Under the supervision of the Encounter/Special Project Department Supervisor, this position supports the core business activities of the CHRISTUS Health Plans by providing analytic and strategic insight. This position is responsible for the submission of clean Encounter Data and Error corrections for the Medicaid Product Line of Business in a timely manner. Responsible for submitting the Error corrections for EDPS/Edge-Medicare Advantage Generations Product Line of Business, Raps-Texas HIX and New Mexico HIX Product Line of Business and processing of all claims submitted for special projects. The Encounter/Special Project Analyst will be responsible for reviewing and validating reported claim issues, trends and assisting the Business System Analyst with getting the proper query in place to identify all claims associated with the issue that has been identified. The Analyst will work with other departments to confirm that their needs are being met and determine and report trends in Encounter rejections, Provider billing issues, under/overpayments to providers are addressed. The Analyst will complete the research utilizing TMHP, NUBC, CMS, Encounter 837 Submission Guidelines, EMDEON, NIPPES, Optum 360 Encoder Pro, CSSC Operations-EDPS Edit Code Lookup and Risk Adjustment CMS Newsletter for EDPS & RAPS, TMHP MCO Mailbox, EDIFECS Testing site for updates and to identify additional mapping/segment issues within HSP System. The Encounter/Project Analyst will ensure timely, accurate, and quality resolution is being completed, participate in improvement initiatives to increase overall clean data and efficiency within the department.
Our Mission: WHY WE EXIST. To extend the healing ministry of Jesus Christ. Our Core Values: WHAT WE BELIEVE IN.DIGNITY Respect for the worth of every person, recognition and commitment to the value of diverse individuals and perspectives, and special concern for the poor and underserved. INTEGRITY Honesty, justice, and consistency in all relationships. EXCELLENCE High standards of service and per...formance. COMPASSION Service in a spirit of empathy, love, and concern. STEWARDSHIP Wise and just use of talents and resources in a collaborative manner.Our Vision: WHAT WE ARE STRIVING TO DO. CHRISTUS HEALTH, a Catholic health ministry, will be a leader, a partner and an advocate in the creation of innovative health and wellness solutions that improve the lives of individuals and communities so that all may experience God's healing presence and love. Our Name and Symbol:WHO WE ARE. CHRISTUS is Latin for "Christ," and proclaims publicly the core of our mission. OUR NAME choice also recognizes the heritage of our two congregational sponsors, the Sisters of Charity of the Incarnate Word in Houston and San Antonio. Jesus Christ is the Incarnate Word, the Word of God made flesh. It is, therefore, only fitting that it is in another form of His name that our health ministries are called together. OUR SYMBOL Reflects the healing ministry of Jesus Christ - a combination of a medical cross and a religious cross. The flowing banner on the cross is a common symbol of the risen Christ, while the royal purple signifies Christ. The flowing banner also conveys a sense of motion as we move forward into a new era of service to our communities.