Accounts Payable Assistant / Claims Adjustment Specialist I

Job Title: Accounts Payable Assistant / Claims Adjustment Specialist I
Location: New York, NY 10004
Duration: 04/27/2026 – 06/20/2026
Shift: 9:00 AM – 5:00 PM
Schedule: 5 days/week, 7 hrs/day, 35 hrs/week, No on-call
Schedule Notes: Monday–Friday; Hybrid work setting; Non-patient facing; Minimum 3 years of healthcare claims operations experience required; Experience with claim adjudication systems and CRM (Salesforce preferred); Strong knowledge of CPT, ICD-10, Revenue Codes, HCFA and UB04 required; Experience handling provider claim inquiries required
Work Setting: Managed Care / Health Plan (Non-Patient Facing)
Pay Range: $25-$28/hr.

Required Skills & Experience

• Minimum 3 years of claims operations experience in a healthcare field with integrated claims processing knowledge
• Experience analyzing and adjusting post-paid healthcare claims involving overpayments and underpayments
• Experience with claims adjudication systems and medical claims adjustment processes
• Strong analytical, problem-solving, decision-making, and time management skills
• Experience using CRM software (Salesforce preferred)
• Experience working with large data sets and spreadsheets; proficiency in Excel and Word
• Knowledge of medical terminology, CPT, ICD-10, and Revenue Codes
• Experience processing medical claim forms (HCFA, UB04)
• Knowledge of CMS/Medicare/Medicaid guidelines and claims processing procedures
• Experience handling provider claim inquiries and provider billing information
• Knowledge of HIPAA and protected health information compliance
• Experience with audit/accounting support, invoice review, and error identification
• Ability to work independently and exercise sound judgment

Education

• High School Diploma or GED required
• Associate Degree preferred

Certifications & Licensure

• None

Responsible for analyzing and adjusting post-paid healthcare claims to determine payment accuracy, mitigate payment errors, and resolve claims issues related to system processing, reimbursement discrepancies, and contractual findings.

• Research and analyze medical claims adjustment requests and documentation
• Adjust/adjudicate claims based on coding, reimbursement rates, authorizations, and contractual findings
• Apply claims processing procedures, CMS/Medicare/Medicaid guidelines, and benefit plans
• Investigate incorrectly paid claims and communicate findings for adjustment resolution
• Respond to provider inquiries regarding claim payments and required documentation
• Process claims adjustments within established timelines
• Maintain accurate claims records and documentation
• Generate claim activity reports and support audits
• Communicate findings to business partners to support issue resolution
• Remain current on changes in claims processing and coding systems
• Support accurate data entry and claims file maintenance
• Perform additional duties as assigned