<p><strong>Job Description</strong>: Medical Billing Specialist </p><p><br></p><p><strong>Overview:</strong> We are seeking a highly motivated and detail-oriented Medical Billing Specialist for an organization located in Mars, PA. The ideal candidate will have expertise in medical billing and payment posting, ensuring accurate and timely processing of accounts receivable transactions and claims processing.</p><p><br></p><p><strong><u>Key Responsibilities:</u></strong></p><p><strong>1. Billing:</strong></p><ul><li>Generate and issue invoices for a wide range of care services, including senior living, skilled nursing, home care, and outpatient services.</li><li>Ensure compliance with service agreements, insurance policies, and applicable healthcare regulations.</li><li>Address billing discrepancies by coordinating with internal departments, including admissions and patient services.</li><li>Prepare and submit claims to insurance companies, Medicare, and Medicaid as applicable.</li></ul><p><strong>2. Payment Posting:</strong></p><ul><li>Accurately enter payments received (cash, checks, and electronic transfers) into the accounts receivable system.</li><li>Reconcile posted payments with bank statements and patient billing systems.</li><li>Manage and resolve unapplied payments or discrepancies to maintain accurate account balances.</li></ul><p><strong>3. Revenue Cycle Management:</strong></p><ul><li>Work collaboratively with other departments to monitor and manage the overall revenue cycle.</li><li>Track and follow up on outstanding payments or insurance claims to reduce accounts receivable aging.</li><li>Prepare reports on accounts receivable status, payment trends, and delinquent accounts for management review.</li></ul><p><strong>4. Customer and Client Communication:</strong></p><ul><li>Respond to patient or payer inquiries regarding invoices, payments, or account details with professionalism and clarity.</li><li>Serve as a point of contact for resolving disputes or escalations concerning billing errors or payment issues.</li></ul><p><strong>5. Compliance:</strong></p><ul><li>Ensure billing and payment posting processes comply with industry standards, healthcare regulations (including HIPAA), and organizational policies.</li><li>Document procedures and maintain accurate, auditable records for all accounts receivable transactions.</li></ul><p><strong>Location:</strong> This position is ONSITE and located in the Mars, PA area.</p><p><br></p><p><strong>Schedule:</strong> The hours are Monday through Friday from 8:30am-5pm.</p><p><br></p><p><strong>Why is this role available?</strong> This organization recently had a tenured team member retire.</p><p><br></p><p><strong>How to Apply: </strong>Submit your updated resume on the Robert Half website or apply using the Robert Half App.</p>
<p>Are you a detail-oriented professional with expertise in denials management and medical collections? We are seeking a <strong>Clinical Appeals Medical Collector</strong> to join our team remotely! The ideal candidate will be experienced in handling denials, appeals, and working with various insurance payers, including HMO, PPO, Medicare, and Medi-Cal. If you thrive in a fast-paced environment and are ready to make an impact, this position is for you!</p><p><strong>Key Responsibilities:</strong></p><ul><li>Manage insurance denials and appeals with precision and timeliness.</li><li>Analyze denied claims and identify root causes to reduce future occurrences.</li><li>Submit detailed and comprehensive appeals to insurance providers (HMO, PPO, Medicare, Medi-Cal) to secure payment.</li><li>Stay up-to-date with payer policies and procedures to ensure compliance.</li><li>Collaborate with healthcare providers, payers, and internal team members for resolution of outstanding accounts.</li><li>Maintain accurate documentation of claims and communications.</li></ul><p><br></p>
We are looking for a detail-oriented Medical Billing Specialist to join our team on a long-term contract basis. In this role, you will play a critical part in ensuring accurate and timely processing of medical claims, collections, and coding. Based in New Orleans, Louisiana, this position offers an opportunity to contribute your expertise to a fast-paced healthcare environment.<br><br>Responsibilities:<br>• Process medical claims with accuracy and efficiency, adhering to industry standards and regulations.<br>• Conduct medical coding to ensure proper classification and compliance with billing requirements.<br>• Manage collections by following up on outstanding balances and resolving discrepancies.<br>• Utilize Epaces and other systems to monitor claims and maintain data integrity.<br>• Communicate effectively with healthcare providers and insurance companies to address billing issues.<br>• Verify patient information and insurance details to facilitate accurate billing.<br>• Identify and resolve errors in claims submissions to minimize delays and denials.<br>• Maintain up-to-date knowledge of billing policies, procedures, and regulatory changes.<br>• Generate reports to track billing performance and identify areas for improvement.<br>• Collaborate with team members to streamline billing processes and enhance operational efficiency.
