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Performant Financial jobs - 43 jobs

  • Supervisor, Healthcare Customer Service

    Performant Financial 4.7company rating

    Remote Performant Financial job

    ABOUT MACHINIFY: In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare payment through seamless intelligence. ABOUT THE OPPORTUNITY: Hiring Range: $50000 - $60000 The Healthcare Customer Service group is the primary point of contact for all providers, Medicare contractors, commercial clients, etc. They respond to all verbal and written inquiries and are responsible for utilizing reports to track inventory and aging. The Healthcare Customer Service Supervisor oversees daily operations and a team supervision to ensure client customer service requirements are met timely and with high quality to meet business needs. Oversees the daily team productivity, quality, handles escalated process issues, ensures staff is properly trained, and flow-down of changes are implemented and adopted accordingly. Demonstrates knowledge and expertise in carrying out the following scope of responsibilities: Key Responsibilities Supervise a team of clerical support staff and leads in accordance with policies, laws, and in the best interest of the company. Ensures smooth workflow for successful completion of customer service activities with high quality. Interfaces with other internal departments and subject matter experts as needed to resolve issues and communicate changes in requirements, systems, processes and procedures, as well as supports transition and adaptation by the team in a positive and effective manner. Provides answers and handles escalation from team members; handles escalated questions from providers and resolves issues via phone and written correspondence. Drives research, analysis and resolution of questions and issues that arise. Provides training and support to new team members as well as all CSS team for any new or changing workflows or requirements. Contributes to continuous improvement efforts and develops/delivers tools and training to increase knowledge, efficiency and consistency of department output. Assists management with establishing and communicating goals and expectations to team members. Review team members' performance on a regular basis and provides direction, coaching, and training to maximize the efficiency and results workflow process of the team(s). Prepares and conducts annual staff performance reviews with support of management, and provides input to recommendations for transfer, promotion, termination, etc. of the team members. Resolves problems within the team and promotes collaboration and teamwork to ensure efficient, effective, team performance. Conducts regular meetings and communicates effectively with the team. Analyzes individual staff performance, attendance, compliance, work behaviors and adherence to policies; identifies individual and group issues and trends; communicates results and recommendations to the next level of management; and partners with management and HR to address accordingly. Reviews and approves scheduled time off requests, timecards, and other direct supervisory responsibilities as assigned through the HR/Payroll systems. Monitors attendance and effectively raises and addresses concerns in collaboration with the next level management and HR. Follows and complies with company policies, processes and procedures. Successfully completes, retains, applies and adheres to content in required training as assigned including, but not limited to, information security, anti-harassment and other compliance and policy/ procedure training applicable for position. Maintain policy and procedure documents as well as contribute to the development and/or improvement of workflows and procedures based upon changing requirements. Maintain a current knowledge of all Medicare rules, regulations, policies and procedures, and contract requirements. Knowledge, Skills and Abilities Needed To perform this job successfully, an individual must be able to perform each essential function satisfactorily. Below are representative of the knowledge, skills, and abilities required. Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10 coding. Strong verbal and written communication skills; Ability to communicate professionally with internal and external audiences. Excellent interpersonal skills: Ability to maintain professionalism and composure in difficult interactions or conflict as well as builds credibility and trust. Solid supervisory skills: ability to effectively assess skills, transfer knowledge/skills to others and lead/direct the work of others. Ability to handle any non-standard situations that may arise applying good judgment and decision- making skills. Strong understanding of customer service policies and processes; healthcare Provider customer service background with demonstrated ability to adapt and document workflow as needed in a dynamic growth environment. Possess knowledge of Medicare rules and regulations. Demonstrated knowledge and skills in medical claims processing and/or billing experience required to perform job duties. Experience in some capacity of medical claim quality assurance, or past demonstrated experience in a QA function. Good problem-solving and analytical skills; ability to identify and resolve root-cause. Able to maintain confidentiality of sensitive data. Solid desktop system skills; strong use of standard Microsoft office applications including strong Excel skills; and adept in quickly adapting to use of various business systems and applications. Proven attention to detail and excellent organization skill. Ability to successfully perform function with minimum supervision. Time management skills to effectively manage diverse workload while completing work within allocated time frames in a fast-paced dynamic environment. Ability to adapt to changes easily and assist others to do so. Required and Preferred Qualifications Education and Experience: High school degree or GED required. Some college AS or BS degree is plus. Minimum 6 years progressive customer service experience in the medical or health insurance field. Minimum 1+ years prior experience successfully supervising or managing clerical, administrative or operations non-exempt staff. WHAT WE OFFER: Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview. Physical Requirements & Additional Notices: If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location. The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary. Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse. Regularly reads and comprehends information in electronic (computer) or paper form (written/printed). Regularly sit/stand 8 or more hours per day. Occasionally lift/carry/push/pull up to 10lbs. Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position: Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions. Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists. Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures. Other requirements may apply. All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination. Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify's Human Resources team to discuss further. Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING
    $50k-60k yearly Auto-Apply 12d ago
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  • Medical Review Coding Appeals Auditor (Outpatient)

    Performant Financial 4.7company rating

    Remote Performant Financial job

    ABOUT MACHINIFY: In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare payment through seamless intelligence. ABOUT THE OPPORTUNITY: Hiring Range:$65,000 - $73,000 The Medical Review Coding Appeals Auditor (Outpatient) is responsible for conducting Appeals reviews of new evidence presented by auditee's, disputing all or part of the findings from medical review audit work completed by the medical review coding audit team members, Communicates and supports the identification of potential training opportunities or enhancements to training and/or concept review guideline materials and tools. Responsible for performing some audit activity and consistently achieves or exceeds productivity goals and quality standards. Serves as subject matter expert, provides supplemental escalation support, and may perform special project activity as needed. Key Responsibilities Performs limited volume of outpatient coding reviews on medical records to maintain subject matter expertise, and additionally as needed to support business needs. Conducts Appeals reviews on medical review audit work completed by the medical review coding audit team members, as new evidence is presented by auditees Objectively and accurately documents Appeals results in accordance with department quality policies and procedures, scoring and reporting all Appeals results and routes record appropriately within audit platform based upon how the Appeal review resulted in concurrence with audit finding or identified corrections required. Reviews audit documentation and conducts research, analyzes claims data, applies knowledge of client SOW, applicable concept guidelines, policies, and regulations as necessary to determine if audit result is accurate and includes complete details to support findings. Provides correction to narrative rationale to correspond with audit determination and flags patterns of concern to audit leadership for real-time intervention, preventing an accumulation of improper findings Contributes to the continuous improvement feedback process and suggests or makes any edits, documentation, next steps, and reporting as may be necessary in accordance with department process and audit leadership direction. May perform primary audit activity as assigned by management Monitors, tracks, and reports on all work conducted in accordance with Appeals process and management direction. May prepare reports for management that includes a variety of data and trends at the individual, department, and client program level, as well as date range or concept based/trended, or other characteristic that will provide valuable business insights. Consults with internal resources as necessary. Become subject matter expert for assigned business segment(s). Maintain current knowledge and changes that affect our industry and clients as it pertains to medical practice, technology, regulations, legislation, and business trends. Participates in and contributes to applicable department meetings. Successfully completes, retains, applies, and adheres to content in required training as assigned that includes but not limited to information security, anti-harassment and other compliance and policy/procedures training applicable for position. Proactively contributes to continuous improvement of activities and sets positive example Contributes collaboratively to identifying opportunities for improvement of audit results and continuous improvement initiatives. May support training material/tools and best practices development. May identify/make recommendations to management for supplemental team/concept type training. May support training activities for new audit staff or provide supplemental training for existing staff as needed. Contributes to positive team environment that fosters open communication, sharing of information, continuous improvement, and optimized business results. Receives feedback and adjusts work priority as necessary. Serves as positive role model and example for other audit staff and conducts work in accordance with company policies, government regulations and law. Performs job duties with high level of professionalism and maintains confidentiality Perform other incidental and related duties as required and assigned to meet business needs. Knowledge, Skills and Abilities Needed Demonstrated ability to perform claim payment audits with high quality and production results, as well as successful application of skills to conduct quality assurance review of audit work completed by others. Must be able to manage multiple assignments effectively, create documentation outlining findings, Appeals review results and/or documenting suggestions, organize and prioritize workload, problem solve, work independently and with team members. Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10. Proficiency with MCS 1500/UB 04 forms Strong knowledge of medical documentation requirements and an understanding CMS, Medicaid and/or Commercial insurance programs, particularly the coverage and payment rules and regulations. Working knowledge of encoder Proven ability to review, analyze, and research coding issues Reimbursement policy and/or claims software analyst experience Familiarity with interpreting electronic medical records (EHR) Basic understanding of accounting principles for accounts payable and receivable as it relates to medical billing. Independent, out-of-the-box thinker; Performs successfully against work given in the form of objectives and projects; leads by example. Understands processes, procedures, and workflow; and demonstrated ability to identify areas of opportunity Demonstrated ability to consistently apply sound judgment and good effective decision making. Understands Medical Review Audit and Quality Assurance objectives, activities, and key drivers in achieving operational goals. Ability to efficiently and effectively run reports, analyze information, identify meaningful trends, and identify potential solutions. Strong communication skills, both verbal and written; ability to communicate effectively and professionally at all levels within the organization, both internal external. Demonstrated ability to collaborate effectively in a variety of settings and topics. Excellent editing and proofreading skills. Ability to independently organization, prioritize and plan work activities effectively for self and others; develops realistic action plans with the ability to multi-task effectively. Excellent time management and delivers results balancing multiple priorities. Strong analytical skills; synthesizes complex or diverse information; collects and researches data; uses experience to compliment data. Leverages strong critical thinking, questioning, and listening skills to research and effectively resolve complex issues. Demonstrated ability to identify areas of opportunity and create efficiencies in workflows and procedures. Demonstrated ability to be proactive; identifies and resolves problems in a timely manner; develops alternative solutions. Ability to create documentation outlining findings and/or documenting suggestions. Strong general computer skills, including, but not limited to Desktop and MS Office applications (Intermediate Excel Skills), application reporting tools, and case management system/tools to review and document findings. Solid technical aptitude with demonstrated ability to quickly learn and adapt to new systems and tools. Ability to be flexible and thrive in a high pace environment with changing priorities. Adaptable to applying skills to diverse operational activities to support business needs. Self-starter with the ability to work independently in remote setting with minimum supervision and direction in the form of objectives. Serves as a positive role model; and demonstrates characteristics that align and contribute to a collaborative culture of continuous improvement and high performing teams. Capability of working in a fast-paced environment, flexibility with assignments and the ability to adapt in a changing environment Ability to obtain and maintain client required clearances, if applicable, as well as pass company regular background and/or drug screening. Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to, : able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours. Required and Preferred Qualifications Current certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P Not currently sanctioned or excluded from the Medicare program by OIG 3+ years of direct experience in medical chart review for all provider/claim types for outpatient 5+ years relevant auditing experience in a provider or payer environment demonstrating breadth and depth of knowledge/skills for the position. (less than 5 yrs. may be considered for internal candidates based upon demonstrated skills and results). Prior experience in role with responsibility for conducting primary audit, utilization management or prior-authorization work, or review of audit work performed by others (QA function, appeals function, lead, supervisory role, etc.) Prior experience in payer edit development and/or reimbursement policy a plus. Prior experience working in remote setting preferred. WHAT WE OFFER: Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview. Physical Requirements & Additional Notices: If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location. The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary. Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse. Regularly reads and comprehends information in electronic (computer) or paper form (written/printed). Regularly sit/stand 8 or more hours per day. Occasionally lift/carry/push/pull up to 10lbs. Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position: Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions. Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists. Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures. Other requirements may apply. All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination. Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify's Human Resources team to discuss further. Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING
    $65k-73k yearly Auto-Apply 55d ago
  • Title Associate

