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Claims Specialist
Claims SpecialistPACE Southeast Michigan • Southfield, MI, US
Claims Specialist

Claims Specialist

PACE Southeast Michigan • Southfield, MI, US
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Claims Specialist

Under the supervision of the Finance Manager, the PACE Southeast Michigan (PACE SEMI) Claims Specialist is responsible for the performance of a variety of functions related to processing and analyzing medical claims.

PRINCIPLE DUTIES AND RESPONSIBILITIES :

  • Process all medical claims according to vendor contracts and Medicare / Medicaid guidelines and internal authorizations.
  • Manages collection and submission of risk adjustment and encounter data to Medicare.
  • Analyzes, maintains and updates computer programs to provide accurate financial data to various departments.
  • Keep abreast of governmental regulations pertaining to Medicare / Medicaid reimbursement.
  • Other duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES :

  • Must have 2 years' experience in claims processing.
  • Bachelor's degree in Business Administration with an Accounting or Finance major required.
  • Basic knowledge of computer programming to learn PACE SEMI's financial system and voluminous governmental regulations.
  • Visual ability required in the analysis of reports, contracts, and other documents.
  • Manual dexterity required to prepare and tabulate data and write reports.
  • Must meet or exceed core customer service responsibilities, standards and behaviors as outlined and summarized below :
  • Communication
  • Ownership
  • Confidentiality
  • Understanding
  • Motivation
  • Sensitivity
  • Excellence
  • Team work
  • Respect
  • Self-directed, flexible and committed to the team concept.
  • Demonstrated teamwork, initiative and a willingness to learn.
  • Maintains customer service skills as provided through on-going training and in-services.
  • Completes all annual, mandatory in-service training and screening, including but not limited to : infections control, TB testing, Flu shot, Emergency Preparedness, HIPAA, Ergonomics and Participant Rights.
  • Possesses the ability to establish and maintain interpersonal and interdependence relationships.

    • WORKING CONDITIONS :

  • An office setting which may require some local travel to other PACE centers.
  • Normal office environment with minimal exposure to noise, dust or extreme temperatures.

    • Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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    Claim Specialist • Southfield, MI, US