grievance and appeals specialist

MCS HEALTHCARE HOLDINGS, LLC

<div><p><b>Especialista Senior De Querellas Y Apelaciones</b></p><p><br>
Regular</p><p>
Exempt</p><p></p><p><b><br>
GENERAL DESCRIPTION:</b><br>
Analyzes, investigates, resolves, and answers grievances received through the Center for Medicaid and Medicare Services (CMS) and Complaint Tracking Module (CTM), pre-service appeals, Office of Insurance Commissioner (OIC), and Administrative Organization Determinations (AOD). Ensure timely resolution of cases following contractual obligations and regulatory requirements applicable across all lines of business (LOB) in the company.
</p><div><b>ESSENTIAL FUNCTIONS:</b><br>
<ul><li>Records, manages, and resolves cases submitted through the CTM. Complies with verbal contact with the insured and/or authorized representative, or provider during the CTM case investigation process to document and categorize the issue presented, and review the documentation provided by operational areas to ensure proper resolution of cases.</li></ul></div><ul><li>Document in English the chronology of investigation and resolution on the CMS database, applying the contractual language of benefits and covered services according to the evidence of coverage, or others.</li><li>Evaluate in the investigation whether a root cause can be identified for the issue. If a root cause is determined, collaborate with the management of the affected operational areas to develop and implement corrective action plans aimed at minimizing the recurrence of CTMs or grievances.</li><li>Actively participate in the CTM workgroup, engaging with leaders from other Departments or Units to review RCA and coordinate on sustainable action plans to prevent future occurrences.</li><li>Complies with the validation and registration on electronic platforms, as applicable for the pre-service appeals processes, such as Clinical, USA, Dental, SSBCI, and Part B medication.</li><li>If a reconsideration or member request for a pre-service appeal is denied by the Classicare LOB, it is responsible for submitting the cases to the CMS contracted Independent Review Entities (IRE - Maximus). If the reconsideration or member request is denied by the MCS Life LOB, and the member requests a second-level appeal, it must follow the compliance guidelines of the OIC regulations and submit the cases to the Independent Review Organizations (IRO). Case files must be documented in English during the appeals process, considering the required records and timeliness.</li><li>Reviews and validates MCS Classicare members&rsquo; requests to determine eligibility for processing on the electronic platform, ensuring compliance with investigation protocols, evaluation standards, and timeliness requirements, following the company&rsquo;s Evidence of Coverage.</li><li>Document notes or chronology of CTM&rsquo;s, AOD&rsquo;s, and pre-service appeals investigations in the electronic platform to evidence proper management. This includes attachment of documentation related to the case and evidence of written notices to members or providers, based on the regulatory requirements.</li><li>Monitors CTM&rsquo;s and appeals processes to avoid impact on three (3) Stars metrics related to CTM, Appeals Timeliness, and Appeals Review (Upheld).</li><li>Supports in the unit rotation process by responding to inquiries related to pre-service appeals and AODs. Ensures appropriate referrals to other Departments for cases that do not qualify as appeals or AODs, assigns cases to relevant Specialists, and accurately updates internal logs and systems.</li><li>Responsible for overseeing the on-call program and monitoring processes related to the Unit. This includes supervision of corporate cell phone usage assigned to the Unit and ensuring timely access to staff by company personnel and regulatory agencies during and outside regular business hours, including evenings, weekends, and holidays. This is a regulated function that requires continuous availability and compliance with applicable regulatory requirements, to mitigate operational and compliance risks.</li><li>Complies with the delivery of data required by G&amp;A Analysts or immediate Supervisor to complete reports required by Regulatory Agencies, in the established timeframes and as requested (Example: CMS, ASES, OPP, OIC, other Departments, and/or MCS Units).</li><li>Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.</li><li>May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.</li></ul><p><b>
MINIMUM QUALIFICATIONS</b><br>
<b>Education and Experience:</b> Bachelor&rsquo;s Degree in Business Administration, Finance, Social Services, or Criminal Justice. At least four (4) years of experience in the areas of Research, Auditing, or Client/Provider Service, preferred in the Healthcare Insurance Industry.</p><p><b>
&ldquo;Proven experience may be replaced by previously established requirements.&rdquo;</b></p><p><b>
Certifications / Licenses: N/A Other:</b> Knowledge of the following systems is preferred: HPMS, PMHS, Beacon Healthcare System, and TruCare.</p><p><b>
Languages:</b></p><p>
Spanish &ndash; Advanced (comprehensive, writing and verbal)</p><p>
English &ndash; Advanced (comprehensive, writing and verbal)</p><p></p><p><b><br>
&ldquo;We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.&rdquo;</b></p></div>

