Robert Half Finance & Accounting Contract Talent is currently seeking a highly skilled Healthcare Claims Processor to join our client's team.<br><br>Opportunity Overview:<br>We are in search of a detail-oriented Healthcare Claims Processor with a strong background in healthcare AR follow-up, insurance claim collection, and claims processing. This role is critical in understanding the complexities of claim denials, drafting appeal letters, and ensuring the reimbursement process operates smoothly. The position demands a commitment of 40 hours per week.<br><br>Key ResponsibIlities:<br>Conduct thorough healthcare AR follow-up, focusing on prompt reimbursement.<br>Skillfully handle the collection of insurance claims, ensuring accuracy and completeness.<br>Execute comprehensive claims processing, proactively addressing potential denial factors.<br>Demonstrate expertise in identifying and resolving issues leading to claim denials.<br>Draft persuasive appeal letters to challenge and rectify denied claims.<br>Stay informed about industry changes and insurance regulations affecting claims processing.<br><br>Qualifications:<br>Proven experience in healthcare claims processing, with a deep understanding of industry best practices.<br>Proficient knowledge of insurance claim collection procedures.<br>Familiarity with the intricacies of claim denial factors and effective resolution strategies.<br>Exceptional skills in drafting compelling appeal letters.<br>Available to commence work in March with a commitment of 40 hours per week.<br><br>Additional Details:<br>Familiarity with relevant healthcare coding systems is preferred.<br>Ability to navigate and utilize healthcare information systems effectively.<br>Understanding of healthcare compliance regulations and privacy laws.<br>Strong analytical skills to identify patterns and trends in claim denials.<br>Collaborative approach to work, ensuring seamless coordination with other healthcare professionals.<br><br>To express your interest in this role or to obtain further information, please reach out to us directly at (314) 262-4344. We are eager to discuss this exciting opportunity with you.
We are looking for a Claims Support specialist to join our team in Alpharetta, Georgia. This Contract position requires an individual with strong organizational skills who can handle claims processing, customer service, and administrative tasks with efficiency and attention to detail. The role is fully onsite, with a five-day workweek, offering an excellent opportunity to contribute to a dynamic office environment.<br><br>Responsibilities:<br>• Verify and review the accuracy of information for newly received claims in accordance with coverage guidelines.<br>• Update claim files within the system as instructed by claims representatives.<br>• Process loss payments using Claim Vision and ensure all transactions are accurately recorded.<br>• Deliver exceptional customer service to agents, insureds, clients, and other stakeholders.<br>• Handle the processing of authorized payments and maintain detailed records.<br>• Input data, correspondence, and diary updates into the system, while preparing form letters and maintaining documentation.<br>• Perform administrative duties such as typing, photocopying, indexing, and filing to support claims operations.<br>• Calculate wages and draft well-crafted correspondence related to claims.<br>• Contact insureds to request missing information required for claim file completion.<br>• Apply basic knowledge of Southeastern jurisdiction laws related to workers' compensation, when necessary.
We are looking for a detail-oriented Medical Claims Analyst to join our team in Raleigh, North Carolina. This long-term contract position is ideal for someone with extensive experience in medical claims processing and a strong ability to manage repetitive clerical tasks effectively. The role requires a collaborative team player who is dependable, punctual, and committed to delivering high-quality results.<br><br>Responsibilities:<br>• Process and reconcile medical claims efficiently, ensuring all records are accurate and up-to-date.<br>• Resubmit denied or rejected claims, following proper protocols to secure approvals.<br>• Post payments accurately into multiple systems, maintaining consistency and precision.<br>• Utilize payer portals to manage claims and track progress effectively.<br>• Perform clerical tasks such as data entry and filing with a focus on accuracy and attention to detail.<br>• Collaborate with a team of professionals to ensure smooth workflows and timely completion of tasks.<br>• Monitor claim statuses to identify and resolve discrepancies proactively.<br>• Maintain compliance with relevant policies and regulations in the healthcare industry.<br>• Provide support in behavioral health payment posting processes.<br>• Communicate effectively with team members and external parties regarding claim-related issues.