<p>We are looking for a dedicated Medical Billing Specialist to join our team in Glen Burnie, Maryland. In this Contract-to-permanent role, you will play a critical part in ensuring accurate and timely processing of medical claims while maintaining compliance with industry standards. The ideal candidate will bring a strong understanding of medical billing practices and a commitment to delivering exceptional service.</p><p><br></p><p>Responsibilities:</p><p>• Submit medical claims to insurance companies and ensure timely reimbursement for healthcare services provided.</p><p>• Verify the accuracy of patient demographic information and insurance details to prevent claim errors.</p><p>• Review denied or unpaid claims and work on appeals to secure payment.</p><p>• Communicate effectively with insurance companies, healthcare providers, and patients to address billing concerns.</p><p>• Utilize medical coding knowledge, including ICD-10, to process claims accurately.</p><p>• Maintain confidentiality of patient information in compliance with healthcare regulations.</p><p>• Handle insurance verifications and follow up on outstanding claims.</p><p>• Collaborate with team members to streamline billing processes and improve efficiency.</p><p>• Utilize electronic medical record (EMR) systems to manage data entry and documentation.</p><p>• Stay updated on changes in medical billing procedures and insurance policies.</p>
We are looking for a meticulous Medical Billing Specialist to join our team in Santa Barbara, California. This long-term contract position offers an excellent opportunity to contribute to the efficient management of radiology billing and insurance processes while ensuring compliance with industry standards. The ideal candidate will excel in communication and collaboration, supporting both patients and clinical staff in navigating complex billing and authorization procedures.<br><br>Responsibilities:<br>• Verify patient insurance eligibility and coverage for scheduled radiology exams, ensuring all checks are completed ahead of schedule.<br>• Initiate and secure prior authorizations or pre-certifications for radiology procedures, maintaining accuracy in coding and documentation.<br>• Follow up proactively with insurance providers to obtain approvals and communicate authorization status to patients and clinical teams.<br>• Address patient billing inquiries, assist with payment collections, and resolve discrepancies in claims or appeals.<br>• Process denied claims and write appeals for radiology procedures, ensuring timely follow-through on billing issues.<br>• Generate zero balance bills upon request and provide financial support to patients as needed.<br>• Maintain clear and precise communication with patients, physician offices, insurance companies, and internal staff.<br>• Document all interactions and updates accurately in electronic health and billing systems.<br>• Stay informed about changes in insurance regulations, payer policies, and coding guidelines relevant to radiology services.<br>• Ensure all processes adhere to compliance standards and organizational guidelines.
We are looking for a skilled Medical Collections Specialist to join our team in Irvine, California. This is a Contract-to-Permanent position, offering an excellent opportunity to grow your career in a dynamic healthcare environment. The ideal candidate will play a vital role in managing accounts receivable, resolving payment discrepancies, and ensuring compliance with industry regulations.<br><br>Responsibilities:<br>• Manage accounts receivable by following up on outstanding payments, payment errors, and claim denials.<br>• Analyze insurance Explanation of Benefits (EOBs) and initiate appeals when necessary to resolve discrepancies.<br>• Maintain detailed documentation of account issues, resolutions, and follow-up actions for patient records.<br>• Prepare and send required documentation via mail or other channels to support claims processing.<br>• Stay informed about commercial and managed care pricing models, as well as relevant rules and regulations.<br>• Ensure compliance with organizational policies and healthcare laws, safeguarding patient confidentiality at all times.<br>• Participate in compliance training sessions and promptly report any concerns or incidents to management.<br>• Utilize systems such as EHR platforms, Epic Software, and IBM AS/400 to ensure efficient claims and collections processes.<br>• Support the team by performing additional tasks as directed by supervisors or management.<br>• Contribute to the overall success of the department by collaborating with colleagues to meet organizational goals.
