Qureos Mentor

Alignment Healthcare

<div>Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
This is a remote position. 
The MRA Coding Auditor supports departmental Quality Assessment audits of internal Coding Analyst team and vendors to ensure accurate and complete data is submitted to CMS. Assists in Risk Adjustment related data audits (RAF, prevalence, clinical documentation improvement, P360, process) audits to identify areas of opportunity for improvement (training, data integrity, chart reviews).
GENERAL DUTIES/RESPONSIBILITIES: 
1. Supports regular quality assurance (QA) audits of internal Coding Analyst Team to validate and confirm coding &amp; abstracting quality (95% HCC accuracy). These ongoing audits ensure coding quality &amp; performance improvement standards are maintained, achieved &amp; improved per department policies and procedures. 
2. Tracks and reports progress of QA audits performed on the coding vendors to verify the coding accuracy and quality of the data submitted to AHP is accurate for submission to CMS. 
3. Works with Risk Adjustment Management on any MRA data validation / coding audit to ensure completeness and coding accuracy of all submissions to CMS. This work may encompass reviews of data for reconciliation, data flow integrity, UAT testing, high cost / low risk score members, retrospective chart reviews, or other risk adjustment related data review as directed by Manager. 
4. Analyzes and shares audit results with Manager. This information may be used for training physicians and clinical staff, documentation improvement, and system / process improvement. 
5. Utilizes, protects, and discloses Alignment Healthcare patients&rsquo; protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. 
6. Ensures compliance with all applicable federal, state &amp;local regulations, as well as with institutional/organizational standards, practices, policies &amp; procedures.
7. Maintains professional / technical knowledge by attending appropriate educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies. Stay current of industry coding, compliance, and HCC issues. Required to maintain relevant continuing education units (CEUs) in relation to individual coding certifications. 
8. Other duties as assigned to meet the organization&rsquo;s needs.
Job Requirements:
Experience:<ul><li>Required: Minimum three years of Medicare Risk Adjustment coding in a medical group or health plan setting required</li><li>Preferred:</li></ul>
Education:<ul><li>Required: High School Diploma or GED. Completion of a Medical Coding training program.</li><li>Preferred: Bachelor&rsquo;s degree in Business Administration, health Care Management or in a related field</li></ul>
Training:<ul><li>Required: Technical School or courses that are required to become a certified coder.</li></ul>
Specialized Skills:<ul><li>Required:</li></ul><ul><li>
Knowledge of</li><li>
Proficient user in MS office suite &ndash; Excel, Word, Outlook</li><li>
Previous use of Epic, Allscripts, EZCap</li><li>
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.</li><li>
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;</li><li>
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly</li><li>
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.</li><li>
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.</li><li>
Report Analysis Skills: Comprehend and analyze statistical reports.</li></ul>
Licensure:<ul><li>Required: Certified Coder required, CCS, CCS-P, CPC, or CRC</li></ul>
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $64,384.00 - $96,577.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.<ul><li>DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email careers@ahcusa.com.</li></ul></div>

MRA Coding Auditor - Remote

<div>Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Alignment Health is seeking an organized, detail-oriented, and customer service oriented telehealth coordinator (bilingual Spanish, medical assistant with front- and back-office, and remote experience) to join the remote Virtual Care Center (VCC). 
 
As a telehealth coordinator, you will support patients and providers in the Virtual Care Center. This includes, but is not limited to, answering calls in the phone queue, scheduling telephonic and virtual appointments, following up on referrals and authorizations, supporting outbound follow up calls, providing systems trainings for new hires, and completing administrative tasks. You will also be responsible for managing inbound and outbound calls in the phone queue while collaborating with cross-functional teams such as Clinical Operations, Member Services, AVA Product team, and DTS Help Desk support to successfully manage the program. As a telehealth coordinator, you will be focused on assisting Alignment Health staff and patients with resolving issues in a timely manner. This role reports to the Director of Virtual Health. 
 
Individuals with front and back office medical assistant experience in PCP, clinic, and / or urgent care settings, and remote experience are highly encouraged to apply! 
 
