Claims Examiner
Posted on :
18-10-2022
Employer Active
The job posting is outdated and position may be filled
Job Alert
You will be updated with latest job alerts via emailValid email field required
Send jobs
Share
Send me jobs like this
Job Alert
You will be updated with latest job alerts via emailValid email field required
Send jobs
Job Description
Job Description: Claims Payment Specialist
Summary: Under the direction of the Accounting Manager, the Claims Payment Specialist is
primarily responsible for ensuring that claims are selected for payment according to client
regulations and client processing rules. The position is responsible for ensuring all payments are
authorized by the client, and check dates are updated in the claims system.
Summary: Under the direction of the Accounting Manager, the Claims Payment Specialist is
primarily responsible for ensuring that claims are selected for payment according to client
regulations and client processing rules. The position is responsible for ensuring all payments are
authorized by the client, and check dates are updated in the claims system.
Essential functions:
- Generate pre-check register and authorization form for clients
- Verify approvals have been received
- Modify pre-check based on approvals received, ensuring the batch ties to the client approval
- Generate export file from claims system for check printing
- Obtain secondary approval from clients in situations with interest payments, prior to releasing export file for check printing
- Import check register file into claims system
- Coordinate voided checks with the claims department
Additional Functions:
- Assists with special projects, as requested
- Communicates clearly and concisely, with sensitivity to the needs of others
- Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
- Maintains courteous, helpful and professional behavior on the job
- Establishes and maintains effective working relationships with co-workers
- Ensures customer satisfaction by understanding and applying the Customer Service Policy, Procedure and Standards
- Follows all Policies and Procedures and HIPAA regulations
- Maintains knowledge and understanding of current Medicare regulations related to PACE Health Plan Management.
- Maintains a safe working environment
- Maintains knowledge and understanding of current Medicare claims processing guidelines
- Attends continuing education seminars as requested
Supervisory Responsibility: None
Travel: No travel is anticipated for this position.
Knowledge, Skills and Abilities:
Travel: No travel is anticipated for this position.
Knowledge, Skills and Abilities:
- Associates Degree in Accounting or equivalent experience required
- 2 years of related work experience in and office setting
- Proficient in Microsoft Word and Excel
- Experience with Pivot Tables is required
- Detail oriented with strong analytical skills
- Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels
- Skilled in data analysis and problem solving using defined methodologies
- Ability to work independently with minimal supervision
- Ability to independently follow through on projects
- Ability to communicate professionally, clearly and effectively, verbally and in writing
- Ability to prioritize effectively
- Ability to consistently multitask
- Ability to understand issues, demonstrates resourcefulness, and resolve issues in a timely manner
- Ability to demonstrate good judgment and have excellent critical thinking skills Physical Demands & Requirements:
- Communicate by way of the telephone with participants, customers, vendors and staff
- Operate a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer
- Remain stationary for extended periods of time
- Occasionally exert up to 20 pounds of force to lift, carry, push, pull or move objects
- Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy
- Occasional reaching to retrieve shelved items
- Occasional bending/stooping
Work Environment:
- This job operates in a professional or home office environment with a conversational noise level.
- No substantial exposure to adverse environmental conditions is expected.
- Moderate pressure to meet scheduled appointments and deadlines
- Potential for occasional verbal aggression by clients and vendors Supervised By: Accounting Manager
Employment Type
Full Time
Key Skills
Report This Job
Disclaimer: Drjobpro.com is only a platform that connects job seekers and employers. Applicants are advised to conduct their own independent research into the credentials of the prospective employer.We always make certain that our clients do not endorse any request for money payments, thus we advise against sharing any personal or bank-related information with any third party. If you suspect fraud or malpractice, please contact us via contact us page.
