Medical Claims Specialist

1 week ago


Flushing, Michigan, United States Momentum Resource Solutions Full time
Job Summary

Momentum Resource Solutions is seeking a skilled Claims Resolution Professional to join our team. This role is responsible for reviewing and resolving claims processed by external vendors, including provider appeals and disputes.

Key Responsibilities
  • Perform root cause analysis to identify areas for provider education and system configuration.
  • Initiate and follow through with resolution of all pended claims, (re)pricing, returned or refund checks, and the development of provider and facility compensation grids.
  • Communicate with internal and external sources, including providers, members, attorneys, regulatory agencies, and other carriers on claim-related matters.
  • Analyze patient and medical information to identify COB, Worker's Compensation, No-Fault, and Subrogation conditions.
  • Validate DRG grouping and (re)pricing outcomes presented by the claims processing vendor.

Requirements

  • Bachelor's degree in a related field.
  • Minimum 2 years of experience in claims resolution or a related field.
  • Excellent analytical and problem-solving skills.
  • Strong communication and interpersonal skills.

Salary Range: $65,000 - $85,000 per year, depending on experience.



  • Flushing, Michigan, United States Momentum Resource Solutions Full time

    Job Title**Medical Claims Specialist**About the JobThe Medical Claims Specialist plays a crucial role in reviewing claims processed by external vendors. Key responsibilities include resolving provider appeals, performing root cause analysis to identify areas for education and system reconfiguration, and initiating resolution of pending...

  • Claims Specialist

    2 weeks ago


    Flushing, Michigan, United States Momentum Resource Solutions Full time

    Job Title: Claims Specialist - Clinical ExcellenceAt Momentum Resource Solutions, we are seeking a skilled Claims Specialist to join our team. This role plays a vital part in reviewing claims processed by external vendors, resolving provider appeals and disputes, and performing root cause analysis to identify areas for provider education and system...


  • Flushing, Michigan, United States Momentum Resource Solutions Full time

    Job Title: Medical Claims Analyst - Provider RelationsMomentum Resource Solutions is looking for a detail-oriented Medical Claims Analyst to join our team. In this role, you will play a critical part in reviewing claims processed by external vendors, resolving provider appeals and disputes, and performing root cause analysis to identify areas for provider...


  • Flushing, Michigan, United States Momentum Resource Solutions Full time

    Job Title: Healthcare Claims Coordinator - Workflow EfficiencyMomentum Resource Solutions seeks a highly organized and detail-oriented Healthcare Claims Coordinator to optimize our claims processing workflow. As a key member of our team, you will review claims processed by external vendors, resolve provider appeals and disputes, and perform root cause...


  • Flushing, Michigan, United States HeartVeinNYC Full time

    Administrative Support SpecialistWe are seeking a highly organized and detail-oriented Administrative Support Specialist to join our team at HeartVeinNYC. As a key member of our medical staff, you will provide critical administrative and clinical support to our medical professionals, ensuring the smooth operation of our medical...


  • Flushing, Michigan, United States Momentum Resource Solutions Full time

    Job DescriptionThe Claims Resolution Professional at Momentum Resource Solutions will be responsible for reviewing and resolving claims processed by external vendors, including provider appeals and disputes.Main ResponsibilitiesConduct root cause analysis to identify areas for provider education and system configuration.Develop and implement plans to resolve...


  • Flushing, Michigan, United States Momentum Resource Solutions Full time

    Job OverviewWe are looking for a skilled Healthcare Payment Analyst to join our team at Momentum Resource Solutions. In this role, you will be responsible for reviewing claims, analyzing data, and providing recommendations to improve our claims processing efficiency.Your Key ResponsibilitiesData Analysis: Analyzing patient and medical information to identify...


  • Flushing, Michigan, United States HeartVeinNYC Full time

    Job DescriptionWe are seeking a highly organized and detail-oriented Bilingual Medical Assistant to support our team at HeartVeinNYC.As a Clinical Support Specialist, you will be responsible for performing routine administrative and clinical tasks to ensure the smooth operation of our medical facility.Key Responsibilities:Administrative Tasks:Handle all...


