Novus jobs - 104 jobs

Health Insurance Product Development Assistant, Pittsburgh, PA 15219 Secure your future with a direct-hire position as an employee of the company - this is not a temporary role, and you'll never pay a fee for our assistance. As a proud partner of the company, Novus Group is dedicated to helping you succeed. We provide comprehensive support, including resume fine-tuning, personalized interview coaching, compensation insights, and end-to-end navigation of the employment process, leading you directly to an offer. Location: [Downtown Pittsburgh, PA 15219] This role does offer some remote/work-from-home flexibility, but will require a regular presence in Pittsburgh, PA. Company Overview:The Company, a non-profit healthcare organization, is a leader in providing high-quality, compassionate care to patients. With an extensive network of hospitals, clinics, and other medical facilities, the Company is dedicated to improving the health and well-being of the communities served. Job Summary:As the Health Insurance Product Development Assistant, you will assist in the research, analysis, and design of new health insurance products that meet the evolving needs of customers. Working closely with cross-functional teams, you will gather and interpret data, identify market trends, and collaborate on the development of product features and pricing strategies. Your attention to detail, analytical skills, and passion for the insurance industry will be essential as you help shape the future of Company's healthcare solutions. Key Responsibilities:- Conduct market research and data analysis to inform the development of new health insurance products - Assist in the design and testing of product features, benefits, and pricing structures - Collaborate with actuaries, underwriters, and marketing professionals to ensure the viability and competitiveness of new insurance offerings - Gather and synthesize customer feedback to identify opportunities for product enhancements - Support the implementation and launch of new insurance products - Participate positively in various workgroups by offering valuable input, taking action on relevant items, and coordinating between departments as requested by leadership- Assist/take lead in development and presentation of training materials Minimum Qualifications: Bachelor's degree in business, health care, management, a related field OR relevant experience. 2 years of business experience required. Knowledge of Commercial Insurance products is a bonus. Experience in product development a plus, but not required. Good project management skills with proven ability to manage multiple tasks and priorities. Strong computer skills required, with proficiency in Outlook, Excel, Word and Internet Explorer. Strong organizational skills and attention to detail. Strong analytical and problem-solving skills. Strong communication skills, both verbal and written, and the ability to communicate effectively with all levels and all departments. Positive, professional attitude and enthusiastic demeanor. Ability to work independently with minimal or no direction from leadership Compensation and Benefits:A competitive salary is offered to new hires of up to $67,000 per year, commensurate with experience, as well as a comprehensive benefits package including health, dental, and vision insurance, retirement plan contributions, tuition reimbursement, and generous paid time off. In addition to your base salary, you have the potential to significantly increase your earnings. After hire, the Company offers performance-based raises and pathways for higher pay through continuous learning and education, with the potential to reach up to $95,000 annually in this position. Equal Opportunity Employer:Our organization is committed to providing equal employment opportunities to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.

Healthcare Provider Contract Specialist, Pittsburgh, PA 15222 Secure your future with a direct-hire position as an employee of the company - this is not a temporary role, and you'll never pay a fee for our assistance. As a proud partner of the company, Novus Group is dedicated to helping you succeed. We provide comprehensive support, including resume fine-tuning, personalized interview coaching, compensation insights, and end-to-end navigation of the employment process, leading you directly to an offer. Location: [Downtown Pittsburgh, PA 15222] This role does offer some remote/work-from-home flexibility, but will require a regular presence in Pittsburgh, PA. Travel: Occasional travel throughout the Pittsburgh, PA area Company Overview:The Company, a non-profit healthcare organization, is a leader in providing high-quality, compassionate care to patients throughout Pennsylvania and beyond. With an extensive network of hospitals, clinics, and other medical facilities, the company is dedicated to improving the health and well-being of the communities they serve. Job Summary:As the Health Provider Contract Specialist, you will play a crucial role in managing and negotiating contracts with our extensive network of healthcare providers. Leveraging your expertise in contract administration and financial analysis, you will ensure that our contractual agreements are favorable and compliant, enabling us to continue delivering exceptional care to our patients. This position is responsible for facilitating a seamless process from the time a provider is identified as needed in the network to contract with the provider for services. The Contract Specialist reviews any alterations in the status of contracted providers that may have an impact on their ability to continue to be in the provider network including changes in license, certifications, and/or enrollment by assisting with completing pre-credentialing requirements. Key Responsibilities:- Review and negotiate contracts with healthcare providers, including hospitals, clinics, and medical practices- Analyze financial data and contractual terms to identify opportunities for improved cost savings and operational efficiency- Ensure contractual compliance and maintain accurate records of all provider agreements- Collaborate with cross-functional teams to address any issues or concerns related to provider contracts- Stay up to date with industry regulations and best practices in healthcare contracting Minimum Qualifications:- Bachelor's degree in Business Administration, Finance, or a related field- Minimum 3 years of experience in healthcare contract management or provider relations networking - Demonstrated expertise in contract negotiation, financial analysis, and contract compliance- Thorough knowledge of NCQA standards and other relevant external quality standards- Knowledge of state and federal standards for contracting- Strong communication and interpersonal skills to effectively liaise with healthcare providers- Proficient in Microsoft Office suite, with the ability to analyze complex data and create detailed reports Compensation and Benefits:A competitive salary is offered to new hires of up to $57,000 per year, commensurate with experience, as well as a comprehensive benefits package including health, dental, and vision insurance, retirement plan contributions, tuition reimbursement, and generous paid time off. In addition to your base salary, you have the potential to significantly increase your earnings. We offer performance-based raises and pathways for higher pay through continuous learning and education, with the potential to reach up to $81,000 annually in this position. Equal Opportunity Employer:Our organization is committed to providing equal employment opportunities to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.

