Central Health ยท 1 day ago
Health Plan Claims Finance Specialist
US-TX-Austin
Full-time
Onsite
Senior Level
7+ years expCentral Health is seeking a Claims Finance Specialist for Sendero Health Plans, a Health Maintenance Organization (HMO) based in Texas. In this role, you will oversee the efficient and accurate processing of refunds, voids, and claim payments, ensuring compliance with healthcare regulations and supporting the Claims Department as needed.
Health CareHealth DiagnosticsMedical
Responsibilities
Responsible for running check payments and coordinating with banks as well as internal finance or external client to ensure all payments are tracked
Process outstanding check voids and reissue payments to ensure all payments are made
Apply provider refunds to claims ensuring proper documentation and tracking
Recoup claims as needed, monitor recoupments, and ensure timely processing
Ensure penalty payments are calculated and paid in a timely manner and identify causes for penalty payments
Audit and maintain thorough accounting of all provider and member payments within the VBA database
Support Claims Department on projects and other items as required
Qualification
Required
Strong understanding of healthcare claims processing principles, coding systems, and reimbursement methodologies
Excellent communication, and interpersonal skills, with the ability to work independently
Thorough knowledge of healthcare regulatory compliance requirements, including HIPAA, CMS guidelines, and Texas regulations
Demonstrated ability to effectively manage multiple priorities in a fast-paced environment while maintaining attention to detail and accuracy
High School Diploma or equivalent (higher degree accepted)
7 years of experience in health plans claim finance
7 years of experience in health plans claim adjudication
Preferred
Experience in health plans claim finance, preferably within an HMO or managed care environment
Experience in health plans claim adjudication, preferably within an HMO or managed care environment
Proficiency in utilizing claims processing software and systems (VBA preferable)
Company
Central Health
Central Health is a health care company provides access to healthcare services to eligible residents of Travis County.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Jonathan Morgan
Chief Operating Officer
Alan Schalscha
Chief Medical Officer
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