Senior Claims Analyst

Where Compassion Meets Innovation And Technology

Thank you for your interest in joining our team! Please review the job information below.

Analyze highly complex claims and claim issues 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.

Education and/or Experience:

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.