medical management specialist

Erie Insurance Group

<div><div><div><div><div><div><b>Division or Field Office:<br>
</b></div></div><div><div>Claims I Division</div></div><br>
</div><br>
<div><div><b>Department of Position:</b></div> <div>Medical Management Department</div></div><br>
<div>
<div><div><b>Work from:</b></div>
</div>
<div> New York Branch Claims Office</div>
</div><br>
<div><div><b>Salary Range:</b></div>
<div>
<div>$50,327.00 - $80,392.00 *</div>
<div><i>
salary range is for this level and may vary based on actual level of role hired for</i></div>
</div>
</div><br>
</div></div><ul><li><i>This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location (State) based on ERIE's geographical differences, and experience of an applicant, as well as level of role for which the successful candidate is hired. Position may be eligible for an annual bonus payment.</i></li></ul><br>
<div></div>
<div>
At Erie Insurance, you&rsquo;re not just part of a Fortune 500 company; you&rsquo;re also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia.<br>
<br>
<b>Benefits That Go Beyond The Basics</b></div>
<div>
We strive to be Above all in Service&reg; to our customers&mdash;and to our employees. That&rsquo;s why Erie Insurance offers you an exceptional benefits package, including:</div>
<ul>
<li><b>Premier health, prescription, dental, and vision benefits for you and your dependents.</b> Coverage begins your first day of work.</li>
<li><b>Low contributions to medical and prescription premiums.</b> We currently pay up to 97% of employees&rsquo; monthly premium costs.</li>
<li><b>Pension. </b>We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full-time employees are vested after five years of service.</li>
<li><b>401(k) with up to 4% contribution match.</b> The 401(k) is offered in addition to the pension.</li>
<li><b>Paid time off.</b> Paid vacation, personal days, sick days, bereavement days and parental leave.</li>
<li><b>Career development. </b>Including a tuition reimbursement program for higher education and industry designations.</li><br>
</ul>
<div>Additional benefits that include company-paid basic life insurance; short-and long-term disability insurance; orthodontic coverage for children and adults; adoption assistance; fertility and infertility coverage; well-being programs; paid volunteer hours for service to your community; and dollar-for-dollar matching of your charitable gifts each year.</div><div></div><div><div><div><div><b><br>
Position Summary</b></div>
</div><div><div><i>
Within designated authority, handles medical management claims with limited supervision.</i></div><br>
<div></div>
<ul>
<li><b>This position is based out of our New York Branch Claims office in Rochester, NY.</b></li>
</ul></div></div><div><div><div><b>Duties and Responsibilities</b></div>
</div><div><ul><li>Handles first party medical benefit claims, including fatalities and wage loss claims. Evaluates and makes decisions regarding coverage. Conducts investigations, determines total value of claims, sets and maintains adequate reserves, and manages cases.</li>
<li>Prepares related correspondence and reports, obtains medical and employment related records, calculates wage loss claims per applicable state laws and brings claims to conclusion.</li>
<li>Investigates, evaluates, and resolves coverage questions in compliance with applicable state laws.</li>
<li>Establishes immediate contact with Policyholders and Claimants. Contacts Agents as necessary.</li>
<li>Reviews claim files on a regular basis and takes necessary follow-up and/or closing action.</li>
<li>Evaluates, processes and takes appropriate action on claim-related bills and medical, rehabilitation and special investigative reports. Determines claims to be paid, compromised or contested.</li>
<li>Coordinates activities with the Home Office on serious or massive injury cases. Notifies company investigative services of cases involving suspected fraud.</li>
<li>When appropriate manages claims in litigation and assist in the development of case strategy with legal counsel.</li>
</ul></div></div><div><div><div><b>Duties and Responsibilities (cont'd if applicable)</b></div>
</div><div><ul><li>Attends industry-related training programs to stay current on legal developments and ensure compliance with applicable laws and regulations impacting the operation of the department.</li>
<li>Assists or acts on the behalf of supervisor when required, including handling of insurance department complaints.</li>
<li>When appropriate identifies subrogation situations and initiates appropriate action.</li>
<li>Develops expertise in legal and medical terminology and procedures.</li>
<li>Assists in training branch office personnel in related matters.</li>
<li>Assigns, monitors and controls activities of vendors in a cost-effective manner.</li></ul><br>
<div><br>
<i>The first five duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished.</i></div><br>
<div><br>
<i>This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become evident.</i></div>
</div></div><div><div><div><b>
Capabilities</b></div>
</div><ul><li>Values Diversity
</li><li>Job-Specific Knowledge
</li><li>Self-Development
</li><li>Nimble Learning
</li><li>Collaborates
</li><li>Customer Focus
</li><li>Cultivates Innovation
</li><li>Optimizes Work Processes (IC)
</li><li>Instills Trust
</li><li>Ensures Accountability
</li><li>Decision Quality
</li></ul></div><div><div><div><b>Qualifications</b></div>
</div><div><div><b>
Minimum Educational Requirements</b></div>
<ul><li>High School Diploma or GED and two years of general claims handling experience required, or;</li>
<li>Bachelor&rsquo;s Degree required.</li>
<li>OR completion of formal ERIE training program, required.</li></ul><br>
<div><br>
<b>Additional Experience
</b></div><ul><li>Strong working knowledge of applicable state laws preferred.</li>
<li>Good working knowledge of human anatomy and medical terminology preferred.</li>
<li>Expertise in state no-fault laws and working knowledge of civil law preferred.</li>
<li>Working knowledge of medical bill repricing system preferred.</li></ul><br>
<div><br>
<b>Designations and/or Licenses
</b></div><ul><li>Successful completion of AIC courses preferred.</li>
<li>Appropriate license as required by state.<br>
</li></ul></div></div><div><div><div><b>Physical Requirements</b></div>
</div><ul><li>Lifting/Moving 0-20 lbs; Occasional (&lt;20%)
</li><li>Lifting/Moving 20-50 lbs; Occasional (&lt;20%)
</li><li>Ability to move over 50 lbs using lifting aide equipment; Occasional (&lt;20%)
</li><li>Driving; Rarely
</li><li>Pushing/Pulling/moving objects, equipment with wheels; Occasional (&lt;20%)
</li><li>Manual Keying/Data Entry/inputting information/computer use; Often (20-50%)
</li><li>Climbing/accessing heights; Rarely</li></ul></div></div><br>
<p><br>
<b>Nearest Major Market: </b>Rochester</p></div>

