reimbursement specialist

Afinida

<div><b>Position Overview:</b><br>
The Reimbursement/Billing Specialist is responsible for a portfolio of accounts receivable and oversees the billing cycle from charge review, claims submission and follow-up. The employee is engaged in a proactive and independent collection of outstanding balances for specially handled IV Services, LLC., pharmacy accounts. The Reimbursement/Billing Specialist will serve as the technical expert for complex workflows. The specialist is responsible for handling charge review edits, claim edits and preparation, insurance follow-up, denial resolution, and necessary follow-up to ensure accurate payment.<br>
<br>
<b>Supervisory Responsibilities:</b><ul><li>
None</li></ul><b>
Duties/Responsibilities:</b><ul><li>
Maintain a portfolio of accounts receivable for the pharmacy;
</li><li>Follow accounts through the Pharmacy revenue cycle, including but not limited to: verifying patient coverage information, updating registration, completing charge review, claim edits and claim submissions, and following up with third party payers and patients to facilitate prompt resolution of outstanding account balances;</li><li>
Communicate with Revenue Cycle teams, payors and others to resolve account problems; participate in meetings as needed to address payor concerns;</li><li>
Evaluate the payment status of outstanding third-party claims and resolve impediments to payment by providing information such as medical records, itemization of charges, information regarding other insurance benefits, and explanation of charges;</li><li>
Actively participates in both external third-party audits and in internal audits and quality improvement initiatives, maintains documentation of current workflows, assists with special projects, and works closely with third party billing teams, Dalrada Corporate Accounting teams, and with Pharmacy Department Leadership and Prior Authorization teams;</li><li>
Perform complex patient account follow-up activities and actively participates in quality improvement initiatives to improve accounts receivable processes;</li><li>
Accurate and timely processing of appeals to various pertinent payers or programs;</li><li>
Review and validate adjustments to accounts in the insurance portfolio based on insurance reimbursement, coverage, contracts and services provided;</li><li>
Review charges to ensure filing to correct guarantor (e.g. work comp vs. personal/family);</li><li>
Conduct collection calls to patients with outstanding balances and negotiate full payment from patients and/or assist patients in setting up a payment plan;</li><li>
Provide education to patients on UW Health&rsquo;s financial assistance policy and application process and direct patients to the appropriate resources as necessary (e.g. Financial Counseling, Patient Relations);</li><li>
Receive, document, and respond to all patient correspondence in a prompt and courteous manner; accurately document all actions taken to reconcile outstanding balances;</li><li>
Assist patients in coordinating appeal processes with their insurance company;</li><li>
Review self-pay undistributed and credit balance accounts and provide refunds to patients as necessary;</li><li>
Accurately post EFT, cash and checks made payable to IV Services, LLC., to the billing system;</li><li>
Ensure that all transactions are completed within the appropriate guidelines, policies and regulations, typically the same day received;</li><li>
Process electronic remittance files, payor work queues, and generate payment reports to balance;</li><li>
Communicate with IV Services, LLC., staff, insurance companies, financial institution and third-party payors to resolve issues related to proper posting of payments;</li><li>
Complete work on special projects, queries and reports as assigned;</li><li>
Other duties may be assigned as needed by management.</li></ul><b>
Required Skills/Abilities:</b><ul><li>
In-depth understanding of Pharmacy billing policies and procedures including NCPDP D.0 standards;</li><li>
Proficiency in spreadsheet and database software;</li><li>
Advanced analytic ability;</li><li>
Ability to make good judgments in demanding situations;</li><li>
Effective communication skills;</li><li>
Ability to logically and accurately organize details;</li><li>
Ability to manage multiple tasks with ease and efficiency;</li><li>
Ability to work independently and be result oriented;</li><li>
Positive, can-do attitude coupled with a sense of urgency;</li><li>
Effective interpersonal skills, including the ability to promote teamwork;</li><li>
Ability to ensure a high level of customer satisfaction including employees, patients, visitors, faculty, physicians and external stakeholders;</li><li>
Ability to use various computer applications including EPIC, Microsoft Office, etc;</li><li>
Basic math skills and knowledge of general accounting principles;</li><li>
Knowledge of medical and insurance terminology, CPT, ICD coding structures, and billing forms (UB, UCF, 1500);</li><li>
Maintain confidentiality of sensitive information;</li><li>
Knowledge of local, state and federal healthcare regulations.</li></ul><br>
<b>
Education and Experience:</b><ul><li>
An Associate degree in Business, Finance, Health Information Management, or related field preferred;</li><li>
3-5 years of experience in a healthcare revenue cycle or clinic operations role;</li><li>
3-5 years of experience in an infusion pharmacy setting;</li><li>
Experience with billing within the Caretend pharmacy platform;</li><li>
Experience billing acute infusion and specialty pharmacy claims.</li></ul><b>
Physical Demands and Work Environment:</b><ul><li>
While performing the duties of this job, the employee may be regularly required to stand, sit, talk, hear, reach, stoop, kneel, and use hands and fingers to operate a computer, telephone, and keyboard;</li><li>
Specific vision abilities required by this job include close vision requirements due to computer work;</li><li>
Light to moderate lifting may be required;</li><li>
Regular, predictable attendance is required; including quarter-driven hours as business demands dictate;</li><li>
Moderate noise (i.e., business office with computers, phone, and printers, light traffic);</li><li>
Ability to work in a confined area;</li><li>
Ability to sit at a computer terminal for an extended period;</li></ul><b>
Hourly Rate:</b><ul><li>
$28.00 an hour</li></ul><br>
<i>
Disclaimer:</i><br>
<br>
<i>This Job Description is only a summary of the typical functions of the position or role, not an exhaustive or comprehensive list of all possible responsibilities, tasks, and duties. Additionally, responsibilities, tasks, and duties of the employee in this role might differ from those outlined in the Job Description and other duties may be assigned on a permanent or temporary basis based on business needs.</i><p>
The Job Description is intended to be a general representation of the responsibilities and requirements of the job. However, the description may not be all-inclusive, and responsibilities and requirements are subject to change.</p>
<p>Equal Employment Opportunity</p>
<p>It is the policy of the Company to provide equal employment opportunities to all employees and employment applicants without regard to unlawful considerations of race, religion, color, national origin, sex, sexual orientation, gender identity or expression, age, sensory, physical, or mental disability, marital status, veteran or military status, genetic information, or any other classification protected by applicable local, state, or federal laws. This policy applies to all aspects of employment, including, but not limited to, hiring, job assignment, compensation, promotion, benefits, training, discipline, and termination. Reasonable accommodation is available for qualified individuals with disabilities, upon request.</p><p>
</p><p>wUL3sr7S2K</p></div>

