Claims and Litigation Specialist

Healthcare Claims Adjudication Specialist

Responsible for reviewing, investigating, and resolving health-care claim payment appeals and communicating resolution / determination in accordance with the standards and requirements established by Health and Human Services Commission. Perform routine and / or targeted audit of claims to ensure payment accuracy and adherence to state Medicaid guidelines.

Responsible for the comprehensive research and resolution of claim appeals from health-care providers and related outside agencies to ensure that internal and / or regulatory timelines are met. Research claims appeals using support systems to determine appeal outcomes. Composes all correspondence and appeal information concisely and accurately, in accordance with regulatory requirements. Strong understanding of claims adjudication process, provider contracts, fee schedules and system configurations to determine root cause of payment error. Effective verbal and written communication skills to collaborate with internal teams to identify, address and resolve systemic claim issues or defects. Excellent analytical, research and problem-solving skills.

Education : High School diploma equivalency with 2 years of cumulative experience OR Associate's degree / Bachelor's degree with 1 year of experience OR 5 years of applicable cumulative job specific experience required. 2 years of leadership or management experience preferred.

Additional Preference : Three (3) years of experience in health-care claims adjudication required. Expertise in the Facets platform preferred. Experience working with Texas Medicaid claims and Medicaid regulatory requirements is preferred. Knowledge of Texas Medicaid pricing and reimbursement methodologies is a plus.

Ascension associates are key to our commitment of transforming healthcare and providing care to all, especially those most in need. Join us and help us drive impact through reimagining how we can deliver a people-centered healthcare experience and creating the solutions to do it. Explore career opportunities across our ministry locations and within our corporate headquarters.

Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex / gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws.

As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.

This employer participates in the Electronic Employment Verification Program.