Claims Specialist
As the Claims Specialist, you will coordinate activities critical to the successful completion of clinical reviews projects. You will support programs by monitoring requests, liaising with clinical partners, managing provider and contractor interactions, tracking deliverables and deadlines, and develop project frameworks to support interdisciplinary and interagency communications. Duties include but are not limited to:
- Monitor appeal/dispute status and communication received on client portals.
- Conduct initial eligibility reviews and recommend course of action to internal team and department management.
- Track and assign cases using commercial off-the-shelf and custom software applications.
- Monitor and measure key performance indicators.
- Identify barriers and roadblocks in work processes, recommend solutions to solve problems, and execute approved solutions.
- Routinely present case/project status in huddles and scrums while using an agile, iterative approach to implementation and data presentation.
- Schedule regular team status meetings and record decisions (e.g., assigned tasks and next steps).
- Prepare billing invoices at conclusion of cases, submit to the Finance department, and liaise with accounting to track and trend payments.
This is an in office position based in IPRO's headquarter office located in Jericho, NY
QUALIFICATIONS:
- Knowledge and experience with collaborative project management software, electronic documents, and design.
- Ability to problem solve and work collaboratively with peers, medical, analytical, and administrative support staff.
- Excellent written and verbal skills including phone manner.
- Ability to work independently with little supervision.
- Ability and desire to be flexible, innovative, and creative while multi-tasking.
- Ability to meet deadlines in time sensitive environment.
EDUCATION & EXPERIENCE:
- Bachelors' degree in healthcare, business, management digital studies or related field AND one (1) year experience in medical billing, auditing or claims review, appeals or dispute resolution in healthcare or insurance industries, regulatory, required.
- OR-
- Associates degree in related field AND two (2) years’ experience in medical billing, auditing or claims review, appeals or dispute resolution in healthcare or insurance industries, regulatory, required.
The salary range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The salary range for this position is $66,300.00 to $70,000.00. Actual salary and/or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.
The salary range listed does not include other forms of compensation or benefits.
IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, protected veteran status or military status.
Skills Required
- Bachelor’s degree in healthcare, business, management, digital studies, or a related field, plus one year of experience in medical billing, auditing, claims review, appeals, or dispute resolution within healthcare or insurance industries
- Alternatively, an associate degree in a related field plus two years of experience in medical billing, auditing, claims review, appeals, or dispute resolution within healthcare or insurance industries
- Experience with collaborative project management software, electronic documents, and design
- Strong written and verbal communication skills, including professional telephone manner
- Ability to work independently with little supervision
- Ability to problem solve and collaborate with medical, analytical, administrative, and peer staff
- Ability to meet deadlines in a time-sensitive environment
What We Do
IPRO is a non-profit organization that works with government agencies, providers and patients to implement innovative programs that bring policy ideas to life. For more than 40 years we’ve made creative use of clinical expertise, emerging technology, and data solutions to make the healthcare system work better. IPRO holds contracts with federal, state, and local government agencies, as well as private-sector clients, in more than 34 states and the District of Columbia. IPRO is headquartered in Jericho, NY and also has offices in Albany, NY; Hamilton, NJ; and Beachwood, OH. IPRO’s staff of more than 300 professionals includes physicians, registered nurses, mental health professionals, epidemiologists, biostatisticians, data analysts, medical record reviewers, health policy experts, pharmacists, coding professionals, claims analysts, auditors, programmers, systems analysts, web technology experts, and healthcare communications specialists. IPRO also retains a network of more than 300 board-certified physician consultants.
