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Claims Resolution Specialist

Facility: CHS Services Inc Location: Garden City, NY Department: CHS PP Administration Category: Administrative / Business Support Schedule: Full Time Shift: Day shift ReqNum: 6020501

Catholic Health Services of Long Island (CHS) is an integrated health care delivery system with some of the region's finest health and human services agencies. CHS includes six hospitals, three skilled nursing facilities, a regional home nursing service, hospice and a multiservice, community-based agency for persons with special needs. Under the sponsorship of the Diocese of Rockville Centre, CHS serves hundreds of thousands of Long Islanders each year, providing care that extends from the beginning of life to helping people live their final years in comfort, grace and dignity.

Position Summary: The Provider Operations Analyst is to serve as a liaison between Provider Relations and insurance payers, to promote satisfaction and accuracy of physician contracts while maintaining a strong foundation for the CHSPP physician network.

Responsibilities:

  • Serve as liaison between Practice Administrators, Office Managers and/or Billing Managers and insurance plans
  • Responds to requests for information and telephone inquiries from Providers and insurance carriers, in a courteous manner.
  • Investigate, research, track, resolve and communicate any claims issues related to payment and contractual rates
  • Submit monthly rosters to payers to add/update the physician network
  • Report trends of payer behavior
  • Must manage short term projects and tasks as assigned by supervisor
  • Stay informed on product information, changes in Medicare/Payer procedures and updates in policies.
  • Uses problem solving skills and planning abilities to diagnose and solve root process, payer and communicate system issues impacting revenue cycles
  • Responsible to update and maintain databases for efficient access.
  • Responsible to update physician practices, email lists, fee schedules, payer information in Salesforce.
  • Update and respond to all provider/payer inquiries on a daily basis.
  • Contribute beyond fundamental responsibilities to support company growth and department development.
  • Maintain a climate of teamwork and collaborative problem solving.
  • Requirements:

    • At minimum, Associates degree required.
    • Minimum 2 years of experience in a Health Care environment or equivalent background with a strong understanding of the medical field.
    • Knowledge of health care claims and health insurance industry
    • Knowledge of physician office operations and the effect of managed care on a physician's practice.
    • Advanced computer literacy, including Microsoft Office, data entry, retrieval and report generation.
    • Must demonstrate ability to identify problems and make reasonable recommendations and/or take the necessary action to resolve.
    • A team player that can follow protocols to achieve a common goal.
    • Time management skills with ability to manage multiple tasks.
    • Must have the ability to self-motivate, prioritize and be willing to change processes in order to reach a common goal.
    • Must be able to manage shifting priorities and escalates issues as appropriate.

    At Catholic Health Services of Long Island your well-being comes first, with comprehensive compensation and benefits; our offerings go beyond the basics. In addition to multiple medical plans, life insurance, generous paid time off and flexible spending accounts, we also offer substantial tuition reimbursement, an employer funded pension plan and several savings plan options for your future.

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  • Administrative / Business Support, Garden City, New York, United StatesRemove