Billing Specialist jobs at Emergency Ambulance Service

The Patient Financial Representative is responsible for the accurate and timely verification of insurance and benefit information for patients receiving inpatient medical, inpatient psychiatric, observation, ambulatory surgery and/or outpatient procedure related services. Plays a key role in the organization's financial health by obtaining or ensuring that insurance authorizations or pre-authorizations are on file and accurate prior to the service being rendered. This position must also ensure patient demographic and insurance information is correct, resulting in accurate claims for reimbursement. Position provides excellent customer service during all interactions. Core Job Responsibilities For designated services, this position is responsible for ensuring that each patient account has accurate insurance information entered in the correct billing order and that each insurance listed has been verified as eligible for the designated date of service range. For each insurance, benefit information is obtained and documented. Verification and benefit information can be obtained via electronic or verbal method but must be completed prior to services being rendered. Position must have or develop excellent working rapport with surgeons' office staff, as well as hospital nursing staff. For pre-scheduled services, this position is responsible for verifying that authorization is on file with each of the appropriate insurance companies and that authorization is accurate based upon location, CPT code, service type, surgeon, date range and any or all other necessary elements to secure payment for services rendered. For emergent or urgent services, this position is responsible for accurately and timely requesting that each verified insurance company has been notified of patient services being rendered and also request authorization for requested services. Position must have or develop excellent working rapport with insurance company representatives, surgeons' office staff, as well as hospital nursing staff. Ensures each patient account has accurate insurance information entered in the correct billing order and that each insurance company listed has been verified as eligible for the designated date of service range. Secures and documents any and all authorization requirements in appropriate computer systems with relevant information to capture authorization timely. Enters pertinent information in all necessary systems. Retains any written documents received. Performs related duties as assigned. Education/Experience Requirements REQUIRED: High school diploma or equivalent. Minimum 3 years of pre-authorization and/or insurance verification experience. Demonstrated computer proficiency and ability to learn new applications rapidly. Strong documentation skills. Strong follow up skills, accuracy and attention to detail. Excellent customer service and interpersonal skills. Ability to work under restrictive time. PREFERRED: Associate's degree in healthcare related field. 4 years or more of hospital, medical office, coding or billing experience; or 6 years of experience in other healthcare related field. Proficient with EMR, QES, MIDAS, SIS and related computer programs. Licensure/Certification Requirements PREFERRED: Medical terminology certification. Disclaimer Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability. Successful candidates might be required to undergo a background verification with an external vendor. Job Details Req Id 95876 Department PATIENT ACCESS SVCS Shift Days Shift Hours Worked 8.00 FTE 0.19 Work Schedule HRLY NON-UNION Employee Status A7 - Occasional Union Non-Union Pay Range $19 - $25/Hourly #Evergreen

(Mon,Tue,Wed,Thu,Fri-08:00 AM - 04:00 PM ) New York City Health and Hospitals Corporation Outposted Therapeutic Housing Units Program (OTxHU) Since 2016, Correctional Health Services (CHS) has been the direct provider of health care in the New York City jails. Deeply committed to human dignity and patient rights, CHS is part of the NYC Health + Hospitals system and is a key partner in the City's efforts to reform the criminal-legal system. Our in-jail clinical services include medical, nursing, and mental health care; pharmacy services; substance-use treatment; social work; dental and vision care; discharge planning; and reentry support. Given the high visibility of this initiative, we are seeking the highest caliber health care professionals in key clinical services to staff our Outposted Therapeutic Housing Units (OTxHU). To be located in three NYC Health + Hospital acute care facilities, the OTxHU is a pioneering approach to safely increasing access to high quality clinical care for patients in custody who have complicated health conditions. OTxHUs will bridge the gap in the continuum between care provided in the jails and inpatient hospitalization, with admission to and discharge from the OTxHU in accordance with a patient's clinical needs. CHS will be the primary health care providers on these units and the NYC Department of Correction will provide security and custody management. The OTxHU at NYC Health + Hospitals/Bellevue in Manhattan will be the first of this unique, groundbreaking project to open with a planned completion date as early as the end of 2024. This is an incredible opportunity to be part of a passionate and motivated team providing care to some of the City's most marginalized, vulnerable people. *To help support continuity of operations and care, staff selected to work in the OTxHU may also be required to work in CHS locations within the jails. Additionally, while CHS seeks the most qualified individuals for these positions, preference will be given to equally qualified, internal candidates. Position Overview Under supervision of the Site Medical Director, the Physician will provide comprehensive, compassionate, and thoughtful care to patients with complex chronic disease in the New York City jail system. The Physician will be part of a core interdisciplinary team working in a unique environment delivering the care to patients with significant chronic illnesses. The Physician will provide general primary care including conducting histories and physicals, diagnosing and treating acute and chronic illnesses, and evaluating the need for consult services. The interdisciplinary team will work under supervision of a Site Medical Director. Responsibilities include: Diagnose and treat acute and chronic illnesses. Evaluate the need for consult services and submit the prioritized consult when indicated. Complete comprehensive histories and physicals on all new admissions including documentation of problem list, diagnosis, orders (e.g. labs, imaging and referrals) and ordering appropriate medications where applicable. Evaluate patients requesting sick call, schedule follow-ups and update medication orders. Update problem lists and reconcile patient orders at all visits. Implement plans for patientcare utilizing protocols approved by the medical leadership and/or treatment plans reflecting the current standard of care. Request radiology exams, lab tests, EKGs when clinically indicated and interpret these results based on clinical findings and in consultation with supervisors where appropriate. Collaborate closely with CHS Physician Assistants, including providing clinical guidance, cosigning notes, and providing other supervision based on clinical circumstance and PA requirements. Review all specialty consults and hospital returns to ensure that the standard of care is met and recommendations of the consultant are implemented. Perform chart reviews and summaries for patients transferring facilities including updating problem lists, rewriting medication orders, and reconciling orders and consults as needed. Generate special needs referrals and documentation as needed (for patients with (disabilities, dietary restrictions, heat sensitivity, or other relevant flags). Teach patients about their medical conditions and treatments; counsel on risks and benefits of different treatment decisions; witness, sign, and document patient refusals of care. Ensure that all progress notes and orders are signed before the end of the shift. Respond to emergencies in a timely and professional manner. Notify the appropriate parties, including Urgicare, about 3-hour runs and EMS activation. Complete special housing rounds when assigned. Be familiar with quality of care and population health indicators. Take appropriate action to meet or exceed standards. Maintain clinical competency by participating in all CME and CHS training and in-service requirements. Maintain your schedule as directed with particular attention to punctuality and timely notification of absences. Adhere to policies and procedures of CHS and be familiar with them by reviewing them as needed. Complete tasks as delegated by a Site Medical Director or other supervising clinical team member. Maintain all required credentials. Maintain current licensure and CME requirements (Appropriate documentation must be on our files). Maintain professional attitude and appearance. Adhere to Occupational Health Services requirements. Departmental Preferences Three to five years' work experience, which may include residency in a directly related medical specialty Experience working with patients in a skilled nursing facility or other residential setting Experience working with patients who have serious mental illness Experience working with patients who carry substance use diagnoses; knowledge of harm reduction approaches to care; and familiarity with medications to treat opioid use disorder Experience leading quality improvement initiatives Understanding of trauma-informed care Skilled in patient-centered shared decision making Skilled in communicating risks and benefits of clinical interventions and assessing capacity to make informed decisions. Completion of residency in internal medicine, family medicine or other primary care-oriented specialty. Compliance with appropriate Maintenance of Certification requirements or other Board Certification requirements. Excellent interpersonal communication skills and ability to work collaboratively within a multidisciplinary team, as well as with NYC DOC staff Flexible disposition Minimum Qualifications: 1. Graduation from an approved medical school. 2. Completion of approved residency or fellowship in the specialty or sub-specialty and Board eligible or certified or Subboard eligible or certified. 3. Five years experience in field of specialty or subspecialty acceptable to the Medical Board of the Hospital. 4. Licensed to practice medicine in the State of New York.

