Specialist jobs at HCA Healthcare - 33 jobs

Campus Engagement Specialist
HCA 4.5
Specialist job at HCA Healthcare
Salary Estimate: 42764.80 - 59862.40 / year Learn more about the benefits offered for this job. The estimate displayed represents the typical salary range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range. You Can Change the Life of One to Care for the Lives of Many! At Galen College of Nursing, we educate and empower nurses to change lives. Since 1989, we've dedicated our work to delivering high-quality nursing education with a student-first mindset. As one of the largest private nursing colleges in the country, we combine the support of a close-knit learning environment with the strength of a nationally recognized institution, HCA Healthcare. That same passion for excellence in the classroom extends to our offices. At Galen, you'll find a culture deeply rooted in collaboration, innovation, and a shared commitment to improving the future of healthcare. Your work directly touches the next generation of nurses, and your contributions help our students pursue their dream of a compassionate career. If you're looking for a career where you can make a difference, grow professionally, and be part of a caring team, we'd love for you to apply for the Campus Engagement Specialist position today! Click here to learn more about Galen! Position Overview: As a Campus Engagement Specialist at Galen College of Nursing, you will coordinate campus and student engagement activities, as well as other related services to support student success in the nursing programs and career preparation. This position will collaborate with Galen's faculty, administration, and staff in addressing the needs of a student population with diverse academic, cultural, ethnic, and socioeconomic backgrounds. In addition, the Campus Engagement Specialist will organize career fairs, new student orientation and other campus events. Key Responsibilities: * Collaborate to organize and/or implement graduation and honor ceremony events, as required. * Organize and facilitate new student orientation. * Develop and facilitate career information workshops and career fairs to enhance student/graduate readiness for employment. * Collaborate with the nurse sponsor Galen Student Nurse Association and assist GSNA in planning quarterly programming, as required. * Facilitate the Student Advisory Committee. * Facilitates the Student Veteran's Association. * Recruits, trains, monitors, and coordinates the Student Ambassador and Peer Mentor programs. * Serve as the primary student point of contact for the Student Success Department. * Refers students in need of services to the appropriate Student Success Department staff. * Promote Student Success Department services within the campus. * Monitor, document, and report student utilization of department services * Participate in campus activities including committee work, and campus events. * Serve as the campus-level coordinator for internal investigations of ADA related grievances. * Collaborate with the 504 Coordinator, campus leadership, and Compliance and Regulatory Affairs to ensure that attempts to mediate and resolve complaints are made prior to formal grievance stage. * Assist the 504 Coordinator and campus leadership to ensure that ADA investigations and hearings are conducted according to policies and procedures. Position Requirements: * Education: Bachelor's degree in education, student affairs, social services, counseling, or related field preferred. * Special Qualifications: Microsoft Office computer skills, including Microsoft Word and Microsoft Excel competencies. Student information system program experience preferred. Excellent oral and written communication skills. Must present a professional demeanor and appearance. Must assist in a variety of complex administrative duties involving contact and exposure to proprietary information. Utilizes independent judgement, determining when to act for management and when to refer problems for personal attention. Must have dependable transportation for frequent local travel. Demonstrate dependability and attention to detail. Membership in a professional career services organization is a plus. Physical Requirements: Must be able to sit in front of a computer screen, lift up to 30 pounds, and sit, stand, or walk for extended periods of time. * Degree of Supervision: Minimal Benefits At Galen College of Nursing, we want to ensure your needs are met. We offer a comprehensive package of medical, dental, and vision plans, tuition discounts, along with unique benefits, including: * Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. * Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance, and more. * Free counseling services and resources for emotional, physical, and financial well-being * 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) * Employee Stock Purchase Plan with 10% off HCA Healthcare stock * Family support through fertility and family building benefits with Progyny and adoption assistance. * Referral services for children, elders, and