Support Specialist jobs at HCA Healthcare - 29 jobs

CDI Reconciliation Specialist
HCA Healthcare 4.5
Support 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

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Application Support Specialist - Remote based in the US
Tenet Healthcare Corporation 4.5
Frisco, TX jobs
The Spec, Application Support is tasked with the optimization and management of specified technology. This position will work closely with various vendors, ensuring the most up-to-date information and changes are evaluated for use and effectiveness in the process. Will work with the process team to determine what technology changes and needs are required to drive process improvements. Will own the development and follow through of any service requests or new implementations. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Stays current and has deep, ingrained knowledge of systems, including end user applications, reporting and enhancements. Can demonstrate full understanding of how the technology supports and is used within specific processes and brings technology driven ideas to the process team. * Reviews all ISB's for procedural impact. Edits and works with process leaders and trainers to develop procedural and training documentation. Clarifies system processes and responds to additional requests for information. * Works closely with peers to reduce redundancies and ensure there are no conflicts between multiple technologies within processes. * Ensures that Software Transfer Implementations are completed accurately and develops test plans. Meets user deadlines for system changes and other requested information. * Coordinates with IS to ensure that facility IS departments have the knowledge required to ensure the front-end system is set up appropriately. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. * Understands workflow and technology needs within the business. * Excellent grammar and writing skills * Must have good organizational skills * Able to work independently with little supervision * Able to communicate with all levels of management * Must have general computer skills and be proficient in Word, Excel, and PowerPoint * Excellent working knowledge of Patient Financial Services operations with specific focus on applicable discipline. * Ability to work and coordinate with multiple parties * Ability to manage projects * Knowledge of AR management technology tools being utilized to deliver on key performance * Knowledge of healthcare regulatory rules and how they apply to revenue cycle operations and outsourcing service providers * Excellent verbal and written communication skills EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * 4-year college degree in Healthcare Administration, Business or related area or equivalent experience * 2 - 6 years of experience in Healthcare Administration or Business Office * Lean, Six Sigma or other process improvement certification is a plus PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Must be able to work in a sitting position, use computer and answer telephone WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Office Work Environment As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation * Pay: $21.70 - $34.70 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * Discretionary 401k match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. #LI-NO3 Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********
$21.7-34.7 hourly 60d+ ago
Representative, Support Center III - Bilingual (Spanish/English) Preferred
Molina Healthcare 4.4
Columbus, OH jobs
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences. Responsible for continuous quality improvements regarding member/provider engagement and retention. Represents Member/Provider issues in areas involving member/provider impact and engagement including: Appeals and Grievances, Problem Research and Resolution, and the development/maintenance of Member/Provider Materials. **Job Duties** - Provide service support to members and/or providers using one or more contact center communication channels and across multiple states and/or products. To include, but not limited to, phone, chat, email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business. Also provides product and service information, identifies opportunities to maintain and increase member/provider relationships and engagement. - Handles escalated calls on behalf of management. - Provides excellent customer service for all call center communication channels. - Accurately documents all member/provider communication - Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed. - Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations. - Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the customer's needs. - Achieves individual performance goals established for this position in the areas of call quality, attendance and scheduled adherence. - Engages and collaborates with other departments. - Demonstrates personal responsibility and accountability by taking ownership of the call/ issue and following it through to resolution, on behalf of the customer, in real time or through timely follow up with the customer. - Supports member needs for a wide variety of inquiries and assistance involving their benefits, claims, premiums, and other areas including very complex issues. Conducts initial research and works to immediately resolve issues. Appropriately escalates issues based on established risk criteria. - Supports provider needs for a wide variety of inquiries and assistance involving claims, authorizations, appeals, contracting, credentialing and other areas including the