    Firstsource Solutions 4.3company rating

    Palm Bay, FL job

    Pay Rate: $17/hour Hours: 8:30am-5:00pm Monday-Friday are eligible Process incoming documents for Post Closing and recording; identifying any item including but not limited to title execution problems; such as matters that may prevent recording. RESPONSIBILITIES: * Receive incoming Post closing Documents * Conduct a review of signed closing packages to ensure all signatures, initials, and dates are present * Verify that all documents (Deeds, Mortgages, Affidavits) are properly notarized according to state-specific requirements * Identify and resolve missing information or errors by coordinating with the Borrowers, Lenders, Closing & Escrow team. * Obtain appropriate Schedule A, legal description from the system and verify data against property address as noted on the Mortgage/DOT. * Manage Post closing Mailbox to address any post closing document related queries from the Lenders, borrowers, Closers and Escrow * Determine if document is properly executed and conforms to registry state requirements. * Identify title and execution problems and send back to lender, or internal department as necessary, in accordance with client requirements. * Prepare and submit recordable documents (Deeds, Mortgages, Releases, Power of Attorney) to the appropriate County Recorder or Register of Deeds or ERecording platforms * Request checks for recording and/or mortgage tax fees. * Ship documents to the counties and track for recording status * When applicable, Call/fax/email and/or research on-line websites for various recorded information for mortgages that remain outstanding in Tracking Queue. * When applicable, Calls and/or faxes searchers on overdue orders. * Must be able to meet established minimum daily expectations for this position. * This position may require over time, at times on a daily basis; must be available to work additional hours on short notice as determined by management to meet client service level agreements * Perform other duties as required. QUALIFICATIONS: Education: High school education or equivalent Job Related Experience: * Knowledge of mortgage documents and title ownership. * Working knowledge of Excel, Word, Outlook and Internet Explorer required. * Strong PC skills and ability to adapt to data base systems and Internet access. * Ability to work independently with minimum supervision. * Strong work ethic with the ability to complete tasks in a timely and accurate manner. * Must be able to work within required deadlines and turn times. Sourcepoint is an Equal Employment Opportunity/Affirmative Action Employer and maintains a Drug-Free Workplace. All candidates who have received a written offer of employment will be required to undergo a company paid drug test. Failure to submit to this test and/or to successfully test negative will result in withdrawal of the applicant's job offer. Sourcepoint participates in E-Verify and we will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee's I-9 to confirm work authorization. It is the policy of this Company to seek and employ qualified individuals at all locations and facilities, and to provide equal employment opportunities for all applicants and employees in recruiting, hiring, placement, training, compensation, insurance, benefits, promotion, transfer, and termination. To achieve this, we are dedicated to taking affirmative action to employ and advance in employment qualified individuals with disabilities, disabled veterans, and other eligible veterans.
    $17 hourly 13d ago
  • Claims Examiner

    Firstsource Solutions 4.3company rating

    Remote job

    Job Title: Medical Claims Examiner-Work From Home Job Type: Full Time FLSA Status: Non-Exempt/Hourly Grade: H Function/Department: Health Plan and Healthcare Services Reporting to: Team Lead/Supervisor - Operations Pay Range: $16 Role Description: The Claims Examiner evaluates insurance claims to determine whether their validity and how much compensation should be paid to the policyholder. The Claims Examiner is responsible for reviewing all aspects of the claim, including reviewing policy coverage, damages, and supporting documentation provided by the policyholder. Roles & Responsibilities * Review insurance claims to assess their validity, completeness, and adherence to policy terms and conditions. * Collect, organize, and analyze relevant documentation, such as medical records, accident reports, and policy information. * Ensure that claims processing aligns with the company's insurance policies and relevant regulatory requirements. * Conduct investigations, when necessary, which may include speaking with claimants, witnesses, and collaborating with field experts. * Analyze policy coverage to determine the extent of liability and benefits payable to claimants. * Evaluate the extent of loss or damage and determine the appropriate settlement amount. * Communicate with claimants, policyholders, and other stakeholders to explain the claims process, request additional information, and provide status updates. * Make recommendations for claims approval, denial, or negotiation of settlements, and ensure timely processing. * Maintain accurate and organized claim files and records. * Stay updated on industry regulations and maintain compliance with legal requirements. * Provide excellent customer service, addressing inquiries and concerns from claimants and policyholders. * Strive for high efficiency and accuracy in claims processing, minimizing errors and delays. * Stay informed about industry trends, insurance products, and evolving claims management best practices. * Generate and submit regular reports on claims processing status and trends. * Perform other duties as assigned. Top of Form Qualifications The qualifications listed below are representative of the background, knowledge, skill, and/or ability required to perform their duties and responsibilities satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. Top of Form Top of FormEducation * High School diploma or equivalent required Work Experience * Medical claims processing experience required, including use of claims processing software and related tools Competencies & Skills * Highly-motivated and success-driven * Exceptional verbal and written communication and interpersonal skills, including negotiation and active-listening skills * Exceptional analytical and problem-solving skills * Strong attention to detail with a commitment to accuracy * Ability to adapt to change in a dynamic fast-paced environment with fluctuating workloads * Basic mathematical skills * Intermediate typing skills * Basic computer skills * Knowledge of medical terminology, ICD-9/ICS-10, CPT, and HCPCS coding, and HIPAA regulations preferred * Knowledge of insurance policies, regulations, and best practices preferred Additional Qualifications * Ability to download 2-factor authentication application(s) on personal device, in accordance with company and/or client requirements * Ability to pass the required pre-employment background investigation, including but not limited to, criminal history, work authorization verification and drug test Work Environment The work environment characteristics described here are representative of those an employee encounters while performing this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position may work onsite or remotely from home. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to regularly or frequently talk and hear, sit for prolonged periods, use hands and fingers to type, and use close vision to view and read from a computer screen and/or electronic device. Must be able to occasionally stand and walk, climb stairs, and lift equipment up to 25 pounds. Firstsource is an Equal Employment Opportunity employer. All employment decisions are based on valid job requirements, without regard to race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, age, disability, genetic information, veteran status, or any other characteristic protected under federal, state or local law. Firstsource also takes Affirmative Action to ensure that minority group individuals, females, protected veterans, and qualified disabled persons are introduced into our workforce and considered for employment and advancement opportunities. About Firstsource Firstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes. We are trusted brand custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines, India and Mexico. Our 'rightshore' delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals. Our clientele includes Fortune 500 and FTSE 100 companies. Job Type: Full-time Benefits: * 401(k) * 401(k) matching * Dental insurance * Employee assistance program * Flexible spending account * Health insurance * Life insurance * Paid time off * Referral program * Vision insurance Work Location: Remote
    $16 hourly 5d ago
  • Facilities Coordinator

