EOB jobs near me - 55 jobs

The Revenue Cycle Clinician for the Appellate Solution is responsible for: a) Recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review b) Preparing and documenting appeal based on industry accepted criteria. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Performs retrospective (post -discharge/ post-service) medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review. Demonstrates proficiency in use of medical necessity criteria sets, currently InterQual or other key factors or systems as evidenced by Inter-rater reliability studies and other QA audits. Constructs and documents a succinct and fact based clinical case to support appeal utilizing appropriate module of InterQual criteria (Acute, Procedures, etc). If clinical review does not meet IQ criteria, other pertinent clinical facts are utilized to support the appeal. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization. Demonstrates ability to critically think and follow documented processes for supporting the clinical appellate process. Adheres to the department standards for productivity and quality goals. Ensuring accounts assigned are worked in a timely manner based on the payor guidelines. Demonstrates proficiency in utilization of electronic tools including but not limited to ACE, nThrive, eCARE, Authorization log, InterQual , VI, HPF, as well as competency in Microsoft Office. Demonstrates basic patient accounting knowledge i.e. UB92/UB04 and EOB components, adjustments, credits, debits, balance due, patient liability, denials management, etc. Additional responsibilities: Serves as a resource to non-clinical personnel. Provides CRC leadership with sound solutions related to process improvement Assist in development of policy and procedures as business needs dictate. Assists Law Department with any medical necessity reviews as capacity allows up to and including attending mediation hearings, other litigation forums, etc. 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. Demonstrates proficiency in the application of medical necessity criteria, currently InterQual Possesses excellent written, verbal and professional letter writing skills Critical thinker, able to make decisions regarding medical necessity independently Ability to interact intelligently and professionally with other clinical and non-clinical partners Demonstrates knowledge of managed care contracts including reimbursement matrixes and terms Ability to multi-task Ability to conduct research regarding State/Federal appellate guidelines and applicable regulatory processes related to the appellate process. Ability to conduct research regarding off-label use of medications. Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. Must possess a valid nursing license (Registered) Minimum of 3 years recent acute care experience in a facility environment Medical-surgical/critical care experience preferred Minimum of 2 years UR/Case Management experience preferred Managed care payor experience a plus either in Utilization Review, Case Management or Appeals Previous classroom led instruction on InterQual products (Acute Adult, Peds, Outpatient and Behavioral Health) preferred CERTIFICATES, LICENSES, REGISTRATIONS Current, valid RN licensure (Must) Certified Case Manager (CCM) or Certified Professional in Utilization Review/Utilization Management/Healthcare Management (CPUR , CPUM, or CPHM) preferred 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. Ability to lift 15-20lbs Ability to travel approximately 10% of the time; either to facility sites, National Insurance Center (NIC) sites, Headquarters or other designated sites Ability to sit and work at a computer for a prolonged period of time conducting medical necessity reviews 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. Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc. OTHER May require travel - approximately 10% Interaction with facility Case Management, Physician Advisor is a requirement. As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation Pay: $30.85 - $46.28 per hour. Compensation depends on location, qualifications, and experience. Position may be eligible for a signing bonus for qualified new hires, subject to employment status. Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: Medical, dental, vision, disability, and life insurance Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. 401k with up to 6% employer match 10 paid holidays per year Health savings accounts, healthcare & dependent flexible spending accounts Employee Assistance program, Employee discount program Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act.

CUSTOMER SERVICE SUPPORT REP - PATIENT BILLING CUSTOMER SERVICE At Labcorp, you are part of a journey to accelerate life-changing healthcare breakthroughs and improve the delivery of care for all. You'll be inspired to discover more, develop new skills and pursue career-building opportunities as we help solve some of today's biggest health challenges around the world. Together, let's embrace possibilities and change lives! LabCorp's Patient Billing Customer Service department within the Revenue Cycle Management Division is seeking energetic, passionate customer service focused individuals who seek solutions to challenging patient billing issues. This empowered and valued employee will help deliver exemplary customer experiences through innovation and continuous improvement. If you are interested in a career where learning and engagement are valued, and the lives you touch provide you with a higher sense of purpose, then LabCorp is the place for you! RESPONSIBILITIES Answer 80+ inbound calls per day from patients, doctor's office and/or private insurance carriers. Initiate payment plans for patients for outstanding balances. Routinely utilize multiple resources to resolve patient inquiries while on the phone Maintain performance goals Ability to become proficient with processes after completing a structured training program. KNOWLEDGE|SKILLS|ABILITIES Ability to work and learn in a fast-paced environment Attention to detail Perform successfully in a team environment Excellent organization skills Proficiency navigating multiple computer screens and applications Alpha-Numeric data entry proficiency Excellent communication skills QUALIFICATIONS High School Diploma or equivalent required Minimum 1+ year work experience required Previous work in medical billing, customer service, insurance claims, EOB, call center, fast paced environment strongly preferred Previous work in high volume calls environment with several computer windows open highly desirable Previous interaction and communications with Patients regarding medial information strongly preferred Technical/Other Requirements Internet download speed of at least 50 megabytes per second connectivity required - if work remote (not just satellite) Ability to connect equipment to router/modem with Ethernet cord. Equipment cannot be connected through Wi-Fi, mobile routers, or mobile hotspot with ethernet port. Dedicated area to perform duties without interference; will be structured environment with structured breaks Ability to manage time and tasks independently while maintaining productivity Why should I become a Customer Service Support Representative at Labcorp? Work from home opportunity! Quarterly variable bonus potential! Generous paid time off! Medical, Vision and Dental Insurance Options! Flexible Spending Accounts! 401k and Employee Stock Purchase plans! No Charge Lab Testing! Fitness Reimbursement Program! And many more incentives! Pay Range: $17.75-$21.00 or State/Local minimum wage, if higher. All job offers will be based on a candidate's skills and prior relevant experience, applicable degrees/certifications, as well as internal equity and market data. Application Window Closes: 10/20/2025 The shift for this position will be Monday-Friday; 11am-8pm (EST) which is 10am-7pm CST and 9am-6pm (MST) and 8am-5 pm (PST). NOTE: During training, the hours will be 9am-6pm EST. OFFERS SHIFT DIFFERENTIAL - 11AM-8PM (EST) SHIFT - 10% Shift Differential for residents in Eastern time zone. Benefits: Employees regularly scheduled to work 20 or more hours per week are eligible for comprehensive benefits including: Medical, Dental, Vision, Life, STD/LTD, 401(k), Paid Time Off (PTO) or Flexible Time Off (FTO), Tuition Reimbursement and Employee Stock Purchase Plan. Casual, PRN & Part Time employees regularly scheduled to work less than 20 hours are eligible to participate in the 401(k) Plan only. For more detailed information, please click here Labcorp is proud to be an Equal Opportunity Employer: Labcorp strives for inclusion and belonging in the workforce and does not tolerate harassment or discrimination of any kind. We make employment decisions based on the needs of our business and the qualifications and merit of the individual. Qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic. Additionally, all qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable law. We encourage all to apply If you are an individual with a disability who needs assistance using our online tools to search and apply for jobs, or needs an accommodation, please visit our accessibility site or contact us at Labcorp Accessibility. For more information about how we collect and store your personal data, please see our Privacy Statement.