pet care, home and auto repair, event planning, and more. * Consumer discounts through Abenity. * Retirement readiness, rollover assistance services, and preferred banking partnerships. * Education assistance (tuition, student loan, certification support, dependent scholarships). * Colleague recognition program. * Time Away from Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence). * Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits. Note: Eligibility for benefits may vary by location. Galen College of Nursing is recognized as a 2023 National League of Nursing (NLN) Center of Excellence (COE). Galen's Compassionate Care Model Values * Inclusivity: I foster an environment that provides opportunity for every individual to reach their full potential. * Character: I act with integrity and compassion in all I do. * Accountability: I own my role and accept responsibility for my actions. * Respect: I value every person as an individual with unique contributions worthy of consideration. * Excellence: I commit myself to the highest level of quality in everything I do. Learn more about our vision and mission. Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for the opportunity below: Campus Engagement Specialist Galen College of Nursing
$55k-67k yearly est. 21d ago

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Bilingual Remote Medical Scheduling Specialist - Patient Access Center
Community Health Systems 4.5
Fort Smith, AR jobs
The Bilingual Scheduling Specialist is responsible for supporting scheduling functions across assigned hospitals, clinics, or centralized patient access centers and will be the first point of contact for patients. This focuses on managing patient appointment scheduling, helping with general patient needs, and accurately communicating patient needs to the clinical staff through centralized call center operations. The Scheduling Specialist ensures communications and appointments are accurate, timely, and compliant with organizational policies while fostering effective communication with clinicians, patients, and leadership. The ideal candidate will be bilingual in English and Spanish. _As a Scheduling Specialist at Community Health Systems (CHS) - Patient Access Center, you'll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental, and vision insurance, paid time off (PTO), 401(k) with company match, tuition reimbursement, and more_ **Essential Functions** + Completes accurate patient appointment scheduling across multiple clinics, depending on assignment. + Receives inbound communication from clinicians, patients, and staff via phone, text, email, and/or call center platforms to address scheduling needs, and handle urgent or emergent requests. + Assesses caller needs to identify urgent clinical matters for immediate warm transfer to clinic staff. For non-urgent requests (refills, clinical questions), accurately documents and route communications to the appropriate staff via the EMR. + Verifies patient demographics and insurance information, ensuring compliance with applicable requirements. + Research patient requests within the medical record, provide necessary information, and resolve inquiries effectively while maintaining patient confidentiality. + Monitors EMR in-baskets, call center systems, and related technology (as needed) to manage communication workflows effectively. + Provides timely and professional service to patients, providers, and facility staff, ensuring positive experiences and adherence to standards. + Bilingual in English and Spanish + Performs other duties as assigned. + Complies with all policies and standards. + _This is a fully remote opportunity._ **Qualifications** + H.S. Diploma or GED required + Bachelor's Degree in Healthcare Administration, Business Administration, or a related field preferred + 1-3 years of experience in scheduling, operations, or healthcare administration required + 1-3 years of experience in physician/provider scheduling, patient appointment scheduling, or call center operations + **Bilingual in English and Spanish** **Knowledge, Skills and Abilities** + Proficiency in scheduling software, EMR systems, and Microsoft Office Suite. + Excellent verbal and written communication skills with strong customer service orientation. + Delivers prompt, courteous, and knowledgeable support to customers. + Strong problem-solving skills and attention to detail. + Ability to manage multiple priorities in fast-paced hospital, clinic, or call center environments. + Knowledge of healthcare industry standards, patient confidentiality, and compliance protocols. We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible. Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers. _This position is not eligible for immigration sponsorship now or in the future. Applicants must be authorized to work in the U.S. for any employer._ Equal Employment Opportunity This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to ************************************************* to obtain the main telephone number of the facility and ask for Human Resources.
