Claims Processor - Revenue Cycle Management - Business Services Group

Position: Claims Processor - Revenue Cycle Management - Business Services Group

Job ID: 152791

Location: US-TX-Houston


Talent Area: Administrative Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 7am - 3:30pm Monday - Friday

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.   Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.   To join our community of 14,000+ dedicated team members, visit for career opportunities. You can also learn more about our amazing culture at   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.


We are searching for a Claims Processor -- someone who works well in a fast-paced setting. In this position, you will process and submit electronic and paper claims in accordance with federal, state and other payor requirements and in an accurate and efficient manner to ensure timely payment of hospital receivables.


Think you’ve got what it takes?

Responsibilities :

Job Duties & Responsibilities

  • Analyzes, edits, and prepares hospital claims for payment, timely and accordance with payor requirements
  • Determines and reviews each third-party payor’s specific requirements as indicated by the daily third-party Explanation of Benefits and Rejection Reports
  • Transmits and submits processed claims directly to the payor, either electronically through the clearing house or via paper submission
  • Mails paper claims within 24 hours of receipt in order to ensure appropriate reimbursement as determined in system notes and file room logs
  • Updates and maintains billing and hospital systems to reflect current information; keeps billing losses to a minimum
  • Verifies that gross receivables greater than 90 days old represent between 13-15% and less of the outstanding accounts receivable balance as evident in account reviews and departmental reports
  • Actively participates in special assignments, programs, or improvement initiatives with successful outcomes


Skills & Requirements

  • High school diploma or equivalent combination of education and experience required
  • 1 year insurance billing experience involving electronic claims processing required, preferably using the Premis Billing System

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