The Mayo Clinic Store Assistant Manager is responsible for the day-to-day operations of the retail medical supply store or supporting work centers. This individual oversees employees and job functions that include staffing (hiring and firing), coaching and employee development. Optimizes work center productivity, resolves service issues and develops and maintains policies and procedures. Responsible for maintaining excellent product selection, presentation standards and proper pricing. Works closely with or reports to the Mayo Clinic Store Revenue Cycle Manager to ensure proper product and claim billing and Medicare/Medicaid compliance. Maintains compliance with HIPPA and other third-party payer requirements. May perform special projects at the discretion of the Manager. Works with Management staff for all stores to ensure staff are adequately cross-trained and maintain competencies with processes, policies and procedures. The candidate must also possess strong customer service, interpersonal, and leadership skills. Preferred durable medical billing experience. This position will be a part of Mayo Clinic Store Business Office (Revenue Cycle) and responsible for oversight of 10-14 direct billing staff members, along with unbilled claim submission, clearing house organization, payer contracts, and payer data integrity management. Applicant must understand HCPCs, ICD-10, PDAC, EOB/ERAs, authorizations, remittance, and advanced insurance terminology. Must be able to manage call center and escalated call resolution. If you're considering applying, emphasize your experience with revenue cycle management, insurance billing codes, team leadership, and durable medical equipment (DME) billing. Will be required to come on campus for some on-job training, some leadership meetings, and team collaboration. During the selection process, you may participate in an OnDemand (pre-recorded) interview that you can complete at your convenience. During the OnDemand interview, a question will appear on your screen, and you will have time to consider each question before responding. You will have the opportunity to re-record your answer to each question - Mayo Clinic will only see the final recording. The complete interview will be reviewed by a Mayo Clinic staff member and you will be notified of next steps. This vacancy is not eligible for sponsorship/ we will not sponsor or transfer visas for this position. Also, Mayo Clinic DOES NOT participate in the F-1 STEM OPT extension program. High school diploma required. Bachelor's degree preferred. 2+ years of related experience required with a Bachelor's degree; 4+ years of related experience required with a high school diploma. Must be customer service oriented and possess strong skills in team building, communication, decision making, problem solving, goal setting and business sense. Knowledge of medical terminology, exposure to durable medical equipment and HCPCS coding and billing preferred. Prior Lead or Supervisory experience a plus. Valid driver's license if applicable.

Established in 2021, Independence Pet Holdings is a corporate holding company that manages a diverse and broad portfolio of modern pet health brands and services, including insurance, pet education, lost recovery services, and more throughout North America. We believe pet insurance is more than a financial product and build solutions to simplify the pet parenting journey and help improve the well-being of pets. As a leading authority in the pet category, we operate with a full stack of resources, capital, and services to support pet parents. Our multi-brand and omni-channel approach include our own insurance carrier, insurance brands and partner brands. PetPartners, a subsidiary of IPH, is an ensemble of seasoned industry experts who are working to strip away all the complexities that don't add real value to pet insurance coverage. We're delivering solutions that make it easy for employers to offer this sought-after benefit in a way that's painless and worry-free - a truly one-of-a-kind approach to pet insurance. Job Summary: PetPartners is seeking a Claims Adjuster- Associate who will report to the Supervisor, Claims. The Claims Adjuster- Associate is responsible for investigating, evaluating, and settling insurance claims. This role also determines policy coverage for the claimed loss and appropriate compensation amount. Job Location: Remote- USA Main Responsibilities: Works closely with veterinary hospitals, and policyholders to evaluate and review a pet's medical history to determine a baseline of health. Investigates and processes assigned insurance claims, verifies coverage, and compensation amounts, per insurance policy. Updates Explanation of Benefits (EOB), pays and closes claim. May order medical records from providers. May communicate with clients and providers during treatment. Performs other duties and responsibilities as assigned. Basic Qualifications: 1 year relevant experience working in a veterinary clinic Education: Must meet one of the following requirements: Associate's Degree or equivalent work experience (One-year relevant experience is equivalent to one year college); or Certified Veterinary Technician (CVT) Registered Veterinary Technician (RVT) Licenses/Certifications Must have and maintain Adjusters license or must obtain within 90 days of hire Only United States residents will be considered for this role Expected Hours of Work: This is a full-time position: Days and hours to be determined by needs of business. Hours to be determined between employee and director. #li-Remote #PPI All of our jobs come with great benefits including healthcare, parental leave and opportunities for career advancements. Some offerings are dependent upon the location of where you work and can include the following: Comprehensive full medical, dental and vision Insurance Basic Life Insurance at no cost to the employee Company paid short-term and long-term disability 12 weeks of 100% paid Parental Leave Health Savings Account (HSA) Flexible Spending Accounts (FSA) Retirement savings plan Personal Paid Time Off Paid holidays and company-wide Wellness Day off Paid time off to volunteer at nonprofit organizations Pet friendly office environment Commuter Benefits Group Pet Insurance On the job training and skills development Employee Assistance Program (EAP)

