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healthcare specialist

Global Furniture Group

<div><p>Global Furniture Group is a leading North American manufacturer of furniture solutions, offering a broad range of high-quality, value-driven products for the workplace, education, healthcare, and hospitality markets. With over 50 years in operation and more than 4,000 employees worldwide, Global has a strong presence across Canada, the US, Mexico, China, and the UK.</p><p>
Global currently has an immediate career opportunity for a Healthcare Specialist for Healthcare Sales for targeted strategic healthcare accounts in the Houston Metro area.</p><p>
This role serves as the key contact with customers to develop and establish productive relationships with decision-makers, influencing them by using selling skills to discover/diagnose their needs and deliver world-class healthcare solutions.</p><p>
This candidate will increase awareness and interest among healthcare end-users of Global&rsquo;s brand, product and capabilities. As a Healthcare Specialist, you'll be accountable for achieving/exceeding revenue, profit, and market share growth objectives, inclusive of the full Global Furniture Group family.<br>
<br>
<b>Duties and Responsibilities</b></p><p>
Speak up, solve problems, and be an owner every day as you...</p><ul><li>
Hold accountability for achieving assigned goals for sales, orders, shipment volumes, new business, and margin percentage.</li><li>
Build and maintain key relationships and present a positive image of Global Furniture Group in the marketplace.</li><li>
Develop and execute a business plan for new and existing healthcare accounts, and guide relationships with end users, A+D firms, and dealers associated with these accounts.</li><li>
Develop and grow assigned strategic accounts in the local market.</li><li>
Guide the strategy for assigned healthcare accounts to achieve volume goals through the development and maintenance of long-term relationships with select customers, ensuring long-term customer satisfaction.</li><li>
Protect accounts from the competition by understanding the competitions' position and strategies.</li><li>
Provide insight into new healthcare trends and modes of work that will make a case for change or help customers realize a need (demand generation).</li><li>
Spend over 75 percent of time supporting and consulting with healthcare customers, partnering with Territory Managers and dealers to grow relationships, and developing/managing business plans (including necessary overnight travel).</li></ul><p><b>
Education/Experience</b></p><p>
You might be just who we&rsquo;re looking for if you have . . .</p><ul><li>
A Bachelor's degree in Marketing, Business Administration, or a related field. An equivalent level of experience will also be considered.</li><li>
At least two years of successful contract/capital goods selling and account management with healthcare experience (preferred).</li><li>
Some knowledge of healthcare products, services, and culture, as well as the ability to distinguish Global Healthcare products and services from the competition.</li><li>
Selling skills, including account penetration, strategic selling, conceptual selling, issues-based selling, consultative selling, negotiation, and contracts.</li><li>
The ability to think strategically and execute tactically.</li><li>
Excellent verbal, written, and interpersonal communication abilities with a strong emphasis on listening and healthcare environments vernacular.</li></ul><p><b>
Working Conditions/Physical Requirements</b></p><p>
The role is a mix of office, remote, showroom, and client-facing settings. Frequent travel within the assigned territory is required, with exposure to varying customer environments such as offices, showrooms, event places as well as occasional outside weather conditions.</p><p>
While performing the duties of this job, team members are regularly required to frequently travel within the assigned territory &ndash; more than 50% of time spent in the field including driving to client meetings or events. This role may occasionally require lifting or transporting product samples or materials up to 50 lbs. (e.g., product samples, display materials). Must be able to sit, stand, and move throughout showrooms, client spaces and event locations.</p><p><b>
WHO WE ARE</b></p><p>
Global Furniture Group is a leading North American Manufacturer of furniture solutions. Global offers a broad range of furniture products designed for the workplace, education, healthcare + hospitality markets, delivering exceptional value and quality to its network of dealers, designers and customers.</p><p>
Operating for 50+ years and employing more than 4,000 people worldwide, Global has locations throughout Canada, the US, Mexico, China and the UK.</p><p><b>
COMPENSATION &amp; BENEFITS</b></p><p>
Actual base pay offered will be based on multiple factors, including but not limited to job-related knowledge/skills, experience, geographical location, and internal equity. At Global, an individual may not be hired at the high end of the range for their role. Compensation decisions are dependent upon the facts and circumstances of each potion and candidate. (If a bonus or commissions see below for additional sentence).</p><p>
Global offers a comprehensive employee benefit program that enables our employees to stay healthy, feel secure and maintain a work/life balance. The following are benefits we offer employees (or may be eligible for): Paid Time Off | Holiday Pay | Medical/Prescription Insurance | Dental Insurance | Vision Insurance | Health Savings Accounts (HSA) | Company-Paid Life and AD+D Insurance | Company Sponsored Long-term Disability | Short-term Disability | Voluntary Life Insurance | Employee Assistance Program (EAP) | Critical Illness and Accidental Injury Insurance | FSA | 401(k) &amp; Roth 401(k)</p><p><b>
BONUS/COMMISSIONS</b></p><p>
This position is also eligible for performance-based commissions based on sales volume in assigned region.</p><p><b>
WHERE WE ARE</b></p><p>
Global has distribution centers and showrooms located all across the USA + Canada.</p><p>
Global USA Showrooms:</p><p>
Atlanta | Boston | Chicago | Irvine | Miami | NYC | Philadelphia | Phoenix | Washington DC</p><p>
Global USA Showrooms + Distribution Centers:</p><p>
Atlanta | Baltimore |Chicago | Cincinnati | Dallas | Denver | Houston | Kansas City | Los Angeles | Miami | Philadelphia | Seattle | Tampa</p><p><b>
You can visit us at </b><b>www.globalfurnituregroup.com</b><b>.</b></p><p><b>
Work Authorization:</b> Must be legally authorized to work in the U.S. on a full-time basis. Global does not sponsor work authorization or visas for this role.</p><p>
Global is a smoke-free, drug-free workplace and equal opportunity employer.</p><p>
Qualified applicants will receive consideration for this position without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. To request assistance in completing this application, please call 800.220.1900 and ask for Human Resources.</p><p>
Veterans encouraged to apply.</p></div>

