Claims Analyst
Claims Analyst
ABOUT US
Driscoll Children’s Hospital has a rich history of bringing the best and brightest healthcare professionals home to South Texas. Physicians and staff use a creative blend of treatment, education and play to reach the best possible outcome in the treatment of every child. Smiles, hugs and a soothing touch are as much a part of Driscoll’s approach to treating children as is its advanced medical treatments and technologies. When patients and families come to Driscoll for help, they are met with the same compassion, spirit and generosity with which Clara Driscoll blessed our community when she founded Driscoll Children’s Hospital more than 60 years ago.
The hospital and its specialty centers, urgent care centers and after-hours facility, serve a vast area. On a daily basis, physicians and patients are transported by ground and air to ensure the children of South Texas can receive the best treatment possible. Driscoll treats more than 100,000 children every year from 31 South Texas counties.
The hospital is a 189-bed tertiary care center offering 32 medical and 13 surgical specialties.
GENERAL PURPOSE OF JOB
The Claims Analyst performs claims analysis and associated responsibilities in support of claims administration, and performs other related work as required.
DISTINGUISHING CHARACTERISTICS
Claims Analyst: In this position, individuals perform routine and directed tasks, following established procedures. Examples of responsibilities include:
- Claim entry
- Routine claim analysis
- Support functions as instructed
ESSENTIAL 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 .
- Enter, or 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.
EDUCATION AND/OR EXPERIENCE - Any combination of education and experience that would likely provide the required knowledge, skills, and abilities is qualifying.
|
Experience |
Knowledge |
Skills |
|
Minimum of one year professional experience in claims analysis, provider medical billing, or medical coding. |
Experience with Microsoft Excel and Word, as well as familiarity with medical terminology, coding and billing concepts. Knowledge of health insurance and managed care principles. |
Ability to work independently, or in a team environment, toward meeting common goals. Ability to apply entry level concepts of claims adjudication, following established procedures and workflows for completion of assigned tasks. Integrity and discretion to maintain confidentiality of member and provider data. |
Visit our website at www.driscollchildrens.org
Driscoll Health Plan
Corpus Christi, TX