Claims Examiner

University-Health-3; San Antonio (TX); In loco; USD 48.000 - 62.000; Tempo pieno

Descrizione del lavoro

Community First Health Plans in San Antonio, TX is seeking an experienced Claims Examiner to join the Claims department. The role focuses on adjudicating medical (HCFA) and hospital (UB92) claims for Medicaid, Commercial, and CHIP, ensuring compliance with departmental and regulatory requirements.

Requirements include a high school diploma or GED, and at least two years of claim processing or billing experience. Knowledge of ICD-9, CPT-4 coding and medical terminology is required.

Competenze

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

Mansioni

• Performs adjudication of 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.

Conoscenze

Claims processing

Audit standards

Medical terminology

Coding knowledge

Formazione

High school diploma or GED

Strumenti

ICD-9/CPT-4 coding

UB92/HCFA knowledge

Descrizione del lavoro

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.