Position Summary

The Accounts Payable Claims Specialist is responsible for modeling the Compassus values of Compassion, Integrity, Excellence, Teamwork, and Innovation and for promoting the Compassus philosophy, using the 6 Pillars of Success as the foundation. S/he is responsible for upholding the Code of Ethical Conduct and for promoting positive working relationships within the company, among all departments, and all external stakeholders. The Accounts Payable Claims Specialist is primarily responsible for processing payments and denials for claims and invoices related to patient care. The majority of these services are provided under terms of a contract and include respite care, general inpatient care, outpatient ancillary services, contracted physician services, and transportation. It does not include routine room and board payments.

Position Specific Responsibilities

* Reviews all claims and invoices for accuracy and appropriateness by verifying the patient status at the time of service delivery. May use Homecare Homebase (HCHB) directly and HCHB level of care reporting.

* Ensures all claims and invoices receive the required clinical approval/denial for appropriateness of payment by a Director of Clinical Services (or appropriate clinical designee) before processing.

* Identifies and reviews related service provision contract(s) to discern the terms and rates for payment.

* Calculates the payment amount based on the contract's stated rates. Verifies Medicare allowable rates and contracted hospital rates for claims, when applicable, by searching the web for the appropriate state and HCPCS/CPT/or other codes.

* Assigns Workday general ledger coding for processing payment or denial including assignment of the supplier, line of business, cost center, legal entity, and spend category. Ensures the Hospice Area Executive of Clinical Operations (or other appropriate budget administrators) approves the payment amount.

* Processes denied claims/invoices that do not meet hospice reimbursement requirements, confirms a letter is generated with the Director of Clinical Services denial reason stated, and ensures the letter is mailed or emailed to the supplier.

* Researches payments and denials, when requested, by the program office or supplier regarding any past due or disputed claims/invoices and takes appropriate action to resolve any issues.

* Matches any required backup with payments/denials for distribution to the supplier.

* Performs other duties as assigned.

Education and/or Experience

* High school diploma or general education degree (GED) required.

* Experience with general ledger functions and coding required.

* Experience with reading legal contracts and being able to discern key elements required.

* Three (3) years of related experience and/or training highly preferred. An equivalent combination of education and experience will be considered.

* Experience with HCPCS, CPT, and medical terminology preferred.

* Experience in healthcare or hospice preferred.

Skills

* Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percentage. Ability to solve word problems. Ability to multiply a payment amount by a percentage.

* Language Skills: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from leaders, team members, investors, and external parties. Strong written and verbal communications.

* Other Skills and Abilities: Ability to understand, read, write, and speak English. Articulates and embraces hospice philosophy. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, or schedule form. Proficiency in Microsoft Office Suite. Experience in accounting information systems is required. Strong organizational and time management skills. Must be able to work a flexible schedule to include nights and weekends.

Physical Demands and Work Environment: The demands of this role necessitate a team member to effectively perform essential functions. Adaptations can be made to accommodate team members with disabilities. Regular standing, walking, and manual dexterity are fundamental, along with the ability to lift and move objects up to 25 pounds. Visual acuity requirements include close and distance vision, color and peripheral vision, depth perception, and the ability to adjust focus. This description provides a general overview and may vary by role and department, capturing the nuanced demands and conditions inherent to positions in our organization.

At Compassus, including all Compassus affiliates, diversity, equity, and inclusion are fundamental to our Pillars of Success. We are committed to creating a fair work environment where our team members feel welcomed, highly valued, and respected. As an equal opportunity employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.