Jobs
>
Dallas

    Submission for the position: Claims Analyst - Dallas, United States - Baylor Scott & White Healthcare

    Baylor Scott & White Healthcare
    Baylor Scott & White Healthcare Dallas, United States

    3 weeks ago

    Default job background
    Description
    JOB SUMMARY

    This hybrid role as the Claims Analyst is accountable for claims processing, research, and adjudication to correctly apply benefit determination and pricing for areas of responsibility to include clinic professional claims, physician claims, and Rx-drug claims (CMS 1500 and UB04), by claims processing guidelines.

    ESSENTIAL FUNCTIONS OF THE ROLE
    • Processes and adjusts professional and facility claims, including, but not limited to, transplant, special handle, negotiations, and MSO, according to claims processing guidelines. Maintains confidentiality rules in compliance with HIPPA guidelines.
    • Pends claims as directed by departmental policies and procedures; follows up for resolution; and processes pended claims immediately following a benefit / payment determination.
    • Researches claims and adjustments; effectively gathers documentation needed to process claims and adjustments. Examines information including, but not limited to, authorizations, benefits, payments, and denials.
    • Works claims inventory from assigned queues to ensure all claims are processed within the established turnaround time as directed by department policies and procedures.
    • Consistently meets or exceeds productivity standards and accuracy standards for payment, both procedural and financial.
    • Performs follow-up and takes the necessary actions required to resolve errors and findings assessed by the Quality Review Team.
    • Identifies and reviews systematic or procedural problems with the supervisor for timely follow-up and correction.
    • Completes reports / special projects to ensure prompt payment of claims.
    KEY SUCCESS FACTORS
    • Medical terminology, CPT, HCPCS, ICD9, ICD10, and coding knowledge are preferred.
    • Ability to use good judgment and reason in evaluating and resolving difficult claim issues.
    • Demonstrates full knowledge of all products.
    • Ability to work autonomously, with minimal supervision to meet internal and external customer satisfaction goals. Must be a sound option maker.
    • Responds positively to goal-setting and performance measurements. Easily fits and responds effectively to shifts in priorities and unexpected events.
    • Excellent verbal and written communication skills, with attention to detail.
    • Ability to comprehend and adhere to policies and procedures.
    • Excellent data-based, problem solving, and organizational skills.
    • May be required to work in excess of regular scheduled hours.
    BENEFITS

    Our competitive benefits package includes the following
    • Immediate eligibility for health and welfare benefits
    • 401(k) savings plan with dollar-for-dollar match up to 5%
    • Tuition Reimbursement
    • PTO accrual beginning Day 1
    Note: Benefits may vary based on position type and/or level

    QUALIFICATIONS
    • EDUCATION - H.S. Diploma/GED Equivalent
    • EXPERIENCE - 2 Years of Experience with physician claims
  • ERISA Recovery

    Claims Analyst

    3 weeks ago

    ERISA Recovery Dallas, United States

    Job Description: · Are you a high-performing collections analyst and underpaid? Join a team where compensation and opportunities have no limits · We are seeking an experienced · Medical Claims Analyst with extensive knowledge in the Federal ERISA appeals process · to join our t ...

  • Turner Construction Company

    Claims Analyst

    1 day ago

    Turner Construction Company Dallas, United States Regular, Full time

    Division: · Turner Surety & Insurance Brokerage · Project Location(s): · Dallas, TX 75202 USA · Minimum Years Experience: · 4Travel Involved: · 20-30%Job Type: · RegularJob Classification: · ExperiencedEducation:Bachelors DegreeJob Family:Insurance and ClaimsCompensation:Salaried ...

  • UnitedHealth Group

    Upgrade Claims Analyst

    3 weeks ago

    UnitedHealth Group Dallas, United States

    Provide expertise or general claims support by reviewing, researching and investigating claims and policy language. Analyze medical records and determine eligibility. Consistently meet established productivity, schedule adherence and quality standard Claims Analyst, Claims, Analy ...

  • ERISA Recovery

    Medical Claims Analyst

    3 weeks ago

    ERISA Recovery Dallas, United States

    Job Description: · Are you a high-performing collections analyst and underpaid? Join a team where compensation and opportunities have no limits · We are seeking an experienced Medical Claims Analyst with extensive knowledge in the Federal ERISA appeals process to join our team. ...

  • MV Transportation

    Liability Claims Analyst

    1 week ago

    MV Transportation Dallas, United States

    Job Description · Responsibilities · MV Transportation is seeking a · Liability Claims Analyst · to provide support to the Liability Claims Program Manager and Director of Liability Claims. This role reports to the Director of Liability Claims and will play an integral part in ...

  • MV Transportation

    Liability Claims Analyst

    3 weeks ago

    MV Transportation Dallas, United States

    Job Description · Responsibilities · MV Transportation is seeking a Liability Claims Analyst to provide support to the Liability Claims Program Manager and Director of Liability Claims. This role reports to the Director of Liability Claims and will play an integral part in assist ...

