We are looking for an experienced Medical Insurance Claims Specialist to join our team in Worthington, Ohio. In this long-term contract role, you will play a key part in ensuring accurate processing of medical claims and verifying patient insurance eligibility. This position offers the opportunity to work in the dynamic social care/services industry, contributing to efficient billing and claims management.<br><br>Responsibilities:<br>• Process medical insurance claims with a high level of accuracy and attention to detail.<br>• Verify patient eligibility and insurance coverage to ensure proper billing procedures.<br>• Collaborate with healthcare providers and insurance companies to resolve claim discrepancies.<br>• Maintain comprehensive records of claims and billing activities for audit purposes.<br>• Identify and address issues with insurance claims to prevent delays in processing.<br>• Review and analyze patient data to ensure compliance with insurance requirements.<br>• Assist in the preparation and submission of claims to insurance carriers.<br>• Provide support and guidance to team members regarding claims procedures and policies.<br>• Stay updated on changes in medical billing regulations and insurance policies.<br>• Communicate effectively with patients and stakeholders to address billing inquiries.
<p>Our client is looking for a medical biller who has experience with the denials process for healthcare companies. This role is 100% onsite and will be a standard 8am - 5pm schedule. </p><p><br></p><ul><li>Review, analyze, and interpret medical claim denials from insurance companies.</li><li>Investigate root causes of denials and work to resolve them via appeals or corrected submissions.</li><li>Communicate professionally with payers to gather needed information and negotiate claim resolution.</li><li>Collaborate with providers, coders, and revenue cycle staff to prevent future denials.</li><li>Maintain detailed records of denied claims and actions taken.</li><li>Prepare and submit written appeals with supporting documentation as needed.</li><li>Monitor payer trends and identify opportunities to enhance billing and collections processes.</li><li>Ensure compliance with all regulatory guidelines and organizational policies.</li><li>Meet daily and monthly productivity targets for denial resolution and claims follow-up.</li></ul><p><br></p>
We are looking for a skilled Medical Billing Specialist to join our team in Kansas City, Missouri. In this long-term contract role, you will play a vital part in managing and processing medical claims, ensuring accurate billing, and supporting efficient revenue cycles. This is an excellent opportunity for professionals with expertise in medical billing, coding, and collections.<br><br>Responsibilities:<br>• Accurately process and submit medical claims to insurance providers and other payers.<br>• Review and verify patient billing information for accuracy and compliance with regulations.<br>• Resolve discrepancies and follow up on denied or unpaid claims to ensure timely collections.<br>• Collaborate with healthcare providers to obtain documentation needed for billing purposes.<br>• Maintain detailed records of billing activities and payment statuses.<br>• Ensure compliance with medical coding standards and billing guidelines.<br>• Address inquiries from patients and insurance companies regarding billing issues.<br>• Assist in identifying and implementing improvements to the billing process.<br>• Monitor accounts receivable and prepare reports on billing and collections.<br>• Provide support for audits and regulatory reviews related to billing procedures.
We are looking for a skilled Case Manager to join our team in Encino, California. In this role, you will oversee multiple pre-litigation cases, ensuring prompt and effective resolution while providing exceptional support to clients. This is an onsite position that offers a dynamic work environment and opportunities for growth.<br><br>Responsibilities:<br>• Manage multiple pre-litigation cases, ensuring timely and effective resolution.<br>• Supervise and guide entry-level case managers in their daily tasks and responsibilities.<br>• Facilitate claims processing with insurance carriers, including health insurance, Medicare, and Medi-Cal.<br>• Coordinate property damage and loss of use claims, ensuring proper resolution.<br>• Identify healthcare providers and schedule medical appointments for injury treatment.<br>• Advocate for clients by monitoring their medical treatment and arranging necessary care based on provider recommendations.<br>• Review, analyze, and interpret medical records, surgical reports, and medical bills.<br>• Prepare case files and documentation for submission to the demands department.<br>• Communicate effectively with clients, healthcare providers, and internal staff to maintain a high level of service.