Are you a dedicated law enforcement professional who values quality and safety? Look no further! We are excited to announce opportunities for Sr. Police Officer II positions at UPMC Hanover. Assigned shift will be based upon hospital need. Why Choose UPMC?Whether you are just starting your law enforcement career, retired, considering retirement, or looking for a change of pace from traditional law enforcement, UPMC offers: Generous Sign-On Bonus: Kickstart your journey with a $10,000 sign-on bonus when you commit to a full-time position for two years. Career Advancement: Take advantage of promotional and leadership opportunities to grow your career. Shift Differential: Enjoy an additional $1.75 per hour for working non-traditional shifts. Annual Merit Increase: Receive yearly pay boosts based on your performance. Community: Join one of the largest private police forces in Pennsylvania and be part of a close-knit team within the UPMC network. Benefits: UPMC offers world-class health benefits, generous paid time off, tuition assistance, and much more. Note: The Act 235 Certification is required prior to hire. The Act 120 Municipal Police Officer training is not a substitute for the Act 235. To learn more about Act 235, please visit the Pennsylvania State Police website. The Police Officer is responsible for maintaining a safe and secure environment for patients, visitors, staff, and all UPMC owned and adjacent properties. Enforces UPMC rules and regulations to both employees and the public. Establish a uniformed police presence by patrolling UPMC hospitals, buildings, grounds, and associated areas to deter criminal activity, investigate criminal events, document activities, and take appropriate police action when necessary. Monitors security, fire, and environmental alarms. Responds to and resolve problems, disputes, and unusual circumstances as necessary. Provides customer service to patients, families, visitors, and staff to maintain a safe and secure environment. Serves as a first responder to any violent act occurring at a UPMC location. Will be armed with a firearm. Oversees the operations of assigned shift and formally leads the daily operations of the department. Organizes and assigns work and provides daily instruction to staff regarding specific duties and assignments. Responsibilities: Ability to handle evidence control pertaining to UPMC initiated criminal investigations Responds to acts of extreme violence at UPMC owned or controlled properties that have the potential to require the deployment of deadly force as dictated by UPMC policy. May be required to support various types of investigations that have system-wide implication Required to carry, properly handle, and be able to deploy a firearm. Tasked with the ability to issue PA state citations for certain criminal and traffic offenses, using specific law enforcement applications such as the PA Justice Network, and performing other law enforcement duties as necessary. Investigates incidents of unusual circumstances reported by UPMC staff, visitors, physicians, and patients. Must be able to perform as a Security Officer when necessary. Appropriately escalates problems and concerns to Management's attention. Will be responsible for the transportation of those subjected to criminal arrest and subsequent prosecution May be required to serve legal documents such as arrest warrants, subpoena, Protection From Abuse, etc. May function as a shift supervisor as needed to oversee the operations of assigned shift and formally lead the daily operations of the department, organize and assign work, and provide daily instruction to staff regarding specific duties and assignments. May be required to provide support at various UPMC facilities which would include: Detailed knowledge of the physical layout of multiple facilities. Working knowledge of site specific policies and procedures between sites. Ability to effectively interact with differing management and customer bases from site to site. Qualifications: High School diploma or equivalent. Pennsylvania Municipal Police Officers' Education and Training Commission (MPOETC) basic training program (Act 120) or equivalent (PA State Police Academy training, out of state Police Academy), OR Police Officer training as mandated by the Federal Law Enforcement Training Centers), OR Federal Agent (to include but not limited to FBI, DEA, Secret Service, U.S. Marshal, Veteran's Administration) OR Military Police Training, OR Five years of prior law enforcement experience (to include Sheriff, Deputy Sheriff, Probation/Parole Officer, Liquor Enforcement Officer, Fish/Game Commission and/or Park police officer) wherein a firearm was an essential tool and at a minimum, annual firearm training and qualification was maintained. Must possess strong interpersonal skills, especially the ability to effectively interact, communicate, and diffuse potential combative situations with persons from all walks of life. Psychological fitness required to deal with stress and potentially dangerous conflict situations. Physical fitness requirements to deal with typical physical demands that require full body motion and physical strength and stamina sufficient to respond to crisis interventions and medical emergencies. Be able to effectively communicate both orally and in written format. Good interpersonal skills; able to deal with stress and potentially dangerous conflict situations. All applicants will be subject to a thorough background and criminal record check. Must be available for all shifts. Officers are required to wear a bullet proof vest. Must be able to perform as a security officer when necessary. Licensure, Certifications, and Clearances: Act 235 with successful completion of both the academic and firearms training modules, required prior to hire. Must meet audio and visual standards outlined in Act 235 at time of hire. Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR) Driver's License UPMC Physical Fitness Standard Act 235 with Firearms prior to hire Act 31 Child Abuse Reporting Act 33 with renewal Act 34 with renewal Act 501 Act 73 FBI Clearance Successful completion of UPMC Police Training upon hire. Successful completion of all UPMC-mandated weapons and firearms training. Successfully pass UPMC Physical Fitness Standard: Physical fitness requirements to deal with typical physical demands that require full body motion and physical strength and stamina sufficient to chase, apprehend, and subdue criminal suspects, and respond to crisis interventions and medical emergencies. Must have good hand/eye coordination and able to pass an eye and hearing test with appropriate correction.

Secure your future with a direct-hire position as an employee of the company - this is NOT a temporary role, and you'll never pay a fee for our assistance. As a proud partner of the company, Novus Group is dedicated to helping you succeed. We provide comprehensive support, including resume fine-tuning, personalized interview coaching, compensation insights, and end-to-end navigation of the employment process, leading you directly to an offer. Job Status: Full-time Work Schedule: Monday through Friday, 9:00 am - 5:00 pm, overtime as necessary Hybrid: Remote/work-from-home and a presence in the Downtown Pittsburgh office, when needed Company Overview: The Company, a non-profit healthcare organization, is a leader in providing high-quality, compassionate care to patients. With an extensive network of hospitals, clinics, and other medical facilities, the Company is dedicated to improving the health and well-being of the communities served. Job Summary: As a Commercial Health Insurance Enrollment Specialist, you will play a vital role in assisting individuals and businesses in enrolling in comprehensive suite of commercial health insurance plans. Leveraging your expertise in health insurance products and regulations, you will educate clients on their options, process enrollment applications, and provide ongoing support to ensure a seamless plan implementation. Knowledge of Centers for Medicare and Medicaid Services (CMS), Pennsylvania Department of Welfare (DPW), and Pennsylvania Insurance Department (PID) will be crucial. Key Responsibilities: - Educate clients on the detailed features and benefits of commercial health insurance plans, enrollment and disenrollment requirements and processing rules based upon the product (HMO, PPO, EPO, SNP, PDP, Select, Supplemental, or National Complimentary) and Individual vs. Employer Group, including, but not limited to, understanding and application of service areas by product- Ability to make eligibility determinations based on CMS (Part A/Part B Eligibility), DPW (Medical Assistance Eligibility), and/or PID requirements, in accordance with the application election period guidelines. Ability to accurately identify appropriate election period based upon analysis of beneficiary/member history and regulatory guidance- Process enrollment applications and ensure accurate data entry- Assist clients with plan selection and provide guidance on plan utilization- Maintain detailed records and documentation related to enrollment activities- Stay up to date on industry regulations and changes to commercial health insurance products Minimum Qualifications: REQUIRED: High school diploma or equivalent REQUIRED: Minimum 6 months of experience in a customer service/call center healthcare insurance setting working with CMS, DPW, and PID Must be proficient in Microsoft Office Suite Products (Outlook, Excel, Word) Familiarity with health insurance products and regulations Strong customer service and communication skills Proficiency in data entry and administrative tasks Excellent problem-solving and attention to detail Compensation and Benefits: A competitive salary is offered to new hires. Candidates will be placed within the range of $19.00 to $22.00 per hour. Applicants will be placed in the appropriate salary based on their individual experience and education. Also offered is a comprehensive benefits package including health, dental, and vision insurance, retirement plan contributions, tuition reimbursement, generous paid time off, and many more perks! In addition to your base salary, you have the potential to significantly increase your earnings. After hire, the Company offers performance-based raises and pathways for higher pay through continuous learning and education, with the potential to reach up to $29.00 hourly in this position. Equal Opportunity Employer:Our organization is committed to providing equal employment opportunities to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.

