Medical Claims Specialist
3 months ago
- 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. Provides feedback or suggestions to enhance current processes or systems.
- 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
- Communicates and follows up with a variety of internal and external sources, including but not limited to providers, members, attorneys, regulatory agencies, and other carriers on any claim related matters
- 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
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Claims Processing Analyst
7 days ago
Flushing, New York, United States Momentum Resource Solutions Full timePosition OverviewThe Claims Processing Analyst will be tasked with evaluating claims managed by external vendors, which includes addressing provider appeals and disputes. This role involves conducting root cause analysis for various provider initiatives to pinpoint opportunities for provider education and necessary system adjustments.Key...
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Billing Specialist
2 weeks ago
Flushing, United States ABI Healthcare Full time $20 - $25Job DescriptionJob DescriptionRequirements: Language:English (Fluent)Mandarin or Cantonese (Preferred)Proficient in Microsoft Word, Excel, and OutlookAbility to work independently and collaboratively in a team environmentExcellent written and verbal communication skillsAbility to build relationships and establish credibility with insurance...
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Billing and Payroll Specialist
4 weeks ago
Flushing, United States ABI Healthcare Full time $20 - $25Job DescriptionJob DescriptionRequirements: Language:English (Fluent)Mandarin or Cantonese (Preferred) Proficient in Microsoft Word, Excel, and OutlookAbility to work independently and collaboratively in a team environmentExcellent written and verbal communication skillsExperience with HHA Exchange platform (preferred)Job Description:As a Billing and...
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Billing and Payroll Specialist
3 weeks ago
Flushing, United States ABI Healthcare Full time $20 - $25Job DescriptionJob DescriptionRequirements: Language:English (Fluent)Mandarin or Cantonese (Preferred)Proficient in Microsoft Word, Excel, and OutlookAbility to work independently and collaboratively in a team environmentExcellent written and verbal communication skillsExperience with HHA Exchange platform (preferred)Job Description:As a Billing and Payroll...
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Bilingual Medical Support Specialist
2 days ago
Flushing, New York, United States V R Della IT Services Private Limited Full timeJob Summary:V R Della IT Services Private Limited is seeking a highly skilled and bilingual medical support specialist to join our team. As a medical support professional, you will play a vital role in providing exceptional patient care and support in a fast-paced healthcare environment.Key Responsibilities:Take vital signs and assist with medical...
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Travel Nurse RN Specialist
2 days ago
Flushing, New York, United States OneStaff Medical Full timeJob Title: Travel Nurse RN SpecialistJob Summary: OneStaff Medical is seeking a skilled Travel Nurse RN Specialist to provide high-quality patient care in a dynamic and fast-paced environment.Job Responsibilities:Monitor and manage patient vital signs using electrocardiogram and other life sign-measuring devices.Provide care to patients with gastrointestinal...
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Travel Nurse RN Telemetry Specialist
2 days ago
Flushing, New York, United States OneStaff Medical Full timeJob Title: Travel Nurse RN Telemetry SpecialistJob Summary: OneStaff Medical is seeking a skilled Travel Nurse RN Telemetry Specialist to provide high-quality patient care in a dynamic hospital setting.Job Responsibilities:Monitor patients' vital signs using electrocardiogram or other life sign-measuring devices.Provide care to patients with gastrointestinal...
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Healthcare Support Specialist
5 days ago
Flushing, New York, United States HeartVeinNYC Full timeJob OverviewAt HeartVeinNYC, we are seeking a highly skilled and detail-oriented Bilingual Medical Assistant to join our team. As a key member of our medical staff, you will play a vital role in ensuring the smooth operation of our facility.Key Responsibilities:Administrative Support: Provide timely and accurate administrative support to our medical staff,...
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Clinical Review Nurses
2 weeks ago
Flushing, United States Mitchell Martin Full timeA Day treatment facility located in Flushing, NY is looking for an Clinical Review Nurses. Type: Contract Schedule: M-F 8:30am-5:30pm -1 Hour Break, as well as two 15-minute breaks Location: Flushing, NY JOB PURPOSE: The Clinical Review Nurse is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance...
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Certified Central Processing Specialist
2 weeks ago
Flushing, New York, United States Pride Health Full timeJob OverviewCertified Central Processing SpecialistAre you an experienced Central Processing Specialist dedicated to supporting the success of others in the staffing sector? Do you aspire to join a well-respected and expanding organization that offers opportunities for career advancement? If this resonates with you, Pride Health has an exciting opportunity...
