Claims System Administrator

Volunteers of America National Services is seeking a Claims System Administrator to round out our Claims team. This new role is a key contributor to the overall success of the PACE Support Team.

About the Job:

Maintain all aspects of the Claims processing system including: claims adjudication system modules, provider/vendor set up, contracts and fee schedules, codes and types, Provider Portal, user roles and access, and other data, infrastructure, maintenance and security modules.

Schedule: M-F 8:00 AM-4:30 PM (Fully Remote)

Salary: $80,000-$95,000 (Commensurate with experience)

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)

Essentials:

Medical Claims Processing System Maintenance and Support
• System Optimization: Manage and monitor medical claims processing system and associated infrastructure, ensuring high availability, optimal performance, and compliance with PACE, federal and state, and HIPAA regulations.
• Upgrades and Security: Works closely with claims processing system vendor representative for system upgrades and security updates to maintain system integrity, prevent downtime, and safeguard patient information.
• Testing: Develop and execute test plans for system upgrades, patches, and new implementations to ensure functionality and data integrity.
• Issue Resolution: Diagnose and resolve system and network issues related to claims processing promptly, minimizing disruptions to claims workflows. Works with claims processing system vendor to submit support tickets as needed and ensure timely issue resolution.
Application Support and Integration
• Claims Processing System Maintenance: Provide support and maintenance for specialized claims processing applications, including updates, troubleshooting, and user support.
• Third-Party Integrations: Oversee integrations with third-party vendors (i.e. EDI gateway and transaction management), coordinating with vendors and ensuring data accuracy and security through EDI and PACE Portal claims submission.
Data Security and Compliance
• Healthcare Compliance: Implement and maintain security protocols to protect sensitive patient and claims data in accordance with HIPAA and other relevant regulations.
• Data Integrity: Monitor and enforce data integrity measures for claims processing, ensuring accurate record-keeping and secure access controls.
• Contingency Planning: Work with claims processing system vendor to ensure system availability and data protection in emergencies.
• Ongoing Compliance Monitoring: Stay updated on changes in healthcare regulations and guidelines to ensure the system complies with all relevant laws and standards.
Documentation and Reporting
• System Documentation: Maintain detailed documentation for claims processing infrastructure, including system configurations, procedures, and troubleshooting guides.
• Compliance Reporting: Prepare and maintain reports for audits and compliance reviews, tracking system performance, security updates, and issue resolutions.
• Custom Reporting: Develop and generate custom reports to support management decision-making and operational efficiency, offering insights into system performance and claims processing metrics.
Performance Monitoring and Continuous Improvement
• System Monitoring: Utilize specialized audit tools to ensure optimal performance of claims processing systems, identifying trends, anomalies and opportunities for system enhancements and process improvements.
• Quality Assurance (QA): Implement QA processes to maintain high standards in system operations and outputs.
• Scalability Planning: Collaborate with management to plan system expansions or upgrades in line with company growth and technology advancements in the healthcare industry.
User Access and Support
• User Roles and Access Management: Configure, manage, and regularly review user roles and access permissions to ensure appropriate access control, prevent unauthorized use, and maintain compliance with HIPAA and organizational policies.
• User Support: Support users to ensure staff are proficient in using the claims processing system.
• Technical Support: Provide ongoing technical support to users, addressing system-related inquiries and issues promptly, coordinating resolution directly with vendor representative as needed.
Performs other duties as required or requested.

Required Qualifications:

• Education: Bachelor’s or Associate’s Degree in Systems/Informational Technology or a related field.
• Experience: Minimum 3-5 years in a HealthCare Systems Administration role required.
• Ability to communicate and work effectively with various levels of facility and VOA/VOANS staff and providers.
• Analytical and organizational ability.
• Excellent problem-solving and critical thinking; ability to identify the underlying causes of issues in claims processing, such as pending claims/errors, system holds, provider/vendor set up and pricing, and propose effective solutions.
• Preferred experience with SQL Query reporting.

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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Salary : $80,000 - $95,000