Claims Specialist / Contract

About the job

Claims Specialist / Contract - Jericho or Albany, NY (#25349)

Location: Jericho, NY or Albany, NY Employment Type: Full-time, Temporary/Contract (Monday to Friday) Hourly Rate: $44/hr

About Greenlife Healthcare Staffing:

Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.

Position Overview:

Greenlife Healthcare Staffing is currently seeking a Claims Specialist to fill an opening with a Non-profit organization located in Jericho or Albany, NY. This assignment is ideal for a detail-oriented professional with a background in healthcare, business, or digital studies who thrives in a collaborative, fast-paced environment managing appeal and dispute adjudication programs.

Requirements

Qualifications:

• Education: Must have a bachelor's or advanced degree in healthcare, business, management, digital studies, or a related field.

• Experience: 2 years of collaborative project support is preferred; however, new graduates will be considered.

• Technical Skills:

• Knowledge and experience with collaborative project management software, electronic documents, and design.

• Familiarity with commercial off-the-shelf and custom software applications for tracking and case management.

• Proficiency in Microsoft Office applications.

• Soft Skills:

• Must have the ability to problem-solve and work collaboratively with peers, 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.

Key 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

Why Join Us?

• Competitive Compensation: Earn a competitive rate of $44 per hour.

• Comprehensive Benefits:

• 1 Week of Paid Vacation

• 6 Major Paid Holidays per year

• 5 Sick Days (40 Hours) subject to the provisions of the NYS Paid Sick Leave Act

• License Reimbursement after 1 year of employment

• Health insurance subject to plan eligibility requirements

• 401k Matching eligibility after 1 year of employment

• Benefits from Paychex, such as Payactiv

• GLHS is a great company to work for with 93% retention of employees 2 years+, excellent Google reviews, and a strong company culture.

• Work Schedule: Full-time position, Monday to Friday.

• Professional Growth: Gain valuable experience in claims management, appeal adjudication, and collaborative project work within a mission-driven organization.

• Impactful Work: Contribute to a non-profit organization dedicated to improving healthcare processes and ensuring accurate claims adjudication that supports providers, patients, and healthcare plans.