The Claims Examiner II is responsible for assisting Claims Examiner I with education and training opportunities, processing UB and CMS 1500 claims, evaluating and assisting with development of system, policy and procedural documents, performing data entry and claim issue resolution within the quality and production requirements.
* Meet and/ or exceed claims processing production requirements * Maintain statistical accuracy of 98%, and financial accuracy of 98% * Correct DoD error report as needed * Provide excellent customer service to internal and external customers * Other duties as 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)
High school diploma or equivalent, some college preferred
Knowledge of HCFA, Medicare and TDI regulations
Excellent 10-key and computer skills
Requires excellent data entry speed and accuracy, working with large volumes of input
Knowledge of CPT, ICD-9 and medical terminology
Good written and verbal skills
3-5 years Claims processing experience - Medicaid, Commercial, Medicare Advantage or Tricare
Experience developing and maintaining claims processing documents, job aides, policies and/ or desktops
Experience evaulating examiner and system procedures
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.