Claims Specialist, Managed Care (full-time, Days, FF)

The Claims Specialist is responsible for claims processing, electronically auditing medical group and hospital claims, processing check returns, printing and mailing checks and EOBs to providers, researching payment issues, issuing denial letters, keying high deductible plan adjustments and coordinating electronic fund transfers with finance.

1. Education : Associate of Arts Degree preferred in business, finance, healthcare or related field required

2. Experience : Claims payment experience required (three years preferred), with proof of accurate claims processing ability. Experience in paying managed care and/or capitated claims from an automated system is required. Experience using the current claims payment system (Quick Cap) is preferred.

3. Skills : The ability to prioritize work and meet deadlines. Intermediate knowledge of personal computers, as well as spreadsheet (Excel) and word processing programs, is required. Medical terminology knowledge required. The ability to exercise independent judgment and to solve problems is required. Ability to master computer programs related to claims processing is required. Database knowledge preferred. Requires a high comfort level with taking initiative and responsibility, high energy and productivity, plus an orientation and ability to manage details in an organized work style.

4. Interpersonal Skills : Demonstrates the NorthBay Way. The NorthBay Way is a set of value-based behaviors that are to be consistently demonstrated and role modeled by all employees that work at NorthBay Healthcare. The NorthBay Way principles consist of Caring, Communication, Collaboration, and Competence. Ability to communicate effectively, and pleasantly to members, providers, payers and internal staff is essential. A willingness to work as a team player with co-workers and other internal staff as well as people outside NorthBay.

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