Eligibility�Claims�Specialist�

Coastal Horizons Center•Wilmington, NC

14h•Onsite

About The Position

At Coastal Horizons, our mission is to provide a continuum of professional services to promote healthier lives, stronger families, and safer communities. We are currently seeking a motivated and passionate Eligibility Claims Specialist to join our dynamic team. If you're looking for an opportunity to make a difference, we invite you to explore the exciting positions available with us. The Eligibility Denial Specialist is responsible for providing financial, administrative and clerical services to ensure accuracy and efficiency of Coastal Horizons Center's billing operations as it relates to the accounts receivable. This position will be responsible for following up on all eligibility claim denials and will work directly with our payers and providers to rectify denials so that they can be accurately adjusted for payment.

Requirements

High school diploma or GED with 2-3 years' experience related to responsibilities specified.
Familiar with billing concepts, practices, and procedures.
Knowledge of health care billing systems, procedures, documentation, and standards.
Familiar with DSM and ICD-10 codes
Previous experience with NC Medicaid and billing commercial payers
Knowledge of billing/insurance terminology
Basic computer skills including Excel
Strong organizational, problem solving and analytical skills.
Working knowledge of cash management principles and/or procedures.
Proficient with MS Office (word, excel, power point, access); excellent with spreadsheet and medical billing software applications.

Responsibilities

Thoroughly review pay source documentation and communicate directly with the appropriate staff when errors need to be corrected to receive payment.
Reprocess claims within EMR and/or directly on the payer’s website to assure timely receipt of payment.
Reconcile claims weekly to ensure receipt of claim by the payer for all eligibility related denials.
Encourages teamwork, energetic and motivates teams and individuals.
Maintains a cooperative work environment to foster Coastal Horizons Center's missions and values and to meet goals.
Performs miscellaneous job-related duties as assigned.