Salary: up to $29.00 as a new hire. Promotional pay increases can be earned, after hire. The Opportunity Are you a detail-oriented problem solver who enjoys the intersection of technology, data, and physical production? We seek a Print Production & Process Strategist to join the Print & Fulfillment team.In this role, you won't just be managing "mail"-you'll be a strategic partner in communication with healthcare members. From optimizing budget reporting and vendor performance to building complex letter templates in Inspire Interactive, your work ensures our members receive the right information at the right time. Why should you join the team? Impact: Your work directly affects the member and provider experience. Innovation: Help modernize the fulfillment technologies and data workflows. Balance: Enjoy a hybrid work schedule (2-3 days in-office) Pittsburgh, PA 15219 Employee of the Company with access to benefits What You'll Do Strategic Execution: Collaborate with Operations teams to integrate print and fulfillment strategies into core business functions using modern tech stacks. Technical Content Management: Utilize Inspire Interactive to develop, maintain, and audit letter templates, ensuring they meet compliance and design standards. Vendor & Project Management: Act as a key liaison between internal departments and external vendors to ensure project timelines and service levels are met. Data & Insights: Generate reports and trend analyses to identify cost-saving opportunities and process improvements. Process Improvement: Stay ahead of industry trends in fulfillment technology to recommend innovative ways to streamline our communications. Who You Are Experienced: You have a Bachelor's degree (degree preferred, will accept equivalent recent and relevant experience) and at least 2 years of experience in operations, client relationship management, or production, required Tech-Savvy: You are proficient in the Microsoft Office Suite (Excel, Visio, Access) and are comfortable learning specialized software like Inspire Interactive. Adaptable: You thrive in fast-paced, sometimes ambiguous environments and can manage multiple high-priority projects simultaneously. Communication Pro: You can translate complex operational needs into clear instructions for vendors and internal stakeholders alike. Knowledgeable: Experience in healthcare insurance, print production, or marketing operations is a significant plus. Who We AreNovus Group is a partner with the Company. Through this affiliation, we help with resume revision advice, interview preparation and we'll act as your liaison with the hiring team. There is no fee for our services since the Company provides this service through Novus Group.

Novus Group is your advocate to DIRECT HIRE positions with a multibillion-dollar organization.Employees of this organization can enjoy the following benefits and much more! Caregiving support for childcare/elderly family members Paid time off up to 5 weeks Student Loan Refinancing / forgiveness Medical, Dental, Vision and other coverages Up to 8% retirement savings match Up to $6,000 per year in Tuition Assistance to you and your immediate family Adoption Assistance, Pet Insurance and Retail Perks & Discounts Ongoing learning Accelerated Career Path Flexible work arrangements 7 holidays per year PTO buy back and selling excess, when eligible Medical Billing Representative - Mechanicsburg, PA 17055 Direct Hire -Full-time hire as an employee of the Company Access to full benefits Monday - Thursday - 7:00 am - 5:00 pm (2 nights per week required until 6 pm); Fridays 8:00 a.m. - 5 p.m. Up to $22 per hour as new employee, based on experience (performance raises available up to $27/per hour, after hire) Must have at minimum all of the following - candidates without this experience will be declined: MINIMUM REQUIREMENTS: Minimum High School diploma or equivalent, required Proficiency with computers, required Knowledge of medical terminology, required Minimum of 2 years' related experience in a medical office billing position Prior experience is required in electronic medical health records is required; Medipac or Epic preferred Medical Billing Representatives are responsible for welcoming patients upon arrival, promoting the usage of new and emerging consumer-friendly technologies, educating patients on their copayments and financial obligations and collecting payments when applicable, scheduling subsequent appointments within the continuum of care, connecting patients to financial advocacy resources when appropriate, updating patient's demographics and insurance coverage information, and promoting an overall culture of service excellence. Display strong customer service skills that ensure that patients and family members have the desired excellent experience at physician practices, hospitals, and outpatient surgery departments. Responsibilities: Provide a warm greeting for all patients. Guide patient through use of self-arrival technology or check-in patient at desk depending on patient preference. Collect copayments and all applicable patient payments at the point of service. Confirm and/or update patient registration information at checkout. Schedule follow-up appointments within the practice at checkout. Schedule or connect patients to resources to schedule for ancillary services at checkout. Help patients navigate the healthcare system by providing clear and understandable instructions. Provides follow-up to unresolved patient questions or needs to ensure the appropriate continuity of care. Understands the principles of service recovery and is both empowered and responsible for taking appropriate action to recover from service that does not meet the expectation. Register patients in Biometrics (fingerprint recognition) program and explain benefits. Promote patient portal and assist patients in registration when applicable Assist patients in education of financial responsibility and connect them to advocacy resources Confirm/verify insurance benefits with the appropriate carrier via online verification systems or telephone inquiries. Obtain signature of patient or family member for consent to treatment and financial responsibility following the Health Insurance Portability and Accountability Act (HIPAA) rules and regulations. Appropriately distribute / triage phone calls to other areas and / or clinical providers. Assist with administrative duties in the office

Phlebotomist - Lititz, PA 17543 Job Status: Direct Hire as an employee of Company - NOT a temporary job Work Schedule & Compensation Full-time, full benefits Daylight shift Salary for new hires: up to $20.00 per hour, to start - candidates will be placed in the appropriate salary rate based on experience and education Promotional growth through dedicated career ladders is expected Based on performance, established employees can earn additional pay up to $28.00 per hour (pay raises are based on work performance, career development, and occur incrementally, over time). Novus Group offers job-preparedness resources to help you navigate direct hire career opportunities through our partnership with the Employer. We are dedicated to helping you achieve your career goals through resume revision assistance, job interview preparation, and we communicate with the Employer on your behalf to get real-time status updates on your applications. These valuable resources are paid by the Employer, there is NO cost to you as the job seeker. Below are some of the perks that focus on you, as the employee: Caregiving support for childcare/elderly family members Paid time off up to 5 weeks Student Loan Refinancing / forgiveness Medical, Dental, Vision and other coverages Up to 8% retirement savings match Up to $6,000 per year in Tuition Assistance to you and your immediate family Adoption Assistance, Pet Insurance and Retail Perks & Discounts Ongoing learning Accelerated Career Path Flexible work arrangements 7 holidays per year PTO buy back and selling excess, when eligible Job Description Phlebotomists are responsible accurately performing phlebotomy and specimen collection of inpatients and/or outpatients. Samples collected by the phlebotomist are used for laboratory test procedures that are essential in the diagnosis and treatment of patients. Phlebotomists may also perform computer, courier, and clerical functions that are essential to laboratory operations. Phlebotomists works in conjunction with and under the supervision of the Medical Technologists.We're looking for Phlebotomists with a MINIMUM of 6 months experience performing phlebotomy required AND current certification from an accredited Phlebotomy or Medical Assistant program required in addition to the requirements below: Minimum Requirements: High School Diploma or equivalent Certification: Phlebotomy Technician PBT (ASCP) Phlebotomy Technician certified by the American Society for Clinical Pathology or equivalent is required Completion of a phlebotomy and/or medical assisting program from an accredited program Proficiency in medical terminology General knowledge of computer software is essential. Laboratory information systems experience Job Responsibilities: Interact with all laboratory customers courteously and professionally Respond to telephone inquiries in a timely manner. Follow proper patient identification procedures, procures appropriate blood specimens by venipuncture, heelstick and fingerstick. Instructs patients on the collection procedures for laboratory specimens and may collect samples other than blood. Demonstrates dependability, reliability, and independent judgment recognizing priorities to accommodate department needs and acceptance of appropriate authority. Specimen collection may be performed at off-site locations. Transports specimens from on- and off-site collection areas to the appropriate section of the laboratory following established safety procedures. Adhere to established laboratory and hospital policies in areas of procedures, methods, quality control, quality assurance, safety, including hand hygiene techniques and proper isolation precautions., compliance and personnel policies. Perform related clerical duties, and utilize various computer functions to accurately enter demographic information into the information system(s), enters test orders, receives, cancels, charges, and credits tests, while ascertaining adequacy of patient information as well as sample identity. Trains and orients new employees, students, and residents, as applicable and as assigned. Inform technical staff, supervisory personnel and/or pathologists of any unusual or problematic incidents. May also perform arterial puncture following strict collection and post collection guidelines. Monitors and maintains supplies for those functions for which the position is responsible; uses materials and reagents in a cost-effective manner.

