Claims Processing Specialist

Position Description

The Billing Coordinator is a member of the Claims Department and is responsible for accurately processing and submitting claims to the appropriate payers for services provided to Blessings4Ever Home Care Agency consumers. The position works closely with Claims, Consumer Authorization and Eligibility, Payroll, Care Management, and management to identify and resolve billing discrepancies, maintain accurate claim documentation and tracking, and support timely reimbursement. The Billing Coordinator is also responsible for generating and submitting claim batches for payment processing.

Primary Responsibilities:

• Use HHAeXchange to prepare, review, process, and submit claims while maintaining accuracy and efficiency.
• Review consumer and visit information for completeness and accuracy prior to claim submission, including visit verification.
• Generate and submit claim batches to the appropriate payers for processing and payment.
• Document and maintain complete and accurate billing, claims, and tracking records.
• Monitor claims for missing, incomplete, or late documentation and promptly notify the appropriate management team members of items that may delay claim processing.
• Research billing discrepancies, rejected claims, and other claim-related concerns and work with the Claims Specialist and/or management toward resolution.
• Collaborate with the Consumer Authorization and Eligibility Coordinator to resolve discrepancies involving eligibility, authorizations, claims, or consumer discharge status.
• Collaborate with Payroll and Care Managers to ensure PCA timesheets and supporting documentation are accurate and contain the information necessary for claims processing
• Assist with billing for consumers processed through the DPW/Promise system.
• Maintain confidentiality and handle consumer, caregiver, and billing information in accordance with organizational policies and applicable regulatory requirements.
• Communicate professionally with internal departments and other parties regarding billing documentation and claim-related issues.
• Perform other claims- and billing-related duties as assigned based on departmental and business needs.
• Perform additional duties as assigned by the Operations Manager.

Primary Responsibilities:

• Use HHAeXchange to prepare, review, process, and submit claims while maintaining accuracy and efficiency.
• Review consumer and visit information for completeness and accuracy prior to claim submission, including visit verification.
• Generate and submit claim batches to the appropriate payers for processing and payment.
• Document and maintain complete and accurate billing, claims, and tracking records.
• Monitor claims for missing, incomplete, or late documentation and promptly notify the appropriate management team members of items that may delay claim processing.
• Research billing discrepancies, rejected claims, and other claim-related concerns and work with the Claims Specialist and/or management toward resolution.
• Collaborate with the Consumer Authorization and Eligibility Coordinator to resolve discrepancies involving eligibility, authorizations, claims, or consumer discharge status.
• Collaborate with Payroll and Care Managers to ensure PCA timesheets and supporting documentation are accurate and contain the information necessary for claims processing
• Assist with billing for consumers processed through the DPW/Promise system.
• Maintain confidentiality and handle consumer, caregiver, and billing information in accordance with organizational policies and applicable regulatory requirements.
• Communicate professionally with internal departments and other parties regarding billing documentation and claim-related issues.
• Perform other claims- and billing-related duties as assigned based on departmental and business needs.
• Perform additional duties as assigned by the Operations Manager.