Managed Care Claims Validator / Biller
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About The Position
Since 1984, the CommuniCare Family of Companies has been committed to delivering exceptional person-centered care as a national leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 150 skilled nursing, assisted living, independent living, behavioral health, and long-term care facilities deliver sophisticated and transformative care to nearly 16,000 residents and patients at any given time. CommuniCare employs more than 19,000 employees across six states (Ohio, Indiana, Maryland, Virginia, West Virginia, Pennsylvania). Due to continued growth, CommuniCare Health Services is currently recruiting for a Claims Validator / Biller to support our Central Billing Office team. The position of Managed Care Claims Validator / Biller is responsible for accurate and timely filing of all managed care claims on their assigned caseload with the appropriate insurance carrier. The position requires working with the CBO cash collections team, CBO cash posting team, Business Office Manager, Regional Director of Finance, MDS, Case Management, and others. The CBO claims validation staff will strive to always be the expert and resource to others for all aspects of the UB04 and 1500 claim forms. Claim validators must be proficient with all coding required on claims for SNF billing. To ensure the highest possibility of billing a clean initial claim, the claim information requires validation against the data located within the PCC tabs and documents. The PCC data to validate on the claim may be contained within areas of the Census, AR Insurance, authorization documentation, and eligibility. The claims validator will play a role in triple check with the facility to ensure all information confirmed accurate during triple check process is also accurate on the claim. This will be done according to an outlined process, that could change or evolve at times, that will allow for proper documentation and will ensure that all necessary data was verified prior to billing.