Job DescriptionCompliance Specialist (Hybrid) Status: Full-Time, Direct Hire - employee of the Company (not a contract or temporary job) Work Arrangement: Hybrid (Combined Work from Home & In-Office requirement at the Pittsburgh office) New Hire Salary Range: $34.98 - $41.37 per hour based on match to job requirements and experience Opportunity to Earn More: After hire, performance-based increases can be earned Benefits: Health & Wellness: Multiple medical plan options (HSA/FSA eligible), $0 preventive care Financial Future: A comprehensive retirement program, some plans have a 50% match on the first 4% of your contributions. Education: Up to $6,000 per academic year in tuition assistance for you and your dependents. Work-Life Balance: A hybrid schedule (home/office), 7 paid holidays, and up to 5.5 weeks of accrued PTO per year. Extra Perks: Paid Parental Leave, Student Loan Refinancing, and much more! The Compliance Specialist is integral to the Corporate Compliance and Ethics Program. You will work alongside the Compliance Officer and Committee to ensure our health insurance practices meet federal, state, and local regulations while mitigating operational risks.The ideal candidate is a self-motivated professional who thrives in an independent working environment and takes proactive initiative in regulatory oversight. Responsibilities Strategic Reporting: Assist in developing dashboards, metrics, and reports for senior management and the Board to demonstrate Compliance Program effectiveness. Risk & Policy Management: Perform regular gap analyses and risk assessments. Draft, adapt, and review Compliance policies and procedures to ensure internal operations remain consistent and accurate. Remediation: Develop and oversee corrective action plans and remediation protocols to ensure timely compliance across all departments. Regulatory Liaison: Act as a representative during regulatory agency reviews, investigations, and requests for information. Industry Expertise: Keep abreast of changing industry laws and standards. Communicate contractual requirements throughout the health plan and research complex regulatory inquiries. Collaboration: Coordinate with internal subject matter experts (SMEs) and business teams to support regulatory product filings, proposal development, and service area expansions. Training: Support Program Leadership in conducting annual and ongoing compliance training for staff and applicable third parties. Qualifications Education: Bachelor's degree required. A Juris Doctor (JD) or Master's degree in a related field is a plus. Experience: Direct experience conducting compliance assessments, audits, or risk assessments. Five (5) years of compliance or legal experience preferred, specifically on the insurance (payer) side. Pennsylvania-specific regulatory experience is highly preferred. Knowledge Base: Proficiency in Medicaid/Medicare Managed Care and various lines of business (Commercial, CHIP, Marketplace). Expert level experience with Medicaid and/or Medicare managed care and with the different lines of business/benefits (i.e., Commercial, Medicaid, CHIP, Marketplace

Pay rate up to $27 per hour, based on experience Opportunity to earn performance-based increases, after hire Hybrid/Remote work structure - candidates must be based in Pennsylvania Responsible for recovery of self-pay balances due. Communicates with patients and outside agencies regarding payment issues. Establishes reasonable payment arrangements, determines charity eligibility, and recommends write-offs according to policies. Responsibilities: Ability to perform peer to peer training Go to person for escalated accounts Advanced knowledge of Microsoft Office Ability to communicate with multiple levels of management Perform duties and job responsibilities in a fashion, which coincides with the service management, including the demonstration of “The Basics of Service Excellence” towards patients, visitors, staff, peers, physicians and other departments within the organization. Verify accuracy of payment posting and reimbursement. Work with appropriate payer and/or department to resolve any payment discrepancies. Understand third party billing and collection guidelines Proficient working multiple payers Identify root cause issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials. Assist in claim appeal process and/or perform follow-up in accordance with Revenue Cycle policies and procedures. Demonstrate knowledge of the current functionality of the patient accounting system Identify issues and submit corrective action recommendations Ability to work independently with minimal supervision Ability to understand complex reimbursement issues Managed assigned book of business by ensuring the timeliness and accuracy of billing, collections, contractual postings, payments and adjustments of accounts based upon their functional area standards. Evaluate and recommend referrals to agency, law firm, financial assistance and bad debt Actively engaged in process improvement for efficiency gains. Able to review complex issues, determine the root cause issue and present a solution that will result in a cost reduction the majority of the time. Meet quality assurance benchmark standards and maintain productivity levels as defined by management. Qualifications: High school diploma or equivalent and 3 years of billing, registration or patient business services or equivalent combination of education and experience Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary Must be able to communicate with patients, payers, outside agencies, and general public through telephone, electronic and written correspondence Prior working experience in billing/collections, denials, credit balances and/or various payers This position requires organization and time management skills The incumbent must develop and manage relationships with colleagues in a professional, independent manner The position requires the ability to maintain confidentiality with regard to all assignments.

Job DescriptionRevenue Cycle Analyst (Health Insurance) Position Type: Full-Time, Permanent (Not Temporary) Shift: Day Job (Monday - Friday) Work Arrangement: Hybrid New Hire Pay Range: $25.40 - $30.00 per hour Opportunity to earn more: After hire, advancement opportunities to earn more through continuing education, performance-based increases and merit incentives can go up to $44.00 per hour. Fee Policy: There is no fee to use our services for your job search. About the Opportunity We are a dedicated Company partner assisting in the search for an Intermediate Revenue Cycle Analyst to join a high-performing Insurance Collections department. This is a full-time, permanent position offering long-term career stability, comprehensive benefits, and a hybrid work environment. Job SummaryIn this role, you will conduct moderately complex analysis of financial and operational Key Performance Indicators (KPIs). You will provide detailed written analysis, financial reports, and proposals outlining solutions for revenue cycle enhancements. You will also audit operations-including detailed reviews of accounts receivable-and work across departments to resolve outstanding issues. Key Responsibilities Data & Root Cause Analysis: Extract and analyze financial/operational datasets to identify root cause drivers of significant variances and trends. Executive Reporting: Prepare financial metrics and create high-quality, executive-level presentations summarizing key projects and metrics. Process Auditing: Facilitate audits of revenue cycle operations to ensure compliance with published protocols and Sarbanes-Oxley controls. Cross-Functional Collaboration: Partner with Finance and Clinical Administration to understand drivers of revenue outcomes and develop action plans to address issues. Project Management: Effectively manage the reporting request intake process, ensuring timely delivery and data integrity. Qualifications Education: Bachelor's degree in Finance, Business, or a related field. Experience: Minimum of one (1) year of related work experience. Alternative: High School Diploma/GED with three (3) years of related work experience. Technical Skills: Proficiency in Microsoft Excel is required. Familiarity with PeopleSoft General Ledger or similar ERP systems is preferred. Clearances: Must be able to obtain standard background clearances (Act 34). BenefitsOur partner provides a culture that cares for the "whole employee" with a robust benefits package: Time Off: Over 5 weeks of paid time off (PTO) per year. Retirement: Employer retirement contributions of up to 8% of eligible pay. Education: Up to $6,000 in annual tuition assistance, plus student loan assistance and tuition help for dependents. Health & Family: Affordable medical/dental/vision, 2 weeks of paid parental leave, and emergency child/elder care options. Career Path: Accelerated growth pathways and access to ongoing learning via LinkedIn Learning.

