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Harris Health · 3 weeks ago

Claims Resolutions Analyst

Houston, TX

Full-time

Onsite

Senior Level

$27/hr - $34/hr

5+ years exp

Harris Health System is a non-profit managed care organization that serves over 400,000 members through various health programs. The Claims Resolutions Analyst is responsible for reviewing and resolving payment disputes, preparing written responses to appeal decisions, and tracking incorrect claims outcomes to improve adjudication processes.

Hospital & Health Care

Responsibilities

Support the review and resolution of payment disputes including indebt research and response to project related disputes

Preparing written responses to appeal and reconsideration decisions

Receipt of complex sys-aid tickets, call tracking and web related inquiries

Tracking and trending of incorrect claims outcomes and work with department leaders to correct adjudication processes

Work urgent and priority requests, work in tangent with leaders to support testing and training initiatives

Additional tasks include corrected claims, retro authorizations, incorrect denial requests, and review of correspondence, reconsiderations, compliance related complaints, and provider payment appeal in a timely manner

Utilize payment experience and problem-solving skills to determine outcomes

Determine root causes and remediate impacted claims

Qualification

Claims payment experienceCMS guidelines knowledgeClaims researchResolutionMicrosoft Office SuiteMedical terminology knowledgeAnalytical skillsMathematicsResearch skillsQuick learnerCommunication skillsProblem-solving skillsTeam player

Required

High School Diploma, GED or Equivalent

Five (5) years of professional and facility (inpatient/outpatient) claims payment experience or claims research, resolution or analysis of reimbursement methodologies experience

Microsoft Office Suite

Extensive knowledge of CMS and/or TMHP guidelines

Claims Adjustment Analyst skills mastery; handle highest level of claim appeals and complaints; communicate with legal to secure determination; support arbitration and provider interest and penalty dispute process

Sound analytical problem-solving and documentation skills

Computer literate with basic knowledge of claims software usage

Basic knowledge of medical procedures and terminology, medical CPT, ICD-10, DRG and Healthcare Common Procedure Coding System (HCPCS)

Ability to speak, listen and write effectively

Quick learner with the ability to adjudicate professional and facility claims, applying appropriate reimbursement methodologies

Ability to problem solve and work independently

Team player with the ability to establish and maintain effective work relationships

Writing /Composing (Correspondence / Reports)

Analytical

Mathematics

Medical Terminology

Research

MS Word

Company

Harris Health

Glassdoor3.8

At Harris Health, we champion better health for our patients, their families and our community, by connecting all to an integrated healthcare system that provides high-quality healthcare.

Founded in 1966

Bellaire, Texas, US

5001-10000 employees