Claims Resolution Analyst

Req #:

3020

Job ID:

14493

Job Location:

New York, NY

Zip Code:

10041

Category:

Claims

Agency:

Elderplan

Status:

Regular Full-Time

Office:

Office/Remote Based

Salary:

$42,400.61 - $53,000.76 per year

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

The MJHS Difference

At MJHS, we are more than a workplace; we are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services to diverse populations. We foster collaboration, celebrate achievements, and promote diversity, equity, and inclusion. Our contributions are recognized with comprehensive compensation and benefits, career development, and the opportunity for a healthy work-life balance, advancement within our organization and the fulfillment of having a lasting impact on the communities we serve.

Benefits include:

• Tuition Reimbursement for all full and part-time staff
• Generous paid time off, including your birthday!
• Affordable and comprehensive medical, dental and vision coverage for employee and family members
• Two retirement plans! 403(b) AND Employer Paid Pension
• Flexible spending
• And MORE!

MJHS companies are qualified employers under the Federal Government’s Paid Student Loan Forgiveness Program (PSLF)

Responsibilities:

Responsible for researching inquiries received via Payor, correspondence, e-mail or escalation from upper management pertaining to denied, rejected or underpaid claims for services rendered by participating and non-participating independent physicians, groups, vendors and ancillaries for EP Lines of Business.

Qualifications:

• High School Diploma, or equivalent, required; bachelor’s degree, preferred.
• With bachelor’s degree; minimum of one year of experience in Managed Care, provider billing, and/or customer service. Without bachelor’s degree, minimum of three (3) years of experience, as above.
• Knowledge of Microsoft and Excel.
• Knowledge of ICD 10 and CPT4 coding and medical terminology.
• Knowledge of coordination of benefits regulations.
• Knowledge of various payment methodologies, i.e. DRG, APC, etc.
• Ability to multi-task, work in a fast-paced environment and with minimal supervision.
• Ability to develop and maintain client relationships.
• Strong communication skills, both written and oral.

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