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Hospital Analytics Jobs in Texas (NOW HIRING)

Tenet Health

Analytics & Planning Manager

El Paso, TX · On-site

Full Time, Days The Manager of Analytics & Planning will support regional data and analytics needs ... At The Hospitals of Providence - Trans Mountain Campus hospital, were seeking an innovative and ...

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Hospital Analytics information

What are the key skills and qualifications needed to thrive in Hospital Analytics, and why are they important?

To succeed in Hospital Analytics, you need strong analytical skills, statistical knowledge, and a background in healthcare data or a related field, often supported by a degree in health informatics, statistics, or data science. Familiarity with data analysis tools like SQL, Python, R, and healthcare information systems such as EHRs is typically required. Attention to detail, problem-solving abilities, and effective communication are vital soft skills for interpreting data and conveying insights to stakeholders. These skills ensure accurate analysis, informed decision-making, and improved hospital operations and patient outcomes.

What is the difference between Hospital Analytics vs Data Analyst in Healthcare?

AspectHospital AnalyticsData Analyst in Healthcare
Required CredentialsBachelor's in Healthcare Administration, Data Science, or related fields; often certifications in healthcare analyticsBachelor's in Statistics, Data Science, or related fields; certifications like CAP or Microsoft Certified Data Analyst
Work EnvironmentHospitals, healthcare systems, clinicsHospitals, healthcare organizations, research institutions
Employer & Industry UsagePrimarily healthcare providers focusing on operational and clinical dataVarious industries including healthcare, insurance, research

Hospital Analytics professionals focus on analyzing healthcare data to improve hospital operations, patient outcomes, and clinical processes. Data Analysts in Healthcare may work across multiple sectors, including hospitals, but their scope is broader, often involving diverse datasets and organizational types. While both roles require strong analytical skills and healthcare knowledge, Hospital Analytics roles are more specialized in clinical and operational healthcare data.

What is hospital analytics?

Hospital analytics refers to the process of collecting, analyzing, and interpreting data from various hospital operations to improve patient care, operational efficiency, and financial performance. It involves using data-driven tools and techniques to track metrics such as patient outcomes, resource utilization, and costs. By leveraging hospital analytics, healthcare organizations can identify trends, optimize workflows, and make informed decisions that enhance both patient and organizational outcomes.

How does a Hospital Analytics professional typically collaborate with clinical and administrative teams to drive data-informed decisions?

Hospital Analytics professionals work closely with both clinical staff (such as doctors and nurses) and administrative teams to gather, interpret, and present healthcare data. They translate complex data insights into actionable recommendations, supporting initiatives like patient care improvement, resource allocation, and cost reduction. Frequent collaboration involves attending interdisciplinary meetings, developing custom reports, and training stakeholders on data tools, ensuring that analytics are effectively integrated into decision-making processes. This cross-team interaction is vital for aligning data projects with hospital goals and driving tangible improvements.
What are popular job titles related to Hospital Analytics jobs in Texas? For Hospital Analytics jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Hospital Analytics jobs in Texas look for? The top searched job categories for Hospital Analytics jobs in Texas are:
What cities in Texas are hiring for Hospital Analytics jobs? Cities in Texas with the most Hospital Analytics job openings:
Hospital Analytics jobs near you
Infographic showing various Hospital Analytics job openings in Texas as of July 2026, with employment types broken down into 93% Full Time, 5% Part Time, and 2% Contract. Highlights an 80% Physical, 6% Hybrid, and 14% Remote job distribution.
Senior Claims Analyst - Hospital Bill Review

