Claim Specialist jobs at LogixHealth

BroadPath is excited to announce that we are hiring **Work-From-Home Claims Processors!** In this role, you'll play a key part in ensuring the accurate and timely entry, review, and resolution of simple to moderately complex Medicaid claims. You'll follow established guidelines, procedures, and client policies while helping deliver a smooth, efficient claims experience. **Compensation Highlights:** + Base Pay: $18.00 per hour + Pay Frequency **:** Weekly **Schedule Highlights:** + Training Schedule: 1 week, Monday-Friday, 8:00 AM - 5:00 PM AZ + Production Schedule: Monday-Friday, 8:00 AM - 5:00 PM AZ, no weekends! **Responsibilities** + Process incoming Medicaid claims in accordance with all applicable policies, procedures, and guidelines + Verify that all required data fields are present and that necessary medical records are included and reviewed when required + Refer claims for medical claim review when appropriate + Work effectively in a virtual, work-from-home environment while accurately processing claims **Qualifications** + 2+ years of recent health insurance claims processing experience + Ability to maintain balanced performance across production and quality + Ability to uphold confidentiality and present a professional business image + Positive attitude, strong reliability, and the ability to work independently from home while collaborating well with a team **Preferred** + Prior experience processing Medicaid claims highly preferred but not required + Prior work-from-home experience + IDX system experience + AHCCCS system experience + Experience with Citrix, Siebel, HPIS, DataNet, Excel, and SharePoint **Diversity Statement** _At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!_ _Equal Employment Opportunity/Disability/Veterans_ _If you need accommodation due to a disability, please email us at_ _*****************_ _. This information will be held in confidence and used only to determine an appropriate accommodation for the application process._ _BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law._ _Compensation: BroadPath has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location._

At Zurich North America Claims we acknowledge that work life-balance and flexibility are a priority when it comes to choosing your next career move. Designed with our employees' needs in mind, the ZNA Claims hybrid work model emphasizes flexibility, allowing claims employees to conduct individual work in their preferred location, while facilitating in-person connections and collaborative activities when meaningful and valuable. While the model provides a high level of flexibility and autonomy, occasional circumstances requiring in-office attendance should be expected. The candidate selected for this opportunity should be able to report into one of the following North American Claims offices: Dallas, TX; Maitland, FL; or Schaumburg, IL. About the Role: Zurich is currently seeking an individual interested in growing their career with our General Liability team. As a General Liability (GL) Claims Specialist, you will work with a diverse team of claims professionals. This environment will support your development as you enhance your technical skills in GL policy interpretation and coverage analysis to effectively resolve claims. Key Responsibilities: Handle non-litigated GL claims of low to moderate exposure and complexity, such as slip/trip and falls, product liability, and other third-party injuries resulting from premises liability exposures. Manage a caseload within specified authority limits from beginning to end with coaching and supervision. Collaborate and develop partnerships with internal and external points of contact, including customers, vendors, suppliers, and brokers, to provide a quality claims experience. Learn and develop knowledge of established protocols and industry best practices to ensure efficient, effective, and customer-centric claims handling. Basic Qualifications: Bachelor's Degree and 2 or more years of experience in Claims Handling or Insurance; OR Completion of Zurich Claims Training Program and 2 or more years of experience in the Claims or Insurance area OR Zurich Certified Insurance Apprentice including an Associate Degree with 2 or more years of experience in Claims Handling or Insurance; OR High School Diploma or Equivalent and 4 or more years of experience in Claims Handling or Insurance. Additional Requirements: Must obtain and maintain required adjuster license(s) Proficiency in Microsoft Office Knowledge of insurance regulations, markets, and products Preferred Qualifications: General liability claims handling experience Active adjuster's license Experience collaborating across work groups Ability to develop and maintain strong relationships Understanding of the claims adjustment process and ability to determine scope/exposure for losses Knowledge of vendor utilization and litigation strategy development Financial and actuarial/reserving concepts comprehension Familiarity with negotiation strategies and alternative approaches Strong organizational and time management skills Customer service experience Strong analytical, critical thinking, and problem-solving skills Excellent verbal and written communication skills Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to apply-your unique background matters to us. The pay range shown is a national average and may vary by location. The proposed Salary range for this position is $48,600.00 - $79,500.00, with short-term incentive bonus eligibility set at 10%. We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here.] Why Zurich? At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment-so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500 . Join us for a brighter future-for yourself and our customers. Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets. Zurich complies with 18 U.S. Code § 1033. Please note: Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal. Location(s): AM - Addison, AM - Maitland, AM - Schaumburg Remote Working: Hybrid Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-MM1 #LI-HYBRID