The Patient Experience Representative influences the systems, processes and behaviors that cultivate positive experiences across the continuum of care. They have an unwavering commitment to the field of patient experience and to transforming human experience in healthcare. Experience: Minimum 3 Years' Experience In a Healthcare Setting Required. Education, License & Certification: Associate degree preferred or 5 years direct experience in a role of advocate in healthcare setting. Registered Nurse or other Healthcare related licensure preferred. Certified Patient Experience Professional (CPXP) required, or within 3.5 years of hire. Essential Functions: Advocates for the needs of our patients and their representatives in a proactive, inclusive, empathetic, and positive manner. Supports organizational learning and a holistic approach to our patient's needs. Provides guidance for new or inexperienced caregivers related to patient-service recovery. Collaborates with all caregivers to improve processes that directly impact patient and community perception. Oversees the internal system for managing patient/representative concerns and maintains applicable regulatory body compliance. Provides data analysis to identify trends specific to patient experience and develops corrective action plans based on those trends. Actively participates on or leads workgroups or committees related to patient advocacy. Supports the design and innovation of the Patient Family Advisory Council. Works collaboratively with the Patient Safety and Legal Departments. Other Duties: Travel for this position is sometimes required. It is understood that this description is not intended to be all‐inclusive and that other duties may be assigned as necessary in the performance of this position. update 1-13-25 About Us Joining the Guthrie team allows you to become a part of a tradition of excellence in health care. In all areas and at all levels of Guthrie, you'll find staff members who have committed themselves to serving the community. The Guthrie Clinic is an Equal Opportunity Employer. The Guthrie Clinic is a non-profit, integrated, practicing physician-led organization in the Twin Tiers of New York and Pennsylvania. Our multi-specialty group practice of more than 500 physicians and 302 advanced practice providers offers 47 specialties through a regional office network providing primary and specialty care in 22 communities. Guthrie Medical Education Programs include General Surgery, Internal Medicine, Emergency Medicine, Family Medicine, Anesthesiology and Orthopedic Surgery Residency, as well as Cardiovascular, Gastroenterology and Pulmonary Critical Care Fellowship programs. Guthrie is also a clinical campus for the Geisinger Commonwealth School of Medicine.

The Aspen Group (TAG) is one of the largest and most trusted retail healthcare business support organizations in the U.S. and has supported over 20,000 healthcare professionals and team members with close to 1,500 health and wellness offices across 50 states in four distinct categories: dental care, urgent care, medical aesthetics, and animal health. Working in partnership with independent practice owners and clinicians, the team is united by a single purpose: to prove that healthcare can be better and smarter for everyone. TAG provides a comprehensive suite of centralized business support services that power the impact of five consumer-facing businesses: Aspen Dental, ClearChoice Dental Implant Centers, WellNow Urgent Care, Chapter Aesthetic Studio, and AZPetVet. Each brand has access to a deep community of experts, tools and resources to grow their practices, and an unwavering commitment to delivering high-quality consumer healthcare experiences at scale. As a reflection of our current needs and planned growth we are very pleased to offer a new opportunity to join our dedicated team as Credentialing Specialist . Job Summary: The Credentialing Specialist plays a vital role within our Insurance Operations Team. This position will be responsible for ensuring the expeditious procurement of provider licenses and credentialing documents. Successful candidates will have excellent time management and communication skills. The position will report to and maintain full support of the Credentialing Manager. Essential Responsibilities: Execute licensure and credentialing processes for new and existing providers including but not limited to obtaining or requesting required documentation from various third-party sources and regular communication with appropriate state board representatives and the Field Management Team Source and maintain up-to-date information regarding all new and existing state and federal requirements as they pertain to professional licensing and credentialing requirements, processes, schedules, etc. Report licensure and credentialing expiration dates and renewal requirements to the providers as well as the appropriate members of the Field Operations Management Team, Compliance & Risk Management, etc. Work closely with the enrollment team to ensure proper processing of Provider credentials for enrollment in various dental plans Perform other clerical and administrative responsibilities as assigned Position requirements: High School Diploma or equivalent, College Degree preferred 1-2 years years credentialing experience required Excellent verbal & written communications & customer service skills Excellent time management, prioritization, and organizational skills a must Detail oriented with a strong analytical, and problem-solving skills Proficient use of Microsoft Office Suite Pay rate: $23 ~ $25 / hr.

The Insurance Eligibility Coordinator is responsible for verifying patient insurance coverage, ensuring accurate benefit information, and supporting efficient revenue cycle operations. This role works closely with patients, insurance carriers, clinical staff, and billing teams to confirm eligibility, resolve coverage discrepancies, and help prevent claims denials. Essential Functions: Verify patient insurance eligibility and benefits using electronic systems, payer portals, and direct insurance carrier communication. Accurate document coverage details, copayments, deductibles, prior authorization requirements, and plan limitations. Prepare and submit claims in a timely and accurate manner. Obtain Authorizations as required. Identify and correct rejected claims for prompt resubmission Submit and follow up on authorization requests. Follow up on denied or unpaid claims and work to resolve discrepancies. Post payments and adjustments to patient accounts in a timely manner. Communicate with insurance companies and internal staff regarding billing inquiries or issues. Maintain up-to-date knowledge of payer rules, policy changes, and medical coverage guidelines. Protect patient privacy and maintain compliance with HIPAA and organizational standards. Support revenue cycle improvement initiatives related to eligibility and insurance workflows. Participate in team meetings and contribute to quality improvement initiatives. Adhere to practice policies, procedures, and protocols including confidentiality. Other tasks as assigned. Travel: 100% Remote Supervisory Responsibilities: N/A Qualities & Skills: Strong understanding of insurance plans, terminology, HMOs, PPOs, Medicare/Medicaid and commercial payer policies in NJ, NY, & PA. Excellent communication, customer service, and problem-solving skills. Proficiency with medical practice management software, EHR systems, and payer portals. Ability to multitask and work in a fast-paced environment. Strong Knowledge of Microsoft Office Suite. Comfortable working independently and collaboratively. Outstanding problem solver and analytical thinking skills. Attention to detail and ability to prioritize. Ability to maintain confidentiality. Experience in Behavioral health is preferred. Education & Experience: High School diploma or equivalent required. 1-2 years of experience in medical insurance verification, medical billing, or related roles Compensation details: 20-24 Hourly Wage PI4bd1ff***********2-39233634

