Claim Specialist jobs at Akumin

Work Schedule: Onsite Assignment Length: 6+ months **NO C2C due to client restrictions** Top Skills: Claims Management - 2+ years of hands-on claims management experience Customer Care Legal knowledge/experience Excellent written/oral communication and customer care skills Strong Excel and PPT The primary objective of the Claims Management Specialist is to support Product Safety/Product Liability Department with operational activities including Direct Claim handling, customer contact & admin support, and overall claims management. The goal of the Claims Operations Specialist is to support the Product Safety Team by handling Claims with professionalism, care and urgency, making sure claims are reported and being handled in a timely manner. To achieve the highest performance, the person in this position is expected to maintain effective and timely communication with key customers, claims adjusters, stakeholders and leaders within the department, team, and cross-department where applicable. Responsibilities: Collaborate with team members in the Product Safety department, PL Insurance Carrier, outside law firm and 3rd Party administrators. Generate daily/weekly/monthly reports, with analysis and recommendations Manage 4-7 ongoing and ad-hoc projects that may include KPIs and Metrics Ensure that all projects have required documentation as they move through the project tollgates Communicate to Product Liability leadership on project status and escalation/decision points Works cross functionally with HQ teams in Korea (occasional evening conference call) and client operations to manage all possible risks. Pending Claim Management, KPI & TAT Management - Claim registration to closure Product Verification Liability Assessment by reviewing diagnosis results Report on high-profile claims to the leadership Qualifications: 2+ years of hands-on claims management & customer care experience Expertise in MS, Excel, and PPT Proven capability to analyze data and develop a course of action Proven ability to prioritize and manage multiple projects, meet deadlines and drive to resolution Process, procedure, strategic planning and project development experience Experience working with and influencing cross-functional teams. Experience working within the insurance and/or home appliance industry a plus Experience with product development or testing a plus Experience working in a complex and wide organization and department Claims Adjuster License a plus Takes project ownership and possesses leadership qualities with an entrepreneurial approach Must be able to analyze, make judgments, decisions and recommendations for ongoing and new projects or tasks Able to apply critical thinking and imaginative solutions to analyze and present solutions to challenges based on data Communicate professionally both verbally and through written correspondence Explain reports and analysis to all levels of the organization Sense of urgency, Flexible, self-motivated, self-organized self-directed, and results-oriented Customer service focus with excellent relationship management skills Team oriented, but able to work independently and manage multiple tasks Able to perform complex quantitative analysis (Advanced Excel skills) to flag risk and report in timely manner

CAP seeks a Senior Claims Specialist for its Orange County office. This role involves handling technical and administrative duties to manage assigned claim files; assumes increased workload of highly complex claims. The Senior Claims Specialist also plays an active role in the ongoing training and oversight of Claims Specialist I and II team members. Our dedicated employees are the essential element to CAP's success. CAP's team of well-trained professionals with a commitment to excellence has helped deliver to our member physicians an unparalleled quality of products and services. Our corporate culture and collegial collaboration of minds and efforts is unmatched. Essential Duties and Responsibilities: Manage medical malpractice claims, including the assignment, direction, and control of defense counsel, under supervision and in compliance with the Claims Technical Manual, the Defense Attorney Guidelines, and the MPT Agreement. Manage increasingly complex cases with larger financial exposure. Investigate and evaluate claim files including complying with the standards of performance, interviewing members, reviewing medical records, corresponding with plaintiff attorneys, obtaining preliminary expert evaluation/opinions, and preparing interview summaries. Prepare case evaluation reports for publication and presentation to the CRC and CSC. Prepare case evaluation reports for discretionary authority on selected cases. Manage and participate in all litigation activity, including discovery plan, mediation, MSC, and negotiation under supervision, as necessary. Monitor trials and arbitrations including daily progress reports, providing member and defense attorney with support. Education and/or Experience: Bachelor's degree from four-year college or university. Relevant legal and/or medical education background or the equivalent. Minimum five years of medical malpractice claims management experience and/or three years CAP claims experience. Starting Salary: $110,000 - $130,000 annually (Depending on Experience)

The Risk, Claims & Carrier Qualifications Specialist plays a critical role in protecting Patterson Companies from operational, financial, and reputational risk. This position is responsible for managing all Overages, Shortages, and Damages (OS&D), processing and resolving freight claims, qualifying and onboarding carriers, maintaining carrier insurance compliance, and overseeing organizational risk management procedures. This role ensures that Patterson Companies operate within industry regulations while building strong partnerships with carriers and safeguarding our customers' freight. Key Responsibilities Claims & OS&D Management Serve as the first point of contact for all OS&D and freight claims from shippers, carriers, and internal teams. Investigate, document, and process claims in compliance with company policies, federal regulations, and industry best practices. Communicate with carriers, customers, and internal stakeholders to resolve disputes promptly and fairly. Maintain detailed claim files, documentation, and reporting for trend analysis and process improvement. Carrier Vetting & Qualification Conduct thorough vetting of new carriers, including verifying MC/DOT authority, safety ratings, insurance coverage, and operational capabilities. Ensure carriers meet Patterson Companies' safety and compliance standards before onboarding. Monitor ongoing carrier compliance, including insurance renewals, safety performance, and regulatory changes. Manage the carrier onboarding process in collaboration with the operations team, utilizing TMS-integrated vetting tools (e.g., Highway). Insurance & Compliance Management Track and verify carrier insurance policies, ensuring timely renewals and appropriate coverage. Coordinate with carriers and insurance providers to update coverage documents in company systems. Monitor regulatory requirements and ensure company compliance with FMCSA, DOT, and other governing bodies. Organizational Risk Management Identify operational risks and recommend preventive strategies to mitigate exposure. Develop and update company policies related to risk, claims, and carrier compliance. Provide regular risk and claim trend reports to leadership to inform decision-making. Collaborate with sales, operations, and leadership to ensure contractual agreements protect company interests. Other duties as assigned Qualifications Required: Minimum 3 years of experience in transportation, logistics, risk management, or claims processing. Strong knowledge of carrier vetting, insurance requirements, OS&D processes, and freight claims procedures. Proficient in using TMS platforms and compliance monitoring tools. Excellent communication, negotiation, and problem-solving skills. Ability to manage multiple priorities and meet deadlines in a fast-paced environment. Preferred: Experience in a 3PL or freight brokerage environment. Operations experience is preferred. Familiarity with Highway, RMIS, SaferWatch, Carrier411, or equivalent compliance software. Knowledge of cargo insurance policies, Carmack Amendment, and freight claim regulations. To apply online, please visit: *********************************

