Senior Claims Analyst

• Analyze highly complex claims and claim issues to ensues 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.