Agilent is seeking a proactive and detail-oriented Federal Government Billing Specialist to join our Customer Operations Center (COpC). This position plays a key role in supporting the Order Management process by ensuring accurate and compliant billing for federal contracts. The ideal candidate will manage complex invoices in accordance with FAR, DFARS, CAS, and other agency-specific billing requirements, while maintaining operational excellence and compliance across all transactions. Working within the COpC, this role partners closely with cross-functional teams across Agilent, including Credit and Collections, Revenue team, Sales and other COpC teams, to ensure timely and compliant billing. The Specialist will also support internal and external audits, uphold high standards of data accuracy, and contribute to continuous improvement initiatives within the Customer Operations Center. Key Responsibilities Prepare and submit invoices via federal platforms (WAWF, IPP, Tungsten, etc.). Review contract terms and funding modifications for billing accuracy. Monitor unbilled receivables and resolve holds or rejections. Collaborate with Contracts, Project Management, Accounting, and other COpC teams. Maintain billing documentation and support audits (DCAA, DCMA). Assist with month-end close activities and revenue reconciliation. Ensure compliance with federal regulations and company policies. Provide excellent customer service to government agencies and internal teams. Manage portal invoicing based on agency-specific requirements to prevent rework and ensure timely payment. Act as liaison with the collections team to resolve issues and ensure billing integrity. Additional Information This is a complex role requiring adaptability, attention to detail, and a customer-focused mindset. You'll thrive in a fast-paced, diverse environment where ownership and collaboration are key. Schedule: Flexibility required; occasional overtime and late hours on the last working day of each month Qualifications Required Qualifications Associate's or Bachelor's degree in Accounting, Finance, or related field (or equivalent experience). 2+ years of experience in federal billing or government contract accounting. Familiarity with FAR/DFARS and federal audit processes. Proficiency in Microsoft Excel and ERP systems (SAP, Oracle, Deltek). Strong communication, organizational, and time management skills. Ability to work independently and manage multiple priorities. Preferred Qualifications Experience with DCAA-compliant accounting systems. Knowledge of indirect rate structures and cost allocations. Prior experience in a government contractor environment. SAP/CRM experience. Proficiency in Microsoft Office Suite (Outlook, Excel, Word, PowerPoint, OneNote). Additional Details This job has a full time weekly schedule. It includes the option to work remotely. Applications for this job will be accepted until at least November 10, 2025 or until the job is no longer posted.The full-time equivalent pay range for this position is $28.27 - $44.17/hr plus eligibility for bonus, stock and benefits. Our pay ranges are determined by role, level, and location. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training. During the hiring process, a recruiter can share more about the specific pay range for a preferred location. Pay and benefit information by country are available at: ************************************* Agilent Technologies, Inc. is an Equal Employment Opportunity and merit-based employer that values individuals of all backgrounds at all levels. All individuals, regardless of personal characteristics, are encouraged to apply. All qualified applicants will receive consideration for employment without regard to sex, pregnancy, race, religion or religious creed, color, gender, gender identity, gender expression, national origin, ancestry, physical or mental disability, medical condition, genetic information, marital status, registered domestic partner status, age, sexual orientation, military or veteran status, protected veteran status, or any other basis protected by federal, state, local law, ordinance, or regulation and will not be discriminated against on these bases. Agilent Technologies, Inc., is committed to creating and maintaining an inclusive in the workplace where everyone is welcome, and strives to support candidates with disabilities. If you have a disability and need assistance with any part of the application or interview process or have questions about workplace accessibility, please email job_******************* or contact ***************. For more information about equal employment opportunity protections, please visit *************************************** Required: NoShift: DayDuration: No End DateJob Function: Customer Service

Remote Home Health Billing Specialist Pay: $18-$24 per hour, DOE Schedule: Full-time Please Note: Due to current hiring restraints, we are unable to hire candidates residing in Maine, New York, Massachusetts, Connecticut, New Hampshire, or Hawaii at this time. About the Role Puget Sound Home Health & Hospice is seeking an experienced Billing Specialist to join our growing team. This is a remote position with a strong preference for candidates familiar with Home Health (possibly Hospice) billing processes and experience using HCHB. If you are detail-oriented, thrive in a fast-paced environment, and have a passion for supporting quality patient care through accurate billing, we want to hear from you! Why Work With Us? Competitive Pay: $18-$24/hour, DOE Remote Work: Enjoy flexibility while supporting our mission Health Benefits: Medical, Dental, Vision first of the month following hire date Financial Benefits: FSA, HSA, 401K with match, voluntary insurance options Work-Life Balance: PTO, paid holidays, sick time Additional Perks: Tuition reimbursement, employee assistance program, company-wide celebrations, and more Supportive Culture: Inclusive team environment with room for growth Our Culture - How We Do What We Do We believe in creating an environment where employees feel valued, supported, and empowered to deliver exceptional care. Our approach is rooted in collaboration, respect, and continuous learning. Core Values: CAPLICO Customer Second (Employee First!) Accountability Passion for Learning Love One Another Intelligent Risk Taking Celebration Ownership Responsibilities Process Home Health (possibly Hospice) billing accurately and efficiently Ensure compliance with Medicare, Medicaid, and payer regulations Manage accounts receivable, collections, and aged accounts Submit claims and reconcile fiscal data following GAAP standards Prepare reports, including Medicare cost reports and bad debt summaries Collaborate with internal teams to resolve billing issues promptly Maintain accurate documentation and reporting for audits and compliance Follow up on claim denials and resubmissions Qualifications Minimum 3 years of Home Health (or Hospice) Agency billing experience with Medicare and Medicaid Home Care Home Base (HCHB) experience required Strong knowledge of payer contracts and government billing regulations Ability to work independently and meet deadlines in a remote setting Excellent communication and organizational skills Important Note If your resume does not clearly show the required experience, please include a cover letter or message explaining your background. Applications without this information will not be considered. To learn more about Puget Sound Home Health & Hospice, please visit our website at ************************ The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at ****************************

