Eligibility & Encounters Data Analyst

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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview

Under the direction of ACO Operations Management, the Eligibility and Enrollment (E&E) Data Analyst performs specialized functions to maintain eligibility data integrity for ACO members and collaborate closely with Team Lead and/or Manager on work assignment prioritization and maintain assigned process and procedure documents. The E&E Data Analyst is the intermediate working level in the Eligibility and Enrollment job series. E&E Data Analyst coordinates with third party vendor to ensure Tapestry Encounter data rejects are processed accurately. Incumbent has strong knowledge of Commercial and Managed Care plans.

Locations
Stanford Health Care

What you will do

• Eligibility:

• Verify eligibility by utilizing Health Plan websites and/or call Health Plan eligibility contact number.

• Create or update Member record in Tapestry accurately with appropriate notation.

• Create or update Member coverage in Tapestry accurately with appropriate notation.

• Identify non-member claims and document accordingly each case clearly in support of mail back notification process.

• Collaborate with Decision Support per established workflow on root cause analysis and resolution implementation.

• Assist in creation and maintenance of procedure documents.

• Encounters:

• Navigate in the Clearing House and third vendor portals fluently and understand functionality of each portal.

• Keep track of encounter reject records for reporting purpose.

• Assist in creation and maintenance of procedure documents.

• Fix and resolve enrollment system rejections in the portals.

• Communication:

• Collaborate with internal customers in the registration and claims payment processes.

• Collaborate with external vendors and Health Plans.

• Escalate complex issues to team leader and/or management.

• Notify department manager proactively with issues, instances of errors or obstacles that prevent successful completion of work.

• Apply strong writing skills in email communication and internal notes/memos.

• Have strong verbal articulation ability.

• Customer Service:

• Manage email traffic and phone call volume by responding in a timely manner.

• Adhere to professional conduct and exercise reasonable care to maintain member privacy and confidentiality.

• Operational Efficiency:

• Re-prioritize work regularly to adapt to changes in the department or environment.

• Collaborate with other departments and outside agencies to meet the identified needs of the patient.

• Consistently meet or exceed productivity and quality standards established by Eligibility and Encounter Team Lead and/or Department Manager.

• Assist Department Manager with special projects as needed.

• All other duties as assigned including department-specific functions and responsibilities.

• Performs other duties as assigned and participates in organization projects as assigned.

• Adheres to safety, HIPAA and compliance policies.

Education Qualifications

• Associate degree or equivalent combination of education and experience may be considered

Experience Qualifications

• Three (3) - five (5) years related experience obtained from working in a health or health-related field including experiences in Eligibility Data and Encounters.

• Working knowledge of Electronic Data Interchange processes and procedures.

• Claims and Referrals experience highly preferred.

• EPIC/Tapestry experience highly preferred.

Required Knowledge, Skills and Abilities

• Strong verbal/written communication and listening skills; including excellent interpersonal skills and telephone communication.

• Ability to maintain composure during challenging interpersonal interactions.

• Ability to effectively organize and prioritize tasks to complete assignments within the time allotted and maintain standard workflow.

• Ability to establish and maintain effective working relationships with co-workers and management.

• Proficiency in the operation of a computer using Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).

• Skill in identifying and resolving problems.

• Ability to interpret, adapt and apply guidelines and procedures.

Physical Demands and Work Conditions

Physical Demands

• Constant Sitting.

• Frequent Walking.

• Occasional Standing.

• Occasional Bending.

• Occasional Squatting.

• Occasional Climbing.

• Occasional Kneeling.

• Seldom Crawling.

• Constant Hand Use.

• Constant Repetitive Motion Hand Use.

• Occasional Grasping.

• Frequent Fine Manipulation.

• Occasional Pushing and Pulling.

• Occasional Reaching (above shoulder level).

• Frequent Twisting and Turning (Neck and Waist).

• Constant Vision (Color, Peripheral, Distance, Focus).

Lifting

• Frequent lifting of 0 - 10 lbs.

• Occasional lifting of 11 - 20 lbs.

Carrying

• Frequent lifting of 0 - 10 lbs.

• Occasional lifting of 11 - 20 lbs.

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care

• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $25.30 - $32.26 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.