Job Description

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Facility Claims Specialist

Responsible for timely and accurate adjudication of claims Analyzes claim resubmissions to determine areas for provider education or system re-configuration. Provides feedback on department workflows and identifies opportunities for redesign.  Performs claims testing to ensure that systems are designed efficiently based on the Plan's benefit structure.

RESPONSIBILITIES: 

  • Review, research and finalize provider claims within established regulatory requirements
  • Review provider disputes or appeals and provide a detailed analysis of findings.
  • Conduct claim testing products.
  • Review claim processing results of Delegated Vendors
  • Document provider contacts; including telephonically, emails, written correspondence
  • Trouble shoot and identify root cause of problems and participate in developing solutions
  • Provides follow up and intervention relating to provider claim inquiries
  • Collaborate with internal teams and departments to ensure applications are processed, contracts are executed and all providers are credentialed in a timely manner.
  • Participates in standing meetings as necessary, including but not limited to provider relations, contracting, network development, team building.
  • Performs other duties and special projects as assigned and directed.

Requirements:

  • BA/BS degree in a financial field or equivalent healthcare experience preferred  
  • 3+ years of claim processing experience, preferably in health care environment
  • Knowledge of Microsoft Access or similar query tool.
  • Proficiency with MS applications, including but not limited to Word, Excel, Outlook, Power Point, Project

Position Type/Expected Hours of Work

  • Full Time - Monday through Friday

We offer:

  • Health Benefits
  • Dental
  • 401K
  • Generous Paid Time Off
  • Voluntary Employee Benefit Programs
  • Employee Referral Award Program

Location:

Staten Island, New York

ABOUT US:

Centers Home Care is one of the largest home health care organizations in New York, providing every type of healthcare from Health aide to Physical Therapists, Registered Nurses, and more. Our network includes Alpine Home Health Care, Revival Home Health Care, InterGen Health, and Amazing Home Care. Whether you are a hospital planner arranging patient discharges, a rehabilitation patient in need of continuing care when you return home, or you’re taking care of someone at home and need a little extra help, we’re here for you. We have the staff and most importantly, we have the expertise. We can solve your care needs, assist you with short or long-term equipment rental, and resolve insurance questions all with one call. AHC18, LB123

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Application Instructions

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