Medical Office Assistant - Loretto, PA 15940 Job Status: Direct Hire as an employee of Company - NOT a temporary job Work Schedule & Compensation Full-time, full benefits Daylight shift - Monday - Friday Salary for new hires: up to $20.00 per hour, to start (based on experience and education) Promotional growth through dedicated career ladders is expected Based on performance, established employees can earn additional pay up to $27.00 per hour (pay raises are based on work performance, career development, and occur incrementally, over time). Novus Group offers job-preparedness resources to help you navigate direct hire career opportunities through our partnership with the Employer. We are dedicated to helping you achieve your career goals through resume revision assistance, job interview preparation, and we communicate with the Employer on your behalf to get real-time status updates on your applications. These valuable resources are paid by the Employer, there is NO cost to you as the job seeker. Below are some of the perks that focus on you, as the employee: Caregiving support for childcare/elderly family members Paid time off up to 5 weeks Student Loan Refinancing / forgiveness Medical, Dental, Vision and other coverages Up to 8% retirement savings match Up to $6,000 per year in Tuition Assistance to you and your immediate family Adoption Assistance, Pet Insurance and Retail Perks & Discounts Ongoing learning Accelerated Career Path Flexible work arrangements 7 holidays per year PTO buy back and selling excess, when eligible Job Description Office Assistant will be responsible for making and scheduling patient appointments in an efficient and timely manner. They will assist customers in person and on the phone, providing information, and communicating with various departments. They will obtain and enter complete demographic and insurance information. The ideal candidate will have a strong background with medical terminology, electronic health systems, and at least 1 year of experience in a medical office setting. Minimum Requirements: High School Diploma or equivalent required Minimum of 1 year experience in a medical office setting required Knowledge of medical terminology Proficiency with using computers, general navigation, ability to learn new software, prefer prior experience working with Epic or electronic health software

Job Description Quality Assurance Analyst (Insurance Auditor Focus) - Pittsburgh, PA 15219 (Downtown) Status: Full-Time Shift: Day Job Work Arrangement: Hybrid (2 days in-office required, 3 days remote) Location: Pittsburgh, PA 15219 (Downtown) Department: Operational Risk Integrity Starting Pay Range: $24.00 - $29.00 per hour as a new hire, based on experience. Compensation increases: After hire and through promotional, performance-based increases, additional compensation can be earned up to $42.00 per hour. Continuous and experiential learning will be required to achieve pay increases. Comprehensive Benefits Package The Company offers competitive compensation and a full range of benefits designed to support your total well-being, including: Competitive Pay: Base wages, Merit Pay, and generous Premium Pay (Off-Shift Differential, Holiday Pay, Standby/Call-in Pay). Health & Wellness: Comprehensive Medical, Dental, Vision, and Prescription Drug Coverage, plus Flexible Spending Accounts (FSAs). Access to Employee Assistance Programs (EAP) and various Wellness Programs (e.g., stress management, weight management). Financial Security & Retirement: Cash Balance and Savings Plans, along with Basic Life, AD&D, and Disability Insurance. Time Off & Leave: Generous Vacation/Personal/Sick Time (PTO), Paid Holidays, Funeral Leave, and Paid Parental Leave. Professional Growth: Opportunities for Tuition Assistance, access to training resources, and defined Advancement Opportunities via Career Ladders and Internal Job Postings. Work-Life Support: Child and Elder Care Referrals, Legal Insurance, and Employee Discounts/Perks. Recognition: Programs like Merit Awards, ACES, and Service Awards to recognize your valuable contributions. The Quality Assurance Analyst is meticulous and analytical working with the Company's Operational Risk Integrity department in Pittsburgh, PA. This role functions as a critical Insurance Auditor Analyst, primarily responsible for ensuring the accuracy and integrity of the claim payment systems. This is a full-time, hybrid position, working daylight hours (Monday - Friday), requiring two days per week in our Pittsburgh office. Key Responsibilities As a core member of the Operational Risk Integrity team, you will: Claim Auditing: Conduct comprehensive prospective and retrospective audits of high dollar claims to verify payment accuracy and adherence to policy. Payment Integrity: Collaborate directly with Reimbursement and Configuration Specialists to identify, investigate, and resolve payment inaccuracies and ensure correct system configuration. Risk Mitigation: Analyze audit results, identify root causes of errors, and detect emerging error trends to recommend policy/procedure modifications and necessary staff training. Process Improvement: Drive continuous improvement by participating in and leading initiatives to target potential problems and enhance operational efficiency. Data Analysis & Reporting: Devise sampling methodologies, retrieve audit samples, and compile/report statistical data to internal stakeholders and external client audit teams. Stakeholder Management: Act as a subject matter expert to resolve complex or difficult issues, ensuring satisfaction for internal (Claims, Customer Service, Marketing) and external customers. Maintain strict confidentiality in all activities. Core Competencies and Minimum Qualification Requirements: Proven experience and knowledge of reimbursement mechanisms and clinical/procedural coding (e.g., CPT, ICD-10, HCPCS). Note: Five (5) years of claims processing experience, including commercial and government health insurance plans, may substitute for coding/reimbursement knowledge. Basic to intermediate understanding of managed care delivery systems. Excellent analytical skills and familiarity with basic statistical analysis. High level of oral and written communication skills for effective reporting and issue resolution. Highly detail-oriented with superior organizational skills. Technical Skills: Intermediate proficiency with Microsoft Excel (e.g., pivot tables, formulas). Intermediate proficiency with general MS Office products. Familiarity with reporting tools like MS Access or COGNOS is a plus.

