Community Health Choice Inc.
Community is a non-profit managed care organization MCO licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid • State of Texas Access Reform • STAR program for low-income children and pregnant women • Childrens Health Insurance Program (CHIP) for the children of low-income parents • CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid • Health Insurance Marketplace Plans that offer individual health coverage • including preventive care, emergency services, prescription drugs, and hospitalization • available to all regardless of pre-existing conditions • Community Health Choice HMO D-SNP • a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid • combining Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits • with additional health benefits like dental, vision, transportation, and more
Improving Members experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System, Harris Health Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
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 Choices policies and procedures.
MINIMUM QUALIFICATIONS
Education • Specialized Training • Licensure • High School Diploma, GED, or Equivalent
Work Experience • Years and Area • One year of high-performance claims processing analyst experience or • Two years of Claims Adjustment experience
Software Operated • Microsoft Office (Word, Excel, Outlook, etc.)
Other Requirements • Analytical problem-solving and documentation • Reimbursement methodologies • Ability to adjudicate • Ability to speak, listen, and write effectively • Team player with the ability to establish and maintain effective work relationships
Communication Skills • Writing • Composing • Correspondence • Reports
Other Skills • Analytical • Mathematics • Medical Terminology • Research • MS Word
Work Schedule • Flexible • Overtime