HP Reimbursement Analyst
Core
Maintains payment integrity by executing claim recovery strategies, analyzing claims data for cost containment, and auditing provider contracts for compliance.
Role type
Healthcare reimbursement analyst (claims data & contract audit)
Builds
Operational claims processing systems compliant with Medicaid and regulatory guidelines
Domain
Healthcare administration / Medicaid claims / Texas state regulations
Deliverable
dashboards & analysis
Required skills
Claims data analysis, Provider contract auditing, Knowledge of OPPS/DRG/TMHP fee schedules, Medicaid guideline compliance, CPT/ICD-10/HCPCS coding, SQL, MS Access/Excel
Preferred skills
Bachelor's degree, Project management experience, Claims adjudication logic expertise
Responsibilities
Analyze claims data to identify cost containment opportunities, Audit provider contracts for proper payment configuration, Support delegation processes by auditing delegated entities, Act as subject matter expert for CCHP regulatory contracts, Collaborate with Claims Operation, Compliance, and Finance teams, Ensure claims process compliance with Texas Medicaid guidelines