Job DescriptionHealth Insurance Product Development Assistant, Pittsburgh, PA 15219 Secure your future with a direct-hire position as an employee of the company - this is not a temporary role, and you'll never pay a fee for our assistance. As a proud partner of the company, Novus Group is dedicated to helping you succeed. We provide comprehensive support, including resume fine-tuning, personalized interview coaching, compensation insights, and end-to-end navigation of the employment process, leading you directly to an offer. Location: [Downtown Pittsburgh, PA 15219] This role does offer some remote/work-from-home flexibility, but will require a regular presence in Pittsburgh, PA. Company Overview:The Company, a non-profit healthcare organization, is a leader in providing high-quality, compassionate care to patients. With an extensive network of hospitals, clinics, and other medical facilities, the Company is dedicated to improving the health and well-being of the communities served. Job Summary:As the Health Insurance Product Development Assistant, you will assist in the research, analysis, and design of new health insurance products that meet the evolving needs of customers. Working closely with cross-functional teams, you will gather and interpret data, identify market trends, and collaborate on the development of product features and pricing strategies. Your attention to detail, analytical skills, and passion for the insurance industry will be essential as you help shape the future of Company's healthcare solutions. Key Responsibilities:- Conduct market research and data analysis to inform the development of new health insurance products - Assist in the design and testing of product features, benefits, and pricing structures - Collaborate with actuaries, underwriters, and marketing professionals to ensure the viability and competitiveness of new insurance offerings - Gather and synthesize customer feedback to identify opportunities for product enhancements - Support the implementation and launch of new insurance products - Participate positively in various workgroups by offering valuable input, taking action on relevant items, and coordinating between departments as requested by leadership- Assist/take lead in development and presentation of training materials Minimum Qualifications: Bachelor's degree in business, health care, management, a related field OR relevant experience. 2 years of business experience required. Knowledge of Commercial Insurance products is a bonus. Experience in product development a plus, but not required. Good project management skills with proven ability to manage multiple tasks and priorities. Strong computer skills required, with proficiency in Outlook, Excel, Word and Internet Explorer. Strong organizational skills and attention to detail. Strong analytical and problem-solving skills. Strong communication skills, both verbal and written, and the ability to communicate effectively with all levels and all departments. Positive, professional attitude and enthusiastic demeanor. Ability to work independently with minimal or no direction from leadership Compensation and Benefits:A competitive salary is offered to new hires of up to $67,000 per year, commensurate with experience, as well as a comprehensive benefits package including health, dental, and vision insurance, retirement plan contributions, tuition reimbursement, and generous paid time off. In addition to your base salary, you have the potential to significantly increase your earnings. After hire, the Company offers performance-based raises and pathways for higher pay through continuous learning and education, with the potential to reach up to $95,000 annually in this position. Equal Opportunity Employer:Our organization is committed to providing equal employment opportunities to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.

Job DescriptionAre you a dedicated law enforcement professional who values quality and safety? Look no further! We are excited to announce opportunities for Sr. Police Officer II positions at UPMC Hanover. Assigned shift will be based upon hospital need. Why Choose UPMC?Whether you are just starting your law enforcement career, retired, considering retirement, or looking for a change of pace from traditional law enforcement, UPMC offers: Generous Sign-On Bonus: Kickstart your journey with a $10,000 sign-on bonus when you commit to a full-time position for two years. Career Advancement: Take advantage of promotional and leadership opportunities to grow your career. Shift Differential: Enjoy an additional $1.75 per hour for working non-traditional shifts. Annual Merit Increase: Receive yearly pay boosts based on your performance. Community: Join one of the largest private police forces in Pennsylvania and be part of a close-knit team within the UPMC network. Benefits: UPMC offers world-class health benefits, generous paid time off, tuition assistance, and much more. Note: The Act 235 Certification is required prior to hire. The Act 120 Municipal Police Officer training is not a substitute for the Act 235. To learn more about Act 235, please visit the Pennsylvania State Police website. The Police Officer is responsible for maintaining a safe and secure environment for patients, visitors, staff, and all UPMC owned and adjacent properties. Enforces UPMC rules and regulations to both employees and the public. Establish a uniformed police presence by patrolling UPMC hospitals, buildings, grounds, and associated areas to deter criminal activity, investigate criminal events, document activities, and take appropriate police action when necessary. Monitors security, fire, and environmental alarms. Responds to and resolve problems, disputes, and unusual circumstances as necessary. Provides customer service to patients, families, visitors, and staff to maintain a safe and secure environment. Serves as a first responder to any violent act occurring at a UPMC location. Will be armed with a firearm. Oversees the operations of assigned shift and formally leads the daily operations of the department. Organizes and assigns work and provides daily instruction to staff regarding specific duties and assignments. Responsibilities: Ability to handle evidence control pertaining to UPMC initiated criminal investigations Responds to acts of extreme violence at UPMC owned or controlled properties that have the potential to require the deployment of deadly force as dictated by UPMC policy. May be required to support various types of investigations that have system-wide implication Required to carry, properly handle, and be able to deploy a firearm. Tasked with the ability to issue PA state citations for certain criminal and traffic offenses, using specific law enforcement applications such as the PA Justice Network, and performing other law enforcement duties as necessary. Investigates incidents of unusual circumstances reported by UPMC staff, visitors, physicians, and patients. Must be able to perform as a Security Officer when necessary. Appropriately escalates problems and concerns to Management's attention. Will be responsible for the transportation of those subjected to criminal arrest and subsequent prosecution May be required to serve legal documents such as arrest warrants, subpoena, Protection From Abuse, etc. May function as a shift supervisor as needed to oversee the operations of assigned shift and formally lead the daily operations of the department, organize and assign work, and provide daily instruction to staff regarding specific duties and assignments. May be required to provide support at various UPMC facilities which would include: Detailed knowledge of the physical layout of multiple facilities. Working knowledge of site specific policies and procedures between sites. Ability to effectively interact with differing management and customer bases from site to site. Qualifications: High School diploma or equivalent. Pennsylvania Municipal Police Officers' Education and Training Commission (MPOETC) basic training program (Act 120) or equivalent (PA State Police Academy training, out of state Police Academy), OR Police Officer training as mandated by the Federal Law Enforcement Training Centers), OR Federal Agent (to include but not limited to FBI, DEA, Secret Service, U.S. Marshal, Veteran's Administration) OR Military Police Training, OR Five years of prior law enforcement experience (to include Sheriff, Deputy Sheriff, Probation/Parole Officer, Liquor Enforcement Officer, Fish/Game Commission and/or Park police officer) wherein a firearm was an essential tool and at a minimum, annual firearm training and qualification was maintained. Must possess strong interpersonal skills, especially the ability to effectively interact, communicate, and diffuse potential combative situations with persons from all walks of life. Psychological fitness required to deal with stress and potentially dangerous conflict situations. Physical fitness requirements to deal with typical physical demands that require full body motion and physical strength and stamina sufficient to respond to crisis interventions and medical emergencies. Be able to effectively communicate both orally and in written format. Good interpersonal skills; able to deal with stress and potentially dangerous conflict situations. All applicants will be subject to a thorough background and criminal record check. Must be available for all shifts. Officers are required to wear a bullet proof vest. Must be able to perform as a security officer when necessary. Licensure, Certifications, and Clearances: Act 235 with successful completion of both the academic and firearms training modules, required prior to hire. Must meet audio and visual standards outlined in Act 235 at time of hire. Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR) Driver's License UPMC Physical Fitness Standard Act 235 with Firearms prior to hire Act 31 Child Abuse Reporting Act 33 with renewal Act 34 with renewal Act 501 Act 73 FBI Clearance Successful completion of UPMC Police Training upon hire. Successful completion of all UPMC-mandated weapons and firearms training. Successfully pass UPMC Physical Fitness Standard: Physical fitness requirements to deal with typical physical demands that require full body motion and physical strength and stamina sufficient to chase, apprehend, and subdue criminal suspects, and respond to crisis interventions and medical emergencies. Must have good hand/eye coordination and able to pass an eye and hearing test with appropriate correction.

