Senior Health Claims Analyst - Process & Recovery Lead

Driscoll Children's Hospital; Corpus Christi (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

Driscoll Children’s Hospital in Corpus Christi, TX is seeking a Senior Claims Analyst to perform highly complex analysis for research, resolution and recovery of health plan claims. You will coordinate with Claims Administration, staff and health plan partners to ensure accurate payments and compliance with policies.

The role offers opportunities to lead departmental projects, improve processes, mentor staff, and participate in team meetings to drive efficiency and quality while upholding

Qualifications

• 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 ensure correct payments, collaborating with Claims Administration and health plan partners for resolution.
• Identify trends and recommend solutions for errors identified through pre- and post-payment claim and recover reviews.
• Assist department leadership to develop daily inventory plans based on 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 examining, assessing, and documenting 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, assist and provide feedback to less experienced staff, and lead training for new employees.
• Participate in team meetings, offering ideas to improve efficiency and quality and promote teamwork.
• Maintain privacy and confidentiality standards.
• Maintain or exceed established performance, quality and timeliness standards.
• Demonstrate ethical business practices and adherence to Health System and Health Plan policies and procedures.
• Assist with other related work responsibilities as requested.

Skills

Claims analysis

Provider billing

Medical coding

Texas Medicaid experience

Education

High school diploma or GED

Job description

Driscoll Children’s Hospital in Corpus Christi, TX is seeking a Senior Claims Analyst to perform highly complex analysis for research, resolution and recovery of health plan claims. You will coordinate with Claims Administration, staff and health plan partners to ensure accurate payments and compliance with policies.

The role offers opportunities to lead departmental projects, improve processes, mentor staff, and participate in team meetings to drive efficiency and quality while upholding