Daymar College, Columbus, OH If you have at least three years of work experience in medical billing and/or coding and have a passion for teaching and training others, then this may be the opportunity for you! Courses are taught in a blended format. This position requires the faculty member to teach on campus one day per week, for approximately 3 hours and 45 minutes, for a total of 6 weeks. The remainder of the course is taught asynchronously/remotely each week. We are seeking adjuncts to teach the following courses: Claims Production Medical Office Management Position Summary: Adjunct faculty plan, prepare and deliver quality instruction to students by utilizing approved course curriculum and instructional methods that accommodate multiple learning styles. Position Responsibilities: Facilitate organized, engaging classes based on course objectives and course curriculum Assess student learning using appropriate methods Monitor and evaluate student progress; provide feedback and advising to students regarding progress Effectively resolves student concerns or complaints Participate in new student orientation, graduation and other campus events, as appropriate Participate in professional development activities to maintain currency in the field and with instructional and educational practices and methods Other duties as required Education: Diploma or higher in medical billing & coding or health information management is preferred, but not required. Experience: Minimum of three years' work experience in medical billing and/or coding; experience with billing cycles, payment calculation, payment processing and EOB interpretation preferred Prior teaching experience preferred, but Hussian College provides training for those with no prior teaching experience

Patient Support Medical Claims Processing Representative Remote Role - Location (Open to Remote US) As the only global provider of commercial solutions, IQVIA understands what it takes to deliver nationally and internationally. Our teams help biopharma, medical device and diagnostic companies get their therapies to the people who need them. We help customers gain insight and access to their markets and ultimately demonstrate their product's value to payers, physicians, and patients. A significant part of our business is providing patient support programs on the behalf of our customers. With the right experience, you can help provide support to patients in need of available therapies. IQVIA has the world's largest Commercial Sales & Medical Solutions (CSMS) organization dedicated to the launch and marketing of pharmaceutical and medical products. With a focus on providing talent for patient support, field/inside sales, medical device support, clinical support, and medical affairs our CSMS division has 10,000+ field professionals in more than 30 countries addressing physician and patient needs. We are excited to announce that currently we are looking for a 100% remote (work from home-WFH) contact Patient Support Medical Claims Processing Representative to join our team. In this position, you will provide payment assistance solutions such as co-pay cards or vouchers. The Patient Support Call Center Representative is primarily responsible for receiving medical claims from HCPs or patients and vetting the claim against program specific business rules to determine if the claim should be paid or rejected. This role will be a contract role with IQVIA managed by an external agency, with the opportunity to be converted to an IQVIA full-time employee. Job Responsibilities: Primary responsibilities involve receiving medical claims from HCPs or patients, ensuring the adequate supporting documentation has been provided, interpreting the EOB/CMS1500, vetting the claim against program specific business rules and ultimately determining if the claim should be paid or rejected Exceptional organizational skills are required May provide support as needed for customer requests via telephone, email, fax, or other available means of contact to the Support Center Requires the ability to recognize operational challenges and suggest recommendations to management, as necessary Ability to work 40 hours per week (shifts available: 8:00 am - 5:00 pm ET or, 9:00 am - 6:00 pm ET or, 10:00 am - 7:00 pm ET or, 11:00 am ET - 8:00pm EST) under moderate supervision Minimum Education & Experience: High School Diploma or equivalent Experience in claim processing required Medical Billing Certification required Coding Certification required Ability to interpret Explanation of Benefits (EOB) HIPPA certified Customer Service Experience preferred Pharmacy Technician experience preferred Bi-lingual (English/Spanish) preferred The pay range for this role is $23.00 per hour. To be eligible for this position, you must reside in the same country where the job is located. IQVIA is an Equal Opportunity Employer. We cultivate a diverse corporate culture across the 100+ countries where we operate, celebrating and rewarding teamwork and inclusiveness. By embracing our differences, we create innovative solutions that are good for IQVIA, our clients, and the advancement of healthcare everywhere. This role will be a contract role with IQVIA managed by an external agency, with the opportunity to be converted to an IQVIA full-time employee. #LI-CES #LI-Remote #LI-DNP IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at ********************** IQVIA is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable law. **********************/eoe The potential base pay range for this role is $23.00 per hour. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for four years, HMA has been chosen as a ‘Washington's Best Workplaces' by our Staff and PSBJ™. Our vision, ‘Proving What's Possible in Healthcare™,' and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results. What we are looking for: We are always searching for unique people to diversify our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: ************************** How YOU will make a Difference: This role is responsible for the successful implementation and programming clients benefit plans, as setting up buy up products for our clients as well as managing third party vendor files. The importance of this role is to ensure benefits are correctly programmed and product services are readily available for members. What YOU will do: Review prior SPD's and make recommendations for new group implementations, such as system capabilities and regulatory requirements, and present to new clients as needed. Ask clarifying questions about plan details that could be missing. Create and update plan summaries and program the claims system for simple and medium complexity client renewals and implementation of off-cycle benefit changes. With the assistance of the Plan Building Specialist II or III, assist with programming updates for clients with complex renewals. Assist with complex and escalated customer service issues to ensure resolution. maintaining the vendor file maintenance for buy-up products. This includes incoming/outgoing files, setting up SFRP and retroactive programming of the balance of our Book of Business, to facilitate non-standard benefits for select groups. Work with vendor to ensure accurate EOB design and setup as needed. Review and respond to applicable TechOps Support tickets and MDI claims queries as needed. Assist Plan Building Specialist III with programming new group implementations as needed. Assist with complex and escalated customer service issues to ensure resolution. Retroactive programming of the balance of our Book of Business, to facilitate non-standard benefits for select groups. Assist in training of Plan Building Specialist I team members. Review and respond to applicable TechOps Support tickets and MDI claims queries as needed. Conduct peer-to-peer audit for Plan Building team programming. Requirements Knowledge, Experience, and Key Attributes needed for Success: High school diploma or equivalent experience required 3-5 years of recent relevant experience Strong QicLink knowledge is beneficial for the programming of benefits in QicLink. Strong analytical skills are crucial for translating client intent into programming of their benefits in QicLink. Comprehensive understanding of benefits that we administer and different plan types. Solid understanding of regulations that impact benefit design, including but not limited to, the Affordable Care Act, Mental Health Parity and IRS rules related to administration of high deductible health plans. Clear and effective verbal and written communication skills. Strong interpersonal skills and ability to work with team members at all levels. Benefits The base salary for this position in the greater Seattle area is $108,000-$120,000 and varies dependent on geography, skills, experience, education, and other job or market-related factors. Performance-based incentive bonus(es) is available. Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law. In addition, HMA provides a generous total rewards package for full-time employees that includes: Seventeen (IC) days paid time off (individual contributors) Eleven paid holidays Two paid personal and one paid volunteer day Company-subsidized medical, dental, vision, and prescription insurance Company-paid disability, life, and AD&D insurances Voluntary insurances HSA and FSA pre-tax programs 401(k)-retirement plan with company match Annual $500 wellness incentive and a $600 wellness reimbursement Remote work and continuing education reimbursements Discount program Parental leave Up to $1,000 annual charitable giving match How we Support your Work, Life, and Wellness Goals At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party. We hire people from across the US (excluding the state of Hawaii and the cities of Los Angeles and San Francisco.) HMA requires a background screen prior to employment. Protected Health Information (PHI) Access Healthcare Management Administrators (HMA); employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures. HMA is an Equal Opportunity Employer. For more information about HMA, visit ******************

