Position Summary:
The Claims Management Specialist is responsible for managing the billing and claims lifecycle to ensure accurate claim submission, timely reimbursement, regulatory compliance, and effective collaboration with internal and external stakeholders. This role supports the organization’s revenue cycle performance through proactive claims management, customer service, and adherence to Necco’s corporate culture and operational standards.
You should be accurately described as:
A happy warrior who thrives on leading from the front with strategic thinking. A solid communicator in search of decisions that deliver real results. A problem-solver, financial steward, and one who excels at collaboration. Ridiculously passionate about the company’s success, growth, and program quality.
The candidate selected will be responsible for the following:
Claims Management
- Utilize the Electronic Health Record (EHR) system to generate claims for per diem and fee-for-service billing and submit invoices to payors
- Review and take action on submitted claims within 30–45 days to ensure timely resolution
- Monitor, investigate, and resolve held, rejected, or denied claims using EHR and clearinghouse tools
- Assist with cash application processes, including reconciliation of open accounts receivable balances
- Maintain accurate documentation related to billing activities and claim outcomes
Customer Service
- Foster strong internal and external relationships to support timely resolution of billing discrepancies
- Communicate effectively with payors, service line teams, and leadership regarding claim status and issues
- Identify and recommend opportunities for process and policy improvement based on trends observed during collections and claim follow-up.
- Collaborate with the Revenue Cycle Management Team to ensure systems, workflows, and processes operate efficiently
Quality Performance & Risk Management
- Maintain compliance with all regulatory agencies governing Medicaid and governmental billing practices
- Ensure adherence to organizational policies, governmental regulations, and fiscal management standards
- Maintain strict confidentiality of financial and client information
- Assure compliance with HIPAA regulations related to billing and protected health information
Corporate Citizen
- Demonstrate ruthless pragmatism in problem solving and decision making
- Engage in constructive peer-to-peer feedback
- Know and live the Necco Corporate Culture Principles
- Embody the three essential virtues of humble, hungry, and smart
- Actively manage and drive Individual Performance Scorecard goals
- Participate in and contribute to Necco’s meeting structure and organizational initiatives
Position Qualifications
- Degree or certificate in medical billing/coding (or nearing completion) preferred
- Proficient with Microsoft Office Suite
- Preference for experience with claims submission to Medicaid/MCOs or governmental entities
- Experience with EHR and Clearinghouse Software
- Experience managing complex, voluminous datasets and electronic records
- Valid driver’s license and 100/300/100 required auto insurance coverage
- Strong communication skills to build and maintain relationships with internal and external customers as well as provide valuable feedback to management
- Must be self-directed, resourceful, vigilant and persuasive
- Successful completion of all required criminal background checks
- Travel/training willingness
At Necco, we value diversity and are committed to creating an inclusive and equitable work environment. We embrace individuals of diverse backgrounds, experiences, and perspectives. We believe that a diverse team fosters innovation and creativity, and we actively seek candidates from all races, ethnicities, religions, genders, sexual orientations, abilities, and ages to join our organization. We are dedicated to providing equal opportunities for employment and advancement to all qualified individuals, and we encourage applicants of all backgrounds to apply.