<p>We are looking for a dedicated Personal Injury Claims Representative to join our team in the Lawrenceville, New Jersey area. In this role, you will manage complex personal injury protection claims, ensuring compliance with company policies and regulatory requirements. This position requires a detail-oriented individual with strong analytical skills and a commitment to delivering high-quality service.</p><p><br></p><p>Salary is 58,240 - 76,960.</p><p><br></p><p>Benefits include medical, dental, vision insurance, PTO, life insurance, and 401k. </p><p><br></p><p>Responsibilities:</p><p>• Investigate assigned claims, confirm coverage, verify eligibility, and determine the appropriate course of action.</p><p>• Evaluate gathered information to assess claim validity, injury extent, and potential exposure.</p><p>• Establish and maintain accurate reserves for each claim based on exposure estimates.</p><p>• Coordinate medical case reviews, independent medical examinations, or expert consultations when necessary.</p><p>• Respond to inquiries and concerns from subscribers, claimants, attorneys, and healthcare providers.</p><p>• Document claim files comprehensively and maintain an organized follow-up system for timely reporting.</p><p>• Ensure claims are managed in alignment with the organization's Decision Point Review Plan.</p><p>• Collaborate with internal departments and external specialists to optimize claim outcomes.</p><p>• Oversee loss adjustment expenses and manage vendor activities to ensure efficient and necessary work completion.</p><p>• Adhere to guidelines outlined in the Unfair Claim Practices Acts and other relevant regulations.</p>
<p>We are looking for an experienced Insurance Claims Examiner to join our team on a contract basis in Oakland, California. In this role, you will analyze and process medical claims, ensuring accuracy and compliance with healthcare regulations. Ideal candidates will have a strong background in insurance claims management and coding, along with the ability to work independently in a fast-paced environment.</p><p><br></p><p>Responsibilities:</p><p>• Review and adjudicate medical claims for accuracy and compliance with Medi-Cal, Medicare, and other healthcare regulations.</p><p>• Research and resolve claim discrepancies, ensuring proper payment and documentation.</p><p>• Utilize coding systems such as ICD-10, CPT, and HCPCS to verify claim accuracy.</p><p>• Maintain confidentiality while handling sensitive participant and family information.</p><p>• Follow organizational policies and procedures to ensure compliance and attention to detail.</p><p>• Exhibit consistent attendance and punctuality while meeting deadlines.</p><p>• Communicate effectively with internal teams and external stakeholders to address claim issues.</p><p>• Input accurate data into various computer systems and software programs.</p><p>• Provide courteous and detail-oriented customer service to all stakeholders.</p><p>• Perform additional duties as assigned to support claims processing activities.</p><p><br></p><p>If you are interested in this role please apply now and call us at (510) 470-7450, it is an urgent need for our client. </p>
We are looking for an experienced Billing Clerk to join our team in Forest Hills, New York. In this role, you will manage various billing functions, ensuring accuracy and efficiency in processing claims, invoices, and payments. This is a long-term contract position within the non-profit industry, offering an opportunity for growth and stability.<br><br>Responsibilities:<br>• Prepare and process billing statements and invoices with precision.<br>• Handle claims processing for Medicaid and healthcare-related billing.<br>• Investigate and resolve discrepancies in billing records or payments.<br>• Maintain accurate documentation and records for all billing activities.<br>• Collaborate with internal teams to ensure timely submission of claims and invoices.<br>• Monitor and track payments to ensure compliance with deadlines.<br>• Apply appropriate codes to invoices and claims based on regulations and policies.<br>• Support the implementation and maintenance of billing systems.<br>• Communicate with clients and stakeholders to address billing inquiries.<br>• Generate reports to analyze billing performance and identify areas for improvement.
