Enrollment Specialist jobs at Sharecare - 2352 jobs

At Christian Healthcare Ministries (CHM), we exist to glorify God, show Christian love, and serve members of the Body of Christ by sharing each other's medical bills. The Member Enrollment Representative (MER) plays a vital role in this mission by increasing membership through various communication channels while delivering exceptional member experience. The MER is responsible for converting sales leads into new memberships, guiding prospective members through the enrollment process, and ensuring that every interaction reflects CHM's core values and commitment to service excellence. WHAT WE OFFER Compensation based on experience. Faith and purpose-based career opportunity! Fully paid health benefits Retirement and Life Insurance 12 paid holidays PLUS birthday Professional Development Paid Training ESSENTIAL JOB FUNCTIONS Meet sales targets, goals, and performance expectations. Engage in inbound and outbound phone sales (no cold calling) to assist and guide prospective members through the enrollment process. Establish referrals, build relationships, and develop contacts with potential prospects. Respond promptly and professionally to prospective member calls and inquiries. Ensure delivery of high-quality, Christ-centered service. Address member questions, concerns, and provide thoughtful recommendations. Assist in retaining memberships when appropriate. Respond to emails, calls, and voicemail promptly. Clearly explain CHM guidelines, programs, and options to members. Offer suggestions for improvement to the Member Enrollment Supervisor and Team Leader. Maintain professionalism, empathy, and a positive attitude. Demonstrate strong communication skills in both phone and written correspondence. Uphold CHM's Core Values and Mission Statement in all interactions. Collaborate with other departments, including Member Services, Marketing, and Communications, to ensure seamless member experience. Gain a deep understanding of the Member Enrollment Team's structure and objectives. Input, track, and manage prospects using HubSpot and internal CHM systems. Develop ongoing relationships with prospects through consistent and intentional follow-up. OTHER FUNCTIONS Demonstrate Christian values and adhere to ethical and legal business practices. Support CHM initiatives and departmental goals as assigned. EDUCATION, EXPERIENCE & SKILLS REQUIRED Prior experience in online or phone-based sales (preferred). College education or equivalent work experience (preferred). Strong verbal and written communication skills, including professional phone and email etiquette. Proficiency in CHM guidelines, programs, and policies (training provided). Competence with Microsoft Office Suite and CRM tools such as HubSpot. Excellent organizational and time management skills with the ability to handle multiple priorities. Self-motivated, collaborative, and committed to teamwork. Strong problem-solving and conflict resolution skills. Willingness to ask questions, seek guidance, and support team initiatives. TRAINING & DEVELOPMENT New representatives will complete a structured training program designed to build a strong understanding of CHM's membership process, communication tools, and ministry values. Ongoing professional development and mentorship opportunities are also provided. WORKING CONDITIONS Must adhere to organizational policies and procedures as outlined in the employee handbook. Occasional travel may be required for ministry or business purposes. Flexibility to work hours between 8:00 a.m. and 6:00 p.m., based on department needs. Requires extended periods of sitting, working on a computer, and communicating by phone or email. Strong reasoning and problem-solving abilities to overcome objections and assist prospective members effectively. About Christian Healthcare Ministries Founded in 1981, Christian Healthcare Ministries (CHM) is a health care sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other's medical bills. The mission of CHM is to glorify God, show Christian love, and experience God's presence as Christians share each other's medical bills.

The Grievance & Appeals Specialist II reviews appeals submitted by Medicaid and Medicare providers and all future providers contracted with CareSource. This is a hybrid role and works a few days in our Ridgeland Mississippi office. . Essential Functions: Prepare the appeals for clinical review and be responsible for recording and tracking on a regular basis Review submitted appeals daily for validation of the appeal Identify appropriate claim problem within the appeal Prepare all clinical edit appeals for review by computer research, print claim from Facets system, and print off all the code descriptions to assist the reviewer in decision making for committee meetings Attend and participate in Appeals Committee meetings as needed Maintain spreadsheet of all appeals reviewed with the outcomes resulting from the Appeals Committee Meetings Document within Facets the detailed information as to the outcome of the claim appeal Identify System changes, log the ticket and track the resolution Complete claim appeal through claim adjustments or letters of denials Review claim appeals for possible fraud and abuse and report to SIU Research and release claim appeals with other health insurance, notifying the COB unit when there is other insurance Process a variety of appeals, including but not limited to: dental appeals, low difficulty appeals, non-clinical appeals - (i.e. tobacco surcharge, etc.), medically frail appeals, RCP appeals, member and provider appeals Resolve assigned appeals within regulatory timeframes, achieve departmental quality expectations, and meet daily production requirements Identify and log any related issues Perform UAT testing when necessary Perform any other job related instructions, as requested Education and Experience: High school diploma or equivalent is required Associates Degree or equivalent years of relevant work experience preferred Minimum of two (2) years of healthcare customer service, claims, compliance or related experience is required Competencies, Knowledge and Skills: Technical writing skills Intermediate level skills in Microsoft Word & Excel with Access skills a plus Communication skills (written, oral and interpersonal) Multitasking ability Able to work independently and within a team environment Familiarity of the Healthcare field Knowledge of Medicaid Time Management Decision-making and/or problem solving skills Proper grammar skills Phone etiquette skills Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Compensation Range: $37,080.00 - $59,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type: Hourly Competencies: - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-SD1

Under the direction of the Benefits Manager, the Benefits Analyst assists in administering and communicating Midland Health benefits programs. Assists administering and maintaining benefits programs, including medical, pharmacy, retirement plans, etc. Monitor, research, and analyze current processes, trends, and compliance requirements. Responsible for creating and maintaining employee benefit files. Supports employees and plan members with questions and issues. Oversee key operations, including FMLA administration, Tuition Reimbursement, Affordable Care Act requirements, invoicing, and core and optional insurance plans. SHIFT AND SCHEDULE Monday - Friday: 8:00 AM - 5:00 PM ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS Responsible for assuring proper staffing levels according to policy or request by management. Comprehend and follow healthcare regulations by adapting to new laws quickly. Process accurate and complete benefit documentation, such as collecting supporting documents for life events, dependent verification, and evidence of insurability determinations. Maintain benefit files (digital and paper) by keeping them organized in the HR drive and within the HRIS. Develop benefit communication materials for the New Employee Benefits Orientation, Open Enrollment, and mid-year benefit plan changes; distribute employee notices related to benefit plans; communications may include eBrochure, postcards, videos, and live presentations and other forms of communication. Distribute benefit communication materials by email to new employee benefit orientation, including New Hires, Newly Eligible, PPACA, Life Event, COBRA, and Open enrollments. Guide employees with benefits enrollments or login questions and assist them in filing claims, such as FMLA, Life, STD, LTD, Accident, Hospital Indemnity, Critical Illness, HSA, FSA, EAP, etc. Respond promptly to walk-ins, phone, and email inquiries, including claims processing issues related to benefit coverages, including Customer Identification Processing for HSA issues. Utilize vendor websites to export data for audits and help employees register and gain access to find providers, view claims, print temp cards, etc. Assist employees with utilizing vendor websites to register and gain access to find providers, view claims, print temporary insurance cards, etc. Apply Microsoft Office applications skills, such as demonstrating Excel V-lookups, tracking and monitor enrollment events, Evidence of Insurability exceptions, Dependent Verification status, Amazon Awards, etc.; notify employees of pending open issues; resolve issues to resolution. Monitor Dayforce notifications daily to process new hires, job assignments, terminations, dependent verifications, life event declaration/enrollments, dependent no longer eligible, and HSA changes. Respond to Centers for Medicare and Medicaid Service forms and National Medical Support Notices and update benefit elections and payroll deductions accordingly. Assist in administering 403(b), 457(b), 401(k) plans by determining the proper course of action to resolve escalated employee issues after investigating the facts; guide employees to enroll in the plan-specific to their assigned entity; assist with the annual retirement audits. Provide functional support on payroll/HRIS related to benefits, including benefit deductions, payroll corrections, calculating PTO donations, and performing system audits and testing. Prepare and maintain biweekly payroll deduction reports to support and process benefit vendor invoices; process new benefit vendor requests and expense reports. Prepare bill detail to process biweekly and monthly invoice payments to all benefit vendors. Coordinate and achieve project deadlines are complete and on time; Perform special projects as assigned, including the Open Enrollment event, the Years of Service banquet, new benefit implementation projects, etc. Promptly answer questions, process betterU forms, and process PTO requests/donations submitted through the HR Service Center and assist employees when needed. Act as a liaison with designated department personnel and third-party vendors; understand and identify benefits technology requirements to support system testing, data interfaces, data audits, development of test plans, and execution; conduct audits and implement solutions to correct defects. Monitor and troubleshoot benefit enrollment issues in the HRIS to provide vendors with accurate benefit eligibility data, such as resolving file feed errors promptly (EDC FML Errors, BCBSIL Discrepancy Reports, etc.). Provide functional support for third-party benefits administration systems and file feeds, including documentation, testing, monitoring successful file transmission, ensuring successful data loading to the applicable platforms, and addressing data issues that arise with file loads. Manage day-to-day relationships with benefits administration service providers and all plan administrators; attend related meetings and resolve complex plan issues with vendors. Maintains a positive atmosphere by acting and communicating promptly; facilitates and collaborates cross-functionally with HR and other department teams; Participate with HR inner departmental needs as needed, such as assisting in recruiting events, front desk coverage, etc. Provide guidance and training on benefits policy and procedures for Midland Health Managers and the HR department, such as presenting the FMLA course on Management Essentials training. Review and validate Year End Processing, such as 1095c per the Affordable Care Act requirements. Administer all aspects of FMLA including employee assistance, communication with departments, restricting/enabling employees' return to work, initiating long term disability claims, remove from payroll, etc. EDUCATION AND EXPERIENCE Minimum of a high school diploma or equivalent. BS degree preferred. Five (5) or more years as a Benefits Coordinator or Analyst experience. Demonstrated experience with HRIS systems, including design, development, and testing Demonstrated experience utilizing Microsoft Excel Pivot Tables and VLOOKUP's Bilingual in Spanish is strongly preferred. Customer service expert: telephone and email follow-up beyond compare. Ability to verbally communicate with all levels of the organization and vendors. Stand-up training experience required. Ability to work efficiently under conditions of multiple deadlines and changing priorities to produce a large volume of high-quality material with meticulous attention to detail. Microsoft Office experience required. PHYSICAL REQUIREMENTS To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to: Stand, walk, sit, stoop, reach, lift, see, speak and hear. Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.