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

Zurich North America is currently hiring a Litigation Claims Specialist to join our Auto Bodily Injury Team. At Zurich North America Claims, we prioritize work-life balance and flexibility to support your career and personal goals. Our hybrid work model is thoughtfully designed to offer employees flexibility in choosing their preferred work location while fostering meaningful in-person connections and collaborative opportunities. While this model emphasizes autonomy, occasional in-office attendance may be required. The selected candidate should be able to report to one of our major claims hub offices in: Atlanta, GA Addison, TX Omaha, NE Overland Park, KS Schaumburg, IL Gold River, CA Job Responsibilities: Under moderate supervision, the Auto Litigation Claims Specialist II will manage commercial line auto claims of low to moderate complexity and exposure within specific authority limits. This includes auto property damage and injury claims both litigated and non litigated, uninsured and underinsured motorist claims. This role adheres to established claims-handling protocols, delivering efficient, customer-focused service. Basic Qualifications: Bachelor's Degree with 3+ years of experience in Claims or Insurance OR Zurich Certified Insurance Apprentice (including an Associate Degree) with 3+ years of experience in Claims or Insurance OR Completion of the Zurich Claims Training Program with 3+ years of experience in Claims or Insurance OR High School Diploma (or equivalent) with 5+ years of experience in Claims or Insurance Must obtain and maintain required adjuster license(s) Knowledge of insurance regulations, markets, and products Proficiency in Microsoft Office Preferred Qualifications: 3-5 years' experience handling commercial auto litigated claims Experience managing bodily injury and litigated claims Familiarity with uninsured and underinsured motorist coverage Strong verbal and written communication skills Proven analytical, critical thinking, and problem-solving abilities Effective time management, prioritization, and multi-tasking skills Experience working collaboratively within a team and building cross-functional relationships Proficiency in explaining complex financial and/or actuarial concepts Ability to assess scope and exposure for moderately complex claims Understanding of the reserving process for indemnity and expense to analyze potential claim exposure Skill in developing and executing negotiation strategies for claim resolution Your pay at Zurich is based on your role, location, skills, and experience. We follow local laws to ensure fair compensation. You may also be eligible for bonuses and merit increases. If your expectations are above the listed range, we still encourage you to apply-your unique background matters to us. The pay range shown is a national average and may vary by location. For this position, the salary is $58,700.00 - $96,200.00, plus a short-term incentive bonus of 10%. We offer competitive pay and comprehensive benefits for employees and their families. [Learn more about Total Rewards here.] Why Zurich? At Zurich, we value your ideas and experience. We offer growth, inclusion, and a supportive environment-so you can help shape the future of insurance. Zurich North America is a leader in risk management, with over 150 years of expertise and coverage across 25+ industries, including 90% of the Fortune 500 . Join us for a brighter future-for yourself and our customers. Zurich in North America does not discriminate based on race, ethnicity, color, religion, national origin, sex, gender expression, gender identity, genetic information, age, disability, protected veteran status, marital status, sexual orientation, pregnancy or other characteristics protected by applicable law. Equal Opportunity Employer disability/vets. Zurich complies with 18 U.S. Code § 1033. Please note: Zurich does not accept unsolicited CVs from agencies. Preferred vendors should use our Recruiting Agency Portal. Location(s): AM - Addison, AM - Atlanta, AM - Gold River, AM - Omaha, AM - Overland Park, AM - Schaumburg Remote Working: Hybrid Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-JJ1 #LI-ASSOCIATE #LI-HYBRID

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of the Claims Production Manager and Supervisor, the Claims Processor Level II will be processing outpatient professional and institutional claims. This includes but is not limited to; lab, radiology, ambulance, behavior health, outpatient COB, dialysis, oncology/chemo, hospital exclusions etc., in an accurate and expedient manner. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary Telecommute schedule CalPERS retirement State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account - Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities Responsible for non-delegated provider claims verification and adjudication. Adjudicate all professional and outpatient claims including COB, denials, and reduction in service notifications. Meet Regulatory Compliance Regulations on turnaround times and claim payments. Read and interpret Medi-Cal/Medicare Fee Schedules. Must be able to make a sound determination if claim is eligible for payment or denial. Interface with other IEHP Departments, when necessary, regarding claims issues. Participate in Claims Department staff meetings, and other activities as needed. Responsible for meeting the performance measurement standards for productivity and accuracy. Any other duties as required to ensure the Health Plan operations are successful. Qualifications Education & Requirements Minimum of two (2) years of experience adjudicating outpatient professional and/or institutional claims preferably in an HMO or Managed Care setting Processing of Medicare, Medi-Cal, or Commercial claims required Proficient in rate applications for Medi-Cal and/or Medicare pricers High school diploma or GED required Key Qualifications ICD-9 and CPT coding and general practices of claims processing Knowledge of capitated managed care environment preferred Microcomputer skills, proficiency in Windows applications preferred Excellent communication and interpersonal skills, strong organizational skills Professional demeanor Must be computer literate, maintain good attendance, and have the right attitude and discipline to work from home Data entry involving computer keyboard and screens, filing, and copying of records and/or correspondence Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Pay Range USD $23.98 - USD $30.57 /Hr.

This position is a temporary role facilitated through one of our contracted agencies and is not a direct employment opportunity with IEHP. The contracted agency offers an assignment length of up to six months, during which the candidate will provide support for IEHP. What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of the Claims Production Manager and Supervisor, the Claims Processor Level II will be processing outpatient professional and institutional claims. This includes but is not limited to; lab, radiology, ambulance, behavior health, outpatient COB, dialysis, oncology/chemo, hospital exclusions etc., in an accurate and expedient manner. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Key Responsibilities Responsible for non-delegated provider claims verification and adjudication. Adjudicate all professional and outpatient claims including COB, denials, and reduction in service notifications. Meet Regulatory Compliance Regulations on turnaround times and claim payments. Read and interpret Medi-Cal/Medicare Fee Schedules. Must be able to make a sound determination if claim is eligible for payment or denial. Interface with other IEHP Departments, when necessary, regarding claims issues. Participate in Claims Department staff meetings, and other activities as needed. Responsible for meeting the performance measurement standards for productivity and accuracy. Any other duties as required to ensure the Health Plan operations are successful. Qualifications Education & Requirements Minimum of two (2) years of experience adjudicating outpatient professional and/or institutional claims preferably in an HMO or Managed Care setting Processing of Medicare, Medi-Cal, or Commercial claims required Proficient in rate applications for Medi-Cal and/or Medicare pricers High school diploma or GED required Key Qualifications ICD-9 and CPT coding and general practices of claims processing Prefer knowledge of capitated managed care environment Microcomputer skills, proficiency in Windows applications preferred Excellent communication and interpersonal skills, strong organizational skills Professional demeanor Must be computer literate, maintain good attendance, and have the right attitude and discipline to work from home Data entry involving computer keyboard and screens, filing, and copying of records and/or correspondence Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location Telecommute Pay Range USD $23.98 - USD $23.98 /Hr.

