This position's primary responsibility revolves around correspondence and the resulting necessity for research and communication in order to ensure timely collection of recoveries due from other health insurance (OHI) carriers. The Senior Processor also maintains all member demographic information in the computer system relative to OHI. This position processes a heavy volume of paperwork.

MAJOR RESPONSIBILITIES

• Open, read and process all incoming correspondence in a timely manner
• Determine course of action to ensure recovery
• Communicate effectively with other health insurance carriers
• Re-bill, attaching explanation letter when appropriate, requesting status for claims over 60 days old with no recovery or claims pended for another carrier's EOB
• Quality check and stamp recovery letters for mail-out
• Close claims in the computer system that do not result in a recovery
• Communicate effectively with members to resolve problem issues with OHI
• Assist Supervisor with annual OHI member investigations
• All other duties as assigned by management
• Collaborate with and maintain open communication with all departments within CHRISTUS Health to ensure effective and efficient workflow and facilitate completion of tasks/goals
• Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)

• High school diploma or equivalent
• Excellent data entry speed and accuracy, working with large volume of paperwork
• Knowledge of coordinating benefits or claims payment (basic knowledge of medical claims)
• Integrity regarding working with very large recovered monetary amounts
• Good communication skills a must

• Three plus years experience in Managed Care claims
• At least one year coordinating benefits preferred

• None