The RCM OPEX Specialist plays a critical role in optimizing the financial performance of healthcare organizations by ensuring that revenue cycle management processes are efficient and compliant with industry regulations. This position requires detail-oriented professionals who can navigate complex insurance claims and reimbursement processes. Essential Job Functions Manage internal and external customer communications to maximize collections and reimbursements. Analyze revenue cycle data to identify trends and proactively remediate suboptimal processes. Maintain fee schedule uploads in financial and practice operating systems. Review and resolve escalations on denied and unpaid claims. Collaborate with healthcare providers, payors, and business partners to ensure revenue best practices are promoted. Monitor accounts receivable and expedite the recovery of outstanding payments. Prepare regular reports on refunds, under/over payments. Stay updated on changes in healthcare regulations and coding guidelines. *NOTE: The list of tasks is illustrative only and is not a comprehensive list of all functions and tasks performed by this position. Other Essential Tasks/Responsibilities/Abilities Must be consistent with Femwell's core values. Excellent verbal and written communication skills. Professional and tactful interpersonal skills with the ability to interact with a variety of personalities. Excellent organizational skills and attention to detail. Excellent time management skills with proven ability to meet deadlines and work under pressure. Ability to manage and prioritize multiple projects and tasks efficiently. Must demonstrate commitment to high professional ethical standards and a diverse workplace. Must have excellent listening skills. Must have the ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards and organization attendance policies and procedures. Must maintain compliance with all personnel policies and procedures. Must be self-disciplined, organized, and able to effectively coordinate and collaborate with team members. Extremely proficient with Microsoft Office Suite or related software; as well as Excel, PPT, Internet, Cloud, Forums, Google, and other business tools required for this position. Education, Experience, Skills, and Requirements Bachelor's degree preferred. Minimum of 2 years of experience in medical billing, coding, revenue cycle or practice management. Strong knowledge of healthcare regulations and insurance processes. Knowledgeable in change control. Proficiency with healthcare billing software and electronic health records (EHR). Knowledge of HIPAA Security preferred. Hybrid rotation schedule and/or onsite as needed. Medical coding (ICD-10, CPT, HCPCS) Claims management (X12) Revenue cycle management Denials management Insurance verification Data analysis Compliance knowledge Comprehensive understanding of provider reimbursement methodologies Billing software proficiency

The Tissue Donation Specialist (TDS) supports the mission, goals, and strategic plan of Nevada Donor Network Inc. (NDN) by providing clinical support to facilitate safe, efficient procurement of tissues for transplant and research. TDS also serve to promote effective communication with relevant stakeholders to facilitate donation including organizational recovery staff, funeral homes, hospital, and medicolegal partners. ESSENTIAL FUNCTIONS Performs thorough donor physical assessment. Recovers donated human tissue for transplantation and research. Prepares donated tissues and relevant specimens such as blood and cultures, for shipment. Completes all required donor charts and related reports completely, accurately, and in a timely manner according to protocol. Completes daily tasks such as basic supply management, instrument maintenance, routine cleaning of clinical facilities, etc. to support clinical activities. Applies Universal Precautions and appropriate safety precautions at all times. Adheres to the regulations, policies, and procedures published by the Food and Drug Administration (FDA), American Association of Tissue Banks (AATB), NDN, and our outside partners. Maintains confidentiality on all donor-related activities and internal matters. Requests applicable medical records and any additional requests of recovered donors to facilitate timely release of tissue for transplant. Adheres to inventory control practices, including the utilization of the inventory management system(s), and stocking supplies according to protocol. SKILLS & ABILITIES Education: Bachelor's Degree (preferred); relevant work experience may be substituted for academic requirements. Experience: Six months to one-year healthcare related experience (preferred) Computer Skills: basic computer skills, knowledge of MS office programs, facsimile/scanner/copy machine Certificates & Licenses: RN, Paramedic/EMT, CST licenses considered. Must have a valid Nevada driver's license Other Requirements: Must be able to work overnights, weekends, and holidays as a regular shift. Availability on-call or on-site, according to a fixed schedule and able to participate in (12) hour shift rotations day and night. Required to have a personal cell phone and must remain within a reasonable radius to respond to case activity within (1) hour of being notified when on-call. Travel by personal or company auto is required to meet all of the duties and responsibilities of the position. Knowledge of basic aseptic technique, universal precautions, medical terminology, anatomy, and physiology preferred.

