Healthcare Customer Service Specialist Hybrid

AcuteCare Health System LLC•Mooresville, NC

13h•Hybrid

About The Position

BoldAge PACE is seeking a Healthcare Customer Support Specialist to respond to phone calls from participants, families, insurance representatives, and internal staff regarding questions or concerns. This role involves making calls on participant statements to ensure claims are processed, evaluating claims, administering prompt and accurate resolution of claim issues, supporting the claims submission process, and upholding the organization’s standards for exceptional customer service and compliance within the PACE program. BoldAge PACE is an all-inclusive program of care, personalized to meet the individual health and well-being needs of our participants, focusing on helping older adults live meaningful, independent lives at home with grace and dignity by listening to their needs and desires.

Requirements

High school diploma or GED required
1–2 years of experience in medical billing, claims processing, or healthcare customer service, with familiarity in Medicare/Medicaid billing.
Must have reliable transportation, a valid driver's license, and the minimum state required liability auto insurance.
Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact.
Employment with BoldAge PACE is contingent upon successful completion of post-offer pre-employment screening and verification processes.

Nice To Haves

Associate's degree in health administration, Billing, or related field preferred.
Prior PACE or long-term care experience is strongly preferred.

Responsibilities

Respond promptly and professionally to participants, family, and insurance inquiries related to claims and billing.
Review and verify participant insurance coverage and eligibility.
Assist in processing claims accurately and within the time frames established by management using the claims processing system.
Demonstrate a thorough understanding of matching appropriate authorizations to claims and tracking missing authorizations.
Master and utilize a thorough understanding of such items as HCPC modifiers and their effect on reimbursement, coordination of benefits (COB), appropriate billing guidelines for anesthesia claims, hospital stays, ambulance and other services.
Communicate with internal personnel, vendors, providers, and billing representatives about claim-related issues.
Work as a team in resolving claims issues or special projects
Report any inconsistencies that are identified in regard to internal department policies and procedures to management
Provide administrative support including data entry, scanning, and filing as needed.
Perform other duties as assigned.
Maintain confidentiality and comply with HIPAA and PACE program requirements.
Participate in department meetings, training, and process improvement initiatives.