Especialista Senior De Querellas Y Apelaciones

Robert Half

<div>
 <p>
  Appeals Specialist (Temporary Contract)
 </p>
 <p>
  <strong>
   Location:
  </strong>
  Remote
 </p>
 <p>
  <strong>
   Schedule:
  </strong>
  Full-Time | Monday&ndash;Friday | 8:00 AM &ndash; 4:30 PM
 </p>
 <p>
  <strong>
   Duration:
  </strong>
  Approximately 3 Months (through September 2026)
 </p>
 <p>
  <strong>
   Pay Rate:
  </strong>
  $21.50/hour
 </p>
 <p>
  Position Overview
 </p>
 <p>
  We are seeking detail-oriented and customer-focused Appeals Specialists to join a growing healthcare operations team. This fully remote opportunity is ideal for individuals with experience in healthcare administration, claims processing, customer service, or medical office support who enjoy research, problem-solving, and working in a fast-paced environment.
 </p>
 <p>
  In this role, you will support the review, intake, research, and processing of healthcare-related appeals and inquiries while ensuring accuracy, quality, and compliance with established guidelines. Successful candidates will possess strong organizational skills, the ability to manage multiple priorities, and a commitment to delivering high-quality work.
 </p>
 <p>
  Key Responsibilities
 </p>
 <ul>
  <li>
   Review and research incoming correspondence, documentation, and requests to determine appropriate routing and handling
  </li>
  <li>
   Enter and maintain appeal cases and related information within internal systems
  </li>
  <li>
   Research and validate information using various databases, reference materials, and online resources
  </li>
  <li>
   Manage daily workload to meet established productivity, quality, and turnaround time expectations
  </li>
  <li>
   Accurately identify and triage expedited appeal requests
  </li>
  <li>
   Respond to internal inquiries via phone, email, and instant messaging as needed
  </li>
  <li>
   Process authorization-related requests and ensure appropriate documentation is obtained
  </li>
  <li>
   Assist with privacy-related activities and documentation requirements
  </li>
  <li>
   Support administrative functions including filing, scanning, printing, and document management
  </li>
  <li>
   Assist with scheduling activities and other operational support tasks as needed
  </li>
  <li>
   Collaborate with team members to achieve departmental goals and service standards
  </li>
  <li>
   Perform additional duties as assigned
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  Additional Information
 </p>
 <ul>
  <li>
   Fully remote position
  </li>
  <li>
   Equipment provided
  </li>
  <li>
   Standard Monday&ndash;Friday schedule
  </li>
  <li>
   No overtime anticipated
  </li>
  <li>
   Opportunity to gain valuable experience within a large healthcare organization
  </li>
  <li>
   Collaborative and supportive team environment
  </li>
 </ul>
 <p>
  If you enjoy research, problem-solving, and delivering high-quality work while supporting important healthcare operations, we encourage you to apply.
  <br/>
 </p>
 <p>
  Qualifications
 </p>
 <p>
  Required
 </p>
 <ul>
  <li>
   High School Diploma or GED
  </li>
  <li>
   Minimum six months of experience in customer service, administrative support, healthcare operations, claims processing, or a related field
  </li>
  <li>
   Strong data entry and computer skills
  </li>
  <li>
   Experience working with multiple systems and databases simultaneously
  </li>
  <li>
   Ability to research information, analyze findings, and make appropriate decisions
  </li>
  <li>
   Excellent attention to detail and organizational skills
  </li>
  <li>
   Strong written and verbal communication abilities
  </li>
  <li>
   Ability to work independently in a remote environment
  </li>
 </ul>
 <p>
  Preferred
 </p>
 <ul>
  <li>
   Previous experience within the healthcare industry from either a payer or provider perspective
  </li>
  <li>
   Experience supporting appeals, claims, authorizations, benefits, or healthcare administration functions
  </li>
  <li>
   Familiarity with healthcare terminology and insurance processes
  </li>
  <li>
   Experience meeting productivity and quality performance metrics
  </li>
 </ul>
 <p>
  Knowledge, Skills &amp;  Abilities
 </p>
 <ul>
  <li>
   Strong keyboarding and data entry accuracy
  </li>
  <li>
   Proficiency with Microsoft Office and Windows-based applications
  </li>
  <li>
   Ability to multitask and prioritize work effectively
  </li>
  <li>
   Strong problem-solving and critical thinking skills
  </li>
  <li>
   Ability to maintain confidentiality and handle sensitive information appropriately
  </li>
  <li>
   Excellent customer service and interpersonal communication skills
  </li>
  <li>
   Ability to adapt to changing priorities and business needs
  </li>
  <li>
   Strong commitment to quality, accuracy, and service excellence
  </li>
 </ul>
 <p>
  <br/>
  <br/>
 </p>
 TalentMatch
 <sup>
  &reg;
 </sup>
 <br/>
 <br/>
 <p>
  Robert Half is the world&rsquo;s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
 </p>
 <br/>
 <br/>
 <p>
  Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app and get 1-tap apply, notifications of AI-matched jobs, and much more.
 </p>
 <br/>
 <br/>
 <p>
  All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
 </p>
 <br/>
 <br/>
 <p>
  &copy; 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking &ldquo;Apply Now,&rdquo; you&rsquo;re agreeing to Robert Half&rsquo;s Terms of Use and Privacy Notice.
 </p>
</div>


