What are the responsibilities and job description for the Claims Validation Specialist position at Access Health Services LLC?
Role and Responsibilities
Under general supervision and following established policies, procedures and professional guidelines, the Claims Validation Specialist performs claims payment reviews to establish the accuracy of contractual provider reimbursement, and will conduct random audits of contract and claim payments across Medicare and Commercial reimbursement methodologies. The Claims Validation Specialist ensures accurate and timely payments from third party administrators in compliance with Managed Care contracts and negotiated fee schedules. They will review third party payments and compare actual payments to managed care contract reimbursement and negotiated fee schedules.
The Claims Validation Specialist will prepare relevant reports for management review. Identifies and recommends corrective actions to departmental Directors when repeated errors or trends occur. Represents AHS on issues related to provider billing, documentation and reimbursement with third party payers, members and plan personnel. Responsible for performing job duties in accordance with mission, vision and values of Access Health Services.
This position will obtain, manipulate and analyze data from a variety of sources including but not limited to: billing systems, contract management systems, and claims systems.
Essential Functions/Responsibilities:
* Work closely with Contracting and Administrative teams to ensure accurate set up of contract terms in proprietary and third party contract management platforms.
* Perform testing and other validation processes to ensure accurate contract reimbursement information being entered.
* Be key liaison with third party administrator in claims reimbursement accuracy and reporting.
* Validate contractual entries into claims system.
* Interprets requirements and coordinates with the Claims System Administrator to ensure any changes are implemented.
* Assist with program, financial, timeliness and other audits.
* Assist in gathering data for reporting.
* Comply with all regulatory requirements.
Qualifications and Education Requirements
* College degree preferred.
* 3 or more years’ experience working in a health care claims environment related to audits, provider billing, claims payment, and contract analysis.
* Strong Knowledge of Medicare, Medicaid, and self-funded carrier contract administration operations.
* Knowledge of health plan technology challenges.
* Proficiency in MS Office Suite.
Additional Notes
* Must possess valid driver's license.
*Travel is required occasionally
Job Type: Full-time
Pay: $45,000.00 - $50,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Flexible schedule
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- Monday to Friday
Ability to commute/relocate:
- North Little Rock, AR 72114: Reliably commute or planning to relocate before starting work (Required)
Education:
- Bachelor's (Preferred)
Experience:
- Microsoft Office: 1 year (Preferred)
- claims audit: 1 year (Required)
Work Location: One location