Business Process Specialist

2 weeks ago


Bellaire, United States Texas Children's Health Plan Full time
Details

Client Name
Texas Children's Health Plan
Job Type
Travel
Offering
IT
Profession
Technical
Specialty
Business/Systems Analyst
Job ID
29120603
Job Title
Business Process Specialist
Weekly Pay
$700.0

Shift Details

Shift
Day - 8x5 - 09AM
Scheduled Hours
40

Job Order Details

Start Date
11/18/2024
End Date
02/15/2025
Duration
13 Week(s)

Job Description
Job Title: Business Process Specialist

Job Specialty: Business Operations - Admin, Health Plan

Job Duration: 13 months

Shift: Hybrid, day shift (5x8 Hr)

Guaranteed Hours: 40.00 hours per week

Experience: Required - 2 years of experience in a managed care organization or related healthcare organization. A Master's degree in Business, Health Care Administration, Public Health, Nursing, MIS, or an IS-related field may substitute for 2 years of required experience.

License: N/A

Certifications: Certified Coder (CPC, CIC, CPMA)

Must-Have:

- Experience with claims, payment integrity, medical billing and coding, and business process analysis
- Direct and relevant experience with HCFA/UB-04 claims management, coding rules and guidelines
- Knowledge of centers for Medicare & Medicaid Services (CMS) & Medicaid, and other CMS and American Medical Association (AMA) guidelines
- Experience in Tapestry (preferred)
- Knowledge of Texas Medicaid
- Bachelor's degree in Business, Health Care Administration, Public Health, Nursing, MIS, or an IS-related field

Job Description:

- Support and develop programs aligned with strategic health plan goals through effective and timely assessment of resources
- Facilitate education and implementation of processes to maintain a cost-effective provider network
- Participate in medical policy, reimbursement committees, and other workgroups as needed
- Propose, implement, and support quality control measures related to practice and/or system changes that impact claims adjudication
- Review current and newly implemented processes to ensure accurate reports and deliverables
- Lead collaborations with other departments to ensure compliance standards are met
- Manage process and workflow for audit response, contract adherence, and regulatory compliance functions
- Prioritize key project tasks and deliverables, identifying project risks, issues, and dependencies
- Develop enhanced, customized prospective medical coding and reimbursement policies and necessary coding configuration requirements
- Utilize data to examine large claims data sets for analysis and reporting on provider billing patterns compared to industry coding regulations
- Make recommendations based on new/revised coding edits for committee meetings
- Analyze, measure, manage, and report outcome results on system configuration/ edits implemented
- Serve as a subject matter expert on coding guidelines and impact on provider reimbursement

Client Details

Address
6330 W Loop S
City
Bellaire
State
TX
Zip Code
77401

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