PACE Southeast Michigan Claims Specialist in Southfield, Michigan

div id="description" class="details-content"divUnder the supervision of the Finance Manager, the PACE Southeast Michigan (PACE SEMI) Claims Specialist is responsible for the performance of a variety of functions related to processing and analyzing medical claims.PRINCIPLE DUTIES AND RESPONSIBILITIES:ululliProcess all medical claims according to vendor contracts and Medicare/Medicaid guidelines and internal authorizations./li/ul/ulululliManages collection and submission of risk adjustment and encounter data to Medicare./li/ul/ulululliAnalyzes, maintains and updates computer programs to provide accurate financial data to various departments./li/ul/ulululliKeep abreast of governmental regulations pertaining to Medicare/Medicaid reimbursement./li/ul/ulJob Requirements:/div/divdiv id="requirements" class="details-content"divululliMust have 2 years’ experience in claims processing./li/ul/ulululliBachelor’s degree in Business Administration with an Accounting or Finance major required./li/ul/ulululliBasic knowledge of computer programming to learn PACE SEMI’s financial system and voluminous governmental regulations./li/ul/ulululliVisual ability required in the analysis of reports, contracts, and other documents./li/ul/ulululliManual dexterity required to prepare and tabulate data and write reports./li/ul/ulululliMust meet or exceed core customer service responsibilities, standards and behaviors as outlined and summarized below: ululliCommunication/li/ul/ulululliOwnership/li/ul/ulululliConfidentiality/li/ul/ulululliUnderstanding/li/ul/ulululliMotivation /li/ul/ulululliSensitivity/li/ul/ulululliExcellence/li/ul/ulululliTeam work/li/ul/ulululliRespect/li/ul/ul/li/ul/ulululliSelf-directed, flexible and committed to the team concept./li/ul/ulululliDemonstrated teamwork, initiative and a willingness to learn./li/ul/ulululliMaintains customer service skills as provided through on-going training and in-services./li/ul/ulululliCompletes all annual, mandatory in-service training and screening, including but not limited to: infections control, TB testing, Flu shot, Emergency Preparedness, HIPAA, Ergonomics and Participant Rights./li/ul/ulululliPossesses the ability to establish and maintain interpersonal and interdependence relationships./li/ul/ulWORKING CONDITIONSululliAn office setting which may require some local travel to other PACE centers./liliNormal office environment with minimal exposure to noise, dust or extreme temperatures./li/ul/ul/div/div