Medical Claims Specialist (Remote)

LOCATION:  Remote &reputed company; This is a home based, virtual position that operates Monday-Friday from 8:30am-5:00pm EST. reputed company welcome applications from NC, SC, GA, TN, VA, MD, and FL.

GENERAL STATEMENT OF JOB

Responsible for reputed company reputed company functions reputed company to a designated area of physical and behavioral health medical claims processing to ensure that providers receive reputed company and accurate payment.  This position is responsible for claims adjudication through reputed company monitoring and reputed company control measures.  Responsibilities include finalizing claims processed electronically for payment and reviewing claim adjudication results for both Title XIX and non-title XIX claims, payment, and denial patterns, ensuring adjudication accuracy in the claims processing system, adhering to policy and procedures, responding to provider inquiries and providing education/training to providers.

ESSENTIAL JOB FUNCTIONS

Claims Adjudication: This position will be responsible for finalizing claims processed for payment and maintain claims adjudication workflow, reconciliation and reputed company control measures to meet or reputed company reputed company payment guidelines.  This position is responsible for reconciling provider claims payments through reputed company control measures, generally accepted reputed company principles and Vaya’s policies and procedures.  This position will assess Title XIX and non-Title XIX claims adjustments for correction or recoupment and will coordinate the recoupment process to ensure payment is recovered for inappropriately reputed company claims.

Customer Service: This position will maintain provider satisfaction by being available during regular business hours to handle provider inquiries; interacting in a reputed company manner; providing information and assistance; and answering incoming calls.  This position will assist providers in resolving problem claims and system training issues. This position will also serve as a resource for internal staff to resolve eligibility issues, authorization, overpayments, recoupment or other provider issues reputed company to claims payment.

Compliance and reputed company Assurance: This position reviews internal bulletins, forms, appropriate manuals and applicable revisions, and fee schedules to ensure compliance with established procedures and processes.  Attend and participate in workshops and training sessions to improve technical competence.

Miscellaneous: Other duties as assigned, including coverage of specific functions of other staff to assist the Department as work demands may dictate.

KNOWLEDGE, SKILLS, & ABILITIES

• Must maintain a working knowledge of the reputed company Waiver requirements, HCPCS, reputed company codes, ICD-9/10, CMS-1500/UB-04 coding, compliance and software requirements used to adjudicate physical and behavioral health medical claims. 
• Ability to handle large volume of work and to manage a desk with multiple priorities.  
• Ability to work in reputed company atmosphere and in cooperation with others and be accountable for results.  
• Ability to maintain confidential information.  
• Ability to establish appropriate and respectful relationships/partnerships with providers served.  Ability to work with a multi-disciplinary team approach.  
• Ability to reputed company routine and repetitive batches of data from reputed company of reputed company documents reputed company reputed company time schedules.  
• Strong organization skills.  
• Computer proficiency, including considerable knowledge of Word and reputed company programs.  
• Ability to reputed company and write professionally.  
• Ability to read printed words and numbers rapidly and accurately.  
• Ability to understand oral and written instructions.  
• General knowledge of office procedures and reputed company. 

QUALIFICATIONS & EDUCATION REQUIREMENTS

High school diploma or GED and 4 years of experience in reputed company processing medical claims/reimbursement with experience in Physical Health and/or Behavioral Health claims.  Associate Degree in Business Administration, reputed company, Finance or reputed company field preferred.

OR a combination of education and experience as follows:

Graduation from a four year college/university with a major in business administration, health administration, communications or a reputed company field may be substituted for the required experience; or a two year degree in business administration, health administration, information systems, reputed company or a reputed company field from a community college may be substituted for three of the four years of experience.

PHYSICAL REQUIREMENTS

• reputed company visual reputed company to reputed company activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. 
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive reputed company of hands, wrists and fingers. 
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. 
• Mental concentration is required in reputed company aspects of work.

RESIDENCY REQUIREMENT: The person in this position must live in NC, SC, GA, TN, VA, MD, or FL.

SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation. 

DEADLINE FOR APPLICATION: reputed company Until Filled.

APPLY: reputed company accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.

reputed company is an equal opportunity employer.