Senior Claims Analyst - Hospital Bill Review

SmartLight Analytics

Plano, TX • On-site, Remote

Full-time

Posted 11 days ago

Job description

We are seeking an experienced Senior Claims Analyst with deep expertise in hospital claims adjudication, stop loss reporting, high-cost/catastrophic claims, and DRG (Diagnosis-Related Group) reimbursement methodology. This individual will analyze itemized hospital bills and claims data to identify billing errors, coding discrepancies, DRG misassignments, and other overpayment opportunities, then work directly with claims administrators on behalf of our ASO clients to secure claim adjustments, recoveries, and repricing.
This is a highly analytical, client-facing role requiring both technical claims expertise and strong negotiation/communication skills.
Key Responsibilities
Claims Analysis & Review
  • Perform detailed audits of hospital and facility claims, including itemized bills, UB-04 claim forms, medical records, and remittance advices, to validate billing accuracy.
  • Analyze DRG assignments and coding to identify DRG upcoding, unbundling, duplicate billing, and other irregularities that affect reimbursement.
  • Review high-cost and catastrophic claims (typically $100K+) to identify overpayments, contract misapplication, and opportunities for negotiated adjustments.
  • Evaluate claims against plan documents, provider contracts, reference-based pricing methodologies, and CMS guidelines to determine appropriate reimbursement.
Stop Loss & High-Cost Claims Expertise
  • Understand and apply stop loss (specific and aggregate) provisions, laser terms, and reporting requirements as they relate to claim adjustments and client financial exposure.
  • Coordinate with stop loss carriers and reinsurers as needed to ensure adjustments and recoveries are properly reflected in stop loss reimbursement calculations.
  • Identify claims nearing or exceeding specific deductible thresholds and prioritize review accordingly.
Client Advocacy & Claims Administrator Negotiation
  • Serve as the subject matter expert and advocate on behalf of ASO clients in disputes with claims administrators (TPAs) and carriers regarding claim payment accuracy.
  • Prepare clear, well-documented findings packages (clinical, contractual, and coding rationale) to support requested claim adjustments and appeals.
  • Lead or support negotiations with claims administrators to reach adjusted payment resolutions.
  • Track disputes through resolution, escalating unresolved cases appropriately and maintaining strong working relationships with TPA claims and provider relations teams.
Data & Reporting
  • Analyze large claims data sets to identify trends, outlier claims, and systemic overpayment patterns across client populations.
  • Build and maintain claim tracking logs, savings reports, and client-facing summaries of identified and recovered savings.
  • Partner with internal data/analytics teams to refine claim-flagging logic and improve identification of high-value review opportunities.
Required Qualifications
  • 5+ years of experience in hospital claims analysis, medical bill review, claims auditing, or payment integrity, with direct exposure to self-funded/ASO plans.
  • Strong working knowledge of DRG methodology (MS-DRG/APR-DRG), UB-04 billing, ICD-10-CM/PCS, CPT/HCPCS coding, and hospital chargemaster structures.
  • Demonstrated understanding of stop loss insurance, including specific/aggregate deductibles, laser provisions, and how claim adjustments impact stop loss reimbursement.
  • Experience analyzing high-cost/catastrophic claims and identifying overpayment or billing error patterns.
  • Prior experience interacting with or negotiating against TPAs, insurance carriers, or claims administrators on disputed claims.
  • Proficiency with claims data analysis tools (Excel required; SQL, Access, or claims analytics platforms a plus)
  • Excellent written and verbal communication skills, with the ability to build persuasive, well-supported adjustment requests and appeals.
  • Strong attention to detail and ability to manage a high volume of complex claims simultaneously.
Preferred Qualifications
  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Medical Bill Review Specialist, or similar credential.
  • Prior experience at a TPA, insurance carrier, hospital billing/coding department, or payment integrity/cost containment vendor.
  • Familiarity with reference-based pricing (RBP), Medicare fee schedules, and out-of-network claims repricing.
  • Nursing background (RN) or clinical coding background is a plus for clinical validation of DRG and medical necessity issues.
What Success Looks Like
  • Consistent identification of material overpayments and billing errors on high-cost hospital claims.
  • Strong track record of securing favorable claim adjustments through negotiation with claims administrators.
  • Clear, professional communication that strengthens client trust and TPA relationships.
  • Measurable contribution to client savings and stop loss cost containment.

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