Claims Analyst
2 weeks ago
Claims Analyst is responsible for accurate and timely research of all providers claim inquiries according to policies, process instructions and system requirements, regulatory reporting, and acts as a liaison between internal stakeholders for associated claims processes. Candidate will respond to all incoming inquiries and coordinate with other internal and external stakeholders to resolve the issue, determine the underlying cause and make recommendations regarding system changes that may be relevant.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Responsible for data collection and analysis regarding provider inquiries and/or disputes or other trending payment integrity activities
- Acts as point of contact for submission and/or resolution of denial determinations and provider disputes. Interfaces with internal stakeholders regarding reconsiderations, disputes and/or appeals as appropriate
- Research and documents denial determinations at all levels of provider disputes in a thorough, professional, and expedient manner
- Coordinates workflow between departments and interfaces with internal and external resources
- Composes all correspondence and dispute information concisely and accurately, in accordance with regulatory requirements
- Supports the development and standardization of business rules documents including appropriate trend reporting
- Maintains tracking system of correspondence and outcomes; maintains well-organized, accurate and complete files for all provider disputes
- Monitors each dispute to ensure all internal and regulatory timelines are met
- Provides re-enforcement training for new and existing associates as needed
- Work with contracting, provider relations and configuration teams when inconsistencies are found
- Collaborate with internal and external stakeholders to ensure prompt and appropriate action is taken regarding cost avoidance/cost containment activities
- Conducts regulatory research to determine revisions/updates to various federal and state payment requirements for hospital, ambulatory surgery, and physician providers
- Consults and coordinates with various internal departments, external resources, business partners, and government agencies as appropriate
- Works closely with clinical personnel to ensure alignment with clinical and benefit policies
- Reviews technical documents and specifications for compliance with operational procedures
- Ensures safe care to patients, staff, and visitors; adheres to all Apex policies, procedures, and standards within budgetary specifications including time management, supply management, productivity, and quality of service.
- Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
Minimum Qualifications
Education: High School diploma; Bachelor’s in business or health care field preferred
Licenses/Certifications: (None)
Experience / Knowledge / Skills:
- Three (3) years of experience working in a healthcare data or regulatory environment; payment integrity and claims experience preferred.
- Effective oral and written communication skills.
- Knows how to obtain and use data and is comfortable with statistical concepts.
- Strong interpersonal skills to work with all levels across all functional areas to include internal business partners.
- Strong understanding of regulatory requirements and reporting related to claims processing including Texas Department of Insurance and CMS.
- Expert understanding health care claims data, pricing and claims editing concepts, including UB04 and HCFA 1500 claim content for varying business lines including Medicare Advantage, Commercial Fully Insured, Medicaid, etc.
- Experience with Microsoft Word, Excel, PowerPoint, Visio.
- Preferred systems knowledge – Facets, NetworX Pricer, CES, Tableau.
- Ability to solve practical problems and deal with a variety of variables in situations where information may be limited.
-
Claims Adjustment Analyst II
3 days ago
Houston, United States Harris Health System Full timeThe Claims Adjustment Analyst II supports the review and resolution of complex level payment disputes including corrected claims; retro authorizations, incorrect denial requests, reconsiderations and provider payment appeals in a timely manner. This Claims, Analyst, Technology, Healthcare
-
Claims Analyst
2 weeks ago
Houston, United States Apex Health Solutions Full timeSummary Claims Analyst is responsible for accurate and timely research of all providers claim inquiries according to policies, process instructions and system requirements, regulatory reporting, and acts as a liaison between internal stakeholders for associated claims processes. Candidate will respond to all incoming inquiries and coordinate with other...
-
Claims Analyst
2 days ago
Houston, United States Apex Health Solutions Full timeSummary Claims Analyst is responsible for accurate and timely research of all providers claim inquiries according to policies, process instructions and system requirements, regulatory reporting, and acts as a liaison between internal stakeholders for associated claims processes. Candidate will respond to all incoming inquiries and coordinate with other...
-
Collections Analyst Healthcare
18 hours ago
Houston, United States LHH Full timeLHH Recruitment Solutions is seeking a Collections Analyst to join our client's billing department in Houston, TX. The Collections Analyst will be responsible for managing accounts receivable and following up on unpaid claims to ensure timely payment.Responsibilities:Review and analyze accounts receivable reports to identify delinquent accounts and unpaid...
-
Collections Analyst Healthcare
2 days ago
Houston, United States LHH Full timeLHH Recruitment Solutions is seeking a Collections Analyst to join our client's billing department in Houston, TX. The Collections Analyst will be responsible for managing accounts receivable and following up on unpaid claims to ensure timely payment.Responsibilities:Review and analyze accounts receivable reports to identify delinquent accounts and unpaid...
-
Collections Analyst Healthcare
3 hours ago
Houston, United States LHH Full timeLHH Recruitment Solutions is seeking a Collections Analyst to join our client's billing department in Houston, TX. The Collections Analyst will be responsible for managing accounts receivable and following up on unpaid claims to ensure timely payment. Responsibilities: Review and analyze accounts receivable reports to identify delinquent accounts and unpaid...
-
Senior Business Analyst
2 weeks ago
Houston, United States Infinite Computer Solutions Full time16942BR Texas Job Description The business analyst must be able to work independently under minimal supervision, must have strong health care domain experience, and be able to support any business functional area – enrollment, claims, encounters, etc. Medicaid domain experience in Managed Care Organization 8 to 10 years of business analysis...