The RCM OPEX Specialist plays a critical role in optimizing the financial performance of healthcare organizations by ensuring that revenue cycle management processes are efficient and compliant with industry regulations. This position requires detail-oriented professionals who can navigate complex insurance claims and reimbursement processes. Essential Job Functions Manage internal and external customer communications to maximize collections and reimbursements. Analyze revenue cycle data to identify trends and proactively remediate suboptimal processes. Maintain fee schedule uploads in financial and practice operating systems. Review and resolve escalations on denied and unpaid claims. Collaborate with healthcare providers, payors, and business partners to ensure revenue best practices are promoted. Monitor accounts receivable and expedite the recovery of outstanding payments. Prepare regular reports on refunds, under/over payments. Stay updated on changes in healthcare regulations and coding guidelines. *NOTE: The list of tasks is illustrative only and is not a comprehensive list of all functions and tasks performed by this position. Other Essential Tasks/Responsibilities/Abilities Must be consistent with Femwell's core values. Excellent verbal and written communication skills. Professional and tactful interpersonal skills with the ability to interact with a variety of personalities. Excellent organizational skills and attention to detail. Excellent time management skills with proven ability to meet deadlines and work under pressure. Ability to manage and prioritize multiple projects and tasks efficiently. Must demonstrate commitment to high professional ethical standards and a diverse workplace. Must have excellent listening skills. Must have the ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards and organization attendance policies and procedures. Must maintain compliance with all personnel policies and procedures. Must be self-disciplined, organized, and able to effectively coordinate and collaborate with team members. Extremely proficient with Microsoft Office Suite or related software; as well as Excel, PPT, Internet, Cloud, Forums, Google, and other business tools required for this position. Education, Experience, Skills, and Requirements Bachelor's degree preferred. Minimum of 2 years of experience in medical billing, coding, revenue cycle or practice management. Strong knowledge of healthcare regulations and insurance processes. Knowledgeable in change control. Proficiency with healthcare billing software and electronic health records (EHR). Knowledge of HIPAA Security preferred. Hybrid rotation schedule and/or onsite as needed. Medical coding (ICD-10, CPT, HCPCS) Claims management (X12) Revenue cycle management Denials management Insurance verification Data analysis Compliance knowledge Comprehensive understanding of provider reimbursement methodologies Billing software proficiency

Who We Are: Quest Global delivers world-class end-to-end engineering solutions by leveraging our deep industry knowledge and digital expertise. By bringing together technologies and industries, alongside the contributions of diverse individuals and their areas of expertise, we are able to solve problems better, faster. This multi-dimensional approach enables us to solve the most critical and large-scale challenges across the aerospace & defense, automotive, energy, hi-tech, healthcare, medical devices, rail and semiconductor industries. We are looking for humble geniuses, who believe that engineering has the potential to make the impossible possible; innovators, who are not only inspired by technology and innovation, but also perpetually driven to design, develop, and test as a trusted partner for Fortune 500 customers. As a team of remarkably diverse engineers, we recognize that what we are really engineering is a brighter future for us all. If you want to contribute to meaningful work and be part of an organization that truly believes when you win, we all win, and when you fail, we all learn, then we're eager to hear from you. The achievers and courageous challenge-crushers we seek, have the following characteristics and skills: What You Will Do: Analyze the current state of CMM programs Write CMM programs to support operations Develop CMM inspection strategies for high-precision aerospace components to ensure compliance with engineering requirements Create new and modify existing CMM programs using off-line systems. Preferably utilizing PC-DMIS, open to multiple programming language Output new and edit existing code to run articulated automatic CMM machines Organize and plan work effectively to produce output according to budget and schedule constraints Troubleshoot programming result errors and work holding issues with production personnel to optimize automated inspection results Employment is contingent on passing a customer administered certification course on CMM programming and GD&T What You Will Bring: 2-7 years' experience in CMM setup, inspection, and programming techniques Competency using CMM software. PC-DMIS software preferred Competency with machines and tools required to fabricate and manufacture sheet metal Understanding of Manufacturing Engineering core processes (e.g. process planning, inspection planning, tooling, creation of operator instructions) Ability to characterize various tools, gages, and fixtures Knowledge of GD&T and can integrate it within a production process. A keen understanding of blueprint interpretation is desired as well Solid background in manufacturing Knowledge of Siemens NX solids and NX CMM or other CAD/ CAM, DEMIS, and MODUS tools Proficient in reading and interpreting blueprints Understanding of GD&T Excellent communication and teamwork skills Must be able to communicate effectively with manufacturing engineering, precision inspection personnel, and shop floor employees Must be able to pass a customer administered certification course on CMM programming and GD&T. Pay Range: $90,000-$110,000 a year Compensation decisions are made based on factors including experience, skills, education, and other job-related factors, in accordance with our internal pay structure. We also offer a comprehensive benefits package, including health insurance, paid time off, and retirement plan. Work Requirements: This role is considered an on-site position located in Windsor Locks, CT. You must be able to commute to and from the location with your own transportation arrangements to meet the required working hours. Shop floor environment, which may include but not limited to extensive walking, and ability to lift up to 40 lbs. Typical 8-hour days plus lunch / 40-hour weeks / hours are 3 PM to 11:30 PM for 2nd Shift Travel Requirements: Due to the nature of the work, no travel is required Citizenship Requirement: Due to the nature of the work, U.S. citizenship is required. Benefits: 401(k) 401(k) matching Dental insurance Health insurance Life insurance Paid time off Referral program Vision insurance Short/Long Term Disability