Reimbursement/Billing Specialist

Signature HealthCARE LLC

<div>About Us :
<div><b>
Morgantown Care &amp; Rehabilitation Center</b> is a 122-bed skilled nursing that offers a variety of comprehensive programs and services such as in-patient therapy and out-patient therapy, Rehab to Home. The vision, to radically change the landscape of healthcare, forever. Through education and empowerment, we earn the trust of every patient, family member, and the community we serve.</div>
About Signature :
<div><b>
Signature HealthCARE</b> is a family-based healthcare company offering integrated services across multiple states. Our continuum of care includes skilled nursing, rehabilitation, assisted and memory care, and home-based services supported by innovative technologies like telehealth and Care.ai-enabled solutions.</div><div><br>
We are committed to advancing person-directed care and quality outcomes. Many of our facilities continue to receive high performance ratings and accreditations. As an award-winning organization recognized over the years by national outlets such as <i>U.S. News &amp; World Report</i>, we take pride in fostering compassionate care environments and being an employer of choice in the healthcare industry.</div>
Overview:
<div><b>
The ideal Clinical Reimbursement Specialist Candidate is very detailed orientated, organized, self-motivated, a love for supporting and training Stakeholders.
</b></div><div><b>The ability to travel to assigned sites Monday &ndash; Friday is a must.</b></div>
Additional Details:
<p><b>
MDS LEADER NEEDED! MUST LOVE TO TRAVEL!</b></p><p><b>
Do you love to train, perform audits, mentor MDS Coordinators and have TONS of autonomy? If so, this opportunity is for YOU!</b></p><p><b>
**TRAVEL REQUIRED TO MULTI-SITE FACILITIES (</b><b>Bowling Green, Glasgow, Hart, Monroe, and Morgantown) </b><b>4 DAYS PER WEEK WITH ONE DAY WORKING REMOTE**</b></p>
How you Will make a Difference:
<ul><li>Assist with systems development and implementation of programs that apply to the Resident Assessment Instrument (RAI), Prospective Payment Systems (PPS), Quality Measures (QM&rsquo;s), Medicaid Casemix and Medicare/Medicaid guidelines for all SHC Stakeholders.</li><li>
Assist with design and presentation of RAI, PPS, Quality Measures, Medicare and Medicare education utilizing various types of media, technology, workshops, classes, and one on one.</li><li>
Conduct facility site visits to orient new MDS Coordinators as well as to evaluate and reinforce RAI/MDS/PPS processes.</li></ul>
What you Need to make a Difference:
<ul><li>Current licensure as a Registered Nurse with ability to obtain multi-state licensures.</li><li>
Minimum of five (5) years related experience as a licensed Registered Nurse in a long-term care setting.</li><li>
MDS Experience in LTC in the past two (2) years</li><li>
Willing to travel eighty to ninety percent (80% - 90%) travel with overnight stays.</li></ul>
Our exceptional Benefits Package and Signature Perks include the following and more! (if applicable):
<ul><li>Medical, Dental and Vision &ndash; Voluntary Life/Disability</li><li>
Free Telemedicine with Medical Plan</li><li>
401(K) and Roth 401(K)</li><li>
Tuition Forgiveness/Education Reimbursement</li><li>
A variety of additional specialized Insurances</li><li>
Pay Advance and Next Day Pay!</li><li>
Work Life Balance (WLB)</li><li>
Partner Perks and Discounts!</li><li>
Reward &amp; Recognition Program (HEART)</li><li>
Vital Links</li></ul><p>
At Signature HealthCARE, our team members are permitted &ndash; no, encouraged &ndash; to employ their talents and abilities to solve problems.<br>
Our culture is built on three distinct pillars: Learning, Spirituality and Intra-preneurship.<br>
Each pillar has its own staff and initiatives, ensuring that our unique culture permeates the entire organization.<br>
<b>Come see what the revolution is all about!</b></p><p></p><p><br>
Signature HealthCARE is an Equal Opportunity-Affirmative Action Employer &ndash; Minority / Female / Disability / Veteran and other protected categories</p>
Hashtag : #LI-MH1</div>

