Verification Specialist Jobs

Benefits:

• Job Code: FIT040
• Health and Flexible Benefits
• Teleworking Options Available
• 13 Paid State Holidays
• Annual & Sick Leave

Criminal Justice Coordinating Council

The Criminal Justice Coordinating Council (CJCC) is administratively attached to GBI. CJCC is legislatively charged with eleven areas of criminal justice coordination. Among those responsibilities is to serve as the statewide clearinghouse for criminal justice information & research. Develop criminal justice legislative & executive policy proposals; & serve in an advisory compacity to the Governor on issues impacting the criminal justice system. CJCC plans & administers tens millions of dollars in federal criminal justice and victim services grants.

Location: This position is located at 244 Washington Street, Atlanta GA 30334

Applicants chosen for employment will be subject to financial, driving, education, criminal background, and reference checks. Work eligibility will be checked in EVerify. As a federally funded agency, CJCC is subject to federal Drug Free Workplace requirement. CJCC is an equal opportunity employer.

Description: Under the direct supervision of the Program Director, reviews and investigates claim requests according to Crime Victims Compensation Law of Georgia and/or rules and regulations of the Crime Victims Emergency Fund. Specialists at this level review bills to determine reimbursement eligibility according to Crime Victims Compensation Law of Georgia and/or rules and regulations governing the Georgia Crime Victims Compensation Program. Coordinates information exchange between all necessary entities, including victims/claimants, service providers, advocates, and insurance companies to ensure bill eligibility. Handles highly sensitive and confidential customer information, including medical records and reports to determine benefit eligibility. Ensures that the verification process is handled accurately and timely to allow the Claims Investigator to make prompt and accurate payment recommendations.

Make payment recommendations to the Claims Investigator on disbursement of victims’ compensation for each allowable category (e.g., medical, counseling, funeral expenses, etc.) as is provided under the state law by determining to whom benefits are payable, reviewing claims to verify all billing information and charges are related to the injury, identifying eligibility of the bill payment according to statutory guidelines, and ensuring all legal reimbursement prerequisites are met.

Accurately documents files in the Claims Management Information System (CMIS) by providing detailed information on payment statuses to the Claims Investigator, including recording accurate information regarding the victim/claimant and respective insurer(s) or other payment resources.

Assists with answering inquiries and explaining rules and regulations regarding the State of Georgia Crime Victim Compensation Program, including claims processing, claim status, payment of benefits (reimbursements); and where applicable, status of vendor payment.

Utilizes excellent customer service skills in person, by phone, and in writing when dealing with all identified customers. Communicates effectively and tactfully with all customers to ensure questions are properly handled, and concerns are resolved in a timely manner.

Key Duties & Responsibilities

• Assembles data and makes computations within established guidelines
• Categorizes expenditures and maintains appropriate files
• Performs work related to the examination and approved/denial of claims
• Record financial transaction to expenditure documents, journals, ledgers, and/or automated accounting systems
• Provides assistance with the resolution of claim/settlement disputes
• Processes and maintains applications and records, and reconciles accounts related to claims
• Monitors claims and payments to insure timely processing and compliance with rules and regulations
• Prepares documents initiating payment or settlement of approved claims
• Tracks/monitors payments and related activity
• Gather and compile data and prepares reports
• Responds to request from clients regarding filing requirements, returned/denied claims, program eligibility and/or interpretation of federal and state laws

Note: The above job description represents the general nature, primary duties and responsibilities, and qualifications for the work performed by employees with this job but is not a comprehensive and exhaustive list. Employees may be required to perform other duties assigned, and specific duties , responsibilities and activities with the core nature of the job may change at any time with or without notice. Employees must be able to perform the essential functions of the job, as specified by the employing entity with or with reasonable accommodation.

Entry Qualifications

Familiarity with ICD-9/CPT medical coding, EOBs, general medical terminology, HMO contractual agreements, Medicaid/Medicare requirements, and various billing systems utilized for medical claims billing; strong data entry and analytical skills, detail-oriented, and strong customer service skills.

OR

A minimum of 12 months of professional level work experience in the medical billing or medical insurance industry as a medical biller, coder, or patient account representative.

Preferred Qualifications

Completion of an undergraduate degree in Healthcare Management or Health Information Technology, certification in the medical billing/coding field, such as Certified Professional Coder (CPC), National Certified Coding and Insurance Specialist and/or Certified Medical Reimbursement Specialist. General knowledge of and experience with victims compensation programs and the statute, which governs such programs. Public speaking and report-writing experience

Note: An equivalent combination of education and job specific experience that provide the knowledge, experience and competencies required to successfully perform the job at the level listed may be substituted on a year-over-year basis

Only applicants selected for interview will be notified for applicant selection. Human Resources maintains the discretion to close the job announcement prior to the closing date if a significant number of applications are received.