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Claim Adjustment Coordinator - Heath Plan

Company: Baylor Scott White Health
Location: Temple
Posted on: October 28, 2018

Job Description:

Job Description

Claim Adjustment Coordinator - Heath Plan

Preferred Qualifications

The Claim Adjustment Coordinatorfor Scott & White Health Plan (SWHP) is responsible for research andinvestigation of previously paid or denied claim(s), to correctly apply benefitdetermination and pricing for areas of responsibility: 1) Clinic professionalclaims, 2) Hospital-facility inpatient and outpatient claims, (CMS 1500 andUB04) in accordance with claim processing guidelines. The Claim AdjustmentCoordinator researches written inquiries, service forms action grams and emailregarding previously paid or denied professional and facility claimseffectively gathering documentation needed to process an adjustment. The ClaimAdjustment Coordinator identifies overpayments, enters into data base and sendletter request for refund. The Claim Adjustment Coordinator works adjustmentinventory from assigned queues and service forms to ensure all claims processwithin established turnaround time as directed by department policy andprocedures. The Claim Adjustment Coordinator completes reports / specialprojects to ensure prompt adjustment or recovery of paid claims in accordancewith turnaround time standards.


The ideal candidate for the ClaimAdjustment 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 theClaim Adjustment Coordinator role will also be highly self-motivated andaccountable and be able to learn and apply new and changing information.


-- Location/Facility - Health Plan


Formore information on the facility, please click our Locationslink.


-- Specialty/Department/Practice - Claims


-- Shift/Schedule - Full Time Days


-- Benefits - Our competitive benefitspackage includes*:


-- Immediate eligibility forhealth and welfare benefits


-- 401(k) savings plan withdollar-for-dollar match up to 5%


-- Tuition Reimbursement


-- PTO accrual beginning Day1


*Note: Benefits may vary based upon position type and/orlevel.





BaylorScott & White Health (BSWH) is the largestnot-for-profit health care system in Texas and one of the largest in the UnitedStates. With a commitment to and a trackrecord of innovation, collaboration, integrity and compassion for the patient,BSWH stands to be one of the nation's exemplary health care organizations. Foundedas a Christian ministry of healing, the mission of Baylor Scott & White Health is to promote thewell-being of all individuals, families and communities. Joiningour team is not just accepting a job, it's accepting a calling!


-- Associate'sDegree or Equivalent Experience


-- 2+Years Experience


United States
S&W Health Plan - West Campus (11042)
1206 W Campus Dr
Temple, 76502

Health PlanInsurance

Keywords: Baylor Scott White Health, Temple , Claim Adjustment Coordinator - Heath Plan, Other , Temple, Texas

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