We are looking for a dedicated Medical Claims Analyst to join our healthcare team in Minneapolis, Minnesota. In this long-term contract position, you will play a vital role in processing leave of absence claims, ensuring compliance with medical certifications, and calculating benefit allocations. This is an excellent opportunity to contribute to a fast-paced industry while leveraging your expertise in medical claims and benefits administration.<br><br>Responsibilities:<br>• Process and manage leave of absence claims by coordinating medical certifications and ensuring timely submissions.<br>• Calculate benefit amounts, including allocations from corporate and state sources, to ensure accurate disbursements.<br>• Review, approve, or deny claims based on established guidelines and medical documentation.<br>• Utilize systems such as ServiceNow and Workday to track, manage, and process claims efficiently.<br>• Maintain detailed records of claims and benefits to ensure compliance and accuracy.<br>• Communicate with healthcare providers to confirm certifications and resolve discrepancies.<br>• Address rejected claims by investigating issues and providing resolutions.<br>• Collaborate with team members to streamline leave administration processes.<br>• Provide guidance to employees regarding medical leave policies and benefits.<br>• Stay updated on state and federal regulations related to leave and benefits administration.
We are looking for an Insurance Follow-Up Specialist to join our team in Tampa, Florida. In this Contract to permanent position, you will play a vital role in ensuring timely insurance claim processing and maintaining strong relationships with partners. If you have a knack for organization, persistence, and excellent communication, this opportunity is designed for you.<br><br>Responsibilities:<br>• Pursue prompt collection of signatures and necessary documents from funeral home partners to expedite claim processing.<br>• Investigate delays in insurance claims and provide solutions with a proactive and detail-oriented approach.<br>• Build and nurture strong partnerships with insurance representatives and funeral home stakeholders.<br>• Maintain comprehensive and accurate records to ensure all cases are tracked and managed effectively.<br>• Collaborate with the Concierge team to provide additional follow-up support as needed.
<p>We are looking for a dedicated Claims Intake Coordinator to join our team in Ontario, California. This long-term contract position involves supporting the claims processing team by ensuring accurate intake, sorting, and preparation of medical claims for further handling. The role is vital in maintaining efficient workflows and providing support to healthcare providers across various regions.</p><p><br></p><p>Responsibilities:</p><ul><li>Open, sort, prioritize, batch, log, and track all incoming claims mail.</li><li>Distribute claims according to market, priority, appeal status, scanning need, and health plan risk.</li><li>Ensure all claims received are complete and ready for processing.</li><li>Route unclean claims back to providers for correction.</li><li>Forward out-of-state claims to the appropriate health plan for handling.</li><li>Run the Claims Fallout process and distribute Fallout Worksheets via email to relevant departments.</li><li>Assist with the distribution of checks (match checks with Explanation of Benefits, fold, and insert into correct envelopes).</li><li>Match remittance advices with checks and prepare mailing.</li><li>Reconcile processed batches within the audit database.</li><li>Create denial trailers and mail denial letters accordingly.</li></ul>
<p>We are seeking a seasoned Technical Project Manager with deep expertise in the Life Insurance and Annuity domain to lead strategic initiatives across our enterprise systems and data platforms. This role will be instrumental in driving projects that enhance our data warehouse, modernize claims management systems, and optimize enterprise applications to support business growth and operational efficiency.</p><p><br></p><p><strong>Key Responsibilities</strong></p><ul><li>Lead cross-functional teams to deliver complex technology projects on time and within scope.</li><li>Manage full project lifecycle: planning, execution, monitoring, and closure.</li><li>Collaborate with business stakeholders, data architects, and engineering teams to define project requirements and success criteria.