Regional MDS Coordinator / Clinical Reimbursement Specialist (RN)

Renown Health

<div>
 <strong>
  Position Purpose
  <br/>
  <br/>
 </strong>
 The Insurance and Claims Specialist will review and correct claim errors ensuring accurate, timely claim submission and account follow-up to assigned payors and reimbursement on first claim submitted. The Specialist will appeal healthcare claims denied by third-party payors to obtain reimbursement and handle difficult, hard to collect accounts that have been deemed by the insurance company as unpayable. The Specialist will conduct analysis and resolve incorrect reimbursement issues and credit balance resolution with payors. This position is responsible to know all state/federal regulations that relate to contracts and to the appeal process and/or government payor billing and follow-up regulations to include CCI, LCD/NCD and medical necessity rules.
 <br/>
 <br/>
 <strong>
  Nature and Scope
  <br/>
  <br/>
 </strong>
 <strong>
  The Insurance And Claims Specialist Is Responsible For
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Work assigned Work Queues to correct errors, ensuring accurate claims and reimbursement on first claim submission.
  </li>
  <li>
   Audit denials and payment variances to determine root cause and correction as required.
  </li>
  <li>
   Auditing payment variances ensuring appropriate reimbursement.
  </li>
  <li>
   Provide specific and in depth contract knowledge to ensure maximum reimbursement of healthcare claims.
  </li>
  <li>
   Resolve credit balances by reviewing payments, adjustments or transfers correcting the patient account to reflect an accurate account receivable balance.
  </li>
  <li>
   Work with leadership and other internal departments to improve processes, increase accuracy, create efficiencies and decrease denials to achieve the overall goals of Renown Health.
  </li>
  <li>
   Maintain a current knowledge of CPT/HCPCS, ICD, DRG, HCFA forms, ability to manipulate and analyze 837 and all other HIPAA transaction sets.
   <br/>
   <br/>
  </li>
 </ul>
 This position is required to operate within policy and procedural guidelines that will ensure accurate accounts receivable reporting and is compliant with policy and procedural guidelines consistent with Renown Health goals and objectives.
 <br/>
 <br/>
 This position does not provide patient care.
 <br/>
 <br/>
 <strong>
  Disclaimer
  <br/>
  <br/>
 </strong>
 The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
 <br/>
 <br/>
 <strong>
  Minimum Qualifications
  <br/>
  <br/>
 </strong>
 Requirements - Required and/or Preferred
 <br/>
 <br/>
 <strong>
  Name
  <br/>
  <br/>
 </strong>
 <strong>
  Description
  <br/>
  <br/>
 </strong>
 Education:
 <br/>
 <br/>
 Must have working-level knowledge of the English language, including reading, writing and speaking English. Associates degree preferred.
 <br/>
 <br/>
 <strong>
  Experience
  <br/>
  <br/>
 </strong>
 One year healthcare billing office experience with extensive knowledge of healthcare billing, government and third party payor requirements. Associate degree or certification in accredited billing certification may be accepted in lieu of years of experience.
 <br/>
 <br/>
 <strong>
  License(s)
  <br/>
  <br/>
 </strong>
 None.
 <br/>
 <br/>
 <strong>
  Certification(s)
  <br/>
  <br/>
 </strong>
 None.
 <br/>
 <br/>
 <strong>
  Computer / Typing
  <br/>
  <br/>
 </strong>
 Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.
</div>


