On-Site Claims Specialist: Clinical Reviews & Projects

IPRO; Jericho (NY); On-site; USD 66,000 - 70,000; Full time

Job summary

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

Qualifications

• 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.

Responsibilities

• 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.

Skills

Collaborative project management

Problem solving

Written and verbal communication

Independent work

Deadline oriented

Education

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

Associate's degree with 2 years relevant experience

Job description

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