</li><li>Oversee enhancements to the enterprise data warehouse, ensuring scalability, performance, and data integrity.</li><li>Drive modernization efforts for claims management platforms and other core insurance systems.</li><li>Identify and mitigate risks, manage dependencies, and resolve issues to ensure project success.</li><li>Communicate project status, risks, and milestones to senior leadership and stakeholders.</li><li>Ensure compliance with industry regulations and internal governance standards.</li></ul><p><strong>Qualifications</strong></p><ul><li>10+ years of project management experience in the life insurance and annuity industry.</li><li>Proven track record managing enterprise application and data-focused projects.</li><li>Strong understanding of insurance operations, claims processing, and data warehousing.</li><li>Experience with Agile, Scrum, and Waterfall methodologies.</li><li>Proficiency in project management tools (e.g., Jira, MS Project, Smartsheet).</li><li>Excellent communication, leadership, and stakeholder management skills.</li><li>PMP, PMI-ACP, or equivalent certification preferred.</li></ul><p><strong>Preferred Skills</strong></p><ul><li>Familiarity with cloud-based data platforms (e.g., Snowflake, Azure, AWS).</li><li>Experience integrating legacy systems with modern enterprise applications.</li><li>Knowledge of regulatory requirements in the insurance industry (e.g., NAIC, FINRA).</li></ul><p><strong>Why Join Us?</strong></p><ul><li>Be part of a forward-thinking team driving digital transformation in insurance.</li><li>Work on impactful projects that shape the future of our enterprise technology landscape.</li><li>Competitive compensation, benefits, and career development opportunities.</li></ul><p><br></p>
<p>We are looking for a dedicated Case Manager to join a stable team in Sherman Oaks looking to add a new member of the team. This firm specializes in personal injury cases, and this role is crucial to ensuring clients receive the support and advocacy they need throughout the claims process. The ideal candidate will thrive in a collaborative and focused environment while demonstrating exceptional organizational and communication skills.</p><p><br></p><p>Responsibilities:</p><p>• Manage claims processing with various insurance carriers, including health insurance providers, Medicare, and MediCal.</p><p>• Resolve property damage and loss of use claims efficiently and effectively.</p><p>• Coordinate with healthcare providers to schedule medical appointments for injury treatment.</p><p>• Advocate for clients by monitoring medical treatments and organizing care based on provider recommendations.</p><p>• Review, analyze, and interpret medical records, surgical reports, and medical bills.</p><p>• Prepare comprehensive case files for submission to the demands department.</p><p>• Maintain clear and precise communication with clients, healthcare providers, and internal staff.</p><p>• Collaborate with team members to ensure seamless case management and support.</p><p>• Utilize case management software and tools to maintain accurate and organized documentation.</p>
We are looking for an experienced Revenue Cycle Analyst to join our team in Cayce, South Carolina on a contract basis. In this role, you will play a pivotal part in optimizing revenue cycle processes and enhancing the efficiency of billing operations within the healthcare domain. This position requires hands-on expertise in revenue cycle management and the ability to train and guide teams on best practices.<br><br>Responsibilities:<br>• Analyze existing revenue cycle processes to identify inefficiencies and implement improvements.<br>• Provide training and mentorship to the billing department to ensure adherence to industry best practices.<br>• Streamline medical billing operations to enhance accuracy and efficiency.<br>• Manage accounts receivable to ensure timely resolution and cleaning of outstanding balances.<br>• Collaborate with internal teams to establish standardized procedures for billing claims.<br>• Offer guidance on medical claims processing and ensure compliance with healthcare regulations.<br>• Introduce and implement tools or systems to support revenue cycle optimization.<br>• Conduct periodic audits to assess the effectiveness of billing and revenue management processes.<br>• Monitor and report on key performance indicators related to revenue cycle operations.<br>• Support the organization’s goal of expanding billing services to external clients.