Medical Management Specialist

Elevance Health

<div>
 <strong>
  Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
  <br/>
  <br/>
 </strong>
 <strong>
  <em>
   Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
   <br/>
   <br/>
  </em>
 </strong>
 <strong>
  Hours: Monday - Friday 8:00am to 5:00pm depending on your time zone and occasional weekends.
  <br/>
  <br/>
 </strong>
 <strong>
  AmeriBen
 </strong>
 is a proud member of the Elevance Health family of companies. We are a third-party administrator (TPA) of medical benefits, including medical management.
 <br/>
 <br/>
 The
 <strong>
  Medical Management Nurse
 </strong>
 is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member's clinical presentation to determine whether to approve requested service(s) as medically necessary. Works with healthcare providers to understand and assess a member's clinical picture. Utilizes nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy relevant clinical criteria. Acts as a resource for Clinicians. May work on special projects and helps to craft, implement, and improve organizational policies.
 <br/>
 <br/>
 <strong>
  How You Will Make An Impact
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Utilizes nursing judgment and reasoning to analyze members' clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity.
  </li>
  <li>
   Works with healthcare providers to promote quality member outcomes, optimize member benefits, and promote effective use of resources.
  </li>
  <li>
   Determines and assesses abnormalities by understanding complex clinical concepts/terms and assessing members' aggregate symptoms and information.
  </li>
  <li>
   Assesses member clinical information and recognizes when a member may not be receiving appropriate type, level, or quality of care, e.g., if services are not in line with diagnosis.
  </li>
  <li>
   Provide consultation to Medical Director on particularly peculiar or complex cases as the nurse deems appropriate.
  </li>
  <li>
   May make recommendations on alternate types, places, or levels of appropriate care by leveraging critical thinking skills and nursing judgment and experience.
  </li>
  <li>
   Collaborates with case management nurses on discharge planning, ensuring patient has appropriate equipment, environment, and education needed to be safely discharged.
  </li>
  <li>
   Collaborates with and provides nursing consultation to Medical Director and/or Provider on select cases, such as cases the nurse deems particularly complex, concerning, or unclear. Serves as a resource to lower-level nurses.
  </li>
  <li>
   May participate in intradepartmental teams, cross-functional teams, projects, initiatives and process improvement activities.
  </li>
  <li>
   Educates members about plan benefits and physicians and may assist with case management.
  </li>
  <li>
   Collaborates with leadership in enhancing training and orientation materials.
  </li>
  <li>
   May complete quality audits and assist management with developing associated corrective action plans.
  </li>
  <li>
   May assist leadership and other stakeholders on process improvement initiatives.
  </li>
  <li>
   May help to train lower-level clinician staff.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Minimum Requirements
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Requires a minimum of associate's degree in nursing.
  </li>
  <li>
   Requires a minimum of 4 years care management or case management experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience, which would provide an equivalent background.
  </li>
  <li>
   Current active, valid and unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required.
  </li>
  <li>
   Multi-state licensure is required if this individual is providing services in multiple states.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred Skills, Capabilities And Experiences
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Prior healthcare third party vendor (TPA) experience.
   <br/>
   <br/>
  </li>
 </ul>
 For candidates working in person or virtually in the below locations, the salary* range for this specific position is $75,772 to $113,658.
 <br/>
 <br/>
 Locations: Illinois
 <br/>
 <br/>
 In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
 <br/>
 <br/>
 <ul>
  <li>
   The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
   <br/>
   <br/>
  </li>
 </ul>
 Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
 <br/>
 <br/>
 Who We Are
 <br/>
 <br/>
 Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
 <br/>
 <br/>
 How We Work
 <br/>
 <br/>
 At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
 <br/>
 <br/>
 We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
 <br/>
 <br/>
 Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
 <br/>
 <br/>
 The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
 <br/>
 <br/>
 Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
 <br/>
 <br/>
 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
 <br/>
 <br/>
 Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) .
</div>


