SMOKY MOUNTAIN CENTER
For Mental Health, Developmental Disabilities,
And Substance Abuse Services
44 Bonnie Lane
Sylva, NC 28779
GENERAL STATEMENT OF JOB
- Responsible for all functions related to a designated area of claims processing to ensure that providers receive timely and accurate payment.
- This position is responsible for claims adjudication quality control activities through continuous monitoring and quality control measures. Responsibilities include finalizing claims processed electronically for payment and reviewing claim adjudication results for Medicaid and IPRS claims, payment and denial patterns, ensuring adjudication accuracy in the claims processing system, adhering to policy and procedures, responding to provider inquiries and providing education/training to providers.
QUALIFICATIONS & CREDENTIALING REQUIREMENTS:
- Graduation from high school and four years experience in claims/reimbursement; or an equivalent combination of education and experience.
- Graduation from a four year college or university with a major in business administration may be substituted for the required experience; or a two year degree in business administration or accounting from a community college may be substituted for three of the four years experience.
KNOWLEDGE OF JOB:
- Must maintain a working knowledge of the Medicaid Waiver requirements, applicable revenue codes and coding, compliance and software requirements used to adjudicate claims.
- Ability to handle large volume of work and to manage a desk with multiple priorities.
- Strong organization skills. Ability to speak and write professionally.
- Computer proficiency, including the use of Word and Excel programs.
- Ability to work in a team atmosphere and in cooperation with others and be accountable for results.
- Considerable knowledge of the methods of operation of combination alphabetic and numeric computer software.
- General knowledge of office procedures and methods.
- Ability to read printed words and numbers rapidly and accurately.
- Ability to understand oral and written instructions.
- Ability to enter routine and repetitive batches of data from a variety of source documents within structured time schedules.
- Ability to maintain confidential information.
Grade/Step is determined by qualification and experience of candidate.
Hourly Range is $13.19-$14.98/hr. Position is full-time hourly with comprehensive benefits.
Work schedule is 37.5 hours per week. This position is not exempt from overtime compensation.
Send a NC State Application and resume to:
Smoky Mountain Center,
Department of Human Resources,
44 Bonnie Lane, Sylva, NC 28779
Smoky Mountain Center is an equal opportunity, affirmative action employer.
Smoky Mountain Center (SMC) is responsible for serving as the Local Management Entity (LME) for public mental health, developmental disabilities and substance abuse services. SMC provides financial management and accountability for use of State, Federal non-Medicaid and County funds used to contract for services. SMC will provide financial oversight and accountability for mental health, developmental disability and substance abuse services for Medicaid effective July 1st, 2012. SMC ensures the delivery of publically funded services through planning, development, implementation and monitoring of services within its fifteen-county catchment area in Western North Carolina. SMC is comprised of a Northern (Alleghany, Ashe, Avery, Watauga, Wilkes counties), Central (Alexander, Caldwell, McDowell counties) and Western Region (Cherokee, Clay, Graham, Haywood, Jackson, Macon, Swain counties). SMC’s primary administrative office is located in Jackson County where many administrative LME functions are centralized. SMC has three additional office locations in Haywood, Watauga and Caldwell Counties as well as staff which are based out in the counties to provide a localized presence and support for consumers, providers and community stakeholders.
Smoky Mountain Center is a regional organization that coordinates high quality prevention, treatment, and support services for individuals and families in our communities with developmental disabilities, mental health, or, substance abuse needs.
Individuals in our region with developmental disabilities, mental health, and substance abuse needs have access to timely, evidence-based, and culturally sensitive prevention, treatment, and support services in their communities.
- Responsibility - Our actions are transparent, consistent and accountable.
- Integrity - We are honest. We do what we say we will do.
- Quality - We are proactive and consistent in our work, using practices that are proven to be effective.
- Caring - We are compassionate, culturally sensitive, and empathetic with one another and those we serve.
Smoky Mountain Center (SMC)
44 Bonnie Lane
Sylva, NC 28779