Insurance and Claims Specialist

Johnson & Johnson

<div><p>At Johnson &amp; Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity. Learn more at jnj.com.</p><p>
As guided by Our Credo, Johnson &amp; Johnson is responsible to our employees who work with us throughout the world. We provide an inclusive work environment where each person is considered as an individual. At Johnson &amp; Johnson, we respect the diversity and dignity of our employees and recognize their merit.</p><p><b>
Job Function:
</b></p>Market Access<p><b>
Job Sub Function:
</b></p>Reimbursement<p><b>
Job Category:</b></p>
People Leader<p><b>
All Job Posting Locations:</b></p>
Houston, Texas, United States of America<p><b>
Job Description:</b></p><p><b>
About Innovative Medicine</b></p><p>
Our expertise in Innovative Medicine is informed and inspired by patients, whose insights fuel our science-based advancements. Visionaries like you work on teams that save lives by developing the medicines of tomorrow.</p><p>
Join us in developing treatments, finding cures, and pioneering the path from lab to life while championing patients every step of the way.</p><p>
Learn more at https://www.jnj.com/innovative-medicine</p><p>
Johnson &amp; Johnson Innovative Medicine&rsquo;s Patient Engagement and Customer Solutions (PECS) team is recruiting for a Field Reimbursement Manager which will be a field-based position that will include the Houston North, The Woodlands and Spring territories.</p><p>
PECS is committed to setting the standard on Patient Experience (Px), building more personalized, seamless, and supportive experiences to help patients start and stay on treatments across the portfolio.</p><p><b>
Job Description:</b></p><p>
An important aspect of patient&rsquo;s unmet need includes helping them start and stay on their medicine for the best chance at treatment success. The Patient Engagement and Customer Solutions (PECS) organization serves patients, during their treatment journey with Janssen therapies, to help overcome challenges to fulfillment, on-boarding, and adherence.</p><p>
The Field Reimbursement Manager (FRM) is responsible for serving as the primary field-based lead for education, assistance, and issue resolution with healthcare providers (HCPs), and their office staff, with respect to patient access to J&amp;J Immunology therapies. This role involves investing time (up to 50%) on-site with HCPs, assessing their education needs and facilitating collaboration with various stakeholders.</p><p><b>
A Day in the Life</b></p><p>
Every patient&rsquo;s healthcare experience is unique - shaped by personal experiences and beliefs, the presence or absence of support networks, provider and payer dynamics, and socioeconomic factors. For many patients, the decision to start or stop treatment is overwhelming. J&amp;J recognizes this, and wants to create an experience that is personalized, helpful, and hopeful.</p><p><b>
Primary Responsibilities:</b></p><p>
Primary responsibilities include the following. Other duties may be assigned.</p><ul><li>
Educate HCPs on product coverage, prior authorizations and appeals, reimbursement processes, claims submissions, procedures, and coding requirements of payer organizations (local payers, government payers, etc.) for core and launch products.</li><li>
Collaborate with field support team members such as sales representatives and key account managers and serve as reimbursement expert for the local team.</li><li>
Act with a sense of urgency to address critical access and affordability issues for patients.</li><li>
Partner with managed care colleagues to understand current policies and potential future changes.</li><li>
Conduct field-based reimbursement and access support, education and creative problem-solving aligned to FRM Rules of Engagement</li><li>
Build strong, trust-based relationships with customers in all assigned Immunology accounts.</li><li>
Manage territory logistics, routing, and account business planning.</li><li>
Maintain and grow knowledge of national, regional, local, and account market dynamics including coverage and coding requirements.</li><li>
Grow the knowledge of hub and specialty distribution channels to improve practice and patient support needs.</li><li>
Collaborate with internal J&amp;J departments such as marketing, sales, medical science, SCG, IBG, HCC, and PECS. Serve as subject matter expert regarding education and insights on access and affordability solutions across multiple payer types and plans (i.e., Medicare, Medicaid Managed Care, Commercial).</li><li>
Execute business in accordance with the highest ethical, legal, and compliance standards, including timely and successful completion of all required training.</li></ul><p><b>
Market Access Expertise:</b></p><ul><li>
Extensive knowledge of medication access channels (i.e., pharmacy and medical benefits including buy &amp; bill and/or assignment of benefit (AOB) across multiple sites of care</li><li>
Remains current on and anticipates changes in product coverage and access knowledge, marketplace conditions, and stakeholder practices to deliver the most effective delivery of approved materials.</li><li>
Understands and adapts to the changing healthcare ecosystem to customize resourcing and messaging to HCPs and HCP staff</li></ul><p><b>
Qualifications:</b></p><p>
REQUIRED</p><ul><li>
Bachelor&rsquo;s degree (preferably in healthcare or business/public administration). An advanced business degree (MBA), or public health (MPH) is preferred.</li><li>
Minimum of 5 years of relevant professional experience</li><li>
Account Management and/or Reimbursement experience working in the hospital and/or provider office setting, building strong customer relationship.</li><li>
Demonstrated expertise with both pharmacy and medical/buy &amp; bill benefits (as applicable), coding, and billing.</li><li>
Reimbursement or relevant managed care experience (revenue cycle, buy-and-bill, prior authorization, coding, and appeals processes)</li><li>
Ability to establish relationships, collaborate, and influence across a matrix organization.</li><li>
Problem-solving ability to navigate challenging access scenarios and identifies solutions in a timely and efficient manner.</li><li>
Experience in working with patient support HUB services.</li><li>
Valid US driver&rsquo;s license and a driving record in compliance with company standards</li><li>
Ability to consistently maintain up to 50% travel.</li><li>
Permanent residence in the listed territory</li></ul><p><b>
Preferred</b></p><ul><li>
Immunology disease state experience</li><li>
Advanced degree and/or relevant certifications in prior authorization and/or billing and coding</li><li>
Strong market access acumen as it relates to payer approval processes and business acumen.</li><li>
Understanding of Medicare, Medicaid, and private payer initiatives affecting reimbursement of pharmaceutical and biotechnology products</li><li>
Excellent technical knowledge and expertise in payer policy, including all elements of reimbursement (coding, coverage, and payment) is preferred.</li><li>
Demonstrated competence with salesforce.com CRM use, Microsoft Word, and Excel</li></ul><p>
#FRM2026</p><p>
#LI-Remote</p><p>
Johnson &amp; Johnson is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, protected veteran status or other characteristics protected by federal, state or local law. We actively seek qualified candidates who are protected veterans and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act.</p><p>
Johnson &amp; Johnson is committed to providing an interview process that is inclusive of our applicants&rsquo; needs. If you are an individual with a disability and would like to request an accommodation, please contact us via https://www.jnj.com/contact-us/careers or contact AskGS to be directed to your accommodation resource.</p><p><b>
Required Skills:
</b></p><p><b>Preferred Skills:</b></p>
Account Management, Analytical Reasoning, Competitive Landscape Analysis, Compliance Management, Cross-Functional Collaboration, Developing Others, Fact-Based Decision Making, Inclusive Leadership, Leadership, Market Access Reimbursement, Market Opportunity Assessment, Operational Excellence, Performance Measurement, Pricing Strategies, Relationship Building, Strategic Thinking, Team Management</div>