This is a Full Time REMOTE Position Compensation Range: $25.04 to $37.56 Benefits: Medical, Dental, Life, Retirement, Paid Time Off Non-exempt Supervisory-Specific Performance Expectations, Duties, and Responsibilities: N/A Position-Specific Performance Expectations, Duties, and Responsibilities: Process and submit health insurance claims to various insurance companies in a timely and accurate manner. Ensure claims are coded correctly in compliance with the latest medical coding and billing guidelines (CPT, ICD-10, HCPCS). Collaborate with the coding and clinical departments to resolve edits and denials. Maintain a working knowledge of Medicare and Medicaid as well as commercial payer guidelines, and stay abreast of new policy changes. Verify patient eligibility and coverage details before claim submission, and reconcile coverage denials when necessary. Resolve claim edits both in the electronic medical record and in the clearinghouse to prevent denials. Follow up with insurance companies regarding denied or underpaid claims, and submit appeals when appropriate. Review insurance and patient credit balances and resolve them timely. Educate patients on their billing inquiries, providing clear and accurate explanations regarding their insurance coverage and payment responsibilities. Document all actions taken with an account in the electronic medical record (EMR). Performs other duties as assigned. Organization-Specific Performance Expectations, Duties, and Responsibilities: Demonstrates 100% commitment to performance in accordance with the CHOICE values of MRH and representing the organization in a positive and professional manner. Establishes and maintains effective verbal and written communication and good working relationships with all patients, staff, and vendors. Adheres to MRH attire/dress code per policies and procedures. Utilizes initiative; strives to maintain a steady level of productivity; self-motivated; and manages activity and time. Completes annual education, training, in-service, and licensure/certification requirements; and attends departmental and organizational staff meetings or reads meeting minutes. Maintains patient confidentiality at all times. Reports to work on time as scheduled; completes work within designated timeframes. Actively participates in departmental and organizational performance improvement and continuous quality improvement activities. Strives to uphold regulatory requirements to ensure continual compliance with departmental, hospital, state, and federal regulations and policies. Follows policies and procedures for infection control, safety, and risk management to ensure a safe environment for patients, the public, and staff. QUALIFICATIONS: Minimum Requirements: Must be at least 16 years of age (21 for driving positions with a valid driver's license). Must be able to legally work in the United States. Must be able to pass a background check. Must be able to pass a drug screen and breath alcohol test (if applicable). Must complete employee health meeting. Required Education/Licensure/Certification: Medical billing or coding certification highly desired (CPC, CPB, RHIT, CCS, etc.). High School Diploma or equivalent, preferred. Experience: Two (2) years prior experience in medical billing, accounts receivable, or related field required (can substitute with a medical billing or coding certification (CPC, CPB, RHIT, CCS, etc.). Knowledge of UB-04 and CMS-1500 claim forms, preferred. Epic or similar EMR experience, preferred. Prior authorization process experience, preferred. Typing speed of a minimum of 30 WPM, preferred. Proficiency in Excel, preferred.

Job Description Burger Rehabilitation Systems, Inc. has provided therapy services since 1978. We seek a Billing Specialist to join our Customer Service Center team in a work from home full-time position, Monday through Friday, 8:00 a.m. to 5:00 p.m. with a one-hour lunch. We need someone to be local in the Sacramento, California, region. This position requires a high school diploma or GED equivalent, required 1-3 years successful experience in Physical Therapy billing and collections, competency of Rain Tree or EMR equivalent and full knowledge of current billing policies. Our team is solid and led by a popular Director. You may be required to come into the Folsom Office for training for a week or two, and rare, but possible, periodic Folsom meetings. Under the general direction of the Patient Services Director, this position will be responsible for the collection of assigned clinic receivables or financial class receivables, to be determined. Essential duties and responsibilities include the following. Other duties may be assigned. 1. Aggressively work aging's and follow through to complete resolution on all accounts. Be prepared to discuss or prepare listing of accounts over 90 days with explanations for the Patient Services Director's review. Work the highest dollar amounts first. 2. Review electronic claims denials daily to ensure timely collections. Review all paper claims prior to billing. 3. Run insurance bills including electronic claims as directed. 4. Bill secondaries and send appropriate paperwork as required for timely collections. 5. Research, reprocess and appeal claim denials and information requests. 6. Send/release statements timely as directed. 7. Prepare any needed account adjustments and non-contractual write offs for supervisor's approval. 8. Research and prepare patient refund requests on credit balances monthly and give to the Patient Services Director for review and payment. 9. Submit accounts for collections/letter service consideration to supervisor for approval. 10. Submit accounts for bad debt adjustment to supervisor for review. 11. Submit credit balances to supervisor for appropriate action by 12/31 of each year. 12. Monitor lien accounts and follow up needed in order to ensure lien limits are followed or resolved and accounts are resolved timely. Apply appropriate set-up and interest fees. 13. Assist patients in a professional and timely manner and refer any unresolved problem accounts to supervisor as needed. 14. Ensure accurate entry of all charges and patient data entry for Assisted Living billing, (if assigned). 15. Ensure complete and accurate entry of patient data in RT and TS per the deadlines set by the Patient Services Director including but not limited to the insurance, onset date for Medicare patients after charges are extracted and other pertinent information required for accurate billing and copayment collection. 16. Complete related work as assigned, including but not limited to charge entry as required. Compensation starts at $20.00 per hour. QUALIFICATION REQUIREMENTS: Ability to alphabetize and file efficiently, working knowledge of Microsoft EXCEL and WORD experience preferred. Ability to organize and type professional letters to customers as needed, ability to multi-task, must be able to perform 10-12 thousand key strokes per hour. EDUCATION and/or EXPERIENCE: High school diploma or GED equivalent. One - three years' experience plus successful experience in medical billing and collections required. Benefits include competitive compensation, direct deposit, employee assistance programs and may include: Retirement Benefits - 401(k) Plan Paid Time Off (PTO) Continuing Education Medical, Dental and Vision Legal Shield Life Insurance Long Term Disability Plans Voluntary Insurances ID Shield Nationwide Pet Insurance APPLY NOW: Click on the above link “Apply To This Job” Interested in hearing about other Job Opportunities? Contact a member of the Burger Recruiting Team today! P.************** F. ************ ******************** Our Mission Statement: We proudly acknowledge we are in business to provide rehabilitation services that make a POSITIVE difference in the lives of our patients, their families, our staff and the community at large.

