Data Specialist-Nursing Education-Full Time

Summary:

Responsible for providing administrative support to the Critical Care Service Line managers and director in their capacity to fulfill CHRISTUS St. Frances Cabrini Hospital's demands. Performs administrative duties. Attends meetings, records, transcribes and distributes minutes as required, and maintains files and records for various committees such as Critical Care Committee. Maintains department and associate's records and files. Also responsible for special projects as assigned.

Responsibilities:

* Assist with database improvements and audits
* Identify and communicate data quality issues through extensive research by comparing system information to applicable claims based on benefit structure, contract details, and pricing methodologies.
* Analyze benefit coverage and provider data loaded in the claims payment system to determine root cause of data quality issues directly affecting claims payment and/or denials.
* Initiate claims payment analysis based on internal requests from the Health Plan by partnering with the BI department for applicable reports to determine underpayments and overpayments to providers.
* Catalog internal defect results and recommendations then communicating all findings to affected areas and appropriate leadership.
* Collaborate and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow to facilitate completion of tasks/goals.
* Assist with developing and maintaining departmental goals and objectives as well as personal goal maintenance on a quarterly basis.
* Assist in the development of action plans to address system deficiencies to ensure claims correctly adjudicate.
* Monitor and track best practices while also reviewing compliance changes/impacts for continuous improvement opportunities.
* Identify prevalent trends through data reporting and claims analysis.
* Assists in circulating information to staff as needed.
* Perform other related duties and special projects as requested.
* Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)

Requirements:

• Strong organization and communication skills (written & verbal)
• Three to five years experience in related professional setting required preferably Healthcare.
• Must be proficient with all Microsoft Office programs (i.e. Excel, Word, Power Point, and Outlook).
• Current BLS

Work Schedule:

TBD

Work Type:

Full Time