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claims adjustment specialist i

MetroPlusHealth

<div>
 
 Empower. Unite. Care.
 
 
 
 
 MetroPlusHealth
 
 is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
 
 
 
 About NYC Health + Hospitals
 
 
 
 MetroPlus
 
 Health
 
 provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus
 
 Health
 
 's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlus
 
 Health
 
 has been committed to building strong relationships with its members and providers.
 
 
 
 Position Overview
 
 
 
 As a Claims Adjustment Specialist I, this individual will be responsible for analyzing standard to complex post-paid healthcare claims that require in depth research to determine accuracy and mitigate payment errors. The Claims Adjustment Specialist I will also be responsible for adjusting medical claims that
 
 
 result in overpayment or underpayment due to claim processing system issues, contract amendments, processing errors, or other issues. This position will be responsible for responding to inquiries from providers whose claims may be paid incorrectly and performing accurate data entry and maintenance accurate records and files.
 
 
 
 Work Shifts
 
 
 
 
 9:00 A.M &ndash; 5:00 P.M
 
 
 
 
 Duties &amp; Responsibilities
 
 
 
 <ul>
 <li>
 Research and analyze medical claims adjustment requests along with related documentation to determine payment accuracy and adjust/adjudicate as needed using multiple systems and platforms.
 </li>
 <li>
 Ensure that the proper payment guidelines are applied to each claim by using the appropriate tools, processes, and procedures (e.g., claims processing P&amp;P&rsquo;s, grievance procedures, state mandates, CMS/Medicare/Medicaid guidelines, benefit plans, etc.)
 </li>
 <li>
 Research claims that may have paid incorrectly and communicate findings for adjustment; Adjust claims based on findings (i.e., correct coding, rates of reimbursement, authorizations, contracted amounts etc.) ensuring that all relevant information is considered.
 </li>
 <li>
 Advise business partners of findings outcome if their input is needed to help fix the issue.
 </li>
 <li>
 Communicate through correspondence with providers regarding claim payment or additional required information in a clear and concise manner.
 </li>
 <li>
 Process the adjustment of claims in a timely manner, according to established timelines.
 </li>
 <li>
 Remain current with changes/updates in claims processing, as well as updates to coding systems.
 </li>
 <li>
 Maintain accurate records of all claims processed, including notes on actions taken.
 </li>
 <li>
 Generate reports on claim activity as requested.
 </li>
 <li>
 Respond to audits of claims processed.
 </li>
 <li>
 Able to work independently and exercise good judgment
 
 
 
 </li>
 </ul>
 
 Minimum Qualifications
 
 
 
 <ul>
 <li>
 High School Degree or evidence of having passed a High School Equivalency Program required. Associate degree preferred.
 </li>
 <li>
 Minimum 2 years of claims operations experience in a healthcare field, with knowledge of integrated claims processing required.
 </li>
 <li>
 Experience using a PC and claim adjudication system(s)
 </li>
 <li>
 Experience using Customer Relationship Management (CRM) software; Salesforce is a plus.
 </li>
 <li>
 Experience working with large data and spreadsheets.
 </li>
 <li>
 Knowledge of medical terminology, CPT, ICD-10, and Revenue Codes
 </li>
 <li>
 Processing of Medical Claim Forms (HCFA, UB04)
 </li>
 <li>
 Knowledge of Medical Terminology
 </li>
 <li>
 Knowledge of HIPPA Guidelines regarding Protected Health Information
 </li>
 <li>
 Data Entry of Provider Claim/Billing information
 </li>
 <li>
 Experience handling or familiarity with Medical Claim inquiries from provider sites personnel including physicians, clinical staff, and site administrators.
 
 
 
 </li>
 </ul>
 
 Professional Competencies
 
 
 
 <ul>
 <li>
 Integrity and Trust
 </li>
 <li>
 Customer Focus
 </li>
 <li>
 Functional/Technical skills
 </li>
 <li>
 Written/Oral Communication
 </li>
 <li>
 Strong Analytical Skills
 </li>
 <li>
 Knowledgeable in MS Word and Excel
 
 
 
 </li>
 </ul>
 
 Benefits
 
 
 
 NYC Health and Hospitals offers a competitive benefits package that includes:
 
 
 <ul>
 <li>
 Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
 </li>
 <li>
 Retirement Savings and Pension Plans
 </li>
 <li>
 Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
 </li>
 <li>
 Loan Forgiveness Programs for eligible employees
 </li>
 <li>
 College tuition discounts and professional development opportunities
 </li>
 <li>
 College Savings Program
 </li>
 <li>
 Union Benefits for eligible titles
 </li>
 <li>
 Multiple employee discounts programs
 </li>
 <li>
 Commuter Benefits Programs
 
 
 
 </li>
 </ul>
 #MHP50
 
 
</div>

Claims Adjustment Specialist I

PAWLIK LAW GROUP, P.C.

