Summary:

The Senior 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)

Requirements:

• 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

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About CHRISTUS Health

CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.

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https://careers.namcp.org/jobs/18300306/claims-examiner-senior