RESPONSIBILITIES
Manages and directs the activities of analysts, auditors, claims processors and other claims support staff as assigned. Researches and resolves escalated provider issues initiated by claim processors. Provides written and telephonic resolutions to external customer issues (with both providers and members) in accordance with the health plan’s policies and procedures. Develops claim procedure improvement methodology(s), directions and strategic plans for procedural improvement to support Community First Health Plans’ (Community First) business plan.
EDUCATION/EXPERIENCE
Minimum of two years college level work in business, health care administration or a related area is required. College requirement may be substituted for five years claims experience, including two years at the management level. Medicaid, Medicare and/or Commercial claims experience is strongly required. QNXT experience highly desirable.
University Health is the only locally owned health system in San Antonio. For more than 100 years, University Health has been here to heal, improve health, train the next generation of medical professionals and ensure the people of San Antonio, Bexar County and South Texas have access to primary and advanced specialty care close to home.
Almost 11,000 employees and more than 1,200 physicians provide specialized services, including the region’s only Level I trauma center for both adults and children, and maternal and neonatal intensive care centers designated at the highest levels by the State of Texas.
As the region’s only academic health system, University Health is a hub of innovation and discovery, committed to delivering patient-centered, culturally competent, high-quality and compassionate care, based on a strong foundation of outcomes‐based research and innovative teaching.
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