Come to work with us at Community Health Services! We offer full-time benefits, 10 paid holidays, no weekend hours and so much more! We are looking for a full-time Claims Specialist to work in our Fremont office. CHS employs those who are eager to grow professionally, gain great experience, and work with a terrific team. The Claims Specialist will be responsible for performing general finance functions, entering encounters, processing and recording claims and all other duties as assigned. Hours for this position are: Mondays 7am-7pm, Tuesdays through Thursdays 8am-5pm, Fridays 8am-1pm Qualified candidates must have the following to be considered for employment: * Associate's degree from an accredited college or university * Experience in accounting/bookkeeping * Demonstrates ability to organize and implement general accounting and bookkeeping procedures for a healthcare organization * Ability to work with clinic personnel and patients in a courteous, cooperative manner * Ability to function as part of a team * Must have excellent customer service skills * Must have excellent multi-tasking, problem solving, and decision-making skills * Ability to follow instructions with attention to detail * Demonstrates professional relationship skills, and a strong work ethic * Prioritizes responsibilities, takes initiative, and possesses excellent organizational skills * Demonstrates effective communication skills * Ability to work with a culturally diverse group of people At CHS, we value our team and the critical role they play in patient care. If you're dependable, detail-oriented, and passionate about making a difference in your community, we'd love to hear from you. CHS is a drug-free/nicotine free organization. Candidates must pass a drug and nicotine screening upon employment offer.

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com. If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! Benefits and Perks include: * Affordable Medical/Dental/Vision insurance options * Generous paid time-off program and paid holidays for full time staff * TeleMedicine 24/7/365 access to doctors * Optional short- and long-term disability plans * Employee Assistance Plan (EAP) * 401K retirement accounts * Employee Referral Bonus Program ESSENTIAL JOB DUTIES: To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation. * Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials * Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards * Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment * Work assigned claim projects to completion * Provide a high level of customer service to internal and external customers; achieve quality and productivity goals * Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures * Maintain production and quality standards as established by management * Participate in and support ad-hoc audits as needed * Other duties as assigned JOB REQUIREMENTS: * Proficient in processing/auditing claims for Medicare and Medicaid plans * Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations * Current experience with both Institutional and Professional claim payments * Knowledge of automated claims processing systems * Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office. REQUIRED QUALIFICATIONS: * Experience: * Two (2) years' experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system * Two (2) years' experience in managed healthcare environment related to claims processing/audit * Two (2) years' experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS * Two (2) years' experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations * Two (2) years' experience processing/auditing claims for Medicare and Medicaid plans * License/Certification(s): * Coding certification preferred EQUAL OPPORTUNITY EMPLOYER Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. This employer participates in E-Verify.

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com. If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! Benefits and Perks include: * Affordable Medical/Dental/Vision insurance options * Generous paid time-off program and paid holidays for full time staff * TeleMedicine 24/7/365 access to doctors * Optional short- and long-term disability plans * Employee Assistance Plan (EAP) * 401K retirement accounts * Employee Referral Bonus Program ESSENTIAL JOB DUTIES: To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation. * Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials * Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards * Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment * Work assigned claim projects to completion * Provide a high level of customer service to internal and external customers; achieve quality and productivity goals * Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures * Maintain production and quality standards as established by management * Participate in and support ad-hoc audits as needed * Other duties as assigned JOB REQUIREMENTS: * Proficient in processing/auditing claims for Medicare and Medicaid plans * Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations * Current experience with both Institutional and Professional claim payments * Knowledge of automated claims processing systems * Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office. REQUIRED QUALIFICATIONS: * Experience: * Two (2) years' experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system * Two (2) years' experience in managed healthcare environment related to claims processing/audit * Two (2) years' experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS * Two (2) years' experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations * Two (2) years' experience processing/auditing claims for Medicare and Medicaid plans * License/Certification(s): * Coding certification preferred EQUAL OPPORTUNITY EMPLOYER Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. This employer participates in E-Verify.

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com. If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! Benefits and Perks include: * Affordable Medical/Dental/Vision insurance options * Generous paid time-off program and paid holidays for full time staff * TeleMedicine 24/7/365 access to doctors * Optional short- and long-term disability plans * Employee Assistance Plan (EAP) * 401K retirement accounts * Employee Referral Bonus Program ESSENTIAL JOB DUTIES: To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation. * Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials * Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards * Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment * Work assigned claim projects to completion * Provide a high level of customer service to internal and external customers; achieve quality and productivity goals * Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures * Maintain production and quality standards as established by management * Participate in and support ad-hoc audits as needed * Other duties as assigned JOB REQUIREMENTS: * Proficient in processing/auditing claims for Medicare and Medicaid plans * Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations * Current experience with both Institutional and Professional claim payments * Knowledge of automated claims processing systems * Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office. REQUIRED QUALIFICATIONS: * Experience: * Two (2) years' experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system * Two (2) years' experience in managed healthcare environment related to claims processing/audit * Two (2) years' experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS * Two (2) years' experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations * Two (2) years' experience processing/auditing claims for Medicare and Medicaid plans * License/Certification(s): * Coding certification preferred EQUAL OPPORTUNITY EMPLOYER Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. This employer participates in E-Verify.

