Claims Submission Analyst - Risk Adjustment - Southwestern Health Resources (SWHR)
Here’s What You Need
Education
- Require Bachelor’s Degree in Information Technology, Computer Science, or related field of study, OR,
- Require High School Diploma or Equivalent plus 4 years of additional experience in lieu of Bachelor’s degree.
Experience
- Require 2 years of SQL programming /querying experience to include 2 years of experience performing encounter data analysis of RAPS, EDPS & APD, or similar, in a health care or health plan organization.
- Highly prefer 1 year of related Managed Healthcare, or Insurance operations experience.
Skills & Abilities
- Expertise with relational database concepts and data modeling.
- Working knowledge of HIPAA/EDI X12 ANSI 5010 standards and EDI file structure.
- Advanced in MS Office (Excel, PowerPoint, Access, etc.)
- Strong interpersonal, organizational, communication, and workflow skills.
- Experience with Medicare and/or Medicaid risk adjustment encounter management, reporting, and requirements from either a payer or vendor.
- Knowledge of and experience in Medicare and/or Medicaid risk adjustment functions, regulations, and other related activities.
- Knowledge of HCC coding, risk adjustments concepts, medical record review project management, encounter data management, compliance audit concepts.
What You Will Do
Position Responsibilities
The Claims Submission Analyst will be responsible for aiding Medicare and Medicare Advantage operational management and analytics activities and functions.
Position Functions
- Extracts and compiles various sources of information and large data sets from various systems or applications.
- Creates and maintains processes for monitoring, tracking, and trending information and data using various systems or applications.
- Research and analyze report results identifying opportunities and trends.
- Works with internal, external, and enterprise individuals as needed to research, develop, and document new standard reports or processes.
- Consolidates data from multiple sources, using industry-based tools or manually; able to process data effectively using Microsoft Excel, and Access.
- Oversight of risk adjustment encounter file preparation and remediation.
- Other duties as assigned.
Why Southwestern Health Resources
As a Southwestern Health Resources employee, you’ll enjoy, comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.
- Additional perks of being an SWHR employee:
- Gain a sense of accomplishment by contributing to a teamwork environment.
- Positively impact patients’ quality of life.
- Receive excellent mentorship, comprehensive training and dedicated clinical and administrative leadership resources.
- Enjoy opportunities for growth.
Explore Southwestern Health Resources Careers for more information and to search all career opportunities.
Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org
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