The Outpatient Specialist's main mission is to maintain and grow the current customer base while creating new opportunities through selling the BIOFIRE product line. This includes the sales of instruments, reagents and other services to drive increased adoption and market share within a defined geographical region. The Outpatient Specialist is directly responsible for achieving the territory sales goal through outpatient clinics affiliated with IDNs and clinics not affiliated with IDNs within their assigned territory. Additionally, the Outpatient Specialist will manage both direct sales as well as sales through our distribution partners to achieve high performance in the areas of customer satisfaction, revenue, and profitability. Primary Responsibilities Deliver effective sales call management, opportunity management, pipeline management and forecast accuracy. Identify and establish relationships with key customers and opinion leaders within defined territory. Establish and maintain relationships with our distribution partners to support and advance opportunities and closes. Assess, clarify, validate, and quantify the customer's existing and unmet needs on an ongoing basis. As a part of the Regional Sales team, the Outpatient-Market specialist will identify high value targets within assigned territory and develop strategies to close new business those accounts. Maintain existing customer business to minimize lost business. Work cooperatively in a matrix team and other colleagues to advance and close opportunities. Serve as a liaison between the Outpatient market and Marketing. Channel competitive intel from the field to Marketing and participate as needed in marketing projects and new product launch request. Identify key opinion leaders (KOLs) within defined territory. Manage opportunity pipeline to ensure the timing of closes matches the monthly forecast as it is represented in our CRM tool and related dashboards. Ensure the compliance of business activities meet the most stringent requirements of legal and ethical standards and current company policies. Education and Experience Associates degree and a minimum of 4 years of professional sales experience ORBachelors degree and a minimum of 2 years of professional sales experience required Bachelors degree with 4 years of customer facing experience within the IVD market in lieu of professional sales experience will receive consideration. Strong Knowledge of molecular biology technologies, techniques, and disciplines preferred. In vitro diagnostic (IVD) capital equipment preferred. Point-of-care (POC) sales experience preferred. Distribution-sales experience preferred. Knowledge, Skills, and Abilities Business Skills Functional skills including critical thinking, adaptability, time management, communication, problem-solving and digital literacy. Leading without authority through influence and guidance of others towards a common goal by using expertise, persuasion, and personal qualities to inspire action. Business acumen to understand how a business operates and how to make it successful. Intellectual Horsepower Effective and efficient problem analysis that leads to high-quality decisions. Understand complex information and interpret it accurately, often requiring critical thinking and analysis to grasp the full picture. Manage and meet competing deadlines, requiring careful prioritization and time management to ensure all tasks are completed on time. Creating the New and Different Influence change using skills and relationships to persuade others to adopt new ideas, behaviors, or processes. Perspective to see the world from another person's viewpoint thus gaining new insights and finding creative solutions to challenges. Effectively deal with ambiguity requiring adaptability, critical thinking, and proactive communication to navigate situations with limited details Maintaining Focus Make timely decisions by quickly choosing effective solutions in high-pressure situations for optimal outcomes Priority setting that align with business objectives Thriving in a fast-paced environment by managing tasks, multitasking, and adapting quickly to maintain productivity. Getting Organized Organizing work and resources efficiently to ensure smooth operations Planning objectives and strategies to achieve them within a set timeline Practicing time management to allocate tasks, balance priorities, and meet deadlines efficiently Getting Work Done Through Others Informing others by sharing clear, timely information to ensure alignment. Managing and measuring work by tracking progress, performance, and goal achievement using metrics and KPIs. Managing Work Processes Collect and analyze data to drive informed decision-making to improve performance and identify issues Dealing with Complex Situations Communicates instructions clearly and effectively Demonstrates assertiveness and confidence in the face of a challenge Conflict Management Solution oriented in the face of conflict Comfortable giving clear, direct, and actionable feedback Ability to deal with difficult situations in a timely and bold manner Focusing on the Bottom Line Drive for Results: Drive for Results while successfully removing barriers Action Oriented: Takes action even when facing challenges Being Organizationally Savvy Ability to cooperate with others at all levels including leadership Ability to work cross-functionally allowing for better collaboration and communication when working across teams to achieve shared objectives Communicating Effectively Effective verbal communication skills Written Communications - including the ability to communicate technical data in written form Effective Presentation Skills - including the ability to present technical data Relating Skills Build and maintain positive, productive interactions with colleagues Easily accessible and open to communication Effectively navigate social interactions in the workplace Developing and Inspiring Others Reach mutually beneficial agreements through effective communication and compromise Managing Diverse Relationships Participate in a way that enhances team performance and cohesion. Fosters a culture of inclusiveness among all team members Acting with Honor and Being Open Consistently uphold and reflects the core ethical principles and values that bio Merieux promotes Actively and attentively listen to others, ensuring a clear understanding of their messages, needs, and concerns. Emotional intelligence by having the ability to recognize, understand, and manage one's own emotions, as well as the emotions of others. Maintain composure by having the skill of staying calm, focused, and professional in high-pressure or stressful situations. Working Conditions and Physical Requirements Ability to remain in stationary position, often standing, for prolonged periods. Ability to ascend/descend stairs, ladders, ramps, and the like. Ability to adjust or move objects up to 50 pounds in all directions. Domestic travel required 70% of time Location dependent the selected incumbent will be required to be masked while working in client locations for extended periods when on site in hospitals. Ability to conduct client visits which entails the safe operation of motor vehicles, physically accessing customer facilities and frequent air travel in performance of assigned duties. The estimated salary range for this role is between $87,700 - $140,000. This role is eligible to receive a variable annual bonus based on company, team, and individual performance per bio Merieux's bonus program. This range may differ from ranges offered for similar positions elsewhere in the country given differences in cost of living. Actual compensation within this range is determined based on the successful candidate's experience and will be presented in writing at the time of the offer.In addition, bio Merieux offers a competitive Total Rewards package that may include: A choice of medical (including prescription), dental, and vision plans providing nationwide coverage and telemedicine options Company-Provided Life and Accidental Death Insurance Short and Long-Term Disability Insurance Retirement Plan including a generous non-discretionary employer contribution and employer match. Adoption Assistance Wellness Programs Employee Assistance Program Commuter Benefits Various voluntary benefit offerings Discount programs Parental leaves #LI-US#biojobs Please be aware that recruitment related scams are on the rise. Fraudulent job postings are being placed on other websites, and individuals posing as bio Merieux Talent Acquisition team members are reaching out via email or text message in an attempt to collect your personal and confidential information. In some cases, these scammers are also conducting bogus interviews prior to extending fraudulent offers of employment. Beware of individuals reaching out using general phone numbers and non-bio Merieux email domains (i.e. Hotmail.com, Gmail.com, Yahoo.com, etc.). If you are concerned that an interview experience or offer of employment might be a scam, please make sure you are searching for the posting on our careers site or contact us at [emailprotected]. BioMerieux Inc. and its affiliates are Equal Opportunity/Affirmative Action Employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Please be advised that the receipt of satisfactory responses to reference requests and the provision of satisfactory proof of an applicant's identity and legal authorization to work in the United States are required of all new hires. Any misrepresentation, falsification, or material omission may result in the failure to receive an offer, the retraction of an offer, or if already hired, dismissal. If you are a qualified individual with a disability, you may request a reasonable accommodation in BioMerieux's or its affiliates' application process by contacting us via telephone at , by email at [emailprotected], or by dialing 711 for access to Telecommunications Relay Services (TRS).