Schedule: 
<ul><li>Option A: Monday / Tuesday / Wednesday / Friday / Saturday 9:00 AM &ndash; 6:00 PM Pacific Time (Thursdays and Sundays off)</li><li>Option B: Sunday / Monday / Tuesday / Wednesday / Thursday 11:00AM &ndash; 8:00 PM Pacific Time (Fridays and Saturdays off)</li></ul>
General Duties / Responsibilities<ul><li>
Answer inbound calls on the Virtual Care Center queue</li><li>
Collect appropriate patient information for scheduling virtual appointments with providers</li><li>
Screen patients for appropriate telehealth platform use for virtual appointments</li><li>
Support providers with requests for referrals and authorizations including submission, review, and follow up of requests</li><li>
Contact partnered medical offices to support patient requests as necessary (ie. IPA groups, PCP offices, pharmacies, DME companies)</li><li>
Complete outreach calls for various patients&rsquo; groups as applicable (ie. ER admits, Teladoc follow ups, Annual assessments)</li><li>
Support new hire onboarding by completing training or shadowing sessions of systems used in VCC</li><li>
Complete other job duties as assigned</li><li>
Participate in team meetings</li></ul>
Note: The Virtual Care Center provides 24-hour member support, and team schedules rotate to maintain coverage. Because there is no single time when all team members are consistently on shift, team meetings are mandatory and are scheduled with advance notice (approximately 2&times; per month for 30 minutes). Team members are expected to attend these meetings even if they occur during a non-scheduled work hour or meal break. Attendance is clocked and paid, and camera use is optional &mdash; phone participation is acceptable. 
Supervisory Responsibilities:
N/A
Job Requirements:
Experience:
Required:<ul><li>
Experience with providing high quality customer service</li><li>
Experience providing technical assistance</li><li>
Minimum 1 year experience in a primary care or medical office setting using phones and scheduling appointments</li></ul>
Education:
Required:<ul><li>
High school diploma or general education degree (GED).</li></ul>
Preferred:<ul><li>
Completion of medical assistant program from an accredited school of training.</li></ul>
Training:<ul><li>Preferred: Medical Terminology</li></ul>
Specialized Skills:
Required:<ul><li>
Able to use multiple systems simultaneously</li><li>
Basic understanding in current mobile device technology and ability to learn and adapt to Alignment specific applications and protocols</li><li>
Proficiency in Microsoft Suite programs (Outlook, Teams, Work, Excel)</li><li>
Basic math skills required for data analyzation</li><li>
Able to trouble-shoot and research issues effectively</li><li>
Willingness and capability to learn new technologies and adapt to dynamic environment</li><li>
Strong customer service skills</li><li>
Technology and automated solutions oriented</li><li>
Well organized with strong attention to detail and analytical skills while maintaining speed in completing work</li><li>
Efficient working style with strict adherence to deadlines</li></ul>
Preferred:<ul><li>
Bilingual Spanish</li></ul>
Licensure:<ul><li>Required: None</li><li>Preferred:</li></ul><ul><li>
Medical assistant certificate</li><li>
Medical terminology certificate</li></ul>
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $41,472.00 - $62,208.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.<ul><li>DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email careers@ahcusa.com.</li></ul></div>

Telehealth Outreach Coordinator, Virtual Care Center (Saturdays Required)

<div>Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The medical assistant provides clinical and administrative support and works closely with clinicians to administer medical services. Responsible for assisting clinicians in the examination and treatment of patients under the direction of the Physician, PA or Nurse Practitioner.
GENERAL DUTIES/RESPONSIBILITIES: 
1. Provides Front Office support:
a. Greets patients in a friendly, service-oriented manner in compliance with Alignment policies and workflows.
b. Oversees patient check in by ensuring medical records/charts have been pulled, patient data is current, appropriate paperwork is in order, and charts are reviewed/prepared.
c. Oversees patient check out by scheduling follow up appointments, collecting co-payment if applicable, ensuring paperwork is complete.
d. Schedules and confirms patient appointments.
e. Reconciles co-payments at the end of each day.
2. Provides Back Office Support:
a. Rooms and interviews patients measures vital signs and records reason for visit.
3. Explains procedures, performs treatments, and administers prescribed medication.
Minimum Requirements:<div></div>
Experience:<ul><li>Required: 1 year Customer Service experience required.</li><li>Preferred: 2 years&rsquo; experience as a working medical assistant preferred. Experience working with Medicare population preferred.</li></ul>
Education:<ul><li>Required: High School Diploma or GED.</li></ul>
Training:<ul><li>Required: Medical Assistant from an accredited school of training required</li></ul>
Specialized Skills:<ul><li>Required:</li></ul><ul><li>
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.</li><li>
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;</li><li>
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly</li><li>
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.</li><li>
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.</li></ul>
Licensure:<ul><li>Required: MA Certification.</li><li>Preferred:</li></ul>
Other:<ul><li>Preferred: Bi-lingual (English/Spanish) preferred, but not required.</li></ul>
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1 While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2 The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus
Pay Range: $38,569.00 - $57,853.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.<ul><li>DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email careers@ahcusa.com.</li></ul></div>