As an Advantage Care Cancer Specialist, you'll be the initial point of contact for members diagnosed with cancer. Your role involves providing emotional support, actively listening, and offering prayers as they process this difficult news. You'll walk alongside members and their families throughout their cancer journey. Additionally, you'll collaborate with various CHM departments and work closely with our nurse navigator to connect members with high-quality treatment providers at cost-effective rates. What We Offer Compensation based on experience. Faith and purpose-based career opportunity! Fully paid health benefits Retirement and Life Insurance 12 paid holidays PLUS birthday Lunch is provided DAILY. Professional Development Paid Training Role and Responsibilities Obtain necessary treatment details. Assess membership level, CHM Plus, offer pertinent programs based on the membership details and the type of cancer diagnosis. Acquire necessary documentation for a sharing determination. Effectively communicate with the members, supervisors, team members, the nurse navigator, and various departments. Multitask and maintain strong attention to detail. Interact with members to understand their needs, provide information, and help throughout the sharing determination process. Respond to member inquiries, issues, and concerns in a timely and professional manner through various communication channels, including communication with the nurse navigator, phone and/or email. Maintain accurate and organized records of members interactions, inquiries, orders, and other relevant information in CHM's database Collaborate with various internal teams to ensure effective communication, smooth transitions, and a seamless member experience. Seek opportunities for process improvement, suggest enhancements to processes, and provide feedback to member experience and overall effectiveness. Set up negotiating agreements with providers. Bill processing of cancer related Single Case Agreements and Memorandum of Understandings. Guide members to financial assistance program options specific to diagnosis. Assist members to help optimize their lifetime maximum amount when limitations exist. Qualifications High school diploma or successful completion of a high school equivalency Must possess excellent verbal and written communication skills to effectively interact with CHM members and team members across various channels. Proficient PC operating routine office equipment (e.g., faxes, copy machines, printers, multi-line telephones, etc.) Experience with medical bills preferred. Strong analytical and problem-solving skills. Demonstrated history of effective phone communication skills. Obtain knowledge of CHM guidelines. Ability to handle stressful and sensitive situations. Knowledge of cancer related benefit programs is helpful but not required. Note: The qualifications and responsibilities outlined above are subject to change as the needs of the organization evolve. About Christian Healthcare Ministries Founded in 1981, Christian Healthcare Ministries (CHM) is a health care sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other's medical bills. The mission of CHM is to glorify God, show Christian love, and experience God's presence as Christians share each other's medical bills.

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for three years, HMA has been chosen as a ‘Washington's Best Workplaces' by our Staff and PSBJ™. Our vision, ‘Proving What's Possible in Healthcare™,' and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results. What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: ***************** How YOU will make a Difference: As a Claims Specialist, you'll be at the heart of our mission to deliver exceptional service. Working alongside a dedicated team, you'll ensure the accurate and timely processing of medical, dental, vision, and short-term disability claims that HMA administers for our members. Your role goes beyond handling claims, you'll be a key player in shaping a positive healthcare experience for our members. Every claim you interact with helps someone navigate their healthcare journey with confidence, making your work both meaningful and impactful. What YOU will do: Carefully research discrepancies, process returned checks, issue refunds, and manage stop payments with precision. This ensures financial accuracy and builds trust with both clients and members. Manage high-importance claims and vendor billing with urgency and attention to detail. Review and reply to appeals, inquiries, and other communications related to claims. Work with third-party organizations to secure payments on outstanding balances. Process case management and utilization review negotiated claims Spot potential subrogation claims and escalate them appropriately. Actively contribute to team success by assisting colleagues when workloads peak, sharing knowledge, and fostering a collaborative environment. Requirements High school diploma required 3-5+ years of claims processing experience 2+ years of BCBS claims processing experience Strong interpersonal and communication skills Strong attention to detail, with high degree of accuracy and urgency Ability to take initiative and ownership of assigned tasks, working independently with minimal supervision, yet maintain a team-oriented and collaborative approach to problem solving Previous success in a fast-paced environment Benefits Compensation: The base salary range for this position in the greater Seattle area is $28/hr - $32/hr for a level II and varies dependent on geography, skills, experience, education, and other job or market-related factors. While we are looking for level II, we may consider level III for highly qualified candidates. Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law. In addition, HMA provides a generous total rewards package for full-time employees that includes: Seventeen (IC) days paid time off (individual contributors) Eleven paid holidays Two paid personal and one paid volunteer day Company-subsidized medical, dental, vision, and prescription insurance Company-paid disability, life, and AD&D insurances Voluntary insurances HSA and FSA pre-tax programs 401(k)-retirement plan with company match Annual $500 wellness incentive and a $600 wellness reimbursement Remote work and continuing education reimbursements Discount program Parental leave Up to $1,000 annual charitable giving match How we Support your Work, Life, and Wellness Goals At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party. We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.) HMA requires a background screen prior to employment. Protected Health Information (PHI) Access Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures. HMA is an Equal Opportunity Employer. For more information about HMA, visit: *****************

