Claims Projects Mgr., El Paso Health

Job Summary

Responsible for the overall processes, planning, organization, and direction of projects in the Claims department, which includes but is not limited to, claims payment, formulation and submission of regulatory deliverables, and timely resolution of claims projects. Ensures the following are executed accurately and timely: adjudication of claims and correspondence with Health Plan departments, as well as regulatory agencies. Responsible for the prompt and accurate determination of claims, as required through contractual provisions with regulatory agencies such as the Texas Health and Human Services Commission (HHSC), the Texas Department of Insurance (TDI), Centers for Medicare & Medicaid Services (CMS) and internal quality improvement standards.

Skills

• Excellent computer skills, including claims adjudication systems.
• Excellent communication skills (written and verbal) that facilitate the effective interaction with physicians, management, staff, and external agencies/customers.
• Solid organization and time management skills.
• Excellent analytical and research skills.
• Ability to execute strategies, be a self-starter, and complete projects on a timely manner.
  
  

Work Experience

Three years of management/supervisor experience required. Strong experience in project management, insurance, billing, claims processing and adjudication, payment processing of claims service area, CPT, HCPCS, and ICD-9 coding required.

License/Registration/Certification

Certification through Association (AHIMA) by the American Academy of Professional Coders (AAPC) or the American Health Information Management preferred.

Education and Training

High School Diploma Or Equivalent Required. Bachelor Degree Preferred.

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