Claims & Accounting Specialist
Senior TLC (STLC) | Gastonia, NC | Full Time
Job Title: Accounting & Claims Specialist
Job Summary: Under the supervision of the Finance Director, the Accounting Specialist is responsible for timely accurate recording of revenue and Senior TLC claims process.
Education: Minimum of an Associate’s degree.
Experience: 2+ years Medicaid/Medicare knowledge with at least 2+ years of accounting experience in a medical practice or equivalent business office setting. Experience in a healthcare setting in an administrative role or customer service preferred.
Software: PaceLogic, Quickbooks and Claims Adjudication Software
Number and Type of Employees Supervised (optional): None
Special Training: Only act within the scope of his or her authority to practice. Meet a standardized set of competencies for the specific position description established by Senior TLC and approved by CMS before working independently.
· Provide Support for the Director of Finance in payment and reimbursement in compliance with CMS and Medicaid regulations.
· Process all Provider and Vendor claims electronically or paper claims.
· Ensure all claims are adjudicated based on contracts and authorizations. Ensure all claims are paid timely with accuracy.
· Provide weekly reports to Referrals Coordinator of unauthorized claims.
· Generate all Explanation of Benefits for providers and vendors.
· Assist with the internal audit process of claims.
· Monitor and research reason for provider overpayments and underpayments.
· Generate letters & follow-up on overpayments and underpayments.
· Ensure that all HCPCS, ICD & DME are loaded and correct as needed.
· Ensure that all authorizations are entered and attach to all claims.
· Enter all enrollment and disenrollment information in system for accuracy of payments.
· Handle and resolve claims inquiries as requested. Generate weekly payment files for approval for payment.
· Serve as back up for Staff Accountant as needed. Other duties as assigned by the Director of Finance and Staff Accountant.