We are searching for an MRI Specialist-- someone who works well in a fast-paced setting. In this position, you will perform quality routine and specialized radiographic procedures at the request licensed independent practitioner for interpretation by radiologists. As members of the health care team, they must participate in quality improvement processes and continually assess their professional performance. Maintains a safe and hazard free environment. They are responsible for patient care, appropriate documentation, quality control, and quality improvement, and they provide training, education and mentoring to students, technologists, nursing, residents, fellows, staff and others. Think you have what it takes? Responsibilities: • Broad knowledge of MRI physics and procedures; understanding of MRI principles that are developmentally appropriate for ages 0 - adulthood • Operation of all required equipment including troubleshooting, when necessary, of the equipment, including automated processors, copying/digitizing film equipment, R.I.S., and PACS • Basic Life support and medical terminology understanding is required. • Successful demonstration of the professional fundamental competencies • Must be articulate, courteous and supportive in dealing with patients, parents, nursing, faculty, administrative and departmental personnel so that excellent customer service and positive guest relations are achieved • Must honor confidentiality • Must independently scan patients by following the established protocols • Must demonstrate excellent verbal and written skills • Must utilize basic office equipment • Preferable if able to demonstrate bilingual skills • The MRI Specialist will be responsible for multiple duties including: • integrates scientific knowledge; technical skills, patient interaction and compassionate care resulting in diagnostic information, and recognizes patient conditions essential for successful completion of the procedure. • possess, utilize, maintain, and enhance knowledge of MRI safety and protection for self, patients, and others. • demonstrate a detailed understanding of human anatomy, physiology, pathology and medical terminology. • liaison between patients, radiologist and other members of the support team. • maintain a high degree of accuracy in positioning and exposure technique. • prepares, administers and documents activities related to mediations in accordance with state regulations and institution policy. Skills and Requirements: • 3yrs Radiology experience • Graduate of a formal diagnostic Radiology program required • MR-ARRT certification from the American Registry of Radiologic Technologists required • R-AART preferred • CMRT from the Texas Medical Board preferred • BLS certification from the American Heart Association preferred ABOUT US Since 1954, Texas Children's has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children's hospital in Texas, and among the top in the nation by U.S. News & World Report as well as recognition from Houston Business Journal as one of this city's Best Places to Work for ten consecutive years. Texas Children's comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Tower for pediatric research; Texas Children's Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children's Hospital West Campus, a community hospital in suburban West Houston; Texas Children's Hospital The Woodlands, the first hospital devoted to children's care for communities north of Houston; and Texas Children's Hospital North Austin, the new state-of-the-art facility providing world-class pediatric and maternal care to Austin and Central Texas families. We have also created Texas Children's Health Plan, the nation's first HMO focused on children; Texas Children's Pediatrics, the largest pediatric primary care network in the country; Texas Children's Urgent Care clinics that specialize in after-hours care tailored specifically for children; and a global health program that is channeling care to children and women all over the world. Texas Children's Hospital is affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation. To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Job Description An Account Resolution Specialist I is responsible for researching and identifying unpaid, partially paid, incorrectly paid or denied claims. They must follow-up with insurance carriers verbally or via on-line tools and properly discuss the problem with the knowledge of how to negotiate payment/additional payments on all claims. In the event the needs arise, they will also resubmit a corrected claim and/or follow-up with patients regarding the issue(s) as needed. Minimum Education Must have a high-school diploma or a GED. Minimum Work Experience No prior work experience in this related field is required at this level. Required Skills Customer service Must have general Microsoft Office (Word, Excel, PPT, and Outlook) experience. Ability to manage their time in order to meet job requirements. Ability to review an account and come to a decision as to what the proper solution would be to resolve the account. Must be a team player. Screening Requirements: Drug Screen Tuberculosis Test Background Check Physical Exam Respirator Fit Eligible Benefits: Medical, Dental and Vision *Excellent Low Premiums!*- No copays or Deductibles when utilizing MCCH services! Life Insurance *ZERO premium* Retirement Plan Paid Time Off Bereavement Bridge Coverage *ZERO premium for self-coverage when enrolled in medical coverage Tuition Reimbursement Our Mission: To improve the lives of those we serve by providing outstanding care and services through our confident, compassionate and exceptional healthcare professionals. Our Vision: To be chosen by our community and expanded service region based on proven outcomes as the trusted provider to care for their families, friends and neighbors. Our Values: Competence, Excellence, Compassion, Respect and Integrity.

Job Details Blackburn's Corporate - Tarentum, PA InsuranceDescription Job Opening: Claims Processing Specialist at Blackburn's Are you a detail-oriented professional with a passion for the healthcare industry? Blackburn's is looking for a Claims Processing Specialist to join our Corporate Claims department and perform third-party medical billing functions. If you thrive in a fast-paced environment and possess excellent organizational and communication skills, this could be the perfect opportunity for you! What You'll Do: Manage and verify third-party medical claims for accuracy and compliance. Collaborate with cross-functional teams to resolve billing discrepancies and insurance denials. Process claims efficiently while adhering to strict filing deadlines. Contribute to the improvement of billing processes to reduce denials and increase efficiency. Utilize your strong communication skills to work with internal teams and external clients. Why Join Us? At Blackburn's, we're committed to creating a positive impact in the healthcare industry by delivering quality products and services. As part of our team, you'll have access to in-house training, opportunities for career growth, and a collaborative work environment. We offer competitive pay, benefits, and the chance to be part of a company that values its employees. Work Hours: 8:00 a.m. - 4:30 p.m. or 8:30 a.m. - 5:00 p.m. If you have a passion for medical billing and enjoy working in a dynamic, fast-paced environment, we'd love to hear from you! Apply today and join us in making a difference at Blackburn's! Qualifications What We're Looking For: Prior experience in healthcare-related industries, preferably with third-party medical billing. Strong attention to detail, time management, and the ability to juggle multiple tasks. Excellent interpersonal skills, with the ability to work both independently and as part of a team. Proficiency in Microsoft Office, with knowledge of Word and Excel. Ability to work independently, prioritize workload, and adapt to changing environments.

