What are the responsibilities and job description for the Claims Specialist position at Community Integrated Services, Inc.?
About the Role
Community Integrated Services (CIS) is seeking a detail-oriented and self-motivated Claims Specialist to join our Billing & Operations team. This role is central to the organization’s financial operations and is responsible for ensuring accurate, timely, and compliant submission of Medicaid claims across multiple service lines, including Residential, Day, Behavioral Health, and Case Management.
The Claims Specialist serves as the primary in-house billing resource at the Manchester office and works closely with the accounting team. The ideal candidate is organized, analytical, and able to independently identify and resolve billing issues.
Key Responsibilities
Claims Processing and Submission
- Process and submit Medicaid claims across all CIS service lines
- Review and validate attendance data prior to claim submission
- Identify, document, and escalate discrepancies in attendance and billing data
- Process back-billing and post-dated claims in accordance with payer timelines
- Ensure all claims are accurate, complete, and compliant with Medicaid and state billing guidelines
Claims Tracking and Resolution
- Monitor and maintain claim status from submission through payment
- Research and resolve claim denials, rejections, and submission failures
- Analyze payer correspondence, eligibility data, and billing records
- Identify trends and root causes of recurring billing issues and recommend solutions
Reporting and Communication
- Prepare and deliver weekly claims reports summarizing totals and trends by service line
- Maintain accurate, organized documentation of billing activity and resolutions
- Collaborate with internal teams to proactively address potential billing issues
- Communicate clearly with leadership, operations staff, and finance
Compliance and Quality Assurance
- Maintain audit-ready billing documentation
- Identify and report billing errors, duplicate claims, and compliance concerns
- Support additional billing and operational tasks as needed
Qualifications
Education
- Bachelor’s degree in Health Information Management, Business, Finance, Healthcare Administration, or a related field preferred
- Equivalent experience in medical billing or claims processing will be considered
Experience
- Minimum 1 year of relevant experience required
- Experience in medical billing, claims processing, or healthcare administration strongly preferred
- Experience in human services, behavioral health, or developmental disabilities a plus
Skills and Abilities
- Strong attention to detail and accuracy
- Proficiency in Microsoft Excel and billing systems
- Ability to independently research and resolve billing issues
- Strong analytical and problem-solving skills
- Effective written and verbal communication skills
- Ability to manage multiple priorities and meet deadlines
Why Join CIS
- Mission-driven organization serving the community
- Collaborative and team-focused work environment
- Opportunity to play a key role in financial operations
- Competitive salary and benefits package
Pay: From $60,000.00 per year
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person
Salary : $60,000