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Claims Specialist / Contract - Jericho, NY (#25322)

Location:Jericho, NY
Employment Type: Full-time, Contract (minimum 6 months)
Hourly Rate: $44/hr

Position Overview:

Greenlife Healthcare Staffing is currently seeking a Claims Specialist to fill an 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 $44 per hour.
Work Schedule: Full-time position with a contract duration of at least 6 months.
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.

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