Claims Processor

Volunteers of America National Services is seeking a Claims Clerk to work along side our PACE team in our Eden Prairie, MN Support Center location: 7485 Office Ridge Cir, Eden Prairie, MN 55344.

Hourly Wage: $22.00-27.00 per hour based on experience

About the Job:

To maintain integrity of the claims adjudication system across all PACE programs and process requests in a timely and efficiently manner

Benefit Highlights:

• 403(b) Retirement Plan
• Career scholarships;
• Continuing career education and leadership programs;
• Dental and Vision Insurance
• Paid Time Off (Vacation, Holiday & Sick Days)

Schedule: M-F 8:00 AM-5:00 PM (Fully onsite)

Essentials:

• Complete accurate and timely daily review of PACE paper claims and claims correspondence received in the Eden Prairie, MN office or via email or fax, ensuring to track and document the received date and keeping files organized for easy retrieval and reference. Validate completeness of claim submissions, verifying all required fields are populated.
• Assist in claims processing and clerical office functions, including claim handling, participant bills, and provider payment processing. Scan and upload claims and invoices and enter data into the claims processing system accurately, ensuring all required fields are populated.
• Serve as point of contact for external and internal inquiries regarding claim payments, denials, and explanations of payment (EOP). Answer inbound calls and respond accurately, timely and professionally to all other correspondences. Collaborate with internal teams to address claims-related inquiries.
• Work the Customer Service Request module in the claims processing system, investigating and resolving provider inquiries and concerns and escalating unresolved issues as needed. Work weekly check processing report, reviewing for accuracy, printing checks and EOPs, stuffing envelopes, and mailing to providers. Update claims processing system and maintain productivity goals.
• Assist in reviewing and verifying weekly Precheck Registers for accuracy, ensuring correct payment amounts before final processing. Coordinate with Claims Adjudicators to resolve payment discrepancies prior to printing and mailing.
• Ensure complete and accurate processing of claim payments and work with PACE System Administrator on system updates. Assist with troubleshooting system issues, identifying root causes of claim denials, and supporting system enhancements to improve workflow efficiency.
• Maintain accurate records and documentation of claims activities and communication.
• Conduct routine and random claims audits to ensure accuracy of the claims processing system, detect errors, and identify trends in processing discrepancies. Work with the Claims Manager to develop strategies for process improvement.
• Assist Claims Adjudicators in the processing of claims and other tasks as identified.
• Process and track provider claim appeals, verifying documentation and facilitating resolution. Maintain detailed records of appeals and ensure timely follow-up in accordance with regulatory guidelines. Maintain knowledge of PACE, CMS, and state Medicaid policies and claims guidelines. Ensure compliance with federal and state regulations related to claims processing. Participate in compliance training and recommend policy updates to improve adherence.
• Communicate to and prepare reports for the Claims Manager and Director of Health Plan Operations. Maintain comprehensive documentation for audit and compliance purposes.
• Assist in identifying opportunities to improve claims processing efficiency, reduce errors, and streamline workflows. Participate in training initiatives to enhance understanding of claims procedures.
• Work closely with Provider Relations, Contracting, Accounting, and Health Information Systems teams to ensure seamless communication and issue resolution related to claims processing.
• Assist with other duties and projects as assigned.

Required Qualifications:

• High School Diploma required, Associate’s degree or higher preferred.
• Experience with medical claims and administrative duties, 3-5 years required.
• Experience in claims processing, 3-5 years preferred.
• Experience with claim appeals and dispute resolution preferred.
• Excellent communication skills to interact professionally and work effectively with various levels of facility and VOA/VOANS staff, providers and vendors.

VOANS, a subsidiary of Volunteers of America, provides affordable housing and healthcare services in over 40 states and Puerto Rico. The organization employs over 2,000 professionals who provide high quality services and care to clients. As one of the largest non-profit affordable housing owners/operators in the nation, VOANS has over 240 properties and approximately 14,500 affordable housing units. VOANS also operates over forty-six (46) senior healthcare programs, including skilled nursing, assisted living, home health care, adult day, and Program for All Inclusive Care for the Elderly (PACE).

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