Eligibility Claims Specialist

At Coastal Horizons, our mission is to provide a continuum of professional services to promote healthier lives, stronger families, and safer communities. We are currently seeking a motivated and passionate Eligibility Claims Specialist to join our dynamic team. If you're looking for an opportunity to make a difference, we invite you to explore the exciting positions available with us.

JOB TITLE: Eligibility Claims Specialist

REQUIRED EDUCATIONAL/EXPERIENTIAL QUALIFICATIONS

• High school diploma or GED with 2-3 years' experience related to responsibilities specified. Familiar with billing concepts, practices, and procedures.

• Knowledge of health care billing systems, procedures, documentation, and standards.

• Familiar with DSM and ICD-10 codes

• Previous experience with NC Medicaid and billing commercial payers

• Knowledge of billing/insurance terminology

• Basic computer skills including Excel

• Strong organizational, problem solving and analytical skills.

• Working knowledge of cash management principles and/or procedures.

POSITION HIGHLIGHTS:

The Eligibility Denial Specialist is responsible for providing financial, administrative and clerical services to ensure accuracy and efficiency of Coastal Horizons Center's billing operations as it relates to the accounts receivable. This position will be responsible for following up on all eligibility claim denials and will work directly with our payers and providers to rectify denials so that they can be accurately adjusted for payment.

ADDITIONAL INFORMATION:

• Thoroughly review pay source documentation and communicate directly with the appropriate staff when errors need to be corrected to receive payment.

• Reprocess claims within EMR and/or directly on the payer’s website to assure timely receipt of payment.

• Reconcile claims weekly to ensure receipt of claim by the payer for all eligibility related denials.

• Encourages teamwork, energetic and motivates teams and individuals.

• Maintains a cooperative work environment to foster Coastal Horizons Center's missions and values and to meet goals.

• Proficient with MS Office (word, excel, power point, access); excellent with spreadsheet and medical billing software applications.

• Performs miscellaneous job-related duties as assigned.

• Must be able to perform sedentary work exerting up to ten (10) pounds of force occasionally and/or a negligible amount of force frequently on constantly to lift, carry, push, pull, or otherwise move objects.

• Must possess the visual acuity to prepare and analyze data and figures and operate a computer terminal.

SALARY & BENEFITS:

• Competitive salary based on experience
• Comprehensive medical, dental, and vision insurance
• Educational loan repayment programs & Career growth
• Retirement savings plan/401K
• Paid time off programs, rollover hours, 14 paid holidays
• Employee engagement activities, resource groups, and diversity events

HOW TO APPLY:

Interested candidates should submit their resume and cover letter through our Careers Page. If you require an accommodation during the application process, please contact us at [email protected].

We look forward to reviewing your application!

EEO STATEMENT

Coastal Horizons is an Equal Employment Opportunity (EEO) employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender, gender identity and expression, national origin, age, disability or protected veteran status. We celebrate diversity and are committed to creating an inclusive environment for all of our associates.