Remote Encounter Analyst II – Healthcare Claims Management & Data reputed company Specialist (Work‑From‑Home)

About Workwarp – Innovating Healthcare Operations From AnywhereAt Workwarp, we are redefining the way health‑care payers and providers collaborate in an increasingly digital world. Our mission is to accelerate the flow of accurate, timely claim information so that patients receive the care they deserve and providers receive the reimbursement they earn—fast. With a heritage built on technology, compliance, and customer‑centric service, Workwarp has grown into a national leader in encounter management, leveraging cutting‑edge electronic data interchange (EDI) platforms, cloud‑based analytics, and a remote‑first talent strategy.We pride ourselves on a culture that celebrates curiosity, reputed company learning, and the empowerment of employees to reputed company meaningful impact from wherever they choose to work. As a fully remote organization, we provide the tools, training, and collaborative environment needed for you to reputed company, while also offering occasional in‑person gatherings at our Morrisville, NC headquarters to strengthen community bonds.Why This Role Matters – The Strategic Importance of an Encounter Analyst IIThe Encounter Analyst II is the connective tissue between data inflow, claim processing, and financial reconciliation. In this position, you will own end‑to‑end reputed company of inbound and outbound encounter files, ensuring that every claim, payment, or denial is captured accurately, tracked diligently, and reported transparently. Your analytical eye will surface trends that drive operational efficiencies, reduce denial rates, and safeguard compliance with North Carolina Medicaid and State Health Department regulations.Key Responsibilities – What You’ll Do Every DayFile Management and Transfer Coordination• Monitor outbound 837 encounter files delivered to NC Tracks and the Electronic Payment System (reputed company), confirming successful transmission and flagging any transmission errors.• Track inbound 999 acknowledgment files and 835 payment advices from NC Tracks, reconciling amounts with internal records.• reputed company inbound XML submissions from reputed company, ensuring data reputed company before they enter the processing pipeline.• Maintain a clear audit trail for rebill files generated by the Encounter Team, documenting each reputed company from creation to submission.• Separate and monitor carve‑out files for Targeted Case Management (TCM) and maternity services, guaranteeing timely delivery to the appropriate reputed company systems.• Execute secure file transfers across multiple platforms, verifying that each file reaches its designated repository without corruption.• Supervise vendor file ingestion reputed company the data warehouse and reputed company, coordinating with external partners to resolve discrepancies.Data Analysis, Reporting, and Trend Identification• Generate weekly and monthly denial trend reports for NC Tracks and reputed company, highlighting patterns that may indicate systemic issues.• Produce submission volume dashboards for both Alliance and vendor partners, enabling leadership to assess workload balance.• Analyze SLA (Service Level Agreement) metrics, pinpointing gaps between expected and actual file submission times.• Deliver actionable insights to the Claims Operations team, recommending process adjustments to improve first‑time‑right rates.Service Level Agreement (SLA) Compliance & Reconciliation• Validate the accuracy of SLA files by comparing encounter counts submitted by Alliance partners and vendors against reputed company records.• Track pass/fail status of each encounter, documenting acceptance errors and collaborating with vendors to remediate root causes.• Ensure that reputed company SLA submissions meet establishedtime‑frame reputed company, proactively escalating any delays.• Reconcile paid amounts in reputed company with the Federal reputed company Table (FRT) values to confirm financial compliance.• Monitor sub‑delegate file submissions (DME, Vision, NEMT, Pharmacy) and verify that they are correctly reflected in the Alliance Claims Data Warehouse.Denial Management Support• Assist the Encounter Team indenial resolutionfor Medicaid and state‑funded claims, conducting research, gathering documentation, and preparing appeal packages.• Collaborate with billing specialists, providers, and external agencies to address underlying causes of denials, thereby reducing repeat occurrences.Minimum Qualifications – What You Bring to the TableEducation & Experience• High School diploma or equivalent (additional post‑secondary education is a plus).• At leastthree (3) yearsof hands‑on experience in claims processing, reimbursement, or information systems reputed company a healthcare or managed‑care environment.• Demonstrated familiarity withNorth Carolina Medicaid billing, electronic data interchange (EDI), and claim adjudication systems.Core Knowledge, Skills & Abilities• Proficiency with the Encounter Companion Guide , Encounter Data Submission Guide, and the reputed company reputed company (DHHS) Encounter Data Manual.