Payment Integrity Analyst I-HP Benefit Configuration

CHRISTUS Health; Irving (TX); On-site; USD 45,000 - 60,000; Full time

Job summary

CHRISTUS Health is looking for a Payment Integrity Analyst I to work under the Configuration Manager. This position involves analyzing complex data trends, collaborating across departments, and ensuring quality assurance in claim processes.

Candidates should have a high school diploma and skills in data analysis, healthcare claims, and Microsoft Office. This full-time role offers multiple shifts and requires strong problem-solving and communication abilities.

Qualifications

• High school diploma or equivalent experience in healthcare claims adjudication.
• Strong understanding of healthcare claims data and pricing concepts.
• Strong analytical and research abilities to perform reconciliations.

Responsibilities

• Identify and interpret trends in complex data sets.
• Analyze claim information for payment resolution.
• Perform root cause analysis and communicate findings.

Skills

Healthcare claims data

Analytical skills

Microsoft Office

Problem-solving abilities

Communication skills

Education

High school diploma or equivalent experience

Job description

Summary

Under the supervision of the Configuration Manager, the Payment Integrity Analyst I will work in conjunction with Business Configuration, Claims, Network, Provider Data, Utilization Management, as well as other operational departments to ensure validation and quality assurance of benefit, contract, reimbursement, and overall financial analysis that arise during the overpayment identification and recovery process.

Responsibilities

• Identify, analyze, and interpret trends or patterns in complex data sets.
• Leverages available resources and systems (both internal and external) to analyze claim information and take appropriate action for payment resolution; documents all activity in accordance with organization policies.
• Performs review of claim projects resulting from overpayments or underpayments related to benefits, contracts, and fee schedule defects.
• Performs root cause analysis and financial impacts of identified defective claims.
• Communicates findings, including trends and recommendations to appropriate leadership.
• Research, maintain, test, and create fee schedule tables from data obtained from CMS, Tricare (CHAMPUS), or custom rates into the claims system.
• Research, maintain, and create provider reimbursement contract configuration.
• Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals.
• 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).
• All other duties assigned by management.

Requirements

Education / Skills

• High school diploma or equivalent experience in healthcare claims adjudication, system configuration, and auditing
• Strong understanding of healthcare claims data, pricing, and claims editing concepts, including UB04 and HCFA 1500 claim content
• Strong working knowledge of health insurance concepts, practices, and procedures, including the understanding of provider payment methodologies and claims processing workflows, from receipt through final adjudication
• Strong analytical and research abilities to triage issues and perform reconciliations or data analysis
• Working knowledge of Federal and State regulatory rules regarding claims adjudication
• Ability to organize and prioritize work to meet deadlines
• Strong Microsoft Office application skills, including Microsoft Word and Excel (VLOOKUP, Pivot Tables, Index/Match, Formulas, and creating spreadsheets)
• Strong organizational skills and the ability to manage multiple competing projects and deadlines
• Ability to think creatively
• Excellent written and verbal communication skills
• Good judgment, initiative, and problem-solving abilities
• Ability to handle and resolve complex issues independently
• Knowledge of Commercial, Medicare Advantage, Tricare, and Health Care Exchange programs preferred
• Knowledge of CPT/HCPCS, ICD-10 coding, and medical terminology.
• Ability to learn new policies and processes based on written material and observation
• Ability to establish and maintain professional, positive, and effective work relationships
• Demonstrated ability to collaborate effectively and work as part of a team in a fast-changing environment

Experience

• 0–1 year of experience interpreting complex provider agreements, claims adjudication, system configuration, and auditing.

Work Schedule

MULTIPLE SHIFTS AVAILABLE

Work Type

Full Time