Job Directory Medicaid Encounter Support Specialist

Medicaid Encounter Support Specialist
San Diego, CA

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Job Description

Medicaid Encounter Support Specialist

If you're interested in a career within a customer-focused, team-oriented environment that rewards innovation, quality, integrity and collaboration, MedImpact Healthcare Systems, Inc. welcomes your application. MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Position Summary:

The Medicare Support Specialist works internally across functional teams and with external clients. This position interfaces with designated client employees for their Medicaid encounter processing (MEP) and related processes and provides operational support for programs and processes which include claims extract transfer to the MEP solution, monitoring of the claim extract to encounter data/file conversion process, transmission of encounter files, receipt and review of State responses, corrections of encounter records requiring resubmission, and monitoring of the encounter data tracking and reporting systems. The Medicare Support Specialist position requires technically complex analysis and a high degree of accuracy, carrying with it significant consequence of error for the organization and MedImpact customers. This individual will assist subject matter experts (SME) in defining and documenting process steps (policy and procedures), requirements for technical specifications and data requirements to support specified components of the MEP, and related activities. They will perform analytical report analysis and validation, partner with IT or other department members within the Government Programs and Services division (GPS), and utilize multiple company and MEP vendor databases to obtain, record, and analyze Medicaid encounter record/file data and information. The Medicare Support Specialist will complete project activities within the prescribed time frame to ensure timely and accurate delivery of MEP services working proactively, under strict deadlines, to manage client expectations on issue resolution providing customer support to address action items and problems.

The successful candidate will maintain current understanding of customer; State Medicaid policies defined in regulation, and associated State Encounter Processing Companion Guides in order to accurately analyze reports. The incumbent will complete quality control and testing and ensure appropriate updates and adjustments of data prior to submission to customers or to State Medicaid Agencies. They will ensure accurate Medicaid claims extract and applicable encounter records and files are created through root cause analysis of errors, recommendations for systems and procedure enhancements, and education and training as appropriate. As an integral team member, they will make recommendations to department leadership for improvement in workflow processes as appropriate to support Medicaid reporting requirements. It is important that they establish positive working relationships with internal and external customers by providing sustainable, measurable, accurate, reliable and timely execution of MEP activities and responsibilities. In addition they will participate in interdepartmental meetings and customer and MEP vendor conference calls as the subject matter expert regarding MEP requirements, MEP processes, and system capabilities and reporting.


For consideration candidates will need a Bachelor's degree in Information Technology, Finance, Math (or a related field) from a four year college or university and one (1) to two (2 )years of related experience working with Medicaid, Pharmacy, PBM, Healthcare, claims data, or an equivalent combination of education and job related experience. To perform this job successfully an individual must have solid expertise with MS Office tools (including Access and Excel) as well as multiple software applications and databases. Prefer experience using MedImpact's legacy and proprietary health care operating systems. The thorough understanding of claim processing concepts, knowledge of healthcare operating systems in the PBM industry and an understanding of Medicaid Programs is preferred.

This position is eligible for Employee Referral Bonus at Level



To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

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