Senior Encounters Analyst

Position Summary:

Make an Impact on Healthcare Data, Compliance, and Strategy

Community Care Plan is seeking a Senior Encounters Analyst to serve as the business lead for encounters operations across our Medicaid and Marketplace lines of business. This is a highly visible role that sits at the intersection of Finance, IT, Quality, Risk Adjustment, and Operations.

If you're passionate about healthcare data, process improvement, analytics, and solving complex challenges, this is an opportunity to shape how encounter data is collected, validated, reported, and leveraged across the organization. Your work will directly influence regulatory compliance, financial performance, risk adjustment outcomes, and strategic decision-making.

Required Qualifications

• Bachelor's degree in a related field
• 2 years of experience working in a healthcare data environment, preferably within a health plan
• Experience with encounter data, healthcare claims, or healthcare reporting
• Strong SQL skills and experience analyzing large datasets
• Experience developing dashboards and reporting solutions using Power BI
• Strong analytical, problem-solving, and decision-making skills
• Ability to communicate complex technical concepts to business leaders and non-technical stakeholders
• Proven success collaborating across departments and with external partners

Preferred Qualifications

• Experience supporting Medicaid and/or ACA Marketplace lines of business
• Knowledge of encounter submission and validation processes
• Familiarity with risk adjustment, quality reporting, or healthcare regulatory reporting
• Experience working with healthcare compliance and state or federal reporting requirements

Essential Duties and Responsibilities:

• Conduct end to end validation of current encounters creation and submission processes.
• Serve as business lead for implementation of new encounters process for Marketplace line of business.
• Collaborate with risk adjustment, quality, IT and external partners to design processes and dashboards for complete, accurate and timely encounters reporting.
• Work with finance to reduce/eliminate any penalties related to encounters submissions.
• Develop project plan and budget for any new workflows or resources required to optimize encounters reporting.
• Ensure encounters processes and dashboards support accurate risk adjustment, quality and financial metrics.
• Provide encounter data for any and all state and federal agency requirements.
• Perform root cause analysis on encounter errors and work cross-functionally with claims, IT, provider operations, and various partners in care to implement corrections.
• Document standard operating procedures (SOPs) and maintain up-to-date process guides.

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Skills and Abilities:

• Some prior knowledge of encounters creation and submission for Florida Medicaid and Marketplace.
• Ability to summarize and clearly articulate data; create dashboards in a Power BI environment.
• Strong organizational and project management skills to effectively prioritize tasks, meet deadlines, and coordinate cross-functional teams in delivering encounters projects and reports.
• Ability to assess and manage risks inherent in health insurance products, including experience with risk mitigation strategies and decision-making under uncertainty.
• Strong written and verbal communication skills to effectively convey complex IT processes to non-technical stakeholders, including senior management, regulators, and business partners.
• Ability to identify challenges and develop creative solutions to complex IT problems.
• Knowledge of SQL and visual basic

Physical Demands: 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee may occasionally be required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.

Work Environment: 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.

Background Screening Notice:

In compliance with Florida law, candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants.

Additional information is available at: https://info.flclearinghouse.com