What are the responsibilities and job description for the Claims Specialist position at Phaxis?
CLAIMS SPECIALIST
Location : Wallerstein, Bronx NY
Setting : A minimum of 2 days onsite (usually Wednesday and Friday), though this may vary.
Schedule : Monday –Friday 8 : 30 am-5 : 30 pm (1 hour lunch)
Contract Length : Long Term / Ongoing, potential for Direct Hire
Job Summary :
As a Claims Specialist, you will oversee claims processed by external vendors, resolve provider appeals / disputes, and drive process improvements. You’ll conduct root cause analysis to identify areas for provider education and system enhancements. Your key tasks will include investigating claims, managing claim reports, improving workflows, and ensuring accurate reimbursement configurations. You’ll also handle refunds, validate pricing outcomes, and collaborate with internal teams, providers, and vendors. Additionally, you'll contribute to special projects and ensure compliance with regulations and SLAs.
Key Responsibilities Include :
- Review and resolve provider claims, appeals, and disputes.
- Analyze claims and medical data to improve processes and workflows.
- Collaborate with providers, members, and vendors to ensure smooth claim processing.
- Validate DRG grouping and (re)pricing outcomes.
- Manage refund checks, identify trends, and propose process enhancements.
- Produce routine reports to ensure vendor productivity and compliance.
- Participate in special projects and continuous process improvements.
QUALIFICATIONS :
Education : Bachelor's degree. Certified Professional Coder (a plus)
Experience :
Salary : $24 - $25