Job DescriptionCommercial Health Insurance Enrollment Specialist Secure your future with a direct-hire position as an employee of the company - this is NOT a temporary role, and you'll never pay a fee for our assistance. As a proud partner of the company, Novus Group is dedicated to helping you succeed. We provide comprehensive support, including resume fine-tuning, personalized interview coaching, compensation insights, and end-to-end navigation of the employment process, leading you directly to an offer. Job Status: Full-time Work Schedule: Monday through Friday, 9:00 am - 5:00 pm, overtime as necessary Hybrid: Remote/work-from-home and a presence in the Downtown Pittsburgh office, when needed Company Overview: The Company, a non-profit healthcare organization, is a leader in providing high-quality, compassionate care to patients. With an extensive network of hospitals, clinics, and other medical facilities, the Company is dedicated to improving the health and well-being of the communities served. Job Summary: As a Commercial Health Insurance Enrollment Specialist, you will play a vital role in assisting individuals and businesses in enrolling in comprehensive suite of commercial health insurance plans. Leveraging your expertise in health insurance products and regulations, you will educate clients on their options, process enrollment applications, and provide ongoing support to ensure a seamless plan implementation. Knowledge of Centers for Medicare and Medicaid Services (CMS), Pennsylvania Department of Welfare (DPW), and Pennsylvania Insurance Department (PID) will be crucial. Key Responsibilities: - Educate clients on the detailed features and benefits of commercial health insurance plans, enrollment and disenrollment requirements and processing rules based upon the product (HMO, PPO, EPO, SNP, PDP, Select, Supplemental, or National Complimentary) and Individual vs. Employer Group, including, but not limited to, understanding and application of service areas by product- Ability to make eligibility determinations based on CMS (Part A/Part B Eligibility), DPW (Medical Assistance Eligibility), and/or PID requirements, in accordance with the application election period guidelines. Ability to accurately identify appropriate election period based upon analysis of beneficiary/member history and regulatory guidance- Process enrollment applications and ensure accurate data entry- Assist clients with plan selection and provide guidance on plan utilization- Maintain detailed records and documentation related to enrollment activities- Stay up to date on industry regulations and changes to commercial health insurance products Minimum Qualifications: REQUIRED: High school diploma or equivalent REQUIRED: Minimum 6 months of experience in a customer service/call center healthcare insurance setting working with CMS, DPW, and PID Must be proficient in Microsoft Office Suite Products (Outlook, Excel, Word) Familiarity with health insurance products and regulations Strong customer service and communication skills Proficiency in data entry and administrative tasks Excellent problem-solving and attention to detail Compensation and Benefits: A competitive salary is offered to new hires. Candidates will be placed within the range of $19.00 to $22.00 per hour. Applicants will be placed in the appropriate salary based on their individual experience and education. Also offered is a comprehensive benefits package including health, dental, and vision insurance, retirement plan contributions, tuition reimbursement, generous paid time off, and many more perks! In addition to your base salary, you have the potential to significantly increase your earnings. After hire, the Company offers performance-based raises and pathways for higher pay through continuous learning and education, with the potential to reach up to $29.00 hourly in this position. Equal Opportunity Employer:Our organization is committed to providing equal employment opportunities to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.

Job DescriptionNovus Group is your advocate to DIRECT HIRE positions with a multibillion-dollar organization.Employees of this organization can enjoy the following benefits and much more! Caregiving support for childcare/elderly family members Paid time off up to 5 weeks Student Loan Refinancing / forgiveness Medical, Dental, Vision and other coverages Up to 8% retirement savings match Up to $6,000 per year in Tuition Assistance to you and your immediate family Adoption Assistance, Pet Insurance and Retail Perks & Discounts Ongoing learning Accelerated Career Path Flexible work arrangements 7 holidays per year PTO buy back and selling excess, when eligible Medical Billing Representative - Mechanicsburg, PA 17055 Direct Hire -Full-time hire as an employee of the Company Access to full benefits Monday - Thursday - 7:00 am - 5:00 pm (2 nights per week required until 6 pm); Fridays 8:00 a.m. - 5 p.m. Up to $22 per hour as new employee, based on experience (performance raises available up to $27/per hour, after hire) Must have at minimum all of the following - candidates without this experience will be declined: MINIMUM REQUIREMENTS: Minimum High School diploma or equivalent, required Proficiency with computers, required Knowledge of medical terminology, required Minimum of 2 years' related experience in a medical office billing position Prior experience is required in electronic medical health records is required; Medipac or Epic preferred Medical Billing Representatives are responsible for welcoming patients upon arrival, promoting the usage of new and emerging consumer-friendly technologies, educating patients on their copayments and financial obligations and collecting payments when applicable, scheduling subsequent appointments within the continuum of care, connecting patients to financial advocacy resources when appropriate, updating patient's demographics and insurance coverage information, and promoting an overall culture of service excellence. Display strong customer service skills that ensure that patients and family members have the desired excellent experience at physician practices, hospitals, and outpatient surgery departments. Responsibilities: Provide a warm greeting for all patients. Guide patient through use of self-arrival technology or check-in patient at desk depending on patient preference. Collect copayments and all applicable patient payments at the point of service. Confirm and/or update patient registration information at checkout. Schedule follow-up appointments within the practice at checkout. Schedule or connect patients to resources to schedule for ancillary services at checkout. Help patients navigate the healthcare system by providing clear and understandable instructions. Provides follow-up to unresolved patient questions or needs to ensure the appropriate continuity of care. Understands the principles of service recovery and is both empowered and responsible for taking appropriate action to recover from service that does not meet the expectation. Register patients in Biometrics (fingerprint recognition) program and explain benefits. Promote patient portal and assist patients in registration when applicable Assist patients in education of financial responsibility and connect them to advocacy resources Confirm/verify insurance benefits with the appropriate carrier via online verification systems or telephone inquiries. Obtain signature of patient or family member for consent to treatment and financial responsibility following the Health Insurance Portability and Accountability Act (HIPAA) rules and regulations. Appropriately distribute / triage phone calls to other areas and / or clinical providers. Assist with administrative duties in the office