Field Medical Assistant (Reno, NV)

<div>Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Remote Real-Time Analyst (RTA) is responsible for intraday workforce management to ensure optimal alignment between staffing and contact center demand across the Customer Experience workgroup. This role monitors real-time performance against forecast and staffing plans, identifies variances, and executes immediate corrective actions to achieve service level, ASA, occupancy, and efficiency targets. The RTA serves as the operational bridge between Workforce Management and Operations to proactively manage risk, maintain schedule adherence, and protect the customer experience.
ob Duties/Responsibilities:
Intraday Performance Management<ul><li>
Monitor real-time performance against key metrics including Service Level, ASA, Abandon Rate, AHT, Occupancy, and Schedule Adherence</li><li>
Compare actual workload and staffing to forecast and capacity plans; identify intraday variances and implement corrective actions</li><li>
Manage real-time queue, skill, and routing adjustments (ring groups) to balance workload and optimize resource utilization</li><li>
Coordinate with Operations to execute intraday actions such as overtime, VTO, off-phone adjustments, meetings, training, or break/lunch changes</li><li>
Flexibility to work shift based on operational need</li></ul>
Adherence &amp; Capacity Control<ul><li>
Monitor and drive real-time adherence (RTA) to minimize unplanned shrinkage and ensure delivery of planned capacity</li><li>
Identify and communicate adherence risks or behavioral trends impacting service performance</li><li>
Partner with Operations leadership to improve adherence, occupancy balance, and schedule efficiency</li></ul>
Intraday Analysis &amp; Communication<ul><li>
Perform intraday trend analysis of volume, handle time, and volume drivers</li><li>
Identify emerging risks related to contact spikes, AHT changes, absenteeism, system issues, or external drivers</li><li>
Provide timely and concise communication and actionable recommendations to Operations and the broader WFM team</li><li>
Maintain intraday reporting and status updates on performance, risks, and mitigation actions</li></ul>
Forecast vs. Actual Management<ul><li>
Track forecast accuracy at the interval level and document key drivers of variance</li><li>
Monitor external or business events that may impact contact demand</li><li>
Provide intraday insights to support short-term forecasting adjustments and continuous improvement</li></ul>
WFM Systems &amp; Scheduling<ul><li>
Create, maintain, and publish workforce schedules within WFM and ACD telephony platforms</li><li>
Validate schedule integrity, staffing levels, and ring/skill group assignments</li><li>
Monitor real-time system performance and escalate telephony, routing, or application issues impacting service delivery</li><li>
Ensure data accuracy across WFM and telephony platforms</li></ul>
Supervisory Responsibilities:<ul><li>
None</li></ul>
Job Requirements:
Experience:<ul><li>Required:</li></ul><ul><li>
Minimum 5 years in a contact center environment</li><li>
Minimum 3 years in Workforce Management, Real-Time</li><li>Preferred: None</li></ul>
Education:<ul><li>Required: High School Diploma or GED.</li><li>Preferred: Bachelor&rsquo;s degree or equivalent experience</li></ul>
Training:<ul><li>Required: None</li><li>Preferred: WFM or Contact Center related certification</li></ul>
Specialized Skills:<ul><li>Required:</li></ul><ul><li>
Intraday management and service recovery strategies</li><li>
Understanding of Erlang-based staffing principles and interval planning</li><li>
Knowledge of key WFM drivers: shrinkage, occupancy, service level, ASA, AHT, forecast accuracy</li><li>
Advanced Excel skills (data analysis, pivot tables, trend analysis)</li><li>
Ability to interpret interval-level performance data and translate insights into operational actions</li><li>
Strong problem-solving and decision-making in a high-volume, real-time environment</li><li>
Effective communication and collaboration with Operations and WFM partners</li><li>
Experience with WFM and telephony platforms (Talkdesk or equivalent)</li></ul>
Licensure:<ul><li>Required: None</li><li>Preferred:</li></ul>
Other:<ul><li>Required: None</li></ul>
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this 100% Remote job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $53,210.00 - $79,815.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.<ul><li>DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email careers@ahcusa.com.</li></ul></div>

Remote Analyst, WFM Real Time

<div>Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Alignment Health is seeking an compassionate, customer service oriented, and organized, bilingual Spanish care coordinator in California to join the remote Care Anywhere team. The Care Coordinator is responsible for supporting the Care Anywhere Program field providers, scheduling, outreach, and managing all care coordination needs for high-risk members enrolled with the program. If you're looking for an opportunity to learn and grow, be part of a collaborative team, and make a difference in the lives of seniors - we're looking for YOU! 
 
