Claims Specialist (Remote-to-Onsite)

Job Description

Job Description

Claims Specialist / Contract - Remote to Office-Based Setting - Jericho, NY  (#25322A)

Location:  Remote to Office-Based Setting, Jericho, NY
Employment Type: Full-time, Contract, Remote-to-On-site
Hourly Rate: $40 per hour for a remote position; $44 per hour for an on-site position

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 a remote-to-on-site opening with a Non-profit organization located in Jericho, New York. This contract position 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.

Why Join Us?

• Competitive Compensation: Earn a competitive rate of $40 per hour for a remote position; $44 per hour for an on-site position.

• Comprehensive Benefits:

  • 1 Week Paid Vacation based on accruals
  • 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
  • Benefits from Paychex, such as Payactiv
  • GLHS is a great company to work for: 93% retention of employees 2 years+, Google reviews, great company culture, etc.
• Work Schedule: Full-time position. This is a remote-to-on-site position.
• 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.

Qualifications:

• Education: 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.
  • Proficiency with electronic documents and design tools.
  • Familiarity with commercial off-the-shelf and custom software applications for tracking and case management.

• Soft Skills:

  • Excellent written and verbal communication skills, including professional phone manners.
  • Strong problem-solving abilities with the capacity to work collaboratively with peers, medical staff, analytical teams, and administrative support.
  • Ability to work independently with little supervision.
  • Flexible, innovative, and creative mindset with strong multi-tasking abilities.
  • Demonstrated 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.