Field Reimbursement Manager (Immunology Dermatology)– (Houston North) – Johnson & Johnson HCS, Inc.

Recordati S.p.A

<p></p><div><div><div><div><div><b>ID: </b>2553
</div></div></div></div><div><div><div><div><b>Date of Posting: </b>May 8, 2026
</div></div></div></div><div><div><div><div><b>Business Area: </b>Sales &amp; Marketing
</div></div></div></div><div><div><div><div><b>Job Type: </b>Direct Employee
</div></div></div></div><div><div><div><div><b>On site / Remote / Hybrid: </b>Remote
</div></div></div></div><div><div><div><div><b>Hub Office:
</b>Bridgewater, NJ, US
</div></div></div></div><div><div><div><div><b>Territory: </b>California
</div></div></div></div><div><div><div><div><b>Full-Time or Part-Time: </b>Full Time
</div></div></div></div><div><div><div><div><b>Seniority: </b>Mid-senior
</div></div></div></div><p></p><div><div><p><i>With its beginnings in a family run pharmacy in Correggio, Italy in the 1920s, Recordati is now a global pharmaceutical company, listed on the Italian stock exchange, with over 4,500 employees and turnover of over Euro 2bn.</i><br>
<i>
</i><br>
<i>We are a group of like-minded, passionate individuals who go to extraordinary lengths for our patients, customers, partners, investors and the people across the globe who we serve. We develop and commercialise medicines to serve people living with common diseases, as well as those living with some of the rarest, in around 150 countries.</i><br>
<i>
</i><br>
<i>At Recordati, our mantra is simple. We&rsquo;ve always believed that health, and the opportunity to live life to the fullest, is a right, not a privilege. Whether that is for common diseases or the rarest &ndash; we want to give people the opportunity to be the best version of themselves.</i><br>
<i>
</i><br>
<i>This drive will never stop. Together, we will always be reimagining tomorrow &ndash; with new ideas, new technologies and new innovations to fight diseases.</i><br>
<i>
</i><br>
<i>Recordati. Unlocking the full potential of life.</i></p>
</div></div><div><div><div><div><div><div><div><div><b>This position is with Recordati Rare Diseases, Inc. (RRD), North America, an affiliate of Recordati.</b></div>
</div><div><div>
Recordati Rare Diseases, Inc. (RRD) develops high-impact therapies for rare diseases, focusing on providing treatments to underserved communities in the U.S. Our mission is to mitigate the impact of rare diseases through increased awareness, better diagnoses, and improved treatment access in endocrinology, metabolic, hematology and oncology franchises. RRD is dedicated to fostering a dynamic work environment that promotes professional growth and a significant impact on patients' lives.</div></div></div><div><div><div><b>
Reporting Structure</b></div>
</div><div><div>
Reports To: Associate Director, Field Reimbursement<br>
Direct Reports: None<br>
Areas Managed: Field Reimbursement</div></div></div><div><div><div><b>
Overview</b></div>
</div><div><div>
The Field Reimbursement Manager (FRM) will be responsible for managing accounts in a specified region focusing on but not limited to Endocrinology. The FRM is responsible for providing access and reimbursement education to healthcare providers (HCPs)and office personnel, including information regarding medical policies, prior authorization requirements, coding and billing, product access via buy-bill or specialty pharmacy with the goal of minimizing barriers to therapy. The FRM also supports by providing general education and case-specific next steps for appeals process in response to prior authorization denials. This role involves investing time on-site with HCPs, assessing their access and reimbursement needs education needs and facilitating collaboration with various stakeholders.</div></div></div><div><div><div><b>
Key Responsibilities</b></div>
</div><div><ul><li>Partnering with cross-functional parties on overall account and territory strategy to maximize internal/external customer knowledge on payor policy and processes</li><li>Serve as subject matter experts on issues of coverage, access and reimbursement by providing compliant, limited support to US health care providers (HCPs) and their office staff in navigating the reimbursement landscape for products of Recordati Rare Diseases Inc. (RRD) after the HCP made an independent decision to prescribe</li></ul>
<ul><li>Collaborate with HCP staff and Specialty Pharmacy to follow up with accounts that have outstanding prior authorization or appeals submissions</li><li>Being a subject matter expert on reimbursement and regional-specific access landscape. This includes payor policies, prior authorization requirements, denials, appeals, peer to peer and other education required to navigate access for coverage of company therapies</li><li>Collaborating with cross-functional parties on individual case management needs related to HCP education on reimbursement issues</li><li>Collect field insights on payer trends, reimbursement challenges and provider needs to inform internal stakeholders</li><li>Leveraging all available resources including internal data to develop and execute account plans/call purpose</li><li>Complying with all laws, regulations and policies that govern the conduct of company activities, work with the highest degree of professionalism and in accordance with the company&rsquo;s code of Ethics and Business Conduct</li><li>Complying with annual budget allocation within respective territory to Perform additional duties as may be assigned.</li></ul></div></div><div><div><div><b>