<p>We are looking for a skilled and detail-oriented Medical Billing Specialist to join our team on a long-term contract basis. In this role, you will play a key part in ensuring the accurate processing of medical records, billing codes, and claims for healthcare providers. Based in Oakland, California, this position requires a strong understanding of medical billing systems, particularly Welligent coding, and a commitment to maintaining compliance with healthcare standards.</p><p><br></p><p>Responsibilities:</p><p>• Analyze and process medical billing records with precision, utilizing Welligent coding systems to ensure compliance with industry regulations.</p><p>• Manage and organize billing codes and documentation for multiple healthcare entities, ensuring prompt and accurate claims submissions.</p><p>• Review patient records and procedures to verify proper billing practices and adherence to guidelines.</p><p>• Identify and resolve discrepancies in billing processes to facilitate seamless claims management.</p><p>• Collaborate with healthcare providers, insurance payers, and administrative staff to address billing issues and ensure accurate coding.</p><p>• Stay updated on changes to billing regulations, coding standards, and healthcare compliance requirements.</p><p>• Maintain detailed and organized records of all billing activities and claims submissions.</p><p>• Support the implementation of best practices for medical billing processes across the organization.</p><p><br></p><p>If you are interested in this role please apply right away and call us at (510) 470-7450</p>
We are looking for a meticulous Document Management Specialist to join our team on a long-term contract basis in Sacramento, California. In this role, you will ensure the accurate handling of scanned documents, manage claim-related documentation, and uphold quality standards. This position requires someone with strong attention to detail who thrives in an organized and fast-paced environment.<br><br>Responsibilities:<br>• Examine scanned images of incoming mail to ensure clarity and adherence to company standards.<br>• Assign labels and titles to documents following established identification protocols.<br>• Investigate and resolve cases where documents lack a claim number, forwarding them to the appropriate teams for further review.<br>• Conduct quality assurance checks to validate scanned images and ensure they meet company criteria.<br>• Reject or return documents for rescanning when images fail to meet standards or contain invalid claim numbers.<br>• Notify senders of invalid documents and provide guidance on corrections.<br>• Index and assign scanned images to the appropriate claim numbers by cross-referencing relevant details in the claims management system.<br>• Input detailed summaries into the claims software, including document type and service date.<br>• Tackle special assignments and projects as directed, ensuring timely and thorough completion.
We are looking for a dedicated Customer Service Representative to join our team on a long-term contract basis in Boise, Idaho. In this role, you will provide exceptional support to clients by handling inquiries, processing orders, and ensuring smooth communication. This position offers an opportunity to build lasting relationships with customers while contributing to an efficient and detail-focused service environment.<br><br>Responsibilities:<br>• Respond promptly to customer inquiries via inbound calls, ensuring clear and precise communication.<br>• Process and manage customer orders with attention to accuracy and timeliness.<br>• Assist clients with mortgage-related inquiries, including loan administration and foreclosure processes.<br>• Address claims and resolve issues efficiently to maintain customer satisfaction.<br>• Handle both inbound and outbound calls to support various customer service operations.<br>• Collaborate with internal teams to ensure seamless communication and resolution of customer concerns.<br>• Maintain detailed records of customer interactions and transactions using provided systems.<br>• Provide guidance to customers on mortgage lending and closing procedures.<br>• Uphold company standards by delivering high-quality and consistent service.<br>• Identify opportunities to improve customer service processes and suggest solutions.
We are looking for a skilled Compensation & Benefits Specialist to join our team on a short-term contract basis in Baton Rouge, Louisiana. This position is ideal for someone with a strong background in managing employee benefits programs and compensation structures. As part of this role, you will be responsible for ensuring smooth operations of benefits administration while providing exceptional service to employees and maintaining compliance.<br><br>Responsibilities:<br>• Administer and coordinate comprehensive employee benefits programs, including enrollments, claims processing, and compliance reporting.<br>• Collaborate with vendors and third-party administrators to ensure seamless plan management and a positive employee experience.<br>• Analyze and evaluate benefit plans to ensure they meet organizational goals and employee needs.<br>• Maintain and update HRIS systems to ensure accurate and efficient processing of benefits-related information.<br>• Generate detailed reports and metrics to track the effectiveness of benefits programs and identify areas for improvement.<br>• Support employees with inquiries related to benefits, providing clear and timely responses.<br>• Manage compliance with federal and state regulations, including FMLA and other applicable laws.<br>• Work closely with internal teams to streamline benefits processes and improve overall efficiency.<br>• Assist in resolving complex benefits issues and discrepancies while maintaining high levels of confidentiality and professionalism.