-
Remote IT Business Quality Analyst
2 days ago
Houston, United States TCI Technology Consulting Inc Full timeTCI has an immediate need for an IT Business Quality Analyst (BQA) in LaGrange, KY. This is a Direct Hire opportunity. This is not a C2C opportunity.This position requires US Citizenship or Permanent Residence. May consider 100% remote for strong candidates.SUMMARYThe Business Quality Analyst will perform both BA and QA functions and will work as a member of...
-
Collections Analyst
3 weeks ago
Houston, United States Poolsure, an Aquasol Company Full timeJob DescriptionJob DescriptionPoolsure, an Aquasol Company is searching for a Collections Analyst to join our team in the Houston, TX area. The Collections Analyst is primarily responsible for the overall Collections process within the accounts receivable team. The individual will coordinate the daily, weekly, and monthly activities of the Collections Team,...
-
UM Analyst
2 weeks ago
Houston, United States Apex Health Solutions Full timeJob DescriptionJob DescriptionJob Title: UM AnalystDepartment: Medical Management Supervisor (s): UM Supervisor or Manager of Medical ManagementSummaryUtilization Management (UM) Analyst represents the company by assisting leadership in ensuring regulatory compliance, accuracy, and consistency of UM processes. The Utilization Management Analyst will maintain...
-
Reimbursement Analyst III
1 week ago
Houston, United States Texas Department of Aging & Disability Services Full timeJob Description: The Reimbursement Analyst III (RA III) performs highly advanced (senior-level) consultative services, oversight, policy and data development, and technical analyses for the Provider Finance Department under the supervision of the Manager V for the Acute Care School Medicaid Resource and Training team (SMRT) in the Provider Finance...
-
Payer Relations Analyst
7 days ago
Houston, United States BRSI LP Full timeDescription: The Payer Relations Specialist/Manager is responsible for developing and maintaining positive relationships with payers to ensure smooth and efficient billing and reimbursement processes for healthcare services provided by our organization. This role involves negotiating contracts, resolving payment issues, and staying updated on changes in...
-
Credit Analyst
2 weeks ago
Houston, United States Triple-S Steel Full timeOverview: ABOUT THE POSITION: The Credit Analyst will review the creditworthiness of individuals or businesses to determine the risk involved in lending money or extending credit. ABOUT THE COMPANY: At Triple-S Steel we live and work by our core values. Since our inception over 50 years ago, we have followed three basic principles that are the foundation of...
-
Regulatory Compliance Specialist
1 day ago
Houston, United States Houston Methodist Full timeRegulatory Compliance Specialist - Medicare Analyst (Katy) Direct message the job poster from Houston Methodist ***Medicare compliance experience is preferred Note: Office for this position is located at our Continuing Care Hospital: 701 S. Fry Rd. Katy, TX 77450. (Hybrid position) JOB SUMMARY At Houston Methodist, the CBO Regulatory Compliance Specialist is...
-
BI Reporting Analyst
2 weeks ago
Houston, United States Cedar Gate Technologies Inc Full timeJob DescriptionJob DescriptionJob Location: Hybrid Remote in our office in Houston, TXPosition SummaryReasons you will want this position:We are a rapidly growing company with limitless career growth and advancement for top performersOur culture appreciates and rewards creative ideas, especially those that achieve better outcomes for everyoneOffer a variety...
-
BI Reporting Analyst
4 days ago
Houston, United States Cedar Gate Technologies Inc Full timeJob DescriptionJob DescriptionJob Location: Hybrid Remote in our office in Houston, TXPosition SummaryReasons you will want this position:We are a rapidly growing company with limitless career growth and advancement for top performersOur culture appreciates and rewards creative ideas, especially those that achieve better outcomes for everyoneOffer a variety...
-
Credit Analyst
1 week ago
Houston, Texas, United States Triple-S Steel Full timeOverview: ABOUT THE POSITION: The Credit Analyst will review the creditworthiness of individuals or businesses to determine the risk involved in lending money or extending credit. ABOUT THE COMPANY: At Triple-S Steel we live and work by our core values. Since our inception over 50 years ago, we have followed three basic principles that are the...
-
Credit Analyst
3 weeks ago
Houston, Texas, United States Triple-S Steel Full timeOverview: ABOUT THE POSITION: The Credit Analyst will review the creditworthiness of individuals or businesses to determine the risk involved in lending money or extending credit. ABOUT THE COMPANY: At Triple-S Steel we live and work by our core values. Since our inception over 50 years ago, we have followed three basic principles that are the...
-
Budget Analyst
3 days ago
Houston, United States US Army Installation Management Command Full time**Duties**: - Identifying and analyzing cost-benefit relationships between the administrative programs (dollars and work years required) to develop multi-year budget plans and forecasts. - Understanding of the headquarters mission, functions, programs, and objectives in order to review, analyze, adjust and approve budgetary requirements for allocations. -...
-
Management Analyst
6 days ago
Houston, United States US Military Treatment Facilities under DHA Full time**Duties**: - Utilize automated systems to produce various personnel reports, conduct timekeeping, and produce various documents, charts, and spreadsheets. - Analyze and process civilian Requests for Personnel Action from all department/services/divisions within the hospital. - Assist with management studies to determine the validity of requests for...