$27k-30k yearly est. 1d ago
Remote Medical Scheduling Specialist - Patient Access Center
Community Health Systems 4.5
Remote
The Scheduling Specialist is responsible for supporting scheduling functions across assigned hospitals, clinics, or centralized patient access centers and will be the first point of contact for patients. This focuses on managing patient appointment scheduling, helping with general patient needs, and accurately communicating patient needs to the clinical staff through centralized call center operations. The Scheduling Specialist ensures communications and appointments are accurate, timely, and compliant with organizational policies while fostering effective communication with clinicians, patients, and leadership. As a Scheduling Specialist at Community Health Systems (CHS) - Patient Access Center, you'll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental, and vision insurance, paid time off (PTO), 401(k) with company match, tuition reimbursement, and more. Essential Functions Completes accurate patient appointment scheduling across multiple clinics, depending on assignment. Receives inbound communication from clinicians, patients, and staff via phone, text, email, and/or call center platforms to address scheduling needs, and handle urgent or emergent requests. Assesses caller needs to identify urgent clinical matters for immediate warm transfer to clinic staff. For non-urgent requests (refills, clinical questions), accurately documents and route communications to the appropriate staff via the EMR. Verifies patient demographics and insurance information, ensuring compliance with applicable requirements. Research patient requests within the medical record, provide necessary information, and resolve inquiries effectively while maintaining patient confidentiality. Monitors EMR in-baskets, call center systems, and related technology (as needed) to manage communication workflows effectively. Provides timely and professional service to patients, providers, and facility staff, ensuring positive experiences and adherence to standards. Performs other duties as assigned. Complies with all policies and standards. This is a fully remote opportunity. Qualifications H.S. Diploma or GED required Bachelor's Degree in Healthcare Administration, Business Administration, or a related field preferred 1-3 years of experience in scheduling, operations, or healthcare administration required 1-3 years of experience in physician/provider scheduling, patient appointment scheduling, or call center operations Knowledge, Skills and Abilities Proficiency in scheduling software, EMR systems, and Microsoft Office Suite. Excellent verbal and written communication skills with strong customer service orientation. Delivers prompt, courteous, and knowledgeable support to customers. Strong problem-solving skills and attention to detail. Ability to manage multiple priorities in fast-paced hospital, clinic, or call center environments. Knowledge of healthcare industry standards, patient confidentiality, and compliance protocols. We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible. Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers. This position is not eligible for immigration sponsorship now or in the future. Applicants must be authorized to work in the U.S. for any employer.
$29k-33k yearly est. Auto-Apply 1d ago
Specialist, Appeals & Grievances
Molina Healthcare 4.4
Columbus, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-38.4 hourly 22d ago
Practice Transformation Specialist
Community Health Systems 4.5
Remote
This position will schedule virtual or (permitting) in-person visits to assigned provider practices. This position serves as a consultant to assist in the transition to value-based care by enhancing provider practice skills in process improvement and quality, sharing identified practice population trends, and analyzing data and performance measurements. The position will be hybrid/remote. Essential Duties and Responsibilities Support operations, promote development, and maintain industry knowledge related to: Accountable Care Organizations (ACOs) Clinically Integrated Networks (CINs) Other value-based care models as applicable Provide data support to providers by exporting data, running reports, and analyzing trends, and demonstrate proficiency in interpreting the key insights and improvement areas to communicate to practices. Provide general support of payer-driven and value-based quality programs. This includes but is not limited to Medicare Traditional and Advantage, Commercial, governmental, ACO, BPCI, CJR, and other quality-related and value-based reimbursement programs. Schedule monthly/quarterly visits to assigned group practices in order to assist the physicians and staff with practice transformation action plans and update on progress toward established goals. Support annual regulatory reporting submission requirements related to Medicare Quality programs (CQM, eCQM, MIPS, etc.) through coordination of data collection and submission. Assist as needed in EMR data extraction, chart reviews, and quality data collection for assigned practices. Develop deep practice understanding by listening to providers and staff to help identify areas for improvement. Understand practice-level challenges and barriers to achieving goals and share solutions for effectively resolving these issues. Partner with assigned practices to train clinicians and office staff on workflows to incorporate into their daily activities that drive toward outcomes in the practice that improve care and reduce costs. Collaborate on the development of training materials, project plans, tool kits, and evaluation materials. Deliver practice-level training and toolkits for improving member care. Review performance reports, quality dashboards and identify and develop suggestions for improvement plans for assigned practices. Willingness to travel in assigned regions as needed. Qualifications Required Education: Bachelor's Degree from accredited school/university. Preferred Education: Masters degree in relevant field preferred, relevant clinical/operational experience can be substituted. Local candidates are preferred but will consider Remote *** Up to 20% travel required*** Required Experience: 3-5 years of experience in practice engagement or operations, nursing, health technology, healthcare coding, population health, office management, or other healthcare related fields. Excellent verbal/written communication, interpersonal, and customer service skills. Moderate analytic knowledge needed to interpret and explain reports. Preferred Experience: Experience with Electronic Health Records (EHR) for clinical/practice management processes. Computer Skills Required: Proficient in Microsoft Office products such as Word, Excel, PowerPoint, email applications and in at least one analytics platform.