most complex issues. Conducts initial research and works to immediate resolve issues. Appropriately escalates issues based on established risk criteria. - Proficient in three or more lines of business (for example, Medicare, Medicaid, Marketplace, MMP) for members services, provider services and member retention. - Responds to incoming calls from providers on a variety of issues of varying complexity, including highly complex or executive issues. - Completes research for state, legislative or regulatory inquiries as applicable. - Gathers information to critically evaluate options, seeking alternative perspectives to identify root causes and develop solutions. - Achieves individual performance goals as it relates to call center objectives. - Proactively engages and collaborates with other departments as required. - Demonstrates personal responsibility and accountability by meeting or exceeding attendance and schedule adherence expectations. - Assists with formal training needs of other employees along with new hire or training classes as needed. - Supports provider and member needs for a wide variety of inquiries involving member eligibility, and covered benefits. - Provides inquiry assistance involving claims, authorizations, appeals, contracting, credentialing and other provider related issues. - Supports other inquiry areas including the most complex issues. - Conducts initial research and works to immediately resolve issues. - Appropriately escalates issues based on established risk criteria. - Recommends and implements programs to support member needs. - Resolves member inquiries and complaints fairly and effectively to ensure member retention. - Responds to incoming calls from members and providers. - Conducts member satisfaction assessment services and other member surveys as applicable and based on business needs - Assist other retention or inbound functions as dictated by service level requirements - Remains professional & courteous in verbal & written communications, utilizing concise & effective language at all times. **Job Qualifications** **REQUIRED EDUCATION** : Associate's Degree or equivalent combination of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : 3-5 years customer service or sales experience in a fast paced, high volume environment **PREFERRED EDUCATION** : Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE** : 5-7 years Proficient in systems utilized: + Microsoft Office + Genesys + Salesforce + Pega + QNXT + CRM + Verint + Kronos + Microsoft Teams + Video Conferencing + CVS Caremark + Availity + Molina Provider Portal + Others as required by line of business or state **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** : Broker/Healthcare insurance licensure To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-34.9 hourly 22d ago
Representative, Support Center III - Bilingual (Spanish/English) Preferred
Molina Healthcare 4.4
Cleveland, OH jobs
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences. Responsible for continuous quality improvements regarding member/provider engagement and retention. Represents Member/Provider issues in areas involving member/provider impact and engagement including: Appeals and Grievances, Problem Research and Resolution, and the development/maintenance of Member/Provider Materials. **Job Duties** - Provide service support to members and/or providers using one or more contact center communication channels and across multiple states and/or products. To include, but not limited to, phone, chat, email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business. Also provides product and service information, identifies opportunities to maintain and increase member/provider relationships and engagement. - Handles escalated calls on behalf of management. - Provides excellent customer service for all call center communication channels. - Accurately documents all member/provider communication - Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed. - Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations. - Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the customer's needs. - Achieves individual performance goals established for this position in the areas of call quality, attendance and scheduled adherence. - Engages and collaborates with other departments. - Demonstrates personal responsibility and accountability by taking ownership of the call/ issue and following it through to resolution, on behalf of the customer, in real time or through timely follow up with the customer. - Supports member needs for a wide variety of inquiries and assistance involving their benefits, claims, premiums, and other areas including very complex issues. Conducts initial research and works to immediately resolve issues. Appropriately escalates issues based on established risk criteria. - Supports provider needs for a wide variety of inquiries and assistance involving claims, authorizations, appeals, contracting, credentialing and other areas including the most complex issues. Conducts initial research and works to immediate resolve issues. Appropriately escalates issues based on established risk criteria. - Proficient in three or more lines of business (for example, Medicare, Medicaid, Marketplace, MMP) for members services, provider services and member retention. - Responds to incoming calls from providers on a variety of issues of varying complexity, including highly complex or executive issues. - Completes research for state, legislative or regulatory inquiries as applicable. - Gathers information to critically evaluate options, seeking alternative perspectives to identify root causes and develop solutions. - Achieves