    Firstsource Solutions 4.3company rating

    Palm Bay, FL job

    The Facilities Coordinator is responsible for overseeing the efficient operation, maintenance, and safety of all building and facility systems. This role ensures that the organization's physical environment supports its operational needs, providing a safe, functional, and comfortable space for employees, visitors, and stakeholders. Key Responsibilities: Oversee contractors and service providers, including negotiating contracts and monitoring performance. Conduct regular inspections to identify issues and ensure facilities are maintained to a high standard. Manage space allocation and planning to optimize office or facility layout and construction. Manage security protocols to safeguard personnel and assets. Maintain accurate records of maintenance activities, inspections, and compliance documentation. Foster a safe and productive working environment for staff and visitors. Collaborate with other departments to coordinate facilities-related needs and projects Qualifications: * Strong knowledge of building systems, safety standards, and regulatory compliance. * Excellent organizational and project management skills. * Effective communication and interpersonal abilities. * Budget management and cost-control experience. * Proficiency in facilities management software and MS Office 365 Preferred Skills: * Certification in Facilities Management (e.g., IFMA CFMP, BIFM, or similar). * Experience with sustainability and energy efficiency initiatives. * Ability to handle emergency situations effectively.
    $39k-55k yearly est. 43d ago
  • Supervisor, HCS Reclamation Operations (Medicare & Medicaid Focus)

    Performant 4.7company rating

    Performant job in Plantation, FL or remote

    ABOUT MACHINIFY: In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare payment through seamless intelligence. ABOUT THE OPPORTUNITY: Hiring Range: $70,000 - $82,000 Annual Salary The Supervisor, HCS Reclamation Operations oversees and supports daily business operations for Performant's Post-Payment Reclamation-related solutions. We are looking for a candidate with a strong knowledge of Medical claims billing and recovery. Must have a vast knowledge in Medicare regulations, Medical terminology, medical coding, forms UB04 and CMS 1500. This role will require the ability to gather and interpret explanation of benefits (EOB) and Provider feedback to answer questions and assist recovery teams with Provider and Network communications. They will leverage their knowledge in Medical and Rx billing and recovery, with a focus on Medicaid and Medicare rules and regulations; paired with leadership experience and adaptability to support team functions to make a positive impact in the growth of our overall recovery operations. They will play a key support role in continual improvement of recovery processes, procedures, and staff development. Key Responsibilities •Monitoring staff and daily recovery efforts •Effectively collaborates with Management and teams to ensure departmental needs are met. •Communicates with team to ensure all production goals are clear •Leverages strong communication skills, both verbal and written, to assist recovery staff with escalated Provider and Network communications. •Provides insight and collaborates to ensure appropriate staffing levels and staff competencies for assigned business •Contributes to continual improvement of reclamation processes, procedures, and staff development •Supports the organization in meetings with the clients and other reclamation business constituents as needed •Assist with implementation of new accounts as needed •Uses excellent communication skills to influence a wide range of internal and external audiences. •Assists in development and revision of team training materials. •Advises Leadership of operational training gaps, staff development issues and other observation and areas or opportunities that may involve training. •Assist in operational training for staff to support operational quality and compliance, and optimal service delivery to clients as needed •Leads by example and adheres to all Company policies and procedures in performance of job duties and all interactions •Performs other duties as assigned. Knowledge, Skills and Abilities Needed •Working knowledge of Medicaid Third-Party Liability (TPL) business, recovery, and revenue cycle management •Excellent professional written and verbal communication skills •Proven experience leading and overseeing high performing dynamic teams •Understands and adheres to HIPAA standards and regulations •Strong critical thinking, analytical and problem-solving skills •Self-motivated and thrives in a fast-paced business performing multiple tasks cohesively, with keen attention to detail •Ability to adapt quickly and transition effectively to changing circumstances, client requirements, assignments, and business needs; and consistently performs job responsibilities •Perform other duties as may be required to meet business needs Required and Preferred Qualifications •High School Diploma or GED required •BA or equivalent combination of education and experience •3 + years of Revenue cycle or Recovery experience. •3+ years in a Healthcare claims or revenue cycle management environment. •2+ years supervisory experience in fast paced production or call center environment. •Some college or training in medical terminology, billing, coding, or Medical billing/Coding certificate. •Extensive experience with provider outreach and communication. WHAT WE OFFER: Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview. Physical Requirements & Additional Notices: If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location. The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary. Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse. Regularly reads and comprehends information in electronic (computer) or paper form (written/printed). Regularly sit/stand 8 or more hours per day. Occasionally lift/carry/push/pull up to 10lbs. Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position: Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions. Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists. Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures. Other requirements may apply. All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination. Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify's Human Resources team to discuss further. Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING
    $70k-82k yearly Auto-Apply 60d+ ago
  • Healthcare Audit Recovery Analyst

    Performant 4.7company rating

    Performant job in Plantation, FL or remote

    ABOUT MACHINIFY: In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare payment through seamless intelligence. ABOUT THE OPPORTUNITY: Hiring Range: $54,200 - $67,000 The Healthcare Audit Recovery Analyst is responsible for objectively and accurately completing claim audit reviews on assigned Medicare (State) audits while meeting quality and productivity performance goals, as required. This position makes determinations based on claims payment expertise and knowledge while utilizing audit tools and resources available. This role is also responsible for communicating and supporting the identification of additional audit opportunities and participating in development of new ideas, as necessary. Key Responsibilities to include: Conducts Medicaid claim audit reviews and determines if claims are appropriately paid in accordance with benefits, contracts and edits, includes review of specific coding and billing guidelines Documents findings within audit tracking system and maintains thorough and objective documentation of findings Investigates, researches, and analyzes claims data, applying knowledge of medical or pharmacy policy to determine details of fraudulent or abusive or inaccurate billing activity Creates narrative rationale to correspond with audit determinations As needed, supports findings during the appeals process Serves as a claims payment resource; provides claims payment expertise, and claims payment guidance to the team Works collaboratively with the audit team to identify vulnerabilities and/or cases subject to potential abuse Monitors, tracks and reports on all work conducted Consults with our clients, physicians, other claims payment resources and contractors as necessary Maintains current knowledge of changes in technology, practice and regulatory issues that may affect our clients Participates in process improvement activities and encourages ownership of and group participation in improvement initiatives As needed, assists with quality assurance functions, development of medical review guidelines and training Identifies and recommends opportunities for cost savings and improving outcomes Attends conference calls and meetings as requested Performs other duties as assigned Knowledge, Skills & Abilities Needed: LTC (Long Term Care) Caseworker or Nursing Home technical and administrative skills preferred Understanding of NAMI, Diversion/Deduction Calculations, Spenddown, and Estate Recovery preferred Working knowledge of coordination of benefits and medical claims processing Knowledge of insurance programs, particularly the coverage and Medicaid payment rules preferred Ability to be flexible and seizes the opportunity to cross train Ability to maintain high quality work while meeting deadlines and performance metrics Excellent organizational, interpersonal and communication skills Strong problem solving skills Excellent organizational, interpersonal and communication skills Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload, problem solve, work independently and with team members Acute sense of professionalism and confidentiality Typing skills and working knowledge of computer functions and applications such as MS office (Outlook, Word, Excel) Intermediate level of proficiency with Microsoft Excel, Word and Access Experience with EHRs and billing software such as PointClickCare, SigmaCare or MatrixCare Capability of working in a fast-pace environment, flexibility with assignments and the ability to adapt in a changing environment Requirements & Qualifications: High School Diploma is required. Bachelor's degree, or an equivalent level of competence obtained through experience, education and/or training, may be required for some specific roles Medical Coder certification is a plus Experience with Commercial healthcare contracts and Reimbursement models (e.g. Medicare, Medicaid, & Commercial Insurance), is required 3+ years healthcare claims processing with experience in Medicaid claims 3+ years of experience in the health care industry, preferably in an auditing role 3+ years working with health care claims demonstrating expertise in, ICD-9/ICD-10 coding, HCPS/CPT-4 coding, and MS-DRG including medical billing experience for an Insurance Company or hospital Medical coding experience WHAT WE OFFER: Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview. Physical Requirements & Additional Notices: If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location. The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary. Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse. Regularly reads and comprehends information in electronic (computer) or paper form (written/printed). Regularly sit/stand 8 or more hours per day. Occasionally lift/carry/push/pull up to 10lbs. Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position: Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions. Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists. Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures. Other requirements may apply. All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination. Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify's Human Resources team to discuss further. Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING
    $54.2k-67k yearly Auto-Apply 47d ago
  • Complex Claims Administrator

