Claims & Benefits Specialist - The Health Plan - Bellaire, TX (6a - 3p)
Position: Claims & Benefits Specialist - The Health Plan - Bellaire, TX (6a - 3p)
Location: US-TX-Bellaire
Talent Area: Professional - Non-Clinical
Shift: 6a - 3p
About Texas Children's Hospital
Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.
Summary:
We are on the hunt for a Claims/Benefits Specialist—someone who can thrive in a fast-paced managed care environment. 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
Review and process pended claims within 5 days of 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
Identify trends related to appeals processing
Process refunds/retractions identified by TCHP contracted vendors within 30 days of notification
Process 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 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
Thank you for your interest in applying for this job position.
Texas Children’s is excited to announce that we are transitioning to a new applicant tracking system. During this transition, from April 11-17, 2016 our application functions on our Careers website will be temporarily deactivated.
We sincerely apologize for this inconvenience. Visit us on Monday, April 18, 2016 to check out our new features and apply!