CW Appeals Specialist

Corazon Imaging

<p><b>Full-Time | Hybrid: 3 Days In-Office / 2 Days Remote</b></p><p><b>About Corazon Imaging</b></p><p>Corazon Imaging is the leading outpatient provider of coronary CT angiography, or CCTA, in the United States. Corazon is focused on expanding access to advanced, non-invasive cardiac imaging that helps physicians identify coronary artery disease earlier, improve patient care, and support better clinical decision-making.</p><p>As Corazon continues to grow nationally, we are seeking a highly organized, detail-oriented <b>Cardiac CT Reporting Operations Specialist</b> to support the timely completion, quality control, combination, and distribution of cardiac CT imaging reports.</p><p><b>General Summary</b></p><p>The Cardiac CT Reporting Operations Specialist will manage the operational workflow for CCTA reporting, including tracking report turnaround times, coordinating the completion and combination of CCTA, FFR-CT, AI-plaque analysis, and extracardiac overread reports, and ensuring final reports are accurately distributed to ordering providers and appropriate recipients.</p><p>This role will also support the creation and submission of templated letters of medical necessity, respond to medical records requests, and help ensure that Corazon&rsquo;s reporting operations are timely, complete, compliant, and provider-focused.</p><p>This is an ideal role for someone with a background in radiology operations, cardiology practice operations, medical records, health information management, prior authorization, imaging center administration, or clinical documentation support.</p><p><b>Essential Duties: </b></p><p><b>CCTA Reporting Workflow Management</b></p><ul><li>Monitor all CCTA cases from image acquisition through final report completion and distribution.</li><li>Track report turnaround time and identify cases at risk of delay.</li><li>Communicate with physicians, radiologists, reading teams, and internal operations staff to ensure reports are completed within expected timeframes.</li><li>Maintain daily reporting worklists and case-status trackers.</li><li>Escalate delayed, incomplete, or missing reports to appropriate leadership.</li><li>Support Corazon&rsquo;s commitment to timely, accurate, and complete cardiac CT reporting.</li><li>Perform other duties as assigned.</li></ul><p><b>Report Combination and Finalization</b></p><ul><li>Coordinate and combine multiple report components into a complete final reporting package, including:</li><li>CCTA report</li><li>FFR-CT report, when applicable</li><li>AI-plaque analysis report, when applicable</li><li>Extracardiac overread report</li><li>Ensure all applicable report components are present before final distribution.</li><li>Review reports for completeness, formatting consistency, correct patient identifiers, correct ordering provider information, and appropriate attachment of supporting documentation.</li><li>Confirm that revised or addended reports are properly tracked and redistributed when necessary.</li></ul><p><b>Report Distribution</b></p><ul><li>Distribute finalized reports to ordering physicians, referring practices, and other approved recipients through approved channels.</li><li>Ensure reports are submitted to the correct practice, provider, fax number, portal, or electronic medical record destination.</li><li>Maintain accurate documentation of report delivery and confirmation when required.</li><li>Assist with provider office follow-up when reports are missing, delayed, or need to be resent.</li><li>Support excellent communication with referring provider offices.</li></ul><p><b>Letters of Medical Necessity and Documentation Support</b></p><ul><li>Prepare templated letters of medical necessity using approved Corazon templates.</li><li>Ensure letters are completed accurately using case-specific information, payer requirements, and supporting clinical documentation.</li><li>Coordinate with internal teams to obtain missing information needed for letters or appeals.</li><li>Maintain organized records of submitted letters and related documentation.</li><li>Support prior authorization, appeal, and medical necessity workflows as needed.</li></ul><p><b>Medical Records Requests</b></p><ul><li>Processing medical records requests in accordance with company policy and HIPAA requirements.</li><li>Verify requestor authorization and ensure records are released only to appropriate parties.</li><li>Gather and send requested imaging reports, supporting documentation, and related records.</li><li>Track completion of medical records requests and maintain proper documentation.</li><li>Work with internal teams to resolve incomplete, unclear, or urgent records requests.</li></ul><p><b>Quality Control and Compliance</b></p><ul><li>Ensure all reporting and records workflows are completed in a HIPAA-compliant manner.