Analyst

• Support the team lead with day-to-day operational tasks related to claims processing, including testing, troubleshooting, documentation and Encounter Data submissions.
• Oversee error handling and change management for Encounters, ensuring compliance with CMS, State and client requirements.
• Conduct root cause analysis and implement corrective actions for operational issues, collaborating across departments to drive resolution.
• Monitor claims processing and adjudication trends, identifying systemic issues and opportunities for process improvement.
• Manage complex claims corrections, including retro-eligibility changes, COB adjustments, and other regulatory-driven updates.
• Serve as a subject matter expert (SME) for Medicare, Medicaid and Exchange operations, supporting internal teams and external stakeholders.
• Support development and testing of operational processes, tools, and project deliverables.
• Establish and promote best practices for government programs operations, ensuring scalability and compliance.
• Support product strategy and service delivery by leveraging deep knowledge of Medicare & Medicaid regulatory environments.
• Stay current on CMS/State regulatory guidance updates, translating changes into actionable operational strategies.
• Mentor and guide analysts, fostering professional development and knowledge sharing.
• Maintain current knowledge of Medicare, Medicaid and Exchange requirements to facilitate compliance of ongoing business operations.
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

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