Data Specialist I - Nursing Administration

CHRISTUS Health System; Alexandria (LA); Presencial; USD 45.000 - 60.000; Tempo integral

Resumo da vaga

Christus Health is seeking a Data Specialist I to identify system issues and provide defect resolution analysis through claims and system analysis in support of Benefits Configuration and Provider Data.

The role involves aiding with data quality, auditing, and collaborating across departments to improve workflows and ensure accurate adjudication of claims in a HIPAA-compliant environment. Work hours are 7AM - 5PM, full-time onsite in Louisiana.

Qualificações

• Associate degree required.

Responsabilidades

• Assist with database improvements and audits.
• Identify and communicate data quality issues through extensive research by comparing system information to applicable claims based on benefit structure, contract details, and pricing methodologies.
• Analyze benefit coverage and provider data loaded in the claims payment system to determine root cause of data quality issues directly affecting claims payment and/or denials.
• Initiate claims payment analysis based on internal requests from the Health Plan by partnering with the BI department for applicable reports to determine underpayments and overpayments to providers.
• Catalog internal defect results and recommendations then communicating all findings to affected areas and appropriate leadership.
• Collaborate and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow to facilitate completion of tasks/goals.
• Assist with developing and maintaining departmental goals and objectives as well as personal goal maintenance on a quarterly basis.
• Assist in the development of action plans to address system deficiencies to ensure claims correctly adjudicate.
• Monitor and track best practices while also reviewing compliance changes/impacts for continuous improvement opportunities.
• Identify prevalent trends through data reporting and claims analysis.
• Assists in circulating information to staff as needed.
• Perform other related duties and special projects as requested.
• Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)

Formação

Associate Degree

Descrição da vaga

Summary

Data Specialist I is responsible for identifying system issues and providing defect resolution analysis via claims and system analysis in support of the Benefits Configuration and Provider Data departments.

Responsibilities

• Assist with database improvements and audits
• Identify and communicate data quality issues through extensive research by comparing system information to applicable claims based on benefit structure, contract details, and pricing methodologies.
• Analyze benefit coverage and provider data loaded in the claims payment system to determine root cause of data quality issues directly affecting claims payment and/or denials.
• Initiate claims payment analysis based on internal requests from the Health Plan by partnering with the BI department for applicable reports to determine underpayments and overpayments to providers.
• Catalog internal defect results and recommendations then communicating all findings to affected areas and appropriate leadership.
• Collaborate and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow to facilitate completion of tasks/goals.
• Assist with developing and maintaining departmental goals and objectives as well as personal goal maintenance on a quarterly basis.
• Assist in the development of action plans to address system deficiencies to ensure claims correctly adjudicate.
• Monitor and track best practices while also reviewing compliance changes/impacts for continuous improvement opportunities.
• Identify prevalent trends through data reporting and claims analysis.
• Assists in circulating information to staff as needed.
• Perform other related duties and special projects as requested.
• Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)

Requirements

Education/Skills

• Associate Degree

Work Schedule

7AM - 5PM

Work Type

Full Time