Claims Specialist

Claims Specialist

Under the supervision of the Finance Manager, the PACE Southeast Michigan (PACE SEMI) Claims Specialist is responsible for the performance of a variety of functions related to processing and analyzing medical claims.

PRINCIPLE DUTIES AND RESPONSIBILITIES :

• Process all medical claims according to vendor contracts and Medicare / Medicaid guidelines and internal authorizations.
• Manages collection and submission of risk adjustment and encounter data to Medicare.
• Analyzes, maintains and updates computer programs to provide accurate financial data to various departments.
• Keep abreast of governmental regulations pertaining to Medicare / Medicaid reimbursement.
• Other duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES :

WORKING CONDITIONS :

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.