Community Health Choice

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Sr Claims Auditor

at Community Health Choice

Posted: 10/30/2019
Job Status: Full Time
Job Reference #: 148492
Keywords: financial

Job Description

About Us

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

• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

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 Profile

The Senior Claims Auditor will review claims for new hires, experienced Examiners and auto adjudicated claims in a timely and consistent manner. Generate accuracy reports per processor to be reviewed by operations management and senior management staff. Senior Claims Auditor will be responsible for trending and root cause analysis and providing a clear and concise report to the management staff. Senior Claims Auditor will be responsible for reviewing and responding to all first level appeals. Senior Claims Auditor responsibility will include mentoring Examiners and Quality Analyst as requested. Responsibility also included the review and audit of the Provider Communication, Provider Fee Schedule and Provider Database team.

QUALIFICATIONS:

  • High school Graduate or GED equivalent
  • Five years in claims adjudication with minimum four years of auditing experience.

OTHER SKILLS:

  • Exceptional Verbal (e.g., Public Speaking)
  • Writing /Composing (Correspondence / Reports )
  • Research
  • MS Word
  • MS Excel
  • MS Access
  • Knowledge of ICD-9 coding, HCPCS, and CPT codes.
  • Good Interpersonal and Analytical skills.


Benefits and EEOC

Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.

Community is an Equal Opportunity Employer.

Job Category

CHC Administrative

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!