Cook Children's Health Plan is seeking a Claim Auditor I to audit behavioral and medical claims for Texas Medicaid and CHIP programs, ensuring compliance with regulatory standards and quality metrics. The ideal candidate should possess relevant experience or education in claims auditing, strong analytical skills, and proficiency in Microsoft Office
Job Summary
The Claim Auditor I is responsible for auditing behavioral and medical claims to ensure quality metrics are met for Texas Medicaid and CHIP programs.
This role involves conducting post-claims reviews on routine to moderate complexity claims including paper and electronic submissions while ensuring alignment with regulatory standards.
The individual must perform all job functions in accordance with HIPAA security rules regarding protected health information and possess a thorough understanding of the claims life cycle.
Matching Summary
Match Score: 85
Cook Children's Health Plan is seeking a Claim Auditor I to audit behavioral and medical claims for Texas Medicaid and CHIP programs, ensuring compliance with regulatory standards and quality metrics. The ideal candidate should possess relevant experience or education in claims auditing, strong analytical skills, and proficiency in Microsoft Office.
Salary
Not specified; Not specified; Not specified
Skills & Requirements
Must-have
Texas Medicaid and CHIP program knowledge
UB-1450 and HCFA CMS 1500 claim forms
HIPAA security rules and PHI protection
Medical terminology and coding proficiency
Behavioral health and institutional claims auditing
Nice-to-have
Strong organizational and problem-solving skills
Ability to explain complicated benefit issues
Experience with provider communication
Advanced Microsoft Office Excel and Access skills
Key Requirements
Associates degree or 5 years of claims/audit experience
7-10 years of medical claims processing and adjudication
Experience with federal programs Medicaid and CHIP