Healthcare Specialist

Onco360

<div><div>We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in<b> Houston, TX. </b>This will be a Full-Time position.<b> This position must be located within driving distance to our pharmacy, with a hybrid work style.</b></div>
<div></div><div>Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.</div>
<div></div><div><b>Starting salary from $21.00 an hour and up</b></div>
<div></div><div>We offer a variety of benefits including:</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>Company paid benefits &ndash; life; and short and long-term disability</li>
</ul><div><b>Pharmacy Adjudication </b><b>Specialist Major Responsibilities:</b></div>
<div>The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections</div>
<div></div><div>Pharmacy Adjudication Specialists at Onco360...</div>
<ul><li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.</li>
<li>Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.</li>
<li>Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays</li>
<li>Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)</li>
<li>Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.</li>
<li>Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.</li>
<li>Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.</li>
<li>Document and submit requests for Patient Refunds when appropriate.</li>
</ul><div>Pharmacy Adjudication Specialist Qualifications and Responsibilities...</div>
<div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication</li>
<li>Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Work Experience
<ul><li>Required: 1+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
<li>Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience</li>
</ul></li></ul><ul><li>Skills/Knowledge
<ul><li>Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills</li>
<li>Desired: Knowledge of Foundation Funding, Specialty pharmacy experience</li>
</ul></li></ul><ul><li>Licenses/Certifications
<ul><li>Required: Registration with Board of Pharmacy as required by state law</li>
<li>Desired: Certified Pharmacy Technician (PTCB)</li>
</ul></li></ul><ul><li>Behavior Competencies
<ul><li>Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills</li></ul></li></ul></div></div>

