This position's primary responsibility revolves around correspondence and the resulting necessity for research and communication in order to ensure timely collection of recoveries due from other health insurance (OHI) carriers. The Senior Processor also maintains all member demographic information in the computer system relative to OHI. This position processes a heavy volume of paperwork.
Open, read and process all incoming correspondence in a timely manner
Determine course of action to ensure recovery
Communicate effectively with other health insurance carriers
Re-bill, attaching explanation letter when appropriate, requesting status for claims over 60 days old with no recovery or claims pended for another carrier's EOB
Quality check and stamp recovery letters for mail-out
Close claims in the computer system that do not result in a recovery
Communicate effectively with members to resolve problem issues with OHI
Assist Supervisor with annual OHI member investigations
All 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)
POSITION QUALIFICATIONS A. Education/Skills
High school diploma or equivalent
Excellent data entry speed and accuracy, working with large volume of paperwork
Knowledge of coordinating benefits or claims payment (basic knowledge of medical claims)
Integrity regarding working with very large recovered monetary amounts
Good communication skills a must
Three plus years experience in Managed Care claims
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.
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