Phaxis

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Claims Specialist

Bronx, NY 10467

Posted: 03/27/2025 Employment Type: Contract Job Number: 25186510 Pay Rate: 24-25 USD/Hour

Job Description

Claims Specialist, Bronx NY
HYBRID: 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, potential for Direct Hire

QUALIFICATIONS INCLUDE:
  • 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

JOB RESPONSIBILITIES INCLUDE:

  • Review and resolve claims processed by external vendors, including provider appeals and disputes.

  • Conduct root cause analysis to identify areas for provider education or system improvements.

  • Manage pended claims, (re)pricing, refund checks, and provider compensation grids.

  • Investigate claims, applying contractual provisions in line with provider contracts and authorizations.

  • Generate reports for claim adjustments, vendor inquiries, and internal reviews.

  • Analyze patient and medical data for COB, Worker's Compensation, No-Fault, and Subrogation conditions.

  • Collaborate with internal and external stakeholders to resolve claim-related issues.

  • Assist with provider compensation configuration, including creating and testing compensation grids.

  • Ensure timely processing of refund checks and monitor return trends to improve workflows.

  • Generate daily, monthly, and quarterly reports to track process timeframes, vendor productivity, and compliance.

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