Claims Specialist
CLAIMS SPECIALIST *REMOTE OPTIONS AVALIABLE* (JOB ID: 4844)
Northern Light Health
Department: Patient Financial Services
Position is located: Cianchette Professional Blding
Work Type: Full Time
FTE: 1.000000: (40 hours a week)
Work Schedule: 8:00 AM to 4:30 PM
Summary:
This position is responsible for accurate claims submission to all applicable payers of the EMHS Patient Account Services in a Centralized Business Office environment. This position is responsible for the submission of claims in accordance with regulatory and contractual obligations. This position requires a thorough understanding of the requirements of the Centers for Medicare & Medicaid Services (CMS) claim forms; CMS-1500 and CMS-1450 (UB04). In addition, this position is held accountable to adhere to the policies, procedures, and applicable laws; including metrics related to productivity and quality. This position works closely with a team of Claim Specialists to analyze and take corrective action on claims to ensure an optimum revenue cycle workflow.
Responsibilities:
People
• Actively participate in team huddles and meetings by way of sharing knowledge, requesting information, and recommending process improvements.
Service
• Complete all returned requests from other departments each day.
• Work closely by way of problem solving with peers and leaders to address payer claim issues or changes that directly impact the accounts receivable.
Quality
• Resolve claim edits specific to each payer’s requirements on a daily basis.
• Take necessary AR adjustments in accordance with the department’s adjustment policy.
• Meet or exceed the EMHS performance standards as it relates to quality and productivity.
Finance
• Complete electronic payer rejections on a daily basis.
• Request relevant information from appropriate revenue cycle and clinical departments as required by payer.
• Ensure assigned discharged not final billed (DNFB) and final billed not submitted (FBNS) claims are not delinquent and are escalated timely.
• Advises management of claim issues which may require attention in a timely manner.
• Ensure all functions related to claims submission supports the team goals and objectives as well as EMHS’s financial performance objectives.
• Thoroughly understand the department’s key performance indicators.
Growth
• Maintain the knowledge of payer billing policies; complete AAHAM or other healthcare related webinars.
• Attend internal education sessions to enhance or gain new skills.
Community
• Demonstrate departmental desire to provide community benefits by way of charitable events or contribution outside the four walls of the department.
Competencies and skills:
Essential:
* Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.
* Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
* Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
* Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
* Fosters Innovation: Employs and encourages the use of meaningful creativity in solving challenges. Proactively identifies opportunities and uses new approaches to enhance processes, systems and services. When appropriate, suggests or initiates new strategies, products, services, and markets.
* No previous experience required.
* Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
Education:
Essential:
* High School Diploma/General Educational Development (GED)
Working conditions:
Essential:
* Work with computers, typing, reading or writing.
* Potential exposure to diseases or infections.
* Lifting, moving and loading less than 20 pounds.
* Continuous sitting.
“This role can be performed remotely anywhere in the United States with the exception of California”
Equal Opportunity Employment We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status