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Claims & Accounting Specialist

Senior TLC (STLC) | Gastonia, NC | Full Time

Job Description

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.

Key Responsibilities:

·        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.


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