We are seeking an experienced Bilingual Spanish Immigration Paralegal/Legal Assistant- Part Time, where language skills and legal expertise will make a meaningful impact. This is an in-person position only. You will be instrumental in managing case files, conducting legal research, drafting documents, and providing vital administrative support&mdash;all while working in a collaborative and fast-paced environment. The ideal candidate will be energetic, outgoing, people friendly, organized, and possess a strong foundation in legal procedures, and experience in immigration law. If you are passionate about the law, detail-oriented, and fluent in both English and Spanish, this position is perfect for you to grow your legal career while making a difference.Responsibilities<ul><li>Assist attorneys with in preparing and filing immigration petitions and applications.</li><li>Conduct thorough legal research using Westlaw, AILA, and other case management systems to support case strategies.</li><li>Communicate with clients, perform intakes, and work on USCIS applications, such as, but not limited to, Asylum, and Adjustment of Status.</li><li>Draft legal correspondence, pleadings, and supporting documents while maintaining high standards of proofreading and editing.</li><li>Provide clients with case status updates.</li><li>Prepare immigration forms for family, removal, business, and humanitarian cases. Experience with forms I-130, I-485, I-589, I-140, I-601, I-601A, I-765, EOIR-42B, DS-260 and others.</li><li>File motions and applications to immigration court.</li><li>Prepare statements in support of certain immigration applications such as Asylum.</li><li>Provide general case management over a busy docket, including tracking case deadlines and processing times.</li><li>Conduct client interviews in both English and Spanish to gather relevant case information efficiently.</li><li>Proofread documents for accuracy, transcribe recordings as needed, and assist with general clerical tasks such as filing, organizing files, and managing phone etiquette.</li></ul>Skills<ul><li>Bilingual fluency in Spanish and English with excellent verbal and written communication skills.</li><li>Strong background in immigration law and ability to work independently as well as part of a team</li><li>Ability to manage administrative tasks including data entry, filing systems, document management systems like Clio.</li><li>Excellent organizational skills coupled with professional phone etiquette and the ability to prioritize tasks effectively.</li><li>Prior paralegal experience in a busy law office setting is preferred.</li></ul>We are committed to supporting your professional growth through ongoing learning opportunities while providing a flexible schedule that respects your work-life balance. If you&rsquo;re ready to bring your passion for the law into a vibrant team dedicated to making a difference&mdash;apply today!Pay: $20.00 - $28.00 per hourBenefits:<ul><li>Opportunities for advancement</li><li>Paid sick time</li><li>Paid time off</li><li>Professional development assistance</li></ul>Language:<ul><li>Spanish (Preferred)</li></ul>Work Location: In person

Bilingual Spanish Immigration Paralegal/Legal Assistant - Part Time

DocGo

<div>
 
 Title:
 
 Medical Billing and Coding Associate
 
 
 
 Pay Range:
 
 $20-$24 per hour, based on experience
 
 
 
 Employment Type:
 
 Full-Time, Hourly
 
 
 
 Location:
 
 16-70 Weirfield St, Ridgewood, NY (In-Person)
 
 
 
 Benefits:
 
 Medical, Dental, and Vision (with company contribution), Paid Time Off PTO, Weekly pay, 401k
 
 
 
 About DocGo:
 
 
 
 DocGo is leading the proactive healthcare revolution with an innovative care delivery platform that includes mobile health services, population health, remote patient monitoring, and ambulance services. DocGo disrupts the traditional four-wall healthcare system by providing high quality, highly affordable care to patients where and when they need it. DocGo's proprietary, AI-powered technology, logistics network, and dedicated field staff of over 5,000 certified health professionals elevate the quality of patient care and drive efficiencies for municipalities, hospital networks, and health insurance providers. With Mobile Health, DocGo empowers the full promise and potential of telehealth by facilitating healthcare treatment, in tandem with a remote physician, in the comfort of a patient's home or workplace. Together with DocGo's integrated Ambulnz medical transport services, DocGo is bridging the gap between physical and virtual care.
 