Job Details Cotswold - Charlotte, NC Full Time High School Diploma / GED None Day Health Care The Billing Specialist I is responsible for incoming billing inquiries. This may include, but is not limited to, account research, payment posting and balancing, adjustments, collections, patient and insurance company phone calls and inquiries. ESSENTIAL DUTIES AND RESPONSIBILITIES: Answers telephone and emails promptly and courteously, responds to billing questions, following HEC policy for self-pay balances. Refers escalated inquiries to appropriate patient account representative. Corrects faulty information and advises supervisor of patterns or trends of errors noted. Uses available technology (Virtual Swipe, Electronic Checks, and Online) to offer patients immediate payment options and encourage timely payment of balances due. Understands the process of the “Token” number to encourage patients to sign in on the online portal for patient payments. Prepares requests for refunds or non-contractual adjustments for review by Refunds PAR or Business Services Manager. Ensures that all email and voice mail messages are handled on a daily basis. If the issue cannot be resolved on the same day, employee will notify parties involved about pending status. Processes/Research all returned mail to update the patient information in Nextgen in a timely manner for appropriate filing. Possesses a full understanding of patient accounts workflow, adheres to all processes and participates in improving departmental problems. Abides by the Collector on Call schedule and coordinates schedule with co-workers to maintain proper coverage for patient needs. Performs all necessary job functions related to new technological implementations. Has an understanding of Retina financial assistance. Obtains payments through the Chronic Disease portal, and faxes or mail claims to the other financial assistance programs such as Eylea Copay Card and Lucentis Copay Card. Answers billing correspondence received through lockbox and through patient portal. Research returned business office mailings for corrected addresses and updates demographics in system. POSITION REQUIREMENTS: Minimum Qualifications: High school diploma or equivalent One year of clerical medical office experience. Ability to understand explanations of benefits (EOBs). Preferred Qualifications: Experience in insurance billing. General knowledge of CPT and ICD coding. General knowledge of medical terminology

Pioneering trusted medical solutions to improve the lives we touch: Convatec is a global medical products and technologies company, focused on solutions for the management of chronic conditions, with leading positions in Advanced Wound Care, Ostomy Care, Continence Care, and Infusion Care. With more than 10,000 colleagues, we provide our products and services in around 90 countries, united by a promise to be forever caring. Our solutions provide a range of benefits, from infection prevention and protection of at-risk skin, to improved patient outcomes and reduced care costs. Convatec's revenues in 2024 were over $2 billion. The company is a constituent of the FTSE 100 Index (LSE:CTEC). To learn more please visit **************************** Summary Billing & Invoicing work is focused on designing and ensuring compliance with billing and invoicing processes including: •Information verification (e.g., ensure accuracy of billing information, negotiated terms and compliance with current legislation) •Monitoring customer accounts (e.g., ensure payments made on time, report on overdue accounts, etc.) •Resolving billing discrepancies (e.g., investigate and resolve billing & invoicing errors, recommend process improvements to avoid future errors, etc.) •May include collections activities Job Description Requires basic knowledge of job procedures and tools obtained through work experience and may require vocational or technical education. May require the following proficiency: • Works under moderate supervision. • Problems are typically of a routine nature but may at times require interpretation or deviation from standard procedures. • Communicates information that requires some explanation or interpretation. Key Responsibilities: Responsible for claim review and submission to Medicare, Medicaid, commercial and private insurance payers. Verifies accuracy and completeness of all required information prior to submission. Follows up with insurance companies on unpaid or rejected claims. Resolves issues and resubmits claims. Reads and interprets insurance explanation of benefits. Maintains specialized knowledge in insurance processes and guidelines, including authorizations and limitations. Investigates insurance claim denials, exceptions, or exclusions. Takes necessary action to resolve claim and payer issues in an effort to recover proper reimbursement. Provides customer service relating to all billing inquiries and complaints. Able to explain insurance processes, benefits, and exclusions. Follows HIPAA guidelines in handling customer information. Performs other billing duties as requested by the Billing Supervisor, Billing Manager, or Director of Billing. Qualifications/Education: Must have a high school diploma, college degree preferred, not required. Six months to one year of related experience and/or training; or equivalent combination of education and experience. Proficient in use of computers and software including, but not limited to: practice management software, word processing and spreadsheet applications. Detail oriented with ability to multi-task. Manages one's own time with minimal supervision. Strong mathematics and problem-solving skills. Seeks and shares pertinent information related to insurance or internal processes. Communicates effectively both verbally and in writing to convey and receive information. Use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. Self-evaluates performance to make improvements or take corrective action. Consider the relative costs and benefits of potential actions to choose the most appropriate one. Use equipment, facilities, and materials appropriately as needed to do certain work. This position must commit to 9 months in the role before applying for alternative roles within the organization. Exceptions must be approved by Department leadership. Physical Demands Regularly required to sit, stand, walk, and occasionally bend and move about the facility. Infrequent light physical effort required. Occasional lifting under 10 lbs. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Working Conditions Work performed in an office environment, Special Factors This role can be performed remotely. Beware of scams online or from individuals claiming to represent Convatec A formal recruitment process is required for all our opportunities prior to any offer of employment. This will include an interview confirmed by an official Convatec email address. If you receive a suspicious approach over social media, text message, email or phone call about recruitment at Convatec, do not disclose any personal information or pay any fees whatsoever. If you're unsure, please contact us at ********************. Equal opportunities Convatec provides equal employment opportunities for all current employees and applicants for employment. This policy means that no one will be discriminated against because of race, religion, creed, color, national origin, nationality, citizenship, ancestry, sex, age, marital status, physical or mental disability, affectional or sexual orientation, gender identity, military or veteran status, genetic predisposing characteristics or any other basis prohibited by law. Notice to Agency and Search Firm Representatives Convatec is not accepting unsolicited resumes from agencies and/or search firms for this job posting. Resumes submitted to any Convatec employee by a third party agency and/or search firm without a valid written and signed search agreement, will become the sole property of Convatec. No fee will be paid if a candidate is hired for this position as a result of an unsolicited agency or search firm referral. Thank you. Already a Convatec employee? If you are an active employee at Convatec, please do not apply here. Go to the Career Worklet on your Workday home page and View "Convatec Internal Career Site - Find Jobs". Thank you!