Department: 10413 Enterprise Revenue Cycle - IL HB Non Government Billing Operations Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information: 40 Hours a week, Monday to Friday, and 100% Remote. Pay Range $20.40 - $30.60 MAJOR RESPONSIBILITIES Independently review accounts and apply billing follow up knowledge required for all insurance payors to insure proper and maximum reimbursement. Uses multiple systems to resolve outstanding claims according to compliance guidelines. Prebilling/billing and follow up activity on open insurance claims exercising revenue cycle knowledge (ie;CPT,ICD-10 and HCPCS, NDC, revenue codes and medical terminology).Will obtain necessary documentation from various resources. Ability to timely and accurately communicate with internal teams and external customers (ie; third party payors, auditors, other entity) and acts as a liaison with external third party representatives to validate and correct information. Comprehends incoming insurance correspondence and responds appropriately. Identifies and brings patterns/trends to leaderships attention re:coding and compliance, contracting, claim form edits/errors and credentialing for any potential in delay/denial of reimbursement. Obtains and keeps abreast with insurance payer updates/changes, single case agreements and assists management with recommendations for implementation of any edits/alerts. Accurately enters and/or updates patient/insurance information into patient accounting system. Appeals claims to assure contracted amount is received from third party payors. Complies and maintains KPI (Key Performance Indicators) for assigned payers within standards established by department and insurance guidelines. Compile information for referral of accounts to internal/external partners as needed. Compile and maintain clear, accurate, on-line documentation of all activity relating to billing and follow up efforts for each account, utilizing established guidelines. Responsible to read and understand all Advocate Aurora Health policies and departmental collections policies and procedures. Demonstrate proficiency in proper use of the software systems employed by AAH. This position refers to the supervisor for approval or final disposition such as: recommendations regarding handling of observed unusual/unreasonable/inaccurate account information. Approval needed to write off balance's according to corporate policy. Issues outside normal scope of activity and responsibility. MINIMUM EDUCATION AND EXPERIENCE REQUIRED Level of Education: High School Diploma or General Education Degree (GED) Years of Experience: Typically requires 1 year of related experience in medical/billing reimbursement environment, or equivalent combination of education and experience. MINIMUM KNOWLEDGE, SKILLS AND ABILITIES (KSA) Must perform within the scope of departmental guidelines for productivity and quality standards. Works independently with limited supervision. Accountable and evaluated to organization behaviors of excellence Basic keyboarding proficiency. Must be able to operate computer and software systems in use at Advocate Aurora Health. Able to operate a copy machine, facsimile machine, telephone/voicemail. Ability to read, write, speak and understand English proficiently. Ability to read and interpret documents such as explanation of benefits (EOB), operating instructions and procedure manuals. Preferred but not required knowledge of medical terminology, coding, terminology (CPT, ICD-10, HCPC) and insurance/reimbursement practices. Ability to communicate well with people to obtain basic information (via telephone or in person). This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

#LI-Remote Shriners Children's is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families. All employees are eligible for medical coverage on their first day! In addition, upon hire all employees are eligible for a 403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service. Employees in a FT or PT status (40+ hours per pay period) will also be eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans and a Health Savings Account (HSA) if a High Deductible Health Plan (HDHP) is elected. Additional benefits available to FT and PT employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more! Coverage is available to employees and their qualified dependents in accordance with the plans. Benefits may vary based on state law. Job Overview The Denials Management Analyst is responsible for analyzing denials data, creating payor metrics, as well as tracking and trending denials and result out of multiple systems. The analyst will identify and trend root causes and report out findings as well as assist in mapping out process improvement opportunities. The analyst will coordinate payor denials and audit activities to ensure timely response for the processing of all payor denials, audit requests and appeals. The analyst will communicate and coordinate with various individuals/distributions and assist with monitoring of the day-to-day activities related to claims denials and audit reviews. Responsibilities Collecting/analyzing, report status, metrics and trends of activity by different reviews from multiple systems Distributing reports on a routine basis to specific distribution group Managing Epic work queues and resolving denials. Gathering data to substantiate the request for rule creations in Epic. Research payer fee schedules and provider manuals to ensure appropriate non covered denials. Organizing all data and activity in a retrievable way Coordinating payor denial and audit activities to ensure timely response for the processing of all payor denials, audit request and appeals for both institutional and professional claims Assisting with the coordination of denial and review activities and materials for committee meetings, including analyses, reports, etc. Communicating and coordinating with various individuals/distributions and assisting with monitoring of the day-to-day activities related to claim denials and audit reviews Maintaining the healthcare tracking tool/application that stores/communicates all denial and review activity. This will include user access management, updates to software, and end-user training Supporting projects and initiatives of the Denials Management Team. This may include coordinating meetings, conducting research, performing audits or data analysis, and preparing documents Strong communication skills and a commitment to delivering the highest level of quality work This is not an all-inclusive list of this job's responsibilities. The incumbent may be required to perform other related duties and participate in special projects as assigned. Qualifications Required: Bachelor's degree, or equivalent combination of education and experience 5-7 Years in a Healthcare Revenue Cycle Environment including 3 years in Third Party Collection/AR Receivables and Denials Management Epic PB Resolute experience Healthcare Revenue Cycle management including: • Therapy (Physical/Occupational/Speech) • Radiology • Pediatrics/Pediatric Orthopedics • Anesthesia EDI Transaction sets including 837I, 837P Knowledge of insurance contract rates and terms Knowledge and understanding of Registration and Collections Knowledge and understanding of Government and Managed Care billing, coverage and payment rules Ability to comprehend payor 835 and paper EOB responses Knowledge and understanding of NCCI edits, CPT-4, HCPCS, ICD-10 and Revenue Codes standards Intermediate Excel skills Preferred: CRCR Certification Epic Certification