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Travel Nurse RN
2 days ago
Flushing, New York, United States Host Healthcare Full timeJob DetailsJob Title: Travel Nurse RN - Telemetry SpecialistJob Type: Travel NursingSpecialty: TelemetryDiscipline: Registered Nurse (RN)Shift: 12 hours, nightsHours per Week: 36 hoursDuration: 8 weeksAbout the JobHost Healthcare is seeking a skilled Travel Nurse RN - Telemetry Specialist to join our team. As a Travel Nurse RN - Telemetry Specialist, you...
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Habilitation Specialist
7 days ago
Flushing, New York, United States WellLife Network Full timeJob SummaryWe are seeking a highly motivated and compassionate Habilitation Specialist - Assistant to join our team at WellLife Network. As a key member of our staff, you will play a vital role in supporting individuals with developmental disabilities in achieving their goals and maximizing their independence.Key ResponsibilitiesAssist with Classroom...
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Practical Nursing Specialist
2 weeks ago
Flushing, New York, United States Long Island Care Center Full timeJoin Our Team as a Practical Nursing SpecialistLong Island Care Center is actively looking for dedicated Full-time LPNs to enhance our healthcare team. Union Benefits:We offer a competitive salary along with a comprehensive 1199 benefits package for both full-time and part-time employees, which includes:- Paid Holidays- Paid Time Off (PTO)- Paid Sick Leave-...
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Certified Medical Assistant
2 weeks ago
Flushing, United States Queens Internal Medicine & Geriatrics P.C Full time $16 - $18Job DescriptionJob DescriptionWe are seeking a Certified Medical Assistant (CMA) to become a part of our team! You will perform routine administrative and clinical assignments to keep the medical facility running smoothly.Responsibilities:Handle all administrative duties in a timely mannerPerform routine clinical tasks to support medical...
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Healthcare Support Specialist
2 weeks ago
Flushing, Michigan, United States Flushing Wellness and Aesthetics Full timePosition OverviewWe are looking for a dedicated Healthcare Support Specialist to join our dynamic team. In this role, you will carry out essential administrative and clinical functions to ensure the efficient operation of our medical facility.Key Responsibilities:Manage all administrative tasks promptly and efficientlyAssist in routine clinical procedures to...
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Assistant Habilitation Specialist
3 months ago
Flushing, United States WellLife Network Full time $17 - $18Work Schedule: Mon-Fri 8:30AM-2:30PM or 9AM-3PM (30 Hours Weekly)Position Summary: The Assistant Habilitation Specialist assists with the operation of the classroom.Essential Accountabilities:Responsible for ensuring that all unit activities enhance and support each person’s social responsibility, independence, dignity, and continued growth. Implement...
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Aviation Security Specialist
1 week ago
Flushing, New York, United States Global Elite Group Full timeJob OverviewLocationQueens, NYCompensation$19.00 per hourPosition SummaryAviation Security Specialist - Global Elite GroupGlobal Elite Group is a premier aviation security firm, composed of a diverse and collaborative workforce of dedicated professionals, industry experts, and specialists who utilize optimized processes and tools to provide exceptional...
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Shuttle Transportation Specialist
2 weeks ago
Flushing, New York, United States Avis Budget Group Full timeWe are currently seeking dedicated individuals to join our team as Shuttle Transportation Specialists. In this role, you will be at the forefront of delivering exceptional service to our valued customers as they travel to their desired destinations. If you have experience as a CDL Class A or Class B driver, whether in delivery, trucking, or public...
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Travel Nurse RN
22 hours ago
Flushing, New York, United States LanceSoft Full timeJob Title: Travel Nurse RN - Med Surg SpecialistJob Summary:LanceSoft is seeking a skilled Travel Nurse RN - Med Surg Specialist to join our team. As a Travel Nurse RN - Med Surg Specialist, you will have the opportunity to work in a dynamic and fast-paced environment, providing high-quality patient care and contributing to the success of our...
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Travel Nurse RN Specialist
1 day ago
Flushing, New York, United States LanceSoft Full timeJob OpportunityLanceSoft is seeking a skilled travel nurse RN for a medical surgical position.Job RequirementsSpecialty: Medical SurgicalDiscipline: Registered NurseEmployment Type: Travel2 years of medical surgical experience required Certifications:Basic Life Support (BLS)Advanced Cardiovascular Life Support (ACLS)Covid-19 Vaccination CardNew York State...