Claims Management Specialist

Location: South Bend
Department: Administration
FLSA Status: Non-Exempt
Job Type: Full Time

JOB SUMMARY

This full-time position is responsible for assisting with various types of billing including Medicaid Waiver, Waiver Intake, PAS, Choice, SSBG, Title III, Veterans, Private Pay, and others as needed.   This position also manages Cost Share payments.

ESSENTIAL DUTIES include the following.  Other duties may be assigned.

  • Review and evaluate waiver intake and PAS Pay Point reports and prepare documentation for Director of Billing and Budget Management to submit claim
  • Work with ADRC Team Leads to verify we are capturing all Pay Point dollars
  • Process in-home and contracted services vendor billing and HDM
  • Work with case managers, supervisors, and vendors to correct any billing issues in a timely manner
  • Keep all billing support documents and spreadsheets up to date
  • Notify case managers if vendors are under or over utilizing funds on care plans
  • Track utilization of funds for contractors
  • Prepare check requisitions to accompany claims to Administration and Finance Department for Billing and Budget Management
  • Bill Cost Share
  • Bill Senior Solutions
  • Entering of Expenditures in CaMSS
  • Quarter Demographic Information Tracking
  • Responsible for projects as assigned
  • Assists with year-end close-out procedures and reconciliations for audit

RESPONSIBILITIES

  • Serves as the primary contact person for CADS deposits, IEMC deposits, billing/reporting.
  • Provides assistance to the Billing and Data Coordinator with Medicaid Waiver billing.
  • Provides assistance to the Budget Management Director with DA Grants and Contract claim support.

EDUCATION AND/OR EXPERIENCE REQUIREMENTS

High school diploma or general education degree (GED) required; Associates Degree in Accounting/Business preferred.

  • Database and spreadsheet experience required.
  • Reconciliation experience preferred.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

  • Knowledge of the operation of office equipment, including but not limited to: computer equipment, printers, multi-line telephones, fax machines, and copy machines.
  • Excellent communication and organizational skills.
  • Ability to work with numbers for 7.5 hours per day, 5 days per week.
  • Ability to accurately follow instructions and procedures.
  • Ability to accurately perform responsibilities to completion.
  • Ability and attitude to work cooperatively and productively with staff, vendors and clients.
  • Willingness and ability to work with many different software programs.

DIFFICULTY OF WORK

The work consists of repetitive processes.  Accuracy of data entry and attention to detail and deadlines are critical to the ability of this department to provide accurate, complete, timely, and useful information.

PERSONAL WORKING RELATIONSHIP

  • With Director of Budget Management, Billing and Data Coordinator, Claims Analyst, and other departmental co-workers.
  • With System Administrator, A2AA Case Management staff and vendors.
  • With IEMC Staff.
  • With other REAL Services staff.

WORKING CONDITIONS AND PHYSICAL DEMANDS 

The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is usually seated, standing, or walking at will in a typical office setting.  Very limited physical effort required.

CONDITIONS OF EMPLOYMENT

  • Successful candidate must submit to a pre-employment drug screening, National Sex Offender Registry check and a limited criminal history check.
  • Proof of educational credentials is required at time of employment.
  • This position has a 6 month probationary period.

Apply for this position

Thank you for applying for this position. Please remember to fill out and upload your Pre-Employment Application and resume.

Download the Pre-Employment Application at: https://realservices.org/app

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