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Claims Payment Specialist

Home Health | Paris, TX | Full Time

Job Description

TITLE:  CLAIMS PAYMENT Specialist (CPS)

 

REPORTS TO: Clerical Supervisor

 

MINIMUM QUALIFICATIONS

 

EDUCATION/TRAINING/EXPERIENCE

Must have previous MS Word and Excel experience, preferably in home health or similar operation. Able to use a variety of software applications. Computer proficiency.
Prefer a minimum of one-year practical experience, or graduation from a one or two year business college. Minimum requirement of high school diploma or G.E.D.
Prefer ability to type at least 50 words per minute. Has ability to use personal computer, copier, and facsimile machine.
Prefer knowledge of medical terminology.

 

CHARACTERISTICS

Must be highly attentive to details and accuracy.
Must be able to be assertive in a productive and cooperative way with authority figures, e.g. physician’s offices while maintaining excellent rapport and customer service.
Must have excellent organizational, time management, communication, interpersonal and phone skills.
Must be tenacious in the pursuit of claims in a professional manner.
Must be flexible and cooperative in fulfilling all obligations.
Must have a positive attitude.

 

SUMMARY OF JOB RESPONSIBILITIES

The primary objective for the CPS is to see all claims through to the billing stage from the time it becomes a claim. This will include being responsible for all aspects of every claim. Thoroughly examining all claims prior to releasing them for billing. Ensuring any claims that cannot be released immediately are monitored and pursued as necessary to see the claim through to billing.  The CPS will be responsible for completing any necessary tasks to obtain all items needed for adequate billing. This will require the CPS to work closely with a variety of entities both inside and outside of the company as necessary to complete any tasks required to release claims for billing.

 

RESPONSIBILITIES AND DUTIES

Promotes a positive work environment by consistently modeling in a positive way, agency philosophy, mission, values, and standards of care, and providing a professional role model for other staff. Processes and thoroughly inspects each claim as it is received.  Actively participates in obtaining every item necessary to release all claims to billing in a timely manner. Maintains and monitors all held claims while actively pursuing all avenues for resolve for every held claim on a regular basis. Keeps up with workflow in a timely manner by addressing the tasks periodically throughout each day. Coordinate with physicians, hospitalists, Directors of Nursing, Regional Directors, Billers, Billing Supervisors, Admission Coordinators, Regional Admission Coordinators, Face to Face Coordinators and any other parties necessary to obtain any items needed to release claims for billing. Attach documents to the patient electronic record as necessary to clear claims. Enter all personal non-visit activity for approval daily.

 

Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities and will be directed by their Clerical Supervisor as the need arises.

 

WORKING CONDITIONS

General office with prolonged periods of computer usage
Frequent telephone activity

This position has been designated Class III office position (see Infection/Exposure Control Plan). Employees performing Class III office position duties are not at risk for exposure to blood borne pathogens and other potentially infectious materials. All Class III office position employees will not be offered Hepatitis B vaccination.

 

PHYSICAL REQUIREMENTS

Visual/hearing ability sufficient to comprehend written/verbal communication. Ability to effectively deal with stress.

 

CONTINUING EDUCATION REQUIREMENTS

Agency personnel are expected to participate in appropriate continuing education as may be requested and/or required by their immediate supervisor. In addition, agency personnel are expected to accept personal responsibility for other educational activities to enhance job related skills and abilities. All agency personnel must attend mandatory educational programs.