Claims Specialist

Position Responsibilities

• Enters, updates, and verifies client data from service documents.
• Verifies client Medicaid information using Medicaid EMEVS or E-PACES.
• Tracks client referrals and authorizations in the system.
• Prepares claim batches for transmission to Medicaid, Medicare, and third-party payers.
• Maintains claims batch reports.
• Posts client payments to the service level.
• Produces and analyzes routine reports in a timely manner.
• Reviews and processes payer denials.
• Performs all other duties as assigned.

Qualifications

• A high school diploma or equivalent plus at least two years of paid experience in medical insurance billing.
• An associate’s degree in Business Administration plus one year of paid experience in medical insurance billing, with completion of a medical billing certification preferred.
• Experience assisting clients with medical insurance co-payments, deductibles, and related inquiries.
• Experience following up with medical insurance companies regarding claims and submitting claims.
• Experience balancing a cash drawer and performing cash reconciliations.
• Knowledge of OMH, DOH, Medicaid, Medicare, and TPA regulations.
• Strong ability to use common office technology/software, particularly Microsoft Office Suite (Excel and Outlook).
• High attention to detail.
• Ability to take initiative, make appropriate decisions, and solve problems independently.
• Strong arithmetic computation skills.
• Excellent communication skills with all levels of staff.