Business Process Specialist
: Job Details :

DetailsClient Name Texas Children's Health Plan Job Type Travel Offering IT Profession Technical Specialty Business/Systems Analyst Job ID 29120603 Job Title Business Process Specialist Weekly Pay $700.0 Shift DetailsShift Day - 8x5 - 09AM Scheduled Hours 40 Job Order DetailsStart Date 11/18/2024 End Date 02/15/2025 Duration 13 Week(s) Job Description Job Title: Business Process Specialist Job Specialty: Business Operations - Admin, Health Plan Job Duration: 13 months Shift: Hybrid, day shift (5x8 Hr) Guaranteed Hours: 40.00 hours per week Experience: Required - 2 years of experience in a managed care organization or related healthcare organization. A Master's degree in Business, Health Care Administration, Public Health, Nursing, MIS, or an IS-related field may substitute for 2 years of required experience. License: N/A Certifications: Certified Coder (CPC, CIC, CPMA) Must-Have: - Experience with claims, payment integrity, medical billing and coding, and business process analysis - Direct and relevant experience with HCFA/UB-04 claims management, coding rules and guidelines - Knowledge of centers for Medicare & Medicaid Services (CMS) & Medicaid, and other CMS and American Medical Association (AMA) guidelines - Experience in Tapestry (preferred) - Knowledge of Texas Medicaid - Bachelor's degree in Business, Health Care Administration, Public Health, Nursing, MIS, or an IS-related field Job Description: - Support and develop programs aligned with strategic health plan goals through effective and timely assessment of resources - Facilitate education and implementation of processes to maintain a cost-effective provider network - Participate in medical policy, reimbursement committees, and other workgroups as needed - Propose, implement, and support quality control measures related to practice and/or system changes that impact claims adjudication - Review current and newly implemented processes to ensure accurate reports and deliverables - Lead collaborations with other departments to ensure compliance standards are met - Manage process and workflow for audit response, contract adherence, and regulatory compliance functions - Prioritize key project tasks and deliverables, identifying project risks, issues, and dependencies - Develop enhanced, customized prospective medical coding and reimbursement policies and necessary coding configuration requirements - Utilize data to examine large claims data sets for analysis and reporting on provider billing patterns compared to industry coding regulations - Make recommendations based on new/revised coding edits for committee meetings - Analyze, measure, manage, and report outcome results on system configuration/ edits implemented - Serve as a subject matter expert on coding guidelines and impact on provider reimbursement Client DetailsAddress 6330 W Loop S City Bellaire State TX Zip Code 77401 Job Board Disclaimer By applying for jobs on this website, you consent to receive daily messages from CYNET HEALTH about assignments that match your profile. Email or text HELP for more info, or STOP to unsubscribe. Your mobile info will not be shared with third parties for marketing. Standard messaging and data rates may apply.