Claims Examiner

Texas Children's Medical Center•Houston, TX

About The Position

We are looking for a Claims Examiner, someone who’s ready to grow with our company. In this position, you will process and adjudicate claims received for reimbursement to Providers based on extensive review, research, and a detailed format of claim processing procedures. Think you’ve got what it takes?

Requirements

Required H.S. Diploma or GED
Required 1 year claims examination experience

Responsibilities

Adjudicate claims received into processing system.
Thoroughly reviews, investigates, and adjudicates claims daily, working oldest to newest claim in 30 days or less, and 98% of the time.
Examiners should process at least 14 claims per hour, or 98 claims per day.
Conducts review and investigation of pended claims and follow up with internal and external departments to finalize claims resolution within 30 days.
Macess requests are processed within 30 days of receipt, with a 98% accuracy, to ensure timely resolution of claims, in adherence with HHSC regulatory requirements.
The claims are processed accurately as defined by standard guidelines.
The claims should be adjudicated with a 98% procedural accuracy rate monthly as reviewed by weekly audit reports.
The claims should be adjudicated with a 98% accuracy rate monthly as reviewed by returned claims for adjustment review.
The claims that are manually adjudicated must have notes entered as reviewed by weekly audits, check run, returned claims, management review 98% of the time.
Clear concise documentation/notes must be entered for each claim reviewed, which provides a historical reference of how the claim was processed at the time of adjudication.
Complete special projects as requested.