Job Summary

We are seeking an experienced Encounter Specialist / Senior Analyst with strong expertise in Facets (Claims & Encounter Processing) and automation/testing tools such as Tosca or Playwright. The ideal candidate will be responsible for processing, validating, and reconciling encounter and claims data while ensuring compliance with CMS and payer guidelines.

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Key Responsibilities

• Process, validate, and maintain encounter/claims data within the Facets platform.

• Perform data reconciliation, error analysis, troubleshooting, and corrective actions.

• Ensure compliance with CMS regulations, payer guidelines, and industry standards.

• Analyze encounter processing workflows and identify opportunities for improvement.

• Support automation and testing activities for encounter processing workflows.

• Collaborate with cross-functional teams to resolve data and system-related issues.

• Maintain high levels of accuracy, quality, and data integrity.

Mandatory Skills

• Strong hands-on experience with Facets (Claims/Encounter Processing).

• Experience with Tosca or Playwright (mandatory).

• Good understanding of healthcare claims and encounter processing.

• Knowledge of ICD, CPT, and HCPCS coding fundamentals.

• Familiarity with CMS regulations and payer guidelines.

• Strong analytical, problem-solving, and data validation skills.

• Excellent attention to detail and communication skills.

Must-Have Requirements

• Facets experience is mandatory.

• Tosca OR Playwright experience is mandatory (No Exceptions).

• Immediate availability to join in June.

• Comfortable working in a Hybrid model and 2 PM – 11 PM shift.

Preferred Qualifications

• Experience in Healthcare Payer domain.

• Exposure to claims adjudication and encounter data management.

• Experience in automation testing within healthcare applications.