<p>We are looking for a skilled Medical Billing Specialist to join our team in Hampton, Virginia. This role requires expertise in medical billing, coding, and claims processing to ensure accurate and timely management of healthcare financial transactions. If you have a strong attention to detail and a commitment to maintaining compliance with medical standards, we encourage you to apply.</p><p><br></p><p>Responsibilities:</p><p>• Process and submit medical claims accurately and efficiently to ensure timely reimbursements.</p><p>• Review and verify patient account information for accuracy and completeness.</p><p>• Handle medical collections, including resolving discrepancies and communicating with insurance companies.</p><p>• Collaborate with healthcare providers and staff to address billing inquiries and resolve issues.</p><p>• Maintain up-to-date knowledge of medical billing regulations and compliance standards.</p><p>• Generate reports related to billing activities and provide insights for process improvements.</p><p>• Identify and correct billing errors to minimize delays and denials.</p><p>• Ensure confidentiality and security of patient financial information at all times.</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>A National Healthcare Organization is in the need of a Medical Revenue Cycle Analyst to join its healthcare finance team. The Medical Revenue Cycle Analyst will be responsible for analyzing and improving revenue cycle processes, ensuring the organization's financial health while minimizing inefficiencies. This role requires strong analytical skills, healthcare billing knowledge, and the ability to collaborate across departments to optimize performance. If you're passionate about healthcare finance and thrive in a data-driven environment, we encourage you to apply.</p><p><br></p><p>Key Responsibilities:</p><ul><li>Perform data analysis to identify trends, issues, and opportunities for improvement within the revenue cycle processes, including billing, coding, collections, and reimbursements.</li><li>Maintain and analyze financial and operational performance metrics related to claims processing, denial management, and payment posting.</li><li>Collaborate with cross-functional teams, such as billing and collections, to streamline processes and improve revenue cycle operations.</li><li>Research industry regulations and payer policies to ensure compliance and optimize reimbursements.</li><li>Provide regular reporting to department leaders on revenue cycle performance, including key performance indicators (KPIs).</li><li>Support system upgrades and technology implementation to enhance revenue cycle efficiency.</li><li>Identify and resolve discrepancies in payments or coding to reduce denials and delays in reimbursements.</li><li>Conduct root cause analysis for claim denials and develop strategies for resolution.</li><li>Participate in budgeting and forecasting to align revenue cycle goals with financial strategies.</li><li>Working knowledge of Epic Software.</li><li>CPC or CCS license is a plus but not a must. </li></ul>
<p>We are looking for an experienced Medical Billing Specialist to join a team in Wilmington, Delaware. This position plays a vital role in ensuring accurate billing, claims processing, and accounts receivable management within a healthcare setting. As a Contract to permanent opportunity, this role offers the chance to demonstrate your expertise and grow within the organization.</p><p><br></p><p>Responsibilities:</p><p>• Process and submit medical claims using UB04 forms while ensuring compliance with healthcare regulations and payer requirements.</p><p>• Perform detailed medical coding using current standards to accurately reflect resident care and services.</p><p>• Manage accounts receivable for Medicaid and Medicare billing, resolving discrepancies and handling claim denials effectively.</p><p>• Update and reconcile resident census data to ensure accurate billing for insurance providers.</p><p>• Coordinate billing for resident accounts, verify insurance eligibility, and maintain precise records of claim statuses.</p><p>• Utilize PointClickCare and other healthcare software to manage billing and documentation processes.</p><p>• Monitor claim statuses, investigate rejections or denials, and prepare corrected claims when necessary.</p><p>• Collaborate with clinical and administrative teams to ensure accurate census reporting and smooth billing operations.</p><p>• Uphold compliance with healthcare policies and regulations, safeguarding patient information and confidentiality.</p>
We are looking for a skilled Business Systems Analyst to join our team in Westlake, Ohio. This role is ideal for someone who thrives on analyzing complex data, translating business needs into actionable solutions, and collaborating across teams to enhance system functionality. The successful candidate will bring expertise in business analysis and a proactive approach to ensuring seamless project execution and client satisfaction.<br><br>Responsibilities:<br>• Analyze and interpret data files to translate between proprietary and standard formats, ensuring efficient resolution of business challenges.<br>• Document and implement functional requirements, technical specifications, and templates tailored to client needs while leveraging deep product knowledge.<br>• Review complex data sets, create mapping documents, and provide guidance on best practices to meet client requirements.<br>• Utilize internal databases to identify coding issues and recommend necessary adjustments.<br>• Act as a liaison between teams, managing system enhancements, defect resolution, and validation processes in collaboration with QA teams.<br>• Build and maintain strong relationships with clients, including executive-level stakeholders, and effectively communicate technical and non-technical concepts.<br>• Collaborate with IT teams to develop or improve client products, ensuring business requirements are met, conducting validations, and delivering end-user documentation and training.<br>• Identify opportunities for system improvements and escalate issues to ensure timely resolutions.<br>• Lead discussions with clients to understand their needs and provide strategic guidance, demonstrating professionalism and technical expertise.<br>• Participate in Agile-focused daily stand-up meetings and contribute to project success through disciplined adherence to the Software Development Lifecycle.
