Claims Specialist - Healthcare Provider

Job Description

Compensation : $20 - $25 Job ID : 34576

Job Function :

• The Claims Specialist will be responsible for reviewing claims processed by the outside vendor, including resolving provider appeals / disputes.
• Performs root cause analysis for all provider projects to identify areas for provider education and / or system (re)configuration.
• Initiates and follows through with resolution of all pended claims, (re)pricing, returned or refund checks and the development of provider and facility compensation grids.
• Reviews and investigates claims to be adjudicated by the TPA, including the application of contractual provisions in accordance with provider contracts and authorizations.
• Compiles claim reports for adjustments resulting from external providers, vendors, and internal inquiries in a timely manner.
• Investigates suspense conditions to determine if the system or procedural changes would enhance claim workflow.

Job Requirements :

Disclosure : The hourly rates and / or salaries listed may or may not reflect total compensation packages including bonus and fringe benefits, etc., nor are the advertisement(s) posted a guarantee of a certain compensation package for a position or bona fide offer of employment. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

ITMNY

LI-DNP

34576

Salary : $20