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.