Pharmacy Adjudication Specialist

HCA Houston Healthcare

<p></p><div><h5 class="jobSectionHeader"><b>Introduction</b></h5><p>
Do you want to join an organization that invests in you as a Rehab Liaison - Northwest quadrant of Houston, TX.? At HCA Houston Healthcare, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.</p><h5 class="jobSectionHeader"><b>
Benefits</b></h5><p>
HCA Houston Healthcare offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:</p><ul><li>
Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.</li><li>
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.</li><li>
Free counseling services and resources for emotional, physical and financial wellbeing<br>
</li><li>
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)<br>
</li><li>
Employee Stock Purchase Plan with 10% off HCA Healthcare stock<br>
</li><li>
Family support through fertility and family building benefits with Progyny and adoption assistance.<br>
</li><li>
Referral services for child, elder and pet care, home and auto repair, event planning and more<br>
</li><li>
Consumer discounts through Abenity and Consumer Discounts<br>
</li><li>
Retirement readiness, rollover assistance services and preferred banking partnerships<br>
</li><li>
Education assistance (tuition, student loan, certification support, dependent scholarships)<br>
</li><li>
Colleague recognition program<br>
</li><li>
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)<br>
</li><li>
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.</li></ul><p>
Learn more about Employee Benefits</p><p><b><i>
Note: Eligibility for benefits may vary by location.</i></b></p><p><br>
You contribute to our success. Every role has an impact on our patients&rsquo; lives and you have the opportunity to make a difference. We are looking for a dedicated Rehab Liaison - North Cypress like you to be a part of our team.</p><h5 class="jobSectionHeader"><b>
Job Summary and Qualifications</b></h5><p></p><p>
The Rehab Liaison contributes to high-quality, patient-centered care by identifying candidates for inpatient rehabilitation and initializing timely, appropriate patient transfers. In collaboration with the Rehab Medical Director, the Clinical Rehabilitation Specialist ensures appropriate patient placement through clinical assessments and screening. The Clinical Rehabilitation Specialist serves as an inpatient rehabilitation expert between internal and external referral sources and inpatient rehabilitation operations. The Clinical Rehabilitation Specialist is responsible for establishing relationships with case managers, physicians, payors, and other referral sources.</p><p></p><p><b>
This position will cover for the Northwest Quadrant area - Cypress, Tomball, Spring, and North Houston District.</b></p><p>
Work Schedule - Full-time, 8-hour days Monday thru Friday and 1-weekend requirement per month.</p><p></p><p><i>
***Clinical Rehab Specialist also known as: Rehab Liaison, Rehab Business Development, Rehab Admissions Coordinator, Rehab Sales Representative, Marketing Liaison.</i></p><p></p><p><b>
What You Will Do In This Role:</b></p><p>
You will act as an inpatient rehabilitation expert between internal and external referral sources, and inpatient rehabilitation operations and establish relationships with case managers, physicians, payors, and other referral sources.</p><p></p><ul><li>
You will assist and coordinate the in-take and pre-admission screening process, and accurately document evidence of rehab admission criteria on pre-screen evaluation.</li><li>
You will function as primary contact for case management and referring physicians, ensuring referral sources receive appropriate and timely follow-up communications regarding their patients and hospital programs.</li><li>
You will assist in developing the annual strategic plan for the Rehab Unit/Hospital, to include visible community outreach programming and raising community awareness of services available.</li></ul><p></p><p><b>
What Qualifications You Will Need:</b></p><p></p><ul><li>
Minimum 2 years of recent clinical care experience is required.</li><li>
Graduate of an accredited school in clinical specialty is required.</li><li>
Licensed professional in Texas in a clinical health care specialty (i.e. Registered Nurse, Licensed Physical Therapist, Registered Occupational Therapist, or Speech Language Pathologist/Therapist-SLP) is required.</li><li>
Current BLS certification is required.</li></ul><p></p><p>
HCA Gulf Coast Division is an affiliation of hospitals serving greater Houston area and South Texas. We share a mission, a commitment to the communities we serve and a standard of excellence for providing compassionate patient care. Serving such a large and diverse region requires HCA Gulf Coast Division to offer a range of programs that meets the needs of people of all ages with conditions ranging from acute to chronic illnesses. With 16 acute care and specialty hospitals, freestanding emergency rooms, ambulatory surgery centers, and more than 16,000 employees, HCA Gulf Coast Division offers patients access to a circle of care that is unique in the region. We bring comprehensive care close to home, including advanced medical care, education, and community outreach. By joining together as a network, hospitals are able to focus on improving outcomes and enhancing services for their own communities, while pooling resources for other functions like staffing and systems management.</p><p>
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.</p><p></p><p><br>
&quot;Good people beget good people.&quot;- Dr. Thomas Frist, Sr.<br>
HCA Healthcare Co-Founder</p>
<p>We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Rehab Liaison - North Cypress opening. Qualified candidates will be contacted for interviews. <b>Submit your resume today to join our community of caring!</b></p></div><p></p>

