LyTorre is The Difference – in step with patients and families to build connections and trust.LyTorre is The Difference
We are searching for an Assistant Director of Claims Administration — someone who works well in a fast-paced setting. In this position, you will oversee, develop, implement, and maintain the claims administration functions of the organization. You will be responsible for the integrity of the claims payment and adjudication process while ensuring that claims are processed accurately and timely for reimbursement to the health plan providers and members.
Think you’ve got what it takes?
Job Duties & Responsibilities
• Organize, direct, and implement a coordinated approach to administering health care benefits for children under the guidelines of a primary and secondary Pediatric HMO
• Ensure the delivery of cost-effective, community-based, and culturally sensitive health care through documenting/reporting and education, with continuous quality improvement as a focus
• Develop policies and programs for Medicaid and CHIP HMO based on the organization’s integrated delivery system goals and objectives, and meet performance goals and measurements
• Mentor and develop staff towards the expansion of their job roles in order to meet continuous challenges and changes in the health care environment
• Implement and maintain the claims administration functions and processes in accordance with contracted fee schedules and covered benefits as specified in the member evidence of coverage
Skills & Requirements
• Bachelor’s degree in a business-related field
• Minimum 4 years of claims management and/or oversight experience
• Minimum 4 years of direct supervisory experience
• Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s, unless approved for a medical or religious exemption.
About Texas Children’s