The Claim Adjustment Coordinator for Scott & White Health Plan (SWHP) is responsible for research and investigation of previously paid or denied claim(s), to correctly apply benefit determination and pricing for areas of responsibility: 1) Clinic professional claims, 2) Hospital-facility inpatient and outpatient claims, (CMS 1500 and UB04) in accordance with claim processing guidelines. The Claim Adjustment Coordinator researches written inquiries, service forms action grams and email regarding previously paid or denied professional and facility claims effectively gathering documentation needed to process an adjustment. The Claim Adjustment Coordinator identifies overpayments, enters into data base and send letter request for refund. The Claim Adjustment Coordinator works adjustment inventory from assigned queues and service forms to ensure all claims process within established turnaround time as directed by department policy and procedures. The Claim Adjustment Coordinator completes reports / special projects to ensure prompt adjustment or recovery of paid claims in accordance with turnaround time standards.
The ideal candidate for the Claim Adjustment 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 the Claim Adjustment Coordinator role will also be highly self-motivated and accountable and be able to learn and apply new and changing information.
Immediate eligibility for health and welfare benefits
401(k) savings plan with dollar-for-dollar match up to 5%
PTO accrual beginning Day 1
*Note: Benefits may vary based upon position type and/or level.
Associate's Degree or Equivalent Experience
2+ Years Experience
Internal Number: 19021326
About Baylor Scott & White Health
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!