<p>Our client is looking for a dedicated Bodily Injury Claims Representative in the Lawrenceville, NJ area to manage non-litigation auto insurance claims, including uninsured and underinsured motorist cases. This role requires a strong understanding of insurance policies and the ability to assess claims effectively. </p><p><br></p><p>Salary is 60,000 - 79,000. </p><p><br></p><p>Benefits include medical, dental, and vision coverage, PTO, life insurance, and 401k. </p><p><br></p><p>Responsibilities:</p><p>• Investigate claims thoroughly to validate their authenticity, assess policy coverages, and determine if special investigations are necessary.</p><p>• Set appropriate reserves based on claim details and adjust them as new information becomes available.</p><p>• Negotiate settlements with claimants, attorneys, and other involved parties while adhering to company policies.</p><p>• Issue accurate payments promptly and ensure all transactions align with regulatory standards.</p><p>• Recognize potential fraud or questionable claims and escalate them to the special investigation unit when required.</p><p>• Maintain organized records and follow up regularly to ensure claims are resolved in a timely manner.</p><p>• Ensure compliance with state and local regulations, including NJ, PA, and Michigan Unfair Claims Practices guidelines.</p><p>• Complete other assigned duties as needed to support the claims process.</p>
We are looking for a detail-oriented Fee Coder to join our team in Sacramento, California. This long-term contract position focuses on ensuring the accurate coding and processing of fees for patient services. The role emphasizes collaboration with various departments to optimize reimbursement, maintain compliance, and provide valuable feedback to healthcare providers. Candidates will play a vital role in enhancing charge capture and ensuring timely submission of services.<br><br>Responsibilities:<br>• Accurately apply diagnostic and procedural codes, including modifiers, based on current coding guidelines.<br>• Review and code services for billing while ensuring all charges are properly documented and accounted for.<br>• Collaborate with physicians to clarify documentation and provide feedback on compliance and revenue optimization.<br>• Resolve pre-bill edits and perform follow-up actions to ensure clean claims are filed promptly.<br>• Stay informed about coding standards, guidelines, and reporting requirements to maintain accuracy and compliance.<br>• Conduct queries to address unclear or ambiguous documentation in medical records.<br>• Utilize coding practices that improve cash flow and support efficient claims processing.<br>• Work closely with departments to optimize reimbursement and reduce late charges.<br>• Provide routine feedback to healthcare providers regarding documentation practices and compliance.<br>• Ensure all services are submitted timely and meet quality standards.
<p>We are looking for a skilled Medical Billing Specialist to join our healthcare team in Fayetteville, North Carolina. This is a long-term contract opportunity, ideal for professionals who excel in managing billing processes and ensuring accuracy in financial documentation. The role plays a vital part in supporting the facility's operations and maintaining compliance with healthcare billing standards.</p><p><br></p><p>Responsibilities:</p><p>• Process and submit accurate medical claims to insurance providers in a timely manner.</p><p>• Verify patient billing information and ensure adherence to regulatory guidelines.</p><p>• Investigate and resolve claim discrepancies or denials to ensure proper reimbursement.</p><p>• Maintain detailed records of billing activities and payment statuses.</p><p>• Collaborate with healthcare staff to gather necessary documentation for billing purposes.</p><p>• Handle patient inquiries regarding billing issues and provide clear explanations.</p><p>• Monitor accounts receivable and follow up on outstanding payments.</p><p>• Ensure compliance with healthcare billing regulations and policies.</p><p>• Analyze billing data to identify trends and areas for improvement.</p><p>• Support internal teams with necessary billing reports and documentation.</p>