<p>We are looking for a Patient Service Representative (Medical Receptionist) to join our team in San Francisco, California. In this contract position, you will play a vital role in ensuring patients receive timely and compassionate support as they navigate mobility equipment services. This role requires excellent customer service skills, attention to detail, and the ability to handle sensitive situations with care.</p><p><br></p><p>This is a contract to hire opportunity! </p><p>8AM-4:30PM Monday-Friday </p><p><br></p><p>Responsibilities:</p><p>• Welcome and assist patients and caregivers who visit the facility, addressing their needs with professionalism.</p><p>• Coordinate the intake process by collecting patient information, medical documentation, and insurance details.</p><p>• Verify insurance eligibility and benefits for mobility equipment, ensuring all required information is accurate.</p><p>• Submit pre-authorization requests to insurance providers and track approvals to keep patients informed.</p><p>• Collaborate with internal teams to match patient needs with the appropriate equipment and schedule evaluations or fittings.</p><p>• Arrange delivery or pickup of mobility equipment, ensuring timely and accurate service.</p><p>• Maintain detailed patient records while adhering to compliance standards.</p><p>• Provide billing support by ensuring that all documentation is complete for claims processing.</p><p>• Communicate empathetically with patients and caregivers, especially those in vulnerable situations.</p><p>• Work closely with healthcare providers and physician offices to obtain missing documentation.</p><p><br></p><p>** If you're interested in this position, please apply to this position and contact Georgia Cienkus at georgia.cienkus - at - roberthalf - .com with your word resume and reference job ID#00416-0013308449**</p><p><br></p>
<p>We are looking for a Credentialing Demographic Coordinator to join our team on a contract basis for 6-12 weeks. This role is essential in managing provider demographic and credentialing information with precision and efficiency. Based in Minnetonka, Minnesota, you will play a vital part in ensuring data accuracy for claims processing and network reporting, which directly impacts members and providers.</p><p><br></p><p>Responsibilities:</p><p>• Input and maintain provider demographic and credentialing information in various databases with a focus on accuracy.</p><p>• Collaborate with internal teams to ensure provider data is correct and meets regulatory requirements.</p><p>• Troubleshoot and resolve data errors, identifying potential downstream impacts on claims processing.</p><p>• Prioritize tasks effectively to adapt to shifting work priorities and ensure timely completion.</p><p>• Interpret provider demographic requests and translate them into optimal data entries for multiple systems.</p><p>• Monitor and update provider records to reflect changes, ensuring seamless member and provider experience.</p><p>• Support training efforts by sharing expertise and assisting in the development of policies and procedures.</p><p>• Meet production and quality standards in a fast-paced environment.</p><p>• Utilize software tools such as Microsoft Word, Excel, Access, and Outlook to perform daily tasks efficiently.</p><p>• Communicate effectively to address data-related discrepancies and maintain high-quality standards.</p>
<p>We are looking for a <strong><u>Customer Care Associate</u></strong> for <strong><u>Direct/Permanent Hire </u></strong>in<strong><u> Lewisville, TX.</u></strong> In this role, you will manage customer accounts, ensure seamless order processing from start to finish, act as the primary contact for assigned accounts, and collaborate with internal teams and manufacturing sites to deliver exceptional customer service. </p><p><br></p><p><strong><u>Responsibilities:</u></strong></p><p>• Act as the central point of communication between customers, sales teams, and various internal departments.</p><p>• Handle customer inquiries, complaints, and requests promptly to ensure satisfaction.</p><p>• Collaborate with production control to determine pre-order lead times and set realistic expectations.</p><p>• Review incoming purchase orders and verify feasibility of requested deadlines with manufacturing.</p><p>• Accurately process inbound and outbound sales orders, ensuring compliance with company systems.</p><p>• Validate manual and electronic order entries to guarantee accuracy within the system.</p><p>• Monitor inventory levels to manage item availability and ensure smooth electronic ordering processes.</p><p>• Track order progress, oversee shipment statuses, and provide timely updates to customers.</p><p>• Coordinate shipping logistics with customer teams and internal departments, providing tracking details when needed.</p><p>• Support project managers in resolving quality issues, processing claims, and addressing customer concerns.</p>