individual performance goals as it relates to call center objectives. - Proactively engages and collaborates with other departments as required. - Demonstrates personal responsibility and accountability by meeting or exceeding attendance and schedule adherence expectations. - Assists with formal training needs of other employees along with new hire or training classes as needed. - Supports provider and member needs for a wide variety of inquiries involving member eligibility, and covered benefits. - Provides inquiry assistance involving claims, authorizations, appeals, contracting, credentialing and other provider related issues. - Supports other inquiry areas including the most complex issues. - Conducts initial research and works to immediately resolve issues. - Appropriately escalates issues based on established risk criteria. - Recommends and implements programs to support member needs. - Resolves member inquiries and complaints fairly and effectively to ensure member retention. - Responds to incoming calls from members and providers. - Conducts member satisfaction assessment services and other member surveys as applicable and based on business needs - Assist other retention or inbound functions as dictated by service level requirements - Remains professional & courteous in verbal & written communications, utilizing concise & effective language at all times. **Job Qualifications** **REQUIRED EDUCATION** : Associate's Degree or equivalent combination of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : 3-5 years customer service or sales experience in a fast paced, high volume environment **PREFERRED EDUCATION** : Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE** : 5-7 years Proficient in systems utilized: + Microsoft Office + Genesys + Salesforce + Pega + QNXT + CRM + Verint + Kronos + Microsoft Teams + Video Conferencing + CVS Caremark + Availity + Molina Provider Portal + Others as required by line of business or state **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** : Broker/Healthcare insurance licensure To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-34.9 hourly 22d ago
Application Systems Programming Specialist (Remote)
Community Health Systems 4.5
Remote
Community Health Systems is seeking an Application Systems Programming Specialist to join its Integration Services team. This advanced technical role is responsible for leading the analysis, design, development, and support of complex system interfaces within a healthcare environment. The specialist will demonstrate expertise in industry trends, best practices, and interface programming using tools such as Mirth, Intersystems, and Rhapsody. Key responsibilities include ensuring seamless data integration, maintaining comprehensive documentation, and providing proactive solutions to optimize system performance. This role requires collaboration with internal and external stakeholders to achieve business objectives and the ability to manage complex technical projects in dynamic environments. Essential Functions Mirth Connect (Primary Focus) Develop, maintain, and monitor HL7/FHIR interfaces using Mirth Connect. Manage channels, transformations, filters, and communication protocols (TCP, SFTP, REST, etc.). Handle Mirth upgrades, performance tuning, and participate in Disaster Recovery/High Availability (DR/HA) documentation and validation. Collaborate with platform specialists to ensure high availability and platform integrity. Troubleshoot production issues and lead root cause analysis across a diverse ecosystem of clinical systems and vendors. Coordinate with offshore/onshore teams for 24x7 support coverage. InterSystems HealthShare (Strategic Focus) Participate in the pilot deployment of HealthShare Health Connect. Build and configure message routes, transformations, and business processes using HealthShare components (IRIS, Ensemble). Support platform consolidation planning across fragmented integration engines. Assist in evaluating cloud-hosted options (e.g., Google Cloud Platform) for future-state deployment. Interoperability & Standards Work closely with the Technical Integration Manager and enterprise architecture team. Implement and support workflows involving HL7 v2/v3, FHIR R4, X12, Continuity of Care Document (CCD), and Clinical Document Architecture (CDA). Contribute to roadmap planning for advanced Health Information Exchange (HIE) participation, API adoption, and care coordination use cases. Documentation & Communication Develop and maintain documentation including design specifications, test cases, support runbooks, and DR plans. Communicate effectively with hospital IT teams, vendors (Cerner, Medhost, Athena), and state agencies. Qualifications Bachelor's degree in Computer Science or Information Technology. 8+ years of hands-on integration engine experience in a healthcare integration environment. 5+ years of hands-on Mirth Connect experience in a healthcare integration environment. Strong working knowledge of HL7 v2.x, FHIR, CCD/CDA, and interfacing protocols. At least 2 years of experience with InterSystems HealthShare (Health Connect or Ensemble). Experience supporting production interfaces in mission-critical hospital or HIE environments. Familiarity with EMRs such as Cerner, Athena, Medhost, or Epic. Basic scripting experience (JavaScript, XSLT, or Python preferred). Ability to contribute to a 24x7 on-call rotation. Preferred Qualifications: Experience with cloud-based integration (Google Cloud Platform preferred). Familiarity with Carequality/CommonWell networks, immunization registries, and HIE frameworks. Understanding of HIPAA, HITECH, and healthcare compliance.
