HP Reimbursement Analyst
Company: Disability Solutions
Location: Fort Worth
Posted on: October 16, 2024
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Job Description:
Location:Calmont Operations BuildingDepartment:Reimbursement
AnalysisShift:First Shift (United States of America)Standard Weekly
Hours:40Summary:Systems Reimbursement Analyst is responsible for
maintaining payment integrity by executing a claim recovery
strategy, which includes the analysis of claims data to identify
cost containment opportunities and auditing provider contracts to
ensure proper configuration for claims payments. The Reimbursement
Analyst supports the delegation processes for all lines of business
by performing audits of delegated entities to ensure their policies
and procedures, and claims processing system are operational and in
compliance with regulatory and statutory guidelines. Acts as a
subject matter expert in interpreting requirements and ensuring the
overall areas for delegation are functional and in compliance with
the CCHP regulatory contracts. The Reimbursement Analyst has
extensive knowledge of claim payment methodologies, which include
but not limited to OPPS, DRG, TMHP fee schedules etc., and will
provide superior claim analysis support and expertise to CCHP
executives. This position collaborates with Claims Operation,
Provider Contract, Compliance and Finance and serves as a liaison
to IS for benefit configuration, provider contract and fee
schedules. The Reimbursement Analyst staff ensures that claims
process in compliance with Medicaid guidelines for the State of
Texas and Health and Human Service Commission.Additional
Information:Systems Reimbursement Analyst is responsible for
maintaining payment integrity by executing a claim recovery
strategy, which includes the analysis of claims data to identify
cost containment opportunities and auditing provider contracts to
ensure proper configuration for claims payments. The Reimbursement
Analyst supports the delegation processes for all lines of business
by performing audits of delegated entities to ensure their policies
and procedures, and claims processing system are operational and in
compliance with regulatory and statutory guidelines. Acts as a
subject matter expert in interpreting requirements and ensuring the
overall areas for delegation are functional and in compliance with
the CCHP regulatory contracts. The Reimbursement Analyst has
extensive knowledge of claim payment methodologies, which include
but not limited to OPPS, DRG, TMHP fee schedules etc., and will
provide superior claim analysis support and expertise to CCHP
executives. This position collaborates with Claims Operation,
Provider Contract, Compliance and Finance and serves as a liaison
to IS for benefit configuration, provider contract and fee
schedules. The Reimbursement Analyst staff ensures that claims
process in compliance with Medicaid guidelines for the State of
Texas and Health and Human Service Commission.Education:
Keywords: Disability Solutions, Grapevine , HP Reimbursement Analyst, Professions , Fort Worth, Texas
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