Description & Requirements Maximus is currently hiring for a Certification Tracking Specialist to join our Veterans Evaluation Services (VES) team. This is a remote opportunity. The Certification Tracking Specialist is responsible for maintaining a daily spreadsheet of active providers pending DMA and updates comments in NND documenting to follow up with providers until completion of DMA. - Due to contract requirements, only US a Citizen or a Green Card holder can be considered for this opportunity. Essential Duties and Responsibilities: - Maintains a daily spreadsheet of active providers pending DMA . - Update comments in NND documenting follow up with providers until completion of DMA. - Routinely communicates with PDR and PRC on status or priority providers pending DMA. - Provides feedback on providers who are struggling with DMA content to Provider Development and Retention. - Notify PDR, PRC, and Scheduling upon completion/updating of DMA. - Works closely with other teams within Provider Development and Retention for provider outreach on special projects (new DMA updates, etc.). - Assists with occasional overflow of Provider Relations Specialists and Report Tracking Specialists if needed. Additional Duties and Responsibilities: - Place and answer phone calls to and from medical providers. - Attend meetings as directed. - Work effectively within a team dynamic. - Adapt to new instructions, requests or procedures as provided. - Maintain a high sense of urgency at all times. - Other duties as assigned. Knowledge/Skills/Abilities: - Ability to read and comprehend instructions, correspondence, and memoranda. - Ability to write correspondence. - Ability to effectively present information in one- on- one and small group situations to customers, clients and other employees if the organization. - Ability to add, subtract, multiply and divide all units of measure. - Ability to compute rate, ratio and percent and to draw and interpret bar graphs. - Ability to apply common sense understanding to carry out written or oral instructions. - Ability to deal with problems. - Proficient in the following computer software: Microsoft Excel, Internet functions (searches, research), Microsoft Word, and Microsoft Outlook. Working Conditions: - Normal office environment with some exposure to moderate noise from office equipment and/or generated by staff members. - Extended hours are occasionally required beyond the regular eight hour work day. - Frequently utilizes telephone, computer, and printer; occasionally utilizes copy machine. - Occasionally lifting and/or carrying items weighing up to approximately twenty- five pounds. Generally sedentary work but requires walking up to approximately twenty- five percent of work time in carrying out job functions such as obtaining information from staff members, overseeing office and the like. - The ability to work a shift of 8:00am--4:30pm CST (Monday through Friday) is required. Home Office Requirements: Please note upon hire, Veteran Evaluation Services (VES), a Maximus Co. will provide all necessary computer equipment that is to be utilized to fulfil the duties of your role. New hires will not be exempt from using company provided equipment. Home Office Requirements Using Maximus-Provided Equipment: - Internet speed of 20mbps or higher required (you can test this by going to (1) ****************** - Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router - Private work area and adequate power source - Must currently and permanently reside in the Continental US - In accordance with SCA contract requirements, remote work must be conducted from the location specified at the time of hire. Travel is not permitted, and you are required to remain at your designated home location for all work activities. Minimum Requirements - High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience. - Previous Veterans Evaluation Service (VES) team experience preferred - Previous customer service experience preferred - Professional writing experience preferred EEO Statement Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency For positions on this contract, Maximus will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor. That wage rate will vary depending on locality. An applicant's salary history will not be used in determining compensation. Accommodations Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at **************************. Minimum Salary $ 17.75 Maximum Salary $ 21.17

Description & Requirements Maximus is currently hiring for a Certification Tracking Specialist to join our Veterans Evaluation Services (VES) team. This is a remote opportunity. The Certification Tracking Specialist is responsible for maintaining a daily spreadsheet of active providers pending DMA and updates comments in NND documenting to follow up with providers until completion of DMA. - Due to contract requirements, only US a Citizen or a Green Card holder can be considered for this opportunity. Essential Duties and Responsibilities: - Maintains a daily spreadsheet of active providers pending DMA . - Update comments in NND documenting follow up with providers until completion of DMA. - Routinely communicates with PDR and PRC on status or priority providers pending DMA. - Provides feedback on providers who are struggling with DMA content to Provider Development and Retention. - Notify PDR, PRC, and Scheduling upon completion/updating of DMA. - Works closely with other teams within Provider Development and Retention for provider outreach on special projects (new DMA updates, etc.). - Assists with occasional overflow of Provider Relations Specialists and Report Tracking Specialists if needed. Additional Duties and Responsibilities: - Place and answer phone calls to and from medical providers. - Attend meetings as directed. - Work effectively within a team dynamic. - Adapt to new instructions, requests or procedures as provided. - Maintain a high sense of urgency at all times. - Other duties as assigned. Knowledge/Skills/Abilities: - Ability to read and comprehend instructions, correspondence, and memoranda. - Ability to write correspondence. - Ability to effectively present information in one- on- one and small group situations to customers, clients and other employees if the organization. - Ability to add, subtract, multiply and divide all units of measure. - Ability to compute rate, ratio and percent and to draw and interpret bar graphs. - Ability to apply common sense understanding to carry out written or oral instructions. - Ability to deal with problems. - Proficient in the following computer software: Microsoft Excel, Internet functions (searches, research), Microsoft Word, and Microsoft Outlook. Working Conditions: - Normal office environment with some exposure to moderate noise from office equipment and/or generated by staff members. - Extended hours are occasionally required beyond the regular eight hour work day. - Frequently utilizes telephone, computer, and printer; occasionally utilizes copy machine. - Occasionally lifting and/or carrying items weighing up to approximately twenty- five pounds. Generally sedentary work but requires walking up to approximately twenty- five percent of work time in carrying out job functions such as obtaining information from staff members, overseeing office and the like. - The ability to work a shift of 8:00am--4:30pm CST (Monday through Friday) is required. Home Office Requirements: Please note upon hire, Veteran Evaluation Services (VES), a Maximus Co. will provide all necessary computer equipment that is to be utilized to fulfil the duties of your role. New hires will not be exempt from using company provided equipment. Home Office Requirements Using Maximus-Provided Equipment: - Internet speed of 20mbps or higher required (you can test this by going to (1) ****************** - Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router - Private work area and adequate power source - Must currently and permanently reside in the Continental US - In accordance with SCA contract requirements, remote work must be conducted from the location specified at the time of hire. Travel is not permitted, and you are required to remain at your designated home location for all work activities. Minimum Requirements - High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience. - Previous Veterans Evaluation Service (VES) team experience preferred - Previous customer service experience preferred - Professional writing experience preferred EEO Statement Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency For positions on this contract, Maximus will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor. That wage rate will vary depending on locality. An applicant's salary history will not be used in determining compensation. Accommodations Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at **************************. Minimum Salary $ 17.75 Maximum Salary $ 21.17

