Claims Specialist

IPRO; Jericho (NY); Presencial; USD 66.000 - 70.000; Jornada completa

Descripción de la vacante

IPRO in Jericho, NY is seeking a Claims Specialist to coordinate clinical reviews projects. You will monitor requests, liaise with clinical partners, manage provider and contractor interactions, track deliverables and deadlines, and help develop project frameworks for interagency communications.

The role requires strong collaboration, problem solving, and excellent written and verbal communication. You will work in-office, meet deadlines in a fast-paced environment, and support billing processes

Formación

• Bachelor's degree in healthcare, business, management, digital studies or related field and one year experience in medical billing, auditing or claims review, appeals or dispute resolution in healthcare or insurance industries, regulatory, required.
• OR Associate's degree in related field and two years’ experience in medical billing, auditing or claims review, appeals or dispute resolution in healthcare or insurance industries, regulatory, required.

Responsabilidades

• Coordinate activities critical to the completion of clinical reviews projects.
• Monitor appeal/dispute status and communication on client portals.
• Conduct initial eligibility reviews and recommend course of action to internal team and management.
• Track and assign cases using software applications.
• Monitor and measure key performance indicators.
• Identify barriers and propose solutions and execute approved actions.
• Present case/project status in huddles and scrums using agile methods.
• Schedule team status meetings and record decisions and next steps.
• Prepare billing invoices and liaise with Finance to track payments.

Conocimientos

Collaborative project management

Problem solving

Written and verbal communication

Independent work

Deadline oriented

Educación

Bachelor's degree in healthcare/business/management related field

Associate's degree with 2 years relevant experience

Descripción del empleo

Duties

A s the Claims Specialist, you will coordinate activities critical to the successful completion of clinical reviews projects. You 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. Duties include but are not limited to:

• Monitor appeal/dispute status and communication received on client portals.
• Conduct initial eligibility reviews and recommend course of action to internal team and department management.
• Track and assign cases using commercial off-the-shelf and custom software applications.
• Monitor and measure key performance indicators.
• 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 conclusion of cases, submit to the Finance department, and liaise with accounting to track and trend payments.

Duties

A s the Claims Specialist, you will coordinate activities critical to the successful completion of clinical reviews projects. You 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. Duties include but are not limited to:

• Monitor appeal/dispute status and communication received on client portals.
• Conduct initial eligibility reviews and recommend course of action to internal team and department management.
• Track and assign cases using commercial off-the-shelf and custom software applications.
• Monitor and measure key performance indicators.
• 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 conclusion of cases, submit to the Finance department, and liaise with accounting to track and trend payments.

This is an in office position based in IPRO's headquarter office located in Jericho, NY

Qualifications

• Knowledge and experience with collaborative project management software, electronic documents, and design.
• Ability to problem solve and work collaboratively with peers, medical, analytical, and administrative support staff.
• Excellent written and verbal skills including phone manner.
• Ability to work independently with little supervision.
• Ability and desire to be flexible, innovative, and creative while multi-tasking.
• Ability to meet deadlines in time sensitive environment.

Education & Experience

• Bachelors' degree in healthcare, business, management digital studies or related field AND one (1) year experience in medical billing, auditing or claims review, appeals or dispute resolution in healthcare or insurance industries, regulatory, required.
• OR-
• Associates degree in related field AND two (2) years’ experience in medical billing, auditing or claims review, appeals or dispute resolution in healthcare or insurance industries, regulatory, required.

The salary range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The salary range for this position is $66,300.00 to $70,000.00. Actual salary and/or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.

The salary range listed does not include other forms of compensation or benefits.

IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, protected veteran status or military status.