Claims Examiner II

HealthSpring is committed to providing quality healthcare for our members, as well as forming strong relationships with our providers and their staff. HealthSpring takes an active role in building and maintaining the relationship between the health plan and the doctor by providing ongoing physician and office staff education.

We are seeking a Claims Examiner II for our Claims Department in our Houston office.

PURPOSE:
To accurately and promptly adjudicate Primary Care Physician and Specialist claims, utilizing the necessary skills to ensure quality and timeliness of processing.

REQUIREMENTS:
Knowledge of ICD-9 and CPT coding.
Ability to interact in a positive manner with all departments.

EDUCATION:
High school diploma or equivalent. Some college preferred.

EXPERIENCE:
* Minimum 2 years of claims processing, preferably in a managed care environment.
* Knowledge of CMS, TDI and THD regulations for processing Medicare and Medicaid claims.
* 10-Key by touch - at least 8,000 keystrokes per hour.

RESPONSIBILITIES AND FUNCTIONS:
* Process Primary Care Physician, Specialist and Ancillary Provider claims per Renaissance guidelines.
* Assist as needed in the processing of EDI and PCP claims.
* Accurately process a minimum of 25 "Fee for Service" and "Capitated" specialist claims per hour.
* Achieve and maintain an overall claims processing accuracy of 98%.
* Promote and maintain a positive attitude.
* Provide assistance and support in training level I examiners as requested by supervisor.
* Other duties as assigned.

HealthSpring offers a competitive salary and a full range of benefits. HealthSpring is an EEO/AA employer.