About Our Company
At Altais, we're looking for bold and curious innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, patients, and the clinical community. Doctors today are faced with the reality of spending more time on administrative tasks than caring for patients. Physician burnout and fatigue are an epidemic, and the healthcare experience and quality suffer as a result. At Altais, we’re building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve.
Want more jobs like this?
Get Data and Analytics jobs in Oakland, CA delivered to your inbox every week.
About Your Team
Are you looking to work with a high performing, fast growing and dynamic team? Altais and our subsidiaries, form one of the most recognized medical groups in California. We are 3,000+ physicians, working in over 40 cities in California, caring for more than 350,000 patients. If working in a mission driven organization supporting highly competent, hard-working, thoughtful clinicians who value good ideas and are passionate about reshaping healthcare excites you, then we are thrilled to welcome you to your new career.
This position is located in our brand-new Oakland City Center location, or remotely (within the state of California). We are flexible provided you are open to traveling to the Oakland office locations as needed.
About Your Work
This role serves as the primary point of contact around day-to-day management of Encounter submissions i.e., Responsible for monitoring and managing monthly encounter data submissions ensuring timely and accurate submissions, monthly auditing and reconciliation of monthly encounter submission counts across Epic Resolute, Epic Tapestry to Clearinghouses and/or direct submission partners. Position is responsible for coordinating and performing corrections to encounter data rejects; coordinating efforts with internal departments and external customers (health plans and clearinghouses) ensuring encounter data issues are resolved accordingto regulatory timeframes and health plans guidelines.
You Will Focus On
- Stay updated with CMS guidelines and Health plan data submission guidelines.
- Ensure operational encounter data submissions are meeting industry and individual health plan requirements.
- Outreach for health plans regarding encounter data submissions, serving as a resource and liaison.
- Analyzes and interprets encounter data to identify potential issues and trends.
- Coordinate and perform the correction of data rejections so that files may be resubmitted, error free.
- Monitor daily administrative duties of Encounter Data. This includes direct response to external and internal customers’ issues which may arise, ensuring resolution to customer satisfaction.
- Conduct monthly reconciliation audit of encounter data submissions.
- Maintain clear documentation of encounter data workflow by health plan and submission method.
- Responsible for oversight of encounter data enhancements to include identification, recommendation, coordinating request and implementation of enhancement(s) to ensuring compliance.
- Supports department projects/tasks as they arise. This includes generating standard and ad-hoc reports, managing contact list, and monitoring metrics.
- Facilitates regularly scheduled Encounter Data Workgroup meetings.
The Skills, Experience & Education You Bring
- BA/BS degree in Business, Information Systems, or other related field preferred or equivalent experience and training
- Three (3) to Five (5) years’ experience in operations, data analysis or information
- management in the insurance and/or delivery system in the healthcare industry
- Three (3) to Five (5) years’ knowledge of healthcare administrative functions, including claims processing, remittance advice processing, eligibility, verifications, etc.
- Three (3) to Five (5) years’ experience of Government billing regulations experience,
- including Medicare, Medicare Managed Care, and Medical Terminology
- Three (3) to Five (5) years’ experience on EDI format and Claim/Encounter workflows (837,277,835)
- Two (2) to Four (4) years’ experience working with different payer and clearinghouse partners.
- Two (2) or more years’ analytical experience in a support role
- Two (2) to Four (4) years’ experience of CMS Risk Adjustment & HCC Methodology preferred.
- Two (2) to Four (4) years’ experience in current and progressive healthcare experience in both provider and payer domains
- Two (2) to Four (4) years’ Epic AP Claims hands-on experience
- EDI, HIPAA, and Healthcare expertise with business and technical expertise
- Outbound EDI 837 (professional and institutional) familiarity desired.
- Demonstrated excellent analytical, problem-solving and writing skills
- Intermediate Excel, Access, Word, and PowerPoint skills.
Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.
Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us.
Altais is a leading network of independent doctors focused on delivering personalized and high-quality health care in over 40 cities in California. Its network of more than 3,000 physicians, serving more than 355,000 HMO, ACO and PPO patients, is dedicated to improving care and reducing costs through innovative care management and care coordination programs, use of health care technology, and population health management strategies. For more than 30 years, Altais and its family of companies has proudly collaborated with leading hospitals and health plan providers to provide high quality care in California
Please note that Brown & Toland Physicians is a wholly owned subsidiary of Altais Clinical Services, a division of Altais. Other subsidiaries in the Altais family of companies include Altais Medical Group Riverside and Family Care Specialists Medical Group.
If you would like to search for other open positions within the Altais family of companies, please view the links below:
· Altais Medical Group Riverside (https://altais.com/altais-medical-group-riverside/employment-opportunities/)