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Claims Processing Expert
2 months ago
Claims Processing Expert
We are seeking a Claims Processing Expert to become a vital part of our team.
About BoldAge PACE
BoldAge PACE is dedicated to providing innovative and effective solutions for the Program of All-Inclusive Care for the Elderly. Our approach allows seniors to maintain a fulfilling and independent lifestyle at home, ensuring their dignity and well-being. We adapt to the changing needs of older adults by offering comprehensive solutions that prioritize both their physical and mental health.
POSITION SUMMARY
The Claims Processing Expert will be responsible for receiving and entering new healthcare claims, managing payments, conducting billing inquiries, and addressing phone inquiries. This role involves evaluating claims and administering payments, denials, or returns in accordance with policy provisions and organizational standards. The position also requires generating routine and special reports. A high school diploma is required.
KEY RESPONSIBILITIES
- Accurately process claims within the timelines set by management using the claims processing system.
- Handle AP-DRG claims that are not covered by the automated pricing system.
- Exhibit a comprehensive understanding of matching the correct authorizations to claims and tracking down any missing authorizations.
- Demonstrate expertise in HCPC modifiers and their impact on reimbursement, coordination of benefits (COB), and appropriate billing guidelines for various services.
Maintain communication with internal staff, vendors, providers, and billing representatives regarding claim-related matters.
- Input manual claims and/or services received in non-claim formats.
- Collaborate with the team to resolve claims issues or work on special projects.
- Report any discrepancies related to internal policies and procedures to management.
- Assist management in ensuring that all workloads are managed effectively and within acceptable time frames.
- Provide necessary documentation to support the ongoing development of the department.
- Perform additional duties as assigned.
EDUCATIONAL REQUIREMENTS
- High school diploma or equivalent.
- Some college education is beneficial.
SKILLS AND QUALIFICATIONS
- Excellent verbal and written communication skills.
- Strong organizational abilities.
- Familiarity with the healthcare environment and knowledge of HCFA 1500 and UB92 claim forms.
- Understanding of CPT-4 and ICD9 coding.
- Ability to work independently and meet deadlines under pressure.
EXPERIENCE
Minimum of three (3) years of experience in claims processing or healthcare billing.
BoldAge PACE is an equal opportunity employer, committed to creating a diverse and inclusive workplace for all employees.
