Claim Adjustment Coordinator - Temple Health Plan
Location: Temple, Texas US
Requisition Number: 19018859
The Claim Adjustment Coordinator for Scott & White Health Plan (SWHP) is responsible for research and investigation of previously paid or denied claim(s), to correctly apply benefit determination and pricing for areas of responsibility: 1) Clinic professional claims, 2) Hospital-facility inpatient and outpatient claims, (CMS 1500 and UB04) in accordance with claim processing guidelines. The Claim Adjustment Coordinator researches written inquiries, service forms action grams and email regarding previously paid or denied professional and facility claims effectively gathering documentation needed to process an adjustment. The Claim Adjustment Coordinator identifies overpayments, enters into data base and send letter request for refund. The Claim Adjustment Coordinator works adjustment inventory from assigned queues and service forms to ensure all claims process within established turnaround time as directed by department policy and procedures. The Claim Adjustment Coordinator completes reports / special projects to ensure prompt adjustment or recovery of paid claims in accordance with turnaround time standards.
The ideal candidate for the Claim Adjustment Coordinator role will demonstrate effective data entry skills; ability to navigate within computer/systems environment without assistance; experience in a windows-based computer environment. The ideal candidate for the Claim Adjustment Coordinator role will also be highly self-motivated and accountable and be able to learn and apply new and changing information.
Location/Facility Temple, Texas
Shift/Schedule Full Time Days
Benefits Our competitive benefits package includes*:
401(k) savings plan with dollar-for-dollar match up to 5%
PTO accrual beginning Day 1
*Note: Benefits may vary based upon position type and/or level.
2+ Years Experience
Community / Marketing Title: Claim Adjustment Coordinator - Temple Health Plan
Location_formattedLocationLong: Temple, Texas US
CountryEEOText_Description: We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. To view the most recent EEO is the Law Poster, click here.