Medical Management Nurse

<div>
 <strong>
  Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
  <br/>
  <br/>
 </strong>
 <em>
  <strong>
   Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
   <br/>
   <br/>
  </strong>
 </em>
 <strong>
  Hours: Monday - Friday 8:00am to 5:00pm depending on your time zone and occasional weekends.
  <br/>
  <br/>
 </strong>
 <strong>
  AmeriBen
 </strong>
 is a proud member of the Elevance Health family of companies. We are a third-party administrator (TPA) of medical benefits, including medical management.
 <br/>
 <br/>
 The
 <strong>
  Medical Management Nurse
 </strong>
 is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member&rsquo;s clinical presentation to determine whether to approve requested service(s) as medically necessary. Works with healthcare providers to understand and assess a member&rsquo;s clinical picture. Utilizes nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy relevant clinical criteria. Acts as a resource for Clinicians. May work on special projects and helps to craft, implement, and improve organizational policies.
 <br/>
 <br/>
 <strong>
  How You Will Make An Impact
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Utilizes nursing judgment and reasoning to analyze members&rsquo; clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity.
  </li>
  <li>
   Works with healthcare providers to promote quality member outcomes, optimize member benefits, and promote effective use of resources.
  </li>
  <li>
   Determines and assesses abnormalities by understanding complex clinical concepts/terms and assessing members&rsquo; aggregate symptoms and information.
  </li>
  <li>
   Assesses member clinical information and recognizes when a member may not be receiving appropriate type, level, or quality of care, e.g., if services are not in line with diagnosis.
  </li>
  <li>
   Provide consultation to Medical Director on particularly peculiar or complex cases as the nurse deems appropriate.
  </li>
  <li>
   May make recommendations on alternate types, places, or levels of appropriate care by leveraging critical thinking skills and nursing judgment and experience.
  </li>
  <li>
   Collaborates with case management nurses on discharge planning, ensuring patient has appropriate equipment, environment, and education needed to be safely discharged.
  </li>
  <li>
   Collaborates with and provides nursing consultation to Medical Director and/or Provider on select cases, such as cases the nurse deems particularly complex, concerning, or unclear. Serves as a resource to lower-level nurses.
  </li>
  <li>
   May participate in intradepartmental teams, cross-functional teams, projects, initiatives and process improvement activities.
  </li>
  <li>
   Educates members about plan benefits and physicians and may assist with case management.
  </li>
  <li>
   Collaborates with leadership in enhancing training and orientation materials.
  </li>
  <li>
   May complete quality audits and assist management with developing associated corrective action plans.
  </li>
  <li>
   May assist leadership and other stakeholders on process improvement initiatives.
  </li>
  <li>
   May help to train lower-level clinician staff.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Minimum Requirements
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Requires a minimum of associate&rsquo;s degree in nursing.
  </li>
  <li>
   Requires a minimum of 4 years care management or case management experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience, which would provide an equivalent background.
  </li>
  <li>
   Current active, valid and unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required.
  </li>
  <li>
   Multi-state licensure is required if this individual is providing services in multiple states.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred Skills, Capabilities And Experiences
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Prior healthcare third party vendor (TPA) experience.
   <br/>
   <br/>
  </li>
 </ul>
 For candidates working in person or virtually in the below locations, the salary* range for this specific position is $75,772 to $113,658.
 <br/>
 <br/>
 Locations: Illinois
 <br/>
 <br/>
 In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
 <br/>
 <br/>
 <ul>
  <li>
   The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company&rsquo;s sole discretion, consistent with the law.
   <br/>
   <br/>
  </li>
 </ul>
 Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
 <br/>
 <br/>
 Who We Are
 <br/>
 <br/>
 Elevance Health is a health company dedicated to improving lives and communities &ndash; and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
 <br/>
 <br/>
 How We Work
 <br/>
 <br/>
 At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
 <br/>
 <br/>
 We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
 <br/>
 <br/>
 Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
 <br/>
 <br/>
 The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
 <br/>
 <br/>
 Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
 <br/>
 <br/>
 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
 <br/>
 <br/>
 Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
</div>