Description & Requirements Maximus is currently hiring for a Certification Tracking Specialist to join our Veterans Evaluation Services (VES) team. This is a remote opportunity. The Certification Tracking Specialist is responsible for maintaining a daily spreadsheet of active providers pending DMA and updates comments in NND documenting to follow up with providers until completion of DMA. - Due to contract requirements, only US a Citizen or a Green Card holder can be considered for this opportunity. Essential Duties and Responsibilities: - Maintains a daily spreadsheet of active providers pending DMA . - Update comments in NND documenting follow up with providers until completion of DMA. - Routinely communicates with PDR and PRC on status or priority providers pending DMA. - Provides feedback on providers who are struggling with DMA content to Provider Development and Retention. - Notify PDR, PRC, and Scheduling upon completion/updating of DMA. - Works closely with other teams within Provider Development and Retention for provider outreach on special projects (new DMA updates, etc.). - Assists with occasional overflow of Provider Relations Specialists and Report Tracking Specialists if needed. Additional Duties and Responsibilities: - Place and answer phone calls to and from medical providers. - Attend meetings as directed. - Work effectively within a team dynamic. - Adapt to new instructions, requests or procedures as provided. - Maintain a high sense of urgency at all times. - Other duties as assigned. Knowledge/Skills/Abilities: - Ability to read and comprehend instructions, correspondence, and memoranda. - Ability to write correspondence. - Ability to effectively present information in one- on- one and small group situations to customers, clients and other employees if the organization. - Ability to add, subtract, multiply and divide all units of measure. - Ability to compute rate, ratio and percent and to draw and interpret bar graphs. - Ability to apply common sense understanding to carry out written or oral instructions. - Ability to deal with problems. - Proficient in the following computer software: Microsoft Excel, Internet functions (searches, research), Microsoft Word, and Microsoft Outlook. Working Conditions: - Normal office environment with some exposure to moderate noise from office equipment and/or generated by staff members. - Extended hours are occasionally required beyond the regular eight hour work day. - Frequently utilizes telephone, computer, and printer; occasionally utilizes copy machine. - Occasionally lifting and/or carrying items weighing up to approximately twenty- five pounds. Generally sedentary work but requires walking up to approximately twenty- five percent of work time in carrying out job functions such as obtaining information from staff members, overseeing office and the like. - The ability to work a shift of 8:00am--4:30pm CST (Monday through Friday) is required. Home Office Requirements: Please note upon hire, Veteran Evaluation Services (VES), a Maximus Co. will provide all necessary computer equipment that is to be utilized to fulfil the duties of your role. New hires will not be exempt from using company provided equipment. Home Office Requirements Using Maximus-Provided Equipment: - Internet speed of 20mbps or higher required (you can test this by going to (1) ****************** - Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router - Private work area and adequate power source - Must currently and permanently reside in the Continental US - In accordance with SCA contract requirements, remote work must be conducted from the location specified at the time of hire. Travel is not permitted, and you are required to remain at your designated home location for all work activities. Minimum Requirements - High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience. - Previous Veterans Evaluation Service (VES) team experience preferred - Previous customer service experience preferred - Professional writing experience preferred EEO Statement Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency For positions on this contract, Maximus will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor. That wage rate will vary depending on locality. An applicant's salary history will not be used in determining compensation. Accommodations Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at **************************. Minimum Salary $ 17.75 Maximum Salary $ 21.17

