Falck is a is a global emergency medical services provider originating from Denmark that services 4 states in the US including: California, Washington, Oregon, and Colorado. Falck has been operating in the US since 2010 and is one of the largest private providers of emergency medical services in the country today. Our BLS and ALS services impact not only the lives of our patients, but their families and communities.

Position Summary:

The Claims Processing Specialist ensures timely claim submissions to commercial, Medicare and Medicaid payor-classes by electronically filing or by mailing paper claims and supplying payor required documents. Additionally, the Claims Processing Specialist is responsible for the timely release of medical records, collection and distribution of the mail and scanning of documents to the system.

Essential Functions:

The Claims Processing Specialist must be able to adequately perform essential duties in an organized and efficient manner for all phases of Claim Processing. These duties include but not limited to the following:

• Verify submitted claims forms is complete and accurate, updating system information as needed.
• Process claims according to guidelines while identifying claims requiring exception handling.
• Prioritize and coordinate influx of daily workload for claims processing to assure required turnaround time is met.
• Assess accuracy of system adjudication and alert management of potential problems affecting the integrity of claim processing.
• Work with department supervisor to determine special projects on an as needed basis.
• Participate in documentation feedback information for the operations.
• Obtain continuous knowledge of CMS regulations.
• Make decisions and take appropriate actions based on sound reasoning and judgment.
• Contribute ideas; strive to enhance team effectiveness and support decisions made by the team.
• Plan and perform work systematically and efficiently.
• Carry out instructions, maintain a positive attitude, and support company policies/procedures.
• Punctuality and availability for workload.
• Comply with HIPAA guidelines
• Attend and maintain all required Falck USA training
• Maintain knowledge of functional area and company policies and procedures
• Other duties as requested from Postbill management.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. The individual in this position must possess the following qualifications:

• This position is based out of the Mesa office and no remote work is allowed within this position.
• Must be proficient with Microsoft Suite (Excel, Word, PowerPoint).
• Working knowledge of KPI’s/performance measures and the impact of revenue cycle on them.
• Excellent analytical skills and quality orientation-strives for continuous improvement in all activities to consistently achieve excellent results and meet or exceed department expectations.
• Must have knowledge of medical terminology.
• Must have willingness to work a flexible schedule.
• Overall leadership skills, including relationship building and fostering excellent achievement through teamwork.
• Must be self-starter with strong individual motivational skills.
• Strong interpersonal and communication skills with an ability to work effectively with a diverse range of individuals, from field teams to management, as well as external customers.
• Excellent ability to communicate and work cohesively across Department lines.
• Highly dependable and able to meet internal deadlines consistently.
• Flexible and adaptable, willing and able to adjust to rapidly changing priorities in a growing company.
• Must always maintain a professional demeanor and appearance.

Education Requirements:

The individual in this position must possess the following education requirements:

• High school diploma or general education degree (GED)

Physical Requirements:

While performing the duties of this job, the employee is regularly required to stand; walk; sit; use hands to feel objects, tools, or controls; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl; speak, hear, and smell. Specific vision abilities required by this job include close and distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. Must also have the ability to lift, carry up to 15 pounds.

Cognitive/Psychosocial Requirements:

The mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

• Memorization, critical judgment, perception/computation, problem solving, analytical skills, ethical judgment and reasoning, logic, active listening skills, strategic decision making, ability to communicate effectively in written and verbal formats.

Equipment Operated:

The individual in this position must be familiar with using the following equipment to perform the essential functions of this job:

• Computer, printer, scanner, cell phone

Falck is an equal opportunity employer and values diversity. All employment is decided on the basis of qualifications, merit and business need.