</li><li>Protect patient confidentiality and sensitive health information at all times.</li><li>Identify workflow gaps, recurring delays, or documentation issues and escalate appropriately.</li><li>Help maintain standard operating procedures for report tracking, report distribution, letters of medical necessity, and medical records requests.</li><li>Participate in process improvement initiatives to improve turnaround time, reporting accuracy, and provider satisfaction.</li></ul><p><b>Required Qualifications</b></p><ul><li>Minimum of 2&ndash;4 years of experience in a healthcare administrative, radiology, cardiology, medical records, prior authorization, or clinical documentation role.</li><li>Strong understanding of HIPAA and patient privacy requirements.</li><li>Experience working with medical records, physician reports, clinical documentation, or imaging reports.</li><li>Strong attention to detail and ability to manage multiple time-sensitive cases at once.</li><li>Excellent written and verbal communication skills.</li><li>Comfortable communicating with physicians, radiologists, provider offices, patients, and internal team members.</li><li>Strong organizational skills and ability to maintain accurate tracking systems.</li><li>Proficiency with Microsoft Office, Google Workspace, EMR systems, fax platforms, portals, or similar healthcare workflow tools.</li><li>Ability to work independently in a hybrid environment while remaining accountable to daily deadlines.</li></ul><p><b>Preferred Qualifications</b></p><ul><li>Experience in radiology, cardiology, outpatient imaging, hospital imaging, or diagnostic testing operations.</li><li>Familiarity with coronary CTA, cardiac imaging, CT imaging, or advanced imaging workflows.</li><li>Experience with PACS, RIS, EMR, medical records platforms, or provider portal systems.</li><li>Prior experience preparing or supporting letters of medical necessity, prior authorization documentation, or payer appeals.</li><li>Associate&rsquo;s or bachelor&rsquo;s degree in healthcare administration, health information management, business, or a related field preferred.</li><li>RHIT, RHIA, CPC, CMA, medical assistant, LPN, radiology assistant, or similar healthcare credential helpful but not required.</li></ul><p><b>Ideal Candidate Background</b></p><p>The ideal candidate does not need to be a clinician, but should have meaningful experience in a healthcare environment where accuracy, timeliness, documentation, and patient confidentiality are critical.</p><p>Strong candidates may come from backgrounds such as:</p><ul><li>Radiology reporting coordinator</li><li>Imaging center operations coordinator</li><li>Cardiology practice coordinator</li><li>Medical records specialist</li><li>Health information management specialist</li><li>Prior authorization or appeals specialist</li><li>Clinical documentation coordinator</li><li>Physician practice operations specialist</li><li>Medical assistant with strong administrative and documentation experience</li><li>PACS/RIS or imaging workflow support specialist</li></ul><p>This role is best suited for someone who is highly reliable, detail-driven, comfortable with medical terminology, and able to manage multiple moving parts in a fast-paced clinical operations environment.</p><p><b>Schedule and Work Environment</b></p><ul><li>Full-time position.</li><li>Hybrid schedule: three days per week in office and two days per week remote.</li><li>Standard business hours, with occasional flexibility required based on reporting volume or urgent provider needs.</li><li>Office-based collaboration with clinical operations, reporting, provider relations, billing, authorization, and medical leadership teams.</li></ul><p><b>Compensation and Benefits</b></p><ul><li>Annual salary range: $55,000&ndash;$65,000, based on experience and qualifications.</li><li>Health insurance.</li><li>Paid time off.</li><li>401(k) with company match.</li><li>Additional benefits available based on company policy.</li></ul><p><b>Why Join Corazon Imaging</b></p><p>Corazon Imaging is at the forefront of outpatient coronary CTA and advanced cardiac imaging. This role offers the opportunity to be part of a growing national organization that is improving access to high-quality cardiac imaging and supporting physicians in the early detection of coronary artery disease.</p><p>The Cardiac CT Reporting Operations Specialist will play a key role in ensuring that providers receive accurate, complete, and timely reports that directly support patient care.</p><p>Pay: $55,000.00 - $65,000.00 per year</p><p>Benefits:</p><ul><li>401(k) matching</li><li>Dental insurance</li><li>Flexible schedule</li><li>Health insurance</li><li>Paid time off</li></ul><p>Work Location: Hybrid remote in Southfield, MI 48076</p>

