Claims Clerk at Volunteers of America - National Services in Eden Prairie, Minnesota

Job Description:

Volunteers of America National Services is seeking a Claims Clerk to work along side our Accounting Department in our Eden Prairie, MN Support Center location: 7485 Office Ridge Cir, Eden Prairie, MN 55344.




About the Job:



To maintain integrity of the claims adjudication system across all PACE programs and process requests in a timely and efficiently manner



Benefit Highlights:

• 403(b) Retirement Plan


• Career scholarships;


• Continuing career education and leadership programs;


• Dental and Vision Insurance


• Paid Time Off (Vacation, Holiday & Sick Days)

Schedule: M-F 8:00 AM-5:00 PM (Fully onsite)



Essentials:

• Complete accurate and timely daily review of PACE paper claims and claims correspondence received in the Eden Prairie, MN office or via email or fax.


• Assist in claims processing and clerical office functions, including claim handling, participant bills, and provider payment processing. Upload claims and invoices and enter data into the claims processing system accurately, ensuring all required fields are populated.


• Serve as point of contact for external and internal inquiries regarding claim payments, denials, and explanations of payment (EOP). Field inbound calls and respond accurately, timely and professionally to all other correspondences. Collaborate with internal teams to address claims-related inquiries.


• Work weekly check processing report, reviewing for accuracy, printing checks and EOPs, stuffing envelopes, and mailing to providers. Update claims processing system and maintain productivity goals.


• Assist with weekly Precheck Registers and coordinate with Claims Adjudicators for accuracy prior to printing and mailing.


• Ensure complete and accurate processing of claim payments and work with PACE System Administrator on system updates.


• Maintain accurate records and documentation of claims activities and communication.


• Assist Claim Adjudicators with monthly claims audits to ensure accuracy of the claims processing system.


• Serve as back up for Claims Adjudicators when they are out of office.


• Maintain knowledge of PACE, CMS, and state Medicaid policies and claims guidelines. Ensure compliance with federal and state regulations related to claims processing.


• Communicate to and prepare reports for the Claims Administrator and Director of Health Plan Operations.


• Assist with other duties and projects as assigned.

Qualifications:

• High School Diploma.


• Experience with medical billing and administrative duties, 2+ years preferred.


• Experience in a claims processing role, 2+ years preferred.


• Ability to communicate and work effectively with various levels of facility and VOA/VOANS staff and providers.


• Analytical and organizational abilities.


• Detail oriented with commitment to accuracy and quality.


• Understanding of healthcare billing and reimbursement processes.


• Knowledge of HIPAA law and PACE regulations.


• Knowledge of state and federal regulations pertaining to insurance and claims processing.


• Ability to examine, evaluate, and adjust claims in accordance with company procedures and state regulations.


• Proficiency in utilizing computers and software for tasks.


• Ability to meet the requirements identified and as indicated in the primary job functions.

VOANS, a subsidiary of Volunteers of America, provides affordable housing and healthcare services in over 40 states and Puerto Rico. The organization employs over 2,000 professionals who provide high quality services and care to clients. As one of the largest non-profit affordable housing owners/operators in the nation, VOANS has over 240 properties and approximately 14,500 affordable housing units. VOANS also operates over forty-six (46) senior healthcare programs, including skilled nursing, assisted living, home health care, adult day, and Program for All Inclusive Care for the Elderly (PACE). Apply Now