Individuals with front office medical assistant experience, experience supporting multiple providers, and high call volume experience are highly encouraged to apply. 
 
Schedule: Mondays - Fridays 
- Option 1: 8:00 AM - 5:00 PM Pacific Time (with 1-hour lunch) 
- Option 2: 8:30 AM - 5:30 PM Pacific Time (with a 30- minute lunch)<div>
General Duties / Responsibilities</div><div><div><div><div><div><div><div><div><div><ul><li>
Manage (4) provider schedules to ensure schedules are filled.</li><li>
Prepare charts for upcoming home visit appointments (check member eligibility, gather records needed by the provider prior to the home visit)</li><li>
Conduct outreach for scheduling, appointment confirmation calls, wellness checks for high risk members, and to providers / pharmacies for member needs.</li><li>
Handle inbound / outbound Call (60 - 80 calls / day)</li><li>
Obtain medical records from provider offices, hospitals and skilled nursing facilities (SNF) and upload medical records to the electronic medical records (EMR).</li><li>
Submit referral authorizations to independent physician association (IPA) / medical groups for specialty, durable medical equipment (DME), and home health (HH) services.</li><li>
Coordinate lab orders, transportation for high-risk members.</li><li>
Documentation via EMR for Inbound / Outbound calls.</li><li>
Support short message service (SMS) and member outreach campaigns.</li><li>
Assist nurse practitioner (NP) team with visit preparation needs<ul><li>
Appointment reminders to members</li><li>
Assign members to NP in EHR</li><li>
Provide needed documentation to NP for visits each day</li></ul></li><li>
Direct inbound calls from members / family related to medication refills</li><li>
Assist with maintaining and updating members' records</li><li>
Assist with mailing or faxing correspondence to primary care physicians (PCP), specialists, related to, as needed.</li><li>
Attend Care Anywhere meetings / presentations and participates, as appropriate.</li><li>
Recognize work-related problems and contributes to solutions.</li><li>
Work with outside vendors to provide appropriate care needs for members</li></ul>
Job Requirements:
Experience:<ul><li>
Required: Minimum (1) year experience entering referrals and prior authorizations in a healthcare setting.</li><li>
Preferred: 2 years' healthcare experience.</li></ul>
Education:<ul><li>
Required: High School Diploma or GED.</li><li>
Preferred: Completion of medical assistant program from an accredited school of training</li></ul>
Training:<ul><li>Preferred: Medical Terminology</li></ul>
Specialized Skills:<ul><li>Required:</li></ul><ul><li>
Able to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.</li><li>
Knowledge of ICD9 and CPT codes</li><li>
Knowledge of Managed Care Plans</li><li>
Able to type by 10-key touch minimum of 40 words per minute (WPM)</li><li>
Proficient with Microsoft Outlook, Excel, Word</li><li>
Effective written and verbal communication skills; able to establish and maintain a constructive relationship with diverse members, management, employees and vendors;</li><li>
Language Skills: Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Able to write routine reports and correspondence. Communicates effectively using good customer relations skills.</li><li>
Mathematical Skills: Able to add and subtract two-digit numbers and to multiply and divide with 10&rsquo;s and 100&rsquo;s. Able to perform these operations using units of American money and weight measurement, volume, and distance.</li><li>
Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Able to deal with problems involving a few concrete variables in standardized situations.</li><li>
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.</li><li>
Bilingual English / Spanish required.</li></ul><ul><li>Preferred:</li><li>
Knowledge working in Athena</li></ul>
Licensure:<ul><li>Required: None</li><li>Preferred:</li></ul><ul><li>
Medical assistant certificate</li><li>
Medical terminology certificate</li></ul>
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</div></div></div></div></div></div></div></div></div>
Pay Range: $41,472.00 - $62,208.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.<ul><li>DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email careers@ahcusa.com.</li></ul></div>

Care Coordinator (Remote, Bilingual Spanish, Medical Assistant, California)

