Claims Examiner

Community First Health Plans • San Antonio, TX

46d

About The Position

POSITION SUMMARY/RESPONSIBILITIES Performs adjudication of medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP (Children's Health Insurance Program) according to departmental and regulatory requirements. Maintains audit standards as defined by the Department.

Requirements

• High school diploma or GED equivalent is required.
• Two or more years of experience claim processing and/or billing experience required.
• Knowledge of ICD-9, CPT 4 coding and medical terminology is required.

Nice To Haves

• Specific knowledge and experience in Medicaid, CHIP and commercial claim processing preferred.

Responsibilities

• Performs adjudication of medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP (Children's Health Insurance Program) according to departmental and regulatory requirements.
• Maintains audit standards as defined by the Department.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 251-500 employees