Director,Claims CCHP Job

Position is responsible for maintaining a claim adjudication process in compliance with CCHP, HHSC and TDI standards and contractual performance requirements. Directs the Claim adjustment process and ensures appropriate follow-through regarding any provider concerns. This position ensures State standards regarding accuracy and timing of claim payments are met.




Education & Experience:

• Bachelor's degree required

• Minimum of 5 years supervisory experience in claims processing for a health insurance company required. Medicaid claim processing experience preferred.

• Health Care industry knowledge and operations (example: claims processing, enrollment, provider file maintenance) with ability to interpret and document business requirements.

• Advanced problem solving, critical thinking, and process analysis skills to lead teams responsible for claims payment.

• Project management skills

• Understands the healthcare industry, including competitors, the regulatory environment, and industry trends.

• Knowledge of Texas Medicaid programs

• Must have knowledge of CPT, ICD-9/ICD-10, HCPCS, Revenue Codes and pricing methodologies.

• Experience working with government agencies such as CMS, Medicaid, etc. along with interpreting agency and contract requirements.

• Strong computer skills with proficiency in MS Word, Excel, Outlook, and Access, and Visio. PowerSTEPP and/or Tapestry claims system experience preferred.

• Excellent communication skills both verbal and written.

• Ability to participate in a team environment.

• Self-starter who requires minimal supervision.

Cook Children's is an EOE/AA - Minority/Females/Disability/Vet