Description & Requirements Maximus is currently hiring for a Certification Tracking Specialist to join our Veterans Evaluation Services (VES) team. This is a remote opportunity. The Certification Tracking Specialist is responsible for maintaining a daily spreadsheet of active providers pending DMA and updates comments in NND documenting to follow up with providers until completion of DMA. - Due to contract requirements, only US a Citizen or a Green Card holder can be considered for this opportunity. Essential Duties and Responsibilities: - Maintains a daily spreadsheet of active providers pending DMA . - Update comments in NND documenting follow up with providers until completion of DMA. - Routinely communicates with PDR and PRC on status or priority providers pending DMA. - Provides feedback on providers who are struggling with DMA content to Provider Development and Retention. - Notify PDR, PRC, and Scheduling upon completion/updating of DMA. - Works closely with other teams within Provider Development and Retention for provider outreach on special projects (new DMA updates, etc.). - Assists with occasional overflow of Provider Relations Specialists and Report Tracking Specialists if needed. Additional Duties and Responsibilities: - Place and answer phone calls to and from medical providers. - Attend meetings as directed. - Work effectively within a team dynamic. - Adapt to new instructions, requests or procedures as provided. - Maintain a high sense of urgency at all times. - Other duties as assigned. Knowledge/Skills/Abilities: - Ability to read and comprehend instructions, correspondence, and memoranda. - Ability to write correspondence. - Ability to effectively present information in one- on- one and small group situations to customers, clients and other employees if the organization. - Ability to add, subtract, multiply and divide all units of measure. - Ability to compute rate, ratio and percent and to draw and interpret bar graphs. - Ability to apply common sense understanding to carry out written or oral instructions. - Ability to deal with problems. - Proficient in the following computer software: Microsoft Excel, Internet functions (searches, research), Microsoft Word, and Microsoft Outlook. Working Conditions: - Normal office environment with some exposure to moderate noise from office equipment and/or generated by staff members. - Extended hours are occasionally required beyond the regular eight hour work day. - Frequently utilizes telephone, computer, and printer; occasionally utilizes copy machine. - Occasionally lifting and/or carrying items weighing up to approximately twenty- five pounds. Generally sedentary work but requires walking up to approximately twenty- five percent of work time in carrying out job functions such as obtaining information from staff members, overseeing office and the like. - The ability to work a shift of 8:00am--4:30pm CST (Monday through Friday) is required. Home Office Requirements: Please note upon hire, Veteran Evaluation Services (VES), a Maximus Co. will provide all necessary computer equipment that is to be utilized to fulfil the duties of your role. New hires will not be exempt from using company provided equipment. Home Office Requirements Using Maximus-Provided Equipment: - Internet speed of 20mbps or higher required (you can test this by going to (1) ****************** - Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router - Private work area and adequate power source - Must currently and permanently reside in the Continental US - In accordance with SCA contract requirements, remote work must be conducted from the location specified at the time of hire. Travel is not permitted, and you are required to remain at your designated home location for all work activities. Minimum Requirements - High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience. - Previous Veterans Evaluation Service (VES) team experience preferred - Previous customer service experience preferred - Professional writing experience preferred EEO Statement Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency For positions on this contract, Maximus will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor. That wage rate will vary depending on locality. An applicant's salary history will not be used in determining compensation. Accommodations Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at **************************. Minimum Salary $ 17.75 Maximum Salary $ 21.17

Description & Requirements Maximus is currently hiring for a Certification Tracking Specialist to join our Veterans Evaluation Services (VES) team. This is a remote opportunity. The Certification Tracking Specialist is responsible for maintaining a daily spreadsheet of active providers pending DMA and updates comments in NND documenting to follow up with providers until completion of DMA. - Due to contract requirements, only US a Citizen or a Green Card holder can be considered for this opportunity. Essential Duties and Responsibilities: - Maintains a daily spreadsheet of active providers pending DMA . - Update comments in NND documenting follow up with providers until completion of DMA. - Routinely communicates with PDR and PRC on status or priority providers pending DMA. - Provides feedback on providers who are struggling with DMA content to Provider Development and Retention. - Notify PDR, PRC, and Scheduling upon completion/updating of DMA. - Works closely with other teams within Provider Development and Retention for provider outreach on special projects (new DMA updates, etc.). - Assists with occasional overflow of Provider Relations Specialists and Report Tracking Specialists if needed. Additional Duties and Responsibilities: - Place and answer phone calls to and from medical providers. - Attend meetings as directed. - Work effectively within a team dynamic. - Adapt to new instructions, requests or procedures as provided. - Maintain a high sense of urgency at all times. - Other duties as assigned. Knowledge/Skills/Abilities: - Ability to read and comprehend instructions, correspondence, and memoranda. - Ability to write correspondence. - Ability to effectively present information in one- on- one and small group situations to customers, clients and other employees if the organization. - Ability to add, subtract, multiply and divide all units of measure. - Ability to compute rate, ratio and percent and to draw and interpret bar graphs. - Ability to apply common sense understanding to carry out written or oral instructions. - Ability to deal with problems. - Proficient in the following computer software: Microsoft Excel, Internet functions (searches, research), Microsoft Word, and Microsoft Outlook. Working Conditions: - Normal office environment with some exposure to moderate noise from office equipment and/or generated by staff members. - Extended hours are occasionally required beyond the regular eight hour work day. - Frequently utilizes telephone, computer, and printer; occasionally utilizes copy machine. - Occasionally lifting and/or carrying items weighing up to approximately twenty- five pounds. Generally sedentary work but requires walking up to approximately twenty- five percent of work time in carrying out job functions such as obtaining information from staff members, overseeing office and the like. - The ability to work a shift of 8:00am--4:30pm CST (Monday through Friday) is required. Home Office Requirements: Please note upon hire, Veteran Evaluation Services (VES), a Maximus Co. will provide all necessary computer equipment that is to be utilized to fulfil the duties of your role. New hires will not be exempt from using company provided equipment. Home Office Requirements Using Maximus-Provided Equipment: - Internet speed of 20mbps or higher required (you can test this by going to (1) ****************** - Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router - Private work area and adequate power source - Must currently and permanently reside in the Continental US - In accordance with SCA contract requirements, remote work must be conducted from the location specified at the time of hire. Travel is not permitted, and you are required to remain at your designated home location for all work activities. Minimum Requirements - High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience. - Previous Veterans Evaluation Service (VES) team experience preferred - Previous customer service experience preferred - Professional writing experience preferred EEO Statement Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency For positions on this contract, Maximus will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor. That wage rate will vary depending on locality. An applicant's salary history will not be used in determining compensation. Accommodations Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at **************************. Minimum Salary $ 17.75 Maximum Salary $ 21.17