The Enterprise Accreditation Specialist III is responsible for supporting the organization to obtain and maintain appropriate accreditations, distinctions and recognitions through NCQA, URAC or other accrediting bodies. This person will serve as the subject matter expert for various accreditations, including but not limited to NCQA Health Plan Accreditation, LTSS Distinction, Health Equity, UM, and Population Health. This person will work cross-functionally with business owners to identify gaps and deficiencies between current processes and the accreditation requirements and assist in implementing any necessary mitigation activities as needed. They will also ensure all changes made by accrediting bodies are communicated and incorporated into business processes. Essential Functions: Serve as subject matter expert in accreditation standards, including NCQA Health Plan, LTSS Distinction, Health Equity, UM and Population Health. Clearly define deliverables associated with delegation agreements including appropriate responsible parties Maintain a strong understanding of the business processes within the assigned Market Collaborate with the business owners to obtain documents, reports, and materials for accreditation submission Provide oversight and monitoring of all surveys and deliverables within assigned Market Monitor, track, and document deliverables related to accreditation process by applying accreditation standards to CareSource processes and documents in conjunction with the business owners Act as advisor to business areas on appropriate documentation and data analysis needs for required improvement opportunities to meet the intent of the NCQA standards Maintain an in-depth knowledge of the standards within the scope of work and ensure that changes made by NCQA are communicated and incorporated into business processes Review and analyze documents, reports, and materials for submission. Ensures accuracy prior to submission Facilitate ongoing annual qualitative and quantitative analyses, assuring business owners are acting on their opportunities for improvement Responsible for preparing materials including but not limited to updating and reformatting for submission to accrediting entities in accordance with standards, coordinating efforts with internal business owners, and tracking readiness against work plans and timelines Manage survey submission process for assigned Market Maintain accreditation roadmaps/workplans Identify and communicate survey status, gaps, and escalations and ensure mitigation plans are implemented, gaps are closed and escalations are resolved Provide management recommendations for improvement related to accreditation processes and document processes Ensure all workplans and dashboards are updated for reporting Manage and execute on multiple module activities consistency Perform a variety of complex work in planning, coordinating, and managing accreditation activities Provide education to staff and business owners on accreditation standards and provide timely updates to affected departments including accreditation activities, survey dates and timelines for deliverables Act as a mentor to the Accreditation Specialist II Assist with the onboarding of new team members on module and Market specific requirements Participate in Market Quality Committees and other applicable committees as required Perform any other job duties as assigned Education and Experience: Bachelor's degree in science, arts, healthcare or other related field or equivalent years of relevant work experience is required. Minimum of three (3) years of experience in a Managed Care Organization or other healthcare related field is required Project Management Experience is preferred Accreditation experience is required Knowledge of IHI, DMAIC, or other process improvement methodologies preferred Competencies, Knowledge and Skills: Knowledge of accreditation bodies and various forms of accreditations, distinctions and recognitions. Expert knowledge of the NCQA Submission process Strong interpersonal skills and high level of professionalism Strong critical thinking/listening skills Excellent problem-solving skills with strong attention to detail Excellent written and verbal communication skills Ability to work independently and within a team environment Ability to develop, prioritize and accomplish goals Analytical and organizational skills Ability to coordinate complex projects and multiple meetings Proficient in Microsoft Office Suite to include Word, Excel, Adobe Pro and SharePoint Excellent written and verbal communication skills Proficient knowledge of the healthcare field and with Medicaid, Medicare, and Marketplace Training/teaching and technical writing skills Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Compensation Range: $62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type: Salary Competencies: - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-JM1

The Grievance & Appeals Specialist II reviews appeals submitted by Medicaid and Medicare providers and all future providers contracted with CareSource. Must live in Indiana. . Essential Functions: Prepare the appeals for clinical review and be responsible for recording and tracking on a regular basis Review submitted appeals daily for validation of the appeal Identify appropriate claim problem within the appeal Prepare all clinical edit appeals for review by computer research, print claim from Facets system, and print off all the code descriptions to assist the reviewer in decision making for committee meetings Attend and participate in Appeals Committee meetings as needed Maintain spreadsheet of all appeals reviewed with the outcomes resulting from the Appeals Committee Meetings Document within Facets the detailed information as to the outcome of the claim appeal Identify System changes, log the ticket and track the resolution Complete claim appeal through claim adjustments or letters of denials Review claim appeals for possible fraud and abuse and report to SIU Research and release claim appeals with other health insurance, notifying the COB unit when there is other insurance Process a variety of appeals, including but not limited to: dental appeals, low difficulty appeals, non-clinical appeals - (i.e. tobacco surcharge, etc.), medically frail appeals, RCP appeals, member and provider appeals Resolve assigned appeals within regulatory timeframes, achieve departmental quality expectations, and meet daily production requirements Identify and log any related issues Perform UAT testing when necessary Perform any other job related instructions, as requested Education and Experience: High school diploma or equivalent is required Associates Degree or equivalent years of relevant work experience preferred Minimum of two (2) years of healthcare customer service, claims, compliance or related experience is required Competencies, Knowledge and Skills: Technical writing skills Intermediate level skills in Microsoft Word & Excel with Access skills a plus Communication skills (written, oral and interpersonal) Multitasking ability Able to work independently and within a team environment Familiarity of the Healthcare field Knowledge of Medicaid Time Management Decision-making and/or problem solving skills Proper grammar skills Phone etiquette skills Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Compensation Range: $41,200.00 - $66,000.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type: Hourly Competencies: - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-SD1

Inspire health. Serve with compassion. Be the difference. In collaboration with perfusion and physician staff, in an acute, critical care inpatient setting, provides clinical direction for all aspects of patient care related to Extracorporeal Membrane Oxygenation [ECMO] therapy. Demonstrates clinical competency utilizing evidence based practices/research in all areas of the nursing process: assessment, planning, implementation, evaluation and outcomes. Incorporates knowledge of safety protocols, cost containment and quality improvement throughout the nursing process. Identifies patient, unit, and organizational priorities and incorporates into the nursing process. Adheres to all compliance and policy/procedures of the organization including, but not limited to: licensure renewal, assigned training, employee health screenings, time and attendance policy, dress code policy, patient confidentiality, infection control and medication administration. Demonstrates knowledge of regulatory agency requirements (TJC, DHEC, CMS). Provides care within the scope of their South Carolina license. The acute inpatient setting usually requires staff to be scheduled for a significant amount of shift, weekend, holiday, and/or on-call work. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Manages and assists with cardio-pulmonary support devices, ECMO (extracorporeal membrane oxygenation). Maintains accurate records of cardio-pulmonary support devices, ECMO, as a permanent copy of the medical record. Follows laboratory procedure for handling specimens, processing test analyses and reporting results. Assists in patient transport activities and manages cardio-pulmonary support devices, ECMO (extracorporeal membrane oxygenation) during patient transport process. Provides direct patient care for patients within scope of practice. Performs other duties as assigned. Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Requirements Education - Associate degree in Nursing or Respiratory Therapy Experience - ECMO specialty device course and required CMEs to maintain proficiency In Lieu Of Three (3) years of intensive care experience may be considered. Required Certifications, Registrations, Licenses Licensed to practice as a RN or RT in South Carolina Knowledge, Skills and Abilities Working knowledge of patient equip-suction, defibrillator, vitals I-STAT point of care competency Work Shift Night (United States of America) Location Greenville Memorial Med Campus Facility 1008 Greenville Memorial Hospital Department 10086166 Mechanical Circulatory Support Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

"Clinica is like my second home and it feels like family. Everyone is inviting and wants to see me grow. I've never had so much positive feedback as I do from patients at Clinica. Patients feel seen, heard and helped as we guide them to a more positive outlook on the medical field. Enrollment is really rewarding!" ~ Dallana Delira, Enrollment Manager Help patients enroll in a discount or insurance program so they can get the medical, dental and behavioral care they need. Job Profile: * Are you experienced with healthcare enrollment including of state and federal programs, eligibility criteria, insurance terminology and coverage types? * Have you absorbed and analyzed large amounts of data? * Are you experienced with electronic health records (EHR), online application portals and basic office software? * Do you empathize with patients and let them know you are here to help them? * Are you positive and approachable with patients and co-workers? * Do you reach out for help when you need it? * Are you bilingual in English and Spanish? What You Get to Do: * You will talk with patients to explain complex insurance terms and program requirements in a way that's easy to understand. * You will prescreen patients to assess what program they qualify for to ensure they have the necessary documents to start the enrollment process. * You will meet with walk-in and scheduled patients to follow through with the application process. * You will keep detailed records of documents, application and billing information in the electronic health record (EHR). * You will add payors to the patient record. * You will prepare reports and submit prior to deadlines. * You get to serve your community - you are here for the patients, and they are very grateful. Compensation: Approximately $21.00 - $26.60 per hour. All individual pay rates are calculated based on the candidate's experience and internal equity. What We Need for this Job: * Bilingual in English and Spanish. * Attention to detail of critical information to determine patient eligibility and their application. * Analyze complex data to determine the correct eligible patient programs. * Strong communication skills - proactively ask for help, etc. * Must be reliable and punctual. * Maintain a high level of professionalism and empathy when interacting with patients. Training takes approximately six weeks even with prior enrollment experience. After six months, this position is eligible for hybrid work. Employees with less experience may still qualify if they can demonstrate role competency, as determined by their manager. What We Offer: * Comprehensive Benefits: * Medical * Dental * Vision * FSA/HSA * Life and Disability * Accident/Hospital Plans * Retirement with Employer Contributions * Vacation, sick, and extended illness time off options * Open communication with leadership and mission-focused engagement * Training and growth opportunities with a supportive team invested in your success We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.

: Eligibility & enrollment SpecialistReports To: Front Office Supervisor Status: Full-Time, Non-Exempt This position is responsible for helping clients enroll in health insurance programs; registering new and established patients in IHC services; conducting outreach to established clients at the Indian Health Center (IHC); assisting patients develop payment plans; and backing up the front desk. The IHC is a Patient Centered Health Home and all employees are an integral part of this model of care delivery. Duties & Responsibilities: Meet with new and established medical clients to inform them about the services offered at the IHC and to enroll them into health insurance programs or any available County coverage Greet patients in waiting room and help them to complete forms Conduct outreach calls to all of the IHC's American Indian clients and encourage them to come in and receive services Conduct outreach calls and mailings to new medical managed care enrollees Create an incentive system aimed at reducing the number of no show clients Provide back up to the receptionist and medical records when needed Develop payment plans if needed for clients Compile monthly statistics for the Medical Department's Board Report Will need to prepare the Eligibility report for registration Make new patient registration packets Confirm appointments Check voicemail daily, follow up with calls and make new patient appointments Maintain schedule for Medi-Cal eligibility worker Assist patients with Medi-Cal applications Assist eligible applicants with the Covered California enrollment process Will attend outreach events as needed Participate as a proactive representative of the Patient Centered Health Home Perform duties utilizing the Team-Based Approach Perform other duties as assigned Required Qualifications, Knowledge and Abilities: Associate degree in a medical related field or comparable A minimum of 2 years of experience in a medical setting in a similar position Able to read, write and speak English fluently Bi-lingual in Spanish preferred Knowledge of medical terminology, procedure codes, ICD-9 codes, and medical records handling Trained as Certified Enrollment Counselor for Covered California or willing to complete training within 3 months of being hired Vast knowledge of Federal and State health programs, and Qualified Health Plans of Cover California Working knowledge of computer programs such as Microsoft Window Experience with Electronic Health Records and patient registries Flexibility, initiative, reliability, and creativity Willingness to cross train for reception and medical records Excellent customer service Knowledge of and ability to relate to the American Indian community and other minority populations Possession of a valid California Driver License, automobile insurance, and a clean driving record. Will need to provide this at time of hire Ability to maintain strict confidentiality Ability to function independently and as a team member within diverse environments as well as with a diverse staff composition Demonstrated ability to perform multiple administrative functions simultaneously in an accurate, organized, and efficient manner. Ability to multitask and thrive in a fast-paced, constantly changing environment Ability to carry out all responsibilities in an honest, ethical and professional manner and demonstrate good judgment Physical Requirements: Ability to sit, stand and walk for extensive periods of time Manual and finger dexterity and eye-hand coordination sufficient to accomplish the duties associated with your job description Ability to lift up to 35 pounds Ability to stoop, squat, or bend frequently Corrected vision and hearing within normal range to observe and communicate with patients and professional staff Working Conditions: Exposure to all patient elements, including communicable disease and blood borne pathogens. Will be working in a fast paced medical environment which can be stressful and constantly changing conditions. Normal working hours are from 8:00 am until 5:00 pm with one hour for lunch. However, working hours may vary depending upon need. Will need to be flexible in performing tasks with limited discretion in making judgment decisions. Preference is given to qualified American Indian/Alaskan Natives in accordance with the American Indian Preference Act (Title 25, U.S. Code Section 472, 473 and 473a). In other than above, the Indian Health Center of Santa Clara Valley, Inc. is an equal opportunity employer including minorities, women, disabled and veterans. Approvals/Acknowledgements

: Eligibility & enrollment Specialist Reports To: Front Office Supervisor Status: Full-Time, Non-Exempt This position is responsible for helping clients enroll in health insurance programs; registering new and established patients in IHC services; conducting outreach to established clients at the Indian Health Center (IHC); assisting patients develop payment plans; and backing up the front desk. The IHC is a Patient Centered Health Home and all employees are an integral part of this model of care delivery. Duties & Responsibilities: * Meet with new and established medical clients to inform them about the services offered at the IHC and to enroll them into health insurance programs or any available County coverage * Greet patients in waiting room and help them to complete forms * Conduct outreach calls to all of the IHC's American Indian clients and encourage them to come in and receive services * Conduct outreach calls and mailings to new medical managed care enrollees * Create an incentive system aimed at reducing the number of no show clients * Provide back up to the receptionist and medical records when needed * Develop payment plans if needed for clients * Compile monthly statistics for the Medical Department's Board Report * Will need to prepare the Eligibility report for registration * Make new patient registration packets * Confirm appointments * Check voicemail daily, follow up with calls and make new patient appointments * Maintain schedule for Medi-Cal eligibility worker * Assist patients with Medi-Cal applications * Assist eligible applicants with the Covered California enrollment process * Will attend outreach events as needed * Participate as a proactive representative of the Patient Centered Health Home * Perform duties utilizing the Team-Based Approach * Perform other duties as assigned Required Qualifications, Knowledge and Abilities: * Associate degree in a medical related field or comparable * A minimum of 2 years of experience in a medical setting in a similar position * Able to read, write and speak English fluently * Bi-lingual in Spanish preferred * Knowledge of medical terminology, procedure codes, ICD-9 codes, and medical records handling * Trained as Certified Enrollment Counselor for Covered California or willing to complete training within 3 months of being hired * Vast knowledge of Federal and State health programs, and Qualified Health Plans of Cover California * Working knowledge of computer programs such as Microsoft Window * Experience with Electronic Health Records and patient registries * Flexibility, initiative, reliability, and creativity * Willingness to cross train for reception and medical records * Excellent customer service * Knowledge of and ability to relate to the American Indian community and other minority populations * Possession of a valid California Driver License, automobile insurance, and a clean driving record. Will need to provide this at time of hire * Ability to maintain strict confidentiality * Ability to function independently and as a team member within diverse environments as well as with a diverse staff composition * Demonstrated ability to perform multiple administrative functions simultaneously in an accurate, organized, and efficient manner. Ability to multitask and thrive in a fast-paced, constantly changing environment * Ability to carry out all responsibilities in an honest, ethical and professional manner and demonstrate good judgment Physical Requirements: * Ability to sit, stand and walk for extensive periods of time * Manual and finger dexterity and eye-hand coordination sufficient to accomplish the duties associated with your job description * Ability to lift up to 35 pounds * Ability to stoop, squat, or bend frequently * Corrected vision and hearing within normal range to observe and communicate with patients and professional staff Working Conditions: Exposure to all patient elements, including communicable disease and blood borne pathogens. Will be working in a fast paced medical environment which can be stressful and constantly changing conditions. Normal working hours are from 8:00 am until 5:00 pm with one hour for lunch. However, working hours may vary depending upon need. Will need to be flexible in performing tasks with limited discretion in making judgment decisions. Preference is given to qualified American Indian/Alaskan Natives in accordance with the American Indian Preference Act (Title 25, U.S. Code Section 472, 473 and 473a). In other than above, the Indian Health Center of Santa Clara Valley, Inc. is an equal opportunity employer including minorities, women, disabled and veterans. Approvals/Acknowledgements

We are a mission-driven, service-orientated industry leader looking for a Benefit Enrollment Specialist to join our team of caring professionals in Phoenix, AZ. Terros Health is a healthcare organization of caring people, guided by our core values of integrity, compassion and empowerment. We engage people in whole person's health through an integrated care delivery system, thus establishing a medical home for our patients. In caring for the whole person, we focus on overall wellness through physical health, mental health and substance use care. Our mission is to provide extraordinary care by empowered people through exceptional outcomes. HOPE ~ HEALTH ~ HEALING Terros Health made the list!! "Most Admired Companies of 2020, 2022 & 2023" as awarded by AZ Big Media. Full-Time Employed: 40 hours/week/ Monday to Friday 8am to 5pm Location: 4451 E Oak St. Phoenix, AZ 85008 Bilingual in Spanish is a plus (Additional Language Differential Pay Available) Full Benefits Package, including 401K Generous PTO/Sick Time (4+ weeks in year 1) As a Benefit Enrollment Specialist, you will ascertain member benefits by interviewing members and assisting them with gathering all pertinent information for benefit application process. You will initiate, track and assist with member benefits during and after the application process. Being detail-orientated is an important requirement of the job, as you monitor the completion of financial member information, work with outside agencies and facilitate AHCCCS eligibility checks and monitoring. In addition, you will train and assist case manager staff in completing application forms. If you are dependable, caring and compassionate and find motivation in helping our members live better lives by sharing your own experiences, apply now! Duties may include: * Meets individually with clients in need of benefit assistance. This includes, but is not limited to: AHCCCS applications, SSDI and SSI applications, benefits through Arizona DES (Food Stamps, Cash Assistance, other). Directly assists clients with completing necessary applications and monitors their status in application process. * Provides information and guidance to clients related to insurance benefits, including Title XIX and Non-Title XIX covered services, Medicare, Federal Marketplace, and other third-party liability insurance. * Maintains all required tracking spreadsheets related to client benefits and eligibility status as required by Terros Health, the RBHA and/or other contractors. Provides updated reports to Terros Health leadership as needed for submission to RBHA and/or other contractors per deliverable requirements. * Ensures effective communication with clinical staff and provides timely notification of any change in a client's benefit status to the clinical team and by Practice Manager. Apply with your resume at ******************** Benefits & Wellness * Multiple medical plans - including a no premium plan for employees and their families * Multiple dental plans - including orthodontia * Financial well-being - 401(k) with a company match, interest free medical line of credit, financial education, planning, and support * 4 Weeks of paid time off in the first year * Wellness program * Pet Insurance * Group life and disability insurance * Employee Assistance Program for the Whole Family * Personal and family mental and physical health access * Professional growth & development - including scholarships, clinical supervision, and CEUs * Tuition discounts with GCU and The University of Phoenix * Working Advantage - Employee perks and discounts * Gym memberships * Car rentals * Flights, hotels, movies and more * Bilingual pay differential

We are a mission-driven, service-orientated industry leader looking for a Benefit Enrollment Specialist to join our team of caring professionals in Phoenix, AZ. Terros Health is a healthcare organization of caring people, guided by our core values of integrity, compassion and empowerment. We engage people in whole person health through an integrated care delivery system, thus establishing a medical home for our patients. In caring for the whole person, we focus on overall wellness through physical health, mental health and substance use care. Our mission is to provide extraordinary care by empowered people through exceptional outcomes. HOPE ~ HEALTH ~ HEALING Terros Health made the list!! "Most Admired Companies of 2020, 2022 & 2023" as awarded by AZ Big Media. Full-Time Employed: 40 hours/week Location: 10844 N 23rd Ave, Phoenix, AZ 85029 Bilingual in Spanish is a plus (Additional Language Differential Pay Available) Full Benefits Package, including 401K Generous PTO/Sick Time (4+ weeks in year 1) As an Benefit Enrollment Specialist you will ascertain member benefits by interviewing members and assisting them with gathering all pertinent information for benefit application process. You will initiate, track and assist member benefits during and after the application process. Being detail-orientated is an important requirement of the job, as you monitor the completion of financial member information, work with outside agencies and facilitate AHCCCS eligibility checks and monitoring. In addition, you will train and assist case manager staff in the completion of application forms. If you are dependable, caring and compassionate and find motivation in helping our members live better lives by sharing your own experiences, apply now! At Terros Health, we promote from within and foster an environment that encourages career growth and development. Duties may include: * Meets individually with clients in need of benefit assistance. This includes, but is not limited to: AHCCCS applications, SSDI and SSI applications, benefits through Arizona DES (Food Stamps, Cash Assistance, other). Directly assists clients with completing necessary applications and monitors their status in application process. * Provides information and guidance to clients related to insurance benefits, including Title XIX and Non-Title XIX covered services, Medicare, Federal Marketplace, and other third party liability insurance. * Maintains all required tracking spreadsheets related to client benefits and eligibility status as required by Terros Health, the RBHA and/or other contractors. Provides updated reports to Terros Health leadership as needed for submission to RBHA and/or other contractors per deliverable requirements. * Ensures effective communication with clinical staff and provides timely notification of any change in a client's benefit status to the clinical team and by Practice Manager. Benefits & Wellness * Multiple medical plans - including a no premium plan for employees and their families * Multiple dental plans - including orthodontia * Financial well-being - 401(k) with a company match, interest free medical line of credit, financial education, planning, and support * 4 Weeks of paid time off in the first year * Wellness program * Pet Insurance * Group life and disability insurance * Employee Assistance Program for the Whole Family * Personal and family mental and physical health access * Professional growth & development - including scholarships, clinical supervision, and CEUs * Tuition discounts with GCU and The University of Phoenix * Working Advantage - Employee perks and discounts * Gym memberships * Car rentals * Flights, hotels, movies and more * Bilingual pay differential

We are a mission-driven, service-orientated industry leader looking for a Benefit Enrollment Specialist to join our team of caring professionals in Phoenix, AZ. Terros Health is a healthcare organization of caring people, guided by our core values of integrity, compassion and empowerment. We engage people in whole person health through an integrated care delivery system, thus establishing a medical home for our patients. In caring for the whole person, we focus on overall wellness through physical health, mental health and substance use care. Our mission is to provide extraordinary care by empowered people through exceptional outcomes. HOPE ~ HEALTH ~ HEALING Terros Health made the list!! "Most Admired Companies of 2020, 2022 & 2023" as awarded by AZ Big Media. Full-Time Employed: 40 hours/week Location: 10844 N 23rd Ave, Phoenix, AZ 85029 Bilingual in Spanish is a plus (Additional Language Differential Pay Available) Full Benefits Package, including 401K Generous PTO/Sick Time (4+ weeks in year 1) As an Benefit Enrollment Specialist you will ascertain member benefits by interviewing members and assisting them with gathering all pertinent information for benefit application process. You will initiate, track and assist member benefits during and after the application process. Being detail-orientated is an important requirement of the job, as you monitor the completion of financial member information, work with outside agencies and facilitate AHCCCS eligibility checks and monitoring. In addition, you will train and assist case manager staff in the completion of application forms. If you are dependable, caring and compassionate and find motivation in helping our members live better lives by sharing your own experiences, apply now! At Terros Health, we promote from within and foster an environment that encourages career growth and development. Duties may include: Meets individually with clients in need of benefit assistance. This includes, but is not limited to: AHCCCS applications, SSDI and SSI applications, benefits through Arizona DES (Food Stamps, Cash Assistance, other). Directly assists clients with completing necessary applications and monitors their status in application process. Provides information and guidance to clients related to insurance benefits, including Title XIX and Non-Title XIX covered services, Medicare, Federal Marketplace, and other third party liability insurance. Maintains all required tracking spreadsheets related to client benefits and eligibility status as required by Terros Health, the RBHA and/or other contractors. Provides updated reports to Terros Health leadership as needed for submission to RBHA and/or other contractors per deliverable requirements. Ensures effective communication with clinical staff and provides timely notification of any change in a client's benefit status to the clinical team and by Practice Manager. Benefits & Wellness Multiple medical plans - including a no premium plan for employees and their families Multiple dental plans - including orthodontia Financial well-being - 401(k) with a company match, interest free medical line of credit, financial education, planning, and support 4 Weeks of paid time off in the first year Wellness program Pet Insurance Group life and disability insurance Employee Assistance Program for the Whole Family Personal and family mental and physical health access Professional growth & development - including scholarships, clinical supervision, and CEUs Tuition discounts with GCU and The University of Phoenix Working Advantage - Employee perks and discounts Gym memberships Car rentals Flights, hotels, movies and more Bilingual pay differential Qualifications Must have High School/GED with 3-5 Years of experience in a Behavioral health or related field Must have one year of experience in coordinating healthcare benefits, and validating member coverage. Preferred - working knowledge of Security Disability programs, Title XIX, Programs for developmentally disabled, welfare programs, Arizona Long Term Care system, Adult and Children/Adolescent programs. Shared experience, preferred. A shared experience is defined as personally (or a family member) utilizing privately or publicly funded behavioral health services, to include substance abuse treatment or having a family perspective of recovery. Computer Skills: Microsoft Word, Excel, Outlook, electronic medical record, NextGen preferred Minimum typing speed of 25 wpm Must have valid Arizona driver's license, be 21 years of age with minimum 4 years driving experience, and meet requirements of Terros Health's driving policy Must have a valid Arizona Fingerprint Clearance card (Level 1) or apply for an Arizona Fingerprint Clearance card within 7 working days of employment Must pass background check, TB test and other pre-employment screening Physical demands of this position 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.

Founded in 1970, East Valley Community Health Center is a Federally Qualified Health Center (FQHC) who's services include providing personalized, affordable, high-quality medical, dental, vision and behavioral health care through a community-based network within the East San Gabriel Valley and Pomona Communities. Our staff practices patient-centered care by serving each patient with a personalized care plan that meets their individual needs. Our patients have access to support services that include, nutrition, health education, case management, pharmacy, lab, and x-ray at our health center locations. East Valley serves the health care needs of uninsured and underserved individuals and families throughout our 8 health center locations. Our mission is to provide access to excellent health care while engaging and empowering our patients, employees, and partners to improve their well-being and the health of our communities. MAJOR POSITION RESPONSIBILITIES AND FUNCTIONS: * Provide enrollment assistance (including but not limited to completing coverage applications, gathering required documentation, and troubleshooting the enrollment process) for uninsured individuals to access subsidized, low-cost and free health insurance programs through the health insurance market place and Medi-Cal. * Provide structured patient education on health coverage, engage in follow-up and offer renewal assistance for enrolled individuals. * Educate patients and community members on COVID-19 best practices including vaccine eligibility and booster requirements. * Establish trusting relationships with patients and their families while identifying and addressing patients' needs. * Provide ongoing navigation with patients and families to assure patient satisfaction, evidenced by patient retention. * Conduct outreach and in-reach strategies within the community with the goal of increasing the number of families enrolled with EVCHC. * Conduct in-reach activities at EVCHC sites to inform patients about health care coverage * Assists and/or completes additional tasks as assigned. POSITION REQUIREMENTS AND QUALIFICATIONS: * High School or GED required. Bachelor's Degree in health or social service-related field of study preferred or, a minimum of two years in the field equivalent combination of education and experience. * 2 or more years of experience working in community social service or healthcare environment. * Experience using technology such as a computer, web-based portal systems, and internet web browsers. * Experience tabling and performing community outreach. * Covered CA Enrollment Assister Certification strongly preferred. * Must have strong Microsoft Office 365 skills (ex: Outlook, Word, and Excel). * Must be able to type 45 words per minute. * Bilingual, Fluent in English/Spanish or English/Spanish/Mandarin required. DOE: $23.00 - $27.16 East Valley offers a competitive salary, excellent benefits to include medical, dental, vision, and defined contribution retirement plan. You will also enjoy work-life balance with paid time off and paid holidays throughout the year. Please apply to this position with your current resume. Principals only. Recruiters, please do not contact this job posting. EOE is the Law. It is the stated policy of EVCHC to conform to all the laws, statutes, and regulations concerning equal employment opportunities and affirmative action. We strongly encourage women, minorities, individuals with disabilities and veterans to apply to all of our job openings. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, or national origin, age, disability status, Genetic Information & Testing, Family & Medical Leave, protected veteran status, or any other characteristic protected by law. We prohibit Retaliation against individuals who bring forth any complaint, orally or in writing, to the employer or the government, or against any individuals who assist or participate in the investigation of any complaint or otherwise oppose discrimination.

Founded in 1970, East Valley Community Health Center is a Federally Qualified Health Center (FQHC) who's services include providing personalized, affordable, high-quality medical, dental, vision and behavioral health care through a community-based network within the East San Gabriel Valley and Pomona Communities. Our staff practices patient-centered care by serving each patient with a personalized care plan that meets their individual needs. Our patients have access to support services that include, nutrition, health education, case management, pharmacy, lab, and x-ray at our health center locations. East Valley serves the health care needs of uninsured and underserved individuals and families throughout our 8 health center locations. Our mission is to provide access to excellent health care while engaging and empowering our patients, employees, and partners to improve their well-being and the health of our communities. Position Responsibilities and Functions: • Provide enrollment assistance (including but not limited to completing coverage applications, gathering required documentation, and troubleshooting the enrollment process) for uninsured individuals to access subsidized, low-cost and free health insurance programs through the health insurance market place and Medi-Cal. • Provide structured patient education on health coverage, engage in follow-up and offer renewal assistance for enrolled individuals. • Educate patients and community members on COVID-19 best practices including vaccine eligibility and booster requirements. • Establish trusting relationships with patients and their families while identifying and addressing patients' needs. • Provide ongoing navigation with patients and families to assure patient satisfaction, evidenced by patient retention. • Conduct outreach and in-reach strategies within the community with the goal of increasing the number of families enrolled with EVCHC. • Conduct in-reach activities at EVCHC sites to inform patients about health care coverage Position Requirements and Qualifications: High School or GED required. Bachelor's Degree in health or social service-related field of study preferred or, a minimum of two years in the field equivalent combination of education and experience. 2 or more years of experience working in community social service or healthcare environment. Experience using technology such as a computer, web-based portal systems, and internet web browsers. Experience tabling and performing community outreach. Covered CA Enrollment Assister Certification strongly preferred. Must have strong Microsoft Office 365 skills (ex: Outlook, Word, and Excel). Must be able to type 45 words per minute. Bilingual, Fluent in English/Spanish or English/Spanish/Mandarin (Highly preferred) East Valley offers a competitive salary, excellent benefits to include: medical, dental, vision, and defined contribution retirement plan. You will also enjoy work-life balance with paid time off and paid holidays throughout the year. Principals only. Recruiters, please do not contact this job posting. EOE is the Law. It is the stated policy of EVCHC to conform to all the laws, statutes, and regulations concerning equal employment opportunities and affirmative action. We strongly encourage women, minorities, individuals with disabilities and veterans to apply to all of our job openings. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, or national origin, age, disability status, Genetic Information & Testing, Family & Medical Leave, protected veteran status, or any other characteristic protected by law. We prohibit Retaliation against individuals who bring forth any complaint, orally or in writing, to the employer or the government, or against any individuals who assist or participate in the investigation of any complaint or otherwise oppose discrimination.

Integrative Emergency Services, LLC (“IES”) is seeking a Revenue Cycle EDI Enrollment Specialist (ESS) who will be responsible for facilitating and managing provider enrollment for all new and existing clients. The EES is responsible for completing and/or overseeing vendor management for all EFT/ERA enrollment submissions for the appropriate payors, providing payor portal access to the appropriate entities, and updating remittance and demographic information for all entities. This specialist will develop, coordinate, implement, and manage all payer/EDI-related processes. Additionally, the EES serves as the primary link between IES and any claims/payer data-trading partners and vendors and manages those relationships. The EES' job is to ensure all items are accurately obtained, tracked, setup, updated and communicated for each implementation and/or payer/provider change. IES is dedicated to cultivating best practices in emergency care, providing comprehensive acute care services, creating value, and supporting patients, employees, clients, providers, and physicians in pursuit of the highest quality health care. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Will be responsible for managing the payor linking process including the development of linking strategies for account processing and establishing procedures for access management. Will be responsible for setting up new group forms with RCM vendors for EDI. Will manage and set-up new group administrator access across all payor websites and manage client profiles across all platforms and all websites for all groups. Will oversee EFT and ERA enrollment for all groups and all payors. Will manage website access for IES and its vendors. Will manage all profile attestations for payor linking. Will manage reporting and processes to redirect paper mail to lockbox and/or convert to ERA and EFT/ACH. Manages the processes associated with new and change payer set ups as it relates to 270/271 eligibility, 835/837 files and EFT's. Responsible for updating workflow processes and documentation related to payor linking (EDI, EFT, and/or ERA). Manage bank account and address linking for all groups. Collaborates with vendor(s) and serves as the primary contact for payor linking. Research and compile new payor contract and/or enrollment scoping for all groups and all payors. Source primary contact and/or process for payor contracting and present to leadership. Assist with research through payor websites as applies to new or existing payor contracts. QUALIFICATIONS Knowledge, Skills, Abilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Excellent analytical, organizational, and verbal/written communication skills Detail orientation Ability to manage multiple priorities Strong customer service orientation Ability to use discretion appropriately and maintain confidentiality High levels of proficiency with MS Office applications Ability to function in a hands-on environment Ability to read, write and speak English proficiently Education / Experience: Include minimum education, technical training, and/or experience preferred to perform the job. Required: HS Diploma or GED equivalent 3+ years of experience working in EDI and Healthcare Revenue Management or Revenue Cycle Management, with a focus on healthcare remittance processing and enrollments 3+ years of experience with EDI, enrollment, and/or insurance portal management 3+ years of experience with billing, collections, and/or coding in revenue cycle Working knowledge with various payer systems and basic enrollment processes (ERA vs. ACH/EFT) Working knowledge of healthcare specific EDI standards (HIPAA, X12, HL7) and transactions sets (270s, 271s, 837s, 835s, etc) Extensive knowledge of medical terminology and revenue cycle industry Preferred: Bachelors Degree in Healthcare Management, Business, Project Management, or a related field 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. Specific vision requirements include the ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus While performing the duties of this job, the employee is regularly required to talk and hear Frequently required to stand, walk, sit, use hands to feel, and reach with hands and arms. Possess the ability to fulfill any office activities normally expected in an office setting, to include, but not limited to: remaining seated for periods of time to perform computer based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.) Occasionally lift and/or move up to 20-25 pounds Fine hand manipulation (keyboarding) WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Office environment; Hybrid schedule 4835 Lyndon B Johnson Fwy, Dallas, TX 75244 Monday/Friday remote Tuesday-Thursday in office 8am-5pm May visit hospital locations and vendors The noise level in the work environment is usually low TRAVEL Occasional travel may be required Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. The company is committed to creating a diverse, inclusive, and equitable environment and is proud to be an equal opportunity employer. Qualified applicants of any age, race, religion, nationality, sexual orientation, gender identity or expression, disability, or veteran status will receive equal consideration for positions. We welcome people of diverse backgrounds, experiences, and abilities and believe that the unique experiences of our team drive our success.

Job Description Integrative Emergency Services, LLC (“IES”) is seeking a Revenue Cycle EDI Enrollment Specialist (ESS) who will be responsible for facilitating and managing provider enrollment for all new and existing clients. The EES is responsible for completing and/or overseeing vendor management for all EFT/ERA enrollment submissions for the appropriate payors, providing payor portal access to the appropriate entities, and updating remittance and demographic information for all entities. This specialist will develop, coordinate, implement, and manage all payer/EDI-related processes. Additionally, the EES serves as the primary link between IES and any claims/payer data-trading partners and vendors and manages those relationships. The EES' job is to ensure all items are accurately obtained, tracked, setup, updated and communicated for each implementation and/or payer/provider change. IES is dedicated to cultivating best practices in emergency care, providing comprehensive acute care services, creating value, and supporting patients, employees, clients, providers, and physicians in pursuit of the highest quality health care. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Will be responsible for managing the payor linking process including the development of linking strategies for account processing and establishing procedures for access management. Will be responsible for setting up new group forms with RCM vendors for EDI. Will manage and set-up new group administrator access across all payor websites and manage client profiles across all platforms and all websites for all groups. Will oversee EFT and ERA enrollment for all groups and all payors. Will manage website access for IES and its vendors. Will manage all profile attestations for payor linking. Will manage reporting and processes to redirect paper mail to lockbox and/or convert to ERA and EFT/ACH. Manages the processes associated with new and change payer set ups as it relates to 270/271 eligibility, 835/837 files and EFT's. Responsible for updating workflow processes and documentation related to payor linking (EDI, EFT, and/or ERA). Manage bank account and address linking for all groups. Collaborates with vendor(s) and serves as the primary contact for payor linking. Research and compile new payor contract and/or enrollment scoping for all groups and all payors. Source primary contact and/or process for payor contracting and present to leadership. Assist with research through payor websites as applies to new or existing payor contracts. QUALIFICATIONS Knowledge, Skills, Abilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Excellent analytical, organizational, and verbal/written communication skills Detail orientation Ability to manage multiple priorities Strong customer service orientation Ability to use discretion appropriately and maintain confidentiality High levels of proficiency with MS Office applications Ability to function in a hands-on environment Ability to read, write and speak English proficiently Education / Experience: Include minimum education, technical training, and/or experience preferred to perform the job. Required: HS Diploma or GED equivalent 3+ years of experience working in EDI and Healthcare Revenue Management or Revenue Cycle Management, with a focus on healthcare remittance processing and enrollments 3+ years of experience with EDI, enrollment, and/or insurance portal management 3+ years of experience with billing, collections, and/or coding in revenue cycle Working knowledge with various payer systems and basic enrollment processes (ERA vs. ACH/EFT) Working knowledge of healthcare specific EDI standards (HIPAA, X12, HL7) and transactions sets (270s, 271s, 837s, 835s, etc) Extensive knowledge of medical terminology and revenue cycle industry Preferred: Bachelors Degree in Healthcare Management, Business, Project Management, or a related field 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. Specific vision requirements include the ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus While performing the duties of this job, the employee is regularly required to talk and hear Frequently required to stand, walk, sit, use hands to feel, and reach with hands and arms. Possess the ability to fulfill any office activities normally expected in an office setting, to include, but not limited to: remaining seated for periods of time to perform computer based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.) Occasionally lift and/or move up to 20-25 pounds Fine hand manipulation (keyboarding) WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Office environment; Hybrid schedule 4835 Lyndon B Johnson Fwy, Dallas, TX 75244 Monday/Friday remote Tuesday-Thursday in office 8am-5pm May visit hospital locations and vendors The noise level in the work environment is usually low TRAVEL Occasional travel may be required Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. The company is committed to creating a diverse, inclusive, and equitable environment and is proud to be an equal opportunity employer. Qualified applicants of any age, race, religion, nationality, sexual orientation, gender identity or expression, disability, or veteran status will receive equal consideration for positions. We welcome people of diverse backgrounds, experiences, and abilities and believe that the unique experiences of our team drive our success. Powered by JazzHR PjEC7ySrXQ