PACE Claims Adjudicator

Valir PACE provides integrated medical and social services to our most vulnerable seniors, helping to unlock their full potential. We are looking for team members who are energized by working in diverse teams toward our shared purpose. Those eager to drive groundbreaking innovation, and who will interact with those we serve and those who serve them in a spirit of understanding and compassion.

WHAT WE OFFER

• Competitive pay, retention and referral bonuses
• Outstanding Medical, dental, and vision insurance
• Paid day off for your birthday
• 401K Company match on day one
• Company paid life insurance
• Generous PTO
• Career development opportunities
• Employee Gym
• Employee Recognition

#PACE

Job Summary:

The PACE Claims Adjudicator is responsible for the accurate review, processing, and resolution of medical claims in accordance with CMS, state, and PACE program guidelines. This position plays a vital role in the financial oversight of participant healthcare expenses by verifying billing accuracy, ensuring compliance with regulations, and maintaining cost-effective claims management. The adjudicator must possess a comprehensive understanding of billing forms (CMS-1500 and UB-04) and adjudication processes, with an emphasis on accounts payable rather than revenue cycle management.

Education, Licenses, Certifications and Experience:

• High school diploma or equivalent required; associate’s or bachelor’s degree in healthcare administration, accounting, or related field preferred.
• Minimum of 3 years of experience in healthcare claims adjudication, billing, or payables processing.
• Prior experience in a PACE, managed care, or Medicare/Medicaid environment strongly preferred.