Claims Specialist - Remote

JOB TITLE (#24995B): Claims Specialist / Contract - Remote

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

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.

Benefits of the Claims Specialist:

• 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

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