Senior Medical Claims Clerk
ABOUT PATH INC.
PATH (People Acting to Help) Inc. is a comprehensive Community Behavioral Health and Intellectual Disability Center. We offer a wide of array of services and supports to meet the needs of our community in Northeast Philadelphia.
PATH regularly achieves the highest levels of accreditation including a 5 Star Provider Rating by CBH, Philadelphia’s Managed Care Entity, and recognition and awards related to our high-quality, innovative programs and staff accomplishments and contributions.
Our Mission? To Help Individuals Achieve a More Independent and Fulfilling Life.
WHY WORK AT PATH?
A Career with Meaning
At PATH, our team members are at the heart of what we do, so we work hard to give them the best reasons to work here and to stay here.
In addition to the satisfaction of making a real difference in people's lives, we offer :
- Competitive pay
- Annual increases
- Performance and longevity bonuses
- Comprehensive benefits package for staff and family
- Generous number of paid holidays, vacation, sick, and personal time
- No-cost pension plan
- Ongoing professional development opportunities, including licensure supervision
- Cutting-edge treatment facility, resources, and treatment modalities
- Opportunities for advancement and growth within the organization
- Eligible for the Federal Public Student Loan Forgiveness (PSLF) program
- Referral bonus for referring a friend who accepts employment
JOB SUMMARY :
To promote the mission of PATH to help individuals achieve a more independent and fulfilling life by being an effective team member.
The Senior Medical Claims Clerk must be able to confirm and update client eligibility, prepare and submit 837P electronic billing files with consistency and accuracy for effective submission to our guarantors.
The position must be able to download and review response files to the 837P electronic billing files, post electronic and manual payment files as received and perform all billing and cash posting tasks in a timely manner to maximize revenue and facilitate cash flow.
Additionally, the position will work with various stakeholders to provide the necessary information to resolve all billing and funding discrepancies.
PHYSICAL DEMANDS : Minimal in nature
Minimal in nature
QUALIFICATIONS :
High School Diploma. Two or more years’ experience in Medical Billing functions, preferably in a Behavioral Health non-profit environment.
Must have data entry experience with Excel, Word, and experience using medical billing software. Ability to work with numbers and systems with minimal supervision.
Experience and knowledge of Primary and Secondary insurance billing including the input of data, generation of electronic billing files and electronic and manual cash application of cash received from billings.
Possess the skills needed to interact with outside parties to collect the necessary information for the successful submission of claims to various guarantors.
SPECIFIC DUTIES :
- Use various programs (Avatar / NX, AVA, Promise / EVS, Excel, etc.) to perform all billing functions.
- Download response files for Behavioral Health 837P billing including the TA1, 999 and / or 277 files within 2 business days of the submission of the 837P file.
- Transfer, rename and store all 837P billing files and related response files electronically in the appropriate assigned folders.
- Review the TA1 and 999 files to confirm the 837P files have been accepted for adjudication by the guarantor within one business day of the file downloads.
- Download all 277 files and use the EDI Power Reader to import / export data into Excel so that the files are readable within one business day of the file downloads.
- Review the converted 277 files and work the claims on the file to resubmit claims within one week of conversion.
- Post Electronic Payment Files for all guarantors as assigned within one week of receipt and confirm posting with supervisor.
- Rebill services to Secondary Payers (CBH) as required within 1 week of the cash posting from the Primary Payer (Medicare).
Senior Claims Program Manager- Medical Malpractice
The daily diary maintains a record of claims, reserves coverage, insurance, medical and legal issues related to any pending claims. Senior Program Manager- Claims. Ability to effectively manage an individual case load of claims and supervise and monitor one claims adjuster. Maintain a rolling diary ...
Tax Associate - Work From Home - 2+Yrs Paid Tax Experience Required
As part of this position, you have the opportunity to work 100% remotely, collaborating with an exceptional team from the comfort of your home or office. By providing tax advice, full service return preparation, tax calculations, and managing product/software inquiries, you will be working toward ad...
Claims Quality Assurance Specialist - Casualty - Blue Bell, PA
Claims Quality Assurance Specialist - Casualty. As an integral member of the Claims team for our Third Party Administrator, you will ensure the overall quality of Casualty claims handling in the assigned states and will provide technical guidance and expertise to analyze and direct major losses to a...
Resolution Claims Adjuster III
Resolution Claims Adjuster III. The Resolution Adjuster is responsible for prompt and independent review of insurance claims, through effective research, evaluation, investigation, negotiation and interaction with insureds, claimants, and counsel. The Adjuster is assigned to mid-sized and / or mid-c...
Staff Property Field Adjuster (Daily Claims)
The Field Adjuster will investigate and evaluate daily property claims for clients pursuant to client and company direction. Understands insurance coverage and applies appropriate claims practices to resolve claims in alignment with company guidelines. Handles all assigned claims promptly and effect...
Remote Administrative Assistant (No Experience Required) - Earn $25/hr-$45/hr, Full-Time/Part-Time, Flexible hours
...
Surety Claims Examiner (Hybrid or Remote)
We currently have an opportunity for a Surety Claims Examiner to join our Surety team in our Blue Bell, PA offices or remotely nationwide. This position is responsible for handling and resolving complex and/or specialized assigned claims through investigation, evaluation and disposition. Independent...
Claims Specialist Surety
The Surety Claims Specialist is a critical role in our growing Claims Department, and will be responsible to direct all aspects of in-house file handling of Performance Bonds and Payment Bonds and Commercial bonds. The Claims Specialist will direct the adjusting and litigation process, strategically...
Senior Claims Specialist-TPA Oversight (Hybrid)
The REH TPA-Oversight Senior Claim Specialist is responsible for investigating and settling high exposure, high risk claims while ensuring a high level of customer service and claim file quality while providing oversight and guidance to our TPA partners. A minimum of 3-5 years experience handling ca...
Sr. Claims Examiner
The auto liability claims department is looking for an experienced senior-level examiner to handle moderately complex and high exposure claims within our organization. Evaluate, negotiate, and settle assigned property damage or bodily injury claims within authority granted, or seek authority for tho...