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TITLE: Claims Specialist (looking for a strong administrative or project coordination background – claims experience not required)
LOCATION: New Hyde Park, NY (onsite)
HOURS: full-time Monday – Friday. 7am to 3:30pm or 9am to 5:30pm EST
GENERAL RESPONSIBILITIES: This individual will coordinate activities critical to the successful completion of clinical studies and review projects. They will support programs by monitoring requests, liaising with clinical partners, managing provider and contractor interactions, tracking
deliverables and deadlines, and develop project frameworks to support interdisciplinary
and interagency communications.
EDUCATION EXPERIENCE:
1. Bachelors or advanced degree in healthcare, business, management, digital studies or related field and 2 years collaborative project support experience, required
OR
2. Associates degree in related field AND 3 years of collaborative project support, required.
DUTIES:
1.
Act as point-of-contact for appeal/dispute adjudication programs.
2. Liaise with healthcare plans, providers, patients, and clients to coordinate requests, correspondence, and submission of case documentation, as necessary.
3. Monitor appeal/dispute status and communication received on client portals.
4. Conduct initial eligibility reviews and recommend course of action to internal team and department management.
5.
Track and assign cases using commercial off-the-shelf and custom software applications.
6. Review and provide case documentation to assigned billers/coders, nurses, physicians and clinicians internal teams and key stakeholders to facilitate clinical and coding reviews.
7. Monitor and measure key performance indicators including, but not limited to, timeliness, adherence to quality and accuracy standards, and deadlines for contract deliverables.
8. Identify barriers and roadblocks in work processes, recommend solutions to solve problems, and execute approved solutions.
9.
Routinely present case/project status in huddles and scrums while using an agile, iterative approach to implementation and data presentation.
10. Schedule regular team status meetings and record decisions (e.g., assigned tasks and next steps).
11. Prepare billing invoices at conclusion of cases, submit to the Finance department, and liaise with accounting to track and trend payments.
12. Mentor and train new staff, at all levels, on process steps and case progression.
13.
Other activities as may be deemed necessary.
QUALIFICATIONS:
1. Knowledge and experience with collaborative project management software, electronic documents, and design.
2. Ability to problem solve and work collaboratively with peers, medical, analytical, and administrative support staff.
3. Excellent written and verbal skills including phone manner.
4.
Ability to work independently with little supervision.
5. Ability and desire to be flexible, innovative, and creative while multi-tasking. Ability to meet deadlines in time sensitive environment
PAY: $22-28/hr DOE
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