SR. CLAIMS PROCESSOR
Company: Memorial Hermann
Location: Houston , TX
Category: Professional, Administrative / Clerical, Healthcare
Job Type: Full Time
Posted: 2/11/2019
JOB DESCRIPTION:

At Memorial Hermann, we’re about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care.

 

Every employee, at every level, begins their journey at Memorial Hermann learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it.

 

Job Summary

Position is responsible for accurately entering medical and dental claims data via claim system meeting production and quality standards as defined by the Claims Department.

 

Basic Function (in addition to current job)

  • Triage employee work injuries via phone and perform initial case management per SafetyNet Plan under the direction of the Claims Adjuster and RTW Manager

 

Principle Accountabilities:

  • Corresponds with clients and providers on detail problem claims.

     

  • Researches problems and processes adjustment claims.

     

  • Writes claim denial and appeal response letters.

     

  • Processes voids and refunds.

     

  • Reviews claims pending file and keeps pending at or below 30 day turn around.

     

  • Authorizes system to pay claims if payable up to $5,000.00.

     

  • Works with Customer Service and Utilization Review staff to resolve claims issues.

     

  • Participates in adjudication of all physician, dental claims and hospital claims at a rate of

    700 per week.

     

  • Communicate, collaborate and cooperate with internal and external stakeholders.

     

  • Adhere to all Compliance/Program Integrity requirements.

     

  • Comply with HIPAA Regulations

     

  • Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time

    management, supply management, productivity and quality of service.

     

  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

     

  • Other duties as assigned.

JOB REQUIREMENTS:

Education: High School diploma or equivalent required.

 

Experience: Minimum of 5-7 years of claims experience to include HMO/TPA or insurance company.

 

Knowledgeable and compliant with all relevant laws, rules regulations and accreditation standards and requirement.

 

Knowledge of dental and multiple medical products (PPO, POS, HMO).

 

Excellent organizational skills, as well as oral and written communication skills.

Ability to handle high volume of work.

 

Working knowledge of PC.

 

Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of “we advance health” through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.

ADDRESS:
929 Gessner Road
Houston, TX 77024
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