Job description

Claims Submission Analyst (Job ID #22017408)

Work location: Southwestern Health Resources Headquarters, 1601/1603 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234.

Work environment: Risk Adjustment Department.

Please note: The Claims Submission Analyst will be an employee of Southwestern Health Resources (SWHR). SWHR is a clinically integrated network formed by Texas Health Resources (THR) and University of Texas Southwestern Medical Center (UTSW).

Work hours:

Full-time, 40 hours per week; Monday - Friday, Day shift.

· This is a Hybrid position, to be based in North Texas/Dallas-Fort Worth area, requiring occasional onsite workdays, based on department business needs.

· In-person attendance required at department meetings, trainings and/or other department authorized activities, at the above-mentioned address or other locations as directed by the department management.

Southwestern Health Resources (SWHR) is a patient-centered, clinically integrated network of 29 hospital locations and more than 6,900 physicians and clinicians caring for more than 730,000 patients across 16 counties in North Texas. Blending the strengths of Texas Health Resources and the University of Texas Southwestern Medical Center, SWHR offers an unmatched ability to connect individuals with a full spectrum of nationally preeminent, clinical care. SWHR is the parent of Care N’ Care Insurance Co., a leading regional Medicare Advantage health plan providing care to over 12,000 members.

At SWHR, we believe healthcare can be more integrated, accessible and affordable for all. Our purpose: to build a better way to care, together. Our promise: to simplify and empower care, for good.

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.

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.

Job Type: Full-time

Pay: $65,000.00 - $104,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Retirement plan
• Tuition reimbursement
• Vision insurance

Physical setting:

• Office

Schedule:

• Day shift
• Monday to Friday

Supplemental pay types:

• Bonus pay

Ability to commute/relocate:

• Farmers Branch, TX 75234: Reliably commute or planning to relocate before starting work (Preferred)

Experience:

• SQL Programming /Querying: 2 years (Required)
• Data Analysis of RAPS, EDPS & APD: 2 years (Required)
• Managed Care, Health/Medical Insurance: 1 year (Preferred)
• Medicare and/or Medicaid Risk Adjustment Functions: 1 year (Preferred)
• HCC coding: 1 year (Preferred)

Work Location: Hybrid remote in Farmers Branch, TX 75234

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