Rehab Liaison - Northwest Quadrant

Senior Psych Care

<div><p><b>Senior PsychCare</b> has an immediate opportunity for a<b> Revenue Cycle Specialist II </b>to support our Billing Team in Houston.</p><p><b>
ABOUT US:</b></p><p>
Senior Psych Care provides fully integrative behavioral health services to the long-term care patient, at their facility. Services include individual, family, and group therapies, along with diagnostic evaluation and collaborative intervention between the therapy team and the psychiatric team.</p><p><b>
Job Description</b></p><p><b>
Revenue Cycle Specialist II</b> is responsible for processing follow-up actions on claims denied for eligibility-related reasons and responding to health plan correspondence. In this role, you would identify billing issues affecting the provider&rsquo;s claims and take necessary action to ensure timely and appropriate claim filing. In addition, perform follow-up activities and identifies reimbursement issues affecting these claims. The Revenue Cycle Specialist also takes necessary actions to insure accurate reimbursement and account resolution.</p><p><b>
Responsibilities :</b></p><ul><li>
Responsible for managing and maintaining a workload of approximately seventy (70) accounts or higher per day to ensure claim(s) resolution.</li><li>
Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD&rsquo;s) for claim resolution.</li><li>
Review and attach appropriate documentation to resolve denied claims and submit appeals.</li><li>
Call payers to determine the true reason for denial and inquire on what corrections need to be made.</li><li>
Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or payer portals.</li><li>
Review underpayments and overpayments, work with management to prepare spreadsheet and summarize findings; escalate as appropriate.</li><li>
Prepare and submit denied claims targeted project files to payers, track reprocessing of project files.</li><li>
Identify problematic claim trends and contract violations and report findings to the Manager and Director.</li><li>
Contact insurers regarding recoupment payments, double debits, overpaid accounts, and missing checks; initiate dispute process as needed.</li><li>
Update insurance information in the system as necessary, initiate and support primary, secondary and tertiary billing.</li><li>
Perform other duties assigned by Revenue Cycle Manger.</li></ul><p><b><i>
This is a full-time, in-person opportunity. Our work week is from Monday-Friday 8am-5pm (NO WEEKENDS Required).</i></b></p><p><b>
Qualifications-Required Experience: 3+ years of recent Healthcare experience, specifically in a claims, Denials, billing, EOB and insurance verification.</b></p><ul><li><b>
Minimum 1+ years&rsquo; experience in Government Payor follow- up (Required)</b></li><li><b>
Ability to work independently and prioritize monthly workflow (Required)</b></li><li><b>
Knowledge of Medical Terminology, CPT Codes, HCPCS, Revenue Codes, Modifiers and Diagnosis Codes (Required)</b></li><li><b>
Payer portal and clearinghouse experience (Required)</b></li><li><b>
Ability to work independently and prioritize monthly workflow (Required)</b></li><li><b>
Mental Health experience (Preferred)</b></li></ul><p><b>
What we offer:</b></p><ul><li>
Paid Time Off and Paid Holidays</li><li>
Comprehensive benefits packages including Medical, Dental, Vision, 401k, Long Term and Short-Term Disability, Life Insurance</li><li>
Healthcare coverage available 1st day of the month following full-time employment.</li></ul><p><b><i><br>
All interested candidates are encouraged to apply. Apply today and START NEXT WEEK!!!</i></b></p></div>

