• The salary range for this position is $81,000 - $91,000 / yr
• This is a Full-time position
• Health Insurance Plans
• Flexible Spending Account Programs
• Management or Union Benefits
• Leave Benefits
• Special Leave of Absence Coverage (SLOAC)
• Retirement Savings Plans
• Additional Savings Plan
• Transit Benefit
• Direct Deposits
• Municipal Credit Union (MCU)

• Must have a bachelor’s degree in a health-related field.
• Must have 3-5 years of experience performing claims-related functions at a healthcare organization.

• Assist in the development of an audit schedule and plan, guided by ongoing regulatory requirements as well as the assessment of compliance risks impacting the organization.
• Conduct one-off or recurring audits of moderate to high complexity involving claims, pre-payment, and reimbursement transactions submitted by and issued to healthcare providers such as hospitals and physicians. Additional populations of related transactions may be carved out for situations requiring special review. Examples include high-dollar value or specialized claims crossing multiple lines of business or insurance products, claim types, and categories/locations of service.
• Reviewing and investigating any or all aspects of individual claim transactions, from receipt to payment. Areas of particular interest may include the application of hold codes, membership enrollment verification, pre-service authorizations, fee schedules and pricing, provider contracts, payment activity, consistency with organizational policies and procedures, and the issuance of Explanations of Benefits (EOB) or Payment (EOP).
• Assist with performing User Acceptance Testing (UAT) on system enhancements or organizational projects in partnership with business areas.
• Analyze errors and determine root causes for the appropriate classification.
• Reviewing existing training materials and interpreting quality assessment scores and observations from external parties in order to provide feedback aimed at improving both accuracy and operational efficiency.
• Investigate recoupment situations in which overpayments may have been issued to healthcare service providers as well as the related efforts to recapture overpaid amounts.
• Draw meaningful conclusions and recommendations for communication, presentation, and review by key stakeholders within various functions throughout the organization. Concise summaries may be requested on occasion by members of senior and executive management.
• Concise summaries may be requested on occasion by members of senior and executive management.
• Other duties as assigned or requested.

We are committed to our core values: integrity, honesty, and transparency Finding a new position as a physician or allied health professional or filling a critical vacancy in your practice, clinic, hospital, or skilled care facility can be stressful and time-consuming. At Greenlife our mission is to make this process easier for you and help you through all the steps necessary to find that perfect new position or the healthcare professional to round out your team. We understand that every situation is different and our approach reflects that: we value personalized interaction with job seekers and employers, our searches are customized not cookie-cutter and our results speak for themselves: Happy job seekers and employers who found the right professional match through our services.