$25k-30k yearly est. Auto-Apply 56d ago
Cloud Specialist
Community Health Systems 4.5
Remote
Community Health Systems is seeking cloud specialist for The Cloud Center of Excellence (CCoE) which is building a scalable, secure, and cost-efficient multi-cloud foundation across Google Cloud Platform (GCP), Oracle Cloud Infrastructure (OCI), and Microsoft Azure. This role will play an integral part roles enable seamless collaboration across architecture, engineering, data, and security teams-driving modernization, cost optimization, and compliance through CCoE best practices. Key Responsibilities: Work collaboratively with architecture team in design, deployment, and governance of enterprise-scale cloud infrastructure. Implement automation frameworks, landing zones, and security controls. Champion FinOps initiatives to optimize spend and performance. Guide with CI/CD pipelines and infrastructure-as-code templates (Terraform, Ansible). Troubleshoot complex multi-cloud issues and guide operational excellence. Collaborate with architecture, security, and data teams to enforce compliance and resilience. Required Qualifications: Bachelor's or Master's in Computer Science, IT, or related discipline. 7-10 years in cloud engineering, DevOps, or platform architecture roles. Deep experience in GCP and OCI; exposure to Azure preferred. Proficiency in Terraform, Kubernetes, and CI/CD frameworks. Strong documentation, troubleshooting, and mentorship skills. Preferred certifications: Google Professional Cloud Architect OR OCI Architect Professional OR Azure Solutions Architect Expert. Soft Skills: Strong troubleshooting and analytical mindset Clear verbal and written communication Team player with ability to work independently and under pressure Strong documentation and customer-facing collaboration skills Why Join Us? Be part of a mission-driven organization serving over 65 hospitals and clinics Contribute to high-impact interoperability and modernization initiatives Work with next-generation platforms Grow within a high-performing integration and data engineering team
$25k-30k yearly est. Auto-Apply 60d+ ago
Collections Specialist I - HMO/PPO (Remote)
Community Health Systems 4.5
Franklin, TN jobs
The Collections Specialist I - HMO/PPO is responsible for performing collection follow-up on outstanding insurance balances, identifying claim issues, and ensuring timely resolution in compliance with government and managed care contract terms. This role requires effective communication with insurance payers, documentation of account activity, and adherence to applicable regulations to support revenue cycle operations. As a Collections Specialist I at Community Health Systems (CHS) - SSC Nashville, you'll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental and vision, insurance, and 401k. **Benefits:** + Comprehensive Health Coverage - Medical, dental, and vision plans to keep you and your family healthy. + Future Security: 401(k) with matching + Student Loan Support - Up to $10,000 repayment assistance, because we invest in your future. + Educational Tuition Assistance + Competitive Pay & Full Benefits - A salary and package designed to reward your expertise and dedication. + Paid Time Off **Essential Functions** + Performs follow-up on outstanding insurance balances within the required timeframe, obtaining payment confirmation or required documentation. + Documents all actions taken on accounts within the appropriate system, ensuring a clear and traceable resolution process. + Makes the required number of outbound calls to insurance payers while maintaining professional and courteous communication. + Handles and resolves incoming correspondence within five days of receipt, updating the system with relevant information. + Analyzes assigned accounts using AS400, Meditech, Accurint, Cerner, directory assistance, and credit reports to maximize collection efforts. + Processes inbound and outbound calls professionally, providing exceptional customer service while resolving outstanding balances. + Ensures proper application of account dispositions and follows self-pay policies and procedures. + Adheres to all local, state, and federal laws and regulations, including FDCPA, TCPA, FCRA, CFPB, PCI, UDAAP, and HIPAA compliance standards. + Performs other duties as assigned. + Maintains regular and reliable attendance. + Complies with all policies and standards. **Qualifications** + H.S. Diploma or GED required + Associate Degree in Business, Finance, Healthcare Administration, or a related field preferred + 0-2 years of experience in medical collections, accounts receivable, billing, or healthcare revenue cycle operations required + Experience working with insurance follow-up, claim resolution, and payer communication in a healthcare setting preferred **Knowledge, Skills and Abilities** + Strong understanding of medical collections processes, payer reimbursement policies, and insurance claim resolution. + Proficiency in electronic medical record (EMR) systems, patient accounting systems, and collections software. + Knowledge