<p>We are looking for a motivated and detail-oriented Medical Billing Specialist to join our team in Oak Brook, Illinois. This contract position is ideal for candidates with a background in medical billing and a commitment to accuracy in claims processing and payment reconciliation. You will play a vital role in ensuring timely submissions and providing support to families relying on Medicaid-funded services.</p><p><br></p><p>Responsibilities:</p><p>• Process and submit clinic patient claims to Medicaid and private insurers twice weekly, ensuring all necessary information is included.</p><p>• Identify and correct errors in claims submissions, resubmitting promptly to avoid delays.</p><p>• Prepare and distribute monthly invoices to families and payers.</p><p>• Perform daily reconciliation of billing records to maintain accuracy and compliance.</p><p>• Coordinate with physicians to obtain scripts for new clients, ensuring accurate documentation.</p><p>• Track claim statuses and escalate complex issues to management when needed.</p><p>• Ensure compliance with Medicaid-specific billing and reporting requirements.</p><p>• Maintain organized records of all billing activities and client interactions.</p><p>• Communicate effectively with families and physicians regarding payment plans and billing inquiries.</p><p><br></p><p>The hourly pay range for this position is $24 to $29/hour. Benefits available to contract/temporary professionals, include medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit <u>roberthalf.gobenefits.net</u> for more information. Our specialized recruiting professionals apply their expertise and utilize our proprietary AI to find you great job matches faster.</p>
<p><br></p><p>Our company is seeking a detail-oriented Claims and Payments Specialist to join our administrative or healthcare support team. This position is responsible for processing claims, working on denials, posting payments, and managing bill payments for our clients. The ideal candidate is proactive, organized, and committed to ensuring accurate handling of financial and billing requests.</p><p><br></p><p>Key Responsibilities:</p><ul><li>Accurately process client claims and documentation.</li><li>Review, research, and resolve claim denials in a timely manner.</li><li>Post payments received to the proper accounts, maintaining clear and accurate records.</li><li>Pay bills for clients, ensuring deadlines and processes are followed.</li><li>Communicate with internal teams and clients regarding billing status, issues, and resolutions.</li><li>Maintain compliance with company and industry billing standards.</li><li>Support additional administrative or billing tasks as needed.</li></ul><p>Qualifications:</p><ul><li>Prior experience in claims processing, payment posting, billing, or related administrative duties is preferred.</li><li>Strong attention to detail and organizational skills.</li><li>Excellent verbal and written communication abilities.</li><li>Proficiency in basic office software and billing systems.</li><li>Willingness to pay bills on behalf of clients as required by the role.</li></ul><p><br></p>
<p>We are looking for a skilled Medical Billing Specialist to join our team in Fayetteville, North Carolina. In this long-term contract role, you will play a vital part in managing billing operations and ensuring that all claims are processed accurately and efficiently. This is an excellent opportunity for someone with expertise in medical billing to contribute to the success of a healthcare facility.</p><p><br></p><p>Responsibilities:</p><p>• Prepare, review, and submit medical claims to ensure accurate billing and timely reimbursement.</p><p>• Verify patient insurance coverage and address any discrepancies or issues with claims.</p><p>• Collaborate with healthcare providers and insurance companies to resolve billing inquiries and disputes.</p><p>• Maintain detailed records of billing activities, including payments, adjustments, and outstanding balances.</p><p>• Ensure compliance with healthcare regulations and billing standards to avoid errors or penalties.</p><p>• Monitor and follow up on unpaid claims to ensure prompt resolution.</p><p>• Assist with coding and documentation to align with current medical billing guidelines.</p><p>• Provide support to the team by identifying and addressing billing system issues.</p><p>• Generate regular reports on billing performance and trends for management review.</p><p>• Communicate with patients regarding billing concerns and payment options.</p>
<p>Quick moving contract to perm opening with hybrid in-office plus remote type schedule. Expectations would be in our client's Tampa office 2 to 3 days per week in mentoring Jr Data Engineer </p><p><br></p><p>If applying, please make sure you have at least 5 years experience in Power BI, ETL Development, Snowflake and Azure. If you have Sigma reporting that will be a huge plus as our client is going that direction with their reporting initiatives. Healthcare background also a strong preference to understand our client technical work flows. </p><p><br></p><p>We are seeking an experienced Senior Data Engineer with 5+ years of hands-on experience to join our dynamic Data Engineering team. In this role, you will design, build, and optimize scalable data pipelines and analytics solutions in a fast-paced healthcare environment. You will play a pivotal role in enabling real-time insights for healthcare stakeholders, ensuring data integrity, compliance with HIPAA and other regulations, and seamless integration across multi-cloud ecosystems.