Claims Administrator

Job Details

• Job Location:
  
  Fairfield, OH
• Position Type:
  Full Time
• Education Level: High School
• Job Shift: Day

• Affordable medical, dental and vision insurance
• Company paid Health Reimbursement Arrangement (HRA)
• Generous paid time off (PTO) & paid holidays
• Retirement plan with company match – up to 6%
• Career ladder – Start here and build a lifelong career
• Company paid life insurance

This is a hybrid position that requires 90 days of in‑office training. After successful completion of training, eligibility to work a hybrid remote/in‑office schedule.

• Maintain and configure all Care Logic billing administration (funders, EDI, modifiers, procedure codes, rate tables).
• Test and validate billing functionality (cert environment) to support funder changes and new services.
• Ensure billing setup accuracy, compliance, and data integrity through ongoing testing and QA.
• Monitor, submit, correct, and resubmit claims (EDI and manual), including clearinghouse rejections.
• Review failed/denied claims and assign follow-up to billing specialists as needed.
• Coordinate with Finance to ensure accurate revenue reporting and error‑free GL cost center reporting.
• Audit claim activity and ensure timely invoicing, including self‑pay.
• Design, test, and maintain billing reports and metrics (Care Logic BI and interim solutions).
• Run monthly patient statements, manage write‑offs, and distribute client balance reports.
• Maintain SharePoint and billing documentation; stay current on billing regulations and funder requirements.

• High school diploma or GED required.
• Certified Professional Coder (CPC), Certified Professional Biller (CPB) or Certified Billing and Coding Specialist (9
  
  CBCS) preferred.
• Minimum of 3 years of healthcare billing experience using EHR systems.
• Proven experience as a Billing Specialist in a healthcare setting.
• Solid understanding of CPT, ICD, and HCPCS coding and medical terminology.
• Experience with Medicare and Medicaid billing regulations.
• Familiarity with contractual adjustments, sequestration, and payment posting/balancing.
• Strong knowledge of healthcare and behavioral health billing workflows and regulations.
• Proficiency with EHR systems, billing software, and Microsoft Office (especially Excel).
• Demonstrated ability to manage relationships with multiple insurance payers.
• Strong working knowledge of billing compliance and reimbursement methodologies.