Summary:
Data Specialist I is responsible for identifying system issues and providing defect resolution analysis via claims and system analysis in support of the Benefits Configuration and Provider Data departments.
Responsibilities:
- Assist with database improvements and audits
- Identify and communicate data quality issues through extensive research by comparing system information to applicable claims based on benefit structure, contract details, and pricing methodologies.
- Analyze benefit coverage and provider data loaded in the claims payment system to determine root cause of data quality issues directly affecting claims payment and/or denials.
- Initiate claims payment analysis based on internal requests from the Health Plan by partnering with the BI department for applicable reports to determine underpayments and overpayments to providers.
- Catalog internal defect results and recommendations then communicating all findings to affected areas and appropriate leadership.
- Collaborate and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow to facilitate completion of tasks/goals.
- Assist with developing and maintaining departmental goals and objectives as well as personal goal maintenance on a quarterly basis.
- Assist in the development of action plans to address system deficiencies to ensure claims correctly adjudicate.
- Monitor and track best practices while also reviewing compliance changes/impacts for continuous improvement opportunities.
- Identify prevalent trends through data reporting and claims analysis.
- Assists in circulating information to staff as needed.
- Perform other related duties and special projects as requested.
- Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
Requirements:
Education/Skills
Work Schedule:
7AM - 5PM
Work Type:
Full Time