Cost Analyst jobs in San Antonio, TX

At Boon-Chapman, our employees are our biggest asset. A few of our benefits include:

• Paid holidays & competitive PTO that increases with tenure
• Full benefits package including healthcare, dental, vision, 401(K), paid STD & life insurance and more
• Casual everyday dress
• Access to an on-staff Medical Director for employees and their family members
• The opportunity to work for a Top Workplace, according to Engage and the Austin American-Statesman

You thrive in a fast-paced environment. You’re curious and have an eye for detail. You strive to exceed expectations, and succeed. You’re excited by the opportunity to join a fast-growing company with unlimited opportunities for growth & competitive benefits. Does this sound like you? If so, Boon-Chapman could be the place for you!

As a Cost Containment Analyst you’ll be serve as support to the Claims team by handling appeals, claim adjustments/refunds, complex claim calculations, Medicare pricing, processing of fees, refund recovery, claim editing verification, and Negotiations. Cost Containment also administers the Dialysis Program, transplant processes and benefits, subrogation, Cost Comparison Program, and bill reviews for the medical department. Key responsibilities include:

• Reviews and researches appeals / disputes and provides a written response in a timely manner.
• Calculates adjustment payments of benefits in accordance with coverage information, contract language or plan document, and medical documentation.
• Calculates overpayments and requests refunds of benefits in accordance with coverage information, contract language, or plan document and medical documentation.
• Contacts providers via phone, fax, and mail for status of outstanding refunds.
• Posts refunds of overpayments in the system and provides a written response to the client or provider.
• Calculates pricing affected by partially denied services.
• Recognizes all parts of a UB04 and HCFA1500 to accurately price to Medicare.
• Reviews transplant contracts and processes related transplant claims according to the transplant program.
• Processes variety of fees, including but not limited to: negotiations, savings, IRO, & PBM.
• Researches editing guidelines to verify reductions are applicable, when needed.
• Aggressively negotiate with OON providers for a savings that benefits both the member and plan.
• Determines and documents primary / secondary status of members who are eligible under the Dialysis Program.
• Identify and pursue potential subrogation recoveries.
• Work with attorneys and/or insurance companies to identify subrogation related claims.
• Communicates clearly with clients, participants, brokers, vendors, and others within the department and company regarding any of their assigned duties.
• Meets monthly quality standards and production goals.
• Performs other duties as assigned.

• High school diploma or equivalent. 2 years of claims processing experience.
• Knowledge of CPT, HCPCS, ICD9, ICD10 coding.
• Knowledge of claims processing.
• Knowledge of Eldorado system preferred.
• Knowledge of professional customer service practices.
• Skill in interpersonal and written communication.
• Ability to work independently.
• Ability to solve problems and analyze information.
• Ability to adapt to a constantly changing environment.
• Ability to multi-task.
• Ability to accurately compile data and perform detailed work.
• Ability to meet deadlines.
• Ability to maintain regular attendance.
• Ability to maintain confidentiality of material and information.
• Ability to maintain professional appearance and demeanor.
• Ability to work as a member of a team.

• Must be able to remain in a stationary position for 80% of the time.
• Must use close visual acuity to perform an activity such as: preparing and analyzing data and figures, transcribing, viewing a computer terminal and expansive reading.
• Must be able to lift or move items up to 20lbs.
• Must have the ability to move files, open filing cabinets and bend or stand as necessary.

The job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice