Claims/Benefits Spec

 
Position: Claims/Benefits Spec

Job ID: 148641

Location: US-TX-Bellaire

Department: Claims - Training/Specialists

Talent Area: Administrative Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

About Texas Children's Hospital

The Texas Children’s Hospital system is the largest pediatric integrated care system and is an industry leader in pediatric population health.    Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children and pregnant women.  We are an Integrated Community System providing holistic care that empowers families to live healthier lives.  Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.  Currently, the Health Plan serves more than 450,000 members across three state territories (Harris, Jefferson, North East), who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at www.infinitepassion.org

Summary:

We are searching for a Claims/Benefits Specialist – someone who works well in a fast-paced setting. In this position, you’ll investigate and accurately process claim appeals within the regulatory requirements mandated by the State of Texas. We need someone who can provide effective, timely investigations and follows up on all internal customer requests.

 

Think you’ve got what it takes?



Responsibilities :

  • Ensures appeals are processed according to claims processing guidelines
  • Reviews and processes pended claims within 5 days of the initial review
  • Provides an exceptional level of customer satisfaction
  • Provides effective, timely investigations and follow up on all internal customer requests and special projects
  • Ensures claim checks are processed in a timely and efficient manner
  • Participates in the development/achievement of action plans and goals
  • Identifies trends related to appeals processing
  • Processes refunds/retractions identified by contracted vendors within 30 days of notification
  • Processes all claims for providers flagged by the Office of Inspector General for prepayment review within 30 days of receipt


Qualifications:

  • High school diploma or GED
  • Three (3) years of claims examination experience
  • In lieu of 3 years of experience, a bachelor’s degree or higher will be accepted
  • Knowledge of ICD9 and CPT coding
  • Knowledge of claims examination functions
  • Ability to perform clerical duties and operate PC and general office equipment


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