Healthcare Customer Service Specialist Hybrid

Join BoldAge PACE and Make a Difference! Why work with us?

A People First Environment:

We make what is important to those we serve important to us. Make an

Impact:

Enhance the quality of life for seniors.

Professional Growth:

Access to training and career development.

Competitive Compensation :

Medical/Dental Generous Paid Time Off 401K with Match• Life Insurance Tuition Reimbursement Flexible Spending Account Employee Assistance Program

BE PART OF OUR MISSION!

Are you passionate about helping older adults live meaningful, independent lives at home with grace and dignity? BoldAge PACE is an all-inclusive program of care, personalized to meet the individual health and well-being needs of our participants.

Our approach is simple:

We listen to our participants and their caregivers to truly understand their needs and desires. Healthcare Customer Support Specialist

JOB SUMMARY

The Healthcare Customer Support Specialist is responsible for responding to phone calls from participants, families, insurance representatives, and internal staff with any questions or concerns that they may have. This role requires calls to be made on any participant statements to ensure that we receive a claim to process for our participants. Evaluates claims and administers prompt and accurate resolution of claim issues, supports the claims submission process, and upholds the organization s standards for exceptional customer service and compliance within the PACE program.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Respond promptly and professionally to participants, family, and insurance inquiries related to claims and billing. Review and verify participant insurance coverage and eligibility. Assist in processing claims accurately and within the time frames established by management using the claims processing system. Demonstrate a thorough understanding of matching appropriate authorizations to claims and tracking missing authorizations. Master and utilize a thorough understanding of such items as HCPC modifiers and their effect on reimbursement, coordination of benefits (COB), appropriate billing guidelines for anesthesia claims, hospital stays, ambulance and other services. Communicate with internal personnel, vendors, providers, and billing representatives about claim-related issues. Work as a team in resolving claims issues or special projects Report any inconsistencies that are identified in regard to internal department policies and procedures to management Provide administrative support including data entry, scanning, and filing as needed. Perform other duties as assigned. Maintain confidentiality and comply with HIPAA and PACE program requirements. Participate in department meetings, training, and process improvement initiatives.

EXPERIENCE AND EDUCATION

:

Education:

High school diploma or GED required Associate's degree in health administration, Billing, or related field preferred.

Experience:

1-2 years of experience in medical billing, claims processing, or healthcare customer service, with familiarity in Medicare/Medicaid billing. Prior PACE or long-term care experience is strongly preferred.

PRE-EMPLOYMENT REQUIREMENTS

Must have reliable transportation, a valid driver's license, and the minimum state required liability auto insurance. Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact. Employment with BoldAge PACE is contingent upon successful completion of post-offer pre-employment screening and verification processes. BoldAge PACE provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. • Match begins after one year of employment Monday - Friday, Full Time, Days 40 Hours