Claims Processing Analyst II

Company: Driscoll Health
Location: Corpus Christi
Posted on: June 20, 2022

Job Description:

Where compassion meets innovation and technology and our employees are family.Thank you for your interest in joining our team! Please review the job information below.GENERAL PURPOSE OF JOB
The Claims Processing Analyst performs claims analysis and associated responsibilities in support of claims administration, and performs other related work as required.Claims Analyst II: In this position, individuals perform the full range of assigned tasks, under minimal supervision, while exercising expanded discretion and independent judgment within established guidelines. Examples of responsibilities include:Claim review/analysis of moderate to advanced complexity Complex provider contract pricing High dollar claim review Claim research Claim issue resolutionESSENTIAL DUTIES AND RESPONSIBILITIES - Positions in this class may perform any or all of the below listed duties. These should be interpreted as examples of the work, and are not necessarily all-inclusive.Validate submitted claims data to ensure accuracy, validity and integrity.Analyze pended claims, collaborating with internal business partners for necessary information and assistance, according to departmental procedures.Effectively prioritize and complete all assigned tasks within appropriate timeframes and with required level of quality.Evaluate claims issues and procedures to identify and suggest opportunities for improvement, both in efficiency and quality.Openly participate in team meetings, providing ideas and suggestions to ensure departmental best practices, and to develop and promote teamwork.Maintain required compliance with privacy and confidentiality standards.Maintain or exceed all established standards for performance, quality and timeliness.Support the Claims department in review, investigation, and research of claims issues and completion of claims projects.Communicate effectively, in verbal or written form, by sharing ideas and reporting facts and issues.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.Claims Analyst IIMinimum of five years professional experience in claims analysis, provider medical billing, or medical coding.High school graduate or GED required.Proficiency with Microsoft Excel and Word, as well as with medical terminology coding and billing concepts.Advanced experience with health insurance and managed care principles.Experience with complex claims analysis and resolution.Ability to work independently, or in a team environment, toward meeting common goals.Integrity and discretion to maintain confidentiality of member and provider data.Advanced analytical skills with ability to collect, organize, analyze and disseminate and communicate information with attention to detail and accuracy.Ability to multi-task and meet deadlines in a fast-paced environment.Ability to access data in varied formats with different methods of analyzing and processing.

Keywords: Driscoll Health, Corpus Christi , Claims Processing Analyst II, Professions , Corpus Christi, Texas