 
 
 Position Overview:
 
 
 
 We are seeking a skilled and detail-oriented Medical Billing and Coding Associate with a primary focus on coding to join our team. The ideal candidate will possess expertise in medical coding, including ICD-10, CPT, and HCPCS coding systems, and will play a vital role in ensuring accurate coding and billing practices.
 
 
 
 Responsibilities:
 
 
 
 <ul>
 <li>
 Partners with Operations to resolve issues surrounding unbilled claims, authorizations, Physician Certification Statements (PCSs), Patient Care Reports (PCRs), and insurance, and demographic capture issues
 </li>
 <li>
 Responsible for escalating concerns regarding questionable paperwork to appropriate management
 </li>
 <li>
 Contact payers to verify claim status via phone or web and follow up on unpaid claims
 </li>
 <li>
 Process appeals on aged insurance claims/denials
 </li>
 <li>
 Ability to analyze, identify and resolve issues which may cause payer payment delays
 </li>
 <li>
 Identify and resolve claim edits through understanding of billing guidelines and payer requirements
 </li>
 <li>
 Reconcile commercial and government accounts, ensuring CPT and diagnostic codes are accurate
 </li>
 <li>
 Interpret terms for Managed Care, Commercial, Medicare, Medicaid and Workers' Compensation and No Fault when applicable
 </li>
 <li>
 Review all EOBs for correct payment, deductible, adjustments, and denials
 </li>
 <li>
 Determining the status of claims with the insurance company, if the claim meets contractual agreements or needs adjustment
 </li>
 <li>
 Reconcile account balances, and verify payments are applied correctly
 </li>
 <li>
 Maintain well aged accounts, promptly resolve, and resubmit denied unpaid claims in a timely and efficient manner
 </li>
 <li>
 Follow up on appeals/corrected submitted claims
 </li>
 <li>
 Review and correct billing errors, which require a strong knowledge of CPT and ICD-10 coding
 </li>
 <li>
 Review and audit customer service account inquiries
 </li>
 <li>
 Receive inbound/outbound customer service call
 </li>
 <li>
 Provide excellent customer service to all patients, Insurances &amp; Facilities
 </li>
 <li>
 Review and correct all rejections in clearing house
 </li>
 <li>
 Perform all other related duties as assigned
 
 
 </li>
 </ul>
 
 Qualifications:
 
 
 
 <ul>
 <li>
 Must have 2-3 years of medical billing experience (required)
 </li>
 <li>
 Ambulance billing experience (preferred)
 </li>
 <li>
 Extensive Medicare and Medicaid experience and understanding medical necessity in ambulance transportation
 </li>
 <li>
 Proficient in CPT and ICD-10 coding
 </li>
 <li>
 Ambulance/Medical billing certification or diploma preferred
 </li>
 <li>
 Certified Ambulance Coder (CAC) or Certified Professional Coder (CPC) preferred
 </li>
 <li>
 Excellent organizational skills and the ability to multitask in a fast-paced environment
 </li>
 <li>
 Analytical - collects and researches data; uses intuition and experience to complement data
 
 
 </li>
 </ul>
 EEO/AAP Statement: DocGo is an equal opportunity employer. We acknowledge and honor the fundamental value and dignity of all individuals. We pledge ourselves to crafting and maintaining an environment that respects diverse traditions, heritages, and experiences. DocGo is an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
 
 
 
 The above-noted job description is not intended to describe, in detail, the multitude of tasks that may be assigned but rather to give the applicant a general sense of the responsibilities and expectations of this position. As the nature of business demands change so, too, may the essential functions of the position.
 
</div>

Medical Billing and Coding Associate

Healthfirst (New York)