<p><strong>Now Hiring: Medical Billing & Front Desk Lead – Quad Cities</strong></p><p><br></p><p>Join a respected healthcare organization as the <strong>Medical Billing & Front Desk Lead</strong>! In this role, you’ll handle medical billing accuracy, insurance verification, and front desk oversight while coaching the team for success.</p><p><br></p><p><strong><u>What You’ll Do:</u></strong></p><ul><li>Manage medical billing: claims, payments, and follow-ups</li><li>Ensure accurate scheduling & insurance verification</li><li>Lead and support front desk staff</li><li>Improve workflows for billing and front desk processes</li></ul><p>Hours: Monday–Friday, 8 AM–5 PM (occasional 7 AM shift)</p><p><br></p><p><strong>Ready to make an impact? Apply today or call Lydia, Christin, or Erin at 563-359-3995!</strong></p>
<p>We are looking for a skilled individual to join our healthcare team in Henrico, Virginia, as a Medical Billing Specialist. In this long-term contract role, you will play a vital part in ensuring the accuracy and efficiency of billing processes, claims management, and collections. This position offers an excellent opportunity to contribute to the healthcare industry's revenue cycle management while utilizing your expertise in medical billing systems.</p><p><br></p><p>Responsibilities:</p><p>• Process and submit medical claims accurately and on time to ensure timely reimbursement.</p><p>• Review and resolve billing discrepancies, denials, and appeals effectively.</p><p>• Manage collections activities by following up on outstanding balances and communicating with patients and insurance providers.</p><p>• Utilize eClinicalWorks (eCW) to maintain and update billing records and claims information.</p><p>• Identify and address issues related to hospital billing processes to improve efficiency.</p><p>• Collaborate with the revenue cycle management team to optimize billing workflows.</p><p>• Analyze financial data and prepare reports related to claims and collections.</p><p>• Ensure compliance with healthcare regulations and billing standards.</p><p>• Provide excellent customer service while addressing patient inquiries regarding billing and payments.</p><p>• Stay updated on industry best practices and changes in medical billing policies.</p>
<p>A growing health technology organization is seeking a <strong>Project Assistant</strong> to support service implementation and ongoing client operations. This role will work closely with internal teams, vendor partners, and external clients to ensure smooth launches, updates, and management of healthcare-related services. The ideal candidate will be detail-oriented, organized, and passionate about improving healthcare access and delivery through technology.</p><p><br></p><p>Monday-Friday Eastern Standard Time (the rest of the team is on the east coast)</p><p><br></p><p><strong>Key Responsibilities</strong></p><ul><li>Support the implementation of new services and manage ongoing operations for existing employer and health plan clients.</li><li>Assist in launching additional services, conducting annual client maintenance, and processing change requests.</li><li>Maintain project documentation, including plans, deliverables, activities, and timelines.</li><li>Attend or facilitate implementation meetings and follow-up touchpoints with clients, health plans, and vendors.</li><li>Collect, document, and communicate client-specific implementation details to key stakeholders.</li><li>Coordinate data collection and integration efforts with client and vendor partners.</li><li>Partner with Client Success and other internal teams to manage implementations and ensure client satisfaction.</li><li>Identify, manage, and escalate risks or issues as needed.</li><li>Contribute to a positive client experience and maintain strong professional relationships.</li><li>Manage Timelines, Construction Projects, Master Scheduling, Scanning, Project Management</li></ul><p><br></p>
