Business Office Administrative Assistant

Position: Business Office Administrative Assistant

Supervisor: Business Office Manager

Positions Supervised: None

Pay Range: To be determined

FLSA Status: Exempt

Job Summary

Under the direction of the Business Office Manager, the Business Office Administrative Assistant is responsible for overseeing and maintaining medical specialist and vendor contracts. Liaison for medical specialists for review of claims to ensure payment is processed according to contract agreement. This individual will also be the backup for the Finance Analyst.

With or without reasonable accommodations: Able to read, write and speak English; Ability to clearly see billing statements and various documents; Ability to perform repetitive hand/wrist movements; Requires sitting and standing associated with a normal office environment; Manual dexterity needed for using a calculator and computer keyboard; Responsibilities, skills and working conditions may change as needs evolve.

Specifications

Education and Special Training: Associate degree in accounting, business, healthcare or related field.

Experience: At least 1 year of experience working with the frail elderly population. 2 plus years of Medicaid/Medicare knowledge with at least 2 plus years of accounting experience in a medical practice or equivalent business office setting. Experience in a healthcare setting working with medical claims.

Licensure, Registry or Certification Required: NC driver’s license.

Special Training: Meet a standardized set of competencies for the specific position description established by Senior TLC, Inc. and approved by CMS before working independently.

Immunizations: Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact.

Ages of Patients Rendered Care: Adult/Geriatric

Key Responsibilities:

• Supports PACE of the Triad’s mission to encourage and support the quality of life of seniors wishing to continue living in the community; its vision to be the preferred provider of individualized care for seniors in the community; and its values of respect, integrity, accountability, compatible goals, and compassionate care.
• Provides administrative support for the Business Office Manager.
• Oversees and maintains the credentialing of all provider and vendor contracts.
• Oversees the Preclusion list of FDR (First Tier Downstream) and related entities to ensure compliance with CMS.
• Assists in conducting annual contract audits.
• Assists in conducting new provider and vendor orientations.
• Maintains contract/vendor files and database.
• Submits contract provider list for annual participant newsletter.
• Maintains and loads new contracts within the claims adjudication software.
• Review weekly Pend Reports for contractual requirements for claims adjudication.
• Assists with the internal audit process of claims adjudication software.
• Review claims financial data utilization for contract negotiations.
• Report new contract providers to third-party payer for authorizations.
• Serves as a backup for the Finance Team as necessary.
• Assists with processing provider claims.
• Other duties as assigned by the Director of Finance and Executive Director.