Cardiac CT Reporting Operations Specialist

VCU Health System

<div>**Remote to Virginia ONLY! Must have active VA Pharmacy and PTCB license in good standing**<br>
<br>
The Reimbursement Specialist Supervisor oversees the daily operations of the Reimbursement Specialist team to ensure timely and accurate processing of prior authorizations, insurance follow-ups, and patient assistance program requests pertaining to high-cost medications that require prior authorization. This role provides guidance, coaching, and performance management for team members, while supporting workflow optimization and departmental revenue collection goals.<p></p><p><b>
Essential Job Statements</b></p><p></p><ul><li><p>
Supervise, coordinate, and prioritize the workflow of Reimbursement Specialists across multiple clinics.</p></li><li><p>
Provide direct line supervision for Reimbursement Specialists, including performance evaluations, disciplinary action, time/attendance, coordination of staff activities, or other work as needed. Conduct hiring, interviewing, onboarding, and training of new employees.</p></li><li><p>
Monitor team productivity and compliance with turnaround times, providing feedback and coaching as needed.</p></li><li><p>
Facilitate training and onboarding of new Reimbursement Specialists.</p></li><li><p>
Review complex or escalated prior authorizations and appeals, ensuring appropriate documentation and</p></li><li><p>
compliance with insurance and regulatory requirements.</p></li><li><p>
Collaborate with providers, nursing staff, and the Patient Assistance Program (PAP) team to ensure patients receive timely access to medications.</p></li><li><p>
Identify process improvements to optimize team efficiency and patient care outcomes.</p></li><li><p>
Prepare and review reports on team performance, Patient Assistance (PA) approvals/denials, and workload metrics.</p></li><li><p>
Ensure compliance with departmental and health system policies and regulatory requirements.</p></li><li><p>
Participate in special projects and cross-functional initiatives as assigned.</p></li><li><p>
Serve as a point of contact for internal and external escalations related to PAs, appeals, or patient access concerns.</p></li><li><p>
Performs other duties as assigned and/or participates in special projects to support the mission of VCUHS and the Department. Provides assistance to team members. Accepts alternate assignments, as required.</p></li></ul><p></p><p><b>
Patient Population</b></p><p></p><p>
Not applicable to this position.</p><p></p><p><b>
Employment Qualifications</b></p><p></p><p>
Required Education:</p><p>
High School Diploma or equivalent</p><p></p><p>
Preferred Education:</p><p>
Associate&rsquo;s Degree or higher in Business, Healthcare Administration, or related field</p><p></p><p>
Licensure/Certification Required:</p><p>
Current certification by the Pharmacy Technician Certification Board (PTCB) Current licensure with the Virginia State Board of Pharmacy</p><p></p><p>
Licensure/Certification Preferred:</p><p>
Additional supervisory or leadership certifications a plus</p><p></p><p><b>
Minimum Qualifications</b></p><p></p><p>
Years and Type of Required Experience &middot;</p><p>
Minimum of three (3) years of experience as a Reimbursement Specialist or equivalent role</p><p>
Previous experience supervising or mentoring staff</p><p></p><p>
Other Knowledge, Skills and Abilities Required:</p><p>
Strong knowledge of PAPs, prior authorizations, and insurance benefit investigations</p><p>
Proficiency in EMR systems and Microsoft Office</p><p></p><p>
Cultural Responsiveness</p><p></p><p>
Other Knowledge, Skills and Abilities Preferred:</p><p>
Strong leadership and communication skills</p><p>
Ability to handle multiple priorities and high-volume workload</p><p></p><p><b>
Working Conditions</b></p><p></p><p>
Periods of high stress and fluctuating workloads may occur.
</p><p>General office environment.</p><p>
May be exposed to high noise levels and bright lights.
</p><p>May have periods of constant interruptions.
</p><p>Prolonged periods of working alone.
</p><p></p><p><b>Physical Requirements
</b></p><p></p><p>Physical Demands: Lifting/ Carrying (0-50 lbs.), Bending</p><p>
Work Position: Sitting, Walking, Standing</p><p></p><p><b>
Additional Physical Requirements/ Hazards
</b></p><p></p><p>Physical Requirements: Manual dexterity (eye/hand coordination), Perform shift work, Hear alarms/telephone/tape recorder, Reach above shoulder, Repetitive arm/hand movements, Finger Dexterity, Color Vision, Acuity - far, Acuity - near
</p><p>Hazards:</p><p></p><p><b>
Mental/Sensory &ndash; Emotional
</b></p><p></p><p>Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking</p><p>
Emotional: Fast-paced environment, Steady Pace, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Noisy Environment, Able to Adapt to Frequent Change</p><p></p><p>
EEO Employer/Disabled/Protected Veteran</p></div>