$25k-41k yearly est. Auto-Apply 60d+ ago
Representative, Support Center III - Bilingual (Spanish/English) Preferred
Molina Healthcare 4.4
Cincinnati, OH jobs
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences. Responsible for continuous quality improvements regarding member/provider engagement and retention. Represents Member/Provider issues in areas involving member/provider impact and engagement including: Appeals and Grievances, Problem Research and Resolution, and the development/maintenance of Member/Provider Materials. **Job Duties** - Provide service support to members and/or providers using one or more contact center communication channels and across multiple states and/or products. To include, but not limited to, phone, chat, email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business. Also provides product and service information, identifies opportunities to maintain and increase member/provider relationships and engagement. - Handles escalated calls on behalf of management. - Provides excellent customer service for all call center communication channels. - Accurately documents all member/provider communication - Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed. - Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations. - Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the customer's needs. - Achieves individual performance goals established for this position in the areas of call quality, attendance and scheduled adherence. - Engages and collaborates with other departments. - Demonstrates personal responsibility and accountability by taking ownership of the call/ issue and following it through to resolution, on behalf of the customer, in real time or through timely follow up with the customer. - Supports member needs for a wide variety of inquiries and assistance involving their benefits, claims, premiums, and other areas including very complex issues. Conducts initial research and works to immediately resolve issues. Appropriately escalates issues based on established risk criteria. - Supports provider needs for a wide variety of inquiries and assistance involving claims, authorizations, appeals, contracting, credentialing and other areas including the most complex issues. Conducts initial research and works to immediate resolve issues. Appropriately escalates issues based on established risk criteria. - Proficient in three or more lines of business (for example, Medicare, Medicaid, Marketplace, MMP) for members services, provider services and member retention. - Responds to incoming calls from providers on a variety of issues of varying complexity, including highly complex or executive issues. - Completes research for state, legislative or regulatory inquiries as applicable. - Gathers information to critically evaluate options, seeking alternative perspectives to identify root causes and develop solutions. - Achieves individual performance goals as it relates to call center objectives. - Proactively engages and collaborates with other departments as required. - Demonstrates personal responsibility and accountability by meeting or exceeding attendance and schedule adherence expectations. - Assists with formal training needs of other employees along with new hire or training classes as needed. - Supports provider and member needs for a wide variety of inquiries involving member eligibility, and covered benefits. - Provides inquiry assistance involving claims, authorizations, appeals, contracting, credentialing and other provider related issues. - Supports other inquiry areas including the most complex issues. - Conducts initial research and works to immediately resolve issues. - Appropriately escalates issues based on established risk criteria. - Recommends and implements programs to support member needs. - Resolves member inquiries and complaints fairly and effectively to ensure member retention. - Responds to incoming calls from members and providers. - Conducts member satisfaction assessment services and other member surveys as applicable and based on business needs - Assist other retention or inbound functions as dictated by service level requirements - Remains professional & courteous in verbal & written communications, utilizing concise & effective language at all times. **Job Qualifications** **REQUIRED EDUCATION** : Associate's Degree or equivalent combination of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : 3-5 years customer service or sales experience in a fast paced, high volume environment **PREFERRED EDUCATION** : Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE** : 5-7 years Proficient in systems utilized: + Microsoft Office + Genesys + Salesforce + Pega + QNXT + CRM + Verint + Kronos + Microsoft Teams + Video Conferencing + CVS Caremark + Availity + Molina Provider Portal + Others as required by line of business or state **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** : Broker/Healthcare insurance licensure To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-34.9 hourly 22d ago
Representative, Support Center III - Bilingual (Spanish/English) Preferred
Molina Healthcare 4.4
Akron, OH jobs
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences. Responsible for continuous quality improvements regarding member/provider engagement and retention. Represents Member/Provider issues in areas involving member/provider impact and engagement including: Appeals and Grievances, Problem Research and Resolution, and the development/maintenance of Member/Provider Materials. **Job Duties** - Provide service support to members and/or providers using one or more contact center communication channels and across multiple states and/or products. To include, but not limited to, phone, chat, email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business. Also provides product and service information, identifies opportunities to maintain and increase member/provider relationships and engagement. - Handles escalated calls on behalf of management. - Provides excellent customer service for all call center communication channels. - Accurately documents all member/provider communication - Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed. - Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations. - Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the customer's needs. - Achieves individual performance goals established for this position in the areas of call quality, attendance and scheduled adherence. - Engages and collaborates with other departments. - Demonstrates personal responsibility and accountability by taking ownership of the