About Us All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. We also offer paid holiday, sick time, and vacation time as well as a 410k plan. Additional employee paid coverage options available. Job purpose The Payment Posting Coordinator will be responsible for monitoring and posting all non-electronic payments from health plans and health savings accounts. They will reconcile payments received and posted daily. The ideal candidate must also be able to demonstrate excellent written and verbal communication skills, as communicating with clients and various insurance agents is required. Duties and responsibilities Payment Management: Manual posting of insurance payments from a paper EOB or Remittance Select and apply appropriate CARC and RARC adjustments to match payer adjustment reasons. Balance payments posted to manual EOB using sql queries and Excel spreadsheets. Review documentation received for Health Savings Account (HSA) payments and document on patient accounts. Reconcile Health Savings Account (HSA) payments received and disbursed to providers weekly. Assist in tracking missing payments identified by Claim Coordinators and Examiners. Reconcile payment documents received to list of manual and HSA payments reported. Use existing tracking logs and queries to ensure all reported manual payments are posted accurately and timely. All other duties as assigned. Communication: Communicate effectively with insurance companies, healthcare providers, and their billing staff to resolve claims issues and answer inquiries. Document all interactions and updates in the claims management system. Documentation and Reporting: Maintain accurate records of claim status, actions taken, and resolutions utilizing established policies and procedures. Prepare and submit reports on payment activities and status updates to management as requested. Compliance: Ensure all claims follow-up activities comply with company policies, industry regulations, and legal requirements. Stay updated on changes in insurance policies, regulations, and industry standards. Must meet quantitative production standard of working 100 - 150 claims per week with less than 5% error rate. Attend departmental and company meetings as required. Problem Resolution: Identify and report trends which could have an overall negative impact on claim payments such as processing errors, denials, or billing issues. Investigate and resolve discrepancies or issues related to claims processing and payment. Work with other team members and departments ensure proper claim submission. Continuous Improvement: Identify and recommend process improvements to enhance the efficiency and effectiveness of the claims follow-up process. Participate in training and development opportunities to stay current with best practices and industry trends. Qualifications A minimum of 2 years' experience as a medical payment poster or similar role. Solid understanding of health plan payment procedures and electronic (835) remittance files Knowledge of healthcare benefits, coordination of benefits, referral and authorization requirements, and insurance follow up. Experience with CPT Codes, ICD-10 Codes, Modifiers, and CCI edits. EZ-Cap experience preferred. Epic experience preferred. Electronic Data Interchange (EDI) Clearinghouse experience preferred. Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe. Detail oriented and highly organized. Strong ability to multi-task, project management, and work in a fast-paced environment. Strong ability in problem-solving. Ability to self-manage, strong time management skills. Ability to work in an extremely confidential environment. Strong written and verbal communication skills.