Education and Experience</b></div>
</div><div><ul><li>Bachelor&rsquo;s degree</li><li>Experience in working in field-based role working with provider offices and/or with patient support HUB services</li><li>Minimum of five to seven years of experience in the healthcare and/or pharmaceutical industry</li><li>Minimum of three years successful field reimbursement experience</li><li>Minimum of two years of experience working with buy and bill and/or specialty pharmacy networks</li><li>Ability to analyze and interpret regulations and legislation regarding coding, coverage and reimbursements</li></ul>
In-depth knowledge of the U.S. pharmaceutical market, specifically rare diseases.<br>
<ul><li>Reimbursement or relevant managed care experience (buy-and-bill, prior authorization, coding, and appeals processes)</li><li>Problem-solving ability to navigate challenging access scenarios and identifies solutions in a timely and efficient manner</li><li>Comfortable presenting in person or virtual to Healthcare practitioner office staff</li><li>Superior communication skills (written and verbal) and efficient follow-through</li></ul></div></div><div><div><div><b>
Knowledge and Skills</b></div>
</div><div><ul><li>Strong relationship-building skills, with demonstrated ability to collaborate and operate across functions</li><li>Strong planning and organizational skills; demonstrated decision-making ability</li></ul>
Reliable transportation within territory<br>
<ul><li>Proficiency in Microsoft Office</li><li>Demonstrated highest ethical standards</li><li>Demonstrated effective problem-solving and decision-making capabilities</li><li>Ability to prioritize/multi-task effectively</li><li>Excellent verbal and written communication skills</li></ul></div></div><div><div><div><b>
Work Environment</b></div>
</div><div><div>
This job operates in a professional remote environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Based upon job requirements, the employee is required at times to travel to HCP offices offices within a specified territory and attend meetings including travel out of state over weekends and nights. The employee must be able to freely operate and travel by car and train/plane modes of transportation. The employee is required to have a valid driver&rsquo;s license and means of transportation.</div></div></div><div><div><div><b>
Physical Demands</b></div>
</div><div><div>
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. The employee must be able to fly via commercial air carrier.<br>
This is largely a sedentary role; however, the employee frequently is required to travel outside the office and also stand; walk; use hands to finger, handle or feel; and reach with hands and arms; talk and hear. Occasionally is required to lift and/or move light to moderate weight up to 25 lbs.</div></div></div><div><div><div><b>
Location/Travel</b></div>
</div><div><div>
This position is a remote position with proximity to a major airport<br>
This position requires approximately 30-40% travel (need based).</div></div></div><div><div><div><b>
FLSA Classification</b></div>
</div><div><div>
This position is considered Exempt.</div></div></div><div><div><div><b>
EEO Statement</b></div>
</div><div><div>
It is the policy of Recordati Rare Diseases to provide equal employment opportunity (EEO) to all persons regardless of race, color, religion, sex, sexual orientation, gender identity, or national origin. Further, Recordati Rare Diseases will not discriminate on the basis of any characteristic protected by federal, state, or local law. Recordati Rare Diseases will provide reasonable accommodations for a qualified individual with disabilities.</div></div></div><div><div><div><b>
Disclaimer</b></div>
</div><div><div>
This job description is not designed to cover or contain a comprehensive listing of the activities, duties or responsibilities that may be required.</div></div></div><div><div><div><b>
Disclosures
</b></div></div><div><div>Annualized Pay Range (Base Pay): $144,000 - $198,000 Other Types of Pay: Annual bonus<br>
Health Insurance: Medical, dental, orthodontia, vision, life &amp; ADD, short and long term disability insurance benefits.<br>
Retirement Benefits: 401k<br>
Paid Time Off: Vacation, holiday, and sick/personal time.</div></div></div></div>
</div></div></div></div><div></div><div><div><p><i>At Recordati we believe in people! Inspired by our purpose - unlocking the full potential of life - we are committed to creating a diverse environment and cultivating a culture of inclusion. We strive to continually lead with our values and beliefs, enabling our employees to bring their whole selves to work and develop their potential.</i></p>
<p><i>We are proud to be an equal opportunity employer. We recruit, develop and reward without regard to, amongst others, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental ability, race, ethnicity, political or religious belief.</i></p>
<p><i>If you are looking to join a company where you can try new things, speak openly, and be bold, we invite you to apply today.</i></p></div></div></div><p></p>