<div>The Manager, Total Cost of Care, will monitor financial performance and provide analytic insights into all products offered within the Healthfirst portfolio. This leader will serve as healthcare economics and analytics subject matter expert, across all areas of medical trend, medical cost savings, provider network informatics, and reimbursement accuracy. The ideal candidate will come from a managed care, medical economics, insurance, actuarial, or hospital background, and will be a results-oriented individual who enjoys working in a fast-paced and challenging environment.
Scope of Responsibilities:<ul><li>
Monitor medical cost and utilization trends, provide concise actionable insight into the root cause drivers, and develop potential remediation opportunities.</li><li>
Develop savings analyses for Medical Economics cost trend reduction initiatives, applying financial modeling expertise and using independent judgement to determine best valuation methods.</li><li>
Prioritization of cost mitigation activities across business areas.</li><li>
Provide actionable data driven analysis to Finance, Claims, Pharmacy, Payment Integrity, Medical Management, Network, and other departments to enable critical decision making.</li><li>
Optimize contractual reimbursement terms and coding across agreements, systematically identifying reimbursement outliers. Assess and work with Network to standardize contractual terms and language across all provider agreements.</li><li>
Evaluate data to identify and root cause of payment integrity issues and lead cross-functional efforts to problem solve.</li><li>
Lead development of tools and processes for efficient operational and reimbursement management of hospitals and physician partners, including unit cost projections.</li><li>
Develop interactive financial models to evaluate the impact of provider reimbursement changes.</li><li>
Support all provider settlement and data reconciliation activities.</li><li>
Development of tools to define profitability dashboards by product.</li><li>
Keep abreast of New York Medicaid and Medicare reforms, reimbursement methodologies, and their impact on Healthfirst and their owner hospital performance.</li><li>
Individual contributor subject matter expert and/or managerial responsibilities.</li><li>
Perform ad hoc analyses.</li></ul>
Minimum Qualifications:
<ul><li>Bachelor&rsquo;s Degree from an accredited institution.</li><li>
At least six (6) years of healthcare analytics experience, with at least three (3) years of experience in contract evaluation, medical economics, medical cost containment, actuarial, healthcare reimbursement model design</li><li>
Extensive knowledge of managed care financial metrics (PMPM, util/k, cost/unit).</li><li>
Experience utilizing healthcare claims data to uncover valuable insights to improve financial performance.</li><li>
Experience with Government and proprietary payor reimbursement methodologies and unit cost management.</li><li>
Experience with SAS or SQL (creates queries and manipulation of data).</li><li>
Extensive experience with Microsoft Excel (building financial models, utilizing pivot tables, VLOOKUP's, index match, and calculated fields).</li><li>
Claims experience including root-cause analysis, system set-up, etc.</li><li>
Ability to work with large data sets.</li><li>
Strong written and verbal communication skills.</li><li>
Experienced in leading a team of analysts.</li><li>
Resourceful and creative in solving complex issues and working corroboratively with others on a solution.</li><li>
Ability to manage projects and project plans within stated timelines.</li></ul>
Preferred Qualifications:
<ul><li>Expertise in key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG&rsquo;s), Ambulatory Patient Groups (APG&rsquo;s), Ambulatory Payment Classifications (APC&rsquo;s), and other payment mechanisms.</li><li>
Understanding of value-based risk arrangements.</li><li>
Experience using Tableau, Python</li><li>
Experience mentoring other team members.</li></ul> 
Hiring Range*:<ul><li>
Greater New York City Area (NY, NJ, CT residents): $103,400 - $149,430</li><li>
All Other Locations (within approved locations): $88,700 - $131,920</li></ul>

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
<ul><li>The hiring range is defined as the lowest and highest salaries that Healthfirst in &ldquo;good faith&rdquo; would pay to a new hire, or for a job promotion, or transfer into this role.</li></ul> 
88700-131920</div>