Castle Biosciences Earns "Top Workplaces USA Award" for Phoenix, Pittsburgh, and Friendswood! You won't find a work culture and benefits package like ours every day. Come join our team and a group of colleagues who love working at Castle! Learn more at ************************* Castle Biosciences Inc. is growing, and we are looking to hire a Pre-Billing Specialist (Eligibility) working remotely from your home office based in the USA, with a start date on or before January 16, 2026. Why Castle Biosciences? Total Compensation Package: * Salary Range: $40,000 - $42,000. Final salary is based on Experience and Education levels. * Excellent Annual Salary + 20% Bonus Potential * 20 Accrued PTO Days Annually * 10 Paid Holidays * 401K with 100% Company Match up to 6% * 3 Health Care Plan Options + Company HSA Contribution * Company Stock Grant Upon Hire * $75/month reimbursement for internet service A DAY IN THE LIFE OF A Pre-Billing Specialist (Eligibility) This individual will be responsible for assigning medical insurance plans and performing eligibility verification checks on new patient accounts entering the billing system. They will resolve eligibility issues by contacting providers and patients to obtain updated information, and will submit and follow up on assigned prior authorizations. This role will spend the most time assigning medical insurance plans, verifying eligibility, resolving issues, and managing prior authorization submissions and follow-ups. REQUIREMENTS * High school Diploma, GED, or equivalent work experience. * Minimum of two years of health insurance eligibility and prior authorization experience. * Experience collaborating with patients, providers, and insurance plans to complete the pre-billing process. * Experience researching and utilizing payor websites. * Certification in Medical Billing and/or Coding or equivalent experience. * Must demonstrate the ability to type 35 WPM with 90% or higher accuracy. TRAVEL REQUIREMENTS * SCHEDULE * Monday - Friday, 8:00 AM to 5:00 PM, non-exempt position, working remotely from your home office based in the USA. READY TO JOIN OUR BIOTECH TEAM? We truly appreciate your time. If this feels like the right opportunity for you, we'd love for you to complete our mobile-friendly application. We're excited to learn more about you and look forward to connecting soon! Castle Biosciences Awards and Research Developments! WORK AUTHORIZATION All candidates must be legally authorized to work in the United States. Currently, Castle Biosciences does not sponsor H-1B visas, OPT, or employment-related visas. ABOUT CASTLE BIOSCIENCES INC. At Castle Biosciences, people are at the heart of everything we do. Our mission is to improve health through innovative tests that guide patient care. We empower patients and clinicians to make more confident, personalized treatment decisions through rigorous science and clinically actionable solutions that help improve disease management and patient outcomes. Our impact starts with our team. Every individual at Castle plays a meaningful role in advancing patient care. We value integrity, trust and collaboration in all we do and are committed to fostering an environment where people can grow, thrive and make a lasting impact. Here, your work has purpose, your voice matters and together, we're shaping the future of precision medicine. Castle Biosciences is an equal opportunity employer as to all protected groups, including protected veterans and individuals with disabilities. If you have a disability and you believe you need a reasonable accommodation in order to search for a job opening or to submit an online application, please e-mail ReasonableAccommodationsRequest@castlebiosciences.com. This email was created exclusively to assist disabled job seekers whose disability prevents them from being able to apply online. Only messages left for this purpose will be returned. Messages left for other purposes, such as following up on an application or technical issues not related to a disability, will not receive a response. No third-party recruiters, please

Pacesetter Health is a leading growth partner for podiatry clinics throughout the country. The Company is actively partnering with growth-oriented independent podiatrists and podiatry groups across the United States. The company is backed by private equity investors. We would love for you to join our Revenue Cycle Management team in Nashville, TN! We offer a competitive base pay, eligibility for quarterly bonuses and an excellent benefits program. This position is eligible to work remotely. We are seeking Medical Billing Specialist to assist with filing medical claims, processing payments, resolving denials, and AR management. As a member of the RCM team, you will: Scrub claims to ensure that all diagnosis codes (ICD-10-CM) and procedure codes (CPT/HCPCS) meet coding standards and comply with coding guidelines and regulations Submit scrubbed claims to appropriate payers Post payments, AR management, review and resolve denials and inquiries Stay updated with the latest coding guidelines, regulations and industry changes Maintain confidentiality and adhere to HIPAA regulations Balance cash receipts report to all batch receipts daily Document all follow up efforts in a clear and concise manner into the AR system Initiate refunds if necessary Support RCM initiatives and relevant RCM efforts What you bring: 2 years of medical coding and billing experience required Knowledge of anatomy, physiology, and medical terminology EHR system experience Strong analytical and problem-solving skills Excellent attention to detail and highly organized Ability to work independently and in a team environment Effective communication skills, both written and verbal Ability to maintain benchmarks such as production and low error rate Benefits: Eligible to Work Remote Quarterly Bonus Program Health Insurance Dental & Vision Insurance Flexible Spending and HSA plans Life & Disability Insurance 401k with employer match Paid Time Off

Job Description The Teresian House is currently hiring. This opportunity is a Full Time Day position, working 8 am-4 pm! Thank you for considering Teresian House in your choice for employment! The Nursing Home Billing Specialist is responsible for: Timely insurance verification of all referrals for potential admission to the facility. Ensuring accurate and timely billing of all services rendered to residents in compliance with NYS Medicaid, Medicare, Mafae Care Organizations (MCO's) and private insurance. Preparing and submitting claims, resolving billing issues, managing accounts receivable, and working with families and third-party payers to ensure proper reimbursement. Verifying resident insurance eligibility and insurance coverage using Availity, Epaces and other electronic systems daily. Preparing and submitting timely billing for Medicare, MCO's, Medicaid and private insurers using electronic and payer formats. Monitor and manage outstanding balances and follow-up on unpaid claims. Communicating with families, residents and insurance companies regarding account status and unpaid claims. Maintaining up to date knowledge of Medicare, MCO and NYS Medicaid regulations and billing practices. Working with other departments to ensure accurate census date and payer sources are maintained. Assisting with audits and providing requested documentation for compliance and financial reviews. Maintain accurate and confidential billing records in accordance with HIPAA regulations. Qualifications: High School Diploma or GED required. Associate's Degree in Accounting, Business or related field experience preferred. 2+ years of billing experience in a skilled nursing facility (SNF) or healthcare setting Strong knowledge of Medicare Part A/B, MCO's, NYS Medicaid and commercial billing. Experience with billing software - Point Click Care Proficient in Excel and data entry Excellent communication and organizational skills Ability to manage multiple tasks and meet deadlines Knowledge of HIPAA regulations and healthcare confidentiality standards. Preferred Skills: Previous Nursing Home Billing experience. Knowledge of claims and experience resolving billing issues. Experience with SNF benefits specific to rehabilitation. Knowledge of NYS Medicaid application process. Do you want to join a team committed to enhancing the lives of our residents by providing optimal service in a homelike atmosphere? We invite you to join our team and reap the benefits of becoming part of the Teresian House family: Excellent starting pay rate with competitive and generous benefits Generous paid time off with cash-in options Cost-shared health, dental, and optical insurance with a significant employer paid share Opportunity for career pathways Retirement plan with employer match Free meal daily Fully paid group life insurance Employee Assistance Plan including individual counseling and referral to community services Tuition assistance and scholarships! Our mission is evident in the daily interactions our staff have with residents and their families. At Teresian House, we are truly "Where the spirit of love and dedication lives..."

Job Description Rome Health is seeking a full-time Billing Clerk for the daily review, validation and submission of claims, review and timely follow-up of denials, routine and timely ATB and credit balance review and follow-up. The successful candidate must be detail-oriented and committed to maintaining up-to-date payer knowledge and compliance requirements. The hours for this roll with be Monday - Friday 8:00 a.m. - 4:00 p.m. The Billing Clerk's duties will also include: POSITION RESPONSIBILITIES: Submitting or resubmitting claims in an accurate, efficient, and timely manner Reviewing and validating claims with errors in the electronic billing system on a daily basis. Working with follow-up and personal ticklers in an accurate, efficient, and timely manner. EDUCATION, TRAINING, EXPERIENCE, CERTIFICATION AND LICENSURE: High School diploma or GED. Medical billing experience. Typing, customer service.

