Data & Claims Specialist-In- Person & On-Site Daily

Bay Aging; Urbanna (VA); On-site; USD 42,000 - 65,000; Full time

Job summary

Bay Aging is seeking a Data & Claims Specialist to support GUIDE program growth and manage data workflows. The role uses athenaOne and Excel to monitor patient status, intake, and billing processes, ensuring timely progression from enrollment to monthly follow-up.

The ideal candidate has strong Excel skills, experience with electronic health records or billing platforms, and attention to detail. This in‑person, on‑site position reports to the Director of Strategic Analysis and offers a

Qualifications

• 3–5 years in data/claims roles.
• Strong Excel and reporting skills.
• Knowledge of HIPAA and privacy rules.

Responsibilities

• Manage patient onboarding and GUIDE-related workflows.
• Submit and track GUIDE model claims electronically to CMS.
• Generate reports and analyze data for program performance.
• Assist with special projects and demographic analyses.
• Maintain documentation and ensure data accuracy.

Skills

Data analysis

Attention to detail

Communication

Tools

athenaOne

CMS

ICD-10

HCPCS

Excel

Job description

Job Details

Job Location: Urbanna, VA 23175

Position Type: Full Time

Salary Range: $20.00 - $31.25 Hourly

Data & Claims Specialist- In-Person & On-site Position

Bay Aging is a leader in the movement to integrate social and clinical care. Bay Aging’s expansion of services and diversification of revenue streams has resulted in the need to increase data collection, exchange data with payors, track new metrics, and use new platforms including an electronic health record system.

The Data & Claims Specialist supports Bay Aging by assisting with the growth of new revenue-generating programs such as the Guiding an Improved Dementia Experience (GUIDE) Model, and participating in the strategic analysis of current programs and future opportunities.

The Data & Claims Specialist will use athenaOne and Excel tools to monitor patient status and patient documents, communicating with team members to ensure that home-based patients progress smoothly and efficiently through intake, alignment, and monthly follow-up processes. The Data & Claims Specialist will submit and manage claims and prepare reports, troubleshooting issues that arise and developing tools to facilitate workflows and ensure quality outputs. Extreme attention to detail is required; some experience with online billing platforms or electronic health record systems is a plus. The Data & Claims Specialist will also assist the Director of Strategic Analysis with recurring data analysis tasks and special projects. The position reports to the Director of Strategic Analysis. The compensation range is $20/hr to $31.25/hr depending on qualifications and experience.

Essential functions

1. Manage patient onboarding and unalignment processes (40%):

   • Monitor incoming messages and documents related to GUIDE, including patient referrals and inquiries from the public. Respond directly or route to the appropriate team member.
   • Process consent forms, check patient eligibility, and advise team members of outcomes.
   • Communicate with patients and team members to resolve administrative problems that arise, such as missing signatures on documents.
   • Send form letters to patients electronically or by mail.
   • Assist team members with organizing electronic documents in athenaOne.
   • Monitor appointments and the progress of patient encounters through athenaOne to ensure timely outcomes and adherence to GUIDE rules.
   • Monitor events that impact patient eligibility and billing, such as hospice enrollment and transitions to nursing facilities. Communicate with team members, ensure appropriate documentation occurs, and take needed actions to maintain compliance with GUIDE rules.
   • Maintain client lists to facilitate communication and metrics.

2. Manage electronic billing of GUIDE model claims (40%):

   • Use existing and new Excel models to track patient eligibility for monthly billing.
   • Follow up with team members to help them avoid missed billing opportunities.
   • Receive, review, and track GUIDE respite invoices.
   • Submit claims electronically to CMS, using appropriate HCPCS codes and ICD-10 codes.
   • Generate athenaOne reports on claim status and reconcile with CMS reports and Excel tracking models. Follow up on claim denials, working with representatives of athenaOne, GUIDE, and/or CMS to resolve billing issues.

3. Assist the Director of Strategic Analysis with data analysis and special projects (15%):

   • Become familiar with Bay Aging’s health, housing, and transportation divisions and assist with data analysis and reporting on programs’ performance.
   • Become familiar with the demographics of Bay Aging’s service area and assist with the preparation of demographic data from the Census and other sources.
   • To maximize Bay Aging’s success in a landscape of rapidly changing healthcare regulations, participate in the exploration and implementation of additional HCPCS billing codes.
   • Assist with special projects such as research, surveys, data analysis, report preparation, and grant applications.
   • Assist other Bay Aging programs as assigned or needed.

4. Become a subject matter expert on GUIDE and athenaOne (5%):

   • Keep up to date on GUIDE regulations and best practices by studying CMS’s GUIDE materials, attending GUIDE webinars, and participating in internal GUIDE meetings.
   • Participate in athenaOne trainings and webinars.
   • Set up new users in athenaOne. Manage assignment of athenaOne training and resolve user problems such as password resets.
   • Work closely with Bay Aging’s Caregiver Support, Intake, and Home Care teams. Serve as a resource to them on GUIDE and athenaOne.
   • Update and distribute internal documents that provide information and instruction about athenaOne and/or the GUIDE Model.
   • Participate in outreach events to raise awareness of GUIDE and other Bay Aging services.
   • Use knowledge gained from the GUIDE Model to evaluate and assist with the future development of other programs.

DECISION MAKING

Rely on training, experience, and judgment to plan and accomplish goals in a complex financial and compliance environment. Handle daily responsibilities with minimal supervision. Consult supervisor when faced with new or unusual situations, and when engaging in sensitive communications with patients, colleagues, or external stakeholders.

KNOWLEDGE

Strong Microsoft Excel skills, especially use of basic formulas and the ability to organize data to easily track patients and invoices over time. Working knowledge of other Microsoft Office programs (e.g., Word, Outlook, PowerPoint). Experience with online billing platforms a plus. Experience with electronic health records a plus. Knowledge of statistics and demographics a plus.

ABILITIES

Extreme attention to detail. Strong organizational skills. Strong problem-solving skills. Commitment to handling confidential materials safely, protecting PHI and observing HIPAA rules. Establish and maintain effective working relationships with co-workers, clients, and outside parties. Strong verbal communication skills in person and on the phone. Strong written communication (e.g., reports, letters, emails). Strong computer skills and proficiency in math.

Comfort working in a new program involving unknown factors that can lead to the need to research solutions to problems and/or adjust established processes. Adaptability in an environment where regulations can change suddenly. Empathy for clients.

WORKING ENVIRONMENT

Office-based position with minimal physical requirements (ability to lift 20lbs, walking and climbing stairs). Infrequent travel to attend training and meetings. Must have or be willing to obtain an ID.ME account to access federal databases.

Qualifications

High school graduate with a minimum of three to five years’ experience. Post-secondary education may be substituted for relevant experience. Proficient to excellent Excel skills. Must possess a valid driver’s license. Bachelor’s degree preferred.

FLSA status

This is a non-exempt position.

Disclaimer

This job description is not designed to cover or contain a comprehensive listing of all activities, duties or responsibilities that are required of the employee. From time to time, the supervisor will ask job holder to perform additional duties related to the completion of the work.

Bay Aging is an Equal Opportunity Employer

All applicants will be considered for employment without discrimination on the basis of race, color, religion, sex, national origin, age, veteran or disability status. Bay Aging is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request reasonable accommodation, contact MaDena DuChemin, Director, Human Resources at [phone], Ext. 1228 or [e-mail].