Total Cost of Care, Manager - Hybrid NY

EmblemHealth

<div></div><div><div>Summary of Job</div><div>
Develop and execute a comprehensive annual Risk Adjustment strategy that supports the Company strategies and improves the quality of care delivered to Emblem members, and to ensure the plan reimbursement accurately reflects the clinical diagnosis of our Medicare, Medicaid, and Affordable Care Act (ACA) members. Develop and execute an annual Provider Risk Adjustment strategy to improve the accuracy of their diagnosis coding through education and engagement of our risk adjustment programs, reimbursement models and the ongoing development/ enhancement of support capabilities that complement their clinical practice model. Prepare and present provider risk adjustment results at all Emblem joint operating committee meetings and monthly risk adjustment operational meetings. Select and manage best-in-class risk adjustment vendors to drive continual improvement in the accuracy of diagnosis coding for Medicare, Medicaid, and ACA members. Manage the ongoing performance, compliance and return on investment for each risk adjustment vendor. Create and maintain a capabilities framework that is member and provider centric and is appropriate given for the clinical and demographic dynamics of members in risk adjusted products. Manage the creation and timely production of risk adjustment operation and financial performance reports for all risk adjustment programs, and lead monthly risk adjustment operation meetings with Emblem leaders for VP, Risk Adjustment. Be a strategic partner with the Actuarial, Quality and Product teams to enhance risk adjustment interventions and results. Establish enterprise-wide monitoring and reconciliation reports to ensure that risk adjustment vendor results are accurately, timely and completely submitted to government entities.</div><div>
Responsibilities</div><ul><li>
Develop, manage, and improve all retrospective risk adjustment programs to retrospectively identify, retrieve, code and submit diagnostic information from providers on EmblemHealth members enrolled in Medicare, Medicaid, and ACA products; manage all vendor relationships that support these retrospective activities. 
</li><li>
Develop, manage, and improve prospective and concurrent risk adjustment programs to ensure accurate capture and reporting of diagnostic information for EmblemHealth members enrolled in Medicare, Medicaid and ACA products. 
</li><li>
Work with risk adjustment vendors and providers to execute in office assessment programs through which they 1) identify members based on clinical needs and quality gaps, 2) outreach to patients to encourage them to make office visits to receive services and 3) completely and accurately document all diagnostic conditions. 
</li><li>
Manage the In-Home Assessment risk adjustment vendor program. 
</li><li>
Manage team completing revenue management opportunities for Medicaid, Medicare and Health Exchange products which includes identification of risk score opportunities, suspects, analysis and tracking of performance and attribution of interventions. 
</li><li>
Direct EmblemHealth provider relationship and engagement risk adjustment activities. 
</li><li>
Direct interaction with the CFO, CEO and other physician leaders of ACPNY groups and other large, sophisticated medical groups to integrate our programs into the provider&rsquo;s operations. 
</li><li>
Analyze data to identify submission trends against historic data and membership changes and recommend opportunities to improve accuracy and completeness of all government submissions. 
</li><li>
Collaborate with EmblemHealth medical management, quality, marketing &amp; sales and network departments to identify opportunities to achieve efficiencies and improve effectiveness of risk adjustment activities by integrating both prospective and retrospective programs with care management, CMS Stars, Medicaid and Health Exchange quality programs, sales outreach and provider contracting.</li></ul>
<div><div>Qualifications</div><ul><li>
Bachelor&rsquo;s Degree in Healthcare, Finance, Business, or related field (Required); Master&rsquo;s degree (Preferred) 
</li><li>
10 &ndash; 12+ years of relevant, professional work experience (Required) 
</li><li>
Experience in healthcare, plan or provider operations and relations or related experience (Required) 
</li><li>
Leadership experience - including staff and process management experience (Required) 
</li><li>
Risk adjustment knowledge and expertise across Medicare, Medicaid, and Commercial exchange (Required) 
</li><li>
Capacity to multi-task at high detail-oriented level (Required) 
</li><li>
Strong communication skills (verbal, written, presentation, interpersonal) including executive leaders meeting experience (Required) 
</li><li>
Strong working knowledge of MS Office - Word, Excel, PowerPoint, Access, Outlook (Required) 
</li><li>
Strong analytical and logical skills paired with strong attention to detail (Required)</li></ul>
</div><div>Additional Information
<ul><li>Requisition ID: 1000003033</li>
<li>Hiring Range: $135,000-$253,800</li></ul></div></div>

Director, Risk Adjustment - Hybrid

Medix™

<div>
 
 
 Claims Specialist (Contract)
 
 
 
 
 Location:
 
 New Yor (remote)
 
 
 
 Duration:
 
 Contract 6 months with possible extension
 
 
 
 Schedule:
 
 Full-time, Monday&ndash;Friday
 
 
 Flexible shifts:
 
 7:00 AM &ndash; 3:30 PM or 9:00 AM &ndash; 5:30 PM (EST)
 
 
 
 
 
 
 
 Job Summary
 
 
 
 The Claims Specialist will coordinate activities critical to the successful completion of clinical studies and review projects. This role supports appeal and dispute adjudication programs by monitoring requests, coordinating with clinical partners, managing provider and contractor interactions, tracking deliverables, and supporting cross-functional communication. The ideal candidate is highly organized, detail-oriented, and comfortable working in a fast-paced, deadline-driven environment.
 
