Claims Specialist
at Volunteers of America

Date Posted: 6/18/2020

Job Description

We Are Inspired to Serve. Join us at PACE!

Making a difference in the lives of others – that’s what working at Volunteers of America is all about. Our healthcare professionals have the opportunity each and every day to make a difference in the lives of older adults. From improving our residents’ quality of life, to creating peace of mind for them and their families, our team members know that as a part of our community, they are changing lives. 

In this role you will be working both in our PACE clinic but mostly in our elderly participants homes.

Benefits of working for Volunteers of America (VOA):

At VOA we understand that our employees are our greatest asset, and we are happy to offer them the following benefits:

Flexible scheduling and consistent hours
Competitive pay
Stable organization; we've been a nonprofit for over 120 years
PTO for full-time staff
Positive work environment
Paid training/Continuing education
A variety in your daily duties
Supportive managers
Fast paced, low stress working environment

Insurance Benefits:
Retirement
Flexible Spending Account
Loan Program
ID Theft
Insurances offered:
medical (available when working 30 or more hours a week)
dental
vision
legal
life
accident
critical illness
short-term disabilities
pet

For more information about our us follow this link: http://seniorcommunitycaremi.org/about-us/

PRIMARY RELATIONSHIPS: Interacts with Business Services/Manager/Regional Claims Manager, Executive Directors, Business Services Managers at other VOA PACE sites, Specialty Appointment Scheduler, and Account Manager at PEAK PACE Solutions

OBJECTIVE: To ensure that the claims for all VOA PACE sites are processed timely and fall within all contracted terms

ESSENTIAL FUNCTIONS:

1. Administrative responsibilities (copying, faxing, etc)
2. Verifying insurance coverage
3. Gaining approvals on claims and submitting insurance claims
4. Managing and coordinating contracts
5. Data analysis and problem solving using defined contracting and claims management methodologies
6. Resolves claims processing problems and recommends solutions to increase accuracy and/or efficiency
7. Organizes and documents actions, interventions and communication related to claims entry and resolution
8. Generates reports in EMR for submissions
9. Responds to provider/member claims questions on behalf of all VOANS PACE Programs
10. Manage provider/member data while maintaining compliance with HIPAA.
11. Resolves provider/participant challenges using appropriate measures
12. Maintains records of provider/participant interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions are taken.
13. Attend the needs of the provider/member and continually seeking ways to add value to the relationship.
14. Submit medical claims received from providers in to claim system.
15. File electronic and paper documents as needed.

 



Job Requirements

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Minimum one year of experience as a Medical Claims Specialist or equivalent, preferably in a healthcare setting. Medicare and Medicaid billing experience is desirable.
2. Ability to communicate and work effectively with various levels of facility and corporate staff, participants, family members and the public.
3. Numerical ability.
4. Organizational ability.
5. Detail oriented.
6. Ability to handle interruptions on a regular basis as well as the stress associated with meeting a variety of deadlines.
7. Ability to operate computerized equipment.
8. Ability to utilize computers and other electronic devices for tasks such as timekeeping, in-servicing and documentation.
9. Only acts within the scope of his or her authority to practice. Must meet a standardized set of competencies for the specific position description established by Senior Community Care and approved by CMS before working independently.
10. Prioritizes effectively
11. Ability to meet requirements as indicated in the essential job functions.

Work Environment

The work environment characteristics described here are representative of those an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential functions:

1. Works in office areas, but stands and walks intermittently throughout the working day.
2. Interacts with staff and other personnel.
3. May be subjected to interruptions throughout the workday.
4. Exposure to blood, body tissue of fluids.
5. Exposure to hazardous waste materials, dust and loud or unpleasant noises.

Physical Demands

The physical demands 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 individual with disabilities to meet these demands:

1. Is frequently required to sit throughout day.
2. The employee is required to finger, feel, touch, hear, and use the phone extensively.
3. Stands and walks intermittently throughout the working day.
4. On occasion may lift and carry up to thirty-five (35) lbs.
5. Must be able to bend, stoop, squat, reach, push and pull throughout workday.
6. Works inside; working area is subject to slight increase in temperature and noise due to the operation of computer equipment.
7. Ability to adapt to changes in daily work hour and schedule.

Safe Work Performance Expectations

The safety of employees, residents and visitors is of paramount importance to Volunteers of America. Our work place safety program will be incorporated as the standard of practice for this organization. Compliance with these safe work expectations will be required of all employees as a condition of employment. Our organization focus will hold all employees accountable for safety performance equal with quality and production expectations.

Employees will be expected to:

1. Follow correct policy and procedures for department and facility Fire/Disaster/Missing Person Plan. Know the location of fire alarms and extinguishers.
2. Follow correct policy and procedure for hand washing.
3. Follow guidelines for proper method of lifting.
4. All doorways, hallways and areas are to be kept clear.
5. Know the location and purpose of Safety Data Sheets (SDS).
6. Follow guidelines for department environment and safety measures.
7. Follow guidelines for safe handling, inspection, maintenance and storage of equipment. Report any malfunction of equipment.
8. Follow guidelines for safe handling and storage of chemicals and supplies.
9. Follow correct policy and procedure for reporting of incidents: staff, residents, etc.

EOE M/F/Vets/Disabled

Job Snapshot

About Us

Volunteers of America

At Volunteers of America, we are more than a nonprofit organization. We are a ministry of service that includes nearly 16,000 employees and more than 55,000 volunteers with a shared vision of a world where all people live in safety with social, emotional and physical well-being, spiritual fulfillment, justice and hope.

The national office is located in Alexandria, Va., part of the greater Washington, DC area. The headquarters includes executive staff and major office departments that have national responsibilities and provide support to local offices and Volunteers of America housing and senior living and care communities: communications, fundraising; public policy, finance, chartering, housing, volunteer services, program services and other operations.

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