Claims Adjustment Analyst - Community Health Choice - Claims Department
Harris Health System is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management and population health services. Ben Taub Hospital (Level 1 Trauma Center) and Lyndon B. Johnson Hospital (Level 3 Trauma Center) anchor Harris Health’s robust network of 39 clinics, health centers, specialty locations and virtual (telemedicine) technology. Harris Health is among an elite list of health systems in the U.S. achieving Magnet® nursing excellence designation for its hospitals, the prestigious National Committee for Quality Assurance designation for its patient-centered clinics and health centers and its strong partnership with nationally recognized physician faculty, residents and researchers from Baylor College of Medicine; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); The University of Texas MD Anderson Cancer Center; and the Tilman J. Fertitta Family College of Medicine at the University of Houston.
Skills / Requirements
JOB SUMMARY: The Claims Adjustment Analyst supports the review and closure of payment disputes including: corrected claims, retro authorizations, and incorrect denial requests in a timely manner. This position is responsible for processing medical claims, using industry standard practices for medical claims processing. The Claims Adjustment Analyst applies relevant rules and regulations specific to coding, providers, plan benefits, contracts, state and federal guidelines as well as Community Health Choice's policies and procedures.
1. Education/Specialized Training/Licensure: High School Diploma, GED or Equivalent.
2. Work Experience (Years and Area): One (1) year of high performance claims processing analyst experience or Two (2) years of Claims Adjustment experience.
3. Management Experience (Years and Area): N/A
4. Software Operated: Microsoft Office (Word, Excel, Outlook, etc.)
5. Other Requirements:
' Analytical problem solving and documentations; Reimbursement methodologies; ability to adjudicate.
' Ability to speak, listen and write effectively.
' Team player with the ability to establish and maintain effective work relationships.
SPECIAL REQUIREMENTS: (Check Applicable Areas)
1. Communication Skills:
Writing /Composing (Correspondence / Reports)
2. Other Skills:
3. Advanced Education: N/A
4. Work Schedule: Flexible, Overtime
RESPONSIBLE TO: Supervisor/Manager
EMPLOYEE SUPERVISED: N/A