Health Plan Claims Finance Specialist

Central Health • Austin, TX

22h

About The Position

In the Claims Finance Specialist position for Sendero Health Plan, a Health Maintenance Organization (HMO), and other Health Plans based in Texas, you will oversee the efficient and accurate processing of refunds, voids, and claim payments.

Requirements

• Strong understanding of healthcare claims processing principles, coding systems, and reimbursement methodologies.
• Proficiency in utilizing claims processing software and systems (VBA preferrable).
• Excellent communication, and interpersonal skills, with the ability to work independently.
• Thorough knowledge of healthcare regulatory compliance requirements, including HIPAA, CMS guidelines, and Texas regulations.
• Demonstrated ability to effectively manage multiple priorities in a fast-paced environment while maintaining attention to detail and accuracy.
• High School Diploma or equivalent (higher degree accepted)
• 7 years of experience in health plans claim finance, preferably within an HMO or managed care environment.
• 7 years of experience in health plans claim adjudication, preferably within an HMO or managed care environment.

Responsibilities

• Claims Payment Oversight: Responsible for running check payments and coordinating with banks as well as internal finance or external client to ensure all payments are tracked.
• Claim Voids: Process outstanding check voids and reissue payments to ensure all payments are made.
• Claim Refunds: Apply provider refunds to claims ensuring proper documentation and tracking.
• Claim Recoupments: Recoup claims as needed, monitor recoupments, and ensure timely processing.
• Manage Interest and Penalty payments: Ensure penalty payments are calculated and paid in a timely manner and identify causes for penalty payments.
• Audit and maintain thorough accounting of all provider and member payments within the VBA database.
• Support Claims Team: Support Claims Department on projects and other items as required.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 51-100 employees