Payment Integrity Analyst I-HP Benefit Configuration

Description

Summary :

Under the supervision of the Configuration Manager, the Payment Integrity Analyst I will work in conjunction with Business Configuration, Claims, Network, Provider Data, Utilization Management, as well as other operational departments to ensure validation and quality assurance of benefit, contract, reimbursement, and overall financial analysis that arise during the overpayment identification and recovery process.

Responsibilities :

• Identify, analyze, and interpret trends or patterns in complex data sets.
• Leverages available resources and systems (both internal and external) to analyze claim information and take appropriate action for payment resolution; documents all activity in accordance with organization policies.
• Performs review of claim projects resulting from overpayments or underpayments related to benefits, contracts, and fee schedule defects.
• Performs root cause analysis and financial impacts of identified defective claims.
• Communicates findings, including trends and recommendations to appropriate leadership.
• Research, maintain, test, and create fee schedule tables from data obtained from CMS, Tricare (CHAMPUS), or custom rates into the claims system.
• Research, maintain, and create provider reimbursement contract configuration.
• Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks / goals.
• Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
• All other duties assigned by management.

Requirements : Education / Skills

Experience

Work Schedule :

MULTIPLE SHIFTS AVAILABLE

Work Type : Full Time

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