<div>Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
This position is in our Orange County office. 
The Claims Clerical-Mailroom Support Clerk is responsible for managing incoming mail from providers while ensuring a high level of accuracy. Requires the ability to multi-task while providing accurate and timely mail triaging and processing.
Job Responsibilities:<ul><li>
Opens, triages, and batches incoming mail &amp; faxes.</li><li>
Utilizes claim processing system to research provider and member status.</li><li>
Attaches appropriate correspondence to member claims.</li><li>
Keeps a daily log &amp; count of all mail.</li><li>
Processes daily pend, denial and claim forwarding correspondence.</li><li>
Provides the requested documentation to internal departments and provider network (EOB, faxes, scanning, requests for letter copies).</li><li>
Supports research projects through claims look-up and simple documentation via Excel spreadsheets.</li><li>
Supports the needs of providers and claims team through professional communication that demonstrates the company culture.</li><li>
Conducts outbound calls to research and gather information for provider data updates.</li><li>
Participates in the Claims Department team meetings and other activities (as needed).</li><li>
Ensures the privacy and security of PHI (Protected Health Information) as outlined in the department policies and procedures relating to HIPAA Compliance.</li><li>
Performs other duties and projects as assigned.</li></ul>
Job Requirements:
Experience:
Required: At least one year of mailroom or clerical experience in a healthcare environment, along with entry-level claims processing experience.
Preferred: Medicare claim knowledge.
Education:
Required: High School Diploma or GED
Preferred: Medical Billing or Medical Front Office Assistant Certificate
Specialized Skills:<ul><li>
Required: Possess a strong team attitude.</li><li>
Ability to multi-task.</li><li>
Ability to remain focused and productive while performing tasks daily.</li><li>
Ability to perform data entry.</li><li>
Ability to travel between locations.</li><li>
Ability to operate a telephone, computer, scanner, copier, fax machine, and other office equipment.</li><li>
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.</li><li>
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors.</li><li>
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly.</li><li>
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.</li><li>
Computer Skills: Knowledge of computer programs and applications required.</li></ul>
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $41,600.00 - $57,600.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.<ul><li>DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email careers@ahcusa.com.</li></ul></div>

Claims Mailroom Support Clerk (Temp to Hire Benefits Included) - Orange County

<div>Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Hybrid Manager for our Pharmacy Technicians is responsible for the day-to-day supervision and performance management of the pharmacy technician team. This role ensures operational efficiency, supports the MAPD Pharmacy department&rsquo;s goals related to medication adherence and pharmacy quality, and collaborates cross-functionally to enhance member experience and outcomes.
Job Responsibilities:<ul><li>
Supervise Pharmacy Technician Leads and pharmacy technicians to ensure timely and accurate completion of work supporting pharmacy operations.</li><li>
Monitor team performance and provide coaching, feedback, and development opportunities.</li><li>
Conduct performance evaluations and support corrective action processes as needed.</li><li>
Translate strategic goals into actionable workflows for the technician team.</li><li>
Foster a culture of accountability and continuous learning through coaching, mentoring, and performance feedback.</li><li>
Collaborate with the Sr. Manager, Pharmacy Technicians to implement workflow improvements and operational policies.</li><li>
Ensure compliance with departmental procedures and regulatory requirements.</li><li>
Support audit readiness and ensure technician documentation meets internal standards.</li><li>
Assist in resolving issues related to claims processing, member/provider correspondence, and PBM interactions.</li><li>
Work cross-functionally to enhance workflows and improve pharmacy quality outcomes, Star performance, and member satisfaction.</li><li>
Support various pharmacy programs and campaign activities.</li><li>
Participate in departmental meetings and contribute to quality improvement initiatives.</li><li>
Participate in PBM oversight meetings and quality control monitoring.</li><li>
Other duties and projects not listed above</li></ul>
Supervisory Responsibilities:
Oversees assigned staff. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and performance management.
Job Requirements:
This is a Hybrid remote role, working in office at least 1 day per week and will require more days in office to cover for other members of management for time off coverage.
Experience:
Required: 3&ndash;5 years of experience as a pharmacy technician, with at least 1&ndash;2 years in a supervisory or lead role.
Preferred: Call Center Management experience highly preferred, Experience in managed care, Medicare Part D, or pharmacy quality programs
Education:
Required: High school diploma or equivalent required
Preferred: Associate or Bachelor&rsquo;s degree in healthcare, business, or related field
Specialized Skills:
Required: Strong leadership and team management skills. Excellent communication and interpersonal abilities. Proficient in workflow coordination, performance monitoring, and coaching. Proficient in Microsoft Office Suite and pharmacy systems (e.g., claims platforms, CRM tools).
Licensure:
Required: Active Pharmacy Tech License or equivalent work experience
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $58,531.00 - $87,797.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.<ul><li>DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email careers@ahcusa.com.</li></ul></div>

Hybrid-Manager, Pharmacy Technicians

Join Alignment Healthcare and explore 9   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.