Finance II - Claims Processor (52335)

Humboldt Senior Resource Center is looking for a full-time accounting and administrative professional. This position works in our Eureka site and the schedule for is Monday through Friday, 8 hours a day between 7 am and 6 pm. 

JOB SUMMARY:  Under the general supervision of the Director of Finance, the Finance Specialist II – Claims Processor is responsible for performing a wide range of claims processing and financial support functions for the Redwood Coast PACE program in accordance with departmental policies, contractual obligations, and applicable regulatory requirements. This position ensures timely, accurate processing and tracking of claims, serves as a key point of contact for providers and internal staff regarding claims status and inquiries, and collaborates closely with the PACE program team and Third-Party Administrator (TPA) to resolve issues and ensure compliance. The Claims Processor also provides general accounting and administrative support to the Finance Department, contributing to efficient financial operations and a collaborative, service-oriented work environment.

ESSENTIAL DUTIES & RESPONSIBILITIES:

Claims Processing

1. Ensures invoices, claims, and payments are processed within department, program, and contractual requirements.
2. Receives claims and uploads them daily to the Third-Party Administrator (TPA) for payment.
3. Tracks claims in PACE Care Online (PCO) and monitors progress to ensure all claims are paid within 30 days of receipt.
4. Reviews payment batches on a weekly basis to ensure each claim has been assigned the proper general ledger account and submits corrections to the Third-Party Administrator (TPA), as needed.
5. Submits the weekly payment batches to PACE Director and/or designee for approval, retrieves approved payment batch, and submits to the Director of Finance.
6. Serves as the point of contract for providers and internal staff on status of claims payments, questions, inquiries, and appeals. Monitors the claims e-mail account and voicemail, responding promptly.
7. Monitors the claims that have been suspended and works with the Third-Party Administrator (TPA) and Senior Financial Analyst to resolve documentation deficiencies such as obtaining letters of agreement and W-9s. 

Accounting Support

1. Reconciles Agency Amazon account to the monthly payment amounts, ensuring the proper general ledger account has been assigned to each purchase, works with departments to resolve any discrepancies.
2. Assists accounts payable with verifying participants and GL coding on PACE invoices.
3. Scans accounts payable check stubs and invoices into Laserfiche weekly.
4. Orders supplies and runs errands as needed for Finance team.

General/Other

1. Work collaboratively with other team members and participate as an active member of the Finance team when appropriate.
2. Performs other general office duties including filing, copying, scanning, and preparing correspondence.
3. Contributes to a positive work environment by participating in solutions to problems as they occur.
4. Demonstrates behaviors consistent with agency values: Respect, Patient, Courteous, Tolerant, Friendly, and Teamwork.
5. Additional duties may be assigned, as needed, that align with the responsibilities of the position and support the vision, mission, and values of the organization.

EDUCATION &/or EXPERIENCE:

1. Two (2) years of office administration, accounting, or finance experience.
2. High School Diploma or GED equivalent, required. Additional education is preferred.

PRE-SCREENING REQUIREMENTS:

1. COVID-19 and Influenza (flu) vaccinations preferred.
2. This position requires the successful completion of a background check.

JOB SKILLS:

1. Proficient in using computerized accounting systems, databases, and standard office software (including Microsoft Office and Laserfiche) to accurately enter, retrieve, and maintain financial and claims data.
2. Ability to use various client-orientated software programs to bill for client services.
3. Make accurate arithmetic and financial computations.
4. Ability to work independently, organize and prioritize tasks, manage time effectively, and meet deadlines with minimal supervision while maintaining accuracy and accountability.
5. Strong verbal and written communication abilities; able to convey information clearly and professionally to staff, vendors, providers, and other external partners.
6. Builds positive relationships with diverse populations, including staff, providers, and community stakeholders.
7. Works effectively as part of a multidisciplinary team demonstrating sound listening skills to receive directions and understand expectations; maintains a cooperative and supportive attitude.
8. Applies good judgement, resourcefulness, and flexibility to resolve issues and adapt to changing circumstances.
9. Maintains confidentiality, reliability, and ethical standards; consistently demonstrates punctuality, attendance, and responsibility in work performance.
10. Maintains participant privacy and organizational confidentiality, adhering to HIPAA and agency standards.
11. Remains calm and effective when priorities shift, deadlines change, and unexpected issues arise.
12. Ability to be dependable, accept supervision, follow direction, and improve performance through feedback.
13. Ability to accurately establish, maintain, and research files to ensure organized, complete, and accessible records.

PHYSICAL REQUIREMENTS:

Ability to sit for extended periods of time; use hands and fingers to operate a computer, keyboard, and other office equipment; and communicate verbally and in writing. Physical abilities sufficient to move between different staff work areas; and bend, reach, or lift and carry office materials weighing up to 10 pounds. Specific vision abilities include close vision and the ability to focus on a computer screen and written documents.

The above statements are intended to describe the general nature of work performed.  They are not considered as an exhaustive list of all job tasks performed.  The agency reserves the right to change job descriptions, work hours or work sites as required by the program.

The Humboldt Senior Resource Center is a private, non-profit, multi-purpose senior center providing a continuum of social and health related services. The agency currently holds contracts with the California Department of Aging and Area 1 Agency on Aging.

The Humboldt Senior Resource Center is an equal opportunity employer.  We will not unlawfully discriminate against qualified applicants or employees with respect to any terms or conditions of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, medical condition, pregnancy, breastfeeding, gender identity, marital status, citizenship status, military or veteran status, genetic information, or other basis protected by applicable federal or state law.

Salary : $21 - $23