<p>Our healthcare client in Carlsbad is searching for a <strong>Billing Specialist</strong> to join their fast-paced and collaborative administrative team. This role is ideal for someone who enjoys problem-solving, has strong attention to detail, and thrives in an environment where accuracy and efficiency directly support patient care. The Billing Specialist will manage insurance claims, patient accounts, and billing inquiries. You’ll play a key part in ensuring that revenue cycles flow smoothly, and that both payors and patients are served with professionalism.</p><p><br></p><p><strong><u>Responsibilities</u></strong></p><ul><li>Process billing claims accurately and in a timely manner, ensuring compliance with insurance regulations.</li><li>Work with a wide range of payor groups, from commercial carriers to government programs.</li><li>Apply knowledge of CPT, ICD-10, and HCPCS coding when preparing claims.</li><li>Review and resolve claim rejections, denials, and outstanding balances.</li><li>Communicate with insurance companies, patients, and providers to clarify and resolve billing issues.</li><li>Maintain accurate patient billing records in the system.</li><li>Support month-end reconciliation and reporting related to billing and collections.</li><li>Collaborate with internal departments to ensure proper documentation is received for claims processing.</li></ul><p><br></p>
We are looking for a skilled Medical Billing Specialist to join our team in Loveland, Colorado. In this long-term contract role, you will be responsible for managing essential billing operations, ensuring accuracy in claims processing, and contributing to the efficiency of healthcare administration. This position is ideal for professionals with expertise in medical billing systems who thrive in a collaborative and fast-paced environment.<br><br>Responsibilities:<br>• Submit accurate claims to insurance providers, adhering to regulatory standards and guidelines.<br>• Monitor and manage accounts receivable, resolving discrepancies and ensuring timely payments.<br>• Utilize medical billing software, including Allscripts and Cerner Technologies, to oversee daily operations.<br>• Handle appeals and follow up on denied claims to secure reimbursements.<br>• Perform medical coding and maintain detailed documentation in compliance with industry practices.<br>• Coordinate third-party billing processes and maintain effective communication with insurance carriers.<br>• Verify patient benefits and eligibility to support billing accuracy.<br>• Conduct numeric data entry and maintain meticulous records of transactions.<br>• Respond to billing inquiries from patients and healthcare providers, delivering excellent customer service.<br>• Collaborate with colleagues to optimize workflows and improve overall billing performance.
<p><strong>Job Title: </strong>Medical Biller</p><p><strong>Location:</strong> Hatboro, PA (100% Onsite)</p><p><strong>Schedule</strong>: Monday – Friday, 8:00 AM – 5:00 PM</p><p><strong>Employment Type: </strong>Permanent, Full-Time</p><p><br></p><p><strong>Overview:</strong></p><p>A healthcare facility near Hatboro, PA is seeking an experienced and detail-oriented Medical Biller to join their team. This role is fully onsite and offers the opportunity to play a key part in the billing and revenue cycle process. The ideal candidate will have strong knowledge of medical billing practices, claims management, and coding standards, with a proven ability to ensure accuracy and timely collections.</p><p><br></p><p><strong>Responsibilities:</strong></p><ul><li>Code charges and process billing for medical procedures</li><li>Prepare, review, and complete billing cycles for accuracy and timeliness</li><li>Research and resolve billing discrepancies; identify and process refunds, credits, and write-offs</li><li>Collect and process patient payments, including credit card transactions; set up payment plans for past due balances</li><li>Generate and mail weekly patient statements</li><li>Post patient and payer Explanation of Benefits (EOB) payments into the system</li><li>Monitor and follow up on unpaid claims and denials; prepare reconciliations and appeals as necessary</li><li>Submit claims to insurance carriers electronically or by mail</li><li>Communicate with staff, physicians, and their offices to obtain billing details and updated patient demographic information</li><li>Collaborate with internal staff and physician offices to gather required documentation and ensure billing accuracy</li><li>Handle incoming patient inquiries, providing thorough and timely follow-up to resolve account issues</li></ul>