Field Reimbursement Manager (Los Angeles or San Francisco)

Mission Health Communities

<div><p><b>Spring Hill Care and Rehab</b> in <b>Spring Hill, KS</b> is looking to hire a full-time Clinical Reimbursement Coordinator to join our team, who will manage all of the MDS and Clinical Reimbursement duties for our amazing health care company! You'll be a valued member of our caring, dynamic team, with a full suite of benefits available to you. If this sounds interesting to you, please read on!</p>
<p>
Mission Health is a family of communities, and we are proud to employ exceptional individuals who deliver a positive Mission experience to our residents and families, as well as our co-workers. Our CARES values of Character, Attitude, Respect, Excellence, and Service are at the core of everything we do, from billing to patient care!</p>
<p>
This position earns a <b>competitive salary of $41.00 to $45.50/hr with on-call pay.</b> We also provide comprehensive benefits, including medical, dental, vision, short- and long-term disability, a flexible spending account (FSA), a 401(k) plan, paid time off (PTO), life insurance, continuing education unit (CEU) reimbursement, and daily pay options.</p>
<p>
The Clinical Reimbursement Coordinator is responsible for the timely and accurate completion of the Federal and State assessment tools but may also be called upon to perform duties of an RN, if needed. This position requires an understanding of the MDS rules and regulations as described in the MDS User's Manual, including item coding, RAPS, CAA's, Care Planning, electronic submission, scheduling, PPS including knowledge of MDS submission process, final validation reports, and an understanding of Medicare rules and regulations including coverage, benefit periods, certification, 30 Day rule. you will intake all processed forms, including but not limited to, order sheets, doctor notes, pharmacy recommendations, order summaries and lab results and scanning them into electronic form to upload each document into the applicable resident's electronic medical record.</p>
<p>
QUALIFICATIONS FOR MDS COORDINATOR / CLINICAL REIMBURSEMENT COORDINATOR</p>
<ul><li>Current RN licensure with the KS Board of Nursing</li></ul>
<ul><li>Current CPR certification</li></ul>
<ul><li>1-2 years of experience as an MDS Coordinator / Clinical Reimbursement Coordinator</li></ul>
<ul><li>Good organization skills</li></ul>
<ul><li>Experience with 3.0, PPS, and Case Mix</li></ul>
<ul><li>Ability to pass license check, background check and drug screen</li></ul>
<ul><li>Ability to maintain confidentiality and comply with all HIPPA regulations</li></ul>
<ul><li>Desire to work with the elderly</li></ul>
<p>
Are you trustworthy and respectful of others? Is being dependable, professional, and a team player at the heart of all you do? Do you enjoy serving and caring for seniors? Can you easily</p>
<p>
establish a good rapport with others and communicate effectively? If yes, you might just be perfect for this dietary manager position!</p>
<p>
ARE YOU READY TO JOIN OUR TEAM?</p>
<p>
If you feel that you would be right for this job, please fill out our initial 3-minute, mobile-friendly application. We look forward to meeting you!</p></div>

