Claims Administrator

Job Details Job Location: Fairfield, OH 45014-1844 Position Type: Full Time Education Level: High School Job Shift: Day Benefits Affordable medical, dental and vision insurance Company paid Health Reimbursement Arrangement (HRA) Generous paid time off (PTO) & paid holidays Retirement plan with company match – up to 6% Career ladder – Start here and build a lifelong career Company paid life insurance Additional Information This is a hybrid position that requires 90 days of in‑office training. After successful completion of training, eligibility to work a hybrid remote/in‑office schedule. Responsibilities Maintain and configure all CareLogic billing administration (funders, EDI, modifiers, procedure codes, rate tables). Test and validate billing functionality (cert environment) to support funder changes and new services. Ensure billing setup accuracy, compliance, and data integrity through ongoing testing and QA. Monitor, submit, correct, and resubmit claims (EDI and manual), including clearinghouse rejections. Review failed/denied claims and assign follow-up to billing specialists as needed. Coordinate with Finance to ensure accurate revenue reporting and error‑free GL cost center reporting. Audit claim activity and ensure timely invoicing, including self‑pay. Design, test, and maintain billing reports and metrics (CareLogic BI and interim solutions). Run monthly patient statements, manage write‑offs, and distribute client balance reports. Maintain SharePoint and billing documentation; stay current on billing regulations and funder requirements. Qualifications High school diploma or GED required. Certified Professional Coder (CPC), Certified Professional Biller (CPB) or Certified Billing and Coding Specialist (9CBCS) preferred. Minimum of 3 years of healthcare billing experience using EHR systems. Proven experience as a Billing Specialist in a healthcare setting. Solid understanding of CPT, ICD, and HCPCS coding and medical terminology. Experience with Medicare and Medicaid billing regulations. Familiarity with contractual adjustments, sequestration, and payment posting/balancing. Strong knowledge of healthcare and behavioral health billing workflows and regulations. Proficiency with EHR systems, billing software, and Microsoft Office (especially Excel). Demonstrated ability to manage relationships with multiple insurance payers. Strong working knowledge of billing compliance and reimbursement methodologies. #J-18808-Ljbffr Community Health Alliance-Ohio