Claims Examiner

University Health; San Antonio (TX); On-site; USD 52,000 - 76,000; Full time

Job summary

University Health is seeking an experienced Claims Examiner to join our Claims department, supporting Community First Health Plans. The role involves adjudicating medical and hospital claims (HCFA/UB92) for Medicaid, Commercial, and CHIP, while upholding departmental audit standards.

Ideal candidates will have a high school diploma or GED and at least two years of claim processing or billing experience, with preferred knowledge of Medicaid/CHIP processing and coding systems.

Qualifications

• Two or more years of experience in claim processing or billing.
• Knowledge of Medicaid, CHIP and commercial claim processing preferred.
• Knowledge of ICD-9, CPT 4 coding and medical terminology is required.

Responsibilities

• Adjudicate medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP.
• Maintain audit standards as defined by the Department.

Skills

Claim processing

Billing experience

Medicaid/CHIP knowledge

Medical terminology

Education

High school diploma or GED

Job description

We are looking for an experienced Claims Examiner for our Claims department with Community First Health Plans!

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.