Revenue Cycle Specialist II – Appeals and Denials

LifeGift

<div><h2 class="jobSectionHeader"><b>R1375H - Family Engagement Specialist I</b></h2><h4 class="jobSectionHeader"><b>
Houston</b></h4><div>
<p><b>
Would You Like a Life-Changing Career with LifeGift</b></p>
<p><b>Where You Can Grow as a Family Engagement Specialist I?</b></p>
<p><b>Kick-start the career of a lifetime where you can be a part of our mission of hope, working with an incredible team saving lives while modeling our values of Passion, Compassion, and Professionalism to the LifeGift community.</b></p><br>
<p></p>
<p>LifeGift is currently looking for a <b><i>Family Engagement Specialist I</i></b><i> </i><b><i>in Houston</i></b> who serves as a critical link between LifeGift and the families whose loved ones are considering or have opted for organ donation. This role encompasses providing emotional support, education about the donation process, and facilitating meaningful conversations between families and healthcare personnel. The <b>Family Engagement Specialist</b> will work collaboratively with medical professionals, social workers, and bereavement coordinators to ensure families receive comprehensive and compassionate care during emotionally challenging times.</p><br>
<p></p>
<p>Do you possess the attributes to be a successful <b>Family Engagement Specialist I </b>and perform the following essential functions?</p>
<ul><li>Provide compassionate support to families during the organ donation process, addressing their questions and concerns with empathy and understanding.</li>
<li>Educate families on the process of organ donation, including the medical, ethical, and emotional aspects, to help them make informed decisions.</li>
<li>Act as a liaison between families and medical providers, ensuring effective communication and clarity regarding the donation process.</li>
<li>Offer immediate support and resources to families in crisis, assisting them in navigating complex emotions and providing grief counseling as necessary.</li>
<li>Collaborate with the Family Engagement Manager to develop and refine educational materials, resources, and training programs to enhance family engagement strategies.</li>
<li>Maintain accurate records and documentation of family interactions, ensuring confidentiality and compliance with all regulatory standards.</li>
<li>Participate in community outreach initiatives to promote organ donation awareness and educate the public about LifeGift&rsquo;s mission and the importance of donor families.</li>
<li>Work closely with multidisciplinary teams to advocate for families&rsquo; needs and ensure their voices are heard in policy and operational discussions.</li></ul><br>
<p>
</p><p>Do you have the education and experience to be a <b>Family Engagement Specialist I</b>?</p>
<ul><li>Bachelor&rsquo;s degree in Social Work, Nursing, Psychology, Public Health, Human Services, Communications, Counseling, Education, or a related field; Master&rsquo;s degree preferred.</li>
<li>Minimum of 2-3 years&rsquo; experience in family support, grief counseling, or a related field, preferably in healthcare or organ donation settings.
</li><li>Backgrounds that demonstrate advanced interpersonal communication, conflict resolution, and the ability to guide individuals through complex, emotionally charged decisions</li>
<li>Knowledge of the organ donation process and relevant regulatory frameworks is highly desirable.</li>
<li>Ability to navigate sensitive and complex situations with professionalism and poise.</li>
<li>Proficient in Microsoft Office Suite and experience with data management systems.</li>
<li>Bilingual (English/Spanish) is a plus.</li>
<li>This is <b><i>NOT</i></b> a remote position.</li></ul><br>
<p>
</p><p><b><i>This role requires frequent travel and ability to commute to different hospital partners within our service area.</i></b></p>
<p><b>As a condition of employment, you must be able to attain Hospital Badge and EMR Access from all of the LifeGift Hospital Partners, as well as the availability to work 12-hour shifts, including nights, weekends and holidays.</b></p><br>
<p></p>
<p><b>The Heart of Our Culture</b></p>
<p>Established in 1987, LifeGift offers hope to the thousands of people in Texas and beyond who need lifesaving organ and tissue transplants. Our organization is diverse by nature, and inclusive by choice. LifeGift strives to reflect the communities where we live and work, and our multi-cultural and diverse team contributes an abundance of talent, abilities, and innovation that have continued to elevate our success.</p>
<p><b>Rewards and Benefits for Your Career and Well-Being</b></p>
<p>LifeGift values its team members and offers a variety of highly competitive benefits. Full-time team members have the opportunity to enroll in the following insurance plans: medical, dental, and vision, as well as life insurance, LTD and STD, and FSAs and HSAs that are pre-tax and to which LifeGift contributes. LifeGift also offers an exceptional retirement package that includes 403(b) and 401(a) retirement plans with the opportunity for a generous match. Additionally, LifeGift offers a tuition reimbursement program to encourage team members to expand their knowledge and further their education. LifeGift recognizes the importance of a work-life balance and encourages team members to take advantage of a generous vacation and sick leave plan.</p>
<p>LifeGift is an equal opportunity employer!</p><br>
<p></p>
<p><b>If you are qualified and want to be considered for a career that is life-changing, has purpose, and where you can be a part of an organization that cares about its employees, we encourage you to apply by completing the application at </b>www.lifegift.org/careers/</p><br>
<p></p>
<p><b><i>LifeGift is a drug-free workplace.</i></b></p></div></div><p></p>