Reimbursement Specialist Supervisor - Remote

Southwest Ohio ENT Specialists Inc

<div>Description:
<p>
POSITION OVERVIEW</p><p>
The Billing Specialist is responsible for Accounts Receivable Management, working all denied claims, seeks full payment from the specific insurance carriers they are responsible for. In addition, prepares appeals for incomplete or non-payments with proper documentation along with researching, analyzing and reconciling billing and reimbursement practices.</p><p>
ESSENTIAL DUTIES AND RESPONSIBILITIES</p><ul><li>
Works in our practice management systems Collection Module and/or Aging Reports to identify aged/denied claims and pull necessary information to investigate claims.</li><li>
Actively follow-up on outstanding claim balances by checking claims on the carrier&rsquo;s website or by calling the insurance companies and other payers as needed.</li><li>
Prepare appeals paperwork for all payers by gathering supporting documentation as needed.</li><li>
Recognize and appropriately report problems or negative patterns in support of maximization of billing and collections.</li><li>
Work claims hitting edits in TriZetto Provider Solutions (Clearinghouse).</li><li>
Avoid and/or resolve errors which may lead to undo write-offs or insurance rejections.</li><li>
Identify accounts requiring charge or payment corrections.</li><li>
Credentialing new physicians, nurse practitioners, audiologists and SLP&rsquo;s for the insurance carriers they are responsible for.</li><li>
Run collection reports per physician call to collection outstanding balance prior to next visit or communicate to the scheduler to cancel appointment.</li><li>
Respond to emails from Patient Services team regarding patients in collections then calling the patient to collect outstanding balance.</li><li>
Phone work as scheduled to include incoming calls requesting account information and making outgoing calls for account investigation.</li><li>
Review weekly statements sending letters or emails to patients to collect payment prior to sending to collections.</li><li>
Provide backup phone coverage and other office responsibilities as a member of the Billing Team.</li><li>
Handle other duties and special projects as assigned.</li></ul>
Requirements:
<p>
EDUCATION, EXPERIENCE &amp; KNOWLEDGE REQUIREMENTS</p><p>
Education</p><ul><li>
High School Diploma or equivalent</li></ul><p>
Experience</p><ul><li>
Minimum 3-5 years medical billing experience.</li></ul><p>
Knowledge &amp; Skills</p><ul><li>
Proficiency in using computers and ability to learn various software.</li><li>
Superior organizational and problem-solving skills, and attention to detail</li><li>
Familiarity with medical billing systems, ICD-10, CPT, medical coding, and basic medical terminology.</li><li>
Ability to work well in a team environment.</li><li>
Strong communication (verbal and written) skills.</li></ul></div>