call/ issue and following it through to resolution, on behalf of the customer, in real time or through timely follow up with the customer. - Supports member needs for a wide variety of inquiries and assistance involving their benefits, claims, premiums, and other areas including very complex issues. Conducts initial research and works to immediately resolve issues. Appropriately escalates issues based on established risk criteria. - Supports provider needs for a wide variety of inquiries and assistance involving claims, authorizations, appeals, contracting, credentialing and other areas including the most complex issues. Conducts initial research and works to immediate resolve issues. Appropriately escalates issues based on established risk criteria. - Proficient in three or more lines of business (for example, Medicare, Medicaid, Marketplace, MMP) for members services, provider services and member retention. - Responds to incoming calls from providers on a variety of issues of varying complexity, including highly complex or executive issues. - Completes research for state, legislative or regulatory inquiries as applicable. - Gathers information to critically evaluate options, seeking alternative perspectives to identify root causes and develop solutions. - Achieves individual performance goals as it relates to call center objectives. - Proactively engages and collaborates with other departments as required. - Demonstrates personal responsibility and accountability by meeting or exceeding attendance and schedule adherence expectations. - Assists with formal training needs of other employees along with new hire or training classes as needed. - Supports provider and member needs for a wide variety of inquiries involving member eligibility, and covered benefits. - Provides inquiry assistance involving claims, authorizations, appeals, contracting, credentialing and other provider related issues. - Supports other inquiry areas including the most complex issues. - Conducts initial research and works to immediately resolve issues. - Appropriately escalates issues based on established risk criteria. - Recommends and implements programs to support member needs. - Resolves member inquiries and complaints fairly and effectively to ensure member retention. - Responds to incoming calls from members and providers. - Conducts member satisfaction assessment services and other member surveys as applicable and based on business needs - Assist other retention or inbound functions as dictated by service level requirements - Remains professional & courteous in verbal & written communications, utilizing concise & effective language at all times. **Job Qualifications** **REQUIRED EDUCATION** : Associate's Degree or equivalent combination of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : 3-5 years customer service or sales experience in a fast paced, high volume environment **PREFERRED EDUCATION** : Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE** : 5-7 years Proficient in systems utilized: + Microsoft Office + Genesys + Salesforce + Pega + QNXT + CRM + Verint + Kronos + Microsoft Teams + Video Conferencing + CVS Caremark + Availity + Molina Provider Portal + Others as required by line of business or state **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** : Broker/Healthcare insurance licensure To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-34.9 hourly 22d ago
Representative, Support Center III - Bilingual (Spanish/English) Preferred
Molina Healthcare 4.4
Dayton, OH jobs
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences. Responsible for continuous quality improvements regarding member/provider engagement and retention. Represents Member/Provider issues in areas involving member/provider impact and engagement including: Appeals and Grievances, Problem Research and Resolution, and the development/maintenance of Member/Provider Materials. **Job Duties** - Provide service support to members and/or providers using one or more contact center communication channels and across multiple states and/or products. To include, but not limited to, phone, chat, email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business. Also provides product and service information, identifies opportunities to maintain and increase member/provider relationships and engagement. - Handles escalated calls on behalf of management. - Provides excellent customer service for all call center communication channels. - Accurately documents all member/provider communication - Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed. - Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations. - Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the customer's needs. - Achieves individual performance goals established for this position in the areas of call quality, attendance and scheduled adherence. - Engages and collaborates with other departments. - Demonstrates personal responsibility and accountability by taking ownership of the call/ issue and following it through to resolution, on behalf of the customer, in real time or through timely follow up with the customer. - Supports member needs for a wide variety of inquiries and assistance involving their benefits, claims, premiums, and other areas including very complex issues. Conducts initial research and works to immediately resolve issues. Appropriately escalates issues based on established risk criteria. - Supports provider needs for a wide variety of inquiries and assistance involving claims, authorizations, appeals, contracting, credentialing and other areas including the most complex issues. Conducts initial research and works to immediate resolve issues. Appropriately escalates issues based on established risk criteria. - Proficient in three or more lines of business (for example, Medicare, Medicaid, Marketplace, MMP) for members services, provider services and member retention. - Responds to incoming calls from providers on a variety of issues of varying complexity, including highly complex or executive issues. - Completes research for state, legislative or regulatory inquiries as applicable. - Gathers information to critically evaluate options, seeking alternative perspectives to identify root causes and develop solutions. - Achieves individual performance goals as it relates to call center objectives. - Proactively engages and collaborates with other departments as required. - Demonstrates personal responsibility and accountability by meeting or exceeding attendance and schedule adherence expectations. - Assists with formal training needs of other employees