Senior Claims Analyst
About The Position
Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below. Analyze highly complex claims and claim issues to ensues to ensure correct claims payment, partner with Claims Administration and staff and health plan business partners for resolution. Identify trends and recommend solutions for errors as identified through pre- and post-payment claim and recover review. Assist with department leadership to develop daily inventory plans based on available resources, priority, and timeliness requirements. Analyze provider correspondence and requests for review to determine correct outcomes and resolution, escalating high priority/risk issues to leadership. Lead departmental projects and/or operational improvement initiatives. Assist in the examination, assessment, and business documentation of operations and procedures to ensure data integrity, security, and process optimizations. Ensure adherence to state and federal compliance, reimbursement and contract policies. Provide mentoring and coaching to team members, provide assistance and feedback to less experienced staff members, and lead training efforts for new employees. Openly participate in team meetings, providing ideas and suggestions to ensure departmental efficiency and quality, and to promote teamwork. Maintain required compliance with privacy and confidentiality standards. Maintain or exceed all established standards for performance, quality and timeliness. Demonstrate business practices and personal actions that are ethical and adhere to all Health System and Health Plan policies and procedures. Assist with other related work responsibilities as requested. Until all children are well. Driscoll Children’s Hospital and its specialty centers, urgent care centers, and after-hours facility serve a vast area covering 31 South Texas counties. The hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties. Combined with our non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace for anyone with a big heart and a drive for success. Smiles, hugs and a soothing touch are as much a part of Driscoll’s approach to treating children as is its advanced medical treatments and technologies. The core values at Driscoll Heath System are: Compassion, Advocacy, Respect, Excellence, and Stewardship. These values are exemplified through every position - from treating the most critical patients hands-on, to maintaining a clean environment, to keeping the organization running from behind the scenes. We invite you to learn about Driscoll’s rich history and explore the laidback lifestyle South Texas has to offer.
Requirements
- Minimum five years professional experience in claims analysis , provider medical billing, or medical coding experience with Texas Medicaid preferred.
- Minimum two years professional experience with Claim research, adjustment and recover; experience with Texas Medicaid preferred.
- Minimum High school graduate or GED required.
Responsibilities
- Analyze highly complex claims and claim issues to ensues to ensure correct claims payment, partner with Claims Administration and staff and health plan business partners for resolution.
- Identify trends and recommend solutions for errors as identified through pre- and post-payment claim and recover review.
- Assist with department leadership to develop daily inventory plans based on available resources, priority, and timeliness requirements.
- Analyze provider correspondence and requests for review to determine correct outcomes and resolution, escalating high priority/risk issues to leadership.
- Lead departmental projects and/or operational improvement initiatives.
- Assist in the examination, assessment, and business documentation of operations and procedures to ensure data integrity, security, and process optimizations.
- Ensure adherence to state and federal compliance, reimbursement and contract policies.
- Provide mentoring and coaching to team members, provide assistance and feedback to less experienced staff members, and lead training efforts for new employees.
- Openly participate in team meetings, providing ideas and suggestions to ensure departmental efficiency and quality, and to promote teamwork.
- Maintain required compliance with privacy and confidentiality standards.
- Maintain or exceed all established standards for performance, quality and timeliness.
- Demonstrate business practices and personal actions that are ethical and adhere to all Health System and Health Plan policies and procedures.
- Assist with other related work responsibilities as requested.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