<p>A growing health technology organization is seeking a <strong>Project Assistant</strong> to support service implementation and ongoing client operations. This role will work closely with internal teams, vendor partners, and external clients to ensure smooth launches, updates, and management of healthcare-related services. The ideal candidate will be detail-oriented, organized, and passionate about improving healthcare access and delivery through technology.</p><p><br></p><p>Monday-Friday Eastern Standard Time (the rest of the team is on the east coast)</p><p><br></p><p><strong>Key Responsibilities</strong></p><ul><li>Support the implementation of new services and manage ongoing operations for existing employer and health plan clients.</li><li>Assist in launching additional services, conducting annual client maintenance, and processing change requests.</li><li>Maintain project documentation, including plans, deliverables, activities, and timelines.</li><li>Attend or facilitate implementation meetings and follow-up touchpoints with clients, health plans, and vendors.</li><li>Collect, document, and communicate client-specific implementation details to key stakeholders.</li><li>Coordinate data collection and integration efforts with client and vendor partners.</li><li>Partner with Client Success and other internal teams to manage implementations and ensure client satisfaction.</li><li>Identify, manage, and escalate risks or issues as needed.</li><li>Contribute to a positive client experience and maintain strong professional relationships.</li><li>Manage Timelines, Construction Projects, Master Scheduling, Scanning, Project Management</li></ul><p><br></p>
<p>Our client is looking for a medical billing specialist to join their team on a contract to hire basis. This is a hybrid role and will require in office days 3 times a week. CPC is a must have and great communication preferred. </p><p><br></p><p>Responsibilities:</p><p>• Prepare and submit medical claims to insurance payers, both electronically and via paper, ensuring accuracy and compliance.</p><p>• Monitor claim submission activities and generate reports to track progress and efficiency.</p><p>• Assemble and mail claims with all necessary documentation, including attachments, explanations of benefits (EOBs), and proper postage.</p><p>• Research patient encounter details to ensure proper packaging and billing of services in alignment with contract guidelines.</p><p>• Identify and resolve claim discrepancies proactively, collaborating with internal teams and external stakeholders.</p><p>• Manage invalid claims by correcting errors and updating physician and contract information.</p><p>• Operate automated systems to retrieve patient demographics, insurance details, and generate reports.</p><p>• Perform data entry for essential claim components, reconciling daily charges to ensure accuracy and compliance with turnaround requirements.</p><p>• Maintain organized records of claims, including storage of batches, transmittals, EOBs, and related documents.</p><p>• Participate in staff meetings, continuing education programs, and provide coverage for all billing activities as needed.our</p>
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 an experienced Benefits Specialist to join our team in San Francisco, California. In this long-term contract position, you will play a vital role in overseeing and managing the firm’s comprehensive benefits programs, ensuring smooth administration and compliance with regulatory standards. This is an excellent opportunity to contribute to employee satisfaction and well-being through effective benefits planning and communication.</p><p><br></p><p>Responsibilities:</p><p>• Develop and implement strategic plans for the firm’s benefits offerings, ensuring alignment with organizational goals.</p><p>• Communicate benefits programs clearly and effectively to employees across all offices.</p><p>• Negotiate terms and renewals with vendors and brokers to secure favorable agreements.</p><p>• Manage day-to-day benefits administration, including medical, dental, life insurance, disability, 401(k), and transportation programs.</p><p>• Serve as the primary liaison between employees, brokers, and vendors, resolving disputes and addressing concerns promptly.</p><p>• Ensure compliance with health and welfare plan regulations, maintaining accurate documentation and reporting.</p><p>• Oversee employee exit program processes related to benefits administration.</p><p>• Monitor and manage time-off policies, ensuring consistency and adherence to company standards.</p><p>• Evaluate and improve benefits-related processes to enhance efficiency and employee satisfaction.</p><p><br></p><p>** If you're interested in this position, please apply to this position and contact Kaylen Dalmacio at Kaylen.Dalmacio - at - roberthalf - .com with your word resume and reference job ID#*00410-0013302444*</p>