JOB TITLE: 820 Billing Assistant - Part-Time REPORTS TO: Director of Revenue Cycle DEPARTMENT: Finance Our Mission: Since 1967, Odyssey House has been providing innovative services and programs to a broad population of individuals and families struggling with substance use and mental health disorders. Odyssey House helps New Yorkers of all ages-and across all five boroughs-beat drugs and alcohol with highly individualized treatment programs. Odyssey House provides high quality, holistic treatment impacting all major life spheres, including: psychological, physical, social, family, educational and spiritual in order to support personal rehabilitation, renewal and family restoration. If that sounds different than other treatment programs, you're right. Because Odyssey is where recovery gets real. In addition to competitive salaries, Odyssey House offers: A 35-hour work week (as opposed to a 40-hour work week) Vacation Plan and Holiday Schedule Life Insurance Medical Insurance (Two Plans) Dental and Vision Insurance Additional Insurance Coverages (hospitalization, accidental, critical illness coverage) Long-Term & Short-Term Disability Flexible Spending Account/Health Reimbursement Account 403(b) Plan Corporate Counseling Associates (CCA) EAP benefit Ability Assist Counseling Services (through The Hartford) Commuter Benefits Educational Assistance Programs Special shopping discounts through ADP Marketplace and PlumBenefits RUFit?! Fitness Program Legal Assistance through ARAG Optum Financial Service through ConnectYourCare Benefit Advocacy Center through Gallagher MAJOR FUNCTION: The 820 Billing Assistant is responsible for assisting billing team with collection of Managed Care Organization payments. SPECIFIC DUTIES & RESPONSIBILITIES: Reconcile client number of days stay between AWARDS and Census Reports Verify accuracy of clients' health insurance in AWARDS through ePaces Access real-time payer portals to verify accuracy in authorization ID entered in AWARDS Verify and confirm appropriate diagnosis and procedure coding as per clinical documentation Navigate payee websites/portals to keep track payments or denials Works closely with co-workers to analyze and identify issues Calling insurance companies to research the reason for denials Post payments in AWARDS database REQUIREMENTS: Excellent analytical, problem solving, and interpersonal and communication skills Proficiency in Microsoft Excel Must be able to work independently and with a team Odyssey House is an equal opportunity employer maintaining a non-discriminatory policy on hiring of its personnel. Odyssey House, and its operational divisions, will not discriminate against any employee or applicant because of race, creed, color, national origin, sex, disability, marital status, sexual orientation or citizen status in all employment decisions including but not limited to recruitment, hiring, upgrading, demotion, downgrading, transfer, training, rate of pay or other forms of compensation, layoff, termination and all other terms and conditions of employment.

is available upon request La versión de esta posición está disponible en Español si es requerida BHSN, one of the fastest growing organizations providing whole person care in the region, is in search of passionate individuals to join our rapidly growing team! Your role at BHSN: As a Billing Specialist, you will play a key role in optimizing financial transactions and systems. You'll be responsible for account reconciliation, communication with insurance companies, and continuous improvements to the revenue cycle. You'll support performance improvements, ensure accuracy in billing and reporting, and assist in staff training to uphold the highest standards in billing compliance. This role is vital to ensuring proper reimbursement and the financial health of the organization. What's in it for you? Generous benefits, including personalized health coverage, paid time off, and holiday pay Working within our community, making a real impact, working alongside passionate colleagues Accessible leadership team, coaching for your growth, and ample training opportunities As a rapidly growing organization, there are endless opportunities to grow within the organization Community discounts, loan forgiveness & more What your day might look like: Reviews and processes claims to ensure accuracy and completeness before submission to insurance companies Tracks the status of submitted claims and follows up on unpaid or denied claims Ensures compliance with the latest billing regulations and guidelines Updates billing systems with correct CPT/HCPCS codes to maintain accuracy Analyzes data related to uncompensated care and produces detailed reports Reviews and tracks payments to ensure accurate reimbursement according to Medicaid rates and insurance contracts Identifies bottlenecks in the revenue cycle and implements improvement strategies Provides training to staff on accurate and timely billing procedures Communicates with patients and insurance companies to resolve billing questions or issues Conducts regular billing audits and implements corrective actions as needed Your skills and qualifications: Associate's or Bachelor's degree in finance, accounting, or a related field strongly preferred 3-5 years of experience working with electronic health records, clearinghouses, and billing systems Strong computer skills, especially with Excel and data analytics tools Excellent written and verbal communication skills Ability to manage large volumes of data with a high level of accuracy Strong attention to detail to ensure correct claim processing and avoid errors EEO Statement: BHSN is an Equal Opportunity Employer, and supports Diversity, Equity, and Inclusion in its hiring and employment practices so that every team member can feel like they belong and be their authentic self to thrive in their personal and professional lives. In order to do that, all applicants will receive consideration for employment without regard to age, race (including traits historically associated with race, including but not limited to, hair texture and protective hairstyles), creed, color, national origin, sexual orientation, military status, sex, disability, genetic predisposition or carrier status, marital status, arrest record or status as a victim of domestic violence, familial status, gender/gender expression, reproductive health decisions, citizenship or immigration status or any other factor prohibited by law.

