Top 128 Claims specialist Jobs in Princeton Nj

Managed Care Contract Specialist - FT - Day - Managed Care Pennington NJ
Capital Health —Pennington, NJ
- $21.33 - $27.73 an hour
- 8 hour shift
- 5 years
- Office
- High school diploma or GED
- AD&D insurance
- Disability insurance
Senior Logistics & Trade Compliance Specialist
CompoSecure —Somerset, NJ
- $31.25 - $38.46 an hour
- Email
- Oracle
- 5 years
- Office
- Health savings account
- Paid holidays
Quick Apply
Regulatory Specialist (Cosmetics)
Atrium —North Brunswick, NJ
- $80,000 a year
- Mid-level
- Bachelor's degree
- Organizational skills
- Paid holidays
- Health insurance
Quick Apply
Cybersecurity Awareness Program Specialist
NJM Insurance —Ewing, NJ
- $104,686 - $131,986 a year
- Full-time
- Hybrid work
- Background check
- Computer Science
- HIPAA
- Opportunities for advancement
Quick Apply
13d
Commercial Claims Specialist II
NJM Insurance Group —Trenton, NJ
- $81,124 - $94,141 a year
- Full-time
- Customer service
- Mid-level
- Office
- Paid parental leave
- Disability insurance
Claims Training & Development Specialist
CURE Auto Insurance —Princeton, NJ
- $65,000 - $85,000 a year
- Full-time
- Hybrid work
- Writing skills
- Mid-level
- Office
- Health savings account
- AD&D insurance
Quick Apply
Medical Records Specialist
Alliance Health Systems —Matawan, NJ
- $20 - $25 an hour
- Full-time
- Hybrid work
- Background check
- HIPAA
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
2d
Customer Solution & Claims Specialist
Nestlé Health Science —Bridgewater, NJ
- $53,000 - $63,000 a year
- Hybrid work
- Microsoft Outlook
- Mid-level
- Bachelor's degree
- Health insurance
- 401(k) matching
5d
Claim Recovery Specialist
Hunterdon Health —Flemington, NJ
- $20.50 - $25.63 an hour
- Full-time
- Hospital
- Medical office experience
- Research
- Health insurance
- Dental insurance
Quick Apply
ESIS Recovery Specialist
Chubb —Whitehouse Station, NJ
- $69,000 - $110,000 a year
- Full-time
- 5 years
- Analysis skills
- Data entry
6d
Complex Claims Specialist
Primma, LLC —Township of Hamilton, NJ
- $127,000 - $148,000 a year
- Full-time
- Hybrid work
- Writing skills
- Office
- Analysis skills
Quick Apply
Prior Authorization Specialist
CentraState Healthcare System —Freehold, NJ
- $25 - $40 an hour
- Per diem
- Acute care
- Microsoft Excel
- Microsoft Outlook
- 403(b) matching
- AD&D insurance
Customer Support Specialist - Returns
Radwell International —Willingboro, NJ
- $25 - $33 an hour
- Full-time
- Computer literacy
- Writing skills
- Mid-level
- Paid holidays
- Disability insurance
Leave of Absence and Accommodation Specialist, North NJ Region
Hackensack Meridian Health —Edison, NJ
- $97,011.20 a year
- Full-time
- Mid-level
- Bachelor's degree
- Travel
- Health insurance
- Dental insurance
Sr. Claims Specialist - Financial & Professional Lines
Munich Re Specialty - North America —Princeton, NJ
- $138,400 - $212,100 a year
- Full-time
- Hybrid work
- 7 years
- Customer service
- Writing skills
- Wellness program
- AD&D insurance
Surgical Revenue Integrity Specialist - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ
Capital Health —Princeton, NJ
- $44.37 - $57.97 an hour
- 8 hour shift
- Nursing
- Surgery
- RN License
- AD&D insurance
- Disability insurance
Senior Specialist, Export
Brother International Corporation —Bridgewater, NJ
- $27 - $33 an hour
- Extended hours
- Hybrid work
- Spanish
- Microsoft Excel
- Microsoft Outlook
Clinical Research Specialist - Skin Health/Personal Care (175269)
Colgate-Palmolive —Piscataway, NJ
- $96,800 - $137,000 a year
- Hybrid work
- Mid-level
- Master's degree
- Bachelor's degree
- Profit sharing
- Paid parental leave
8d
PIP Litigation Specialist
CURE Auto Insurance —Princeton, NJ
- $70,720 - $91,520 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- Bachelor's degree
- Health savings account
- AD&D insurance
Quick Apply
Clinical Research Specialist - Skin Health/Personal Care
Colgate-Palmolive —Piscataway, NJ
- $96,800 - $137,000 a year
- Hybrid work
- Mid-level
- Master's degree
- Bachelor's degree
- Profit sharing
- Paid parental leave
8d

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Managed Care Contract Specialist - FT - Day - Managed Care Pennington NJ

Capital Health -
Pennington, NJ

Apply Now

Job Details

Full-time
$21.33 - $27.73 an hour

Benefits

AD&D insurance
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Paid time off
Employee assistance program
Vision insurance
Life insurance
Prescription drug insurance
Pet insurance

Qualifications

Spreadsheets
High school diploma or GED
Productivity software
Hospital experience

Full Job Description

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).