Family Health Care is currently seeking applications for the position of Pharmacy 340B Claims Specialist! General Function: This position functions at the highest level (III) in the series of Pharmacy Technician roles within Family Health Care. The individual in this role is a "work-leader" serving as the expert on prescription claims reimbursement and performing self-auditing for the pharmacy department. This individual will ensure prescription claim integrity by having advanced knowledge of claim requirements for the various pharmacy benefit managers (PBM) and shall use that information to identify areas of improvement by performing targeted claim audits and will provide education to the pharmacy staff on billing requirements, when needed. Responsibilities: * Acts as pharmacy claims auditor and will audit claims daily into order to track claims accuracy, trends, anomalies and other critical information to help BFHC ensuring appropriate reimbursement while mitigating organizational risk for claims remediations resulting from claim processing errors. * Acts as pharmacy 340B claims auditor and audits claims on a scheduled basis into order to track 340B claims accuracy, trends, anomalies, and other critical information to help BFHC maintain 340B claim integrity while ensuring adherence to 340B policies, procedures, rules and regulations. * Ensures timely and accurate billing/collections of all pharmacy charges and reimbursement activities through the use of reporting and reconciliation. * Ensures integrity if financial reports and provides necessary reports to the finance department upon request. * Assists the Chief Pharmacist and pharmacy staff in the research, development and implementation of new and existing pharmacy services. Location(s): White Cloud, MI Employment Type: Full Time Exempt/Non-Exempt: Non-Exempt Benefits: Competitive wage and excellent benefits package. FHC is an eligible organization for State and Federal Loan Repayment Programs. Family Health Care is an Equal Opportunity Employer.

Family Health Care is currently seeking applications for the position of Pharmacy 340B Claims Specialist! General Function: This position functions at the highest level (III) in the series of Pharmacy Technician roles within Family Health Care. The individual in this role is a “work-leader” serving as the expert on prescription claims reimbursement and performing self-auditing for the pharmacy department. This individual will ensure prescription claim integrity by having advanced knowledge of claim requirements for the various pharmacy benefit managers (PBM) and shall use that information to identify areas of improvement by performing targeted claim audits and will provide education to the pharmacy staff on billing requirements, when needed. Responsibilities: Acts as pharmacy claims auditor and will audit claims daily into order to track claims accuracy, trends, anomalies and other critical information to help BFHC ensuring appropriate reimbursement while mitigating organizational risk for claims remediations resulting from claim processing errors. Acts as pharmacy 340B claims auditor and audits claims on a scheduled basis into order to track 340B claims accuracy, trends, anomalies, and other critical information to help BFHC maintain 340B claim integrity while ensuring adherence to 340B policies, procedures, rules and regulations. Ensures timely and accurate billing/collections of all pharmacy charges and reimbursement activities through the use of reporting and reconciliation. Ensures integrity if financial reports and provides necessary reports to the finance department upon request. Assists the Chief Pharmacist and pharmacy staff in the research, development and implementation of new and existing pharmacy services. Location(s): White Cloud, MI Employment Type: Full Time Exempt/Non-Exempt: Non-Exempt Benefits: Competitive wage and excellent benefits package. FHC is an eligible organization for State and Federal Loan Repayment Programs. Family Health Care is an Equal Opportunity Employer.

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Under the direction of the Covered California Claims (CCA) Manager, the CCA Claims Specialist is responsible for analyzing, managing, and investigating complex and high-dollar healthcare claims that require in-depth research to determine accuracy and mitigate payment errors. The Claims Specialist is also responsible for adjusting first-pass and post-pay claims that result in overpayment or underpayment due to claim processing system issues, contract amendments, processing errors, or other issues. This position collaborates with internal stakeholders, assists with claim audits (internal and regulatory) and utilizes strong analytical skills and independent judgement skills to make effective and accurate decisions. This position will also be responsible for responding to inquiries from the Provider Payment Resolution team on claims that may have been paid incorrectly. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. * Competitive salary * Telecommute schedule * State of the art fitness center on-site * Medical Insurance with Dental and Vision * Life, short-term, and long-term disability options * Career advancement opportunities and professional development * Wellness programs that promote a healthy work-life balance * Flexible Spending Account - Health Care/Childcare * CalPERS retirement * 457(b) option with a contribution match * Paid life insurance for employees * Pet care insurance Education & Requirements * Three (3) years of experience in examining and processing complex and high-dollar institutional and professional claims * Experience in a managed care environment helpful. Commercial, Exchange, and Medicare preferred * High school diploma or GED required * Associate's degree from an accredited institution preferred Key Qualifications * ICD-9/ ICD-10 and CPT coding and general practices of claims processing * CMS/DMHC and Affordable Care Act regulations and guidelines * Commercial line of business specifically Covered California/Exchange * Excellent communication and interpersonal skills * Excellent analytical, critical thinking, customer service, and organizational skills * Ability to think critically with the capacity to work independently * All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range * $25.90 USD Hourly - $33.02 USD Hourly

