What are the responsibilities and job description for the Claims Representative position at St. Paul's Senior Services?
This will be a remote position.
Basic Function: Tracks, processes, and adjudicates PACE claims for all assigned providers/locations. Ensures proper, adequate, and timely payments to outside providers.
Essential Duties and Responsibilities:
Confirms contracted rate per billing and contract guidelines. Determines accurate payment and adjudicates claims through the claims system.
Verifies authorization for services provided. Work with PACE team for any claims requested without authorizations.
Communicates with internal PACE team and outside provider billing teams regarding claims billing, pricing, and authorization issues.
Maintains detailed documentation in the patient account record of all billing activities. Maintains documentation of claims processed as part of the claim’s reconciliation process.
Prepares and completes claims adjudication for PACE providers.
Researches, analyzes and reconciles Medicare/Medicaid/Commercial billing and reimbursement practices.
Maintains detailed documentation in the claims account record of all billing activities. Maintains
documentation of claims processed as part of the daily claims count process.
Consults with appropriate parties to resolve claims processing issues. Reviews claims for proper billing
practices and reimbursement.
Minimum Qualifications:
Within scope of job, requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
Must be able to work in a fast-paced environment.
Education and/or Experience:
High School diploma equivalency OR 1 year of applicable cumulative job specific experience required.
Previous experience with healthcare billing practices including but not limited to Medicare, managed care, and/or PACE is preferred
Salary : $21 - $30
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