CHRISTUS Health · 6 hours ago
Claims Examiner Senior - Health Plan Admin
Irving, TX
Full-time
Onsite
Mid, Senior Level
3+ years expCHRISTUS Health is a healthcare organization, and they are seeking a Claims Examiner Senior to review, analyze, research, and resolve complex medical claims. This role involves ensuring compliance with claims processing guidelines and federal regulations while collaborating with various operational departments to maintain quality assurance of claims processing.
Hospital & Health Care
Responsibilities
Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Analyze medical claim information and take appropriate action for payment resolution in accordance with policies and procedures, desktops, processing guidelines, and federal regulations
Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms from facilities, physicians, Home Health, Durable Medical Equipment providers, laboratories, etc
Work claim projects resulting from overpayments or underpayments related to manual processing errors, benefit updates, and/or contract, fee schedule changes
Process provider refunds, reconsiderations, and direct member reimbursements
Process medical claim adjustments, recovery of claim overpayments, and execution of claim batch adjudication
Solve moderately complex claims and escalate issues to the Claims Team Lead, Supervisor or Manager
Assist with database improvements and testing for system upgrades, conversions, or implementation of new processes
Serves as a resource to assist with training new associates, retraining current associates on new/updated desktops/policies and reports staff progress, deficiencies, and training needs to management
Sets high standards of performance and promotes teamwork to achieve established team goals, while maintaining a positive, professional attitude
Contacting/responding to internal and external customers for resolution on claim issues
Assist claims leadership to identify claim trends, gaps in workflow and create/update desktops and policies and procedures
Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals
Must be able to organize and prioritize work to meet deadlines
Have good judgment, initiative, and problem-solving abilities
Attention to detail is critical to ensure timely and accurate processing of claims
Consistently meet established productivity and quality standards
Follow CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI)
Performs other duties as assigned by management to support claims functions, which are focused on achieving both departmental and organizational objectives
Must be knowledgeable about medical terminology, CPT, HCPCS, ICD-10, Revenue Codes, CMS-1500 and CMS-1450/UB-04 claim forms and reimbursement methodologies
Must have excellent written, verbal, organizational and interpersonal communication skills
Must be proficient in Microsoft Office, Power Point, Excel, Word, Outlook, spreadsheet, and database skills
Qualification
Required
Associate's degree or equivalent job-related experience required
Minimum of 3 years' experience processing medical claims in the healthcare industry
Must be knowledgeable about medical terminology, CPT, HCPCS, ICD-10, Revenue Codes, CMS-1500 and CMS-1450/UB-04 claim forms and reimbursement methodologies
Must have excellent written, verbal, organizational and interpersonal communication skills
Must be proficient in Microsoft Office, Power Point, Excel, Word, Outlook, spreadsheet, and database skills
Preferred
Prior experience working with managed care, Medicare, Medicare Advantage, Health Exchange, and TRICARE are highly desirable
Company
CHRISTUS Health
CHRISTUS Health is a Catholic not-for-profit health care system comprising more than 600 centers, including long-term care facilities, community hospitals, walk-in clinics and health ministries.
10001+ employees
H1B Sponsorship
CHRISTUS Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (43)
2024 (35)
2023 (54)
2022 (46)
2021 (22)
2020 (26)
Funding
Current Stage
Late StageLeadership Team
Terry Kyle
CEO and CDO The Children's Hospital of San Antonio Foundation & Friends of CHRISTUS Santa Rosa Fnd
Thomas Royer, MD
CEO Emeritus
Company data provided by crunchbase