EnableComp jobs - 40 jobs

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM ™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers' Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient of the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years. Position Summary The Sr. Director, Clinical Denials, will serve as the primary clinical authority supporting clients with denial prevention, appeal strategy, payer policy compliance, and industry education. This role represents the vendor's clinical expertise and partners with provider clients to optimize revenue integrity, improve appeal outcomes, and reduce denial exposure. The Sr. Director, Clinical Denials, provides advanced consultative guidance, supports process design, mentors internal teams, and ensures delivery excellence in all clinical denial-related engagements.This role requires an experienced clinical professional with extensive inpatient experience, a proven record of collaboration with clinicians and payers, root cause research and identification of denial, and a deep understanding of payer behavior and regulatory requirements.Key Responsibilities Serve as the vendor's lead clinical subject matter expert on clinical denials management and prevention. Partner with provider clients to design and implement best practices for denial prevention and appeal workflows. Conduct complex clinical case reviews for DRG validation, identifying and defending clinically appropriate DRG assignments. Develop and refine clinical appeal strategies and templates to improve success rates. Analyze denial trends across multiple clients and provide actionable insights to reduce recurring clinical denials. Collaborate with coding, Clinical Documentation Integrity (CDI), and client operations teams to ensure consistency in methodologies and documentation practices. Support proposal and implementation teams by contributing clinical expertise to solution design and client onboarding. Maintain deep familiarity with Centers for Medicare & Medicaid Services (CMS) regulations, payer guidelines, and medical necessity criteria such as InterQual and MCG Health (formerly Milliman Care Guidelines). Represent the organization as a clinical expert in client meetings, audits, and appeal escalations. Represent EnableComp as an industry expert at national and regional conferences, networking opportunities, community outreach events, and client meetings. Serve as a spokesperson for the company through webinars, speaking engagements, panel discussions, and authored articles. Develop white papers, policy briefs, industry reports, and thought leadership content to elevate the organization's presence in the RCM and policy landscape. Engage with payers and provider networks to advocate for streamlined administrative processes, and enhanced reimbursement methodologies. Lead client education sessions and internal training programs on Medicare Severity Diagnosis Related Group (MS-DRG) and All Patient Refined Diagnosis Related Group (APR-DRG) validation, clinical documentation integrity, and payer policy application. Partner with the sales and client success teams to educate prospective and existing clients on EnableComp's services, value proposition, and regulatory insights. Provide in-depth RCM expertise in responding to RFPs, proposals, and client inquiries. Conduct training sessions and presentations on complex claims and industry trends for internal teams and clients. Requirements and Qualifications Bachelor's Degree Registered Nurse (RN) with at least 10 years of acute care clinical experience (ICU, Medical-Surgical, or similar). 5+ years of experience in clinical denials management or revenue integrity, with strong emphasis on DRG assignment and appeal writing. Excellent written communication and clinical reasoning skills for crafting persuasive appeals and client documentation. Strong knowledge of MS-DRG and APR-DRG methodologies, including Severity of Illness (SOI) and Risk of Mortality (ROM) classifications. Proficiency with CMS rules, payer contracts, and medical necessity guidelines (InterQual, MCG). Regular and predictable attendance. Equivalent combination of education and experience will be considered. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Special Considerations and Prerequisites Practices and adheres to EnableComp's Core Values, Vision and Mission. Executive-level professional presence with the ability to communicate clearly, confidently, and credibly in client-facing settings. Strong organizational skills with the ability to manage multiple priorities across complex client and internal environments. Willingness to learn, adapt, and model resilience in a dynamic, high-expectation environment. Experience working with or supporting multiple hospital or health system clients in a vendor, consulting, or outsourced revenue cycle capacity. Familiarity with Electronic Health Record (EHR) systems such as Epic, Cerner, or Meditech, and denials management platforms. Coding certifications such as Certified Clinical Documentation Specialist (CCDS), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC) preferred but not required if clinical and denial management expertise is extensive. EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment. EnableComp recruits, develops and retains the industry's top talent. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people. We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here. At EnableComp, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies. If you are looking for a company that values its employees and is dedicated to helping them achieve their full potential, then EnableComp is the place for you. Don't just take our word for it! Hear what our people are saying: “I love my job because everyone shares the same vision and is determined and dedicated. People care about you as a person and your professional growth. There is a genuine spirit of cooperation and shared goals all revolving around helping each other.” - Revenue Specialist “I enjoy working for EnableComp because of the Core Values we believe in. EnableComp stands true to these values from empowering employees to ecstatic clients. This company is family oriented and flexible, along with understanding the balance of work, life, and fun.” - Supervisor, Operations

The Medical Record Coordinator is responsible for performing quality checks on automated reports, received scans, and guaranteeing electronic filing for assigned products and the corresponding members. The Medical Record Coordinator collaborates with multiple departments to obtain and confirm necessary documents are in place and properly set-up in the Electronic Medical System (EMS) database. Performs quality checks to maintain the integrity of events and criteria for reporting purposes. Processes members' electronic documents, proof of data for inaccuracies, and any other missing information. Resolves discrepancies identified using standard procedures and/or returning incomplete documents to their respective departments for correction and resolution. Responds and coordinates field assignments for Interpreters by checking availability and assigning staff as appropriate taking location into consideration. Facilitates manual mailings for other departments. Move existing members, auto-enrollees and dis-enrollments to and from the appropriate line of business lists in the centralized NY State Uniform Assessment System (UAS) for Integrated Products. Additional duties as assigned. Minimum Qualifications: HS diploma/GED Preferred Qualifications: Ability to prioritize and follow through on assigned tasks. Proficiency in navigating the Internet. Ability to work with multiple electronic documentation systems simultaneously. Ability to troubleshoot or explain basic hardware and software errors and work with a Technician remotely to perform step-by-step repairs. Work experience with an electronic patient health information (PHI) database (medical records database). Microsoft Excel skills including edit, search, sort/filter, format using already created pivot tables to locate information. Data entry/database management experience with Microsoft Excel and other systems/ applications. Attention to detail performing quality checks and proofreading. Work experience in a healthcare environment. Knowledge of Medicare, Medicaid, or managed care and medical terminology. WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $39,208 - $52,000 All Other Locations (within approved locations): $34,091 - $49,920 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