<p>We are looking for a dedicated Patient Access Specialist to join our team in Bethel Park, Pennsylvania. In this Contract-to-permanent role, you will play a vital part in ensuring seamless patient admissions and interactions, while upholding organizational standards and regulatory compliance. This position offers an opportunity to impact patient care through exceptional service and attention to detail.</p><p><br></p><p>Responsibilities:</p><p>• Accurately assign medical record numbers (MRNs) and complete compliance checks to ensure proper patient documentation.</p><p>• Provide clear and compassionate instructions to patients while collecting insurance information and processing physician orders.</p><p>• Meet assigned point-of-service goals through efficient and precise handling of patient accounts.</p><p>• Conduct audits of patient accounts to ensure accuracy and compliance, generating statistical reports for leadership as needed.</p><p>• Perform pre-registration tasks by contacting patients to gather demographic, insurance, and financial information, including past due balances.</p><p>• Explain and obtain signatures for general consent forms, distributing educational documents to patients and guardians.</p><p>• Verify insurance eligibility and input benefit data into the system to support billing and point-of-service collections.</p><p>• Screen medical necessity using approved software, informing patients of potential non-payment scenarios when applicable.</p><p><br></p><p>Shifts are 10-6:30pm M-F, with rotating Saturdays</p>
<p>We are looking for an experienced Medical Billing Manager with a strong background in medical administration to join our team in Mesa, Arizona. This Contract-to-permanent position offers an exciting opportunity to manage essential financial and administrative operations while contributing to the overall efficiency of our organization. Ideal candidates will possess expertise in accounts management, revenue cycle, and billing functions.</p><p><br></p><p>Responsibilities:</p><p>Oversee daily operations of the medical billing department.</p><p>Ensure accurate, timely, and compliant billing, coding, and collections.</p><p>Train and support billing staff in using billing software and maintaining compliance.</p><p>Develop and implement billing policies and procedures.</p><p>Manage patient billing inquiries and resolve issues efficiently.</p><p>Coordinate with healthcare providers and insurance companies for claim submissions.</p><p>Audit billing and collection procedures for accuracy and regulatory compliance.</p><p>Monitor billing performance and generate reports for senior management.</p><p>Stay current with billing regulations, coding updates, and insurance guidelines.</p><p>Handle sensitive patient and financial information confidentially.</p>
<p>A growing <strong>multi-specialty healthcare organization</strong> in <strong>Vista</strong> is seeking an experienced <strong>Medical Billing Supervisor</strong> to oversee the billing department and ensure timely, accurate claims submission and reimbursement. The ideal candidate is a hands-on leader with deep understanding of medical billing practices, compliance requirements, and payer regulations.</p><p>This position offers a great opportunity to work in a collaborative environment where accuracy, compliance, and mentorship are valued.</p><p><br></p><p><strong>Key Responsibilities:</strong></p><ul><li>Supervise daily operations of the billing department, including claim submission, payment posting, and denial management.</li><li>Train, mentor, and evaluate billing staff to ensure consistent performance and adherence to policy.</li><li>Monitor aging reports and identify trends in claim rejections or delays.</li><li>Review complex claims for accuracy, completeness, and compliance prior to submission.</li><li>Collaborate with the Revenue Cycle Manager to implement process improvements and reduce A/R days.</li><li>Ensure timely follow-up on outstanding claims and coordinate corrections or appeals.</li><li>Maintain compliance with HIPAA, Medicare, Medi-Cal, and all other payer requirements.</li><li>Prepare and present monthly billing performance reports to management.</li><li>Coordinate with clinical and administrative departments to resolve coding and documentation discrepancies.</li><li>Travel locally as needed to attend meetings or gather financial data for reporting purposes.</li></ul>