  • Flushing, Michigan, United States PRIDE Healthcare Full time

    Job OpportunityWe are seeking a skilled Certified Medical Assistant to support a busy neurologist in Flushing, NY.Salary: $26 per hourAbout the Role:Provide exceptional patient care and support for intake proceduresAssist with various medical specialties, including primary care, cardiology, endocrinology, urology, pediatrics, and neurologyUtilize knowledge...


  • Flushing, Michigan, United States Stanton Condominium Full time

    Job SummaryWe are seeking a Condominium Repair Specialist to join our maintenance team at the Stanton Condominium. The successful candidate will be responsible for maintaining the Condominium's facilities and ensuring the safety and well-being of our residents.Main Responsibilities:Perform routine maintenance and repairs of Condominium facilities, including...


  • Flushing, Michigan, United States Mitchell Martin Full time

    Career Opportunity: Mitchell Martin is seeking a skilled Clinical Pediatric Nursing Specialist to join their team.In this role, you will be responsible for providing high-quality patient care in a General Pediatrics setting. If you have a passion for delivering exceptional care and making a meaningful impact, we encourage you to apply.About the Position:This...


  • Flushing, Michigan, United States Greenlife Healthcare Staffing Full time

    We are seeking a skilled Perinatal Care Specialist to join our team in a part-time contract role. As a seasoned healthcare professional, you will conduct clinical reviews of medical records and provide technical assistance to program personnel.The ideal candidate will have at least 4 years of clinical practice experience in a facility or community-based...


  • Flushing, Michigan, United States Cynet Health Full time

    About Cynet HealthCynet Health is a leading healthcare staffing agency, dedicated to providing exceptional nursing professionals to hospitals and healthcare facilities nationwide.Estimated Salary: $140,000 - $180,000 per yearOur current opening is for a Travel Nurse Oncology Care Specialist. As a skilled Registered Nurse with experience in oncology nursing,...


  • Flushing, Michigan, United States Omnipak Import Enterprises, Inc. Full time

    Job OverviewOmnipak Import Enterprises, Inc. is seeking a skilled sales representative to join our team in Flushing, NY. As an Italian food sales specialist, you will be responsible for increasing sales through the opening of new accounts and expanding existing relationships with restaurants, caterers, retail outlets, and other food service establishments....

  • Taxation Expert

    1 month ago


    Flushing, Michigan, United States Wei, Wei & Co., LLP Full time

    Company Overview">Wei, Wei & Co., LLP is a reputable accounting firm dedicated to providing exceptional services to our clients. We are seeking a highly skilled Taxation Expert - Accounting Specialist to join our team.">Job Description">The successful candidate will assist in preparation of the corporation, partnership and individual tax, as well as sales...


  • Flushing, Michigan, United States WellLife Network Full time

    About the RoleWe are seeking an experienced and compassionate Assistant Habilitation Specialist 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 full potential.Key ResponsibilitiesEnsure that all unit activities promote social...


  • Flushing, Michigan, United States Employbridge Full time

    Job DescriptionEmploybridge is seeking an ATM Installation Specialist to join our team. In this role, you will be responsible for installing and maintaining ATMs, as well as performing routine maintenance tasks.You will work with a variety of equipment, including modems, printers, and card readers. The ideal candidate will have a background in construction...


  • Flushing, Michigan, United States PRIDE Healthcare Full time

    Job Title: Certified Nursing AssistantsDescription:We are seeking a highly skilled Certified Nursing Assistants to join our team and contribute to delivering exceptional patient care.About Us:PRIDE Healthcare is a trusted partner in the healthcare industry, providing innovative business process solutions at affordable prices.Main Responsibilities:Collaborate...


  • Flushing, Michigan, United States HR Employer Solutions Group Full time

    Job OverviewWe are seeking a highly skilled Urology Nurse Practitioner to join our team at HR Employer Solutions Group.Salary and BenefitsThe estimated annual compensation for this role is $95,000 - $145,000, reflecting the competitive market rate for a seasoned Urology Nurse Practitioner in New York. Our comprehensive benefits package includes health,...


  • Flushing, Michigan, United States Law Offices of Gary S Park PC Full time

    We are seeking a highly skilled and experienced Paralegal to join our team at the Law Offices of Gary S Park PC. As a key member of our staff, you will play a vital role in supporting our attorneys in personal injury cases and contributing to the success of our law firm.Job Title:ParalegalCompany Overview:The Law Offices of Gary S Park PC is a...