Responsible for validating dispute reasons following Explanation of Benefits (EOB) review, escalating payment variance trends or issues to NIC management, and generating appeals for denied or underpaid claims. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Validate denial reasons and ensures coding in DCM is accurate and reflects the denial reasons. Coordinate with the Clinical Resource Center (CRC) for clinical consultations or account referrals when necessary, * Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations. * Follow specific payer guidelines for appeals submission * Escalate exhausted appeal efforts for resolution * Work payer projects as directed * Research contract terms/interpretation and compile necessary supporting documentation for appeals, Terms & Conditions for Internet enabled Managed Care System (IMaCS) adjudication issues, and referral to refund unit on overpayments. * Perform research and makes determination of corrective actions and takes appropriate steps to code the DCM system and route account appropriately. * Escalate denial or payment variance trends to NIC leadership team for payor escalation. 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. * Intermediate understanding of Explanation of Benefits form (EOB), Managed Care Contracts, Contract Language and Federal and State Requirements * Intermediate knowledge of hospital billing form requirements (UB-04) * Intermediate understanding of ICD-9, HCPCS/CPT coding and medical terminology * Intermediate Microsoft Office (Word, Excel) skills * Advanced business letter writing skills to include correct use of grammar and punctuation. Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. * High School Diploma or equivalent, some college coursework preferred * 3 - 5 years experience in a hospital business environment performing billing and/or collections 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. * Ability to sit and work at a computer terminal for extended periods of time 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. * Call Center environment with multiple workstations in close proximity As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $18.60 - $28.00 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services. Job Details: We are seeking a dedicated Financial Assistance Specialist for our Revenue Cycle Team. In this position you will be responsible for the billing and collection of copay assistance programs and foundation claims. You will also be responsible for enrollment into these programs. Responsibilities Able to identify billing trends Able to identify errors, correct claims and reprocess for reimbursement Able to read and interpret an EOB for accurate understanding of denial Contacts payer, or patient as appropriate Documents all collections activity in patient collections notes Documents work performed/action taken on AR Aging Report and/or Over/Under Report • Process all Payer appeal requests within the time frame required by the Payer Ensure the timeliness and accuracy of billing Identify root cause of issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials. Knows how to investigate claims, and reimbursement contracts Meet quality assurance, benchmark standards and maintain productivity levels as defined by management. Performs other duties as assigned Processes all approved adjustments Processes Home Infusion/Nursing claims Processes patient and insurance changes Processes rejections and denials to determine if the claim needs to be refiled or submitted for an appeal with the payer Processes rejections for NCPDP emails to determine if the claim needs to be refiled or submitted for an appeal with the payer Reviews patient information in the appropriate system to determine why the claim is unpaid, if an adjustment is valid and whether additional approval is required Some knowledge of copay assistance programs and foundation programs Understand Patient level benefits Understand Third Party Billing and Collection Guidelines. Skills & Abilities Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence. Background investigation (company-wide) Basic knowledge of Microsoft Office Collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology is preferred. Drug screen (when applicable for the position) Effectively communicate in English; both oral and written, with physicians, location employees and patients to ensure questions and concerns are processed in a timely manner. Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary Experience in medical field and administrative record management Familiarity with third-party payor guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial Helpful, knowledgeable, and polite while maintaining a positive attitude High school diploma or GED equivalent Interpret a variety of instructions in a variety of communication mediums Knowledge of HCN 360 and/or CPR+ preferable Knowledge of Home Infusion Knowledge of insurance policies and requirements Knowledge of medical billing practices and of billing reimbursement Maintain confidentiality and practice discretion and caution when handling sensitive information. Medicare knowledge of billing requirements specific to DMEMAC HCN360 and CPR+ knowledge preferred Multi-task along with attention to detail Must be able to accurately perform simple mathematical calculations using addition, subtraction, multiplication, and division Must have experience processing pharmacy claims One to three years of related prior work experience in a team-oriented environment Self-motivation, organized, time-management and deductive problem-solving skills Strong customer service background Skills, Knowledge, and Abilities Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence. Valid driver's license in state of residence with a clean driving record (when applicable for the position) Education and/or Experience High school graduate or equivalent Work independently and as part of a team Collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology is preferred Qualifications High school graduate or equivalent. Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary. High school diploma or GED equivalent One to three years of related prior work experience in a team-oriented environment Experience in medical field and administrative record management Strong customer service background Employment is contingent on: Background investigation (company-wide) Drug screen (when applicable for the position) Valid driver's license in state of residence with a clean driving record (when applicable for the position) CarepathRx offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire . CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.

Responsible for providing direct support to internal and subcontracted external legal resources engaged in the collection and recovery of managed care and/or Worker's Compensation claims. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Acts as liaison between the Business Office, Legal Department and outside counsel regarding outstanding litigation (ie.Venders) Coordinates legal analysis for denied, underpaid and unpaid managed care accounts for legal referral; Compiles records and documentation for internal and external attorneys such as process documentation, copies of original contracts, etc to be used in litigation. Reviews all existing documentation including but not limited to UB, IB, Explanation of Benefits (EOB), and Managed Care Contracts to verify claim balance calculation; ensures integrity in supporting documentation. Works with Legal Department to file bankruptcy notifications on payers. May file liens on auto accident patients to state interest in claim. Verifies in system that accounts have been adjudicated correctly once settled. If needed, adjust accounts per Legal request. Works required reports (daily, weekly, monthly) to ensure legal payer issues are referred in a timely manner. 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. Intermediate writing skills Intermediate Microsoft Word and Excel skills Intermediate analytical and math skills Ability to coordinate accounts and record detailed information Ability to research and work independently Ability to work in high volume environment at a fast pace Ability to communicate in a professional manner Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. High school diploma or equivalent Some college helpful 3-5 years experience in medical billing, collections, appeals, legal department and/or contract interpretation 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. Ability to sit at a computer terminal for extended periods of time 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. Call-center environment with multiple workstations in close proximity As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation Pay: $20.51 - $30.77 per hour. Compensation depends on location, qualifications, and experience. Position may be eligible for a signing bonus for qualified new hires, subject to employment status. Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: Medical, dental, vision, disability, and life insurance Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. 401k with up to 6% employer match 10 paid holidays per year Health savings accounts, healthcare & dependent flexible spending accounts Employee Assistance program, Employee discount program Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act.

These individuals will be taking in information from clients, and entering it into their systems. Most of the information are independent Medical Reviews. When new cases come in (the information) they log the information and process it through to the next stage. The form comes in, they pull the data, and then enter it into Microsoft Word or Excel. They want them to hopefully understand HIPAA Regulations. They don't need to be an expert, they just want them to understand they are handling sensitive information and preventing who has access to that information. Soft skills are that they want them to be reliable, accurate, and thorough. This role is mainly backend data entry focused, but will include phone communications with external and internal clients For these roles, she would like them to come from the healthcare background . Would want them to have any experience looking at claims, Explanation of Benefits EOB, healthcare verbiage, knowing diagnosis codes. Would take people are coming from a healthcare facility as background . **Would like someone with Claims background . They will need to be comfortable with taking some calls. And must be savvy on a computer, creating PDFs and writing emails. *MUST HAVE ACCESS TO LAPTOP OR DESKTOP THAT SUPPORTS WINDOWS 11 *MUST BE COMFORTABLE COMPLETED DRUG SCREEN Job Type & Location This is a Contract to Hire position based out of Jacksonville, FL. Pay and Benefits The pay range for this position is $16.00 - $16.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Dec 24, 2025. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

The Revenue Cycle Clinician for the Appellate Solution is responsible for: * Recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review * Preparing and documenting appeal based on industry accepted criteria. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. 1. Performs retrospective (post -discharge/ post-service) medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review. 2. Demonstrates proficiency in use of medical necessity criteria sets, currently InterQual or other key factors or systems as evidenced by Inter-rater reliability studies and other QA audits. Constructs and documents a succinct and fact based clinical case to support appeal utilizing appropriate module of InterQual criteria (Acute, Procedures, etc). If clinical review does not meet IQ criteria, other pertinent clinical facts are utilized to support the appeal. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization. 3. Demonstrates ability to critically think and follow documented processes for supporting the clinical appellate process. 4. Adhers to the department standards for productivity and quality goals. Ensuring accounts assigned are worked in a timely manner based on the payor guidelines. 5. Demonstrates proficiency in utilization of electronic tools including but not limited to ACE, nThrive, eCARE, Authorization log, InterQual, VI, HPF, as well as competency in Microsoft Office. 6.Demonstrates basic patient accounting knowledge i.e. UB92/UB04 and EOB components, adjustments, credits, debits, balance due, patient liability, denials management, etc. 7. Additional responsibilities: a) Serves as a resource to non-clinical personnel. b) Provides CRC leadership with sound solutions related to process improvement c) Assist in development of policy and procedures as business needs dictate. d) Assists Law Department with any medical necessity reviews as capacity allows up to and including attending mediation hearings, other litigation forums, etc. 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. * Demonstrates proficiency in the application of medical necessity criteria, currently InterQual * Possesses excellent written, verbal and professional letter writing skills * Critical thinker, able to make decisions regarding medical necessity independently * Ability to interact intelligently and professionally with other clinical and non-clinical partners * Demonstrates knowledge of managed care contracts including reimbursement matrixes and terms * Ability to multi-task * Ability to conduct research regarding State/Federal appellate guidelines and applicable regulatory processes related to the appellate process. * Ability to conduct research regarding off-label use of medications Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * Must possess a valid nursing license (Registered) * Minimum of 3 yearsacute care experience in a facility environment * Medical-surgical/critical care experience preferred * Appeals writing experience preffered * Minimum of 2 years UR/Case Management experience preferred * Managed care payor experience a plus either in Utilization Review, Case Management or Appeals * * Previous classroom led instruction on InterQual or MCG products (Acute Adult, Peds, Outpatient and Behavioral Health) preferred CERTIFICATES, LICENSES, REGISTRATIONS * Current, valid RN/ licensure * Certified Case Manager (CCM) or Certified Professional in Utilization Review/Utilization Management/Healthcare Management (CPUR , CPUM, or CPHM) preferred 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. * Ability to lift 15-20lbs * Ability to travel approximately 10% of the time; either to facility sites, National Insurance Center (NIC) sites, Headquarters or other designated sites * Ability to sit and work at a computer for a prolonged period of time conducting medical necessity reviews 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. * Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc. OTHER * May require travel - approximately 10% * Interaction with facility Case Management, Physician Advisor is a requirement. Compensation and Benefit Information Compensation * Pay: $30.85 - $46.28 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

Provides extraordinary care to our customers through friendly, courteous, and professional service through a broad understanding of account handling processes, extraordinary interpersonal skills, and the ability to resolve complex issues in a timely and accurate manner. **Essential Functions** + Identifies appropriate payment details and saves back-up as appropriate. + Researches, validates and makes adjustments to payment postings. Follows up in accordance with procedures and policies with an overall goal of account resolution. + Utilize resources to find payment documentation- Interpret payer contracts to ensure all codes on patient's account match contracts. + Initiates payer recoupments, payer refunds, and patients refunds where applicable. Follows up in accordance with procedures and policies with an overall goal of account resolution. + Abel to navigate various payer claim portals and understand payer functionality. + Interacting with others by effectively communicating both orally and in writing. + Operate computers and other office equipment, as well as various computer software's. + See and read computer monitors and documents in English. + Train new and existing associates. **Skills** + Recognizing true overpayments from false credits + Advanced knowledge of revenue cycle and health insurance payers + Reading and Understanding Payer Contracts + Advanced knowledge of Coordination of Benefits + Advanced knowledge of reading EOB + Accurately identifying trends not limited to payer behavior, system or workflow issues, and escalating in a timely manner + Advanced knowledge of Medical Terminology + Payment Handling + Effective written and verbal communication + Assist Leadership with mentoring peers as well as new hires. + Computer Literacy + Time Management + HIPAA Regulations **Physical Requirements:** **Qualifications** + High School Diploma or equivalent (GED) required + One (1) years of experience in hospital or physician back-end revenue cycle (Payment Posting, Billing, Follow-Up) required + Knowledge of Medicaid and Medicare billing regulations required + Two (2) years of experience in hospital or physician insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections) preferred **Physical Requirements** + Operate computers and other office equipment requiring the ability to move fingers and hands. + Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment. + May require lifting and transporting objects and office supplies, bending, kneeling and reaching. **Location:** Peaks Regional Office **Work City:** Broomfield **Work State:** Colorado **Scheduled Weekly Hours:** 40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $18.81 - $27.45 We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package here (***************************************************** . Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process. All positions subject to close without notice.

The Mayo Clinic Store Assistant Manager is responsible for the day-to-day operations of the retail medical supply store or supporting work centers. This individual oversees employees and job functions that include staffing (hiring and firing), coaching and employee development. Optimizes work center productivity, resolves service issues and develops and maintains policies and procedures. Responsible for maintaining excellent product selection, presentation standards and proper pricing. Works closely with or reports to the Mayo Clinic Store Revenue Cycle Manager to ensure proper product and claim billing and Medicare/Medicaid compliance. Maintains compliance with HIPPA and other third-party payer requirements. May perform special projects at the discretion of the Manager. Works with Management staff for all stores to ensure staff are adequately cross-trained and maintain competencies with processes, policies and procedures. The candidate must also possess strong customer service, interpersonal, and leadership skills. Preferred durable medical billing experience. This position will be a part of Mayo Clinic Store Business Office (Revenue Cycle) and responsible for oversight of 10-14 direct billing staff members, along with unbilled claim submission, clearing house organization, payer contracts, and payer data integrity management. Applicant must understand HCPCs, ICD-10, PDAC, EOB/ERAs, authorizations, remittance, and advanced insurance terminology. Must be able to manage call center and escalated call resolution. If you're considering applying, emphasize your experience with revenue cycle management, insurance billing codes, team leadership, and durable medical equipment (DME) billing. Will be required to come on campus for some on-job training, some leadership meetings, and team collaboration. During the selection process, you may participate in an OnDemand (pre-recorded) interview that you can complete at your convenience. During the OnDemand interview, a question will appear on your screen, and you will have time to consider each question before responding. You will have the opportunity to re-record your answer to each question - Mayo Clinic will only see the final recording. The complete interview will be reviewed by a Mayo Clinic staff member and you will be notified of next steps. This vacancy is not eligible for sponsorship/ we will not sponsor or transfer visas for this position. Also, Mayo Clinic DOES NOT participate in the F-1 STEM OPT extension program. High school diploma required. Bachelor's degree preferred. 2+ years of related experience required with a Bachelor's degree; 4+ years of related experience required with a high school diploma. Must be customer service oriented and possess strong skills in team building, communication, decision making, problem solving, goal setting and business sense. Knowledge of medical terminology, exposure to durable medical equipment and HCPCS coding and billing preferred. Prior Lead or Supervisory experience a plus. Valid driver's license if applicable.

