Phaxis

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Claims Specialist

Bronx, NY 10462

Posted: 02/12/2025 Employment Type: Contract to Hire Job Number: 24675231 Pay Rate: 24-25 USD/Hour

Job Description

CLAIMS SPECIALIST
Location: Wallerstein, Bronx NY

Setting: A minimum of 2 days onsite (usually Wednesday and Friday), though this may vary.

Schedule: Monday –Friday 8: 30 am-5: 30 pm (1 hour lunch)

Contract Length: Long Term/Ongoing, potential for Direct Hire

Job Summary:

As a Claims Specialist, you will oversee claims processed by external vendors, resolve provider appeals/disputes, and drive process improvements. You’ll conduct root cause analysis to identify areas for provider education and system enhancements. Your key tasks will include investigating claims, managing claim reports, improving workflows, and ensuring accurate reimbursement configurations. You’ll also handle refunds, validate pricing outcomes, and collaborate with internal teams, providers, and vendors. Additionally, you'll contribute to special projects and ensure compliance with regulations and SLAs.

Key Responsibilities Include:
  • Review and resolve provider claims, appeals, and disputes.
  • Analyze claims and medical data to improve processes and workflows.
  • Collaborate with providers, members, and vendors to ensure smooth claim processing.
  • Validate DRG grouping and (re)pricing outcomes.
  • Manage refund checks, identify trends, and propose process enhancements.
  • Produce routine reports to ensure vendor productivity and compliance.
  • Participate in special projects and continuous process improvements.


QUALIFICATIONS:
Education: Bachelor's degree. Certified Professional Coder (a plus)
Experience:
- Eight or more years of insurance experience within a healthcare or managed care setting (preferred)
- Claims adjudication experience
- Knowledge of MLTC/ Medicaid/Medicaid benefit
- Knowledge of Member (Subscriber) enrollment & billing
- Knowledge of Utilization Authorizations
- Knowledge of Provider Contracting
- Knowledge of CPTs, ICD 9/ICD 10, HCPC, DRG, Revenue, RBRVS
- Proficiency in MS Excel, Word, PowerPoint, and experience using a claims processing system or comparable database software
 

Meet Your Recruiter

Kimberlee Samuel

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About Bronx, NY

Start your journey towards an exciting career in the vibrant Bronx, New York! Nestled within the heart of the Big Apple, the Bronx offers job seekers a unique blend of urban charm and endless growth opportunities. Home to iconic landmarks like the Yankee Stadium, Bronx Zoo, and New York Botanical Garden, this dynamic borough boasts a rich cultural tapestry, diverse cuisine, and a thriving arts scene with galleries and theaters showcasing local talent. Consider pursuing your career in the Bronx to immerse yourself in its enchanting atmosphere and be part of a community teeming with potential for professional development and personal fulfillment. Explore our job listings today and take the first step towards a rewarding career in this remarkable region.
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Drew Anson

Chief Delivery Officer

Drew Anson is Chief Delivery Officer at Phaxis, a Workforce Solutions Company based in New York.

In this role, Drew leads the delivery and recruiting working closely with the leadership team to define a model that is efficient at supporting the firm s current needs and is scalable for future growth.

Drew is a seasoned executive with more than 13 years of Services & Recruitment experience. In that time, he has supported numerous Fortune 100/500/1000 organizations across industries by providing global workforce solutions, namely resources and thought leadership for large-scale projects, implementations, and managed services.

Prior to joining Phaxis predecessor firm Park Hudson in 2021, Drew spent three years at engineering technology and talent solutions firm, Collabera, as Director of Sales in North Carolina. Earlier in his career, he spent nearly eight years at Insight Global, most recently as Sales Manager of the Columbus, OH office.

He holds a degree from Central Michigan University in Sales & Marketing.

Favorite Book: Extreme Ownership Jocko Willink & Leif Babin
Favorite Team: Michigan Wolverines
Inspirational Quote: There is no substitute for hard work. Thomas A. Edison