We are looking for a skilled Compensation & Benefits Specialist to join our team on a long-term contract basis in Stamford, Connecticut. This role is ideal for professionals with a strong background in benefits management and experience in compensation practices. You will play a key role in supporting and administering various health, welfare, and retirement programs, while also contributing to harmonization efforts during a dynamic integration period.<br><br>Responsibilities:<br>• Provide hands-on support for health, welfare, and retirement programs, as well as several global benefit initiatives.<br>• Manage and resolve issues related to benefits, including conducting root cause analysis.<br>• Develop process documentation and create clear communications for associates regarding benefits policies.<br>• Maintain and update SharePoint sites for Benefits and HR policies.<br>• Administer corporate benefit programs such as leaves of absence, tuition reimbursement, and other offerings.<br>• Oversee benefits and retirement administration, including invoice and claims processing, budgeting, reporting, and customer service.<br>• Support the onboarding and harmonization of compensation and benefits plans during mergers and acquisitions.<br>• Assist with compensation benchmarking for both domestic and international markets.<br>• Administer executive compensation programs and equity grants, ensuring accurate reporting and compliance.<br>• Coordinate the annual compensation planning process and manage incentive plan reporting and accruals.
<p>We are looking for a dedicated Patient Financial Services Supervisor to oversee medical billing operations in a healthcare environment. This long-term contract position is based in French Camp, California, and offers an excellent opportunity to lead a team responsible for ensuring accurate claims processing and maximizing reimbursements. The ideal candidate will have a strong background in medical billing and coding, along with proven leadership skills.</p><p><br></p><p>Responsibilities:</p><p>• Lead and manage the daily operations of the medical billing and collections team to ensure efficiency and accuracy.</p><p>• Identify and resolve complex billing issues, including denials, appeals, and system errors.</p><p>• Collaborate with insurance companies, internal departments, and external stakeholders to streamline processes and improve reimbursement outcomes.</p><p>• Train and mentor staff on billing policies, compliance standards, and industry updates.</p><p>• Audit and review claims such as UB-04 and CMS-1500 to ensure accuracy and adherence to guidelines.</p><p>• Monitor account workflows and implement strategies to enhance productivity and cash flow.</p><p>• Prepare detailed reports and analyses on billing performance and account status.</p><p>• Ensure compliance with Medicare, Medicaid, and commercial payer requirements.</p><p>• Leverage billing systems and tools to optimize operations and reduce errors.</p><p><br></p><p>For immediate consideration please call Cortney at 209-225-2014 </p>
<p>A Senior Software Business Analyst is needed to play a crucial role in connecting business requirements to technical solutions. This role involves engaging with stakeholders to gather and analyze requirements, transforming them into actionable functional specifications. Responsibilities include evaluating existing processes, offering solutions to drive business value, and ensuring project success under tight timelines. The position also includes mentoring junior analysts, leading cross-departmental projects, and fostering innovation. Strong analytical and communication skills, along with a solid understanding of software development life cycles, are essential to succeed in this fast-paced environment.</p><p>The ideal candidate will work closely with development and QA teams to monitor project milestones, provide updates to stakeholders, and address any project risks and challenges. A proactive approach to improving application usability and efficiency will be critical. Focusing on the specialty pharmacy sector, the organization provides end-to-end solutions including hub services, pharmacy network management, group purchasing (GPO) services, cutting-edge technology platforms, and more. With a strong presence as an industry advocate, the focus remains on delivering strategic channel management, advanced products, and tailored services to optimize patient outcomes and improve healthcare delivery.</p><p><br></p><p><strong>** Qualified candidates should have experience with pharmacy insurance, medical insurance, and claims processing **</strong></p><p><br></p><p><strong>Key Responsibilities:</strong></p><ul><li>Collect and translate business requirements into detailed functional specifications for new and existing systems.</li><li>Perform gap analyses between current system capabilities and business needs using tools like Confluence, flowcharts, and wireframes to document workflows.</li><li>Create use cases for review during functional testing phases by developers and QA teams.</li><li>Work with IT teams to evaluate project scope and affected systems, providing strategic insights.