The Program Coordinator, Reward Card Program in Clinical Quality is responsible for supporting Healthfirst initiatives and regulatory requirements related to Member Rewards and Incentives, HEDIS Quality Improvement, Medicare Stars and Member Satisfaction. This position is both internal (EDS, Marketing, etc.) and external (Members, Provider, Vendor) facing.Duties & Responsibilities: Verifies reward requests based on required preventive services appropriate for the member's age, gender and other accepted demographics as outlined via the Member Reward Card Program Guidelines, HEDIS/QARR Technical Specifications, and CMS/DOH guidelines Conducts member and provider outreach to inform on reward guidance and status using multiple internal systems and applications Collaborates with internal and external teams to track and document program requirements and implementation status Documents, communicates and presents technical improvement findings and recommendations in all systems supporting Member Rewards Program Provides support in creating, editing and communicating member and provider material updates Additional duties as necessary Minimum Qualifications: High School/GED Diploma from an accredited institution Basic knowledge of MS Word, Excel, Access, and Outlook Strong organizational skills Good communication (verbal and written) and interpersonal skills Flexibility, reliability, and easily adaptable to any work assignments or new computer applications Competent in managing responsibilities in a high-volume and fast-paced environment Ability to resolve member issues with patience and courtesy Preferred Qualifications: Associate's degree from an accredited institution + 2 Years Work Experience. Experience processing reward card requests highly preferred. Bilingual in English and one or more language(s): Spanish, Mandarin, Cantonese may be required based on business needs Familiarity with some medical terminology. Experience addressing member inquiries in a managed care environment. Knowledge of CPT and ICD-9 codes. Compliance & Regulatory Responsibilities: Noted above License/Certification: N/A WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $40,200 - $54,570 All Other Locations (within approved locations): $34,900 - $52,000 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

The Performance Support Specialist will be responsible for providing assistance in resolving complaint issues escalated by the representatives. This role is required to pull non-urgent complaint reporting through various systems on a daily basis, review each matter and reach out to the member in order to provide determinations while maintain a tracking system for any and all incoming complaint issues. Duties & Responsibilities: Assist in resolving customer complaints escalated by internal and external business partners as needed. Assist in reviewing and modifying Physician capitation reports. Assist in resolving member issues who called in multiple times with the same issues. Assist in responding and resolving escalated inquiries from other departments and external contacts. Make recommendations on process improvements. Build sustainable relationships of trust through open and interactive communication with internal and external customers. Able to properly follow procedures based on issues and documents received Make recommendations to management concerning staff performance. Make recommendations on process improvement. Maintain open exchange of information with external and internal customers. Required to multi-task, prioritize and manage time effectively. Timely filing of complaints. Conduct outreaches as required. Attend meetings as business requires. Additional duties as assigned. Minimum Qualifications: High School Diploma or GED from an accredited institution Healthcare industry experience Experience working in customer service Excellent telephone & customer service skills Experience working in clerical or administrative capacity Experience meeting strict deadlines Proficient in Microsoft suite of applications including Word, Power point, Outlook and Excel. Preferred Qualifications: Associate degree from an accredited school Conflict Resolution Experience Experience handling complex situations and/or projects Experience in developing and coaching of staff Compliance & Regulatory Responsibilities: NA License/Certification: NA WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400 All Other Locations (within approved locations): $41,101 - $60,320 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

The Healthfirst Credentialing department credentials and re-credentials providers, facilities and vendors; prepares hard-copy directories and reviews network provider data for accuracy and ensures compliance with regulatory requirements and federal and state regulations. Duties/Responsibilities: Credentials providers, facilities, and vendors in accordance to regulations and Healtfirst policy. Prepares presentations for the quarterly credentialing and delegate vendor oversight committee meetings. Facilitates pre-delegation and delegation vendor audits to ensure adherence to contractual arrangements. Prepares hard-copy directories and works with third party vendors for posting online directories. Reviews relevant data to ensure accuracy. Effectively communicates to internal departments and external partners. Identifies and assesses opportunities to improve processes to better ensure regulatory compliance and adherence to state and federal regulations. Raises issues to management and assists in resolution. Additional duties as assigned. Minimum Qualifications: HS diploma/GED Preferred Qualifications: Bachelor's degree Prior relevant experience Time and project management, critical/creative thinking, communication, and problem-solving skills. Intermediate Microsoft software skills include Adobe, Access, Excel, Word, PowerPoint, and Office WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

