Healthcare Claims & Operations Specialist

Genesys Health Alliance LLC • Waycross, GA

15h • Onsite

About The Position

The Healthcare Claims & Operations Specialist supports billing and operational functions across multiple correctional healthcare facilities. This role focuses on reviewing and repricing claims, tracking medication-related processes, and coordinating operational needs to support facility services. This is not a traditional hospital or physician office billing role. The position requires strong attention to detail, organization, and the ability to manage multiple priorities.

Requirements

• 2+ years of experience in healthcare claims, billing, or related field
• Experience reviewing, scrubbing, or repricing claims preferred
• Strong attention to detail and problem-solving skills
• Ability to manage multiple priorities in a fast-paced environment
• Strong communication and organizational skills
• Proficiency in Microsoft Office (Excel, Outlook, etc.)
• Ability to pass standard background checks and any correctional facility clearance requirements.

Nice To Haves

• Experience in correctional healthcare or multi-site healthcare
• Familiarity with prior authorizations and medication coordination
• Experience working with vendors or supply coordination

Responsibilities

• Review, scrub, and reprice claims for multiple facilities
• Ensure claims align with contracted rates and services
• Identify and resolve discrepancies prior to submission
• Track and follow up on claim status as needed
• Track medication orders and related billing processes
• Monitor and manage prior authorizations for medications and services
• Coordinate with facilities and vendors to ensure timely processing
• Maintain accurate documentation related to approvals
• Order and track medical and operational supplies
• Communicate with vendors regarding orders, delays, and issues
• Assist facilities with supply needs and coordination
• Support day-to-day operational needs across multiple facilities
• Collaborate with HR, Finance, and Operations teams
• Assist with workflow improvements and process organization
• Perform additional duties as assigned

Benefits

• Health, Dental and Vision insurance
• Supplemental plans options include- Life, Cancer, Accident and Short Term Disability insurance
• 401(k) matching (after 1 year)
• Paid holidays
• PTO- Vacation, sick and bereavement

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed