Business Analyst - Managed Care / Claims Jobs Everywhere
(Found 29 Jobs)
Cook Children's Health Care System
Reimbursement Analyst-Health Plan
Cook Children's Health Care System
Location:Calmont Operations BuildingDepartment:Reimbursement AnalysisShift:First Shift (United States of America)Standard Weekly Hours:40Summary:Systems Reimbursement Analyst is responsible for mainta...
Jul 9, 2025
Fort Worth, TX
Apex Systems, Inc.
Configuration Analyst
Apex Systems, Inc.
Job#: 2080286 Job Description: Apex Systems is hiring a Business Analyst for a major Healthcare client!FULLY REMOTE anywhere in the US. 12 months contract to hire4-6 years experience in the followin...
Jul 12, 2025
Lafayette, LA
Kaiser Permanente
Job Summary: Performs full scope of investigative and research functions associated with pre/post authorizations for member claims and referrals. Ensures pre-authorizations are complete, information...
Jun 21, 2025
Aurora, CO
Kaiser Permanente
Job Summary: Performs full scope of investigative and research functions associated with pre/post authorizations for member claims and referrals. Ensures pre-authorizations are complete, information...
Jul 2, 2025
Denver, CO
Cook Children's Health Care System
EPIC Inpatient BI Developer
Cook Children's Health Care System
Location:Rosedale Office BuildingDepartment:IS EpicShift:First Shift (United States of America)Standard Weekly Hours:40Summary:The Business Intelligence (BI) Developer is an emerging data professional...
May 31, 2025
Fort Worth, TX
Reimbursement Analyst-Health Plan
Fort Worth, TX
Jul 9, 2025
Full-time

Location:

Calmont Operations Building

Department:

Reimbursement Analysis

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

Systems Reimbursement Analyst is responsible for maintaining payment integrity by executing a claim recovery strategy, which includes the analysis of claims data to identify cost containment opportunities and auditing provider contracts to ensure proper configuration for claims payments. The Reimbursement Analyst supports the delegation processes for all lines of business by performing audits of delegated entities to ensure their policies and procedures, and claims processing system are operational and in compliance with regulatory and statutory guidelines. Acts as a subject matter expert in interpreting requirements and ensuring the overall areas for delegation are functional and in compliance with the CCHP regulatory contracts. The Reimbursement Analyst has extensive knowledge of claim payment methodologies, which include but not limited to OPPS, DRG, TMHP fee schedules etc., and will provide superior claim analysis support and expertise to CCHP executives. This position collaborates with Claims Operation, Provider Contract, Compliance and Finance and serves as a liaison to IS for benefit configuration, provider contract and fee schedules. The Reimbursement Analyst staff ensures that claims process in compliance with Medicaid guidelines for the State of Texas and Health and Human Service Commission.

Additional Information:

Systems Reimbursement Analyst is responsible for maintaining payment integrity by executing a claim recovery strategy, which includes the analysis of claims data to identify cost containment opportunities and auditing provider contracts to ensure proper configuration for claims payments. The Reimbursement Analyst supports the delegation processes for all lines of business by performing audits of delegated entities to ensure their policies and procedures, and claims processing system are operational and in compliance with regulatory and statutory guidelines. Acts as a subject matter expert in interpreting requirements and ensuring the overall areas for delegation are functional and in compliance with the CCHP regulatory contracts. The Reimbursement Analyst has extensive knowledge of claim payment methodologies, which include but not limited to OPPS, DRG, TMHP fee schedules etc., and will provide superior claim analysis support and expertise to CCHP executives. This position collaborates with Claims Operation, Provider Contract, Compliance and Finance and serves as a liaison to IS for benefit configuration, provider contract and fee schedules. The Reimbursement Analyst staff ensures that claims process in compliance with Medicaid guidelines for the State of Texas and Health and Human Service Commission.

Education:

  • Minimum of associates' degree, bachelor's preferred, or equivalent experience in healthcare claims adjudication logic, database maintenance and project management.
  • Must have knowledge of CPT, ICD-9/ICD-10, HCPCS, Revenue Codes and pricing methodologies.
  • Minimum of 2-3 years Health Care industry knowledge and operations (example: claims processing, enrollment, provider file maintenance) with ability to interpret and document business requirements.
  • Demonstrated ability to process health care claims and to understand claim life cycle.
  • Strong analytical skills and problem solving skills.
  • Understanding of core processing systems in relation to configuration set-up. Demonstrated understanding of working with government agencies such as CMS, Medicaid, etc. along with interpreting agency and contract requirements. Strong computer skills with proficiency in MS Word, Excel, Outlook, and Access. SQL experience preferred.
  • Excellent communication skills both verbal and written.
  • Ability to participate in a team environment.
  • Self-starter who requires minimal supervision.

About Us:

Cook Children's Health Plan

Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region. Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise.

Cook Children's is an equal opportunity employer. As such, Cook Children's offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.

PDN-9f58b8da-c626-4f9d-9612-cd642028fd5f
©2025 TalentAlly.
Powered by TalentAlly.
Apply for this job
Reimbursement Analyst-Health Plan
Cook Children's Health Care System
Fort Worth, TX
Jul 9, 2025
Full-time
Your Information
First Name *
Last Name *
Email Address *
Zip Code *
Password *
Confirm Password *
Create your Profile from your Resume
By clicking the Apply button, you agree to the terms of use and privacy policy and consent to receive emails from us about job opportunities, career resources, and other relevant updates. You can unsubscribe at any time.
Continue to Apply

Cook Children's Health Care System would like you to finish the application on their website.

Supercharge Your Resume with AI

Boost your resume with AI-driven enhancements. The tool analyzes and refines your content, highlighting your strengths and tailoring it for maximum impact. Get personalized suggestions and apply improvements instantly to stand out in the job market.