The Quality Assurance Financial Auditor II is responsible for performing Quality Assurance Audits of financial processes completed by internal employees and outsources vendors to ensure compliance with policies, procedures, and quality standards to mitigate financial risk. You will investigate, audit, conduct root cause analysis, handle processing of determinations, and track/trend findings under minimal supervision. This position is 100% Remote. Scope of Responsibilities: Conduct moderately complex to complex quality audits of provider claims, pre-payments and post-payments including high-dollar and specialized claims across multiple lines of business, claim types and products. Audit the work of more junior auditors and identify opportunities for coaching and/or training. Identify and communicate issues identified through audits and recommended solutions relevant to business operations. Assist management in preparing departmental reports policies and procedures. Mentor and coach Financial and/or Operations QA auditors. Participate as a Subject Matter Expert on various process improvement projects designed to meet departmental and operational needs. Assist with performing User Acceptance Testing (UAT) on system enhancements or corporate projects in partnership with Business Operations Analyze errors and determine root causes for appropriate classification. Record/track quality assessment scores and provide feedback to reduce errors and improve processes and performance to ensure the quality of the network. Review and investigate claims and encounters for medical, facility, pharmacy, dental and vision services including contractual provisions, authorizations and Healthfirst policy and procedure. Prepare written reports concerning investigation activities and present results of investigations to senior staff. Complete subsequent auditing and handling of specific claims and appeal requests including processing where applicable, tracking, documenting, reporting and dispersal of findings and recommendations. Review the accuracy and efficiency of existing training materials. Minimum Qualifications: Audit experience with the investigation, determination and reporting of financial processes. Work experience in Microsoft Office suite of applications including advanced Excel (formatting formulas, managing data, filtering results), Word (creating and editing documents), PowerPoint (creating and editing presentations) Experience conducting root cause analysis in an auditing capacity. Experience conducting analytical work and providing creative ideas for problem solving. Work experience requires written and verbal communication that is clear, concise, grammatically correct, and professional. Experience handling confidential information. Associate degree from an accredited institution. Preferred Qualifications: Bachelor's degree from an accredited institution Audit experience with the investigation, determination and reporting of financial processes specifically around Healthcare Claims Adjudication and Claims Processing Ability and willingness to handle increasing workload and responsibility Willingness and ability to learn and evaluate new information, both technical and procedural ICD10 certification Basic foundation of SQL, Tableau, and SharePoint Knowledge of at least two or more lines of business such as NY Medicare, Medicaid, Family Health Plus, Child Health Plus WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $68,900 - $99,620 All Other Locations (within approved locations): $61,300 - $89,440 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

The Care Manager plans and manages behavioral and/or physical care with members and works collaboratively with them, their supports, providers, and health care team members. The Care Manager is responsible for applying care management principles when engaging members and addressing coordination of their health care services to provide an excellent member experience, address barriers, and improve their health outcomes. The Care Manager is assigned to a specific product line such as CompleteCare, SNP, Medicaid/Medicare, PHSP, HARP, etc. Duties and Responsibilities: Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. Conducts assessments to identify barriers and opportunities for intervention. Develops care plans that align with the physician's treatment plans and recommends interventions that align with proposed goals. Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement and maintenance of successful health outcomes. Liaise between service providers such as doctors, social workers, discharge planners, and community-based service providers to ensure care is coordinated and care needs are adequately addressed. Coordinates and facilitates with the multi-disciplinary health care team as necessary to ensure care plan goals and treatment is person-centered and maximizes member health outcomes. Assists in identifying opportunities for alternative care options based on member needs and assessments. Evaluates service authorizations to ensure alignment and execution of the member's care and physician treatment plan. Contributes to corporate goals through ongoing execution of member care plans and member goal achievement. Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate. Occasional overtime as necessary. Additional duties as assigned. Minimum Qualifications: For Medical Care Management: NYS RN or LCSW or LMSW (any state) For PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations For Behavioral Health (BH) Care Management: NYS RN or LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (any state) 3 years of work experience in a mental/behavioral health or addictions setting For BH PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations Preferred Qualifications: Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing situations. Fluency in Fujianese Knowledge and experience with the current community health practices for the frail adult population and cognitive impaired seniors. Experience managing member information in a shared network environment using paperless database modules and archival systems. Experience and knowledge of the relevant product line Relevant work experience preferably as a Care Manager Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems Experience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $81,099 - $116,480 All Other Locations (within approved locations): $71,594 - $106,080 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM ™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers' Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years. Position Summary The Zero Balance Supervisor is responsible for leading and overseeing Zero Balance. Reviews operations focused on identifying and recovering hospital claims that have been deemed “zero balance” and closed by client hospitals. This role requires deep knowledge of hospital reimbursement, coding, and payer behavior, as well as the ability to identify recovery opportunities across large, complex claim inventories. The Supervisor serves as both a people leader and a subject matter expert, ensuring operational excellence, client satisfaction, and measurable financial results.Key Responsibilities Provide daily supervision, coaching, and support to assigned Zero Balance team members. Manage the full employee lifecycle, including hiring, onboarding, training, performance management, and corrective action. Prepare and deliver performance evaluations and account reviews in partnership with Department Leadership. Train and mentor staff, including new hires, with a focus on accuracy, payer strategy, and zero balance recovery best practices. Perform quality control reviews to ensure due diligence, compliance, and workflow adherence. Identify and pursue recovery opportunities within large inventories of zero balance hospital claims. Analyze and evaluate claim payments using EnableComp proprietary systems, tools, and payer documentation to determine compliance with contractual reimbursement. Prepare and submit initial bill packets and appeal letters using EnableComp systems and tools. Conduct timely and thorough follow-up with insurance companies to drive correct reimbursement. Research, request, and compile medical records, implant invoices, and other supporting documentation required for claim resolution. Apply coding knowledge (CPT, ICD-10, modifiers) to support claim accuracy, appeal success, and recovery strategy. Serve as the primary escalation point for team members issues related to access and roadblocks impacting claim resolution. Manage internal coordination, communication, and messaging related to external client requests and reported issues. Facilitate internal meetings to address client concerns, process improvements, and operational challenges. Communicate directly with clients regarding system access, documentation requests, payment research, training coordination, and related topics. Partner with Managers to prioritize daily work and ensure alignment with operational goals. Collaborate with Data Analytics to research and resolve claim, payment, and data import issues. Work closely with Data and Product teams to investigate calculation issues and support special projects. Support departmental and enterprise operational initiatives through cross-team collaboration. Requirements and Qualifications High School Diploma or GED required. Associates or Bachelor's Degree a plus. 5+ years' experience in healthcare field working in zero balance line of business. 5+ years' client facing/customer services experience. 2-5 years supervisory experience. 5+ years' experience with commercial/government billing and collections. Proven experience in hospital revenue cycle operations, with a strong focus on zero balance or underpayment recovery. Demonstrated ability to identify recovery opportunities within large claim inventories. Experience working with payer portals, claims systems, and healthcare revenue cycle technology platforms. Expert level understanding of insurance payer/provider claims processing and subsequent data requirements. Experience supporting outsourced zero balance or contingency-based recovery programs. Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook). Equivalent combination of education and experience will be considered. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Regular and predictable attendance. Special Considerations and Prerequisites Practices and adheres to EnableComp's Core Values, Vision and Mission. Must demonstrate exceptional interpersonal skills and exhibit an approachable nature to answer questions from Revenue Specialist staff and mentor and train others regularly. Can-do attitude with service-oriented approach and strong sense of urgency with skills to develop and coach team members. Must be a self-starter and able to work independently without direct supervision. Proven written and verbal communication skills. Strong analytical and problem-solving skills. Appropriately handle stress and interact cooperatively with others (at all levels of the organization). Proven experience working with external clients; strong customer service skills and business acumen. Ability to prioritize and manage multiple competing priorities and projects concurrently. General office environment; must be able to sit for long periods of time. EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment. EnableComp recruits, develops and retains the industry's top talent. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people. We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here. At EnableComp, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies. If you are looking for a company that values its employees and is dedicated to helping them achieve their full potential, then EnableComp is the place for you. Don't just take our word for it! Hear what our people are saying: “I love my job because everyone shares the same vision and is determined and dedicated. People care about you as a person and your professional growth. There is a genuine spirit of cooperation and shared goals all revolving around helping each other.” - Revenue Specialist “I enjoy working for EnableComp because of the Core Values we believe in. EnableComp stands true to these values from empowering employees to ecstatic clients. This company is family oriented and flexible, along with understanding the balance of work, life, and fun.” - Supervisor, Operations

The Clinical UM Pharmacist is a dynamic position responsible for the review of prior authorizations for medications requested under the medical benefit. Additionally, the Clinical UM Pharmacist is responsible for developing clinical criteria, medical policies for provider administered medications, review of monthly report for quality assurance, and staying current with literature, evidence-based medicine, and trends in medicine. The Clinical Pharmacist works directly with prescribing physicians and Medical Directors to discuss clinical rationale for review decisions. Duties & Responsibilities: Monitor and review prior authorization requests for medications Calculate appropriate billable units based on dosing, indication, weight, BMI and other clinical considerations Develop clinical criteria and medical policies for the review of medications Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH) Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews Ensure prior authorization reviews are conducted in timeframes set forth by CMS and/or NYSDOH Work across departments as needed to complete Utilization Management reviews Review monthly reports and provide feedback on trends, ideas for efficiency, and innovation Ability to work well in a team environment and be a team player Additional duties as assigned or required Minimum Qualifications: Pharmacy degree from an accredited school of pharmacy Registered Pharmacist with a state license in good standing. Work experience conducting prior authorization reviews Clinical knowledge of pharmaceuticals and disease states in order to conduct prior authorization reviews Work experience requiring written and verbal clinical communication that is clear, concise, grammatically correct, and professional Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits Preferred Qualifications: PGY1 Managed Care Residency Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations Demonstrated critical thinking and problem-solving skills Passion for learning, promoting the profession of pharmacy, and interest in growing skills in a dynamic environment with various opportunities Experience leading large and small working meetings PC Skills with Microsoft Outlook, Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables) Compliance & Regulatory Responsibilities: Assists in regulatory and compliance audits for all plans. Ensure all activities are conducted in compliance with regulations. License/Certification: Licensed pharmacist in good standing WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $103,400 - $149,430 All Other Locations (within approved locations): $88,700 - $131,920 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers' Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years. Position Summary The Document Processing Specialist performs all activities involved in the preparation, printing, handling, scanning and retrieval of medical records and documents from various systems for the timely filing or re-adjudication of medical claims by the Revenue Specialist teams and Account Management. The Document Processing Specialist also helps support sending out and receiving company mail as it pertains to medical claims. This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information. Key Responsibilities * Assist with document retrieval process for including but not limited to implant invoices, UB-04 documents, Explanations of Benefits, medical record components. * Scan and upload documents received from client. * Manual reporting to clients for records requested and received in support of recovery team. * Manual updating of information in electronic HIS systems to support production processes and Account Management teams. * Manual review and reconciliation of ATB reports to locate accounts missing between both systems used to generate bills to EC. * Locate, acquire, and store medical records from within client system. * Assist in efficiently moving work through the department. * Record returned mail in medical billing system for record purposes and to notify sender * Assist and cooperate with other departments. * Use several systems to perform accurate and timely data entry. * File and handle confidential documentation and patient health information (PHI). * Print, coalate and mail outbound correspondence. Collaborate with Administrative and Operations Support teams on outbound and inbound mail relating to client and patient information. * Open, sort and scan inbound mail for timely distribution to correct recipients. * Other duties as required. Requirements and Qualifications * High School Diploma or equivalent. * 1 year of document control experience desired. * Experience with electronic document management in a healthcare setting desired. * Equivalent combination of education and experience will be considered. * Ability to occasionally lift up to 50 pounds while mailing out claims. * Ability to walk to and from all designated collection areas to collect mail and carry or transport on a cart back to desk to be processed. * To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Special Considerations and Prerequisites * Regular and predictable attendance. * Ability to handle large volumes of work while paying close attention to detail. * Ability to work in a fast-paced environment. * Demonstrated experience in working under limited supervision, manage multiple tasks and prioritize assignments with limited time constraints. * Effectively communicate issues/problems and results that impact timelines for project completion. * Ability to interact professionally at multiple levels within a client-oriented organization. * Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook). * General office environment; must be able to sit and/or stand for long periods of time. EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment. EnableComp recruits, develops and retains the industry's top talent. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people. We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here. At EnableComp, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies. If you are looking for a company that values its employees and is dedicated to helping them achieve their full potential, then EnableComp is the place for you. Don't just take our word for it! Hear what our people are saying: "I love my job because everyone shares the same vision and is determined and dedicated. People care about you as a person and your professional growth. There is a genuine spirit of cooperation and shared goals all revolving around helping each other." - Revenue Specialist "I enjoy working for EnableComp because of the Core Values we believe in. EnableComp stands true to these values from empowering employees to ecstatic clients. This company is family oriented and flexible, along with understanding the balance of work, life, and fun." - Supervisor, Operations We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

The UM Pharmacy Technician is responsible for the intake and review of prior authorization requests for medications requested under the medical benefit. The UM Pharmacy Technician makes approval decisions and denial recommendations based on predetermined clinical criteria. They establish rapport with Provider offices and leverages strong communication and customer service skills when providing updates and delivering decision notifications to members and providers, The UM Pharmacy Technician position is part of multidisciplinary team and works closely with Providers, Pharmacists, and Medical Directors. Duties & Responsibilities: Reviews prior authorization requests and units for medications requested under the medical benefit Assesses provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteria Sends notification to members and providers of authorization decisions via telephone, fax, or mail Ensures prior authorization reviews are conducted within timeframes set forth by CMS and/or NYSDOH Establishes great rapport with Provider offices via telephonic communication Sends request for information sheets to Providers Ensures that patient information is shared appropriately maintaining confidentiality and compliance with federal law and HIPAA regulations Additional duties as necessary Minimum Qualifications: High School Diploma or GED from an accredited institution Either nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or licensed Pharmacy Technician in good standing Experience conducting prior authorization reviews Experience requiring written, verbal, and telephonic communication in English that is clear, concise, grammatically correct, and professional Preferred Qualifications: Strong written and verbal communication skills in Chinese, Spanish, or Russian Demonstrated critical thinking and problem-solving skills Team player with a passion for learning and interest in growing skills in a dynamic environment with various opportunities Knowledge of specialty pharmaceuticals and billing practices in the medical benefit Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables). Experience with TruCare Care Management Platform Compliance & Regulatory Responsibilities: Noted above License/Certification: Nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or a licensed Pharmacy Technician in good standing. WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $47,403 - $64,338 All Other Locations (within approved locations): $41,101 - $60,320 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM ™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers' Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years. Position Summary The Provider Enrollment Specialist, Medicaid, has primary responsibility for oversight and maintenance of the professional and facility enrollment process. This will include submission of both online and paper applications. This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.Key Responsibilities Collect, verify, and submit information necessary for the enrollment of hospitals/physicians with Out-of-State Medicaid payers. Develop and maintain ongoing policy and procedures specific to each state for new hospital/physician enrollments. Maintain working knowledge of hospital/physician Out-of-State Medicaid enrollment requirements and regulations. Ensure appropriate education and communication is shared with internal team members, including the Vice President and Senior Vice President of Operations. Submits re-enrollment applications in a timely manner to ensure hospitals/physicians are up to date with their enrollment status. Establish, maintain, and constantly review the accuracy of Out-of-State Medicaid requirements to ensure compliance with government rules and regulations. Manage work queue to ensure all timely submissions/deadlines of all payor-specific forms and documents to the various health plans including license updates, deficiency notifications, approval letters, etc. All maintenance of the provider file and communication of provider changes, corrections, and terminations documented in the database. Requirements and Qualifications High School Diploma or GED required. Associates or Bachelor's Degree preferred. 1+ years' experience in healthcare field working in billing or collections. 1+ years' client facing/customer services experience. Intermediate level understanding of insurance payer/provider claims processing and subsequent data requirements. Thorough understanding of the enrollment requirements and documents needed for the accurate completion of applications Knowledge of general credentials and licenses is preferred but not required: hospital license, CLIA, DEA, NPI, board certifications, etc. Equivalent combination of education and experience will be considered. Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook). Regular and predictable attendance. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Special Considerations and Prerequisites Practices and adheres to EnableComp's Core Values, Vision and Mission. Proven ability to meet and/or exceed productivity targets and goals. Maintains stable performance under pressure or opposition. Handles stress in ways to maintain relationships with all stakeholders. Must be a self-starter and able to work independently without direct supervision. Proven written and verbal communication skills. Strong analytical and problem-solving skills. Proven experience working with external clients; strong customer service skills and business acumen. Ability to prioritize and manage multiple competing priorities and projects concurrently. Must be able to remain in stationary position 50% of the time. Occasionally moves about inside the office to access office equipment, etc. Constantly operates a computer and other office equipment such as a copy/scan/print machine, phone and computer. EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment. EnableComp recruits, develops and retains the industry's top talent. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people. We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here. At EnableComp, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies. If you are looking for a company that values its employees and is dedicated to helping them achieve their full potential, then EnableComp is the place for you. Don't just take our word for it! Hear what our people are saying: “I love my job because everyone shares the same vision and is determined and dedicated. People care about you as a person and your professional growth. There is a genuine spirit of cooperation and shared goals all revolving around helping each other.” - Revenue Specialist “I enjoy working for EnableComp because of the Core Values we believe in. EnableComp stands true to these values from empowering employees to ecstatic clients. This company is family oriented and flexible, along with understanding the balance of work, life, and fun.” - Supervisor, Operations

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM ™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers' Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years. Position Summary The Security Engineer (Application & AI Security) will serve as the technical implementation bridge between our security policy team and development operations. The Security Engineer will be embedded with development teams, writing code, configuring systems, and directly implementing security controls across applications, databases, and AI systems during a major Agentic AI platform transformation.Key Responsibilities Bridge security policy and technical execution by translating organizational security requirements into practical, deployable solutions across applications, data environments, and AI systems. Design, build, and deploy security controls across web applications, data pipelines, APIs, and Agentic AI systems to ensure confidentiality, integrity, and availability. Implement secure-by-design practices throughout the software development lifecycle, including code-level remediations, configuration hardening, and secure infrastructure deployment. Develop automation scripts and infrastructure-as-code to integrate security into CI/CD pipelines, enabling continuous compliance, secrets management, vulnerability scanning, and environment hardening. Implement and operationalize AI-specific security frameworks by building guardrails for agentic models, securing data flows, and integrating AI security tooling into development workflows. Perform hands-on technical security assessments, including penetration testing, threat modeling, and code reviews, and directly remediate identified vulnerabilities. Collaborate with cloud and DevOps teams to deploy monitoring and detection controls and ensure secure configuration baselines across environments. Provide practical security guidance and training to developers and engineers during architecture reviews, sprint planning, and project delivery. Continuously evaluate and improve the organization's security posture through testing, feedback loops, and adoption of emerging best practices for AI and distributed systems. Document security architectures, configurations, and implementation patterns to support ongoing operations, compliance, and knowledge sharing. Other duties as required Requirements & Qualifications Bachelor's degree in Computer Science, Information Security, Engineering, or a related technical field required 3+ years in hands-on application security, DevSecOps, or security engineering roles. Proven experience building and configuring secure CI/CD pipelines (Jenkins, GitLab CI, GitHub Actions, Azure DevOps). Equivalent combination of education and experience will be considered. Deep proficiency with cloud security in AWS, Azure, or GCP environments. Strong implementation experience with infrastructure as code (Terraform, CloudFormation) and container security (Docker, Kubernetes). Strong scripting and automation skills (Python, Bash, PowerShell) for security tooling. Versatility across web/API security, data pipeline security, microservices, and database security. Understanding of security frameworks (NIST, ISO 27001, SOC 2) and compliance requirements (GDPR, HIPAA, PCI-DSS). Hands-on experience deploying and configuring security scanning tools (SAST, DAST, SCA). Excellent communication skills-ability to translate security requirements into working technical implementations. Experience working embedded within cross-functional development teams. Proven track record of hands-on problem-solving in fast-paced development environments. Regular and predictable attendance. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions Special Considerations & Prerequisites Practices and adheres to EnableComp's Core Values, Vision and Mission. Hands-on experience with AI/ML security, model security, and data governance Technical knowledge of LLM security, prompt injection prevention, and AI agent safety Security certifications (CISSP, CEH, OSCP, CSSLP, or cloud security certifications) Strong coding background in Python, Go, or similar languages. Background in software development or engineering transitioning to security. Direct experience implementing secrets management solutions (HashiCorp Vault, AWS Secrets Manager). Practical experience with zero trust architecture implementation. Familiarity with data security, ETL processes, and data warehouse security. Experience with microservices architectures and distributed systems security. EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment. EnableComp recruits, develops and retains the industry's top talent. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people. We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here. At EnableComp, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies. If you are looking for a company that values its employees and is dedicated to helping them achieve their full potential, then EnableComp is the place for you. Don't just take our word for it! Hear what our people are saying: “I love my job because everyone shares the same vision and is determined and dedicated. People care about you as a person and your professional growth. There is a genuine spirit of cooperation and shared goals all revolving around helping each other.” - Revenue Specialist “I enjoy working for EnableComp because of the Core Values we believe in. EnableComp stands true to these values from empowering employees to ecstatic clients. This company is family oriented and flexible, along with understanding the balance of work, life, and fun.” - Supervisor, Operations

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM ™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers' Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years. Position Summary The Document Processing Specialist performs all activities involved in the preparation, printing, handling, scanning and retrieval of medical records and documents from various systems for the timely filing or re-adjudication of medical claims by the Revenue Specialist teams and Account Management. The Document Processing Specialist also helps support sending out and receiving company mail as it pertains to medical claims. This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information. Key Responsibilities Assist with document retrieval process for including but not limited to implant invoices, UB-04 documents, Explanations of Benefits, medical record components. Scan and upload documents received from client. Manual reporting to clients for records requested and received in support of recovery team. Manual updating of information in electronic HIS systems to support production processes and Account Management teams. Manual review and reconciliation of ATB reports to locate accounts missing between both systems used to generate bills to EC. Locate, acquire, and store medical records from within client system. Assist in efficiently moving work through the department. Record returned mail in medical billing system for record purposes and to notify sender Assist and cooperate with other departments. Use several systems to perform accurate and timely data entry. File and handle confidential documentation and patient health information (PHI). Print, coalate and mail outbound correspondence. Collaborate with Administrative and Operations Support teams on outbound and inbound mail relating to client and patient information. Open, sort and scan inbound mail for timely distribution to correct recipients. Other duties as required. Requirements and Qualifications High School Diploma or equivalent. 1 year of document control experience desired. Experience with electronic document management in a healthcare setting desired. Equivalent combination of education and experience will be considered. Ability to occasionally lift up to 50 pounds while mailing out claims. Ability to walk to and from all designated collection areas to collect mail and carry or transport on a cart back to desk to be processed. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Special Considerations and Prerequisites Regular and predictable attendance. Ability to handle large volumes of work while paying close attention to detail. Ability to work in a fast-paced environment. Demonstrated experience in working under limited supervision, manage multiple tasks and prioritize assignments with limited time constraints. Effectively communicate issues/problems and results that impact timelines for project completion. Ability to interact professionally at multiple levels within a client-oriented organization. Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook). General office environment; must be able to sit and/or stand for long periods of time. EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment. EnableComp recruits, develops and retains the industry's top talent. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people. We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here. At EnableComp, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies. If you are looking for a company that values its employees and is dedicated to helping them achieve their full potential, then EnableComp is the place for you. Don't just take our word for it! Hear what our people are saying: “I love my job because everyone shares the same vision and is determined and dedicated. People care about you as a person and your professional growth. There is a genuine spirit of cooperation and shared goals all revolving around helping each other.” - Revenue Specialist “I enjoy working for EnableComp because of the Core Values we believe in. EnableComp stands true to these values from empowering employees to ecstatic clients. This company is family oriented and flexible, along with understanding the balance of work, life, and fun.” - Supervisor, Operations

The RN or SW Clinical Facilitator coordinates with Clinical Teams and other internal stakeholders to advance Healthfirst's clinical practice through technical assistance, education, and innovation solutions by applying adult learning theory. The technical assistance solutions will ensure efficient and effective quality of care in accordance to Healthfirst standards and rules/regulations set forth by state, and federal regulatory and compliance agencies. Within the Clinical Division at Healthfirst, the Clinical Technical Assistance Center (CTAC) will assist clinical employees and other internal stakeholders in tactically obtaining or improving the essential knowledge or skills needed to perform their jobs. The CTAC will also serve as the hub for ongoing adult learning and skills acquisition which supports Healthfirst's commitment to ensuring its teams are capable, engaged, and committed to their work.Leverages adult learning principles and clinical practice standards to move towards a culture of continuous technical assistance improvement and clinical capacity building with innovative learning solutions. Develops technical assistance goals that are congruent with the organization and the Clinical Department's mission, vision, and strategic direction. Provides technical assistance, resources and tools that define performance requirements, identify gaps between existing and required performance, analyze root causes that limit performance and recommend and/or implement learning solutions that focus on and deliver business results. Utilizes current literature, research, and evidence-based findings in the design, implementation and evaluation of technical assistance solutions and education programs for staff learning and development. Conducts onboarding, preceptorship, and ongoing professional training to ensure clinical staff are equipped to perform job responsibilities in accordance to Healthfirst standards and rules/regulations set forth by regulatory and compliance agencies. Facilitates with subject matter experts, instructional designers, training agencies and technical assistance facilitators to design and deliver innovative learning solutions for performance enhancements needed to support the clinical department's business objectives. Facilitates updating departmental training manuals, job aids, quick reference guides and the clinical department's policies/procedures. Develop, implement, and evaluate a preceptorship training program curriculum to standardize the quality of preceptorship practices among the clinical teams. Conducts field assessments as needed to evaluate clinical staff and update the preceptorship training program curriculum. Minimum Qualifications: Licensure: Current Registered Professional Nurse or Registered Social Worker (i.e. LMSW or LCSW) in the State of New York. Education: Bachelor's in nursing or social work preferred with previous work experience in education. Three to five years of clinical experience in a specialty area, or combination of staff nurse/leadership experience in the specialty area, i.e. Care Management, Utilization Management, Clinical Eligibility. Excellent skills in the following areas: verbal and written communication, critical thinking, creativity, interpersonal relationships and team building; change management. Demonstrates knowledge base in professional nursing or social work and evidence based practice; participatory leadership, continuous learning environment, current issues and trends in care management and clinical practice, nursing and social work education and development. Ability to travel about 10% of time around downstate New York including Westchester County and Long Island to conduct clinical observations. Preferred Qualifications: Master's degree in Education and understanding of Adult Learning Theory applications to enhance the technical assistance and education of care management and care coordination activities. Ability to assess educational needs and design and develop responsible curricula. Highly developed verbal and written communication skills and the ability to present effectively to small and large groups. Strong interpersonal skills and ability to work effectively at all levels in a collaborative team environment. Certification in relevant clinical area and Nursing or Social Work Professional Development preferred. Intermediate Microsoft Word, Excel, Outlook and PowerPoint skills WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $81,100 - $117,470 All Other Locations (within approved locations): $71,600 - $106,505 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

The Clinical Auditor performs audit functions for Healthfirst clinical teams (e.g. Care Management, Reassessment/Clinical Eligibility, Utilization Management, etc.) and delegated vendors and partners [within internal timeframes and deadlines] to determine operational efficiency, adherence to regulatory requirements, and achievement of quality standards. The audits may include but are not limited to listening to Care Manager phone calls; review of Uniform Assessment System (UAS) assessments, care plans, medical authorizations, and supporting documentation ensure compliance with regulatory requirements and internal policy; etc. Duties and Responsibilities: Maintains tracking tools to log audit results including areas of non-compliance and informing what areas of improvement are needed for discussion with management and/or at departmental team meetings Assists with evaluating and analyzing aggregate quality performance data Develops strategies for business performance improvement initiatives. This includes: identifying opportunities for improvement, problem prioritization, and creating performance improvement plans for non-compliant audits and/or reports Assists with creating and revising audit tools to ensure audits and reports are value-added Applies clinical and critical thinking skills to evaluate the quality and effectiveness of case management and/or utilization review decision-making Additional duties as assigned Minimum Qualifications: NYS LPN or RN license. In order to access the Uniform Assessment System (UAS), an unexpired NYS driver's license or NYS ID is required. If residing outside of NYS, the candidate must be able to obtain a NYS ID before commencement of employment. Preferred Qualifications: Relevant previous work experience such as medical records review; claims processing; utilization/case management in a clinical practice or managed care organization; managed care plan products (e.g. Medicaid, Medicare, Commercial) and knowledge of Department of Health (DOH) and Local Department of Social Services and Center for Medicare & Medicaid Services (CMS) regulations pertaining to managed care; nursing experience in an acute, sub-acute or long-term care (LTC) setting or managed long-term care plan (MLTCP, FIDA); Geriatrics, Medical Surgical Nursing, Case Management or Discharge Planning; etc. Experience working with any of the following systems: CareEnhance Clinical Management Software (CCMS), TrueCare, PEGA, Citrix, RightFax, VoIP, Virtual work platforms (VPN), Electronic medical record (EMR) database containing patient health information (PHI), and/or MACESS archival system. Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese. Intermediate Microsoft Word, Excel, and Outlook skills Ability to build and maintain positive relationships with cross-functional teams and interact with all levels of management. Time management, critical/creative thinking, project management, communication, and problem-solving skills License or Certification: NYS LPN or RN license. Regulatory or Compliance activities: n/a WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $81,099 - $116,480 All Other Locations (within approved locations): $71,594 - $106,080 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

