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Baylor Scott & White Health Claim Adjustment Coordinator - Austin in Austin, Texas

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.

  • Location/Facility Austin

  • Specialty/Department/Practice Claims - Health Plan

  • Shift/Schedule Full Time Days

  • Benefits Our competitive benefits package includes*:

    • Immediate eligibility for health and welfare benefits
  • 401(k) savings plan with dollar-for-dollar match up to 5%

  • Tuition Reimbursement

  • PTO accrual beginning Day 1

*Note: Benefits may vary based upon position type and/or level.

  • Associates Degree or Equivalent Experience

  • 2+ Years Experience

As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviors that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products.

We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.