along with new hire or training classes as needed. - Supports provider and member needs for a wide variety of inquiries involving member eligibility, and covered benefits. - Provides inquiry assistance involving claims, authorizations, appeals, contracting, credentialing and other provider related issues. - Supports other inquiry areas including the most complex issues. - Conducts initial research and works to immediately resolve issues. - Appropriately escalates issues based on established risk criteria. - Recommends and implements programs to support member needs. - Resolves member inquiries and complaints fairly and effectively to ensure member retention. - Responds to incoming calls from members and providers. - Conducts member satisfaction assessment services and other member surveys as applicable and based on business needs - Assist other retention or inbound functions as dictated by service level requirements - Remains professional & courteous in verbal & written communications, utilizing concise & effective language at all times. **Job Qualifications** **REQUIRED EDUCATION** : Associate's Degree or equivalent combination of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : 3-5 years customer service or sales experience in a fast paced, high volume environment **PREFERRED EDUCATION** : Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE** : 5-7 years Proficient in systems utilized: + Microsoft Office + Genesys + Salesforce + Pega + QNXT + CRM + Verint + Kronos + Microsoft Teams + Video Conferencing + CVS Caremark + Availity + Molina Provider Portal + Others as required by line of business or state **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** : Broker/Healthcare insurance licensure To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-34.9 hourly 22d ago
Representative, Support Center III - Bilingual (Spanish/English) Preferred
Molina Healthcare 4.4
Ohio jobs
Provides customer support and stellar service to meet the needs of our Molina members and providers. Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions. Provides product and service information, and identifies opportunities to improve our member and provider experiences. Responsible for continuous quality improvements regarding member/provider engagement and retention. Represents Member/Provider issues in areas involving member/provider impact and engagement including: Appeals and Grievances, Problem Research and Resolution, and the development/maintenance of Member/Provider Materials. **Job Duties** - Provide service support to members and/or providers using one or more contact center communication channels and across multiple states and/or products. To include, but not limited to, phone, chat, email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business. Also provides product and service information, identifies opportunities to maintain and increase member/provider relationships and engagement. - Handles escalated calls on behalf of management. - Provides excellent customer service for all call center communication channels. - Accurately documents all member/provider communication - Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed. - Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations. - Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the customer's needs. - Achieves individual performance goals established for this position in the areas of call quality, attendance and scheduled adherence. - Engages and collaborates with other departments. - Demonstrates personal responsibility and accountability by taking ownership of the call/ issue and following it through to resolution, on behalf of the customer, in real time or through timely follow up with the customer. - Supports member needs for a wide variety of inquiries and assistance involving their benefits, claims, premiums, and other areas including very complex issues. Conducts initial research and works to immediately resolve issues. Appropriately escalates issues based on established risk criteria. - Supports provider needs for a wide variety of inquiries and assistance involving claims, authorizations, appeals, contracting, credentialing and other areas including the most complex issues. Conducts initial research and works to immediate resolve issues. Appropriately escalates issues based on established risk criteria. - Proficient in three or more lines of business (for example, Medicare, Medicaid, Marketplace, MMP) for members services, provider services and member retention. - Responds to incoming calls from providers on a variety of issues of varying complexity, including highly complex or executive issues. - Completes research for state, legislative or regulatory inquiries as applicable. - Gathers information to critically evaluate options, seeking alternative perspectives to identify root causes and develop solutions. - Achieves individual performance goals as it relates to call center objectives. - Proactively engages and collaborates with other departments as required. - Demonstrates personal responsibility and accountability by meeting or exceeding attendance and schedule adherence expectations. - Assists with formal training needs of other employees along with new hire or training classes as needed. - Supports provider and member needs for a wide variety of inquiries involving member eligibility, and covered benefits. - Provides inquiry assistance involving claims, authorizations, appeals, contracting, credentialing and other provider related issues. - Supports other inquiry areas including the most complex issues. - Conducts initial research and works to immediately resolve issues. - Appropriately escalates issues based on established risk criteria. - Recommends and implements programs to support member needs. - Resolves member inquiries and complaints fairly and effectively to ensure member retention. - Responds to incoming calls from members and providers. - Conducts member satisfaction assessment services and other member surveys as applicable and based on business needs - Assist other retention or inbound functions as dictated by service level requirements - Remains professional & courteous in verbal & written communications, utilizing concise & effective language at all times. **Job Qualifications** **REQUIRED EDUCATION** : Associate's Degree or equivalent combination of education and experience **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : 3-5 years customer service or sales experience in a fast paced, high volume environment **PREFERRED EDUCATION** : Bachelor's Degree or equivalent combination of education and experience **PREFERRED EXPERIENCE** : 5-7 years Proficient in systems utilized: + Microsoft Office + Genesys + Salesforce + Pega + QNXT + CRM + Verint + Kronos + Microsoft Teams + Video Conferencing + CVS Caremark + Availity + Molina Provider Portal + Others as required by line of business or state **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION** : Broker/Healthcare insurance licensure To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. 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 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$21.7-34.9 hourly 22d ago