TITLE: Entitlement Medicaid Specialist (Part - Time) REPORTS TO: Director of Entitlements Our Mission: Since 1967, Odyssey House has been providing innovative services and programs to a broad population of individuals and families struggling with substance use and mental health disorders. Odyssey House helps New Yorkers of all ages-and across all five boroughs-beat drugs and alcohol with highly individualized treatment programs. Odyssey House provides high quality, holistic treatment impacting all major life spheres, including: psychological, physical, social, family, educational and spiritual in order to support personal rehabilitation, renewal and family restoration. If that sounds different than other treatment programs, you're right. Because Odyssey is where recovery gets real. In addition to competitive salaries, Odyssey House offers: A 35-hour work week (as opposed to a 40-hour work week) Vacation Plan and Holiday Schedule Life Insurance Medical Insurance (Two Plans) Dental and Vision Insurance Additional Insurance Coverages (hospitalization, accidental, critical illness coverage) Long-Term & Short-Term Disability Flexible Spending Account/Health Reimbursement Account 403(b) Plan Corporate Counseling Associates (CCA) EAP benefit Ability Assist Counseling Services (through The Hartford) Commuter Benefits Educational Assistance Programs Special shopping discounts through ADP Marketplace and PlumBenefits RUFit?! Fitness Program Legal Assistance through ARAG Optum Financial Service through ConnectYourCare Benefit Advocacy Center through Gallagher MAJOR FUNCTIONS: Maintain a working relationship with the Department of Social Service (DSS), Human Resources Administration (HRA), the Social Security Administration (SSA), Medicaid Office/Expedited and Marketplace to ensure Medicaid Managed Care guidelines, policies and procedures are followed to receive appropriate funding for 819 and Part 820 programs. SPECIFIC DUTIES & RESPONSIBILITIES: Conduct daily comprehensive review of consumers' interviews to determine eligible for Entitlements benefits, Medicaid Eligibility, Medicaid Managed Care, Medicare, Private Insurance coverage, Self-Pay Case conference difficult cases with the Director for guidance and support to ensure funding for 819 and Part 820 programs are obtained in a timely fashion Conduct interviews on new admissions for HRA/DSS/SSI/SSD/Self-Pay Expedite consumers with the selection of Managed Care Organization and NY State Market Place at point of admissions and upon Medicaid Eligibility Daily Data Entry of Medicaid/Managed Care/Medicare/Private Insurance/MAT in AWARDS and E-Lab Navigate Inovalon / eMedNY (Epaces) / STARS / SAAMS / AWARDS / Manage Care System Portals for coverage Communicate with consumers regarding insurance coverage, restrictions, and disenrollment (Medicaid/Managed Care, Medicare, and Private Insurance) Process Medicaid applications and recertifications for consumers through the Department of Social Services, NY State Exchange/Marketplace Investigate Medicaid issues related to County/deferral/eligibility/denials/dropped/ recertifications Identify consumers with Medical/Pharmacy/Out-Patient restrictions to complete MAP forms for the removal of restrictions Process enrollment/disenrollments MAP forms through the Managed Care System (MCS) and to the Medicaid Inspector General OMIG Resolve problematic Medicaid Managed Care issues for Part 820 coverage Daily update the Entitlement 820 Reports with consumers' Medicaid (Fee-For-Service) / Expedited /Managed Care/Medicare/Private Insurance/Undocumented Complete and submit bi-weekly 820 Medicaid Managed Care Reports Submit weekly Medicaid Manage Care Reports to reflect consumers' coverage for 5 Residential Programs to the Pharmacy, Medical and LabCorp Performs related or similar duties assigned by Director. REQUIREMENTS: High School / associate degree Experience with Medicaid Managed Care and Human Service Background with DSS/HRA benefits, Recertifications, Medicaid Managed Care, Expediting, enrollment and disenrollment Demonstrated effective communication, proficiency in Excel, computer skills, organization and multitasking skills Odyssey House is an equal opportunity employer maintaining a non-discriminatory policy on hiring of its personnel. Odyssey House, and its operational divisions, will not discriminate against any employee or applicant because of race, creed, color, national origin, sex, disability, marital status, sexual orientation or citizen status in all employment decisions including but not limited to recruitment, hiring, upgrading, demotion, downgrading, transfer, training, rate of pay or other forms of compensation, layoff, termination and all other terms and conditions of employment.

TITLE: Medicaid Specialist REPORTS TO: Director of Entitlements DEPARTMENT: Entitlements - 219 East 121st St. New York, NY 10035 Our Mission: Since 1967, Odyssey House has been providing innovative services and programs to a broad population of individuals and families struggling with substance use and mental health disorders. Odyssey House helps New Yorkers of all ages-and across all five boroughs-beat drugs and alcohol with highly individualized treatment programs. Odyssey House provides high quality, holistic treatment impacting all major life spheres, including: psychological, physical, social, family, educational and spiritual in order to support personal rehabilitation, renewal and family restoration. If that sounds different than other treatment programs, you're right. Because Odyssey is where recovery gets real. In addition to competitive salaries, Odyssey House offers: A 35-hour work week (as opposed to a 40-hour work week) Vacation Plan and Holiday Schedule Life Insurance Medical Insurance (Two Plans) Dental and Vision Insurance Additional Insurance Coverages (hospitalization, accidental, critical illness coverage) Long-Term & Short-Term Disability Flexible Spending Account/Health Reimbursement Account 403(b) Plan Corporate Counseling Associates (CCA) EAP benefit Ability Assist Counseling Services (through The Hartford) Commuter Benefits Educational Assistance Programs Special shopping discounts through ADP Marketplace and PlumBenefits RUFit?! Fitness Program Legal Assistance through ARAG Optum Financial Service through ConnectYourCare Benefit Advocacy Center through Gallagher MAJOR FUNCTIONS: Maintain a working relationship with the Department of Social Services/Medicaid Office/Expedited and Marketplace to ensure Medicaid Managed Care guidelines and policies and procedures are follow. SPECIFIC DUTIES & RESPONSIBILITIES: • Conduct a comprehensive review to determine eligibility for Medicaid and Managed Care for the 820 Programs • Daily Review of consumers' insurance verification and Medicaid Managed Care coverage • Communicate with consumers regarding insurance coverage, restrictions, and disenrollment (Medicaid/Managed Care, and Medicare) • Process Medicaid applications and recertifications for potential consumers through the Local Department of Social Services or the NY State Exchange/Marketplace • Investigate Medicaid issues related to eligibility, deferrals, denials and recertifications • Identify consumers with Medical and Pharmacy restrictions to complete MAP forms to the removal of restrictions • Process restrictions through the Managed Care System (MCS), Office of the Medicaid Inspector General (OMIG) • Resolve problematic Medicaid Managed Care and Department of Social Services issues • Navigate eMedNY (ePACES) / Managed Care Portals / Inovalon / STARS / AWARDS • Daily Data Entry of Medicaid Managed Care / Medicare / Private Insurance / MAT in AWARDS and E-Lab • Prepare weekly status of consumers' Medicaid Managed Care / Medicare / Private Insurance status and Expedite consumers with straight Medicaid coverage • Review weekly consumers' Medicaid Managed Care coverage and dropped coverage • Prepare biweekly Medicaid Manage Care Reports to reflect current coverage • Assist consumers with the selection of Managed Care and NY State Market Place • Performs related or similar duties assigned by Director. REQUIREMENTS: • Associate/BA Degree preferred • Experience with Medicaid and Managed Care and in Human Service Field • Minimum 2 years of experience in Medicaid, managed care plans, application process, recertifications and regulations • Demonstrated effective communication, proficient with Excel, computer skills, organization and multitasking Odyssey House is an equal opportunity employer maintaining a non-discriminatory policy on hiring of its personnel. Odyssey House, and its operational divisions, will not discriminate against any employee or applicant because of race, creed, color, national origin, sex, disability, marital status, sexual orientation or citizen status in all employment decisions including but not limited to recruitment, hiring, upgrading, demotion, downgrading, transfer, training, rate of pay or other forms of compensation, layoff, termination and all other terms and conditions of employment.