Billing Specialist

State of Indiana

<p></p><div><div><div><div><div><b>Date Posted: </b>Jun 10, 2026
</div></div></div></div><div><div><div><div><b>Requisition ID: </b>479095
</div></div></div></div><div><div><div><div><b>Location:
</b>Indianapolis, IN, US, 46204<br>
</div></div></div></div><div></div><div><div><div><div><div><b>Work for Indiana</b></div><div></div><div><div><br>
Begin a fulfilling career with the State of Indiana by joining one of the largest employers in the state, offering a range of opportunities across 60+ agencies. At the state, you'll find competitive compensation, a robust benefits package and a commitment to work-life balance. Most importantly, you'll have the chance to make a real and measurable impact on the lives of Hoosiers across Indiana.</div></div><div></div><div><b><br>
About the Indiana Department of Workforce Development (DWD):</b><br>
Our mission is to develop a premier workforce that will allow Indiana employers to flourish and entice businesses from outside our state to relocate to Indiana. Everyone at DWD will be required to think outside-the-box; to determine metrics that will allow for measurement and improvement and efficiencies to be made along the way. Cutting edge technologies will be utilized to help assess Indiana&rsquo;s employment future. If managed properly, Indiana&rsquo;s workforce will be second to none and completely prepared for the next phase of the state and country&rsquo;s economic growth.</div><div></div><div><b><br>
Role Overview:</b></div><div>
The Program Specialist serves as a subject matter expert for an assigned program area, providing advanced support across document intake, customer service, and legal processes. This role ensures accurate case management, timely coordination of Review Board and Court of Appeals activities, and effective communication with internal and external stakeholders. The position also supports the Legal Division through special projects and high-level administrative tasks as needed.</div><div></div><div><b><br>
Salary:</b></div><div>
The salary for this position traditionally starts at $39,000.00 but may be commensurate with education and work experience. Use our <b>Compensation Calculator</b> to view the total compensation package.</div><div></div><div><div><div><div><b><br>
A Day in the Life:</b></div>
</div><div><div>
Based upon specific program area and needs, the essential functions of this role could include:</div><ul><li>
Serves as a claims specialist and subject matter expert for specific program area.</li><li><b>
Data Capture</b>: Accurately processes faxed and scanned hardcopy reports, forms, correspondence, and other documents. Assigns the correct Form ID to create the appropriate work item, researches missing critical information needed to index incoming documentation, and accurately indexes the critical information to ensure it is associated with the correct customer. Formats and assigns required tracking data to the imaged documents which become reference tools and work items in the database for the appropriate agency unit.</li><li><b>
Appeals</b>: Provides administrative and clerical support to the Administrative Law Judges within the department. Provides hearing parties with specific information about their cases, prepares correspondence, maintains reference and resource materials, updates files, forms, and reports.</li><li><b>
Compliance</b>: Performs various daily administrative duties, responds to subpoenas sent to the Fraud unit, sets up potential fraud cases, assist and/or completes the appeals for the unit. Handles all requests for corrections, non-issue, and requalifications before being processed for appeals.</li></ul><div>
The job profile is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.</div></div></div><div><div><div><b>
What You'll Need for Success:</b></div>
</div><div><div>
Individuals in this role should minimally be able to articulate or demonstrate the following:</div><ul><li>
Working knowledge of state governmental administrative structure</li><li>
Working knowledge of assigned program area</li><li>
Effective written and verbal communication skills</li><li>
Attention to detail and proofreading skills</li><li>
Organizational skills with the ability to prioritize tasks effectively and multitask</li><li>
Ability to use Microsoft Office Suite (Word, Excel, Outlook)</li><li>
Ability to work with sensitive documents and information, and be privy to sensitive agency information without divulging information to internal or external parties</li><li>
Ability to work independently</li><li>
Ability to provide effective and professional customer service to internal and external parties.</li></ul><div><b>
A degree is not required. However, a High School Diploma or High School Equivalent (HSE) and at least 4 years of experience in administrative support, business administration, program support, public administration or related area, applying the outlined knowledge, skills, and abilities in a similar role may be considered.</b></div><div>
Individuals should have the ability to perform essential functions with or without reasonable accommodation.</div></div></div><div><div><div><b>
Supervisory Responsibilities/Direct Reports:</b></div>
</div><div><div>This role may be utilized in a supervisory capacity based on agency needs.</div></div></div></div><div></div><div><b><br>
Benefits of Employment with the State of Indiana:</b></div><div>
The State of Indiana offers a comprehensive benefit package for full-time employees which includes:</div><ul><li>
Three (3) medical plan options (including RX coverage) as well as vision and dental plans</li><li>
Wellness Rewards Program: Complete wellness activities to earn gift card rewards</li><li>
Health savings account, which includes bi-weekly state contribution</li><li>
Deferred compensation 457(b) account (similar to 401(k) plan) with employer match</li><li>
Two (2) fully-funded pension plan options</li><li>
A robust, comprehensive program of leave policies covering a variety of employee needs, including but not limited to:<ul><li>
150 hours of paid New Parent Leave and up to eight weeks of paid Childbirth Recovery Leave for eligible mothers</li><li>
Up to 15 hours of paid community service leave</li></ul></li><li>
Combined 180 hours of paid vacation, personal, and sick leave time off</li><li>
12 paid holidays, 14 on election years</li><li>
Education Reimbursement Program</li><li>
Group life insurance</li><li>
Referral Bonus program</li><li>
Employee assistance program that allows for covered behavioral health visits</li><li>
Qualified employer for the Public Service Loan Forgiveness Program</li><li>
Free Parking for most positions</li><li>
Free LinkedIn Learning access</li></ul><div></div><div><b><br>
Equal Employment Opportunity:</b></div><div>
The State of Indiana is an Equal Opportunity Employer and is committed to recruiting, selecting, developing, and promoting employees based on individual ability and job performance. Reasonable accommodations may be available to enable individuals with disabilities to complete the application and interview process as well as perform the essential functions of a role. If you require reasonable accommodations to complete this application, you can request assistance by contacting the Indiana State Personnel Department at jobs@spd.IN.gov.</div></div></div></div></div></div><p></p>

