Job DescriptionJob Description

Claim Specialist

We are currently looking for a Claim Specialist - Hybrid - to join our team at our Mooresville, NC office.

About Us

BoldAge delivers innovative, creative solutions for PACE (Program of All-Inclusive Care for the Elderly). Our model of care enables older adults to live a meaningful, independent life at home with grace and dignity. We meet the evolving needs of older adults by providing innovative disciplinary solutions that consider both their physical and mental well-being. Our owner operated model is aimed at expanding the ability for older adults to live happily and healthfully in their own homes for as long as possible.

POSITION OVERVIEW

Receives and inputs new healthcare claims, processes payments, conducts billing research, and responds to telephone inquiries. Evaluates claims and administers payment, denies, or returns claims according to policy provisions and organizational guidelines. Produces routine and ad hoc reports. Requires a high school diploma

POSITION DUTIES AND RESPONSIBILITIES

• Process claims accurately and within the time frames established by management using the claims processing system.
• Process AP-DRG claims that fall outside of the automated pricing process.
• Demonstrate a thorough understanding of matching appropriate authorizations to claims and tracking down missing authorizations.
• Master and utilize a thorough understanding of such items as HCPC modifiers and their effect on reimbursement, coordination of benefits (COB), appropriate billing

guidelines for anesthesia claims, hospital stays, ambulance and other services.

• Communicate with internal personnel, vendors, providers, and billing

representatives about claim related issues

• Perform data entry of manual claims and/or services received in formats other than claims.
• Work as a unit/team in resolving claims issues or special projects
• Report any inconsistencies that are identified regarding internal department

policies and procedures to management

• Work with management to ensure that all existing workloads have been

addressed and are within acceptable time frames

Provide management with required documentation to assist in the continued

• development of the department (e.g. Production totals, etc.)
• Perform other duties as assigned

MINIMUM EDUCATION REQUIREMENTS

• High school diploma or equivalent
• Some College helpful

SPECIAL KNOWLEDGE AND/OR SKILLS

• Strong verbal and written communication skills

• Strong organizational skills

• Exposure to health care environment and knowledge of HCFA 1500 and UB92

claim forms

• CPT-4 and ICD9 knowledge

• Ability to work independently

• Ability to meet deadlines and work under pressure

WORK BACKGROUND/EXPERIENCE

• Minimum three (3) years claims processing/healthcare billing experience

BoldAge PACE provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Hybrid - 2 days in-office each week, other three from home out of our Mooresville, NC office.

40 Hours

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