    Harris & Harris Ltd. 4.3company rating

    Remote or Chicago, IL job

    Job Description Harris & Harris has over 50 years of experience in the customer service and revenue recovery field, specializing in the utilities, government, and healthcare markets. We're looking for friendly, professional, and motivated Complex Claims Administrator join our Legal Compliance team. If you're looking for a company that embraces the principles of respect, compassion, and trust, apply today! Complex Claims Administrator The Complex Claims Administrator will work as a patient advocate, and ensure proper research, billing, and filing of all complex claims. Schedule: 8:00am to 5:00pm Monday through Friday are regular business hours. Location: Can work remotely, candidates local to Chicagoland preferred Salary: $20.00/hour Additional Compensation and Benefits: At Harris & Harris, we truly care about each employee's health, wellness, financial stability, and education. We are proud to offer each employee the following benefits: Medical and Dental insurances from premium providers 401K with matching Company paid Accident and Disability Insurance, Long Term Disability Insurance, EAP, and Travel Assistance Tuition Reimbursement Paid Time Off Additional benefits such as identity theft protection, flexible spending accounts, pre-tax commuter benefits, and more. DAY TO DAY Work in the clients EMR, Patient Account System, and Software Platforms to identify Liability Claims and correctly bill both hospital, and professional claims. Review police reports, medical records, and all available information to assist in correctly billing liability claims. Perform duties as a patient advocate by speaking with a patient that was seen at the hospital as a result of an accident Making outbound/inbound calls to the patient to assist in obtaining liability information, and assisting in opening a claim when deemed necessary Complete daily billing activities for new accounts. Updating the clients Patient Accounting System with proper notation. Completing weekly reports needed to resolve accounts (i.e. rebill reports, reject reports). Electronic filing of incoming documents Develop a relationship with payers to encourage timely request and prompt payment. WHAT YOU MUST POSSESS Must Have: High School Diploma or GED required, some college a plus' Medical Billing experience Experience Working in Multiple systems at the same time Experience with Healthcare systems like Epic General understanding of Workers Compensation laws Must be very detail oriented Experience with 10-key data entry Ability to type 35-40 wpm WHY HARRIS & HARRIS? Harris & Harris is a premier, full-service revenue recovery firm headquartered and founded in Chicago, IL. Founded in 1968, we have been in business for more than 50 years, and we specialize in the utilities, government, and healthcare markets. The family business Sam Harris started is now a firm of more than 500 hundred employees including collections professionals and customer care representatives who employ the latest technology and best ethical practices to help businesses recover revenue and provide world class customer service. We take pride in knowing what it takes to turn a call from "average" to "excellent." We have been delighting clients and customers for decades thanks to our outstanding employees. They make the difference every day, shift, and call and transform challenges into victories. At Harris & Harris, we're proud to be an organization where everyone is welcome and can be their authentic selves at work. We're passionate about celebrating the differences that make each of us unique. Our culture focuses on our employees and we look for opportunities to recognize and celebrate together. We are an organization that cares about our people. From monthly activities, bonuses and contests, to competitive wages and benefits, we foster an environment where we employees feel valued. We also are an organization that believes in the power of giving back. Our internal cross functional committee, Harris Cares, guides our philanthropic activities. We have partnered with organizations such as One Warm Coat, Greater Chicago Food Depository, American Cancer Society, Bright Pink, The Heat and Warmth Fund (THAW), and Operation Stars and Stripes. Most recently we have partnered with local schools and charitable organizations to give back to our communities including the American Heart Association, Habitat for Humanity, A Just Harvest, and R. Nathaniel Dett Elementary School. At Harris & Harris, everyone is important, and one person can make a difference for their colleagues, for our clients, and for our company. We look forward to hearing from you! Harris & Harris is an equal opportunity employer. Applicants will not be discriminated against based on race, color, creed, sex, sexual orientation, gender identity or expression, age, religion, national origin, disability, ancestry, marital status, veteran status, medical condition or any protected category prohibited by local, state or federal laws.
    $20 hourly 2d ago
  • Manager-HRBP

    Firstsource Solutions 4.3company rating

    Remote or Palm Bay, FL job

    The Manager - HRBP is responsible for serving as a strategic partner to business units, driving the execution of HR initiatives, covering areas like talent management, employee relations, performance management, and workforce planning, to ensure alignment with organizational goals, enhance employee engagement, and nurtures a positive workplace culture Roles & Responsibilities * Business Partnership: Build strong relationships with business units and serve as a strategic HR partner, understanding their goals and needs. * Talent Management: Collaborate with business leaders to identify, attract, develop, and retain top talent to meet organizational objectives. * Performance Management: Implement performance management processes, including goal setting, performance evaluations, and feedback, to improve individual and team performance. * Employee Relations: Address and resolve complex employee relations issues, ensuring fair and consistent treatment of employees. * Workforce Planning: Assist in workforce planning, including staffing needs, succession planning, and skills development. * Change Management: Support and lead change management efforts within business units, ensuring smooth transitions during organizational changes. * Workplace Culture: Promote a positive workplace culture by championing diversity and inclusion initiatives, employee engagement, and a values-driven environment. * HR Compliance: Ensure compliance with employment laws, regulations, and company policies, and provide guidance to business units on HR compliance matters. * Data Analysis: Utilize HR data and metrics to make data-driven decisions and recommendations for improving HR strategies. * Employee Engagement: Implement employee engagement initiatives, gather employee feedback, and measure employee sentiment. * HR Reporting: Generate HR reports and analyses to provide insights on workforce trends, HR performance, and areas for improvement. * Collaboration: Collaborate with other HR team members and departments to align HR strategies and initiatives with organizational goals. * Project Management: Manage HR projects and initiatives, ensuring they are completed on time and within budget. * Uphold a strong commitment to business ethics, including confidentiality and data privacy. * Maintain consistent performance to achieve predefined performance metrics. * Strictly adhere to compliance regulations and security policies. * Ensure compliance with all federal, state and local laws. Expected/Key Results * Enhancing Employee Engagement and Ensuring Timely Communication * Elevating Employee Satisfaction * Managing the Performance Management Process and Promoting Career Progression for Employees * Improving Employee Retention * Ensure 100% compliance * Adherence to SLA, quality and KPI targets Qualifications The qualifications listed below are representative of the background, knowledge, skill, and/or ability required to perform their duties and responsibilities satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. * High school diploma or equivalent required * Bachelor's Degree preferred or equivalent combination of education and work experience * 4+ years of experience in human resources * Relevant years of experience in human resources, with a focus on HRBP or CoE roles * Experience in strategic business partnership and talent management, including performance management and workforce planning. Competencies & Skills * Ability to cultivate strong partnerships with stakeholders and employees. * Exceptional communication skills, both written and verbal. * Skill in implementing effective performance management processes, setting clear goals, and providing feedback. * Proficiency in using HR data to make data-driven decisions and provide insights. * Capable to address complex employee relations issues fairly and equitably. * Skill in managing HR projects and initiatives efficiently and within budget. * Possesses a consultative approach, seeking input and feedback from others. * Understanding of the organization's industry, operations, and competitive landscape. * Understanding of employment laws, regulations, and HR compliance standards. * Proficiency in Microsoft Office products, particularly Outlook and Word * Working knowledge of MS Teams and willingness to appear on-camera, when needed * Strong verbal and written communication skills, with the ability to maintain professionalism in interactions with employees * Strong work ethic with high standards of reliability and dependability * Commitment to protecting data privacy in maintaining, disclosing and transmitting employee confidential, private and sensitive information * Self-disciplined and capable of maintaining focus with minimal supervision Additional Qualifications * Ability to occasionally work flexible hours to address business demands and employee needs * Ability to occasionally travel out-of-town, including nationwide and international * Possession of a valid driver's license and ability to meet insurability standards for any work-related driving * Ability to download 2-factor authentication application(s) on personal device, in accordance with company and/or client requirements * Ability to pass a pre-employment background investigation based on client requirements, including but not limited to, criminal history, motor vehicle report, work authorization verification, and credit report . Work Environment * The work environment characteristics described here are representative of those an employee encounters while performing this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * This position may work remotely from home or onsite, exposed to outdoor weather conditions during travel, if applicable. Physical Demands * The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Must be able to regularly or frequently talk and hear, sit for prolonged periods, use hands and fingers to type, and use close vision to view and read from a computer screen and/or electronic device. Must be able to occasionally stand and walk, climb stairs, and lift equipment up to 25 pounds. * Firstsource is an Equal Employment Opportunity employer. All employment decisions are based on valid job requirements, without regard to race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, age, disability, genetic information, veteran status, or any other characteristic protected under federal, state or local law. * Firstsource also takes Affirmative Action to ensure that protected veterans and qualified disabled persons are introduced into our workforce and considered for employment and advancement opportunities.
    $67k-106k yearly est. 60d+ ago
  • Bilingual Quality Auditor