<p>We are looking for a meticulous Billing Clerk to join our team in North Andover, Massachusetts. In this role, you will handle medical billing processes, ensuring accuracy and compliance with industry standards while working closely with healthcare providers, insurance companies, and patients. This position is ideal for professionals with medical billing experience who enjoy a dynamic, collaborative work environment.</p><p><br></p><p>Responsibilities:</p><p>• Process and submit medical claims to insurance providers with precision and attention to detail.</p><p>• Investigate and resolve denied or rejected claims to secure timely reimbursements.</p><p>• Verify patients' insurance coverage and eligibility prior to submitting claims.</p><p>• Oversee accounts receivable, recording payments and applying necessary billing adjustments.</p><p>• Collaborate with healthcare staff to address and correct coding discrepancies.</p><p>• Generate comprehensive financial reports to monitor billing performance and metrics.</p><p>• Ensure compliance with Medicare, Medicaid, and private insurance regulations.</p><p>• Utilize medical billing software and electronic health record systems effectively.</p><p>• Provide responsive customer service by addressing patient and insurance inquiries regarding billing.</p><p>• Conduct follow-ups on unpaid claims to facilitate proper payment collection.</p><p><br></p><p><br></p><p>If interested, please reach out to jeremy.tranfaglia@roberthalf</p>
<p>Robert Half is seeking an experienced Medical Biller with coding experience for a contract opportunity in Des Moines. As a Medical Biller/Coder for our client, your primary focus will be to accurately code medical diagnoses, procedures, and services in line with medical documentation utilizing the International Classification of Diseases, Tenth Edition (ICD-10). We are seeking a candidate who has a strong understanding of medical billing procedures and the ability to sustain high standards of data privacy.</p><p> </p><p>Responsibilities:</p><ul><li>Reviewing patient bills for accuracy and completeness and obtaining any missing information.</li><li>Follow up on unpaid claims within standard billing cycle time-frame.</li><li>Check and balance each day's transactions and address any inconsistencies.</li><li>Updating billing software with rate changes.</li><li>Thoroughly comprehend the intricacies of insurance policy benefit packages and apply this knowledge when coding.</li><li>Possess the ability to discuss billing issues with doctors, hospitals, and clinics.</li></ul>
<p>Robert Half is seeking an experienced Medical Biller with coding experience for a contract opportunity in Des Moines. As a Medical Biller/Coder for our client, your primary focus will be to accurately code medical diagnoses, procedures, and services in line with medical documentation utilizing the International Classification of Diseases, Tenth Edition (ICD-10). We are seeking a candidate who has a strong understanding of medical billing procedures and the ability to sustain high standards of data privacy.</p><p> </p><p>Responsibilities:</p><ul><li>Reviewing patient bills for accuracy and completeness and obtaining any missing information.</li><li>Follow up on unpaid claims within standard billing cycle time-frame.</li><li>Check and balance each day's transactions and address any inconsistencies.</li><li>Updating billing software with rate changes.</li><li>Thoroughly comprehend the intricacies of insurance policy benefit packages and apply this knowledge when coding.</li><li>Possess the ability to discuss billing issues with doctors, hospitals, and clinics.</li></ul>
<p>Robert Half is looking for a full-time Legal Assistant to join a reputable law firm in Chicago, Illinois. In this role, you will play a key part in managing case files, communicating with various partners, and supporting the legal team with administrative and procedural tasks. The ideal candidate is proactive, organized, and skilled at multitasking in a fast-paced environment.</p><p><br></p><p>Responsibilities:</p><ul><li>Handle a high volume of case files and ensure all documentation is up to date.</li><li>Communicate effectively with clients, insurance adjusters, opposing counsel, and medical providers to facilitate case progress.</li><li>Coordinate with insurance representatives to secure necessary authorizations for client medications, treatments, and surgeries.</li><li>Draft legal documents such as routine motions, subpoenas, discovery requests, and correspondence.</li><li>Compile and prepare special reports for insurance carriers to support claims.</li><li>Request and manage itemized bills and medical records from healthcare providers.</li><li>Maintain accurate records and ensure compliance with case management software.</li><li>Assist in billing functions and calendar management to keep schedules organized and deadlines met.</li><li>Stay updated on workers' compensation laws and procedures to provide accurate support</li></ul>
