Collabrios Health

Compensation

Full Description

Description Collabrios delivers purpose-built software solutions that unify the entire care journey. With decades of expertise in Programs of All-Inclusive Care for the Elderly (PACE) and deep industry knowledge, we empower care providers to streamline operations and deliver exceptional care to aging adults. Our integrated SaaS platform includes Electronic Medical Records (EMR), Third-Party Administrator (TPA) financial services, and care coordination solutions, helping PACE programs optimize workflows, ensure compliance, and enhance overall operations. We partner with PACE, government agencies, and community-based organizations to advance care delivery and improve outcomes for the communities they serve. Job Overview The Claims Coordinator is responsible for reviewing and analyzing PACE claims to determine eligibility and payment amounts while ensuring compliance with applicable regulations and policies. This role requires attention to detail, an understanding of Medicare/Medicaid guidelines, and the ability to collaborate across teams to resolve issues and enhance service quality. Key Responsibilities • Claims Evaluation: Evaluate claims for completeness and validity to determine payment or denial in line with provider contracts, authorizations, and Medicare/Medicaid guidelines. • Coverage Determination: Review claim forms and supporting documentation to make informed coverage determinations. • Claims Processing: Accurately process various Medicare and Medicaid claim types, including Professional, Facility, and Dental claims. • Communication: Communicate clearly and in a timely manner with plan stakeholders and internal teams. • Coding & Payments: Apply correct coding and payment requirements to all claims. • Contract Analysis: Analyze and interpret provider contracts to guide accurate claim processing. • Adjustments & Resolutions: Investigate claims and apply adjustments as appropriate. • Decision Sharing: Share decisions with relevant parties—including PACE plans, providers, and other stakeholders—in a clear and timely way. • Record Maintenance: Maintain accurate electronic records of all claim activities. • Compliance: Follow established procedures and ensure compliance with CMS and state regulations. • Training & Policy Adherence: Complete all required training within designated timeframes. • Fraud Escalation: Escalate potential fraud or abuse concerns to leadership. • Issue Identification: Identify and help resolve issues related to claims processing, payment, enrollment, or provider contracts. • Team Collaboration: Collaborate with internal teams to suggest improvements or address client needs. • Meetings & Support: Participate in client-facing and internal meetings as needed. Requirements What You Bring Required • High school diploma or equivalent required • 1–3 years of experience at a health plan, insurance company, or Third Party Administrator (TPA) preferred • Familiarity with Medicare, Medicaid, and PACE programs required • Completion of medical terminology, coding, and claims processing training preferred • Ability to manage multiple priorities in a fast-paced environment • Strong analytical and problem-solving skills • Proficiency with Microsoft Office applications • Effective time management and multitasking abilities • Clear and professional verbal and written communication skills • Ability to work independently, while seeking support when needed • Demonstrated ability to complete assignments without follow-up or prompting Bonus Points If You Have • Completion of medical terminology, coding, and claims processing training • Experience supporting claims for PACE or long-term care programs • Familiarity with healthcare administration platforms or claims adjudication systems • Experience participating in audits or compliance reviews • Involvement in improving claims workflows or documentation practices What We Offer At Collabrios Health, we’re committed to fostering a workplace that supports your well-being, growth, and ability to make a meaningful impact. Here’s what you can expect when you join our team: • A connected, virtual-first culture with a collaborative, mission-driven team • Competitive health benefits, including medical, dental, and vision coverage • 401(k) with company contribution • Generous paid time off, including 15 PTO days, 2 floating holidays, and 6 sick days • Flexibility and trust—we empower our team to manage their schedules and work in ways that support their lives • Opportunities for learning, mentorship, and professional development • A values-driven environment where diverse perspectives are welcomed and purpose guides our work We’re committed to building a diverse and inclusive workplace. Collabrios is an equal opportunity employer. We welcome candidates from all backgrounds, identities, and experiences. If you’re excited about this role but your experience doesn’t align perfectly with every qualification, we encourage you to apply anyway. You may be the right candidate for this or other roles.