Clinical Reimbursement Coordinator

Lakeland Regional Health

<p></p><div><div><div><div><div>Position Details<br>
</div></div><br>
<div><div><p>Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only Provisional Level 1 Trauma center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 910 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.
</p><p><b>Active - Benefit Eligible and Accrues Time Off
</b></p><p></p><b>Work Hours per Biweekly Pay Period: </b>80.00
<br>
<b>Shift </b>: Monday - Friday
<br>
<b>Location </b>: 210 South Florida Avenue Lakeland, FL - Remote after training
<br>
<b>Pay Rate </b>: Min $17.84 Mid $20.53
</div></div><br>
<div><div>Position Summary<br>
</div></div><br>
<div><div><p>Demonstrates commitment to the promises, vision, core purpose/mission and goals of LRMC, modeling the values and culture. Works under the supervision of the PFS Supervisor. The AR Follow and Denials Specialist is responsible for collecting payments for outstanding hospital claims, managing accounts, researching denials, submitting corrected claim requests, submitting appeals, and ensuring payments received are reconciled correctly with emphasis place on HIPAA compliance and in accordance with departmental goals, SOP&rsquo;s, and contract terms. Responsible for adhering to all Federal regulations and maintaining current knowledge of all Insurance guidelines. Escalates payer denials trends or claims issues to the PFS Leadership Team to address with the payer. Identifies trends, system issues, and potential process improvements to avoid future delays and denials.<br>
<br>
</p></div></div><br>
<p></p><div><div>Position Responsibilities<br>
</div></div><br>
<div><div><p><b>People At The Heart Of All We Do
</b></p><p></p><ul><li>Fosters an inclusive and engaged environment through teamwork and collaboration.
</li><li>Ensures patients and families have the best possible experiences across the continuum of care.
</li><li>Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.
</li><li><b>Safety And Performance Improvement
</b><ul><li>Behaves in a mindful manner focused on self, patient, visitor, and team safety.
</li><li>Demonstrates accountability and commitment to quality work.
</li><li>Participates actively in process improvement and adoption of standard work.
</li><li><b>Stewardship
</b></li><li>Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
</li><li>Knows and adheres to organizational and department policies and procedures.
</li><li><b>Standard Work: AR Follow Up Denials Specialist
</b></li><li>Actively participates in team development, achieving dashboards, and in accomplishing department goals and objectives
</li><li>Responsible for all aspects of follow up and collections on accounts. This includes making outbound calls to payers and accessing payer websites.
</li><li>Collect payments for outstanding claims and ensure payments received are reconciled correctly.
</li><li>Confirm the claim expected reimbursement information to ensure claims are paid correctly. Follows department&rsquo;s process for follow up on underpayments/overpayments.
</li><li>Research and prepare responses for payor requests for additional information or documentation.
</li><li>Submits corrected claim rebill requests to the PFS Billing team when necessary to send to the insurance payer with correct information and ensures payment is received and claims are paid per contract
</li><li>Research denials and works with other departments such as Coding, Billing, CDM, UM, ect. to resolve denial.
</li><li>Submits the insurance reconsideration/appeals with supporting documentation in a timely manner and follow up with insurance to ensure receipt and processing. Follows insurance payer claims and appeals timely filing guidelines.
</li><li>Communicate clearly and professionally, in both written and verbal manners with internal personnel, payors, providers, patients, and other authorized representatives in regards to outstanding balances.
</li><li>Responsible for adequately working correspondence timely and efficiently (including EOBs, RA&rsquo;s, denial letters).
</li><li>Maintain knowledge of current government and carrier regulations, policies, manuals relevant to the industry.
</li><li>Identify and report trends in carrier payments and denials, which includes documentation of actions taken to resolve issues. Follows internal escalation process when necessary.
</li><li>Identify complex and aged claims issues and follows internal escalation process appropriately.
</li><li>Maintain patient confidentiality and privacy; adheres to HIPAA standards.
</li><li>Organizes job functions and work assignments to be able to effectively complete assignments within established time frames.
</li><li>Must meet department Productivity Guidelines. Works with all areas of the department to assure maximum productivity. Utilizes the PFS Productivity tracker.
</li><li>Demonstrates knowledge of all equipment and systems/technology necessary to complete duties and responsibilities.
</li><li>Other duties, responsibilities, and activities may change or be assigned at any time with or without notice.
</li></ul></li></ul></div></div><br>
<div><div>Competencies &amp; Skills<br>
</div></div><br>
<div><div><p>Essential:<br>
<br>
</p><ul><li>Four years general Patient Accounting experience including understanding of Managed Care contracts and claims analysis. Understanding of Medicaid, Medicaid Manage Care, Medicare, Medicare Advantage plans, Commercial, Liability, and Workers' Compensation payers and their guidelines. Knowledge of healthcare rules and regulations.
</li><li>An overall understanding of the appeals processes through completion.
</li><li>Ability to read/interpret EOB&rsquo;s
</li><li>Working knowledge of Word, Excel or other Microsoft applications. Good analytical skills for problem solving, typing of 40 WPM and data entry.
</li><li>Knowledge of Accounting Principles; analytical mathematical skills, professional customer service communication skills.
</li><li>Demonstrates accuracy and thoroughness; Meets productivity standards; Completes work in timely manner.
</li><li>Consistently shows ability to recognize and deal with priorities. Adapts to changes in the work environment; Able to deal with frequent change, delays, or unexpected events.
</li><li>Knowledge of HIPAA guidelines.
</li><li>Demonstrates good judgment and reasoning when investigating and solving problems. Good critical thinking skills.
</li><li>Ability to prioritize and manage time effectively.
</li></ul>Nonessential:
<ul><li>Ability to prioritize and manage time effectively.
</li></ul></div></div><br>
<div><div>Qualifications &amp; Experience<br>
</div></div><br>
<div><div><p>Essential:
</p><ul><li>High School or Equivalent
</li></ul>Nonessential:
<ul><li>Associate Degree
 </li></ul>Nonessential:
<p></p><ul><li>Business or Healthcare Administration
 </li></ul>Other information:
<p></p><div>Experience Essential:
<br>
<ul><li>Two years general patient accounting experience. Experience working with and general understanding of Medicaid, Medicaid Manage Care, Medicare, Medicare Advantage plans, Commercial, Liability, and Workers' Compensation payors.
</li></ul><br>
Experience Preferred:
<br>
<ul><li>Four years general patient accounting experience. Experience working with and general understanding of Medicaid, Medicaid Manage Care, Medicare, Medicare Advantage plans, Commercial, Liability, and Workers' Compensation payors.
</li></ul><br>
Certifications Preferred:
<br>
<ul><li>AAHAM or HFMA certification</li></ul></div></div></div></div></div></div><p></p>

AR Follow Up Denials Specialist - Denial & Appeals Mgmt

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