Data & Claims Specialist
Urbanna, Middlesex County, Virginia, 23175, USA
Listed on 2026-09-04
-
Healthcare
Healthcare Administration
Location: Urbanna
Job Details
Job Location:
Bay Aging - Urbanna, VA 23175 Position Type:
Full Time Salary Range: $20.00 - $31.25 Hourly Data & Claims Specialist
- In-Person & On-site Position
Bay Aging is a leader in the movement to integrate social and clinical care. Bay Aging’s expansion of services and diversification of revenue streams has resulted in the need to increase data collection, exchange data with payors, track new metrics, and use new platforms including an electronic health record system.
The Data & Claims Specialist supports Bay Aging by assisting with the growth of new revenue-generating programs such as the Guiding an Improved Dementia Experience (GUIDE) Model, and participating in the strategic analysis of current programs and future opportunities.
The Data & Claims Specialist will use athena
One and Excel tools to monitor patient status and patient documents, communicating with team members to ensure that home-based patients progress smoothly and efficiently through intake, alignment, and monthly follow-up processes. The Data & Claims Specialist will submit and manage claims and prepare reports, troubleshooting issues that arise and developing tools to facilitate workflows and ensure quality outputs. Extreme attention to detail is required;
some experience with online billing platforms or electronic health record systems is a plus. The Data & Claims Specialist will also assist the Director of Strategic Analysis with recurring data analysis tasks and special projects. The position reports to the Director of Strategic Analysis. The compensation range is $20/hr to $31.25/hr depending on qualifications and experience.
- Monitor incoming messages and documents related to GUIDE, including patient referrals and inquiries from the public. Respond directly or route to the appropriate team member.
- Process consent forms, check patient eligibility, and advise team members of outcomes.
- Communicate with patients and team members to resolve administrative problems that arise, such as missing signatures on documents.
- Send form letters to patients electronically or by mail.
- Assist team members with organizing electronic documents in athena
One. - Monitor appointments and the progress of patient encounters through athena
One to ensure timely outcomes and adherence to GUIDE rules. - Monitor events that impact patient eligibility and billing, such as hospice enrollment and transitions to nursing facilities. Communicate with team members, ensure appropriate documentation occurs, and take needed actions to maintain compliance with GUIDE rules.
- Maintain client lists to facilitate communication and metrics.
- Use existing and new Excel models to track patient eligibility for monthly billing.
- Follow up with team members to help them avoid missed billing opportunities.
- Receive, review, and track GUIDE respite invoices.
- Submit claims electronically to CMS, using appropriate HCPCS codes and ICD-10 codes.
- Generate athena
One reports on claim status and reconcile with CMS reports and Excel tracking models. Follow up on claim denials, working with representatives of athena
One, GUIDE, and/or CMS to resolve billing issues.
- Become familiar with Bay Aging’s health, housing, and transportation divisions and assist with data analysis and reporting on programs’ performance.
- Become familiar with the demographics of Bay Aging’s service area and assist with the preparation of demographic data from the Census and other sources.
- To maximize Bay Aging’s success in a landscape of rapidly changing healthcare regulations, participate in the exploration and implementation of additional HCPCS billing codes.
- Assist with special projects such as research, surveys, data analysis, report preparation, and grant applications.
- Assist other Bay Aging programs as assigned or needed.
One (5%):
- Keep up to date on GUIDE regulations and best practices by studying CMS’s GUIDE materials, attending GUIDE webinars, and…
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