 
 
 
 
 
 Key Responsibilities
 
 
 <ul>
 <li>
 Serve as the primary point of contact for appeal and dispute adjudication programs
 </li>
 <li>
 Liaise with healthcare plans, providers, patients, and clients to coordinate requests, correspondence, and case documentation
 </li>
 <li>
 Monitor appeal/dispute status and communications via client portals
 </li>
 <li>
 Conduct initial eligibility reviews and recommend appropriate courses of action to internal teams and leadership
 </li>
 <li>
 Track and assign cases using commercial and custom software applications
 </li>
 <li>
 Compile and distribute case documentation to billers, coders, nurses, physicians, clinicians, and key stakeholders
 </li>
 <li>
 Monitor and report on key performance indicators (KPIs), including timeliness, accuracy, quality standards, and contractual deadlines
 </li>
 <li>
 Identify workflow barriers, recommend process improvements, and implement approved solutions
 </li>
 <li>
 Present case and project updates during team huddles and scrums using an agile, iterative approach
 </li>
 <li>
 Schedule and facilitate team status meetings; document decisions, assigned tasks, and next steps
 </li>
 <li>
 Prepare billing invoices upon case completion and coordinate with Finance and Accounting to track payments
 </li>
 <li>
 Mentor and train new staff on processes and case progression
 </li>
 <li>
 Perform additional duties as assigned
 </li>
 </ul>
 
 
 
 
 
 Education &amp; Experience Requirements
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree (or higher) in healthcare, business, management, digital studies, or a related field
 
 plus 2 years
 
 of collaborative project support experience
 </li>
 <li>
 
 OR
 
 </li>
 <li>
 Associate&rsquo;s degree in a related field
 
 plus 3 years
 
 of collaborative project support experience
 </li>
 </ul>
 
 
 
 
 
 Qualifications
 
 
 <ul>
 <li>
 Experience with collaborative project management software and electronic documentation systems
 </li>
 <li>
 Strong problem-solving skills and ability to work collaboratively with medical, analytical, and administrative teams
 </li>
 <li>
 Excellent written and verbal communication skills, including professional phone etiquette
 </li>
 <li>
 Ability to work independently with minimal supervision
 </li>
 <li>
 Flexible, innovative, and creative mindset with strong multitasking abilities
 </li>
 <li>
 Proven ability to meet deadlines in a time-sensitive environment
 </li>
 </ul>
 
 
</div>

Claims Specialist - 251247

4 Corner Resources

<div>
 
 Healthcare Appeals Specialist (Remote - 4 Month Contract)
 
 
 Pay:
 
 $21-$25/hr
 
 
 Schedule:
 
 Must work
 
 East Coast business hours
 
 
 
 Duration:
 
 
 4-month contract
 
 
 Job Overview
 
 We are seeking a
 
 Healthcare Appeals Specialist
 
 to support the intake, review, and preparation of healthcare appeals and Independent Dispute Resolution (IDR) cases. This role ensures cases are processed accurately, documented properly, and completed within regulatory timelines.
 
 Responsibilities
 <ul>
 <li>
 Manage intake and tracking of
 
 appeals and IDR cases
 
 </li>
 <li>
 Review case documentation for
 
 accuracy and compliance
 
 </li>
 <li>
 Prepare
 
 appeal packets, summaries, and supporting documentation
 
 </li>
 <li>
 Monitor cases to ensure
 
 regulatory deadlines are met
 
 </li>
 <li>
 Maintain accurate records in case management systems
 </li>
 <li>
 Collaborate with internal teams to resolve cases
 </li>
 </ul>
 Qualifications
 <ul>
 <li>
 Minimum of a High School Diploma or GED required.&nbsp;
 </li>
 <li>
 
 1-3 years of healthcare experience
 
 (appeals, claims, managed care, or healthcare operations)
 </li>
 <li>
 Strong attention to detail and ability to manage multiple cases
 </li>
 <li>
 This is a remote position; however, candidates must reside in one of the following states where the company is currently registered to employ staff:
 </li>
 <li>
 
 AL, FL, GA, IN, IA, KS, MS, NC, NE, NV, NH, NJ, NY, OK, SC, SD, TN, TX, VA, WV, or WY.
 
 </li>
 </ul>
 Preferred
 <ul>
 <li>
 
 Experience with
 
 OnBase, TruCare, Hyland, or SharePoint
 
 
 
 
 
 &nbsp;
 
 
 </li>
 </ul>
</div>

Healthcare Appeals Specialist - Remote

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