Encounter Analyst - Remote in Orange at Prospect Medical Systems

Date Posted: 7/24/2020

Job Snapshot

  • Employee Type:
  • Location:
    600 City Parkway West
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
  • Job ID:

Job Description

Encounter Analyst

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Encounter Analyst is responsible for monitoring and oversight of the end-to-end encounter management workflow. This position analyzes complex encounter inbound/outbound process issues, using data from internal and external sources to provide insight to decision-makers.

Job Responsibilities/Duties

  • Responsible for documenting, monitoring and analyzing the end-to-end encounter life cycle, inbound and outbound encounter process.
  • Identifies and interprets encounter data, submission requirements and performance metrics per the regulatory and health plan guidelines.
  • Researches and documents all encounter errors in established systems(s)/database(s) with appropriate statistical and trend analysis
  • Performs root cause analysis of claims/encounters processing and submission issues; develops recommendations based on data and industry standards.
  • Collaborates across various departments to design and implement any business process and/or systems changes to meet encounter data processing and submission goals.
  • Communicates with and provides clear, detailed, effective documentation to other departments within the organization on issues causing encounter pends/denials and potential solutions.
  • Collaborates with the Health Plans, clearinghouses and product Vendors on any encounter related issues   
  • Communicates regularly with management on issues discovered through research efforts
  • Develops various encounter related reports (i.e. exception reports, performance reports, root cause analysis outcome reports, etc.) and distributes them to appropriate departments for error resolution, follow up and performance monitoring.
  • Participates in the workgroup to resolve encounter data and process issues.
  • Owns and maintains the desktop procedures, workflows and policy and procedure documents for encounters
  • Works to optimize business performance by recommending balanced approaches to system design and operational/process oriented solutions
  • Review and research inquiries from regulatory bodies and/or the Health Plans related to submission data including the score cards from the Health Plans
  • Works with the Encounter/ EDI team for rolling out the best practices around encounter management
  • Proactively monitors the performance of encounters metrics and recommend system/business process adjustments as applicable    
  • Other duties as assigned


Minimum Education:  Bachelor’s Degree in a healthcare discipline, or combination of AA Degree plus 5 years of progressive managed care Encounter analysis experience, or seven (7) years of progressive managed care Encounter analysis experience required.

Minimum Experience: Three to five (3-5) years working in the health payer industry with proficient level understanding of general business practices and health plan operations (Membership, Provider, Claims, Customer Service, Care Management, etc.) required. Three to five (3-5) years of experience as a Business Analyst or Operations Analyst (must have some experience writing business requirements and working with technical teams to implement custom solutions) required. Three to five (3-5) years of experience working with ANSI x12 EDI standards for health care required. Solid analytical skills with ability to compile data from many sources and formulate plans and recommendations. Excellent data manipulation, communication, analytical and statistical skills are required. Must be comfortable with SQL, MS Excel, MS Access, MS Word, MS Visio and MS PowerPoint. Must have excellent time management and organizational skills with the ability to handle multiple tasks in a timely and accurate manner. Ability to work under pressure, adhere to deadlines and know when to escalate information/issues. Must have a high level of self-motivation and with little guidance/supervision. Must be able to work both independently as well as a team participant. Must have outstanding verbal and written communications skills with the ability to communicate clearly to all levels of an organization. Must have strong interpersonal skills. Three (3) plus years health plan operations analysis or related work preferred. Experience with multiple health plan operation functional areas. Knowledge of Medicare, Medicaid, TPA business requirements is a plus. Experience executing user acceptance testing and triaging test issues. Prior class room or on-the-job training experience. Experience mapping business processes. Experience working on at least one (1) enterprise-wide system implementation (from start to finish).

Req. Certification/Licensure: None.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm