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Return to Employment Opportunities
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Title :
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Claims Specialist - 3 Positions Available
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Location :
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Western Region
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Classification :
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To be determined by qualification and experience o
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Position # :
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TBA
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General Statement of the Job :
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Responsible for all functions related to a designated area of claims processing to ensure that providers receive timely and accurate payment. This position is responsible for claims adjudication quality control activities through continuous monitoring and quality control measures. Responsibilities include finalizing claims processed electronically for payment and reviewing claim adjudication results for Medicaid and IPRS 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.
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Essential Job Functions :
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This position will be responsible for finalizing claims processed for payment and maintain claims adjudication workflow, reconciliation and quality control measures to meet or exceed prompt payment guidelines. This position is responsible for reconciling provider claims payments through quality control measures, generally accepted accounting principles and SMC's policies and procedures. This position will assess Medicaid and IPRS claims adjustments for correction or recoupment and will play a key role in the recoupment process to ensure payment is recovered for inappropriately paid claims.
This position will maintain provider satisfaction by being available during regular business hours to handle provider inquiries; interacting in a professional 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 related to claims payment.
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Minimum Training and Qualifications :
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Graduation from high school and four years experience in claims/reimbursement; or an equivalent combination of education and experience. Graduation from a four year college or university with a major in business administration may be substituted for the required experience; or a two year degree in business administration or accounting from a community college may be substituted for three of the four years experience.
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Physical Requirements :
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Normal range of motion and reasonable physical health and strength will be required. Must have driver’s license and must be able to use computers, copiers and other office equipment that will be used routinely.
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Knowledge of Job :
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Must maintain a working knowledge of the Medicaid Waiver requirements, applicable revenue codes and coding, compliance and software requirements used to adjudicate claims. Ability to handle large volume of work and to manage a desk with multiple priorities. Strong organization skills. Ability to speak and write professionally. Computer proficiency, including the use of Word and Excel programs. Ability to work in a team atmosphere and in cooperation with others and be accountable for results. Considerable knowledge of the methods of operation of combination alphabetic and numeric computer software. General knowledge of office procedures and methods. Ability to read printed words and numbers rapidly and accurately. Ability to understand oral and written instructions. Ability to enter routine and repetitive batches of data from a variety of source documents within structured time schedules. Ability to maintain confidential information.
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Salary :
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Grade/Step is determined by qualification and experience of candidate. Position is full-time hourly with comprehensive benefits. Work schedule is 37.5 hours per week. This position is not exempt from overtime compensation.
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Deadline for Application :
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Position is open until filled
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Apply To :
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Send a NC State Application and resume to: Smoky Mountain Center, Department of Human Resources, 44 Bonnie Lane, Sylva, NC 28779. Smoky Mountain Center is an equal opportunity, affirmative action employer
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PLEASE NOTE THAT INTERNAL APPLICANTS SHOULD BE AWARE THAT CHANGING POSITIONS
WITHIN THE AGENCY COULD RESULT IN BEING RECLASSIFIED INTO TRAINEE STATUS WHICH
WOULD AFFECT YOUR RIGHTS AS A PERMANENT EMPLOYEE. WHEN APPLYING INTERNALLY, CHECK
CLOSELY WITH HIRING SUPERVISOR AND HUMAN RESOURCES COORDINATOR TO DETERMINE IF YOU
ARE FULLY QUALIFIED FOR POSITION OR IF YOU MUST SERVE IN TRAINEE STATUS UNTIL FULLY
QUALIFIED.
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