Claims Specialist

Job Number 55494
Posted 6/13/2018
Account EMHS
Department PAS - Billing/Cash Control
Location EMHS - Cianchette Building, Brewer, ME 04412
Schedule Regular Full-time
Shift Day
Hours 8:00am-4:30pm
Job Details Job Summary
This position is responsible for accurate claims submission to all applicable payers of the EMHS Patient Account Services in a Centralized Business Office environment. This position is responsible for the submission of claims in accordance with regulatory and contractual obligations. This position requires a thorough understanding of the requirements of the Centers for Medicare & Medicaid Services (CMS) claim forms; CMS-1500 and CMS-1450 (UB04). In addition, this position is held accountable to adhere to the policies, procedures, and applicable laws; including metrics related to productivity and quality. This position works closely with a team of Claim Specialists to analyze and take corrective action on claims to ensure an optimum revenue cycle workflow.

Education and Experience
•High school diploma or equivalent required. Associate's degree preferred.
•1+ year of healthcare claims billing or coding experience preferred.

Required Minimum Knowledge, Skills and Abilities
•Detailed knowledge of billing rules and regulations in a healthcare setting (Government and/or non-Government payers); multiple hospitals/physician practices preferred.
•Knowledge of medical terminology, Current Procedural Terminology (CPT), and International Classification of Disease (ICD) preferred.
•Must possess strong problem solving skills.
•Ensures all claim functions performed are compliant with applicable laws and regulations.
•Excellent professional communication skills; both oral and written.
•Ability to understand payer edits and all applicable billing rules and regulations to facilitate decision making.
•Proficient with Microsoft business applications.
•Experience with EMHS patient accounting software is preferred.
•Customer oriented.
•Demonstrated ability to work independently and collaboratively.

Essential Functions

•Actively participate in team huddles and meetings by way of sharing knowledge, requesting information, and recommending process improvements.

•Complete all returned requests from other departments each day.
•Work closely by way of problem solving with peers and leaders to address payer claim issues or changes that directly impact the accounts receivable.

•Resolve claim edits specific to each payer's requirements on a daily basis.
•Take necessary AR adjustments in accordance with the department's adjustment policy.
•Meet or exceed the EMHS performance standards as it relates to quality and productivity.

•Complete electronic payer rejections on a daily basis.
•Request relevant information from appropriate revenue cycle and clinical departments as required by payer.
•Ensure assigned discharged not final billed (DNFB) and final billed not submitted (FBNS) claims are not delinquent and are escalated timely.
•Advises management of claim issues which may require attention in a timely manner.
•Ensure all functions related to claims submission supports the team goals and objectives as well as EMHS's financial performance objectives.
•Thoroughly understand the department's key performance indicators.

•Maintain the knowledge of payer billing policies; complete AAHAM or other healthcare related webinars.
•Attend internal education sessions to enhance or gain new skills.

•Demonstrate departmental desire to provide community benefits by way of charitable events or contribution outside the four walls of the department

Organizational Values
Passion: We demonstrate a passion for caring for others and the pursuit of service excellence in all that we do.
Integrity: We commit to the highest standards of behavior and doing the correct thing for the right reasons.
Partnership: Working together in collaboration and teamwork is more powerful than working alone.
Accountability: We take a responsible and disciplined approach to achieving our priorities and responding to an ever changing environment.
Innovation: We are capable of extraordinary creativity and are willing to explore new ideas to achieve our healthcare mission.
Respect: We respect the dignity, worth and rights of others.

Physical Demands
•Sedentary: Exerting up to 10 lbs. occasionally, sitting most of the time, and only brief periods of standing and walking.
•Requires the ability to travel to member organizations as needed

Note: the duties listed above reflect the majority of the essential duties of this job and does not, nor is it intended to, reflect all essential duties that may be required for an incumbent in this job to perform.

Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.