Claims Processing Rep, Full-time

Central Maine Healthcare is an integrated healthcare delivery system serving 400,000 people living in central, western and Midcoast Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice organization. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center and other high-quality clinical services.

If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application!

Position Summary:

The Claims Processing Billing Representative’s responsibility is to process claims in the most efficient
method using paper and electronic media in a timely fashion to ensure a positive cash flow for the regional
healthcare system. The use of multiple patient accounting systems and claims processing and scrubbing
systems are used.

Essential Duties:

• Review claims using electronic claims software -compliance products, editing and transmitting.
• Completes processing for claims received on a daily basis.
• Works with follow-up staff to determine status of rebilled and aging claims.
• Enters notes on accounts as necessary and accordingly.
• Follows up on claims that are held for errors on a weekly basis. When appropriate, contacts patients,
employers or third-party payers in order to resolve problems.
• Maintains WIP counts at or below goal.
• Identifies claim problems to include all denials, claim issues, registration errors and other issues for
monthly reporting to individual departments/practices.
• Stays informed of changes in the insurance industry relative to billing regulations and requirements.
• Consults with other departments within the regional healthcare system to obtain, and/or verify billing
information.
• Processes and completes all job responsibilities in compliance with regulatory requirements.
• Works independently to resolve account problems.
• Demonstrates the ability to be flexible, organized and function well in stressful situations.
• Communicates clearly and accurately with the Supervisor.
• Maintains a good working relationship within the department and with other departments of the
regional healthcare system.
• Follows through, in a timely manner, on all action steps requested by supervisor.
• Provides coverage for other team members when necessary, reorganizes workflow as necessary to
accomplish this.
• Assists with projects and other assignments when necessary, offering assistance when possible.
• Acts as a resource to the entire Claims Processing team, providing training and support as necessary.
• Adheres to department protocol and Central Maine Healthcare policies and procedures.
• Customer Service: Interacts with all individuals in a consistent manner, providing attention, support,
and assistance to foster an environment of exceptional personal service.

o Maintains a pleasant and helpful demeanor, and presents a professional appearance toward all
internal and external customers at all times.
o Consistently initiates interaction to provide assistance to individuals who may not be direct
customers of the employee (i.e. asks patients who appear to be lost if they need assistance in
finding their way).
o Takes appropriate action to recover from a service difficulty, ensuring that the necessary action
is taken to affect a resolution to the customer’s problem.
o Conducts all work activities with respect for coworkers, including the maintenance of a
pleasant and professional environment, fostering calmness during stressful situations.
o Interacts with supervisory personnel in a professional, supportive and courteous manner,
venting emotions appropriate to time and place.
o Demonstrates a commitment to service by consistent attendance and punctuality, scheduling
absences according to departmental requirements, and incurring unplanned absences only
when unavoidable circumstances exist.

Education and Experience:

• High School graduate or equivalent.
• Minimum of two years relevant experience, including knowledge of insurance billing and medical
terminology
• Thorough understanding of various insurance plans, government agencies, Medicare and Medicaid.

Knowledge, Skills and Abilities:

• Able to effectively communicate in English, both verbally and in writing.
• Strong written and verbal skills.
• Additional languages preferred.
• Basic computer knowledge.
• High level of interpersonal and communication skills.
• Ability to engage patients and team members utilizing the CMH Experience Standards

i. I am creating a warming, caring, and non-judgmental environment
ii. I am actively listening and seeking information
iii. I am honest, truthful, and consistent
iv. I am respectful, treating all individuals with dignity and empathy
v. I am serving as a role model, taking both initiative and ownership when appropriate
vi. I am working collaboratively and demonstrating teamwork
vii. I am resilient and adapt to change in positive ways.

• Demonstrated ability to direct and triage in a highly fluid dynamic operational environment.
• Ability to collaborate with all layers of the management/ administration team.

CMH actively promotes diversity in its workforce at all levels of the organization. We strive to create and maintain a setting where we celebrate cultural and other differences and consider them strengths of the organization. CMH is an equal opportunity workforce and no one shall discriminate against any individual with regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, genetic information or veteran status with respect to any offer, or term or condition, of employment. We make reasonable accommodations to the known physical and mental limitations of qualified individuals with disabilities.