A global biopharmaceutical company with a growing U.S. presence is seeking a Director of Pricing Policy and Analytics to lead pricing policy evaluation and build an advanced analytics function within the U.S. Pricing & Contracting team. This role plays a key part in shaping pricing strategies, assessing the impact of evolving healthcare policy, and supporting executive decision-making through data-driven insights.<br><br>In this role, you will:<br><br>Evaluate the impact of U.S. healthcare policy (e.g., IRA, CMS reforms, international reference pricing) on pricing strategies and market access.<br><br>Design and implement data-driven pricing dashboards and analytical models to support pricing decisions and strategic planning for in-line and pipeline assets.<br><br>Benchmark pricing strategies across therapeutic areas and geographies; track payer/PBM behavior, formulary trends, and contract performance.<br><br>Oversee advanced analytics efforts, including price elasticity analysis, scenario modeling, and value-based pricing strategy development.<br><br>Use claims data and forecasting tools to inform data-backed reimbursement strategies.<br><br>Collaborate cross-functionally with Market Access, Government Affairs, Legal, Regulatory, Finance, and Commercial teams to ensure pricing approaches are consistent, competitive, and compliant.<br><br>Key stakeholders include:<br><br>U.S. Market Access & Patient Services<br><br>Government Affairs<br><br>Finance & Government Pricing<br><br>Legal and Compliance<br><br>What we’re looking for:<br><br>8–12 years of experience in pharmaceutical pricing and contracting, pricing policy, market access, or advanced analytics, particularly within brand/specialty products.<br><br>Master’s degree preferred (e.g., MBA, Finance, Healthcare Management, or related field).<br><br>Strong knowledge of U.S. healthcare reimbursement landscape and pricing frameworks; global exposure a plus.<br><br>Hands-on experience with value-based contracting and policy analysis.<br><br>Proficiency with SAS, R, Python, or Tableau for data modeling and visualization.<br><br>Excellent communication skills and the ability to simplify complex data for senior leadership.<br><br>Ideal candidate traits:<br><br>Analytical mindset with a proactive, hands-on approach.<br><br>Entrepreneurial spirit with the ability to manage multiple initiatives in a fast-moving environment.<br><br>Detail-oriented and highly organized.<br><br>Additional Details:<br><br>Travel: Approximately 10%<br><br>Work model: Hybrid (3 days per week in Princeton, NJ office)<br><br>Benefits include:<br><br>401(k) with match<br><br>Medical, dental, and vision insurance<br><br>Company-paid life and disability coverage<br><br>HSA/FSA options<br><br>Legal and pet insurance<br><br>Paid parental leave<br><br>Mental health resources<br><br>Employee discounts and incentive compensation programs
<p>We are looking for a dedicated Insurance Referral Coordinator to join our client's team in Cincinnati, Ohio. In this long-term contract role, you will play a vital part in ensuring that patients receive timely and appropriate healthcare services by managing prior authorization requests. This position is ideal for individuals passionate about streamlining healthcare processes and improving patient care.</p><p><br></p><p>Responsibilities:</p><p>• Review and collect necessary documentation, such as medical records and physician recommendations, to support prior authorization requests.</p><p>• Submit and track prior authorization requests with insurance providers, focusing on prescription medications prescribed by primary care providers.</p><p>• Communicate with healthcare providers, patients, and insurance representatives to address and resolve authorization-related inquiries.</p><p>• Monitor the status of authorization requests and promptly inform healthcare teams of approvals, denials, or pending updates.</p><p>• Stay informed about current insurance policies, procedures, and regulations to ensure compliance and efficiency in authorization processes.</p><p>• Analyze trends in authorization denials and collaborate with teams to manage appeals, escalations, and resubmissions when necessary.</p><p>• Maintain accurate and secure records of all authorization activities and ensure adherence to organizational guidelines.</p>
