EDI Analyst, Risk Adjustment
Company: Summa Health
Posted on: February 23, 2021
Sr Recovery Analyst (Part C) / EDI Analyst, Risk Adjustment
SummaCare - 1200 E Market St, Akron OH
Full-Time / 40 Hours
POSITION REQUIRED TO BE ONSITE (AKRON, OH) - NOT A REMOTE POSITION
AT THIS TIME
SummaCare is a Summa Health entity that offers health insurance in
northern Ohio. As a regional, provider-owned health plan, SummaCare
is based in Akron, Ohio, and provides Medicare Advantage,
individual and family and commercial insurance plans. SummaCare has
one of the highest rated Medicare Advantage plans in the state of
Ohio, with a 4.5 out of 5-Star rating. SummaCare has also been
recognized by U.S. News & World Report as being a Best Insurance
Company for Medicare Advantage in 2020. Known for its excellent
customer service and personalized attention to members, SummaCare
is committed to building lasting relationships. Employees can
expect competitive pay and benefits.
Maintains, supports and reconciles Medicare (MC) claims, RAPS and
encounter data before and after the data submission process to CMS
in order to obtain the appropriate risk adjustment capitated
payments per member per month from CMS. Creates needed databases
and applications to support the submission and revenue
reconciliation processes as well as informs management of all
Bachelor Degree or may substitute with 4 years of like
3+ years performing same or similar responsibilities. Relevant
experience includes: in-depth working knowledge on recovering of
Part C revenues. Experience with the following IT applications also
required: working knowledge of Amisys, Crystal Report Writer,
Microsoft Office Products, MS SQL Server applications, SQL, Query
Analyzer, and Enterprise Manager.
A combination of the following: Working knowledge of FTP;
utilization of a text Editor (UltraEdit/UltraCompare Preferred);
SQL (building complex queries); stored procedures; DOS and BAT
files; Relational Databases; Microsoft ACCESS - Form/query/report
Design and VBA; All other MS Office Products; HIPAA EDI /EDPS;
RAPS; CDAT; and CON XX RADV - including Batch uploads and
Required Licenses and/or Certificates
Software and Data Entry Requirement
Skills And Abilities
Complex: ability to communicate complex information verbally and in
written form that may include policies and procedures, financial,
legal, and/or technical documents, and opinion papers; ability to
provide guidance required to implement strategic programs and
projects; ability to supervise work within and/or across
departments; ability to negotiate and persuade professionals, board
members, and general public.
Highly Complex: designing, developing, implementing highly complex
programs, products, technical systems, policies that affect overall
direction of the company. Proofreading completed work to find and
correct errors. Requires excellent attention to detail.
Other Skills And Abilities
- Maintain current knowledge of database management concepts,
techniques and principles.
- Understands business processes and effectively translate
business needs into appropriate data solutions.
- Apply principles of logical thinking to define problems,
collect data, establish facts, and draw valid conclusions.
- Demonstrate strong analytical ability and attention to
- Organize and manage time to accurately complete tasks within
designated time frames in fast-paced environment.
- Maintain current knowledge of and comply with company policies
- Maintain confidentiality of patient and business
- Flexible: ability to adjust work hours to meet business
Physical Effort and Dexterity*
- Sit for prolonged periods of time.
- Bend, stoop, and stretch.
- Lift up to 20 pounds.
- Manual dexterity to operate computer, phone, and standard
Visual Acuity, Hearing, and Speaking*
- Candidates whose disabilities make them unable to meet these
requirements will still be considered fully qualified if they can
perform essential functions of job with reasonable
Occasional overtime work required during peak business periods as
scheduled by supervisor. Occasional travel that may require use of
personal auto to attend meetings, conferences, workshops, and/or
Safety Hazards and Environment
Minimal hazards. General office working conditions.
Keywords: Summa Health, Akron , EDI Analyst, Risk Adjustment, Professions , Akron, Ohio
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