Flexstaff is hiring a CLAIMS SPECIALIST on a fulltime Temporary basis. (Coding/Claims experience needed, Data Analysis a plus) The Claims Specialist will support department operations related to provider communication, pended claim review, reporting, auditing, and oversight activities to ensure compliance with all applicable State, Federal, and contractual guidelines.
Location: Wallerstein, NY
Pay Rate: $28/hr
Schedule: Monday-Friday 8:30 am-5:30 pm (1 hour lunch) (FT), Hybrid Wednesday and Friday in the office.
JOB DESCRIPTION
- Analyzes patient and medical information to identify COB, Worker's Compensation, No-Fault, and Subrogation conditions
- Validates DRG grouping and (re)pricing outcomes presented by the claims processing vendor. Attends JOC meetings with providers as appropriate to assist in communicating proper billing procedures and to explain company coverage guidelines
- Assists TPA with provider compensation configuration by creating and testing compensation grids used for reimbursement and claims processing
- Ensures that refund checks are logged and processed, enabling expedited credit of monies returned
- Analyzes check return/refunds volumes and trends to determine root causes. Proposes workflow changes to correct and enhance claim processes to prevent returned checks/refunds
- Generates routine daily, monthly and quarterly reports used for managing process timeframes and vendor productivity, ensuring compliance with all regulatory requirements and contractual vendor SLAs
- Participates in special projects and performs other duties as assigned
QUALIFICATIONS:
Education: Bachelor's degree. Certified Professional Coder (a plus)
Experience:
- Eight or more years of insurance experience within a healthcare or managed care setting (preferred)
- Claims adjudication experience
- Knowledge of MLTC/ Medicaid/Medicaid benefit
- Knowledge of Member (Subscriber) enrollment & billing
- Knowledge of Utilization Authorizations
- Knowledge of Provider Contracting
- Knowledge of CPTs, ICD 9/ICD 10, HCPC, DRG, Revenue, RBRVS
- Proficiency in MS Excel, Word, PowerPoint, and experience using a claims processing system or comparable database software
Additional Salary Detail:
The salary range and/or hourly rate 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. When determining a team member’s base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).