of insurance contracts, denials management, and accounts receivable workflows. + Excellent problem-solving and analytical skills to research and resolve outstanding claims. + Effective verbal and written communication skills to interact with insurance payers, patients, and internal teams. + Strong attention to detail with the ability to document account activity accurately. + Ability to work independently in a fast-paced environment while meeting productivity and quality standards. + Knowledge of regulatory compliance, including HIPAA, FDCPA, and applicable healthcare finance laws. We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible. The Shared Services Center - Nashville provides business office support functions like billing, insurance follow-up, call center customer service, data entry and more for hospitals and healthcare providers. But we're not only about work. We know employing a skilled and engaged team of professionals is vitally important to our success, so we make sure to offer competitive benefits, recognition programs, professional development opportunities and a fun and engaging team environment. Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers. Equal Employment Opportunity This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to ************************************************* to obtain the main telephone number of the facility and ask for Human Resources.
$28k-32k yearly est. 2d ago
Collections Specialist I - HMO/PPO (Remote)
Community Health Systems 4.5
Remote
The Collections Specialist I - HMO/PPO is responsible for performing collection follow-up on outstanding insurance balances, identifying claim issues, and ensuring timely resolution in compliance with government and managed care contract terms. This role requires effective communication with insurance payers, documentation of account activity, and adherence to applicable regulations to support revenue cycle operations. As a Collections Specialist I at Community Health Systems (CHS) - SSC Nashville, you'll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental and vision, insurance, and 401k. Benefits: Comprehensive Health Coverage - Medical, dental, and vision plans to keep you and your family healthy. Future Security: 401(k) with matching Student Loan Support - Up to $10,000 repayment assistance, because we invest in your future. Educational Tuition Assistance Competitive Pay & Full Benefits - A salary and package designed to reward your expertise and dedication. Paid Time Off Essential Functions Performs follow-up on outstanding insurance balances within the required timeframe, obtaining payment confirmation or required documentation. Documents all actions taken on accounts within the appropriate system, ensuring a clear and traceable resolution process. Makes the required number of outbound calls to insurance payers while maintaining professional and courteous communication. Handles and resolves incoming correspondence within five days of receipt, updating the system with relevant information. Analyzes assigned accounts using AS400, Meditech, Accurint, Cerner, directory assistance, and credit reports to maximize collection efforts. Processes inbound and outbound calls professionally, providing exceptional customer service while resolving outstanding balances. Ensures proper application of account dispositions and follows self-pay policies and procedures. Adheres to all local, state, and federal laws and regulations, including FDCPA, TCPA, FCRA, CFPB, PCI, UDAAP, and HIPAA compliance standards. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. Qualifications H.S. Diploma or GED required Associate Degree in Business, Finance, Healthcare Administration, or a related field preferred 0-2 years of experience in medical collections, accounts receivable, billing, or healthcare revenue cycle operations required Experience working with insurance follow-up, claim resolution, and payer communication in a healthcare setting preferred Knowledge, Skills and Abilities Strong understanding of medical collections processes, payer reimbursement policies, and insurance claim resolution. Proficiency in electronic medical record (EMR) systems, patient accounting systems, and collections software. Knowledge of insurance contracts, denials management, and accounts receivable workflows. Excellent problem-solving and analytical skills to research and resolve outstanding claims. Effective verbal and written communication skills to interact with insurance payers, patients, and internal teams. Strong attention to detail with the ability to document account activity accurately. Ability to work independently in a fast-paced environment while meeting productivity and quality standards. Knowledge of regulatory compliance, including HIPAA, FDCPA, and applicable healthcare finance laws. We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible. The Shared Services Center - Nashville provides business office support functions like billing, insurance follow-up, call center customer service, data entry and more for hospitals and healthcare providers. But we're not only about work. We know employing a skilled and engaged team of professionals is vitally important to our success, so we make sure to offer competitive benefits, recognition programs, professional development opportunities and a fun and engaging team environment. Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.
