**Req Number** 150699 Claims Specialist Bronx, NY Schedule: M-F, 8:30am to 5:30pm Work Location: Hybrid Assignment Length: Undetermined, potential for Direct Hire FlexStaff is seeking a Claims Specialist for our client, a non-profit healthcare organization providing home and community-based healthcare and services for the elderly. This role is responsible for supporting department operations related to provider communication, pending claim review, reporting, auditing, and oversight activities. Responsibilities: + Responsible for reviewing claims processed by the outside vendor, including resolving provider appeals/disputes. + Compiles claim reports + Investigates suspense conditions + Communicates and follows up with a variety of internal and external sources + Attends JOC meetings with providers as appropriate + Ensures that refund checks are logged and processed + Generates routine daily, monthly and quarterly reports + Validates DRG grouping and (re)pricing outcomes presented by the claims processing vendor + Analyzes patient and medical information to identify COB, Worker's Compensation, No-Fault, and Subrogation conditions + Other related duties as assigned by the supervisor Qualifications: + Bachelor's degree + Certified Professional Coder, a plus + Eight or more years of insurance experience within a healthcare setting, preferred + Proficiency in MS Excel, Word, PowerPoint, and experience using a claims processing system + Knowledge of CPTs, ICD 9/ICD 10, HCPC, DRG, Revenue, RBRVS + Knowledge of MLTC/ Medicaid/Medicaid benefit, Member (Subscriber) enrollment & billing, Utilization Authorizations, Provider Contracting Additional Salary Detail The salary range and/or hourly rate 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. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity). The salary range for this position is $27-$27/hour It is Northwell Health’s policy to provide equal employment opportunity and treat all applicants and employees equally regardless of age, race, creed/religion, color, national origin, immigration status, or citizenship status, military or veteran status, sexual orientation, sex/gender, gender identity, gender expression, height, weight, disability, pregnancy, genetic information or genetic predisposition or carrier status, marital or familial status, partnership status, victim of domestic violence, their or their dependent’s sexual or other reproductive health decisions, or other characteristics protected by applicable law.