Claim Specialist Lead

Performs all activities in coordination with Director Finance related to Claim Management for entities that the agency bills for services including Medicare, Medicaid, Managed Care, CHOICE, Older Americans Act, private-pay, and others. Maintains current knowledge of insurance payors to maximize reimbursement. Investigates denial and appeal issues and past-due appealed claims to optimize revenue performance in a timely manner.

Develop and maintain proficiency on tools required to perform job tasks in a timely and accurate manner including specialized computer software.

Develop and maintain depth of knowledge of accounting principles and practices, especially as they apply to billing for services.

Develop and maintain an accurate and thorough knowledge of all agency standards procedures, policies including Fiscal Department accounting standards and processes, and specialized computer software related to accounting functions specific to the contract.

Design Excel spreadsheets and maintain current Excel spreadsheets.

Process all agency billing including Medicaid Waiver and other State funding in an accurate and timely manner ensuring codes are correctly assigned per government and insurance regulations.

Track claims in real-time for département access and identify solutions to issues affecting reimbursement as it relates to denial

Prepare reports for the State including claims for reimbursement, quarterly non-federal report, two-year compare, and all other required reporting.

Submits charges and claims for services through specialized software, working rejections, processing and posting payments, handling program/patient billing inquiries, and ensuring claims ae processed in a timely and effective manner.

Communicate with supervisor on daily basis, and as needed, to report all areas of concern/issues/incidents.

Minimum two-years’ experience working and processing claims in medical/ insurance/ community organization. Computer proficiency in HCP Provider Portal for Medicaid Waiver. Must be proficient in creating and manipulating Excel spreadsheets. Must be familiar with Microsoft Office products and accounting software, such as Quick Books or MIP.

Preferred Education and Experience

Four years’ experience in claims management with organization processing 10.000+ claims per month. Experience in fund accounting. Bachelor’s degree in accounting, or related field of study.

403(b)

Employee assistance program

Flexible spending account

Health insurance

Health savings account

Paid time off

Vision insurance

Education:

Bachelor's (Required)

Experience:

Claims in a Medical Field: 2 years (Required)