</li><li>Assess new methodologies for feasibility and implementation efficiency.</li><li>Gain in-depth knowledge of internal software platforms and their underlying functionalities.</li><li>Analyze and optimize existing processes to identify inefficiencies and propose re-engineering solutions.</li><li>Host regular meetings with development teams to resolve obstacles and track progress.</li><li>Provide project status reports to business stakeholders.</li><li>Identify potential risks and escalate issues as required.</li><li>Continuously explore opportunities to improve application functionality, making recommendations for enhancements.</li><li>Maintain compliance with HIPAA regulations and related amendments</li></ul>
<p>We're looking for a detail-oriented Medical Accounts Receivable Specialist to join our team in Doylestown, Pennsylvania. In this long-term contract position, you will play a vital role in managing Medicare billing, insurance claims, and patient accounts to ensure the financial stability of the organization. This opportunity is ideal for professionals with expertise in medical billing processes and a commitment to resolving accounts efficiently and accurately.</p><p><br></p><p>Responsibilities:</p><p>• Manage Medicare billing operations, ensuring all patient accounts are handled with accuracy and compliance.</p><p>• Submit electronic and paper insurance claims following payer guidelines and regulatory requirements.</p><p>• Process patient claims promptly and oversee account management to maintain compliance standards.</p><p>• Conduct timely follow-ups on payments to resolve outstanding balances, collaborating with stakeholders as necessary.</p><p>• Regularly review work lists to prioritize accounts requiring immediate attention and action.</p><p>• Work assigned accounts diligently until they are fully resolved, maintaining detailed documentation throughout the process.</p><p>• Analyze remittances to confirm that charges processed or paid align with insurance contracts and fee schedules.</p><p>• Utilize and interpret billing forms such as UB04 and 1500 to ensure proper claim submission and resolution.</p><p>• Leverage electronic medical record systems and billing software to streamline account management and reporting.</p>
We are looking for an experienced Medical Billing/Claims/Collections specialist to join our team on a contract basis. This role is based in Northbrook, Illinois, and offers an excellent opportunity to contribute your expertise in medical billing and claims management within a dynamic healthcare setting. The ideal candidate will bring a strong understanding of medical collections, appeals, and denials processes, ensuring timely and accurate handling of claims.<br><br>Responsibilities:<br>• Manage medical billing operations, including hospital billing and claims processing, to ensure accuracy and compliance.<br>• Handle medical collections and follow up on outstanding claims with payers to secure payments.<br>• Investigate and resolve medical denials by reviewing documentation and initiating appeals as needed.<br>• Collaborate with healthcare providers and insurance companies to address claim-related inquiries and discrepancies.<br>• Utilize Epic software and other electronic medical record systems to maintain and update patient billing information.<br>• Ensure adherence to healthcare billing procedures, statutory requirements, and compliance standards.<br>• Perform research to support claim administration and resolve complex billing issues.<br>• Process payments and reconcile accounts to maintain accurate financial records.<br>• Escalate unresolved issues appropriately to ensure timely resolution.<br>• Provide training and support to staff on billing processes and system functionalities.
<p>Reputable and growing firm is seeking a Workers Compensation Attorney. This role involves providing high-quality, cost-effective legal representation and working closely with a diverse range of clients and professionals. You'll be part of a team that values excellent communication, research, and analytical skills in a dynamic work environment.</p><p><br></p><p>Responsibilities: </p><p>• Deliver high-quality legal representation in workers compensation defense</p><p>• Foster strong relationships with a diverse community of clients and colleagues</p><p>• Engage in thorough and efficient research and analytical tasks</p><p>• Participate in court appearances related to workers compensation cases</p><p>• Handle related insurance claims as part of the legal service provision</p><p>• Maintain good standing with the California State Bar</p><p>• Travel occasionally as per case requirements</p><p>• Contribute to a congenial work atmosphere, maintaining excellent communication and cooperation with attorneys/lawyers and staff</p><p>• Participate actively in the firm's Associate Bonus Program.</p>
