Claims Specialist presso PACE Southeast Michigan

CLAIMS SPECIALIST

Under the supervision of the Finance Manager, the PACE Southeast Michigan (PACE SEMI) Claims Specialist is responsible for the performance of a variety of functions related to processing and analyzing medical claims. 

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Process all medical claims according to vendor contracts and Medicare/Medicaid guidelines and internal authorizations.
• Manages collection and submission of risk adjustment and encounter data to Medicare.
• Analyzes, maintains and updates computer programs to provide accurate financial data to various departments.
• Keep abreast of governmental regulations pertaining to Medicare/Medicaid reimbursement.
• Other duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Must have 2 years’ experience in claims processing.
• Bachelor’s degree in Business Administration with an Accounting or Finance major required. 
• Basic knowledge of computer programming to learn PACE SEMI’s financial system and voluminous governmental regulations.
• Visual ability required in the analysis of reports, contracts, and other documents. 
• Manual dexterity required to prepare and tabulate data and write reports.
• Must meet or exceed core customer service responsibilities, standards and behaviors as outlined and summarized below:
  • Communication
  • Ownership
  • Confidentiality 
  • Understanding
  • Motivation
  • Sensitivity
  • Excellence
  • Team work
  • Respect
• Self-directed, flexible and committed to the team concept.
• Demonstrated teamwork, initiative and a willingness to learn.
• Maintains customer service skills as provided through on-going training and in-services.
• Completes all annual, mandatory in-service training and screening, including but not limited to: infections control, TB testing, Flu shot, Emergency Preparedness, HIPAA, Ergonomics and Participant Rights.
• Possesses the ability to establish and maintain interpersonal and interdependence relationships.

WORKING CONDITIONS:

• An office setting which may require some local travel to other PACE centers.
• Normal office environment with minimal exposure to noise, dust or extreme temperatures.