Claims Specialist

Annual Salary Range: $46,465 - $58,081

This is a non-exempt (hourly) position. Pay rates are based on education, skill, experience level and internal equity

Position Summary

Performs thorough review, and transmission of healthcare claims, conducts financial analysis to ensure compliance with established local, state, and governmental billing and coding guidelines, thorough understanding of third-party financial reimbursement, payment posting, and reconciliation policies. This position, under general supervision, is to apply laws, rules, regulations, and policies to complex paraprofessional work.

Essential Functions

• Analyze claim data to ensure proper reimbursement
• Prepare, review, and submit claim payments to financial management system (live check within 24 hours, Online Credit Card payments by next business day, EFT (Electronic Funds Transfer) deposits within 72 hours
• Monitor and analyze all referred accounts to determine categorization, level of the appeal process, and personally handle complex appeal responses for private health care and government-specific denials
• Record financial and statistical data within payment receipt database and accurately balance financial transaction reports
• Performs accurate financial clearance review along with a comprehensive analysis of client/patient and payer specific benefit and liability
• Develop training materials and implement quality assurance processes to serve as a resource to and from internal departments, financial institutions, and external agencies
• Monitor and analyze collection of past due accounts, follow-up on payment arrangements, assign delinquent account as outlined in FIS-02_Uncollectible Account Policy
• Serve as a liaison to public health and clinical administration for financial and statistical claim data
• Participate in special projects related to financial activities
• May assist in monitoring of budgets for fiscal compliance
• Given the wide range of staff involved in the revenue cycle process, the incumbent must be able to work collegially and respond efficiently and effectively
  
  

Minimum Qualifications

Experience: Minimum of three years of directly related experience.

Education: High School Diploma or equivalent and two years of basic accounting coursework.

Combination of relevant education and relevant experience accepted: Yes

Licenses and Certifications

May require a valid North Carolina or South Carolina Driver's License

Preferred Qualifications

Associate degree in accounting or a related field

Knowledge, Skills, And Abilities

Knowledge of

• Revenue Cycle principles
• Federal, State, and local Healthcare Coding and Billing rules and regulations
• Accounting principles
• Medical terminology, ICD-10, CPT, and HCPCS codes
• Budgetary principles
• Arithmetic, algebra, geometry, calculus, statistics, and their applications
• The structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar
• Principles and processes for providing customer service, including customer needs assessment, meeting quality standards for services, and evaluating customer satisfaction
  
  

Skills

• Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times
• Understanding written sentences and paragraphs in work related documents
• Talking to others to convey information effectively
• Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems
• Using mathematics to solve problems
  
  

Abilities

• Applied Learning – Assimilating and applying new job-related information in a timely manner.
• Communication – Clearly conveying information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain information required
• Decision Making – Identifying and understanding issues, problems and opportunities; comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints and probably consequences
  
  

Computer Skills

Proficient in various computer applications including Microsoft Office Suite

REASONABLE ACCOMMODATIONS STATEMENT

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

DISCLAIMER STATEMENT

This is not intended to be an all-inclusive list of job-related responsibilities, duties, skills, requirements or working conditions. Other duties may be assigned based on business need and the supervisor’s request. Mecklenburg County reserves the right to revise the job description at any time. Designated positions may be required to assist in emergency and/or disaster situations.