JOB RESPONSIBILITIES * Financial Support - May perform duties of FSR I & II. May have specialized areas of responsibility (e.g. government & non-government billing, appeal processing, review & approval of refunds, etc.). * Systems Support - Identify system and technology needs. Participate in advancing use of technology. Ensures systems meet all regulatory and compliance requirements. * Quality - May perform research and analysis. Participate in departmental/division performance improvement and quality assurance controls. May develop and execute corrective actions plans. * Billing - Compile and prepare patient charges. Prepare invoices billings, UB-04 and 1500 claim forms to be sent to 3rd party payers for payment indicating individual line items for services and total costs. Review charges. Obtain and evaluate family, third party payers and agency resources for payment of charges. Managing patient billing and ensure procedures are billed according to contracts, transmit or mail all paper and claims, and review correspondence and follow up as needed. * Collaboration - Act as a preceptor and/or lead for new employees. Perform specialty services functions. Act as a resource within the department/division. Provide instruction for performing non-routine functions. Serve as a liaison between Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patent Financial Services and other Cincinnati Children's departments. May have supervisory responsibilities. JOB QUALIFICATIONS * High school diploma or equivalent * 3+ years of work experience in a related job discipline Primary Location South Campus Schedule Full time Shift Day (United States of America) Department Professional Billing Operation Employee Status Regular FTE 1 Weekly Hours 40 * Expected Starting Pay Range * Annualized pay may vary based on FTE status $20.57 - $25.72 Market Leading Benefits Including*: * Medical coverage starting day one of employment. View employee benefits here. * Competitive retirement plans * Tuition reimbursement for continuing education * Expansive employee discount programs through our many community partners * Shift Differential, Weekend Differential, and Weekend Option Pay Programs for qualified positions * Support through Employee Resource Groups such as African American Professionals Advisory Council, Asian Cultural and Professional Group, EQUAL - LGBTQA Resource Group, Juntos - Hispanic/Latin Resource Group, Veterans and Military Family Advocacy Network, and Young Professionals (YP) Resource Group * Physical and mental health wellness programs * Relocation assistance available for qualified positions * Benefits may vary based on FTE Status and Position Type About Us At Cincinnati Children's, we come to work with one goal: to make children's health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children's. Cincinnati Children's is: * Recognized by U.S. News & World Report as a top 10 best Children's Hospitals in the nation for more than 15 years * Consistently among the top 3 Children's Hospitals for National Institutes of Health (NIH) Funding * Recognized as one of America's Best Large Employers (2025), America's Best Employers for New Grads (2025) * One of the nation's America's Most Innovative Companies as noted by Fortune * Consistently certified as great place to work * A Leading Disability Employer as noted by the National Organization on Disability * Magnet designated for the fourth consecutive time by the American Nurses Credentialing Center (ANCC) We Embrace Innovation-Together. We believe in empowering our teams with the tools that help us work smarter and care better. That's why we support the responsible use of artificial intelligence. By encouraging innovation, we're creating space for new ideas, better outcomes, and a stronger future-for all of us. Comprehensive job description provided upon request. Cincinnati Children's is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability

JOB RESPONSIBILITIES * Billing - Compile and prepare patient charges. Prepare invoices billings, UB-04 and 1500 claim forms to be sent to 3rd party payers for payment indicating individual line items for services and total costs. Review charges. Obtain and evaluate family, third party payers and agency resources for payment of charges. Managing patient billing and ensure procedures are billed according to contracts, transmit or mail all paper and claims, and review correspondence and follow up as needed. * Systems Support - Maintain and update departmental system, including templates, and payer and physician information. * Collaboration - Act as a preceptor for new employees. Perform specialty services functions. Act as a resource within the department/division. Provide instruction for performing non-routine functions. Serve as a liaison between Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patent Financial Services and other Cincinnati Children's departments. * Financial Support - Obtain and evaluate family, third party payers and agency resources for payment of charges. Counsel patient on third party coverage and present financial aspects. Determine eligibility for State Medicaid, Social Security and other outside funding. Complete necessary paperwork for eligible patients, including medical and financial applications. Coordinate inpatient and outpatient admissions. Coordinate information with the inpatient and outpatient charge systems. Input charges and relative information. Manage accounts receivable data and collection information, ensure timeliness and accuracy. Research third party payers and community physician charges in order to maintain usual and customary as will as competitive charges. Check and update charge master. Conduct utilization review for the division from insurance companies and working in conjunction with Cincinnati Children's Utilization Review department. Process, post, and balance payments to accounts timely, accurately, and in the correct period. * Quality - Provide Quality Assurance reports for the division. JOB QUALIFICATIONS * High school diploma or equivalent * 2+ years of work experience in a related job discipline Primary Location South Campus Schedule Full time Shift Day (United States of America) Department Professional Billing Operation Employee Status Regular FTE 1 Weekly Hours 40 * Expected Starting Pay Range * Annualized pay may vary based on FTE status $18.16 - $22.25 Market Leading Benefits Including*: * Medical coverage starting day one of employment. View employee benefits here. * Competitive retirement plans * Tuition reimbursement for continuing education * Expansive employee discount programs through our many community partners * Shift Differential, Weekend Differential, and Weekend Option Pay Programs for qualified positions * Support through Employee Resource Groups such as African American Professionals Advisory Council, Asian Cultural and Professional Group, EQUAL - LGBTQA Resource Group, Juntos - Hispanic/Latin Resource Group, Veterans and Military Family Advocacy Network, and Young Professionals (YP) Resource Group * Physical and mental health wellness programs * Relocation assistance available for qualified positions * Benefits may vary based on FTE Status and Position Type About Us At Cincinnati Children's, we come to work with one goal: to make children's health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children's. Cincinnati Children's is: * Recognized by U.S. News & World Report as a top 10 best Children's Hospitals in the nation for more than 15 years * Consistently among the top 3 Children's Hospitals for National Institutes of Health (NIH) Funding * Recognized as one of America's Best Large Employers (2025), America's Best Employers for New Grads (2025) * One of the nation's America's Most Innovative Companies as noted by Fortune * Consistently certified as great place to work * A Leading Disability Employer as noted by the National Organization on Disability * Magnet designated for the fourth consecutive time by the American Nurses Credentialing Center (ANCC) We Embrace Innovation-Together. We believe in empowering our teams with the tools that help us work smarter and care better. That's why we support the responsible use of artificial intelligence. By encouraging innovation, we're creating space for new ideas, better outcomes, and a stronger future-for all of us. Comprehensive job description provided upon request. Cincinnati Children's is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability

General Job Summary: Responsible for performing a variety of clerical duties and responsible for insurance verification for patients with medical or auto insurance as well as authorizations. Essential Job Functions: Greets, screens, schedules, and directs patients/visitors to appropriate areas and demonstrates excellence with respect to treating and caring for customers in-person and over the phone. Responsible for performing a variety of clerical duties: answers phone calls, takes messages, fax, scan, etc. Verify that all forms, test results, and other paperwork are in the electronic health record system according to physician and office protocol. Obtain prior authorization for patients and verify all insurance based on patient schedules, practice management systems and insurance websites for non-automated insurances. Obtain, verify, and update patient information and provides support services to patients and medical staff. Maintain the practice management system. Collect payments for services rendered per policy, including copayments and balances on patient accounts. Daily drawer balancing. Obtain referral from the Primary Care Physician for insurances that require referrals and contact patient regarding missing referrals or inactive insurance coverage. Verify auto and liability eligibility with insurance carriers. Ensure all auto and/or liability forms are completed and received and compare with the schedule. Use these forms to record verification information and file in the chart. Compliance with HIPAA, OSHA, and safety standards of the organization. Performs other duties that may be necessary or in the best interest of the practice. Requirements Education/Experience: High school diploma or equivalent. Minimum one year of experience in a customer service position, preferably in a medical practice setting. Previous medical assisting knowledge preferred. CPR/AED and First Aid certification. Other Requirements: Schedules will change as department needs change, including overtime. Travel as needed. Performance Requirements: Knowledge: Knowledge and proper use of office equipment. Knowledge of practice management and electronic health records systems. Knowledge of HIPAA regulations. Knowledge of current terminology and anatomy. Knowledge of how to obtain insurance benefits and insurance reimbursement policies. Skills: Skilled in communicating effectively with providers, staff, patients and vendors. Use of a practice management software system. Accuracy in data entry. Detailed-oriented with excellent investigational/research skills. Excellent organizational and multi-tasking skills. Excellent adaptability skills. Basic math skills. Abilities: Ability to multi-task and analyze situations to respond appropriately. Ability to use math skills to accurately complete daily balancing and provide accurate change to the patient. Ability to work effectively and deal courteously with patients, staff, and others. Ability to organize work environment and work load to meet needs of the organization. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to accurately examine, understand and enter insurance documents. Ability to work independently with minimal or no supervision. Equipment Operated: Standard office equipment. Work Environment: Medical Office. Mental/Physical Requirements: Sitting about 90% in front of a computer screen. Fast paced high productivity environment.

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more - in our careers and in our communities. Summary: Responsible for the delivery, timeliness, and maintenance of anesthesia supplies, drugs and equipment to Responsible for troubleshooting, as well as performing minor repairs to the anesthesia related equipment. May also provide assistance in perioperative setting. Responsibilities And Duties: 45% to 60% Supports and maintains daily, the anesthesia department equipment and supplies in each operating room on a case by case basis. Maintains and troubleshoots anesthesia related equipment, performing repairs according to level of expertise. Calibrates monitors per unit protocol. Assists in the transfer of patients from OR table to patient cart. Transports patients to the OR. 10% 30% Assists in providing timely and efficient case turnover by gathering, checking, organizing dispensing and/or processing equipment, gas cylinders, supplies and instruments; opens sterile supplies and instruments. Preceptors new O. R. Assistants as needed. Assists with OR readiness through patient transportation, positioning and room preparation; positions patients for procedure. Acts as a second assistant to surgeon, performing duties related to draping, operative site exposure, and video . Performs non-nursing tasks as assigned to support patient care; cleans, runs errands, and performs stocking and maintenance tasks. 10% Identifies and evaluates anesthesia supplies and equipment on a consistent basis working with Medical Director, Anesthesia Department staff and Director. Collaborates with each to determine value/merit, placement, and/or par levels of anesthesia product inventory in the anesthesia stockroom and supply carts. Collaborates with supply chain manager to problem-solve issues regarding order placement, availability of such supplies and alternatives when back orders occur. Orders supplies from supply chain manager and outside vendors. 5% Collaborates with Medical Director, Anesthesia staff, and Director to assess anesthesia product needs. Assists with exploring products needed for related trials of product/equipment. Explores cost effective alternatives and communicates in a timely manner. Explains any budget variance related to anesthesia supplies. 10% Prepares anesthesia order, stocks anesthesia drugs/supplies in each OR daily. Cleans, sets up instrument trays specific to area of work. Performs non-nursing tasks as assigned to support patient care; cleans, runs errands, and performs stocking and maintenance tasks. Minimum Qualifications: High School or GED (Required) Additional Job Description: Computer knowledge that permits troubleshooting/repairing anesthesia equipment within scope of responsibility. Knowledge of surgical environment, inventory control, basic indications of anesthesia drugs, use of equipment and suppliers. Two years of recent progressive perioperative Experience with similar responsibilities. Work Shift: Day Scheduled Weekly Hours : As Needed Department Anesthesia - Main Join us! ... if your passion is to work in a caring environment ... if you believe that learning is a life-long process ... if you strive for excellence and want to be among the best in the healthcare industry Equal Employment Opportunity OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment