Encounter Data Sr. Business Analyst - Remote

About this role

Pinnacle Method Consulting's mission is to help job seekers reach their career peak by accessing top-tier opportunities. We are not a staffing firm or agency. Pinnacle Method does not hire for these roles—we systematically source and verify them from premier employers.


Employer Industry: Healthcare Services


Why Consider This Job Opportunity

• Salary up to $130,000 annually
• Comprehensive benefits package including equity stock purchase and 401k contribution
• Opportunity for career advancement and growth within the organization
• Flexibility to work remotely from anywhere within the U.S.
• Recognition programs and incentives for performance
• Engaging work environment focused on health equity and reducing barriers to care

What To Expect (Job Responsibilities)

• Monitor daily end-to-end encounter submissions from in-house systems to health plans
• Correct rejected encounters according to CMS and DHCS claims processing guidelines
• Write and generate reconciliation reports as required by health plans
• Analyze trends of rejected encounters and conduct root cause analysis
• Manage relationships with health plans, clearinghouses, and internal stakeholders to resolve encounter errors

What Is Required (Qualifications)

• 5+ years of experience in Microsoft SQL query development and reporting
• 2+ years of experience within the healthcare data environment (e.g., encounters, eligibility, provider, claims)
• Experience with EDI 837 production support, including editing and correcting X12 837 transactions
• EDI testing and validation experience
• Proficiency in Microsoft Office, especially Excel (e.g., dashboards, pivot tables, formulas, v-lookup)

How To Stand Out (Preferred Qualifications)

• Proven knowledge of the importance of encounter data reporting and its impact on revenue
• Understanding of the claims billing cycle and reimbursement process
• Based in Southern California

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