Reporting to the Accounts Receivable Supervisor, this role supports the operations of the CommunityCare Revenue Cycle Management (RCM) team related to the follow up and resolution of outstanding insurance claims. Goal of the position is to follow up on, investigate and resolve claims that have been submitted to insurance for payment and to create detailed notes that provide insight into the current status of the individual claims. Responsibilities Essential Functions: * Contact insurance carriers on a daily basis to follow up on/collect past due amounts on outstanding medical claims regarding denials or benefit changes. * Maintain an accurate, up to date aging of assigned accounts including AR analysis and follow up. * Keep educated on billing and medical policies for all payers. * Have a working knowledge of In and Out of Network reimbursement processes/methodologies. * Create and follow up on appeals needed to protest denials or incorrect payments. * Review complex denials/tasks assigned by the payment posting team and resolve accordingly including reviewing refund requests, disputes and appeal as necessary. * Work across all RCM departments to get issues related to claims payment resolved. * Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission and values of the organization. * Work with AR Supervisor to review/resolve open accounts as assigned. * Perform other duties as assigned. Knowledge, Skills and Abilities: * High level of skill at building relationships and providing excellent customer service. * Ability to utilize computers for data entry, research and information retrieval. * Strong attention to detail and accuracy and multitasking. * Must have highly developed problem-solving skills. * Executes excellent customer service and professionalism when interacting with staff, payers, patients and families to ensure all are treated with kindness and respect. * Through leadership and by example, ensures that services are provided in accordance with state and federal regulations, organizational policy, and accreditation/compliance requirements. * Acts in accordance with CommUnityCare's mission and values, while serving as a role model for ethical behavior. * Promptly identify issues and reports them to their direct supervisor. * Maintain regular and predictable attendance. * Acts in accordance with CommunityCare's mission and values, while serving as a role model for ethical behavior * Manage high volumes of work and organize/maintain a schedule independently. * Must be able to effectively monitor steps in claims processing operations. Qualifications Minimum Education: * High School Diploma or GED Minimum Experience: * 3 years of experience managing Accounts Receivable and performing direct follow up with payers. * 1 year experience communicating effectively, both orally and in writing, with insurance payers and internal company communications. * 3 years working with medical terminology, ICD10, CPT, HCPCs coding and HIPAA requirements. * 2 years of experience with data processing and analytical skills, proficiency in Excel and Microsoft Office Suite as well as medical practice management software and electronic medical records. * 3 years of experience working with commercial, government and state insurance payers and their reimbursement policies and procedures. * 3 years' experience working complex insurance issues, including assigning correct payer, EOB adjustments and refunds to accounts.

Company Navitus About Us Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at ************************************ to be considered for internal opportunities. Pay Range USD $42,505.00 - USD $50,601.00 /Yr. STAR Bonus % (At Risk Maximum) 5.00 - Salaried Non-Management except pharmacists Work Schedule Description (e.g. M-F 8am to 5pm) M-F 7am-4pm CT Remote Work Notification ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming. Overview Navitus Health Solutions is seeking an Analyst, Tech. Operations Government Programs to join our team! The Analyst, Tech. Operations Government Programs has responsibility for executing Government Programs processes accurately, efficiently, and in compliance with CMS regulations. Is this you? Find out more below! Responsibilities How do I make an impact on my team? Assignments may include one or more of the following: Employer Group Waiver Plan (EGWP) enrollment administration and oversight, Retro-eligibility processes, Financial Information Reporting (FIR), Plan Finder Submission, Coordination of Benefits (COB), Reject Management, Prescription Drug Event (PDE) error management and reconciliation, Medicaid Encounter Data, Affordable Care Act (ACA) Claims Submission, Explanation of Benefits (EOB), Retiree Drug Subsidy (RDS), and Claim Auditing Oversee the schedules for the processes assigned, adjust schedules when necessary to ensure deadlines are met, and alert management when schedules are at risk Ensure process documentation accurately reflects the current process and update when necessary Assist subject matter experts (SME) in defining and documenting process steps, providing input on requirements for technical specifications Review and research errors and prioritize reconciliation efforts in accordance with State and Federal guidance Effectively communicate with Employer Groups, Clients, State/Federal Agencies, external vendors and Navitus internal departments to address action items, problems, and manage expectations to ensure timely and accurate issue resolution As needed, may require working outside of normal business hours to complete time sensitive processes Other duties as assigned Qualifications What our team expects from you? Bachelor/Associate Degree in business related field; or equivalent of an associate degree and 2 years of work experience, or 4 years of work experience and a high school diploma or equivalent 1+ years' work experience Experience in pharmaceutical claims adjudication systems, retail pharmacy, or in a health plan organization is preferred Participate in, adhere to, and support compliance program objectives The ability to consistently interact cooperatively and respectfully with other employees What can you expect from Navitus? Top of the industry benefits for Health, Dental, and Vision insurance 20 days paid time off 4 weeks paid parental leave 9 paid holidays 401K company match of up to 5% - No vesting requirement Adoption Assistance Program Flexible Spending Account Educational Assistance Plan and Professional Membership assistance Referral Bonus Program - up to $750! #LI-Remote Location : Address Remote Location : Country US