    Firstsource Solutions 4.3company rating

    Remote job

    The primary objective of this role is to evaluate and enhance associate performance by ensuring compliance with quality standards and service level agreements, in alignment with Firstsource's core values. The Quality Analyst will be responsible for conducting audits, generating and analyzing quality reports, identifying performance trends, and acting as a liaison for internal teams and clients. This individual will serve as a subject matter expert in processing knowledge, quality metrics, and improvement initiatives for the assigned unit. Key Responsibilities: * Conduct detailed analysis of individual, team, and organizational quality performance metrics. * Perform regular audits, side-by-sides, coaching sessions, and development meetings to support associate improvement. * Maintain a repository of internal quality data to track trends and guide performance enhancement strategies. * Collaborate with other Quality Analysts to share updates, support content development, and maintain training materials. * Stay informed on industry trends and best practices in quality and employee development. * Contribute to the evolution of quality initiatives, including expanding scope, refining scoring methodologies, and updating guidelines. * Serve as a primary point of contact for quality-related client communications and inquiries. * Perform additional duties as assigned. Skills and Competencies: * Strong understanding of contact center operations and commitment to service excellence. * Demonstrated success in quality monitoring and performance improvement. * Skilled in identifying process inefficiencies and agent performance gaps. * Exceptional verbal, written, and presentation skills, including the ability to deliver feedback constructively and confidentially. * Highly organized, detail-oriented, and capable of managing multiple priorities. * Effective in remote mentoring and coaching environments. * Bilingual (English/Spanish) with the ability to audit, coach, and deliver feedback in both languages. Qualifications: * Bachelor's degree in a related field (education, communication, business) or equivalent experience preferred. * Proficiency in Microsoft Office Suite (Excel, PowerPoint, Outlook, Word) required. * 2 years of experience in an international contact center; quality experience required. * 2 years of healthcare experience. * Fluency in Spanish and English required (written and verbal).
    $29k-38k yearly est. 9d ago
  • Revenue Cycle Billing Specialist

    Firstsource Solutions 4.3company rating

    Remote job

    Schedule: 8am ET to 5pm ET The goal of the Revenue Cycle Billing Specialist is to successfully collect on aging medical insurance claims. Essential Duties and Responsibilities: * File claims using all appropriate forms and attachments * Handle Outbound calls and Maneuver between several different software systems * Research account denials and file written appeals, when necessary. * Evaluate the information received from the client to determine which insurance to bill and attain necessary attachments or supporting documentation to send with each claim. * Ensure the integrity of each claim that is billed. * Document in detail all efforts in CUBS system and any other computer system necessary. * Verify patient information and benefits. Additional Duties and Responsibilities: * Meet specified goals and objectives as assigned by management. * Maintain good working relationships with state and Federal agencies. * Resolve accounts in a timely manner. * Always maintain confidentiality of account information. * Adhere to the prescribed policies & procedures as outlined in the Employee Handbook and Employee Code of Conduct. • Maintain awareness of and actively participate in the Corporate Compliance Program. * Maintain a confidential and orderly remote work area. * Assist with other projects as assigned by management. Educational/Vocational/Previous Experience Recommendations: * High school diploma or equivalent is required. * Formal training in the specialty of Insurance Billing preferred. * Knowledge of all insurance payers preferred. * Ability to effectively work and communicate with patients, co-workers, and management both in person and remote virtual chat environments * Ability to always present oneself in a courteous and professional manner * Ability to stay on task with little or no management supervision * Demonstrate initiative and creativity in fulfilling job responsibilities * Capacity to prioritize multiple tasks using time management and organizational skills. * Proficient PC knowledge and the ability to type 30-40 wpm. Working Conditions: * Remote work from home office, virtual Call Center environment. * Must be able to sit for extended periods of time. We are an Equal Opportunity Employer. All qualified applicants are considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state or local law.
    $32k-42k yearly est. 13d ago
  • Healthcare Provider Contract and Pricing Manager

    Performant Financial 4.7company rating

    Remote Performant Financial job

    ABOUT MACHINIFY: In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare payment through seamless intelligence. ABOUT THE OPPORTUNITY: Hiring Range: $90,000 - $110,000 Annual Salary The Manager, Healthcare Provider Contract and Pricing has responsibility for managing staff and creating an infrastructure to support Performant's claims repricing and contract audits ensuring the needs of the business are met for successful daily operations of healthcare audit and recovery. Key Responsibilities to include: Oversee team functions including, but not limited to: Interpretation (and documentation of) provider contract payment information for use by the complex and automated teams Development of algorithms to identify inappropriate payments QA of fee schedule loads - Analysis of data results to ensure accuracy of contract interpretation and system loads Creation and processing of system files, and needed workflows using available tools, specific layouts, conditions, and instructions to create overpayment files Responds to internal and external questions regarding data results and pricing calculations Participate in the development or analysis of new/changing concepts and related data Concept research and application of appropriate Medicare, Medicaid and other regulatory policy and rules Conducting sample tests to prove and quantify the value of concepts Hires, trains, and develops staff; proactively manages team performance against objectives and deliverables to ensure high quality output meets business needs, and: resolves conflict in a tactful and effective manner. Develops and ensures training and support to new team members as well as all team members for any new or changing workflows or requirements Develop and maintain infrastructure tools and documentation as well as contribute to the development and/or improvement based upon changing requirements and/or new client requirements/contracts. Drives research, analysis and resolution of complex questions, issues, and needs that arise. Drives continuous improvement efforts and develops/delivers tools and training to increase knowledge, efficiency, and consistency of department output. .Applies strong communication and interpersonal skills to develop professional relationships and collaborates effectively with internal department leaders/staff, as well as clients and other external stakeholders and service providers. Maintains current knowledge of and compliance with company policies, processes and procedures, Medicare/Medicaid rules, regulations, policies and procedures, contract requirements, and HIPAA certification; and ensures team members do the same. Keeps abreast of medical practice, changes in technology, and regulatory concepts, or changes in reimbursement that may affect the Client contracts. Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours. Other Duties as assigned Knowledge, Skills and Abilities Needed: Excellent verbal and written communication and interpersonal skills; ability to effectively communicate at all levels within the organization both internal and external. Strong project and operations management skills; inventory management, resource planning, developing, and leveraging reports; developing policies and procedures. Leverages strong analytical, critical thinking and problem-solving skills; Skill in analyzing information, identifying trends, and presenting solutions. Demonstrated ability to apply excellent judgement and decision-making skills. Demonstrated success building and lead high performing teams. Adaptable and thrives in a fast-paced dynamic environment with changing priorities. Possess broad and comprehensive understanding of applicable healthcare concepts, standards, tools, policies, and regulations relevant for medical claim repricing: Knowledge in ICD-10-CM/PCS, CPT-4, and HCPCS coding; Experience with diagnostic grouper tools such as MS DRG, APC, APR-DRG, EAPG, preferred Experience in interpreting provider contracts payment methodologies, preferred Knowledge of the national coding standards, particularly payment rules Knowledge of commercial claims processing systems Knowledge of Medicare/Medicaid programs, particularly payment rules Experience analyzing and manipulating health care data leveraging strong data manipulation skills. using database and spreadsheet applications. Strong computer skills; intermediate level experience with MS Office products including Outlook, Word, PowerPoint, intermediate to advanced Microsoft Excel, and the ability to quickly develop expertise in new systems and applications. Use of logical and critical thinking skills and exceptional problem-solving skills to identify solutions to complex scenarios. Required and Preferred Qualifications: BA/BS in relevant field (e.g., Finance, Accounting, Healthcare Administration) or equivalent combination of relevant education and experience. 7+ years of relevant experience in healthcare provider reimbursement and/or health insurance payor experience in medical billing, claims auditing, claims analysis and/or actuarial analysis. Minimum of 3 years in supervisory/management that includes oversite for remote staff. WHAT WE OFFER: Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview. Physical Requirements & Additional Notices: If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location. The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary. Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse. Regularly reads and comprehends information in electronic (computer) or paper form (written/printed). Regularly sit/stand 8 or more hours per day. Occasionally lift/carry/push/pull up to 10lbs. Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position: Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions. Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists. Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures. Other requirements may apply. All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination. Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify's Human Resources team to discuss further. Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING
    $90k-110k yearly Auto-Apply 55d ago
  • Medical Review Nurse II - SNF/MDS

    Performant 4.7company rating

    Performant job in Plantation, FL

    ABOUT MACHINIFY: In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare payment through seamless intelligence. ABOUT THE OPPORTUNITY: Hiring Range: $75,000 - $84,000 The Medical Review Nurse II - SNF/MDS primarily performs medical claims audit reviews. As a MR Nurse, you will join a team of experienced medical auditors and coders performing retrospective and prepayment audits on claims for Government and Commercial Payers. You will work remotely in a fast paced and dynamic environment and be part of a multi-location team. Key Responsibilities: Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules. Document all findings referencing the appropriate policies and rules. Generate letters articulating audit findings. Supporting your findings during the appeals process if requested. Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse. Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits. Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients. Work with the team to minimize the number of appeals; Suggest ideas that may improve audit workflows; Assist with QA functions and training team members. Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines. Interface with and support the Medical Director and cross train in all clinical departments/areas. Other duties as required to meet business needs. Knowledge, Skills and Abilities Needed: Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual. Experience with and deep knowledge of ICD-9, ICD-10, CPT-4 or HCPCS coding. Knowledge of insurance programs program, particularly the coverage and payment rules. Ability to maintain high quality work while meeting strict deadlines. Excellent written and verbal communication skills. Ability to manage multiple tasks including desk audits and claims review. Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings. Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload Effectively work independently and as a team, in a remote setting. Required and Preferred Qualifications: Active unrestricted RN license in good standing, is required. Must not be currently sanctioned or excluded from the Medicare program by the OIG. Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting. One (1) or more years' experience performing medical records review. One (1) or more years' experience in health care claims that demonstrates expertise in, ICD-9/ICD-10 coding, HCPS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital required. Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions. WHAT WE OFFER: Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview. Physical Requirements & Additional Notices: If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location. The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary. Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse. Regularly reads and comprehends information in electronic (computer) or paper form (written/printed). Regularly sit/stand 8 or more hours per day. Occasionally lift/carry/push/pull up to 10lbs. Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position: Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions. Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists. Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures. Other requirements may apply. All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination. Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify's Human Resources team to discuss further. Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING
    $75k-84k yearly Auto-Apply 12d ago
  • Senior Healthcare Coordination of Benefits (COB) Analyst

    Performant Financial 4.7company rating

    Remote Performant Financial job

    ABOUT MACHINIFY: In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare payment through seamless intelligence. ABOUT THE OPPORTUNITY: Hiring Range: $47,900 - $63,500 The Senior Healthcare Coordination of Benefits (COB) Analyst reviews and analyzes large volumes of client pre-pay and/or post-pay records, investigates coverages for eligibility and determine primacy, educate and resolve discrepancies with insurance carriers, employers, and or providers in order to maximize revenue for our client's recovery programs. Additionally, the senior role leverages subject matter expertise and experience to perform a variety of activities and projects such as supporting team development, handling client requests, analysis, and reporting, as well as initiatives developing and continuous improvement of operational infrastructure and initiating new client programs. Key Responsibilities Leverage strong knowledge and expertise in COB/TPL/EOB to gather and review eligibility, investigate policy coverage to determine proper order of benefits and resolve primacy issues that will bring successful payment or other appropriate account action. Ability to identify unique trends from payer data in order to isolate policy details to process appropriately per client and business needs. Successfully solve complex data or record discrepancies and/or issues. Communicate effectively with carriers, employers, and/or providers to determine primacy; answer complex questions and/or provide information that will bring to successful payment or other appropriate account action. Contact Healthcare Insurance carriers regarding claim responses. Educate Healthcare Insurance carriers on the Coordination of Benefits rules and appropriately responds to complex questions. Analyze and understand written communication from insurance companies including explanation of benefits (EOBs). Actively collaborate with internal groups and/or functions with gathering and interpretation of the claims billing process and denial management for continuous improvement in workflow and systems. Actively contributes to continuous improvement and development for new client programs of scripts, guidelines, and other tools provided to have professional conversations with Healthcare Insurance carriers and/or providers. Effectively works assigned inventories to consistently exceed productivity metrics assigned by management, while also performing other duties of the senior analyst role that support the broader group. Leverage knowledge and expertise to research various scenarios that will bring to successful resolution and payment (e.g., eligibility research and claims appeals) and consistently resolve the most complex eligibility discrepancies and questions. Initiate applicable action and documentation based upon insurance carriers selected. Update company systems with clear and accurate information such as point of contact, updated demographic information, notes from contact from outbound and inbound calls and/or attempts, as well as account status updates as applicable. Supports management with inventory assessment and distribution to team members. Provide ongoing feedback to Management and Analytics Teams to further the enhancement of our products and services, workflows, and documentation. Assist Management on assigned projects (including ramping up new client programs), client requests, regular reporting, data analysis and reconciliations, testing, and analytics reviews as required by the business. Serve as a mentor/subject matter expert to representative and junior analyst team members to maximize their potential throughout their development process and leads by example. Conducts quality reviews on work performed by team representatives and analysts on the team as requested by management. Supports team training activities and contributes to development and enhancement of training materials and tools. Leads and contributes to ad-hoc projects and initiatives and establishing best practices. Consistently maintains regular good attendance, demonstrates professionalism, sound judgment, and good decision making. Follows and complies with company, departmental and client program policies, processes, and procedures. Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations. Successfully completes, retains, applies, and adheres to content in required training as assigned. Consistently achieves or exceeds established metrics and goals assigned, including but not limited to, production, quality, and completion of assigned projects with high quality and timely results. Completes required processes to obtain client required clearances as well as company required background and/or drug screening; and successfully passes and/or obtains and maintains clearances statuses as a condition of employment. (note client/government clearance requirements are not determined or decisioned by Performant.) Demonstrates Performant core values in performance of job duties and all interactions. Corrects areas of deficiency and oversight received from quality reviews and/or management. Performs other duties as assigned. Knowledge, Skills and Abilities Needed: Strong knowledge and substantial experience with Healthcare billing, medical terminology, and high-level medical coding, preferably in a role generating, auditing, recovering and/or researching the same. Demonstrated expertise and experience with Medicaid, Coordination of Benefits, and Third Party Liability and Accounts Receivable specifically relevant to the line of business. Proven strength gathering and interpreting Explanation of Benefits (EOB) to answer questions and resolve complex primacy issues. Demonstrates high degree of critical thinking and analytical accuracy required to be successful in the role. Ability to communicate professionally and effectively with carriers, carriers and other audiences regarding claims and Coordination of Benefits (COB). Strong investigative skills, with proven ability to gather and interpret Explanation of Benefits (EOB), including use of online payer portals, and answer questions and resolve standard as well as complex issues with payments. Demonstrated ability to support management by contributing to development and continuous improvement of operational infrastructure and tools, as well as effectively support training, guidance, and lead by example for team. Protect patients' privacy, understands and adheres to HIPAA standards and regulations. Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service attitude; develops positive rapport with clients. Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail. Strong skills using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset. Intermediate to advanced Microsoft Excel skills with demonstrated skills analyzing large data sets relevant to the position. Applies knowledge learned in training from various forms (memos, classroom training, on-line training, meetings, discussions, individual coaching, etc.) and can provide instructional support to others. Ability to follow policy, procedures, and regulations in the workplace, and demonstrates ability to lead by example and support development of junior team members. Ability to effectively perform work independently and work cooperatively with others to promote a positive team environment; effectively serve as subject matter expert, lead by example, and a lead contributor to the team overall results and progress. Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes; able to support team adaptation to change. Ability to consistently perform job responsibilities. Ability to obtain and maintain client required clearances as well as pass company required background and/or drug screening. Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours. Required and Preferred Qualifications High School diploma or GED; college and/or relevant certification preferred: equivalent combination of education and related experience. Minimum 4 years of directly related progressive experience (claims, billing, eligibility, Medicaid, EOB, etc.), including Coordination of Benefits and Third Party Liability, demonstrating depth and breadth of knowledge and capability required for the position. Minimum 1 year of experience in a function demonstrating the ability to lead or make strong contributions to initiatives involving operations workflow, data reporting and analysis, contributing to the set-up of new clients or programs, or subject matter expertise applied to department workflows or projects, direct or indirect staff oversight or training, etc. Demonstrated experience gathering, researching, interpreting, and documenting data and requirements for projects and/or complex problem solving. WHAT WE OFFER: Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview. Physical Requirements & Additional Notices: If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location. The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary. Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse. Regularly reads and comprehends information in electronic (computer) or paper form (written/printed). Regularly sit/stand 8 or more hours per day. Occasionally lift/carry/push/pull up to 10lbs. Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position: Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions. Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists. Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures. Other requirements may apply. All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination. Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify's Human Resources team to discuss further. Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING
    $47.9k-63.5k yearly Auto-Apply 49d ago
  • Accounts Payable Associate

    First Source Capital Mortgage 4.3company rating

    Miami, FL job

    Obtains and records financial data for use in maintaining accounting records by performing the following duties. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Sort, scan, and electronically file processed AP documents. Codes and prepares invoices for data entry. Enters accounts payable invoices to the system for payment. Enters material receiving information into purchase orders. Prepares manual and computer generated checks. Answers vendor inquiries. Process weekly and monthly check runs. Filing of vendor invoice packages. Assist on projects throughout the Accounts Payable Department. Standard clerical duties as needed. Qualifications SUPERVISORY RESPONSIBILITIES Directly supervises zero employees in the accounting department. QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION and/or EXPERIENCE High school diploma or general education degree (GED); or one to two years related experience and/or training; or equivalent combination of education and experience. LANGUAGE SKILLS Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization. Must be able to read, write and speak English fluently. MATHEMATICAL SKILLS Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. REASONING ABILITY Ability to apply commonsense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations. OTHER SKILLS AND ABILITIES Experience with operating common office equipment including: 10 key calculator, touch method with speed and accuracy, computer knowledge keyboard skills, touch method with speed and accuracy, copy machine, fax machine, knowledge of Microsoft Word, Excel, Windows, Dynamics 2015 and database management preferred. Must be able to alphabetize. Team player with positive attitude. Additional Information All your information will be kept confidential according to EEO guidelines.
    $30k-40k yearly est. 1d ago
  • Partnerships Manager

    Navient 4.1company rating

    Remote job

    Navient Solutions LLC Navient (Nasdaq: NAVI) helps students and families confidently manage the cost of higher education. We create long-term value for customers and investors through responsible lending, flexible refinancing, trusted servicing oversight, and decades of portfolio management expertise. Our employees thrive in a culture of belonging, where they are supported and proud to deliver meaningful outcomes. The Partnerships Manager will lead our partnership strategy-managing existing relationships while identifying and onboarding new partners to support our evolving priorities. This role is all about collaboration and impact: you'll work cross-functionally with Product, Legal, and Engineering to create efficiencies and ensure initiatives are cohesive across the marketing team. You'll own end-to-end execution of partnerships that drive business growth, negotiate agreements, and push partners to meet monthly, quarterly, and annual targets. The ideal candidate is a strategic thinker and expert negotiator who thrives in a fast-paced environment, can juggle multiple projects, and delivers meaningful insights through performance measurement and reporting. If you're a relationship builder with a knack for problem-solving and driving results, we'd love to hear from you! Areas of Responsibility: Strategic Partnership Building and Retention Able to successfully manage a program or channel (multiple campaigns) from end to end, setting and executing a strategy. Oversee and grow strategic partnerships to drive key business goals for the Student Loan Originations product. Identify, evaluate, and analyze new partnership opportunities - both traditional and non-traditional that align with Earnest/Navient's strategic goals. Negotiate and structure deals that meet internal efficiency metrics and performance standards. Define and measure the long-term vision and success of partnerships, including setting clear goals and reporting on progress. Collaborate cross-functionally with Marketing, Product, Engineering, Legal, and Client teams to ensure seamless partner onboarding and retention. Drive revenue growth opportunities with existing partners through conversion optimization and marketing collaboration. Demonstrates complex problem-solving by developing solutions for large-scale challenges and growth barriers. Proactively scouting for new markets, potential partners, and opportunities. Has competitive awareness and stays ahead of industry trends and competitor activity. Lead cross-departmental projects aligned with corporate objectives, managing multiple priorities while delivering high-quality results. Continually assess and improve operational systems and processes, proactively identifying and implementing process improvements. Project and Compliance Management Constructively challenge current practices, identifies trends affecting the business and articulates implications to upper management. Actively participates in discussions to resolve issues and/or implement new processes. Plan and lead cross-departmental initiatives in support of division and corporate business objectives. Handle multiple priorities while producing high-quality results. Regularly seek out knowledge and insights to improve and evolve work products and processes. Ensures that all operational systems are continually evaluated. Continually investigates and introduces process improvement measures and presents suggestions to the executive team for consideration. MINIMUM REQUIREMENTS Bachelor's Degree Business/Finance/Marketing/Operations. 5+ years of experience in account management, or marketing. 2+ years of experience in Partnerships or Business Development, ideally within financial services-preferably in lending, with a strong preference for student loan expertise. Deep expertise in user growth strategies and partnership models, with a strong understanding of how to drive business expansion through strategic collaborations. Exceptional verbal and written communication skills, with the ability to deliver clear, professional presentations and recommendations to executive-level audiences. Strong interpersonal and client relationship management, with a proven ability to build trust and maintain credibility with senior stakeholders. Advanced problem-solving and adaptability, including the ability to analyze complex issues, make sound decisions quickly, and thrive in dynamic, changing environments. Experience implementing marketing automation best practices across email, landing pages, and campaign infrastructure. Prior success working cross-functionally with Product, Legal, and Engineering teams to drive partnership initiatives forward. Strong presentation development skills with the ability to tailor messaging for executive audiences. Background in a high-growth, fast-paced environment within fintech or related industries. Additional equivalent education above the required minimum substitute for level of experience. IMPORTANT NOTICES: All offers of employment are contingent on standard background checks. Depending on the needs of our business, the successful candidate may be subject to further background checks to determine eligibility and suitability. EOE Race/Ethnicity/Sex/Disability/Protected Vet/Sexual Orientation/Gender Identity. Navient Corporation and its subsidiaries are not sponsored by or agencies of the United States of America. Navient is a drug free workplace.
    $72k-99k yearly est. Auto-Apply 7d ago
  • Healthcare Services Segment Specialist (RAC/OIG Focus)

    Performant Financial 4.7company rating

    Performant Financial job in Plantation, FL or remote

    ABOUT MACHINIFY: In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare payment through seamless intelligence. ABOUT THE OPPORTUNITY: Hiring Range: $100,000 - $120,000 The Healthcare Services Segment Specialist applies specific subject matter expertise in Payment Integrity to support of audit business activity performing the following essential duties: Key Responsibilities Responsible and leads reviews, ensures updates of existing concepts based upon required periodic review cycle or as needed based upon client or regulatory changes (research, analysis, update rule documents, code lists and edits accordingly). Ensure training material updates (may develop or coordinate) as necessary for changes to existing concepts. - Contributes to development of training materials and tools for new concepts. Conduct research, identify impact on existing concepts, and document accordingly for new concept development Interpret and apply client policy in existing concept review/updates Responsible for responding to client inquiries and providing support to client services with client presentations Ensure audit concepts are well formulated for Offerings (Data Mining vs Complex Audit; CMS vs Medicaid vs Commercial) Responsible for monitoring and providing statistical analysis to drive scoring and selection for new and existing audit concepts. Responsible for the monitoring of concept performance. Manage, progress, and track multiple tasks within multiple workflows for audit concept maintenance with high degree of accuracy and quality providing status reports and deliver results on-time. Responsible for QA management of all client concepts ensuring compliance with regulatory, coding, or citation changes and are applied to concepts timely. Stay informed of payment integrity policy and current trends. Provides oversight of SME team members to ensure on time project deliveries, cross train, and knowledge transfer, and maintain required quality and productivity standards. Performs other duties as assigned and required to meet business needs. Knowledge, Skills and Abilities Needed Demonstrates expertise (depth and breadth) of knowledge of payment integrity elements. Examples include: ICD-10-CM, ICD-10-PCS, CPT, HCPCS, or HIPPS coding and MS-DRG, APR-DRG, APC, APG, PDPM, or PDGM payment methodologies Strong people skills: ability to communicate with all levels within the organization, with diverse teams as well with external customers. Exceptional written and verbal communication skills. Strong attention to detail. Excellent critical thinking and analytical skills. Time management skills for managing multiple tasks simultaneously, while completing work within allocated time frames. Ability to work independently and in a remote environment. Strong Microsoft suite skills, such as - Excel, Word, Outlook and SharePoint. Required and Preferred Qualifications Minimum 8+ years of progressive experience in healthcare claim type subject matter specialty specific to the position. Bachelor's degree in related field or equivalent experience Registered Nurse or Certified Coder holding nationally recognized credentials (RHIA, RHIT, AHIMA, AAPC, etc.) required A broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology. Progressive health care data analysis experience including gathering and documenting requirements for projects of diverse sizes. WHAT WE OFFER: Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview. Physical Requirements & Additional Notices: If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location. The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary. Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse. Regularly reads and comprehends information in electronic (computer) or paper form (written/printed). Regularly sit/stand 8 or more hours per day. Occasionally lift/carry/push/pull up to 10lbs. Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position: Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions. Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists. Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures. Other requirements may apply. All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination. Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify's Human Resources team to discuss further. Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING
    $29k-47k yearly est. Auto-Apply 32d ago
  • Government Programs Manager

    Performant Financial 4.7company rating

    Performant Financial job in Plantation, FL

    ABOUT MACHINIFY: In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare payment through seamless intelligence. ABOUT THE OPPORTUNITY: Hiring Range: $125-145k The Government Programs Manager has is responsible for overall management and service delivery of assigned customers and projects, including customer satisfaction and financial results. Manage full range of project life cycle (Initiate, Plan, execute, close). Key Responsibilities: Relationships and Collaboration Build relational network within assigned accounts Leads cross functional implementation teams Leads cross functional operational teams May mentor and train other Government Programs staff Sales and Marketing Leverage relational network within assigned accounts to identify opportunities to expand Performant's services footprint Shared responsibility for account financial growth targets Conducts feasibility analysis as part of the sales and contracting process Builds forecasting and growth plans for assigned accounts Solution Delivery and Client Satisfaction Develops implementation strategy, plan and resource requirements for new accounts or projects Establishes metrics, process flow, roles & responsibilities, timelines, budgets, and requirements for project go-live Ensure appropriate alignment of resources and efficiencies to protect and grow margins while delivering value to the customer Responsible for delivery of results according to scope of existing contract Identifies opportunities for increased efficiencies to processes, systems and tools used in delivering client services Understands customer needs and appropriately manages customer expectations Conducts compliance reviews and takes initiative for recommendation and action to mitigate risks Review and input to reporting and analytics for assigned accounts Leverage analytics to identify efficiency opportunities, mitigate potential risks or issues, monitor service delivery activity, and provide status reports Handles escalated problem solving and issue resolution Has accountability for resolution of complex or escalated billing issues Monitor overall account health and client satisfaction Team Management Direct and supervise work of small direct and expanded cross-functional account support team Sets clear expectations aligned with company and account strategy Provides coaching, feedback and holds accountability for results and behaviors Serves as positive role model and leads by example in alignment with company mission, vision, and values Internal Business Process Improvement Participate in developing a program management process based on project and client services best business practices and procedures Develop and ensure quality delivery of Client Training curriculums Develop, adopt and maintain Issue Escalation procedures Participates in vendor selection and management Other duties as assigned Knowlege, Skills and Abilities Needed: Requires exceptional influencing, facilitation, and communication skills coupled with analytical and critical thinking abilities. Ability to deal well with ambiguity. Can effectively shift focus and priorities comfortably, can decide and act without having the total picture, comfortable handling risk and adversity. Applies excellent interpersonal skills both in one-on-one situations and in larger group meetings. Proven ability to work independently and in cross-functional teams, with Government customers and key stakeholders through collaboration, adapting and consulting. Possess ability to work in team environment where collaboration and the knowledge transfer process are critical for success. Ability to build strong relationships both internal and external to the organization Exercises excellent judgment and possesses a keen attention to detail Demonstrates initiative, creativity and innovation to drive excellent customer results and satisfaction Demonstrates good judgment by anticipating the consequences of actions and weighing multiple, sometimes conflicting, priorities Ability to make good decisions and perform work independently to drive results given direction in the form of assigned goals objectives. Demonstrated ability to provide excellent service to diverse clients and maintain positive attitude in fast paced, dynamic environment Able to solve complex problems, and resolve disagreements with informed, rational debate. Acts with confidence and achieves results Builds credibility and trust Mind-set of continuous improvement and adapts quickly to change Strong computer application skills (Microsoft office suite, and others) Experience in managing projects and programs with cross matrix teams Ability to manage multiple projects simultaneously with exceptional organizational skills under pressure Strong process, project and program management skills Strong management skills in coaching, mentoring and training Required and Preferred Qualifications: Bachelor's degree in business, finance, management, or related field Minimum 8 years senior professional level experience in corporate or healthcare management environment, including experience working with Government clients. Minimum 5 years of experience in corporate or healthcare management environment with direct management responsibility for teams of 5 or more. Minimum of 5 years of experience leading and directing large cross functional project teams. Certified coder, registered nurse, healthcare management or other medical field degree or certification for healthcare account focused positions is preferred WHAT WE OFFER: Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview. Physical Requirements & Additional Notices: If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location. The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary. Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse. Regularly reads and comprehends information in electronic (computer) or paper form (written/printed). Regularly sit/stand 8 or more hours per day. Occasionally lift/carry/push/pull up to 10lbs. Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position: Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions. Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists. Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures. Other requirements may apply. All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination. Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify's Human Resources team to discuss further. Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING
    $125k-145k yearly Auto-Apply 19d ago
  • Healthcare Collections Specialist

    Firstsource Solutions 4.3company rating

    Remote job

    Job Title: Healthcare Collections Specialist Schedule: M-F 8am to 9pm EST Role Description: The Healthcare Collections Specialist performs specialized collection work. This task is performed on behalf of clients to help in reducing their outstanding accounts receivables Roles & Responsibilities * Efficiently navigate multiple software systems while documenting current and confidential account information * Maintain a confidential and organized remote work environment * Assist in acquiring and updating debtors' contact information within client systems. * Handle inbound calls from patients seeking assistance with payment on their outstanding medical/healthcare accounts, offering suggestions for resource acquisition or negotiating payment arrangements compliant with the healthcare provider's guidelines * Initiate outbound calls to patients who have yet to establish payment or payment arrangements for resolving outstanding medical/healthcare bills, providing assistance and guidance on payment options * Collaborate effectively in a virtual team environment to meet daily and monthly productivity goals, focusing on call volume and collection targets * Operate within a virtual work setting, participating in weekly contests and incentives to maintain high motivation and engagement with patients to collect outstanding amounts Commit to staying up-to-date with collection laws and company compliance requirements, ensuring adherence to the Fair Debt Collection Practices Act (FDCPA) while assisting patients * Comply with federal laws governing collection practices * Adhere to the company's established policies and procedures, as detailed in the Employee Handbook and the Employee Code of Conduct * Demonstrate an understanding of and active participation in the Corporate Compliance Program * Assist with additional projects as directed by management Preferred Educational Qualifications * High school diploma or equivalent is required Preferred Work Experience * Collection's experience is preferred * 6 months customer service experience Competencies & Skills * Proficiency in engaging and communicating with patients, colleagues, and management, whether in physical or remote virtual chat settings * Consistent demonstration of a courteous and professional demeanor * Self-discipline to remain focused on tasks, even with minimal supervision * Proactive and innovative approach to fulfilling job responsibilities * Skillful prioritization of multiple tasks through effective time management and organizational abilities * Strong PC proficiency, with a typing speed ranging from 30-40 words per minute About Firstsource Firstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes. We are trusted brand custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines, India and Mexico. Our 'rightshore' delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals. Our clientele includes Fortune 500 and FTSE 100 companies
    $31k-40k yearly est. 5d ago
  • Medical Coding Auditor - Inpatient (OIG Focus) Clearance required

    Performant 4.7company rating

    Performant job in Plantation, FL or remote

    ABOUT MACHINIFY: In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We're reshaping healthcare payment through seamless intelligence. ABOUT THE OPPORTUNITY: Hiring Range:$70,000 - $85,000 The Medical Coding Auditor-Inpatient (OIG Focus) is responsible for ensuring the accuracy, integrity, and compliance of medical coding practices within the organization, with a primary focus on Inpatient services. This role involves auditing medical records, coding data, and billing information to verify adherence to coding guidelines and regulations. The Medical Coding Auditor plays a crucial role in minimizing coding errors, preventing fraudulent activities, and ensuring that the organization meets all applicable standards and requirements. Key Responsibilities to include: Audit Medical Records: Review and audit medical records to ensure accurate coding of diagnoses, procedures, and services using ICD-10, CPT, and HCPCS codes. Compliance Monitoring: Ensure that coding practices comply with federal, state, and payer-specific regulations and guidelines, including HIPAA and CMS standards. Identify and Correct Errors: Detect discrepancies and coding errors, provide feedback, and collaborate with coding staff to correct inaccuracies in medical documentation. Education and Training: Provide training and support to coding staff on best practices, coding updates, and compliance standards. Conduct workshops and seminars as needed. Report Generation: Prepare detailed audit reports that highlight findings, trends, and areas for improvement. Present reports to management and relevant stakeholders. Policy Development: Assist in developing and updating coding policies, procedures, and guidelines to ensure ongoing compliance and efficiency. Collaboration: Work closely with medical billing, compliance, and clinical teams to ensure that coding supports accurate billing and reimbursement processes. Stay Current: Keep abreast of changes in coding regulations, industry trends, and best practices. Participate in continuing education to maintain coding certifications. Knowledge, Skills and Abilities Needed: Extensive knowledge of ICD-10, CPT, and HCPCS coding systems. Familiarity with healthcare regulations, including HIPAA, CMS guidelines, and payer-specific requirements. Understanding of medical terminology, anatomy, and physiology. Strong analytical and problem-solving skills. Excellent attention to detail and accuracy. Effective communication and interpersonal skills. Ability to work independently and as part of a team. Ability to work remotely from a home office without on-site Supervision Proficiency in coding software and electronic health record (EHR) systems. Required and Preferred Qualifications: High school diploma or equivalent GED required. Associate's or Bachelor's degree in Health Information Management, Medical Coding, or a related field preferred. Active certification is required. Certified Professional Coder (CPC) and/or Certified Coding Specialist (CCS) are preferred, while CPC-H, CPC-P, RHIA, RHIT, or CCS-P are all generally accepted as well. Other Medical Coding certifications may also qualify. At least three (3) years of direct experience in coding/auditing applicable services, and medical chart review for all provider/claim types. Coding for emergency care, observation, and same day surgery is preferred. Prior auditing experience desirable in either a provider setting, or payer experience in claim processing, edit development, and/or coding and reimbursement policy a plus. Previous payer experience in a claim processing, edit development, and/or coding and reimbursement policy a plus. WHAT WE OFFER: Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview. Physical Requirements & Additional Notices: If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location. The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary. Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse. Regularly reads and comprehends information in electronic (computer) or paper form (written/printed). Regularly sit/stand 8 or more hours per day. Occasionally lift/carry/push/pull up to 10lbs. Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position: Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions. Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists. Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures. Other requirements may apply. All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination. Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify's Human Resources team to discuss further. Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING
    $70k-85k yearly Auto-Apply 12d ago

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Performant Financial may also be known as or be related to PERFORMANT FINANCIAL CORP, Performant Financial, Performant Financial Corporation and Performant Recovery Inc.