|Date Posted:||Jan 5|
TITLE: Operations Systems Analyst
LOCATION: Houston TX
TYPE: Contract/Remote only
HOURLY RATE: flexible depending on experience
URGENCY: start date preferable 1/18/2021
We are seeking a full time , remote Operations Systems Analyst for our hospital client in Houston Texas. The ideal person for this role would be responsible for accurate and timely maintenance of provider information on all claims and provider databases. It also validates that provider information entered on databases adheres to business policies and state requirements.
• Load new providers contracted to our network in QNXT and Cactus.
• Execute changes in provider data and contracts as requested by Provider Network Management team.
• Create contract records for out of network providers to properly adjudicate claims received.
• Research and respond to inquiries related to provider data and affiliation status.
• Loads and maintains provider information in an accurate and timely manner to meet department’s standards of turnaround time and quality.
• Monitors pended claims and work queues to update appropriate systems
• Identifies claims impacted by configuration changes done in the system and sends reports to the claims administration department for reprocessing.
• Supports Claims staff with moderately complex claims issues.
• Identifies and develops process improvements outside of daily scope of work.
• Assists with the development of configuration standards and best practices.
• Maintains thorough and concise documentation for tracking of all provider, contract, benefit or Process Director changes related to Change Control Management or issues for quality audit purposes.
• Monitors pended claims and work queues to update appropriate systems. Responsible for escalating identified issues, making recommendations and assisting with implementing configuration changes to improve accuracy and efficiency of processes.
• Handles fluctuating volumes of work and prioritizes work to meet deadlines and user needs of the Health Plan.
• Knowledge of current managed care business practices and applications, including applications, systems or software used by the Health Plan.
• A working knowledge of the healthcare industry, preferably health insurance/managed care.
• Process mapping, leadership, collaboration, written and verbal communication, detailed analytical skills and organizational skills; ability to analyze the functionality of systems and their fit with specifications; ability to manage time with competing priorities; self-motivation; and ability to work independently with minimum supervision.
• Additional preferred knowledge includes: claims processing experience, provider contract set-up, Claims Editing System knowledge, ability to interpret business requirements into system coding edits, and testing of configuration builds, provider contract configuration, TX Medicaid, Master Provider File.
• Must have 1 – 3 years in Managed Care, provider data and claims processing
• Must have 2 years Health plan payor information systems
• Knowledge of managed care business practices as it pertains to providers, credentialing and contracts as required by the Health Plan.
• Written and verbal communication, detailed analytical skills and organizational skills; ability to manage time with competing priorities; and ability to work independently with minimum supervision.
• EDUCATION: HS Diploma or GED required Prefer Bachelor's Degree Computer science, business administration, healthcare administration or other related field
• Bachelor's degree may substitute for the two years of required work experience.
ADDITIONAL “PERKS” TO CONSIDER: 100% Remote opportunity. Must have someone reliable and have a work from home office with good connection.
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