Central Health
Overview
In the Claims Finance Specialist position for Sendero Health Plan, a Health Maintenance Organization (HMO), and other Health Plans based in Texas, you will oversee the efficient and accurate processing of refunds, voids, and claim payments. Responsibilities
Essential Functions Claims Payment Oversight: Responsible for running check payments and coordinating with banks as well as internal finance or external client to ensure all payments are tracked. Claim Voids: Process outstanding check voids and reissue payments to ensure all payments are made. Claim Refunds: Apply provider refunds to claims ensuring proper documentation and tracking. Claim Recoupments: Recoup claims as needed, monitor recoupments, and ensure timely processing. Manage Interest and Penalty payments: Ensure penalty payments are calculated and paid in a timely manner and identify causes for penalty payments. Audit and maintain thorough accounting of all provider and member payments within the VBA database. Support Claims Team: Support Claims Department on projects and other items as required. Knowledge, Skills and Abilities Strong understanding of healthcare claims processing principles, coding systems, and reimbursement methodologies. Proficiency in utilizing claims processing software and systems (VBA preferrable). Excellent communication, and interpersonal skills, with the ability to work independently. Thorough knowledge of healthcare regulatory compliance requirements, including HIPAA, CMS guidelines, and Texas regulations. Demonstrated ability to effectively manage multiple priorities in a fast-paced environment while maintaining attention to detail and accuracy. Qualifications
Minimum Education: High School Diploma or equivalent (higher degree accepted) Minimum Experience: 7 years of experience in health plans claim finance, preferably within an HMO or managed care environment. 7 years of experience in health plans claim adjudication, preferably within an HMO or managed care environment.
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In the Claims Finance Specialist position for Sendero Health Plan, a Health Maintenance Organization (HMO), and other Health Plans based in Texas, you will oversee the efficient and accurate processing of refunds, voids, and claim payments. Responsibilities
Essential Functions Claims Payment Oversight: Responsible for running check payments and coordinating with banks as well as internal finance or external client to ensure all payments are tracked. Claim Voids: Process outstanding check voids and reissue payments to ensure all payments are made. Claim Refunds: Apply provider refunds to claims ensuring proper documentation and tracking. Claim Recoupments: Recoup claims as needed, monitor recoupments, and ensure timely processing. Manage Interest and Penalty payments: Ensure penalty payments are calculated and paid in a timely manner and identify causes for penalty payments. Audit and maintain thorough accounting of all provider and member payments within the VBA database. Support Claims Team: Support Claims Department on projects and other items as required. Knowledge, Skills and Abilities Strong understanding of healthcare claims processing principles, coding systems, and reimbursement methodologies. Proficiency in utilizing claims processing software and systems (VBA preferrable). Excellent communication, and interpersonal skills, with the ability to work independently. Thorough knowledge of healthcare regulatory compliance requirements, including HIPAA, CMS guidelines, and Texas regulations. Demonstrated ability to effectively manage multiple priorities in a fast-paced environment while maintaining attention to detail and accuracy. Qualifications
Minimum Education: High School Diploma or equivalent (higher degree accepted) Minimum Experience: 7 years of experience in health plans claim finance, preferably within an HMO or managed care environment. 7 years of experience in health plans claim adjudication, preferably within an HMO or managed care environment.
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