Family Engagement Specialist I

<div><div><b>Are you someone looking for professional career growth? </b>Onco360 Pharmacy is looking for a <b>Lead Medical Benefits Verification Specialist</b> for our Pharmacy located in <b>Houston, TX.</b></div>
<div></div><div><b>Work Hours: Monday-Friday 8:30 - 5:00pm CST</b></div>
<div></div><div><b>**Starting salary at $23/hr** </b>We also offer quarterly incentive bonuses.</div>
<div></div><div>We offer a variety of benefits including:</div>
<ul><li>Medical, Dental &amp; Vision insurance</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Paid Volunteer Day</li>
<li>Floating Holiday</li>
<li>Referral Incentive</li>
<li>Paid Life, and short &amp; long-term disability insurance</li>
</ul>
<div></div><div><b>Lead Medical Benefits Verification Specialist Summary:</b></div>
<div>The Lead Medical Benefits Verification Specialist is responsible to support the Medical Benefits Verification Specialist roles while performing insurance authorization and verification for all patients scheduled for services. The Lead will investigate, review, and load accurate patient insurance for medical coverage, assign coordination of benefits, and investigate/identify authorization requirements needed to obtain medication coverage. Support the department's Manager with the daily workflow and distribution of workload, answer questions as the assigned subject matter experts, assist with mentoring and training new members of the team and report any system or process issues identified.</div>
<div></div><div><b>Lead Medical Benefits Verification Specialist Major Responsibilities:</b></div>
<div><ul><li>Support staff in verifying Commercial and Government payer eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. This involves contacting Medicare or other relevant government payers to confirm coverage and benefits for specific services. Verify Commercial insurance plans eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profiles. Confirming patient eligibility and benefits with various commercial insurance carriers (i.e. Aetna, Humana, Anthem, Cigna, etc.).</li>
<li>Facilitate process for requesting medical authorizations, Single Case Agreements, Letter of Agreements, and Terms of Agreement for applicable commercial, Medicaid, and Medicare, or facility medication claims.</li>
<li>Investigate payer plans: Research and document benefit plan specifics for various payer plans, including cost-share responsibilities and restrictions. Address intricate benefit verification issues, such as those involving high-cost or specialized treatments, denials, and appeals.</li>
<li>Develop expertise: Maintain in-depth knowledge of insurance policies, coverage terms, and complex billing practices. Identify the appropriate clinical records and</li>
<li>submit the authorization request to the insurance company based on plan requirements for approval.</li>
<li>Handle complex cases: Address intricate benefit verification issues, such as those involving high-cost or specialized treatments, denials, and appeals.</li>
<li>Collaborate across departments: Work closely with clinical staff, billing and coding teams, and administrative teams to resolve insurance issues and ensure seamless patient care. Will be the liaison between the ordering physician and insurance company to ensure all requirements to secure approval are identified and communicated.</li>
<li>Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
<li><div>Lead process improvement: Analyze workflows, identify opportunities for improvement, and implement more efficient procedures to reduce turnaround times and improve accuracy. Assist the Medical Verification Specialists in achieving: &gt;95% accuracy/quality while handling accounts, as measured by account audits &gt;95% quality of expected customer service etiquette, as measured by phone call audits Meet or exceed Lower controls of average productivity amongst the team productivity standards assist the manager of the department with escalated issues, tracking system and process issues.</div>
 </li><li><div>Mentor and train staff: Guide and train junior specialists on proper benefit verification and claim processing procedures.</div>
</li><li><div>Ensure compliance: Adhere to all federal and state regulations, including the Health Insurance Portability and Accountability Act (HIPAA), to maintain patient confidentiality.</div>
</li><li><div>Performs other duties as assigned.</div>
</li></ul></div><div><b>Education/Learning Experience</b></div>
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification</li>
<li>Desired: Associate degree or equivalent program from a 2-year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience</li>
</ul><div><b>Work Experience</b></div>
<ul><li>Required:
<div>3+ years&rsquo; Medicare and Medical benefit verification experience</div>
</li><li><div>Desired: 5+ years Specialty Pharmacy, Medical Verification, and/or Infusion benefit verification experience</div>
</li></ul><div><b>Skills/Knowledge</b></div>
<ul><li>Required: Medicare and Medical insurance and benefit verification, medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, coordination of benefits, Understanding Medicare Parts A, B, C, and D, as well as relevant laws and guidelines, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, basic math and analytical skills, Intermediate typing/keyboarding skills.</li>
<li>Desired: Specialty Pharmacy experience, Medicare Billing Experience, Medical Authorization experience</li>
</ul><div><b>Licenses/Certifications
</b></div><ul><li>Required: None</li>
<li>Desired: Registration with Board of Pharmacy as required by state law or Certified Pharmacy Technician (PTCB)</li>
<li><div>Certified Revenue Cycle Representative (CRCR)</div>
<div>Certified Medical Insurance Specialist (CMIS)</div>
</li></ul><div></div><div><b>Behavior Competencies</b></div>
<ul><li>Required: Independent worker, self-motivated<br>
Analytical skills: The ability to interpret complex insurance documents and identify potential gaps in coverage is crucial for handling more difficult cases.<br>
Communication: Excellent verbal and written communication skills are essential for interacting with insurance companies, patients, and other healthcare professionals.<br>
Problem-solving: Senior specialists must possess strong problem-solving skills to efficiently address and resolve insurance-related issues.<br>
Technical proficiency: Expertise in electronic health record (EHR) systems, insurance verification software, and payer portals is necessary.<br>
Leadership abilities: The capacity to mentor junior staff and lead process improvement projects is a key differentiator for a senior role.</li>
</ul>
<div></div><div>Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.</div>
<div></div><div>A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.</div>
<div></div><div>We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.</div></div>