Program Specialist

CareMed Specialty Pharmacy

<div><div><div><b>Pharmacy Prior Authorization Specialist &ndash; CareMed Specialty Pharmacy</b><br>
<i>Waltham, MA</i> | <i>Full-Time</i> | <i>Starting at $23.00/hr and up</i></div>
<div></div><div><b>Sign-On Bonus: </b>$5,000 for employees starting before July 31, 2026.</div>
<div></div><div><b>Join a mission-driven team making a difference in the lives of cancer and rare disease patients.</b></div>
<div></div><div>CareMed Specialty Pharmacy is seeking a <b>Pharmacy Prior Authorization Specialist</b> to join our dedicated team in Waltham, MA. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.</div>
<div></div><div><b>Company Benefits</b></div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Quarterly Incentive Bonus</li>
<li>Paid Volunteer Day</li>
<li>Referral Incentive Program</li>
<li>Company Paid Life Insurance; and Short/Long-Term Disability</li>
</ul> <p></p><div><b>Why Join Us?</b></div>
<ul><li>A career with purpose: Help patients access life-saving medications.</li>
<li>Supportive culture: We value <b>teamwork, respect, integrity, and passion</b>.</li>
<li>Growth opportunities: We invest in your professional and personal development.</li>
</ul><p></p><div><b>What You&rsquo;ll Do</b></div>
<div>The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.</div>
<div></div><div><b>How You&rsquo;ll Do This</b></div>
<ul><li>Manage prior authorization requests and appeals with insurance carriers.</li>
<li>Collaborate with physicians, pharmacists, and other departments.</li>
<li>Ensure HIPAA compliance while handling sensitive patient information.</li>
<li>Maintain accurate documentation of authorization details.</li>
<li>Proactively monitor and renew expiring authorizations.</li>
</ul> <p></p><div><b>What You Bring</b></div>
<div><b>Required:</b></div>
<ul><li>High School Diploma or GED</li>
<li>1+ years of pharmacy or prior authorization experience</li>
<li>Registration with Board of Pharmacy (as required by state law)</li>
<li>Strong communication, organizational, and customer service skills</li>
<li>Self-motivated, organized, detail-oriented, and adaptable to changing priorities</li>
<li>Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds</li>
</ul><div><b>Preferred:</b></div>
<ul><li>Associate degree or Certified Pharmacy Technician (PTCB)</li>
<li>3+ years of experience in pharmacy or prior authorizations</li>
<li>Specialty pharmacy experience</li>
</ul><p></p><div><b>Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.</b></div></div></div>

Prior Authorization Specialist

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