Claims Specialist

Job Number 69660
Posted 2/3/2020
Account Northern Light Health Home Office
Department Patient Financial Services
Location |ME| Northern Light Health Home Office-43 Whiting Hill Rd., ME 04412
Schedule Regular Full-time
Shift Day
Hours M-F 8AM to 4:30 PM
Job Details
Job Summary

This position is responsible for accurate claims submissionto all applicable payers of the Northern Light Health Patient Account Servicesin a Centralized Business Office environment.This position is responsible for the submission of claims in accordancewith regulatory and contractual obligations.This position requires a thorough understanding of the requirements ofthe Centers for Medicare & Medicaid Services (CMS) claim forms; CMS-1500and CMS-1450 (UB04). In addition, thisposition is held accountable to adhere to the policies, procedures, andapplicable laws; including metrics related to productivity and quality. This position works closely with a team ofClaim Specialists to analyze and take corrective action on claims to ensure anoptimum revenue cycle workflow.

Education and Experience

• High school diploma or equivalent required. Associate's degree preferred.

• 1+ year of healthcare claims billing or coding experiencepreferred.

Required Minimum Knowledge, Skills and Abilities

• Detailed knowledge of billing rules and regulations in ahealthcare setting (Government and/or non-Government payers); multiplehospitals/physician practices preferred.

• Knowledge of medical terminology, Current ProceduralTerminology (CPT), and International Classification of Disease (ICD) preferred.

• Must possess strong problem-solving skills.

• Ensures all claim functions performed are compliant withapplicable laws and regulations.

• Excellent professional communication skills; both oral andwritten.

• Ability to understand payer edits and all applicablebilling rules and regulations to facilitate decision making.

• Proficient with Microsoft business applications.

• Experience with Northern Light Health patient accountingsoftware is preferred.

• Customer oriented.

• Demonstrated ability to work independently andcollaboratively.

Essential Functions


• Actively participate in team huddles and meetings by wayof sharing knowledge, requesting information, and recommending processimprovements.


• Complete all returned requests from other departments eachday.

• Work closely by way of problem solving with peers andleaders to address payer claim issues or changes that directly impact theaccounts receivable.


• Resolve claim edits specific to each payer's requirementson a daily basis.

• Take necessary AR adjustments in accordance with thedepartment's adjustment policy.

• Meet or exceed the Northern Light Health performancestandards as it relates to quality and productivity.


• Complete electronic payer rejections on a daily basis.

• Request relevant information from appropriate revenuecycle and clinical departments as required by payer.

• Ensure assigned discharged not final billed (DNFB) andfinal billed not submitted (FBNS) claims are not delinquent and are escalatedtimely.

• Advises management of claim issues which may requireattention in a timely manner.

• Ensure all functions related to claims submission supportsthe team goals and objectives as well as Northern Light Health's financialperformance objectives.

• Thoroughly understand the department's key performanceindicators.


• Maintain the knowledge of payer billing policies; completeAAHAM or other healthcare related webinars.

• Attend internal education sessions to enhance or gain newskills.


• Demonstrate departmental desire to provide communitybenefits by way of charitable events or contribution outside the four walls ofthe department

Organizational Values

Passion: We demonstrate a passion for caring for others andthe pursuit of service excellence in all that we do.

Integrity: We commit to the highest standards of behaviorand doing the correct thing for the right reasons.

Partnership: Working together in collaboration and teamworkis more powerful than working alone.

Accountability: We take a responsible and disciplinedapproach to achieving our priorities and responding to an ever-changingenvironment.

Innovation: We are capable of extraordinary creativity andare willing to explore new ideas to achieve our healthcare mission.

Respect: We respect the dignity, worth and rights of others.

Physical Demands

• Sedentary: Exertingup to 10 lbs. occasionally, sitting most of the time, and only brief periods ofstanding and walking.

• Requires the ability to travel to member organizations asneeded

Note: the duties listed above reflect the majority of theessential duties of this job and does not, nor is it intended to, reflect allessential duties that may be required for an incumbent in this job to perform.

Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.

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