Claims Specialist

The Claims Specialist is responsible for maintaining, entering, and following up on all client medical insurance and financial information. The position prepares claim data for transmission to Medicaid, Medicare, and Managed Care plans. A Claims Specialist will organize billing and rebilling materials as well as create and analyze reports from the billing system to provide feedback to program sites. The Claims Specialist is responsible for maintaining positive and professional client and external insurance agency relations.
POSITION RESPONSIBILITIES
Enters, updates, and verifies client data from service documents.
Using Medicaid EMEVS or E-PACES verifies client Medicaid information.
Tracks client referrals and authorizations in system.
Prepares claim batches for transmission to Medicaid, Medicare, and 3rd party payers.
Maintains claims batch reports.
Posts client payments to the service level.
Posting and mailing of client statements.
Produces and analyzes routine reports in a timely manner.
Reviews and processes payer denials.
Performs all other duties as assigned.
QUALIFICATIONS
High school diploma or equivalency plus a minimum of two years paid experience in medical insurance billing.

-OR-

Associates degree in Business Administration plus a minimum of 1 year paid experience in medical insurance billing.
Completion of medical billing certification preferred.
Experience working with clients to assist with their medical insurance co-payments/deductibles and other related medical billing inquiries required.
Experience following up with medical insurance companies regarding clients claims and submitting medical insurance claims.
Experience balancing a cash drawer/cash reconciliation.
Knowledge of OMH, DOH, Medicaid, Medicare, and TPA regulations.
Strong ability to utilize common office technology/software including the use of the Microsoft Office Suite (Excel and Outlook mainly)
Ability to organize and maintain billing materials.
High attention to detail.
Ability to take initiative, make appropriate decisions, and solve problems with autonomy
Ability to perform routine arithmetic computations.
Excellent communication skills with all levels of staff

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