Claims Finance Specialist

EXPECTED WORK AND PERFORMANCE

• Submission of request for funds (RFFs) for clients based on schedule or delivery.
• Submission of client invoices.
• Work collaboratively with Finance for the reconciliation of the clients funding accounts.
• Provide low balance client account information to the Account Management team.
• Assist with voids, refunds, and recoupments from overpaid claims.
• Assist with the resolution of escalated, DOI, OIG, OIC, and BBB complaints and appeals.
• Process first submission claims requiring re-adjudication.
• Audit provider accounts to confirm open receivables and payables and effectively communicate balances either directly to the provider or to an internal provider relations team member.

• Advanced computer skills and experience with MS Application – Adobe, Excel, Word, Outlook is required.
• Accounts Receivable, Audit, Claims Payment and/or Revenue Cycle Management experience.
• Minimum 2-year administrative office experience.

• Associate degree or equivalent combination of education and experience.
• Claims Processing Background.

• Strong mathematical skills.
• Understanding basic principles of finance, accounting, or bookkeeping.
• Extremely organized with the ability to effectively manage multiple tasks.
• Self-motivated and the ability to work independently with minimal supervision