$30k-35k yearly est. Auto-Apply 2d ago
Specialist, Appeals & Grievances
Molina Healthcare 4.4
Cleveland, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-38.4 hourly 22d ago
Specialist, Appeals & Grievances
Molina Healthcare Inc. 4.4
Cleveland, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties * Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. * Meets claims production standards set by the department. * Applies contract language, benefits and review of covered services to claims review process. * Contacts members/providers as needed via written and verbal communications. * Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). * Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. * Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. * Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. Required Qualifications * At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. * Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. * Customer service experience. * Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. * Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.7-38.4 hourly 6d ago
Specialist, Appeals & Grievances
Molina Healthcare 4.4
Cincinnati, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-38.4 hourly 22d ago
Specialist, Appeals & Grievances
Molina Healthcare 4.4
Akron, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-38.4 hourly 22d ago
Appeals & Grievances Specialist (Complaints & Grievances)
Molina Healthcare Inc. 4.4
Dayton, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties * Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. * Meets claims production standards set by the department. * Applies contract language, benefits and review of covered services to claims review process. * Contacts members/providers as needed via written and verbal communications. * Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). * Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. * Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. * Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. Required Qualifications * At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. * Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. * Customer service experience. * Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. * Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.7-38.4 hourly 47d ago
Appeals & Grievances Specialist (Complaints & Grievances)
Molina Healthcare 4.4
Dayton, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-38.4 hourly 46d ago
Specialist, Appeals & Grievances
Molina Healthcare 4.4
Dayton, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-38.4 hourly 22d ago
Specialist, Appeals & Grievances
Molina Healthcare Inc. 4.4
Dayton, OH jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties * Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. * Meets claims production standards set by the department. * Applies contract language, benefits and review of covered services to claims review process. * Contacts members/providers as needed via written and verbal communications. * Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). * Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. * Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. * Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. Required Qualifications * At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. * Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. * Customer service experience. * Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. * Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.7-38.4 hourly 6d ago
Appeals & Grievances Specialist (Complaints & Grievances)
Molina Healthcare Inc. 4.4
Ohio jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties * Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. * Meets claims production standards set by the department. * Applies contract language, benefits and review of covered services to claims review process. * Contacts members/providers as needed via written and verbal communications. * Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). * Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. * Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. * Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. Required Qualifications * At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. * Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. * Customer service experience. * Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Effective verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. * Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$21.7-38.4 hourly 47d ago
Specialist, Appeals & Grievances
Molina Healthcare 4.4
Ohio jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-38.4 hourly 22d ago
