Claims Specialist / Contract

Greenlife Healthcare Staffing • New York, NY

1d • Remote

About The Position

Greenlife Healthcare Staffing is currently seeking a Claims Specialist to fill an opening with a Non-profit organization located in New York, NY

Responsibilities of the Claims Specialist: Act as point-of-contact for appeal/dispute adjudication programs. Liaise with healthcare plans, providers, patients, and clients to coordinate requests, correspondence, and submission of case documentation, as necessary. Monitor appeal/dispute status and communication received on client portals. Conduct initial eligibility reviews and recommend a course of action to internal team and department management. Track and assign cases using commercial off-the-shelf and custom software applications. Review and provide case documentation to assigned billers/coders, nurses, physicians and clinicians internal teams, and key stakeholders to facilitate clinical and coding reviews. Monitor and measure key performance indicators, including, but not limited to, timeliness, adherence to quality and accuracy standards, and deadlines for contract deliverables. Identify barriers and roadblocks in work processes, recommend solutions to solve problems, and execute approved solutions. Routinely present case/project status in huddles and scrums while using an agile, iterative approach to implementation and data presentation. Schedule regular team status meetings and record decisions (e.g., assigned tasks and next steps). Prepare billing invoices at the conclusion of cases, submit them to the Finance department, and liaise with accounting to track and trend payments Mentor and train new staff, at all levels, on process steps and case progression. Other activities as may be deemed necessary

Greenlife Healthcare Staffing is a nationwide recruitment agency, matching both new grads and advanced practitioners to hospitals, clinics, nursing homes, multi-specialty groups, and private practices.

Requirements

• Must have a bachelor's or advanced degree in healthcare, business, management, digital studies, or a related field.
• 2 years of collaborative project support is preferred; however, new graduates will be considered.
• Must have knowledge and experience with collaborative project management software, electronic documents, and design.
• Must have the ability to problem-solve and work collaboratively with peers and medical, analytical, and administrative support staff.
• Must have excellent written and verbal skills, including phone manners.
• Must have the ability to work independently with little supervision.
• Must have the ability and desire to be flexible, innovative, and creative while multi-tasking.
• Must have the ability to meet deadlines in a time-sensitive environment.

Responsibilities

• Act as point-of-contact for appeal/dispute adjudication programs.
• Liaise with healthcare plans, providers, patients, and clients to coordinate requests, correspondence, and submission of case documentation, as necessary.
• Monitor appeal/dispute status and communication received on client portals.
• Conduct initial eligibility reviews and recommend a course of action to internal team and department management.
• Track and assign cases using commercial off-the-shelf and custom software applications.
• Review and provide case documentation to assigned billers/coders, nurses, physicians and clinicians internal teams, and key stakeholders to facilitate clinical and coding reviews.
• Monitor and measure key performance indicators, including, but not limited to, timeliness, adherence to quality and accuracy standards, and deadlines for contract deliverables.
• Identify barriers and roadblocks in work processes, recommend solutions to solve problems, and execute approved solutions.
• Routinely present case/project status in huddles and scrums while using an agile, iterative approach to implementation and data presentation.
• Schedule regular team status meetings and record decisions (e.g., assigned tasks and next steps).
• Prepare billing invoices at the conclusion of cases, submit them to the Finance department, and liaise with accounting to track and trend payments
• Mentor and train new staff, at all levels, on process steps and case progression.
• Other activities as may be deemed necessary

Benefits

• The salary for this position is $39/ hr
• This is a Full-time position
• 1 Week of Paid Vacation based on accruals after 3 months of employment (2 weeks of Paid Vacation with accrual starting your second year of employment)
• 6 Major Paid Holidays per year
• 5 Sick Days (40 Hours) subject to the provisions of NYS Paid Sick Leave Act
• License Reimbursement after 1 year of employment
• Health Insurance is subject to plan eligibility requirements
• 401k Matching eligibility after 1 year of employment

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level