Claims representative Jobs in Fayetteville nc

LOCATION : Remote – This is a home based, virtual position that operates on US Eastern Standard time within the hours of 8 : 30am-5 : 00pm EST. Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL.

GENERAL STATEMENT OF JOB

The Claims Supervisor administers all accounting functions related to a designated area of physical and behavioral health medical claims processing to ensure providers receive timely and accurate payment. Supervision of claims adjudication through continuous monitoring and quality control measures. Finalize claims processed electronically for payment and reviewing claim adjudication results for both Title XIX and non-title XIX claims, payment, and denial patterns, ensuring adjudication accuracy in the claims processing system, adhering to policy and procedures, review and follow up of provider billing concerns, coordination among and follow up, and assure the expected level of customer service to Vaya’s network of providers.

ESSENTIAL JOB FUNCTIONS

Administrative Supervision and Functions :

• Oversight of claims staff for claims adjudication activities; provide technical assistance and technical training to claims staff, keeps staff abreast of all changes involving claims adjudication and policies / procedures
• Ensure claims adjudication policies and procedures and workflows are current.
• Provide support to ensure timely resolution of provider concerns related to claims processing.
• supervise the claims specialists within the MIS department.
• Coordinate the recruitment / selection of new claims specialists and recommend new hires.
• Provide ongoing feedback to staff regarding job performance, performance evaluations, disciplinary action, approving and coordinating leave, coordinating work schedules, signing off and approving timesheets and travel forms.
• Conduct regularly scheduled staff meetings with all staff reporting to this position.

Claims Adjudication :

Customer Service :

Compliance and Quality Assurance :

KNOWLEDGE, SKILL & ABILITIES :

QUALIFICATIONS & EDUCATION REQUIREMENTS

High school diploma or GED required. Associate degree in business administration, health administration, communications or related field preferred.

PHYSICAL REQUIREMENTS :

RESIDENCY REQUIREMENT : The person in this position must live in NC, SC, GA, TN, VA, MD, or FL.

SALARY :   Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.