</p><p><br></p><p>Key Responsibilities</p><p><br></p><p>Architect and implement end-to-end ETL/ELT pipelines using Azure Data Factory, Snowflake, and other tools to ingest, transform, and load healthcare data (e.g., EHR, claims, patient demographics) from diverse sources.</p><p>Design and maintain scalable data warehouses in Snowflake, optimizing for performance, cost, and healthcare-specific querying needs.</p><p>Develop interactive dashboards and reports in Power BI to visualize key healthcare metrics, such as patient outcomes, readmission rates, and resource utilization.</p><p>Collaborate with cross-functional teams (data scientists, analysts, clinicians) to translate business requirements into robust data solutions compliant with HIPAA, GDPR, and HITRUST standards.</p><p>Lead data modeling efforts, including dimensional modeling for healthcare datasets, ensuring data quality, governance, and lineage.</p><p>Integrate Azure services (e.g., Synapse Analytics, Databricks, Blob Storage) to build secure, high-availability data platforms.</p><p>Mentor junior engineers, conduct code reviews, and drive best practices in CI/CD pipelines for data engineering workflows.</p><p>Troubleshoot and optimize data pipelines for performance in high-volume healthcare environments (e.g., processing millions of claims daily).</p><p>Stay ahead of industry trends in healthcare data analytics and contribute to strategic initiatives like AI/ML integration for predictive care models.</p><p><br></p><p><br></p><p><br></p>
<p>We are looking for a dedicated Revenue Cycle Management Director to lead and manage all aspects of our client's revenue cycle operations. This position plays a critical role in optimizing billing, coding, claims processing, insurance verification, and collections to ensure compliance and maximize reimbursement. The ideal candidate will bring strategic leadership and collaboration skills to support equitable healthcare access and operational efficiency.</p><p><br></p><p>Responsibilities:</p><p>• Oversee the revenue cycle processes for Medicaid, Medicare, managed care, commercial payers, and sliding fee programs.</p><p>• Establish and enforce billing policies that align with regulatory requirements and organizational guidelines.</p><p>• Manage provider and facility credentialing processes to ensure timely enrollment with insurance payers.</p><p>• Monitor and analyze key performance indicators, accounts receivable data, and reimbursement trends to identify and implement performance improvements.</p><p>• Handle payer contracts, denial management, and appeals to ensure accurate and timely resolutions.</p><p>• Collaborate with departments such as operations, finance, and quality to enhance workflows and support population health goals.</p><p>• Ensure accurate medical, dental, behavioral health, and vision coding and claims submissions.</p><p>• Provide strategic direction, foster staff development, and oversee performance management within the revenue cycle team.</p><p>• Lead initiatives to improve compliance and efficiency across the revenue cycle.</p><p>• Drive continuous improvement in revenue cycle operations by leveraging data insights and industry best practices.</p>
We are looking for a skilled Medicare Biller to join our team on a contract basis in Boca Raton, Florida. In this role, you will ensure accurate billing processes and compliance with regulations in the healthcare industry. This position requires a strong background in coding and auditing, along with the ability to work collaboratively with providers and administrative staff.<br><br>Responsibilities:<br>• Conduct thorough audits of medical documentation to identify coding discrepancies and ensure accuracy in billing practices.<br>• Collaborate with healthcare providers to clarify documentation and improve compliance with coding standards.<br>• Analyze payor policies and fee schedules to optimize reimbursements and address any trends or discrepancies.<br>• Provide training and guidance to staff and providers on coding regulations and best practices.<br>• Prepare detailed reports on audit findings and present recommendations for improvement to stakeholders.<br>• Monitor changes in payor policies and communicate updates to relevant teams.<br>• Assist with corrections and resubmissions of claims to ensure proper follow-up and maximize reimbursements.<br>• Serve as a resource for coding-related inquiries and act as a subject matter expert in medical billing.<br>• Review and adapt billing procedures to align with organizational policies and industry standards.<br>• Maintain confidentiality of sensitive financial and medical information.
