Job Details: Mgr Claims Administration

Company: Texas Children´s Hospital – Texas Children's Hospital is an internationally recognized full-care pediatric hospital located in the Texas Medical Center in Houston. One of the largest pediatric hospitals in the United States, Texas Children's Hospital is dedicated to providing the finest possible pediatric patient care, education and research.

Description: Texas Children's Hospital is an internationally recognized full-care pediatric hospital located in the Texas Medical Center in Houston.
One of the best pediatric hospitals in the United States, Texas Children's Hospital is dedicated to providing the finest possible pediatric patient care, education and research.

Texas Children's is nationally ranked in the top five among children's hospitals by both Child magazine and U.S. News & World Report. The hospital has garnered widespread recognition for its expertise and breakthrough developments in the treatment of cancer, diabetes, asthma, HIV, premature babies, and cardiogenic and attention-related disorders.
Position Summary

PURPOSE:
Responsible for planning, organizing, developing and implementing Claims processing functions and related processes for the Claims Administration Department of Texas Children?s Health Plan. This position will have key responsibility for the integrity of the claims payment and adjudication process. This position will be responsible for ensuring that claims are processed accurately and timely for reimbursement to the Health Plan Providers and members, in accordance with contracted fee schedules and covered benefits as specified in the member evidence of coverage. Identifying improvement opportunities, in conjunction with the other internal areas or workgroups of the Health Plan. Oversee and direct multiple projects to a successful conclusion. Assuring departmental compliance is met for all TCHP policies and procedures. Texas Children?s Health Plan processes over 1,000,000 claims on an annual basis representing more than $150,000,000 million dollars paid.

Knowledge
Required for completely satisfactory performance in this job is a knowledge of1. Texas Department of Insurance regulations pertaining to HMOs 2. Statutory reporting requirements of HMOs3. Claims processing requirements and general principles4.Systems implementation and maintenance

Skills
Required for completely satisfactory performance in this job is the ability to plan and organize on a global level, including multi-departmental coordination and participation. Excellent communication skills, both oral and written. Basic research methodology, detail oriented, with strong problem solving skills, ability to multi-task; work toward deadlines and be an active learner. Working knowledge of health care industry products/services and operations. Solid supervisory experience.

Formal Educationand Experience
The formal education normally associated with completely satisfactory performance in this job is1. Business degree from an accredited university or 3 years Supervisory experience. In lieu of the degree must have 7 years of direct experience in claims administration.
(CB)

Shift and Salary Grade

Shift: 8a-5p

Salary Grade: 10
Dan Young
Recruiter
P: 832-324-2037
F: 832-825-2801
E: dpyoung@texaschildrenshospital.org

If you prefer to email your résumé to me through this website, please also apply through www.texaschildrens.org for full consideration.

Posting Date: Jun 4 08