Claims Examiner

University Health System- San Antonio; San Antonio (TX); On-site; USD 36,000 - 52,000; Full time

Job summary

University Health System- San Antonio is seeking a claim adjudicator to process medical and hospital claims for Medicaid, CHIP, and commercial payers in compliance with departmental and regulatory standards.

The role requires a high school diploma or GED and at least two years of claim processing or billing experience, with preferred knowledge of Medicaid/CHIP and coding systems (ICD-9, CPT-4). Strong attention to audit standards is essential.

Qualifications

• High school diploma or GED required.
• At least two years of claim processing or billing experience.
• Knowledge of Medicaid, CHIP and commercial claim processing preferred.
• Knowledge of ICD-9, CPT-4 coding and medical terminology required.

Responsibilities

• Adjudicate medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP according to departmental and regulatory requirements.
• Maintains audit standards as defined by the Department.

Skills

Claim processing

Billing experience

ICD-9 coding

CPT-4 coding

Medical terminology

Medicaid/CHIP knowledge

Education

High School diploma or GED

Job description

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.

EDUCATION/EXPERIENCE

High school diploma or GED equivalent is required. Two or more years of experience claim processing and/or billing experience required. Specific knowledge and experience in Medicaid, CHIP and commercial claim processing preferred. Knowledge of ICD-9, CPT 4 coding and medical terminology is required.