Collabera Irving, TX
Job Description
- Performs root cause analysis on the adjudication of Medicaid, CHIP and Marketplace claims using standard principles, applicable policies, and regulations (State Medicaid requirements, Texas Department of Insurance Prompt Payment requirements, etc.) in order to ensure appropriate processing of claims.
- Prepares and provides audit findings of medium to large scale claims projects within the designated timeframes.
- Identifies process issues and/or system defects and escalates to the appropriate team(s) and Health Plan Operations leadership. Provides recommendations for correction.
- Identifies internal standard operating procedures and/or other related documents that are inaccurate, unclear or contains gaps. Works with the appropriate team(s) to provide recommendations for correction of such documents.
- Constant monitoring of the state and federal regulations to ensure Client’s Healthcare of Texas’ compliance with necessary the changes.
- Research and communicate applicable benefit configuration needs and ensure the accuracy of operational processes within Clients claim’s system based on business requirements.
- Support and collaborate with other departments as needed.
MUST HAVES:
- 3-5 years’ experience in Health Plan Operations and/or Managed Care (Claims, Configuration, Provider Data and Credentialing, Compliance, Call Center, Appeals and Grievances, etc.)
- 4+ years Texas Medicaid and CHIP managed care claims experience with.
- 2+ years Large-scale Claims Research and Resolution experience
- 2+ years with provider data set-up, benefit configuration, provider configuration and provider contract analysis.
- Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas.
Billing, Compliance,Managed Care,Appeals,Grievances,Claims,Claims Examiner,Claims auditor,Claims reviewer,healthcare,Health Plan Operations
Company Description
Not only is Collabera committed to meeting and exceeding our customer’s needs, but we also are committed to our employees’ satisfaction as well. We believe our employees are the cornerstone of our success and we make every effort to ensure their satisfaction throughout their tenure with Collabera. We offer an enriching experience that promotes career growth and lifelong learning for our employees. As a result of these efforts, we have been recognized by Staffing Industry Analysts (SIA) as one of the “Best Staffing Firms to Work For” since 2012 – eight consecutive years in a row. Collabera has 60 offices with a presence in 11 countries and provides staff augmentation, managed services and direct placement services to Fortune 500 corporations across the globe.
Collabera
Why Work Here? Collabera has been recognized by Staffing Industry Analysts (SIA) as one of the “Best Staffing Firms to Work For” for 8 consecutive years.
Not only is Collabera committed to meeting and exceeding our customer’s needs, but we also are committed to our employees’ satisfaction as well. We believe our employees are the cornerstone of our success and we make every effort to ensure their satisfaction throughout their tenure with Collabera. We offer an enriching experience that promotes career growth and lifelong learning for our employees. As a result of these efforts, we have been recognized by Staffing Industry Analysts (SIA) as one of the “Best Staffing Firms to Work For” since 2012 – eight consecutive years in a row. Collabera has 60 offices with a presence in 11 countries and provides staff augmentation, managed services and direct placement services to Fortune 500 corporations across the globe.
Address
Irving, TX
75038 USA
Website
http://www.collabera.com View all jobs at Collabera