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.

Why work for MJHS?:

When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors. Do you receive a paid day off for your birthday now? No?  You will here!  You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals.  You take care of our patients, residents, and health plan members, and we will take care of the rest!

 

Benefits include:

• Sign-on Bonuses OR Student Loan Assistance for clinical staff
• FREE Online RN to BSN and MSN degree programs!
• Tuition Reimbursement for all full and part-time staff
• Dependent Tuition Reimbursement for clinical staff!
• Generous paid time off
• Affordable 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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