Analyst

• Review and monitor adjudicated claims for file submission and upstream processing
• Communicate with provider agencies and internal departments regarding claims submission, denial management, and system updates
• Track trends and patterns to identify irregularities in the ACS system
• Work with claims analyst to communicate claims issues
• Ensure contract service level agreements are met
• Research and resolve Encounter Denials
• Determine if claim processed appropriately in ACS
• Rebill encounter denial when appropriate
• Research State initiated encounter recoupments
• Ensure Service Level Agreement (SLA) Maintenance
• Assist in researching discrepancies
• Utilize the A/R system to manage encounter denials and recoupments
• Document current status of denials and recoupments
• Ensure appropriate coordination of benefits using billing and payment policies
• Maintain knowledge of current adjudication edits
• Provide information and feedback to the system team for process improvements
• Communicate with DMH/DHB to resolve complex encounter denials/issues

Encounter Analyst I

BCBA, Board Certified Behavior Analyst

Business Analyst

Board Certified Behavior Analyst, BCBA

Compensation Analyst

Advanced Threat Cyber Analyst