For those who want to keep growing, learning, and evolving. We at Kelly® hear you, and we're here for you! We're seeking a Medical Claims Review Specialist to work at a leading healthcare organization in Rochester, NY. Sound good? Take a closer look below. You owe it to yourself to consider this great new opportunity.
Pay Rate: $23.00 per hour (6-month Contract, possible extension)
Shift: 8am-5pm, Monday-Friday
What's a typical day as Medical Claims Review Specialist? You'll be:
Triaging, researching, and resolving clinical editing review request inquiries for current and future Clinical Editing programs across multiple regions.
Coordinating inquiries by gathering information from Medical Directors, Claims Review nurses, internal staff, and external customers to ensure timely resolution.
Assigning, tracking, and resolving specific clinical editing review inquiries, maintaining detailed logs and updating the dispute review database for reporting and metrics.
Drafting and sending communications regarding approved or denied inquiries, as well as information and problem-solving requests.
Monitoring and reporting on inquiry review, adjudication, and response timelines.
Entering claim information into claims systems, indicating status under inquiry or appeal.
Contacting provider offices to obtain correct claim or ordering information.
Constructing information for claim adjustments and forwarding to the appropriate research unit.
Preparing metrics to monitor department inquiries and functions, and recommending process improvements.
Representing the Clinical Editing Team on relevant project teams and providing support for correspondence, claims, and provider service units related to appeals.
This job might be an outstanding fit if you:
Have a Bachelor's degree in a relevant field with at least three years of experience in claims operations or customer service; or, in lieu of a degree, at least five years of significant work experience with coding, claims system operations, and clinical editing tools.
Are a Certified Professional Coder (CPC) or are willing to enroll in a CPC class within one year of hire (CPC certification desired).
Possess proficiency with spreadsheet, database, word processing, and coding software products.
Demonstrate excellent problem-solving skills and the ability to communicate complex ideas effectively.
Have a solid understanding of health systems operations, including reimbursement methodologies and coding conventions for governmental and commercial products (e.g., Medicare, Medicaid, DRG, APC, RBRVS, CPT, HCPC, ICD9).
Are familiar with coding software products such as ClaimCheck and Correct Coding Initiative (CCI).
Have extensive experience with claims processing systems (preferably CAPS/UWIN, LRSP, TOPPS, FACETS), claims flow, adjudication processes, and system edits.
Exhibit strong communication skills and are comfortable presenting information.
Are detail-oriented, customer-focused, and able to follow through independently.
What happens next
Once you apply, you'll proceed to next steps if your skills and experience look like a good fit. But don't worry-even if this position doesn't work out, you're still in our network. That means all of our recruiters will have access to your profile, expanding your opportunities even more.
Helping you discover what's next in your career is what we're all about, so let's get to work. Apply to be a Medical Claims Review Specialist today!
As part of our promise to talent, Kelly supports those who work with us through a variety of benefits, perks, and work-related resources. Please note: The following benefits reflect Kelly's general offerings. Eligibility may vary by assignment, location, and job @type. Kelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account. In addition, employees are entitled to earn paid sick leave under the applicable state or local plan. Click here (https://www.mykelly.com/help-support-working-with-kelly-us/#Benefits) for more information on benefits and perks that may be available to you as a member of the Kelly Talent Community.
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About Kelly
Work changes everything. And at Kelly, we're obsessed with where it can take you. To us, it's about more than simply accepting your next job opportunity. It's the fuel that powers every next step of your life. It's the ripple effect that changes and improves everything for your family, your community, and the world. Which is why, here at Kelly, we are dedicated to providing you with limitless opportunities to enrich your life-just ask the 300,000 people we employ each year.
Kelly is committed to providing equal employment opportunities to all qualified employees and applicants regardless of race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or any other legally protected status, and we take affirmative action to recruit, employ, and advance qualified individuals with disabilities and protected veterans in the workforce. Requests for accommodation related to our application process can be directed to the Kelly Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment. Kelly participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.
Kelly may use AI-powered tools during the recruitment and hiring process. For full details, including how Kelly uses AI, your rights, and how to request a reasonable accommodation, visit the Recruitment Artificial Intelligence Notice (https://www.kellyservices.com/hubfs/myKelly/Resources/Employment_Policies/Recruitment-Artificial-Intelligence-Notice.pdf?hsLang=en) .
Kelly Services is proud to be an Equal Employment Opportunity and Affirmative Action employer. We welcome, value, and embrace diversity at all levels and are committed to building a team that is inclusive of a variety of backgrounds, communities, perspectives, and abilities. At Kelly, we believe that the more inclusive we are, the better services we can provide. Requests for accommodation related to our application process can be directed to Kelly's Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment.
