPaaS) platform as well as the Joint Venture (JV) clients. The Expert Analyst will work with team members to research, analyze and manage system-generated edits and CMS assigned errors so data can be processed to a successful CMS acceptance status. Tasks also include tracking and monitoring claim encounters from receipt of the claim to submission of the claim to CMS&rsquo;s RAPS &amp; EDPS as well as reconciling EDPS submitted claims and supplemental records for all open payment years for MI, BPaaS, and JV clients.&nbsp;<br /><br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in a remote location or office setting with no unusual hazards.&nbsp;</p>
Responsibilities: <br /> <ul> <li>Provide RAPS &amp; EDPS error resolution for MI, BPaaS, and JV clients through team collaboration and working with business partners.</li> <li>Research, analyze, identify, and evaluate data from system errors to evaluate existing and potential trends and issues.</li> <li>Establish a mechanism to review claims received by Advantasure to improve and maximize submission outcomes.</li> <li>Communicate results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions.</li> <li>Possess and maintain a comprehensive understanding and knowledge of business, products, corporate organizational structure (including functional responsibilities), and research principles/methodologies.</li> <li>Assist in ensuring RAPS &amp; EDPS compliance with CMS regulations.</li> <li>Provide RAPS &amp; EDPS BPaaS and JV client implementation support.</li> <li>Collaborate with Subject Matter Experts to improve client revenue outcomes.</li> <li>Ensure complete, accurate, and timely data for reporting purposes.</li> <li>Recommend and implement solutions to identified problems/root cause of issues.</li> <li>Provide expertise and guidance to other departments, teams, and corporate staff as required.</li> <li>Represent and participate in group or committee discussions.</li> </ul>
Requirements: <br /> <p><strong>EDUCATION:</strong></p> <ul> <li>Bachelor&rsquo;s degree in Business Administration, Economics, Health Care, Information Systems, Statistics, or related field is required.</li> </ul> <p>&nbsp;</p> <p><strong>EXPERIENCE:</strong></p> <ul> <li>Four (4) or more years of experience in a related field required to provide the necessary knowledge, skills, and abilities for the role.</li> </ul> <p>&nbsp;</p> <p>&nbsp;</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Knowledgeable of Medicare Advantage Risk Adjustment business processes.</li> <li>Experience using SQL.</li> <li>Strong communication skills are required to understand, interpret, and communicate ideas.</li> <li>Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).</li> <li>Strong analytical, organizational, planning, and problem-solving skills.</li> <li>Experience with 837 electronic claim format is preferred.</li> <li>Ability to effectively interface with employees at all levels.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> <li>Experience executing in a fast-paced environment with tight deadlines.</li> <li>Administer and adhere to corporate and departmental policies, practices, and procedures.</li> </ul>