Appeals & Grievances Specialist (Complaints & Grievances)
Molina Healthcare 4.4
Ohio jobs
Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-38.4 hourly 46d ago
CDI Reconciliation Specialist
HCA Healthcare 4.5
Specialist job at HCA Healthcare
****This is a fully remote role, but you must live within 60 miles of an HCA facility**** **Introduction** Do you want to join an organization that invests in you as a CDI Reconciliation Specialist? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. **Benefits** HCA Healthcare offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity and Consumer Discounts + Retirement readiness, rollover assistance services and preferred banking partnerships + Education assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) + Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits (********************************************************************** **_Note: Eligibility for benefits may vary by location._** You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated CDI Reconciliation Specialist like you to be a part of our team. **Job Summary and Qualifications** **Assessment of Documentation:** + Performs high priority retrospective reviews of the complete medical record and the coding summary of assigned population. + Analyzes documented and clinically supported conditions in multiple electronic health record technologies to ensure complete documentation. + Performs independent coding of the record to assure that the HIM coding accurately reflects the documentation. + Ensures documented conditions, clarifications, and coded diagnoses are clinically supported. + As appropriate, enters or revises Working and Target DRGs that accurately reflect expected CDI query impact. + Demonstrates knowledge of Official Coding Guidelines and the DRG Classification System to insure regulatory compliance related to the CDI and coding functions. + Identifies and documents education opportunities for CDI Specialists + Thoroughly documents reviews and other pertinent information in designated systems by established deadlines. + Achieves and maintains key operating metrics consistent with CDI Reconciliation program requirements. **HSC Escalation:** + Using critical thinking skills, independent discretion, clinical judgement, Official Coding Guidelines, DRG Classification, and Coding Clinics determines when and/or if escalation to the HSC is necessary. + Escalates DRG mismatches with coding opportunities as appropriate per established protocols. + Monitors and documents HSC responses. **Strategic Relationships:** + Develops and strengthens collaborative relationships with stakeholders to advance the care of our patients + Actively encourages collaboration and possesses excellent interpersonal skills in building and maintaining crucial relationships + Delivers information in a clear, concise and compelling manner to facilitate accomplishment of work goals + Delivers targeted and actionable communications that invites two-way professional communication. Adjusts messages appropriately by audience + Demonstrates a willingness and ability to assist others **Self-Development:** + Demonstrates proficiency in current and emerging technologies + Simultaneously uses multiple technologies to complete unique patient-level reviews + Independently takes proactive steps toward problem resolution + Completes all mandatory and assigned education by established deadlines + Attends scheduled meetings and continuing education programs **Education & Experience:** + Bachelor's degree required + 5+ years of experience in acute inpatient CDI or equivalent combination of education and/or experience required **Licenses, Certifications, & Training:** + Registered Nurse - Currently licensed as a Registered Professional Nurse in the state of residence + Or any coding credential nationally recognized as administered through AHIMA or ACDIS required + (CDIP) Certified Documentation Improvement Practitioner, or (RN) Registered Nurse, or (COC) Certified Outpatient Coder, or (CCS) Certified Coding Specialist, or (CPC) Certified Professional Coder, or (RHIA) Registered Health Information Administrator, or (RHIT) Registered Health Information Technician, or (ACDIS-CCDS) Certified Clinical Documentation Specialist HCA Healthcare (Corporate) (************************************************** , based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleled **resources and opportunities** to reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education and **career advancement opportunities** , every person has a solid foundation for success. Nashville is also home to our **Executive Development Program** , where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Good people beget good people."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our CDI Reconciliation Specialist opening. Qualified candidates will be contacted for interviews. **Submit your resume today to join our community of caring!** We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
$45k-58k yearly est. 60d+ ago