Pay Range:

$21.33 - $27.73

Scheduled Weekly Hours:

Position Overview

Under the direction of the VP of Payer Relations, responsible for reviewing all managed care contracts and the yearly updates. Works with departmental leadership to load all contracted rates in a timely manner. Conducts maintenance and monitoring of the contracts by running ad-hoc reports to ensure compliance and accuracy of pricing according to the various contracts. Works with Management team in the Revenue Cycle department to verify all pricing discrepancies.

MINIMUM REQUIREMENTS
Education: High School degree or equivalent. Bachelor’s degree preferred.
Experience: Five years' experience in hospital-based billing. ICD-10 knowledge preferred.
Other Credentials:
Knowledge and Skills: Proficient knowledge of healthcare billing. Outstanding organization skills. Excellent verbal and written communication skills.
Special Training: Proficient in Microsoft Office. Ability to quickly learn the billing system to become proficient.
Mental, Behavioral and Emotional Abilities: Ability to manage multiple tasks simultaneously and ability to change priorities when necessary to meet deadlines. Demonstrates good judgment as well as attention to detail.
Usual Work Day: 8 Hours
Reporting Relationships
Does this position formally supervise employees? No

If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

ESSENTIAL FUNCTIONS
Facilitates and coordinates process standardization with vendor to promote accurate contractual allowances in the contract management tool.
Reviews claim calculations in contract management tool, identifies discrepancies between the tool and contractual terms and works with the vendor or the payer to resolve discrepancies.
Performs root cause analysis behind payment calculation variances and identifies improvement opportunities for contract management software vendor as appropriate.
Provides ongoing evaluation and assessment of payer contracts, correlation tables, fee schedules, etc. through claims data to ensure the contract management tool remains current and accurate.
Coordinates with management and other revenue cycle leaders on contract valuation issues resulting in payment discrepancies. Assures payment discrepancies are quantified timely and accurately.
Partners with Hospital and Professional Billing Department to engage with different payers in providing feedback regarding trends and issues. Assures compliance of payers with regulatory guidelines and contract provisions.
When discrepancies are found, identifies if it's due to the contract load or due to the payer. When due to the contract load, it goes back to the vendor to have any incorrect loads updated. When due to payer issues, adds all issues to the Payer spreadsheet and works with our Payer Representative to resolve and completed in conjunction with revenue cycle management team.
Obtains a thorough understanding of payer reimbursement practices and procedures.
Contributes to topics included on payer agendas and spreadsheets to support Billing and Contract Management leadership in efficient communication for consistent resolution of payer contracting issues.
Remains current with changes in payer medical policies that impacts claim pricing methodologies and adjusts contract management software and/or communicates impact to management.
Performs other duties as assigned.

PHYSICAL DEMANDS AND WORK ENVIRONMENT
Frequent physical demands include: Pinching/fine motor activities , Keyboard use/repetitive motion , Talk or Hear

Occasional physical demands include: Standing , Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation

Continuous physical demands include: Sitting

Lifting Floor to Waist 20 lbs. Lifting Waist Level and Above 10 lbs.

Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing
Anticipated Occupational Exposure Risks Include the following: N/A

IND123.

This position is eligible for the following benefits:

Medical Plan
Prescription drug coverage & In-House Employee Pharmacy
Dental Plan
Vision Plan
Flexible Spending Account (FSA)

Healthcare FSA

Dependent Care FSA

Retirement Savings and Investment Plan
Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
Disability Benefits – Long Term Disability (LTD)
Disability Benefits – Short Term Disability (STD)
Employee Assistance Program
Commuter Transit
Commuter Parking
Supplemental Life Insurance

Voluntary Life Spouse

Voluntary Life Employee

Voluntary Life Child

Voluntary Legal Services
Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
Voluntary Identity Theft Insurance
Voluntary Pet Insurance
Paid Time-Off Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level.

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.

Apply Now

Refine Your Search

claims specialist jobs in princeton nj

Managed Care Contract Specialist - FT - Day - Managed Care Pennington NJ

Senior Logistics & Trade Compliance Specialist

Regulatory Specialist (Cosmetics)

Cybersecurity Awareness Program Specialist

Commercial Claims Specialist II

Claims Training & Development Specialist

Medical Records Specialist

Customer Solution & Claims Specialist

Claim Recovery Specialist

ESIS Recovery Specialist

Complex Claims Specialist

Prior Authorization Specialist

Customer Support Specialist - Returns

Leave of Absence and Accommodation Specialist, North NJ Region

Sr. Claims Specialist - Financial & Professional Lines

Surgical Revenue Integrity Specialist - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ

Senior Specialist, Export

Clinical Research Specialist - Skin Health/Personal Care (175269)

PIP Litigation Specialist

Clinical Research Specialist - Skin Health/Personal Care

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