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of the Covered California Claims (CCA) Manager, the CCA Claims Specialist is responsible for analyzing, managing, and investigating complex and high-dollar healthcare claims that require in-depth research to determine accuracy and mitigate payment errors. The Claims Specialist is also responsible for adjusting first-pass and post-pay claims that result in overpayment or underpayment due to claim processing system issues, contract amendments, processing errors, or other issues. This position collaborates with internal stakeholders, assists with claim audits (internal and regulatory) and utilizes strong analytical skills and independent judgement skills to make effective and accurate decisions. This position will also be responsible for responding to inquiries from the Provider Payment Resolution team on claims that may have been paid incorrectly. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary Telecommute schedule State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account - Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities Work effectively with other departments (i.e., Special Investigation Unit, Provider Payment Resolution team, and other departments/stakeholders) to investigate and identify fraud, respond to escalated provider inquiries timely, and support the claims process. Investigate and process complex and high-dollar claims determining accuracy and making timely decisions. Advise leadership and internal business units (as applicable) of findings and outcomes on identified claim issues. Research and analyze medical claims adjustment requests along with related documentation to determine payment accuracy and adjust/adjudicate as needed in the Health Rules Processing system and other platforms. Research claims that may have been paid incorrectly and communicate findings for adjustment. Adjust claims based on findings (i.e., correct coding, rates of reimbursement, authorizations, contracted amounts, etc.) ensuring that all relevant information is considered. Assist with internal and regulatory claim audits, reviewing claim accuracy. Identify trends and recommend improvements to IEHP's claim processing system. Analyze and investigate insurance claims to discover or prevent fraud. Be an active participant in the Claims Department's initiatives and participate in Claims Huddles, etc. Remain current with all claim processing changes/updates (i.e. internal processes, regulatory guidelines). Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications Education & Requirements Three (3) years of experience in examining and processing complex and high-dollar institutional and professional claims Experience in a managed care environment helpful. Commercial, Exchange, and Medicare preferred High school diploma or GED required Associate's degree from an accredited institution preferred Key Qualifications ICD-9/ ICD-10 and CPT coding and general practices of claims processing CMS/DMHC and Affordable Care Act regulations and guidelines Commercial line of business specifically Covered California/Exchange Excellent communication and interpersonal skills Excellent analytical, critical thinking, customer service, and organizational skills Ability to think critically with the capacity to work independently All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Pay Range USD $25.90 - USD $33.02 /Hr.

WestCoast Children's Clinic, located in Oakland, California, is a non-profit community psychology clinic that provides mental health services to Bay Area children, youth and families. Working at WestCoast Children's Clinic means being part of an organization that is client-centered, trauma-informed, collaborative, and committed to justice and equity. Position Details Title: Medi-Cal Claims Billing Specialist Classification: Full time (1.0 FTE) Non-Exempt (Hourly), 40 hours per week Location: Oakland, CA / Hybrid (In-person for first 90 days) Regular Work Schedule: Monday - Friday Compensation: * Hourly range: $26.00-$28.00 per hour The Medi-Cal Claims Billing Specialist will hold the crucial responsibility of inputting claims and corrections with precision and timeliness. Additionally, this role involves the monthly reconciliation of data between external and internal Electronic Health Record (EHR) systems. We are seeking an individual who is not only detail-oriented, but also embraces the opportunity to contribute to the seamless integration and accuracy of our healthcare data. Responsibilities: * Generate billing reports from Welligent (WestCoast's internal EHR) and input claims data into Alameda County's EHR (Smart Care) and upload services to the City and County San Francisco EHR (EPIC). * Collaborate with providers, supervisors, and county staff to complete billing process to correct claims. * Reconcile monthly claims generated from Smart Care and EPIC systems to internally generated reports. * Prepare and submit Correction Claim Reports for Alameda and San Francisco with appropriate supporting documentation. * Prepares monthly invoices for Alameda and San Francisco Medi-Cal. * Monthly preparation of HCFA forms for OHC billings. Key Qualifications: * BA/BS degree preferred * Minimum one year of experience with Microsoft Office applications - Excel and Word * At least one year of experience with Google Suite * Professional experience in an office setting * At least one year of experience with Medi-Cal billing procedures and processes is preferred. Competencies (Skills, Abilities, and Knowledge): * Ability to work independently and collaboratively as part of a team * Strong ability to prioritize projects with competing deadlines * Knowledge of issues of race, class, and ethnicity and experience working with diverse communities * Solid understanding of processing Medi-Cal services and claims * Experienced and knowledgeable with EHR systems; preferred experience with Smart Care, EPIC and/or Welligent EHR systems * Excellent interpersonal, communication, and writing skills * Knowledge of MS Office Suite including Excel, PowerPoint, Google Calendar, and Google Mail on a Mac OS platform Benefits: * Employer-paid Medical Benefits for Employees * 100% employer-paid dental and vision * Dependent medical, dental and vision (50% employer-paid) * Medical and Dependent Care FSA and commuter plans * 100% employer-paid life insurance long-term disability insurance * Voluntary accident, term life and hospital indemnity insurance * Annual incentive compensation (10% per year) * 403(b) and ROTH retirement plan options, employer contribution targeted at 7.5% after first year of employment * Three weeks PTO during the first year of employment, 4+ weeks PTO with additional years of service * 12 paid holidays plus one paid floating holiday per year * 4 paid self-care days per year * Wellness stipend ($100.00 per month) * Employee Assistance Program (EAP) Join us and make a difference in the lives of vulnerable children and families in the Bay Area. WCC is passionate about leading and encouraging open conversations around race, gender, power, and privilege and how these impact community mental health. We are an equal opportunity employer. We are committed to diminishing the influence of privilege and discrimination in our field and our workplace, whether due to differences concerning age, citizenship, color, disability, marital or parental status, race, religion, gender, or sexual orientation.