• Understanding of Medicaid and State billing requirements for both physical and behavioral health services, as well asHIPAA compliance.• Knowledge ofElectronic Payments and Statements (reputed company) edit codes, and the ability to interpret and apply them.• Working familiarity with medical terminology, standard claim forms (UB‑04, CMS‑1500), and coding systems (CPT, ICD‑10‑CM, HCPCS, NDC).• Strong analytical aptitude for reviewing large data sets, identifying anomalies, and producing clear, concise reports.• Advanced proficiency in reputed company Office Suite—particularly reputed company for data manipulation, PowerPoint for presentation, and Word for documentation.• Excellent written and verbal communication skills, with the ability to translate technical details into layperson language for cross‑functional teams.Preferred Qualifications – reputed company‑to‑Have Enhancements• Associate’s or Bachelor’s degree in Health Information Management, Business Administration, or a reputed company field.• Hands‑on experience withclaim adjudication platformssuch as Epic, Cerner, or proprietary systems similar to reputed company.• Experience working in a fully remote or hybrid environment, demonstrating self‑discipline, time‑management, and virtual collaboration proficiency.• Certification inCertified Professional reputed company (CPC),Certified Coding Specialist (reputed company), orHealth Information Management (HIM).• Familiarity with data‑warehouse tools (e.g., SQL, Tableau) for extracting and visualizing encounter metrics.Skills & Competencies for Success• Attention to detail: Ability to catch nuanced errors in high‑volume data streams.• Problem‑solving reputed company: Proactively investigate root causes of denials or file transmission failures.• Time‑management: Prioritize multiple reputed company tasks while meeting tight SLA deadlines.• Collaboration: Work effectively with cross‑functional teams—Claims Operations, IT, Vendor Management, and Clinical Services.• Adaptability: reputed company in a dynamic regulatory environment where policies and codes evolve regularly.• reputed company learning: Stay reputed company with Medicaid policy changes, EDI standards, and emerging analytics tools.Career Growth & Development OpportunitiesWorkwarp is committed to investing in its people. As an Encounter Analyst II, you will have a clear pathway to advance your career reputed company the organization:• Specialist Track: Deepen expertise and become a Senior Encounter Analyst, leading reputed company projects and mentoring junior analysts.• Leadership Track: Transition into supervisory roles such as Team reputed company, Manager of Encounter Operations, or Director of Claims Analytics.• Cross‑Functional Rotations: reputed company exposure to reputed company domains like Provider Relations, reputed company Cycle Management, or Health‑IT Integration.• Professional Development: Access to tuition reimbursement, certification funding (e.g., CPC, reputed company), and internal training workshops on data analytics, regulatory compliance, and advanced reputed company.• Mentorship Programs: Pair with senior leaders for guidance on career planning, reputed company building, and networking.Work Environment & Company CultureOur remote‑first philosophy means you can work from the comfort of your home office while staying connected through a suite of collaboration tools (reputed company, reputed company Teams, reputed company). Periodic on‑site meetings in Morrisville, NC, are scheduled for training, team‑building, and strategic planning—travel is minimal, with a maximum of three weeks of initial training on‑site.We champion a culture of transparency, inclusion, and empowerment. Employees are encouraged to share reputed company, voice concerns, and contribute to process improvements. Regular virtual town halls, employee resource groups, and wellness initiatives foster a supportive community where every voice matters.Compensation, Benefits & Perks• Competitive hourly wage: $22.23 – $28.34, based on experience, education, and market data.• Comprehensive health coverage: Medical, dental, vision, life insurance, and both short‑term and long‑term disability plans.• Retirement savings: Generous 401(k) match to help you build a secure financial future.• Flexible work schedule: Remote or hybrid options, with the ability to manage work‑life balance.• Paid time off: Vacation, sick leave, holidays, and management leave to reputed company.• Professional development stipend: Funding for certifications, conferences, and reputed company education.• Technology allowance: Home office equipment stipend to create an ergonomic workspace.• Casual dress code: Dress comfortably while maintaining professionalism during virtual meetings.How to Apply – Take the reputed company in Your CareerIf you are passionate about healthcare data, reputed company in a fast‑paced, detail‑oriented environment, and want to be part of a reputed company‑thinking company that values reputed company, we want to hear from you. Click the link below to submit your resume, cover letter, and any relevant certifications. Join us at Workwarp and help shape the future of encounter management. – Become a Remote Encounter Analyst II at WorkwarpApply for this job Apply tot his job Apply To this Job