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Driscoll Children's Hospital · 2 weeks ago

Senior Claims Analyst

Corpus Christi, TX

Full-time

Onsite

Senior Level

5+ years exp

Driscoll Children's Hospital is a compassionate and innovative healthcare provider, and they are seeking a Senior Claims Analyst. The role involves performing complex analysis for health plan claims, coordinating departmental projects, and ensuring compliance with policies and procedures while mentoring team members.

Child CareChildrenHealth CareMedical

Growth Opportunities

Responsibilities

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