Managed Care Claims Validation Specialist

CHQ CHSI EMP LLC; United States; On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

401(k) with employer match

Medical, dental and vision coverage

Paid time off (PTO)

Job summary

CommuniCare Health Services in Blue Ash, OH seeks a Managed Care Claims Validator to ensure accurate and timely filing of all managed care claims. You will work with the Central Billing Office team to validate claims using PCC data, census, authorizations, and eligibility, following established processes.

The role requires knowledge of medical billing, attention to detail, and the ability to resolve claim denials while meeting internal deadlines and staying current with payer requirements.

Qualifications

• High School graduate or GED required.
• Experience in long-term care setting preferred.
• Healthcare software experience preferred.

Responsibilities

• Validate claims for SNF billing using PCC data.
• Verify data in census, AR insurance, authorization docs, and eligibility.
• Resolve claim rejections by the clearinghouse within 30 days.
• Ensure claims are billed by the 10th business day after close.
• Identify trends in denials and report to revenue cycle.
• Lead in-service trainings when appropriate.

Skills

Medical billing

Accounts receivable

Attention to detail

Decision making

Communication skills

Computer literacy

Organization

Education

High School diploma

Job description

CommuniCare Health Services in Blue Ash, OH seeks a Managed Care Claims Validator to ensure accurate and timely filing of all managed care claims. You will work with the Central Billing Office team to validate claims using PCC data, census, authorizations, and eligibility, following established processes.

The role requires knowledge of medical billing, attention to detail, and the ability to resolve claim denials while meeting internal deadlines and staying current with payer requirements.