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Managed Care Claims Validator
1 month ago
Job Summary:
CommuniCare Health Services Corporate is seeking a highly skilled Managed Care Claims Validator to join our Central Billing Office team. As a key member of our revenue cycle team, you will be responsible for accurate and timely filing of managed care claims with insurance carriers.
Key Responsibilities:
- Validate and verify claim information against PCC data to ensure accuracy and completeness.
- Work with the CBO cash collections team, cash posting team, Business Office Manager, Regional Director of Finance, MDS, Case Management, and others to resolve claim issues and ensure timely billing.
- Develop and maintain expertise on managed care protocols, including UB04 and 1500 claim forms, to ensure compliance and optimal reimbursement.
- Identify and report trends and patterns with claim rejections or denials to revenue cycle for review and improvement.
- Ensure all managed care claims are validated and billed out of PCC by the 10th business day after close, with notes in PCC for any delayed claims.
- Rebill corrected claims as needed, and pay particular attention to NPI and Tax ID requirements for specified claims.
Requirements:
- High School graduate or GED required.
- Prior work/life experience in a long-term care setting, preferably in a healthcare setting.
- Prior experience with related software applications.
- Knowledge of medical billing/collection practices, accounts receivable practices and procedures, and laws, regulations, and guidelines that pertain to long-term care.
- Strong mathematical, written, and verbal communication skills, with a high degree of attention to detail.
- Basic computer literacy and skills, with strong organizational skills.
About Us:
CommuniCare Health Services Corporate is a family-owned company that has grown to become one of the nation's largest providers of post-acute care. We are committed to delivering exceptional person-centered care and creating 'Caring Communities' where staff, residents, clients, and family members care for and about one another.