Lead Medical Benefits Verification Specialist

Kinghaven Counseling Group

<p>Mental &amp; Behavioral Health LCSW or LPC's</p><p>We are seeking a LCSW or LPC's to become a part of our team! You will focus on providing high quality patient care as part of a healthcare team.</p><p>Responsibilities:</p><ul><li>Diagnose and provide treatment plans</li><li>Provide Individual and family therapy sessions</li><li>Perform Clinical Interviews, Biopsychosocials of patients for Psychologist</li><li>Develop and implement patient treatment plans and make recommendations</li><li>Facilitate referrals to other healthcare Preferred professionals and medical facilities</li><li>Communicate with collaborating physician or specialist regarding patient care</li><li>Familiar with Children, Adolescents and Adults</li></ul><p>Qualifications:</p><ul><li>Previous experience in Psychotherapy</li><li>Ability to build rapport with patients</li><li>Ability to thrive in a fast-paced environment</li><li>Excellent written and verbal communication skills</li><li>Strong leadership qualities</li></ul><p>Kinghaven has over 20 years&rsquo; experience with four branches and is committed to providing excellent Mental Behavioral health care to the population and communities it serves. We have established relationships with a network affiliate hospitals and we strive to achieve the best outcome for our patients and their families. Kinghaven Counseling Group has a collaborative group of providers in house that range from Counseling, Psychology, Psychiatry, and Substance Abuse. We service all areas of Houston and joining counties. Join us in making a difference in people&rsquo;s lives and empowering wellness</p><p>Job Type: Full-time</p><p>Pay: $74,000.00 - $99,000.00 per year</p><p>Work Location: In person</p>

LCSW or LPC (Licensed Professional Counselor) in Houston

Explore 212+ Healthcare specialist in Houston this March. Find roles across top companies and apply now to boost your career.