IT Specialty Support & Process Improvement
Community Health Systems 4.5
Remote
CHSPSC, LLC seeks an IT Specialty Services Support & Process Analyst to assist with leading escalated support activities and provide process improvement initiatives. The department handles services lines such as Surgery, Anesthesia, OB/Perinatal, and others. The role will be involved with the facilitation of application services management processes pertaining to analyzing value, evaluating risk, prioritizing projects and onboarding new technology requests to ensure alignment with organizational strategies for the service lines. Key responsibilities include: Alignment with the service lines to address escalated support issues Review transition materials from the Project Management Office for application product ownership Develop and maintain application support plans Document current state and contribute to the direction of the application lifecycle management (LCM) roadmap to reduce costs, mitigate risks, and drive growth and revenue Participate in related efforts such as Disaster Recovery exercises, Cyber Table Top exercises, etc. Present to executive leadership on support-related issues Understand current processes and propose more efficient methods Strategic analysis of the enterprise application portfolio including lifecycle management, application rationalization, consolidation and standardization to achieve the department objectives of the organization including reducing variation of redundant or unused applications Understand the definition, implementation and support of portfolio management standards, policies and processes Understand the data driven decisions pertaining to IT project investments Participate in the structure, attributes, taxonomies and nomenclature of service line elements and categories within the repository toolset (ServiceNow) to ensure completeness and accuracy of the list of enterprise IT business applications Collaborate with business partners, technology leaders and department directors to identify and promote adoption of enterprise standards and rationalization of application systems to achieve economic and patient experience improvement goals Provide expertise on decisions and priorities regarding the overall enterprise application portfolio Track application and vendor trends and maintain knowledge of new technologies to support the organization's current and future needs Maintain an awareness of industry standard best practices and apply relevant methodologies for process improvement Participate in application rationalization feasibility analysis and proposals for management and business partners which support the organization's clinical and economic objectives Review and support applications' advantages, risks, costs, benefits and impact on the enterprise business process and goals Develop and maintain productive relationships of trust both within and outside CHS and embrace the authoritative role in respect to maintaining enterprise standards and align others to the strategic direction Collaborate with Audit teams to respond to and mitigate audit findings and manage audit controls related to application systems and LCM Educate peers and business partners on department methodologies and drive adoption of standard process Support and evaluate portfolio risks and recommend mitigation plans Support business impact analysis and application criticality assessments Partner with key business and delivery stakeholders to conduct application and service line reviews including scope, metrics, expenses and net promoter scores to determine the disposition of existing and proposed solutions Communicate timely and accurate status to appropriate levels and stakeholders including the development and delivery of status reports and presentations Required: Results oriented mentality to drive accurate deliverables with appropriate time to market while taking responsibility for the outcomes Customer focused to align services with customer needs Creativity in developing and executing innovative strategies to meet unique customer needs Excellent verbal and written communication, presentation and customer service skills Ability to handle pressure to meet business requirement demands and deadlines Expertise in analyzing and presenting large volumes of data to senior leadership Critical thinking in developing proposals with sound analysis and achievable outcomes Ability to prioritize tasks and quickly adjust in a rapidly changing environment Exceptional analytic problem solving skills Ability to work independently and in a team environment Organizational awareness and the ability to understand relationships to get things accomplished more effectively Preferred: Experience with APM, CMDB and CSDM components within the ServiceNow platform Application product ownership experience Strong relationship management experience Project management experience/certification 2 or more years in an application portfolio/services management role Lean / Six Sigma Green Belt ITIL certifications Qualifications and Education Requirements: Bachelor's degree in Clinical Informatics, Health Science, Information Systems, Computer Science or a related discipline, or 2 years of relevant experience
$27k-33k yearly est. Auto-Apply 60d+ ago
Specialist, Appeals & Grievances
Molina Healthcare Inc. 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. 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
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
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 Inc. 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. 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 Inc. 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. 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 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
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
Specialist, Appeals & 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 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