Qureos Mentor

Green Light Cost Management

<div>About Green Light:

Green Light is a fast-growing healthcare technology company dedicated to transforming the industry through innovation and service. We&rsquo;re seeking an energetic and knowledgeable Claims and Appeals Specialist who thrives in a dynamic environment and is ready to make a meaningful impact. This role is ideal for someone with experience in healthcare claims, appeals, reimbursement, provider services, or related healthcare operations who enjoys problem-solving, working with providers, and helping drive timely, accurate resolutions. 
Job Summary:

As a Claims and Appeals Specialist at Green Light, you&rsquo;ll play a critical role in supporting provider-facing workflows related to claims, appeals, reimbursement, dispute intake, and case resolution. This position helps ensure matters are handled accurately, efficiently, and in compliance with internal processes and applicable requirements. We&rsquo;re looking for someone who is proactive, detail-oriented, organized, and comfortable managing multiple priorities in a fast-paced environment. The ideal candidate is a strong communicator, a problem solver, and someone who works well with both internal teams and external partners. 
Responsibilities:
<ul>
<li>Support provider-related workflows involving claims, appeals, reimbursement issues, dispute intake, and case follow-up</li>
<li>Review claim details, supporting documentation, and case information to determine appropriate next steps</li>
<li>Communicate clearly and professionally with healthcare providers, billing offices, payers, clients, and internal teams regarding case status and resolution</li>
<li>Track case activity, follow-up items, deadlines, and documentation in internal systems and portals</li>
<li>Assist with appeals coordination, negotiation support, reimbursement issue resolution, and related administrative processes</li>
<li>Prepare and maintain organized case records, supporting materials, correspondence, and internal summaries</li>
<li>Help identify missing information, escalation needs, recurring issues, or barriers to timely resolution</li>
<li>Coordinate across teams to facilitate effective information flow and support case progression</li>
<li>Ensure adherence to HIPAA protocols and company compliance standards</li>
<li>Support timely and accurate handling of cases in accordance with departmental expectations and required timelines</li></ul> 


Qualifications:
<ul>
<li>High school diploma or equivalent</li>
<li>Strong attention to detail and organizational skills</li>
<li>Strong written and verbal communication skills</li>
<li>Ability to multitask, manage multiple priorities, and work efficiently in a fast-paced environment</li>
<li>Strong problem-solving skills and sound judgment</li>
<li>Professionalism, accountability, and follow-through</li>
<li>Ability to work effectively with internal teams and external stakeholders</li>
<li>Must be dependable, team-oriented, and comfortable working in a structured, deadline-driven environment</li>
<li>Familiarity with HIPAA regulations and data privacy requirements</li></ul> 


Preferred Experience:
<ul>
<li>Experience in healthcare customer service, claims, billing, reimbursement, provider services, appeals, intake, or related healthcare operations</li>
<li>Experience working with No Surprises Act workflows, Open Negotiations, IDR, LOA/SCA, Grievances and Appeals, or Claims Processing is a plus</li>
<li>Working knowledge of medical terminology, healthcare billing, claims processes, or reimbursement workflows preferred</li>
<li>Experience with payer/provider portals, EMR/EHR systems, or claims platforms is a plus</li></ul></div>

Claims and Appeals Specialist - Healthcare

Join Green Light Cost Management and explore 1   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Green Light Cost Management

About Company

Claims and Appeals Specialist - Healthcare