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Insurance and Claims Specialist I
Health Research - Menands, NY
posted 2 months ago
About the position
The Insurance and Claims Specialist I position at the New York State Department of Health, AIDS Institute, focuses on processing reimbursements and payments related to various healthcare services for individuals with or at risk of HIV/AIDS. This role is essential in bridging the gap between Medicaid coverage and private insurance, ensuring that eligible individuals receive the necessary medical services and medications. The specialist will also handle complex inquiries, assist in coordination of benefits, and provide training to staff.
Responsibilities
- Process APIC reimbursement and payment processing for pharmacy, primary care, home care, and APIC services.
- Handle complex fiscal hotline calls related to insurance and claims.
- Assist providers and participants with coordination of benefits.
- Provide training and support to staff regarding claims processing and insurance matters.
- Perform other related duties as assigned.
Requirements
- Bachelor's degree in a related field; OR an Associate's degree in a related field and two years of general office, secretarial, or administrative experience; OR four years of such experience.
- At least one year of experience in a health care program providing services to people living with HIV/AIDS.
- At least two years of customer service experience in a financial or medical field.
- At least two years of medical claims or insurance experience.
- Knowledge of COBRA, HIPAA, and coordination of benefits.
Nice-to-haves
- Experience in a healthcare program specifically for HIV/AIDS services.
- Familiarity with insurance claims processing and reimbursement procedures.
Benefits
- Health, dental, and vision insurance with several plans to choose from.
- Flexible benefit accounts for medical, dependent care, adoption assistance, parking, and transit.
- Generous paid time off including federal and state holidays, sick leave, vacation, and personal leave.
- Tuition support for educational or training opportunities.
- Retirement benefits through the New York State and Local Retirement System and optional enrollment in the New York State Deferred Compensation Plan.
- Postretirement health benefits plan for qualified retirees.
- Employee Assistance Program offering educational and wellness programs, training, and 24/7 confidential services.