<p>A boutique <strong>family medicine and wellness practice</strong> in <strong>Rancho Santa Fe</strong> is looking for a reliable and detail-oriented <strong>Medical Biller</strong> to join their administrative team. This role will handle end-to-end billing functions including claim submission, payment posting, and patient collections for a small but high-volume private office.</p><p>The ideal candidate will be self-sufficient, organized, and knowledgeable in both insurance and private-pay billing processes.</p><p><br></p><p><strong>Key Responsibilities:</strong></p><ul><li>Accurately process and submit insurance claims through clearinghouses and payer portals.</li><li>Verify patient eligibility and benefits prior to appointments.</li><li>Post insurance and patient payments; reconcile deposit logs.</li><li>Manage denials, rejections, and appeals with appropriate documentation.</li><li>Generate patient statements and follow up on outstanding balances.</li><li>Maintain compliance with HIPAA and practice policies.</li><li>Communicate with patients regarding billing inquiries in a professional manner.</li><li>Coordinate with the front office and clinical staff to resolve coding or authorization discrepancies.</li><li>Maintain accurate digital and paper billing files.</li></ul>
We are looking for a dedicated and empathetic Customer Service Representative to join a dynamic team in the healthcare industry. This long-term contract position offers an opportunity to make a meaningful impact by providing exceptional support to patients navigating their healthcare needs. If you excel in communication, problem-solving, and thrive in fast-paced environments, this role is for you.<br><br>Responsibilities:<br>• Deliver compassionate and patient-focused customer service to individuals dealing with healthcare-related concerns.<br>• Explain healthcare benefits, assist patients in understanding Explanation of Benefits (EOBs), and clarify claims, billing processes, and payment options.<br>• Guide patients through documentation submission, utilizing tools such as DocuSign to ensure efficient workflows.<br>• Handle and resolve inquiries from the financial service inbox, providing accurate and timely responses.<br>• Review and interpret insurance plans to help patients understand their coverage and financial responsibilities.<br>• Collaborate with the team to establish streamlined processes that enhance operational efficiency.<br>• Support patients in navigating payment plans and financial obligations with clarity and empathy.<br>• Work effectively in a fast-paced environment to address urgent issues and provide solutions.<br>• Maintain up-to-date knowledge of healthcare policies and billing practices to offer accurate assistance.
<p>Our <strong>healthcare client in San Luis Rey</strong> is seeking a proactive <strong>Collections Specialist</strong> to manage outstanding patient and insurance balances within the revenue cycle department. The ideal candidate has prior experience handling medical collections, understands insurance follow-up procedures, and thrives in a fast-paced, results-driven environment.</p><p><br></p><p><strong>Key Responsibilities:</strong></p><ul><li>Follow up on unpaid insurance claims and patient balances to ensure timely reimbursement.</li><li>Contact insurance companies regarding claim denials, underpayments, and appeals.</li><li>Initiate patient outreach for outstanding self-pay balances with professionalism and empathy.</li><li>Record all collection activities in the billing system, ensuring documentation accuracy.</li><li>Work closely with billing and posting teams to correct errors and resubmit claims.</li><li>Review EOBs and identify opportunities to improve collection efficiency.</li><li>Maintain compliance with HIPAA and Fair Debt Collection Practices Act (FDCPA) standards.</li><li>Generate weekly collection reports and aging summaries for management.</li></ul>