<p>We are looking for an Accounts Receivable Specialist to join one of our healthcare clients in Colorado Springs, Colorado. In this role, you will play a vital part in maintaining accurate records, processing claims, and ensuring timely communication with insurers and patients. This position requires strong attention to detail, problem-solving skills, and a commitment to delivering excellent service.</p><p><br></p><p>Responsibilities:</p><p>• Review denied claims and apply current coding and billing practices to resolve issues.</p><p>• Manage claim rejections through third-party clearinghouses, ensuring timely processing.</p><p>• Post and process verified denials during accounts receivable activities.</p><p>• Submit appeals for denied claims and handle overpayments from third-party payers.</p><p>• Collaborate with government and third-party insurers to follow up on missing or improperly denied claims.</p><p>• Support the team by verifying eligibility and benefits for in-office surgeries, including calculating patient estimates.</p><p>• Submit authorization requests to insurance providers for in-office surgeries and patch allergy testing.</p><p>• Coordinate with the Surgery Coordinator team to ensure patients receive approved and timely surgical care.</p><p>• Participate in team workshops and contribute to project assignments as needed.</p><p><br></p><p>Interested in applying? Contact Victor Granados at 719-249-5153 for additional details.</p>
We are looking for a dedicated Customer Service Representative to join our team on a contract basis in Huntington Beach, California. In this role, you will play a key part in assisting individuals with the enrollment process, ensuring accuracy and providing exceptional support. This position offers the opportunity to work in the dynamic healthcare industry, contributing to a seamless onboarding experience for new members.<br><br>Responsibilities:<br>• Respond to inquiries from internal and external customers, providing timely and attentive assistance.<br>• Resolve issues and concerns related to enrollment through claims, emails, and call tracking systems.<br>• Accurately enter and maintain enrollment applications and member information in the company's database.<br>• Process enrollment applications and manage dis-enrollments, ensuring compliance with guidelines.<br>• Verify enrollment statuses with clients and address discrepancies as needed.<br>• Investigate and resolve system rejections related to enrollment data.<br>• Collaborate with team members to address exceptions and take corrective actions to ensure proper member enrollment.<br>• Conduct daily and monthly reconciliation of files and verify data accuracy against source documents.<br>• Maintain organized records in the enrollment database and manage member eligibility changes.<br>• Perform other duties as assigned to support the enrollment process.
We are looking for a skilled Medical Billing Specialist to join our team in Raeford, North Carolina. In this role, you will handle essential billing tasks to ensure accurate processing of medical claims and payments. This is a long-term contract opportunity within the healthcare industry, offering a chance to make a meaningful impact.<br><br>Responsibilities:<br>• Prepare and submit accurate medical claims to insurance providers.<br>• Verify patient insurance information and address any discrepancies.<br>• Follow up on unpaid claims and resolve billing issues promptly.<br>• Ensure compliance with healthcare regulations and billing standards.<br>• Maintain detailed records of payments, adjustments, and account statuses.<br>• Communicate effectively with patients regarding billing inquiries.<br>• Collaborate with healthcare staff to improve billing workflows.<br>• Utilize medical billing software to streamline processes.<br>• Review and analyze billing data for accuracy and completeness.<br>• Stay updated on changes in insurance policies and billing requirements.
<p>We are looking for a dedicated Release of Information Specialist to join our healthcare team in Cooperstown, New York. In this long-term contract position, you will support the efficient management of patient health information while ensuring compliance with privacy regulations. This role offers an opportunity to work collaboratively within a team environment and contribute to the smooth operation of healthcare services.</p><p><br></p><p>Responsibilities:</p><p>• Process requests for patient health records in accordance with privacy and confidentiality regulations.</p><p>• Collaborate with a team of specialists to ensure timely completion of release of information requests.</p><p>• Utilize electronic document management systems to organize, retrieve, and distribute patient records.</p><p>• Provide exceptional customer service to patients, families, and authorized requestors.</p><p>• Verify and validate information to ensure accuracy and compliance with healthcare standards.</p><p>• Handle copying, scanning, and printing of documents as required for health information management.</p><p>• Respond to voicemail messages and inquiries related to release of information processes.</p><p>• Manage document queues and prioritize tasks to meet deadlines efficiently.</p><p>• Work with disability claims and TRICARE-related documentation as needed.</p><p>• Maintain professionalism and adhere to the business casual dress code in all interactions.</p>
