Summary:

Under the supervision of the Claims Department Manager, this position is responsible for balancing workloads, assisting with establishment of structure and standardization, creation and updating of departmental policies and process and implementation and maintenance of oversight within the Claims Department. Monitoring of claim processing production and quality are required. Improvement initiatives in increasing claims auto adjudication will be performed. Additional functions of this role are hiring, developing and supervising, employees, managing overall claim inventory, resolving escalated claim issues and assisting Claims Examiners with policy, regulatory or contractual questions and concerns. This position also will assist in audit related decision making and in training new Claims Examiners on job-specific roles and responsibilities. 

• Claims Examiner hiring, training and development
• KRONOS time tracking
• Success Factors: Employee goal-setting, routine rating
• Overall employee development
• Identify prevalent trends and recommend resolution techniques to management
• Delegates work to Claims Examiners as needed
• Assists with system emergencies with direction from IT department and/or appropriate vendor
• Assignment of Claims Examiner tasks
• Assists in disseminating information to staff as needed
• Performs other related duties and special projects as requested
• All other duties 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:

• Analytic ability to organize and prioritize work to meet deadlines
• Ability to organize and prioritize work to meet deadlines
• Strong computer application skills including Microsoft Word, Excel and Visio
• Excellent written and verbal communication skills required
• Good judgment, initiative and problem solving abilities
• Ability to handle and resolve complex issues independently
• Knowledge of Medicaid, Medicare Advantage, Tricare and Health Care Exchange programs preferred
• Knowledge of claims processing, system configuration, edits, adjustment adjudication and claim department processes
• Knowledge of CPT/HCPCS, ICD9 coding and medical terminology.
• Ability to learn new policies and processes based on written material and observation
• Ability to establish and maintain professional, positive and effective work relationships
• 2 years Healthcare experience with Managed Care experience required
• Prior Claim Team Management experience preferred
• Three years claims processing experience required with Managed Care experience preferred
• Claim system configuration experience preferred
• Prior experience working with TRICARE, Texas Medicaid, Medicare Advantage highly desirable.
• Drivers License

Work Type: 

Full Time