Medicaid & CHIP Claims Adjudication Specialist

University-Health-3; San Antonio (TX); On-site; USD 48,000 - 62,000; Full time

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Claims processing

Audit standards

Medical terminology

Coding knowledge

Education

High school diploma or GED

Tools

ICD-9/CPT-4 coding

UB92/HCFA knowledge

Job description

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.