  • Peacefestival

    Claims Repricing Analyst

    3 weeks ago

    Peacefestival Dallas, United States

    Opportunities for · Claims Repricing Analyst (Hybrid) · in · Dallas, TX · Remote positions only · Search completed. Found 0 matching records. · Claims Repricing Analyst (Hybrid) · Health Plans Inc · Analyze and identify trends in performance that offer continued efficiency ...

  • MV Transportation

    Liability Claims Analyst

    1 week ago

    MV Transportation Dallas, United States

    Overview: · If you reside in California, please see our California Applicant Privacy Policy for more information about our data handling practices and your data rights. · Responsibilities: MV Transportation is seeking a Liability Claims Analyst to provide support to the Liabilit ...

  • CornerStone Staffing

    Medical Claims Analyst

    1 week ago

    CornerStone Staffing Dallas, United States

    CornerStone Staffing is hiring career minded candidates with medical provider experience · We are seeking tenacious candidates with healthcare and outbound call center experience to work for an excellent Healthcare company in Dallas · JOB ID · Job Title: Medical Claims Analyst · ...

  • ERISA Recovery

    Medical Claims Analyst

    1 week ago

    ERISA Recovery Dallas, United States

    Job Description: · Are you a high-performing collections analyst and underpaid? Join a team where compensation and opportunities have no limits · We are seeking an experienced Medical Claims Analyst with extensive knowledge in the Federal ERISA appeals process to join our team. ...

  • CornerStone Staffing

    Medical Claims Analyst

    1 week ago

    CornerStone Staffing Dallas, United States TempToFT

    CornerStone Staffing is hiring career minded candidates with medical provider experience · We are seeking tenacious candidates with healthcare and outbound call center experience to work for an excellent Healthcare company in Dallas · JOB ID · Job Title: Medical Claims Analys ...

  • MV Transportation

    Liability Claims Analyst

    2 weeks ago

    MV Transportation Dallas, United States

    Overview: If you reside in California, please see our California Applicant Privacy Policy for more information about our data handling practices and your data rights. Responsibilities: MV Transportation is seeking a Liability Claims Analyst to provide support to the Liability Cla ...

  • UnitedHealth Group

    Claims Quality Analyst

    5 days ago

    UnitedHealth Group Dallas, United States

    Provide UNET claims experience by reviewing, researching, investigating, and auditing claims Provide feedback to auditors regarding sourcing reviews) Responsible for all aspects of quality assurance Identify trends to build recommendationsand provide Quality Analyst, Claims, Qual ...

  • MV Transportation

    Liability Claims Analyst

    10 minutes ago

    MV Transportation Dallas, United States Full time

    Overview: If you reside in California, please see our California Applicant Privacy Policy for more information about our data handling practices and your data rights. · Responsibilities: MV Transportation is seeking a Liability Claims Analyst to provide support to the Liability C ...

  • CornerStone Staffing

    Medical Claims Analyst

    1 week ago

    CornerStone Staffing Dallas, United States

    Job Description · Job DescriptionCornerStone Staffing is hiring career minded candidates with medical provider experience · We are seeking tenacious candidates with healthcare and outbound call center experience to work for an excellent Healthcare company in Dallas · JOB ID · Jo ...

  • Acosta Group

    Claims Resolution Analyst

    4 hours ago

    Acosta Group Dallas, United States

    This position will be responsible for processing and handling any claims that are incomplete or escalated for validation. This person will also be responsible for analyzing claims and making decisions about their validity. The position will be a communicator to internal and exter ...

  • UnitedHealth Group

    CAMS Claims Quality Analyst

    1 week ago

    UnitedHealth Group Dallas, United States

    Provide CAMS processing experience by reviewing, researching, investigating, auditing Provide feedback to team members on audit results Responsible for all aspects of quality assurance Identify trends to build recommendations and provide feedback and Quality Analyst, Claims, Qual ...

  • UnitedHealth Group

    ACR Enhanced Claim Analysis Analyst

    3 weeks ago

    UnitedHealth Group Dallas, United States

    Assist in creating and managing customized audit rationales, documenting findings, and communicating the results with external teams Review, research, investigate and audit claims and provide feedback to team members on audit results Ensure claim den Analyst, Processing, Remote, ...

  • Hallmark Financial Services, Inc

    Senior Claims Analyst, Commercial

    3 weeks ago

    Hallmark Financial Services, Inc Dallas, United States OTHER

    Job Description: · Summary: Investigates, evaluates, negotiates and resolves claims of moderate to severe complexity through effective research, negotiation and interaction with insured's and claimants in accordance with established procedures and state regulations. Responsible f ...

  • Money Fit by DRS

    Business Analyst IV, Group Claims

    1 week ago

    Money Fit by DRS Dallas, United States

    As Group Claims Business Analyst, you will serve as a Claims subject matter expert to assist in executing all claims projects and strategic initiatives. You will partner with the Group Claims Transformation & Reengineering team to develop project plans, create business requiremen ...