Claims Specialist

Easter Seals Blake Foundation•Casa Grande, AZ

12d

About The Position

The Claims Specialist works with insurance carriers to ensure timely reimbursement of billed charges and claims. The position reconciles accounts receivable from the customer level to the general ledger, reviews revenue postings, prepares adjustment entries, maintains receivable payors in the EHR system, and addresses reimbursement issues with assigned payors. The role collaborates with Medical Billing, monitors denied or rejected billing resubmissions, prepares payor status reports for management, researches revenue transactions, and supports audit preparation and collections. The Specialist also recommends accounts receivable process improvements, participates in professional development and meetings, and communicates with agency contacts, members, and external agencies. The role is based in a normal office environment with regular employee and public interaction.

Requirements

Associate’s degree in Accounting or Business Administration, or a high school diploma/GED with three years of accounts receivable experience.
Must be at least 18 years of age.
Current, unrestricted Arizona driver’s license, with no more than two minor moving violations or one accident within the past three years.
Three years of driving experience.
Must pass a criminal background check.
Ability to obtain and maintain an Arizona DPS Level 1 fingerprint clearance card.
Ability to establish and maintain a collaborative team atmosphere.
Ability to maintain up-to-date guidelines in response to industry and payor demands.
Must be self-directed and sensitive to cultural and linguistic diversity.
Excellent customer service skills, including in stressful situations.
Professional appearance, communication, and actions.
Excellent interpersonal and written communication skills.
High level of computer proficiency.
Able to lift normal office equipment and materials up to 25 pounds.
Visual acuity to read information from computer screens and forms.
Ability to speak clearly and hear for in-person, phone, and electronic communications.
Manual dexterity for typing and writing.
Ability to stoop, squat, reach, pull, push, stretch, ascend and descend stairs, and stand and sit for long periods.
May be required to work additional hours or days depending on circumstances.

Nice To Haves

Bilingual in Spanish.

Responsibilities

Reconcile accounts receivable from the customer level to the general ledger and review revenue postings for accuracy as needed.
Review and prepare adjustment entries, including debit memos, credit memos, and journal entries.
Review the accounts receivable aging report weekly.
Review and maintain all receivable payors in the EHR system.
Write appeals and correspond with assigned payors about discovered reimbursement issues.
Work closely with Medical Billing to ensure funds are received in a timely manner.
Monitor resubmission of denied and rejected billings, including medical claims.
Prepare weekly accounts receivable status reports for assigned payors for management.
Research revenue transactions from financial statements for management.
Review files and financial data in preparation for the annual audit.
Assist with collections duties as needed.
Recommend accounts receivable process improvements.
Participate in ongoing professional development and meetings.
Maintain comprehensive communication with agency contacts, members, and external agencies.
Model professional standards and ethics in accordance with the EBF Code of Conduct, Strategic Plan, Mission, and Vision.
Perform other duties as assigned.