Blue Cross Blue Shield of Michigan

<div><p>Shift &acirc;&euro;&ldquo; 8:30am-5:00pm M-F; shift bidding process based on seniority.
</p><p>Site/Location: Detroit, MI
</p><p>Status &acirc;&euro;&ldquo; Regular Full Time<br>
</p><p></p><p><b>Provide thorough analysis and investigation of authorization requests for specialized medical/surgical/outpatient procedures in an expeditious and accurate manner ensuring provider, hospital/facility, Primary Care Group (PCG), and member quality customer service. Provide information and assistance pertaining to the Medical Management program to providers, hospitals, PCGs and members.
</b></p><ul><li>Assess and investigate requests for medical service authorization and authorize select services that do not require clinical judgment. Collect and record appropriate data to issue authorization and route request for services that require medical review to appropriate team member(s).
</li><li>Facilitate communication with providers regarding status on authorizations and referrals. Identify relevant issues and route to appropriate department for action and resolution.
</li><li>Perform departmental functions such as: data preparation/presentation, interaction with internal and external sources to resolve inquires, assist with on-the-job training of new employees as requested, educate and direct providers on medical management policy, procedures, plan benefits and co-pays for all products.
</li><li>Promote and engage in positive and constructive daily team interactions.
</li><li>Perform other duties as assigned.
</li></ul><p><b>QUALIFICATIONS
</b></p><ul><li>Associate&acirc;&euro;&trade;s degree in health care administration or other health related field or two (2) years full-time college credits preferred.
</li><li>Current Michigan licensed LPN, RHIT (Registered Health Information Technician) or Certified Medical Assistant designation preferred.
</li><li>Validated successful completion of medical terminology course required. Completion of a medical terminology course at an accredited college or career school is preferred.
</li><li>College level course work in anatomy and physiology preferred.
</li><li>One (1) year experience in a clinical or health insurance setting and one (1) year experience in customer service required. Customer and telephonic servicing techniques required.
</li><li>One (1) year experience with ICD10, HCPCS and CPT coding preferred.
</li><li>Knowledge of managed care philosophy, policies and procedures preferred.
</li><li>Knowledge of BCN/BCBSM policies, procedures, and benefits preferred.
</li><li>Demonstrated good verbal and written communication.
</li><li>Time management, analytical, and problem-solving skills to service providers, facilities, members and internal departments. Must be able to multi-task; organized self-starter with the ability to prioritize.
</li><li>Knowledge of current standard personal computer operations required.
</li><li>Data entry skills at 80-85 net keystrokes per minute, with 80% accuracy required.</li></ul></div>