A vital role of the CMO Administration team, the Medical Peer Reviewer plays a critical role in consulting on medical necessity in the context of utilization management and ensuring adherence to internal Healthfirst and external regulations. Duties/Responsibilities: The Medical Peer Reviewer will assess/review requests for authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and recommendations. The Medical Peer Reviewer will render determinations in the format and within timeframes to follow Regulatory and Operational policies. The Medical Peer Reviewer will: Maintain productivity standards. Collaborate with Utilization Management and Care Management and medical departments as needed, reviews and manages cases/caseload from multiple lines of businesses Demonstrate the ability to be flexible when case load volume fluxes and when Leadership requests changes in case priorities to support our members/internal medical departments as needed Complete mandatory Company compliance training and training in new systems and software. Enter each day's hours worked in Workday, on the same day. Perform other duties as assigned Responsibilities may be adjusted based on changing needs of the organization. Weekday Requirements: The Medical reviewer requires 25 hours a week of coverage/5 days per week. Each Medical Reviewer will cover one legal holiday /year and will be compensated Holiday pay and straight hours worked The Medical Reviewer is eligible for Paid Time Off (PTO) and is required to plan and schedule time off with their direct supervisor following the Company policy. Weekend Requirements: Each Medical Reviewer is required to be primary coverage one weekend a month Each Medical Reviewer is required to be available as back up, if needed, one weekend a month . Minimum Qualifications: Licensed M.D. or D.O. or D.M.D. or D.D.S. Board Certified in a specialty recognized by the American Board of Medical Specialties Preferred Qualifications: New York State Board Certified in Internal Medicine or Family Practice Previous, relevant experience in utilization management and clinical practice Knowledge of Medicare, Medicaid, and MLTC plans Time management, critical thinking, communication, and problem-solving skills Knowledge of UM/QM case philosophies and reporting requirements to state and federal agencies Knowledge of member satisfaction/incident management and regulations Knowledge of quality improvement methodologies Compliance & Regulatory Responsibilities: Ensures compliance to internal Healthfirst and external regulations. Licensed M.D. or D.O. or D.M.D. or D.D.S. Annual Compliance and other training as assigned, may include but not limited to hardware, software, and system training upgrades Annual Inter-Rater Reliability (IRR) Testing Complies with the Healthfirst Conflict of Interest Policy for Professionals WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $122,907 - $188,020 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

We are recruiting for a motivated IT Security Analyst II to join our team! We are here for life's journey. Where is your life journey taking you? Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all: Humanity in action, Triumph in hardship, Transformation in health. Department Information Technology-Biomed Job Summary The IT Analyst Security II is responsible for multiple day-to-day security tasks and various information security projects as part of supporting the organization's information security needs. Day-to-day tasks include incident response, evaluation of requests for security changes, and monitoring of various security devices and audit logs. Responsibilities also involve providing ongoing support and advice to IT staff and end users on a variety of security issues, and ensuring that Denver Health's security policy and procedures are adhered to. Essential Functions: In collaboration with infrastructure application teams and external department system administrators, implements and monitors organizational IT security policies and procedures, ensuring technical controls are enforced. (10%) Works with IT department managers and staff to ensure security issues are addressed as new equipment, facilities, systems, and software are installed. (10%) Develops processes for routine and requested internal audits of systems, applications, and data access including tools and techniques used to conduct audits. (5%) Conducts or coordinates audits on predefined schedule and when an audit is requested or indicated as part of an investigation. (5%) Documents audit findings and follows-up on access irregularities. (5%) Follows procedures and industry best practices for reporting and investigating IT related security incidents. (5%) Investigates and documents all reported or suspected security incidents. Maintains documentation of investigations and provides reports to the Chief Information Security Officer. (5%) Recommends implementation of corrective actions needed to mitigate security vulnerabilities. (5%) In coordination with Network/Server and Applications, develops procedures and technical controls to monitor appropriate administrator, end-user, vendor, and remote access to the Denver Health network, and IT systems. (5%) Investigates alerts to ensure that information is not altered or lost during storage, or transmission. (5%) Collaborates with the Project Management Office (PMO) on initiatives involving the IT Security program. (5%) Provide monthly metrics to the CISO and the IT Director of Information Security by the 3 rd business day of each month. (5%) Monitor and respond to help desk tickets within the documented Service Level Agreements (SLA). (5%) Maintain current documentation for all procedures and applications currently in use. (5%) Respond to all on-call notifications within required documented SLA's. (5%) Responsible for periodically updating management, via written or verbal reports, on all issues, concerns, or problems related to the IT Security program. (5%) Monitors changes to applicable laws, industry standards, and regulatory or accreditation requirements, and incorporates requirements into the organization's IT Security program. (5%) Plans and organizes time effectively. Integrate priority changes into work plans. Anticipates resource needs and plans accordingly. (5%) Education: Bachelor's degree required or a minimum of 5 years of IT experience required. At least one IT Security certification (i.e. CompTIA Security+) required. Work Experience: 4-6 years required. Knowledge, Skills and Abilities: Familiarity with regulations and compliance issues, preferably within the healthcare industry Demonstrated ability to drive multiple requirements across systems, users, and workflows Demonstrated ability to communicate with technical and non-technical stakeholders across the organization Working knowledge of IT Security tools and solutions Demonstrated ability to recognize and respond to alerts or other behaviors to quickly detect and mitigate potential threats Demonstrated ability to mentor, educate, and train other team members Familiarity with advanced networking concepts (i.e., TCP/IP) Strong understanding of Microsoft Windows desktop and server operating systems Familiarity with Linux operating systems Advanced knowledge of Web Security Solutions Advanced knowledge E-Mail Security Solutions Advanced knowledge of Security Incident Event Management (SIEM) systems Advanced knowledge of Vulnerability Management Advanced knowledge of security architecture including NIST, OWASP, etc. Shift Days (United States of America) Work Type Regular Salary $77,900.00 - $120,700.00 / yr Benefits Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans Free RTD EcoPass (public transportation) On-site employee fitness center and wellness classes Childcare discount programs & exclusive perks on large brands, travel, and more Tuition reimbursement & assistance Education & development opportunities including career pathways and coaching Professional clinical advancement program & shared governance Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer Our Values Respect Belonging Accountability Transparency All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation. As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year. Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer. Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. Applicants will be considered until the position is filled.