Claims Examiner

Summary:

The Claims Examiner is responsible for processing batches of claims (HCFA and UB) data entered by Pre-Key staff in a timely and consistent manner.

• Adjudicate claims at a rate equal to 150 per normal work day
• Maintain statistical accuracy of 98%, and financial accuracy of 98%
• Correct DoD error report as needed
• Respond timely to all Customer Service, Provider Relations type questions
• Other duties as assigned by management
• Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals
• Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)   

• High school diploma or equivalent, some college preferred
• Knowledge of HCFA, Medicare and TDI regulations
• Excellent 10-key and computer skills
• Requires excellent data entry speed and accuracy, working with large volumes of input
• Knowledge of CPT, ICD-9 and medical terminology Good written and verbal skills
• Minimum three years claims processing in a Managed Care/HMO environment   

Work Type: 

Full Time