WestCoast Children's Clinic, located in Oakland, California, is a non-profit community psychology clinic that provides mental health services to Bay Area children, youth and families. Working at WestCoast Children's Clinic means being part of an organization that is client-centered, trauma-informed, collaborative, and committed to justice and equity. Position Details Title: Medi-Cal Claims Billing Specialist Classification: Full time (1.0 FTE) Non-Exempt (Hourly), 40 hours per week Location: Oakland, CA / Hybrid (In-person for first 90 days) Regular Work Schedule: Monday - Friday Compensation: Hourly range: $26.00-$28.00 per hour The Medi-Cal Claims Billing Specialist will hold the crucial responsibility of inputting claims and corrections with precision and timeliness. Additionally, this role involves the monthly reconciliation of data between external and internal Electronic Health Record (EHR) systems. We are seeking an individual who is not only detail-oriented, but also embraces the opportunity to contribute to the seamless integration and accuracy of our healthcare data. Responsibilities: Generate billing reports from Welligent (WestCoast's internal EHR) and input claims data into Alameda County's EHR (Smart Care) and upload services to the City and County San Francisco EHR (EPIC). Collaborate with providers, supervisors, and county staff to complete billing process to correct claims. Reconcile monthly claims generated from Smart Care and EPIC systems to internally generated reports. Prepare and submit Correction Claim Reports for Alameda and San Francisco with appropriate supporting documentation. Prepares monthly invoices for Alameda and San Francisco Medi-Cal. Monthly preparation of HCFA forms for OHC billings. Key Qualifications: BA/BS degree preferred Minimum one year of experience with Microsoft Office applications - Excel and Word At least one year of experience with Google Suite Professional experience in an office setting At least one year of experience with Medi-Cal billing procedures and processes is preferred. Competencies (Skills, Abilities, and Knowledge): Ability to work independently and collaboratively as part of a team Strong ability to prioritize projects with competing deadlines Knowledge of issues of race, class, and ethnicity and experience working with diverse communities Solid understanding of processing Medi-Cal services and claims Experienced and knowledgeable with EHR systems; preferred experience with Smart Care, EPIC and/or Welligent EHR systems Excellent interpersonal, communication, and writing skills Knowledge of MS Office Suite including Excel, PowerPoint, Google Calendar, and Google Mail on a Mac OS platform Benefits: Employer-paid Medical Benefits for Employees 100% employer-paid dental and vision Dependent medical, dental and vision (50% employer-paid) Medical and Dependent Care FSA and commuter plans 100% employer-paid life insurance long-term disability insurance Voluntary accident, term life and hospital indemnity insurance Annual incentive compensation (10% per year) 403(b) and ROTH retirement plan options, employer contribution targeted at 7.5% after first year of employment Three weeks PTO during the first year of employment, 4+ weeks PTO with additional years of service 12 paid holidays plus one paid floating holiday per year 4 paid self-care days per year Wellness stipend ($100.00 per month) Employee Assistance Program (EAP) Join us and make a difference in the lives of vulnerable children and families in the Bay Area. WCC is passionate about leading and encouraging open conversations around race, gender, power, and privilege and how these impact community mental health. We are an equal opportunity employer. We are committed to diminishing the influence of privilege and discrimination in our field and our workplace, whether due to differences concerning age, citizenship, color, disability, marital or parental status, race, religion, gender, or sexual orientation.

Job Description About Us PACE Southeast Michigan is a unique health plan and comprehensive care provider, committed to keeping chronically ill aging adults in their home, by caring for their medical, psychosocial and spiritual needs. Join a mission-driven team that's changing lives every day - helping seniors age with dignity, purpose, and joy. About the Role Under the supervision of the Finance Manager, the PACE Southeast Michigan (PACE SEMI) Claims Specialist is responsible for performing a variety of functions related to processing and analyzing medical claims. Primary Functions: • Process all medical claims according to vendor contracts, Medicare/Medicaid guidelines, and internal authorizations. • Manage the collection and submission of risk adjustment and encounter data to Medicare. • Analyze, maintain, and update computer programs to provide accurate financial data to various departments. • Keep abreast of governmental regulations pertaining to Medicare/Medicaid reimbursement. • Perform other duties as assigned. Knowledge, Skills, and Abilities: • Bachelor's degree in healthcare administration. • In lieu of degree, 3-5 years of medical claims processing experience will be considered. • Basic knowledge of computer programming to learn PACE SEMI's financial system and understand complex governmental regulations. • Visual ability required for analyzing reports, contracts, and other documents. • Manual dexterity requires preparing and tabulating data and drafting reports • Must meet or exceed core customer service responsibilities, standards, and behaviors, including: o Communication o Ownership o Confidentiality o Understanding o Motivation o Sensitivity o Excellence o Teamwork o Respect • Self-directed, flexible, and committed to the team concept. • Demonstrated teamwork, initiative, and willingness to learn. • Maintains customer service skills as provided through ongoing training and in-services. • Completes all annual mandatory in-service trainings and screenings, including but not limited to infection control, TB testing, flu shot, emergency preparedness, HIPAA, ergonomics, and participant rights. • Possesses the ability to establish and maintain effective interpersonal relationships. Working Conditions: • Office setting with possible local travel to other PACE centers. • Normal office environment with minimal exposure to noise, dust, or extreme temperatures.