Job DescriptionHealthcare Provider Contract Specialist, Pittsburgh, PA 15222 Secure your future with a direct-hire position as an employee of the company - this is not a temporary role, and you'll never pay a fee for our assistance. As a proud partner of the company, Novus Group is dedicated to helping you succeed. We provide comprehensive support, including resume fine-tuning, personalized interview coaching, compensation insights, and end-to-end navigation of the employment process, leading you directly to an offer. Location: [Downtown Pittsburgh, PA 15222] This role does offer some remote/work-from-home flexibility, but will require a regular presence in Pittsburgh, PA. Travel: Occasional travel throughout the Pittsburgh, PA area Company Overview:The Company, a non-profit healthcare organization, is a leader in providing high-quality, compassionate care to patients throughout Pennsylvania and beyond. With an extensive network of hospitals, clinics, and other medical facilities, the company is dedicated to improving the health and well-being of the communities they serve. Job Summary:As the Health Provider Contract Specialist, you will play a crucial role in managing and negotiating contracts with our extensive network of healthcare providers. Leveraging your expertise in contract administration and financial analysis, you will ensure that our contractual agreements are favorable and compliant, enabling us to continue delivering exceptional care to our patients. This position is responsible for facilitating a seamless process from the time a provider is identified as needed in the network to contract with the provider for services. The Contract Specialist reviews any alterations in the status of contracted providers that may have an impact on their ability to continue to be in the provider network including changes in license, certifications, and/or enrollment by assisting with completing pre-credentialing requirements. Key Responsibilities:- Review and negotiate contracts with healthcare providers, including hospitals, clinics, and medical practices- Analyze financial data and contractual terms to identify opportunities for improved cost savings and operational efficiency- Ensure contractual compliance and maintain accurate records of all provider agreements- Collaborate with cross-functional teams to address any issues or concerns related to provider contracts- Stay up to date with industry regulations and best practices in healthcare contracting Minimum Qualifications:- Bachelor's degree in Business Administration, Finance, or a related field- Minimum 3 years of experience in healthcare contract management or provider relations networking - Demonstrated expertise in contract negotiation, financial analysis, and contract compliance- Thorough knowledge of NCQA standards and other relevant external quality standards- Knowledge of state and federal standards for contracting- Strong communication and interpersonal skills to effectively liaise with healthcare providers- Proficient in Microsoft Office suite, with the ability to analyze complex data and create detailed reports Compensation and Benefits:A competitive salary is offered to new hires of up to $57,000 per year, commensurate with experience, as well as a comprehensive benefits package including health, dental, and vision insurance, retirement plan contributions, tuition reimbursement, and generous paid time off. In addition to your base salary, you have the potential to significantly increase your earnings. We offer performance-based raises and pathways for higher pay through continuous learning and education, with the potential to reach up to $81,000 annually in this position. Equal Opportunity Employer:Our organization is committed to providing equal employment opportunities to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.

Certified Phlebotomy Technician Status: Full-Time, Day ShiftWork Arrangement: On-site Location: Hanover, PA 17331 Are you a highly skilled Certified Phlebotomy Technician seeking a stable, Direct Hire opportunity with a leading healthcare provider? We seek a professional and patient-centric Certified Phlebotomist to join the Company's essential Outpatient Lab team. This is a Regular, Full-Time position, making you a permanent employee from day one, offering stability and excellent long-term career prospects. This role requires a day-shift commitment, including a required weekend rotation (every third Saturday), and necessitates reliable transportation for travel between various local outpatient sites. Compensation and Outstanding Employee Benefits Competitive Salary: Earn between $18.49 - $21.00 per hour, commensurate with your certification and experience. Performance-Based Increases: Opportunities to earn raises based on merit and performance reviews. Generous Paid Time Off (PTO): Enjoy substantial paid time off to support your work-life balance. Comprehensive Benefits Package: As an employee, you receive outstanding, industry-leading benefits, including: Health, Vision, and Dental Insurance Life Insurance Retirement/403(b) Plans Tuition Reimbursement for professional development. Key Responsibilities and ExpertiseAs a Certified Phlebotomist, you will serve as the expert resource for all specimen collection procedures, maintaining the highest standards of safety and accuracy. Advanced Specimen Collection: Skillfully and confidently perform venipuncture, capillary collection (heelstick/fingerstick), and guide patient self-collection, including specialized or complex draws as required. Arterial Puncture Expertise: Perform arterial punctures when assigned, strictly following established protocols and maintaining competency. Quality Assurance: Master and enforce precise patient identification and specimen integrity protocols to eliminate pre-analytical errors. Service Excellence: Provide professional, empathetic, and responsive service to all patients and clinical staff. Administrative Support: Execute necessary clerical duties, including accurate data entry, managing test orders via the Laboratory Information System (LIS), and maintaining supply efficiency. Training & Mentorship: Actively participate in the orientation and training of new staff, phlebotomy students, and medical residents. Compliance & Safety: Rigorously adhere to all hospital and laboratory policies, including quality control, infection prevention, and mandated safety guidelines. Mandatory and Preferred Qualifications Category Requirement Education High school diploma or equivalent (Required). Certification Certification from an accredited Phlebotomy or Medical Assistant program is required. Experience Minimum 6 months performing phlebotomy (Preferred). Licensure/Cert. Phlebotomy Technician (PBT(ASCP)) or equivalent professional certification is highly preferred. Knowledge Proficiency in Medical Terminology and prior experience with a Laboratory Information System (LIS) (Preferred).

Compliance Specialist (Hybrid) Status: Full-Time, Direct Hire - employee of the Company (not a contract or temporary job) Work Arrangement: Hybrid (Combined Work from Home & In-Office requirement at the Pittsburgh office) New Hire Salary Range: $34.98 - $41.37 per hour based on match to job requirements and experience Opportunity to Earn More: After hire, performance-based increases can be earned Benefits: Health & Wellness: Multiple medical plan options (HSA/FSA eligible), $0 preventive care Financial Future: A comprehensive retirement program, some plans have a 50% match on the first 4% of your contributions. Education: Up to $6,000 per academic year in tuition assistance for you and your dependents. Work-Life Balance: A hybrid schedule (home/office), 7 paid holidays, and up to 5.5 weeks of accrued PTO per year. Extra Perks: Paid Parental Leave, Student Loan Refinancing, and much more! The Compliance Specialist is integral to the Corporate Compliance and Ethics Program. You will work alongside the Compliance Officer and Committee to ensure our health insurance practices meet federal, state, and local regulations while mitigating operational risks.The ideal candidate is a self-motivated professional who thrives in an independent working environment and takes proactive initiative in regulatory oversight. Responsibilities Strategic Reporting: Assist in developing dashboards, metrics, and reports for senior management and the Board to demonstrate Compliance Program effectiveness. Risk & Policy Management: Perform regular gap analyses and risk assessments. Draft, adapt, and review Compliance policies and procedures to ensure internal operations remain consistent and accurate. Remediation: Develop and oversee corrective action plans and remediation protocols to ensure timely compliance across all departments. Regulatory Liaison: Act as a representative during regulatory agency reviews, investigations, and requests for information. Industry Expertise: Keep abreast of changing industry laws and standards. Communicate contractual requirements throughout the health plan and research complex regulatory inquiries. Collaboration: Coordinate with internal subject matter experts (SMEs) and business teams to support regulatory product filings, proposal development, and service area expansions. Training: Support Program Leadership in conducting annual and ongoing compliance training for staff and applicable third parties. Qualifications Education: Bachelor's degree required. A Juris Doctor (JD) or Master's degree in a related field is a plus. Experience: Direct experience conducting compliance assessments, audits, or risk assessments. Five (5) years of compliance or legal experience preferred, specifically on the insurance (payer) side. Pennsylvania-specific regulatory experience is highly preferred. Knowledge Base: Proficiency in Medicaid/Medicare Managed Care and various lines of business (Commercial, CHIP, Marketplace). Expert level experience with Medicaid and/or Medicare managed care and with the different lines of business/benefits (i.e., Commercial, Medicaid, CHIP, Marketplace