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Georgia Employer RAPS EXPERT ANALYST - REMOTE in Atlanta, Georgia

SUMMARY: The role of the Expert Analyst on the Medicare Advantage Submissions team is to help maximize risk scores and revenue associated with the submission of Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS) data to CMS for all full-service Medicare Advantage clients including both MI plans (PPO & HMO), clients on the business process as a service (BPaaS) platform as well as the Joint Venture (JV) clients. The Expert Analyst will work with team members to research, analyze and manage system generated edits and CMS assigned errors so data can be processed to a successful CMS acceptance status. Tasks also include tracking and monitoring claim encounters from receipt of the claim to submission of the claim to CMS's RAPS & EDPS as well as reconciling EDPS submitted claims and supplemental records for all open payment years for MI, BPaaS and JV clients. RESPONSIBILITIES/TASKS: * Provide RAPS & EDPS error resolution for MI, BPaaS and JV clients through team collaboration and working with business partners. * Research, analyze, identify, and evaluate data from system errors to evaluate existing and potential trends and issues. * Establish a mechanism to review claims received by Advantasure to improve and maximize submission outcomes. * Communicate results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions. * Possess and maintain a comprehensive understanding and knowledge of business, products, corporate organizational structure (including functional responsibilities), and research principles/methodologies. * Assist in ensuring RAPS & EDPS compliance with CMS regulations. * Provide RAPS & EDPS BPaaS and * JV client implementation support. * Collaborate with Subject Matter Experts to improve client revenue outcomes. * Ensure complete, accurate and timely data for reporting purposes. * Recommend and implement solutions to identified problems/root cause of issues. * Provide expertise and guidance to other departments, teams, and corporate staff as required. * Represent and participate in group or committee discussions. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.EMPLOYMENT QUALIFICATIONS: EDUCATION: Bachelor's degree in Business Administration, Economics, Health Care, Information Systems, Statistics or related field is required.EXPERIENCE: Four (4) or more years of experience in a related field required to provide the necessary knowledge, skills, and abilities for the role.SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: * Knowledgeable of Medicare Advantage Risk Adjustment business processes. * Experience using SQL. * Strong communication skills are required to understand, interpret, and communicate ideas. * Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.). * Strong analytical, organizational, planning, and problem-solving skills. * Experience with 837 electronic claim format is preferred. * Ability to effectively interface with employees at all levels. * Other related skills and/or abilities may be required to perform this job. * Experience executing in a fast-paced environment with tight deadlines. * Administer and adhere to corporate and departmental policies, practices and procedures. WORKING CONDITIONS: Work is performed in a remote location or office setting with no unusual hazards. The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will " basis. Nothing herein is intended

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