The Manager of Patient Liability will oversee self-pay AR for Huntsville Hospital Health System and will develop/implement policies or initiatives that support increased patient collections, reduction of refunds and decreased bad debt. The Manager will assure hospital compliance with the Affordable Care Act and its regulations pertaining to our business. This leadership role is responsible for the leadership and direction of approximately 15 direct staff member Qualifications Education: Bachelors Degree in Business or related field required. Equivalent work experience may substitute degree requirement Experience: Must have 3-5 years of acute care hospital or health system experience. Must have at least 5 years of leadership/management experience in a healthcare facility. Experience in healthcare provider finance operations or similar service environment required. Strong communication, organizational, interpersonal and customer service skills required Financial and project management experience needed Additional Skills/Abilities: Ability to communicate effectively, verbally and written Excellent communication skills and exhibits diplomacy and time management skills. Must be proficient in using Microsoft Word and Excel Experience with Microsoft Publisher, PowerPoint and Access preferred. About Us Highlights of our hospitals Huntsville Hospital was recently named Best Regional Hospital and #2 in Alabama by U.S. News & World Report. With 971 beds, a specialized Orthopedic & Spine Tower, a Level III Regional Neonatal ICU, and the largest Emergency Department and Level 1 Trauma Center in the state with our own specialized Red Shirt Trauma Program, there are many opportunities to apply your knowledge and skills. We are a certified Primary Stroke Center and named "One of the Top 100 Hospitals in the Nation with Great Heart Programs." From six cath labs and four EP labs to multiple medical and step-down units, you can continually grow your skillset! We offer a training center on campus for continuing education, Shared Governance Program, Clinical Ladder for professional development, The Daisy Award, and if you are a new grad, a Nurse Residency Program to help you transition from student to professional nurse. We care about you and your well-being by offering an excellent benefits package, childcare, health and wellness programs, an onsite employee pharmacy, a free health clinic, tuition assistance, and much more. We are committed to creating a diverse environment and proud to be an equal opportunity employer. We are a partner to the U.S. Army's Partnership for Your Success (PaYS) program. Ask us about incentives and additional opportunities. Huntsville Hospital Benefits: We are committed to providing competitive benefits. Our benefits package for eligible employees includes medical, dental, vision, life insurance, flexible spending; short term and long term disability; several retirement account options with 401K organization match; nurse residency program; tuition assistance; student loan reimbursement; On-site training and education opportunities; Employee Discounts to phone providers, local restaurants, tickets to shows, apartment application and much more! Learn more about Huntsville Hospital Health System: Careers: ************************************** Benefits: **************************************** Education & Professional Development: ******************************************** Life In Huntsville: ******************************************************

JOB TITLE Claims Specialist Responsible for follow-up of all third-party claims to assure maximum reimbursement for services rendered by Frontier Health staff. Must exercise sound judgment, demonstrate initiative, develop and maintain good working relationships with all corporation staff and clients. EDUCATION AND EXPERIENCE: Education: High School Diploma/GED required. Licensure: N/A Certification: N/A Experience: Medical billing experience preferred. Knowledge/Skills: ICD-10, CPT, DSM-V, and HCPCS coding knowledge. Excellent verbal/written communication skills. Skilled in use of all major computer applications, especially Excel. Able to work independently and as a team player. EQUIPMENT: Computer, fax, copier, calculator and any other equipment required to perform the functions of the position. MAJOR DUTIES AND RESPONSIBILITIES: 1. Responsible for follow-up of all third-party claims in a timely fashion. 2. Assures guidelines and billing procedures are followed. 3. Identifies problem accounts and works with Utilization Management to maximize revenue. 4. Responsible for re-billing appropriate charges to the next responsible funding source. 5. Must obtain and maintain knowledge of all collection policies and procedures. 6. Must obtain and maintain knowledge of all services rendered by the agency and the liability of each third-party contract. 7. Must have or obtain working knowledge of CPT coding, revenue coding, HCPCS coding, DSM-V, and ICD-10 coding. 8. Attend and participate in regularly scheduled staff meetings and in-services and individual program planning staffings as needed. 9. Maintains records and prepares reports related to Accounts Receivable follow-up for applicable payors. 10. Responds to questions, telephone calls and letters for follow-up of accounts and documents as necessary. 11. Works with supervisor or other team members 12. All other duties as assigned. PERFORMANCE RESPONSIBILITIES: Although each position has its own unique duties and responsibilities, the following listing applies to every employee. All employees of the organization are expected to: 1. Support the organization's mission, vision, and values of excellence and competence, collaboration, innovation, commitment to our community, and accountability and ownership. 2. Exercise necessary cost control measures. 3. Maintain positive internal and external customer service relationships. 4. Demonstrate effective communication skills by conveying necessary information accurately, listening effectively and asking questions when clarification is needed. 5. Plan and organize work effectively and ensure its completion. 6. Demonstrate reliability by arriving to work on time and utilizing effective time management. 7. Meet all productivity requirements. 8. Demonstrate team behavior and must be willing to promote a team-oriented environment. 9. Represent the organization professionally at all times. 10. Demonstrate initiative and strive to continually improve processes and relationships. 11. Follow all Frontier Health rules, policies and procedures as well as any applicable laws and standards.