Claims Specialist

Claims Specialist / Contract - Lake Success or Albany, NY (#25148)

Preferably has 2 years of collaborative project support

Greenlife Healthcare Staffing is currently seeking a Claims Specialist to fill an opening with a Non-profit organization located in Lake Success or Albany, New York.

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 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

• The salary for this position is $39/ hr
• This is a Full-time position
• 2 Weeks Vacation
• 6 Major Holidays
• 5 sick days