Claims Specialist

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. 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. 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. Greenlife Healthcare Staffing - Empowering Healthcare Professionals, Enriching Lives #J-18808-Ljbffr Greenlife Healthcare Staffing