Claims/benefits Specialist

Texas Children's Hospital

Bellaire, TX, US
**
Process claim adjustments and appeals
Investigate texas medicaid regulatory requirements
Utilize federal ncci and mue edits for billing review
** Texas Children's Hospital is seeking a Claims Benefits Specialist to manage and process claim appeals within Texas regulatory requirements. The ideal candidate should have at least three years of claims processing experience and a high school diploma or GED. **

Job Summary

  • The role involves investigating and accurately processing claim appeals within the regulatory requirements mandated by the State of Texas.
  • Candidates will utilize expertise with federal NCCI and MUE edits to determine if providers are billing inappropriately or fraudulently.
  • The position requires collaborating with the Provider Relations team to educate providers regarding trends identified in the appeals process.

Matching Summary

Match Score: 75

** Texas Children's Hospital is seeking a Claims Benefits Specialist to manage and process claim appeals within Texas regulatory requirements. The ideal candidate should have at least three years of claims processing experience and a high school diploma or GED. **

Skills & Requirements

Must-have

  • Process claim adjustments and appeals
  • Investigate Texas Medicaid regulatory requirements
  • Utilize federal NCCI and MUE edits for billing review
  • Identify provider upcoding and fraud trends
  • Collaborate with Provider Relations team

Nice-to-have

  • Experience in fast-paced healthcare settings
  • System testing and configuration analysis skills
  • Strong communication with leadership and departments

Key Requirements

  • HS Diploma Or GED Required
  • 3 Years Claims Processing Experience Required
  • Bachelor's degree may substitute for experience

Work Rights

Not specified

Tailored Resume

Cover Letter