Medical Information Specialist

Speak Viral

<p>We are seeking a detail-oriented and organized <b>Medical Billing Specialist</b> to manage billing processes, insurance claims, and payment collections for our healthcare facility. The ideal candidate will ensure accurate billing, timely claim submissions, and compliance with healthcare regulations while maintaining excellent communication with patients, insurance providers, and internal teams.</p><p>Key Responsibilities</p><ul><li>Prepare, review, and submit medical claims to insurance companies and government payers.</li><li>Verify patient insurance coverage and eligibility.</li><li>Review patient bills for accuracy and completeness before submission.</li><li>Follow up on unpaid or denied claims and resolve billing discrepancies.</li><li>Post payments from insurance companies and patients.</li><li>Maintain accurate billing records and documentation.</li><li>Communicate with patients regarding billing inquiries, payment plans, and account balances.</li><li>Work with coding staff to ensure correct use of medical codes (ICD-10, CPT, HCPCS).</li><li>Ensure compliance with healthcare billing regulations and privacy laws (HIPAA).</li><li>Generate billing reports and assist with revenue cycle management.</li></ul><p>Required Qualifications</p><ul><li>High school diploma or equivalent (Associate degree in Healthcare Administration or related field preferred).</li><li>Proven experience as a Medical Billing Specialist or in medical billing and coding.</li><li>Knowledge of medical billing procedures, insurance guidelines, and claim management.</li><li>Familiarity with ICD-10, CPT, and HCPCS coding systems.</li><li>Proficiency in medical billing software and electronic health records (EHR) systems.</li><li>Strong attention to detail and organizational skills.</li><li>Excellent communication and problem-solving abilities.</li></ul><p>Preferred Skills</p><ul><li>Certification such as Certified Professional Biller (CPB) or Certified Coding Specialist (CCS).</li><li>Experience with Medicare, Medicaid, and commercial insurance billing.</li><li>Ability to manage multiple tasks and meet deadlines in a fast-paced environment.</li><li>Strong analytical and reconciliation skills.</li></ul><p>Job Type: Full-time</p><p>Pay: Rs45,000.00 - Rs75,000.00 per month</p><p>Work Location: In person</p>

Medical Billing Specialist

COA Holding Company

<div>
 <strong>
  Job Title:
 </strong>
 Procurement Specialist
 <br/>
 <br/>
 <strong>
  Location:
 </strong>
 Hyde Park, New Cairo
 <br/>
 <br/>
 <strong>
  Employment Type:
 </strong>
 Full Time
 <br/>
 <br/>
 <strong>
  Job Summary
  <br/>
  <br/>
 </strong>
 We are seeking a skilled and detail-oriented
 <strong>
  Procurement Specialist
 </strong>
 with a minimum of
 <strong>
  5 years of experience
 </strong>
 to join our team. The ideal candidate will have a strong background in the
 <strong>
  medical, technology, and food &amp; beverage industries
 </strong>
 , with proven expertise in supplier management, negotiation, and cost optimization.
 <br/>
 <br/>
 <strong>
  Key Responsibilities
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Manage the full procurement cycle including sourcing, negotiation, and purchasing.
  </li>
  <li>
   Identify and evaluate suppliers to ensure quality, cost efficiency, and reliability.
  </li>
  <li>
   Negotiate contracts, pricing, and terms with vendors.
  </li>
  <li>
   Maintain strong relationships with suppliers and ensure timely delivery of goods and services.
  </li>
  <li>
   Monitor inventory levels and coordinate with internal departments to meet business needs.
  </li>
  <li>
   Analyze market trends to identify cost-saving opportunities.
  </li>
  <li>
   Ensure compliance with company policies and procurement procedures.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Requirements
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Minimum 5 years of experience in procurement or supply chain.
  </li>
  <li>
   Experience in medical, technology, and food &amp; beverage sectors is highly preferred.
  </li>
  <li>
   Strong negotiation and supplier management skills.
  </li>
  <li>
   Excellent analytical and problem-solving abilities.
  </li>
  <li>
   Strong communication and organizational skills.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Education
  <br/>
  <br/>
 </strong>
 Bachelor&rsquo;s degree in Business Administration, Supply Chain Management, or a related field.
 <br/>
 <br/>
 <strong>
  How To Apply
  <br/>
  <br/>
 </strong>
 Interested candidates can apply through mail :
 <br/>
 <br/>
 Shams.elbdltagy@coaholding.com
 <br/>
 <br/>
 Please mention
 <strong>
  (Procurement Specialist)
 </strong>
 in the subject line.
</div>


Procurement Specialist

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