reimbursement specialist

Western CBO

<div>Responsibilities:
<div><b>
Universal Health Services (UHS) - Western Region Consolidated Business Office (WCBO)</b></div><div>
The Western Region Consolidated Business Office delivers comprehensive insurance revenue services to our affiliated UHS facilities, encompassing billing, collections, cash posting, pre-access management, variance analysis, and customer service. Our dedication to associate satisfaction and growth is recognized by industry leaders, exemplifying our commitment to fostering a positive and inclusive workplace culture. Our associates can count on competitive salaries, top-tier medical, dental, and retirement benefits, career training, and support for continued professional development.</div><div></div><div><b><br>
Job Description: Reimbursement Analyst 7:00AM-3:30PM</b></div><div>
The Reimbursement Specialist Analyst analyzes reimbursement trends and identifies underpayments, facilitates reconsiderations, and appeals with payers. This role coordinates and oversees the complete process of underpayment reconsiderations, including correction of insurance plan errors, payment transfers, and account adjustments.</div>
Qualifications:
<div><b>
Experience:</b></div><div>
2 + years medical contracts and claims experience.</div><div></div><div><b><br>
Education:</b><br>
High School or equivalent.</div><div></div><div><b><br>
Requirements:</b></div><ul><li>
Experience in medical payer contracts. Explanation of benefits experience preferred.</li><li>
Articulate with medical insurance terminology.</li><li>
Strong attention to detail, analytical and critical thinking.</li><li>
Strong Microsoft Office (Excel and Word) and 10-key data entry skills.</li></ul><div>
 This opportunity offers the following:</div><ul><li>
Challenging and rewarding work environment</li><li>
Growth and Development Opportunities within UHS and its Subsidiaries</li><li>
Competitive Compensation</li><li>
Excellent Medical, Dental, Vision and Prescription Drug Plan</li><li>
401k plan with company match</li></ul><div></div><div><b><br>
About Universal Health Services</b></div><div>
One of the nation&rsquo;s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World&rsquo;s Most Admired Companies by Fortune; and listed in Forbes ranking of America&rsquo;s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com</div><div></div><div><br>
EEO Statement:</div><div>
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.</div><div></div><div><br>
We believe that diversity and inclusion among our teammates is critical to our success.</div><div></div><div><br>
Notice:</div><div>
At UHS and all our subsidiaries, our Human Resources departments and recruiter are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.</div><div>
This position will be deemed the sole property of UHS. No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means.</div><br>
<div></div>
Salary: Starting from $19.00 to $25.17 an hour</div>

REIMBURSEMENT SPECIALIST/ANALY

Alliance Health & Human Services

<div><p><b>ALLIANCE HEALTH MANAGEMENT SERVICES</b></p>
<p><b>
JOB DESCRIPTION AND PERFORMANCE APPRAISAL</b></p>
<p>STAFF NAME:_________________________________________ JOB TITLE: Regional Clinical Reimbursement Specialist</p>
<p>EMPLOYEE #:_____________ HIRE DATE:________________ APPRAISAL PERIOD:______________ TO ______________</p>
<p><b>POSITION PURPOSE:</b></p>
<ul><li>Assess and evaluate the quality of care being given to Alliance facility residents per CMS guidelines.</li></ul>
<ul><li>Oversees and Ensures completion of MDS interviews and assessments following the RAI process.</li></ul>
<ul><li>Ensuries regulatory compliance of Medicare, Medicaid, and Managed Care by following federal and state guidelines.
</li></ul><p><b>INTERPERSONAL RELATIONSHIPS:</b></p>
<ul><li>Coordinate with facility team to ensure implementation of the residents&rsquo; plan of care, assessments, and education.</li></ul>
<ul><li>Works with corporate team to ensure compliance, report any and all issues, and educate as needed.</li></ul>
<p><b>
EDUCATIONAL REQUIREMENTS:</b></p>
<ul><li>Graduate of an accredited School of Nursing (LPN, RN, or BSN). RN preferred.
</li></ul><p><b>PHYSICAL REQUIREMENTS:</b></p>
<ul><li>Physical health sufficient to meet the ergonomic standards and demands of the position and its location. Regular and consistent attendance at the facilities as needed.</li></ul>
<p><b>EXPERIENCE REQUIRED:</b></p>
<ul><li>Minimum 2 years clinical experience in a long-term care setting. Prior MDS/RAI experience</li></ul>
<ul><li>Demonstrated clinical assessment skills.</li></ul>
<ul><li>Knowledge of Medicare and Medicaid regulations and coverage guidelines related to skilled nursing.</li></ul>
<p><b>
SUPERVISORY RESPONSIBILITIES:</b></p>
<ul><li>Dotted line supervision of facility based MDS Coordinators</li></ul>
<p><b>
PROFESSIONAL LICENSURE AND CERTIFICATION REQUIRED:
</b></p><ul><li>Current/active Massachusetts Nursing license</li></ul>
<ul><li>RAC-CT certification preferred.</li></ul>
<ul><li>BLS CPR certification</li></ul>
<p><b>
REPORTING RELATIONSHIPS:</b></p>
<ul><li>Direct report to the Corporate Director for Clinical Reimbursement
</li></ul><ul><li>Dotted line relationships to:</li></ul>
<p>
o Corporate Director of Clinical Services</p>
<p>Issued by:______________________________________________</p>
<p>Approved by:___________________________________________</p>
<div><div><div><div><p>Review Date:____________________________________________</p></div></div><div><div><br>
</div></div><br>
<br>
</div></div><div></div><div><div><div><div><p>JOB DESCRIPTIONS/</p>
<p>
RESPONSIBILITY</p></div><div><br>
<p><b>
MDS COORDINATOR</b></p>
<p>PERFORMANCE INDICATORS</p></div><div><br>
<p>
MEASUREMENT CRITERIA/</p>
<p>
COMMENTS</p>
<p>
list specific examples for 1 - 5 ratings Key*</p></div><div><br>
<p>1</p></div><div><br>
<p>2</p></div><div><br>
<p>3</p></div><div><br>
<p>4</p></div><div><br>
<p>5</p></div><div><br>
</div>
</div><br>
</div><div><div><div><p>Administrative Functions</p></div><div><br>
<ul><li>Serves as corporate lead for either short stay PDPM PPS MDS process or OBRA based long term care OBRA MDS (including MA based Medicaid PDPM based payment process).</li></ul>
<ul><li>Review the current AHMS Clinical Reimbursement (CR) Policies and Procedures for respective area, recommend modifications.
</li></ul><ul><li>Determine compliance with established policy. Develop and utilize a facility reporting process to ensure facility compliance with established policies. This includes both remote monitoring and onsite audits.</li></ul>
<ul><li>Evaluate current clinical reimbursement documentation forms and assessments to ensure facilities capture the care provided and maximize reimbursement.</li></ul>
<ul><li>Provide CR transition training to the organization to ensure that trainees gain functional knowledge, and the organization is prepared for the transition.
</li></ul><ul><li>Serve as a resource to CR staff for problem solving and real time education as needed for respective area.
</li></ul><ul><li>Ensure that all submissions are accurate, timely, and fully compliant with current rules and regulations.
</li></ul><ul><li>Conduct random audits of active and previously submitted MDS&rsquo;s.</li></ul>
<ul><li>Review Point Right data and make recommendations as needed.
</li></ul><ul><li>Review clinical documentation and make recommendations to improve as needed.
</li></ul><ul><li>Assist with end of month process.</li></ul>
<ul><li>Assist the other Lead as needed.</li></ul></div><div><br>
</div>
</div><br>
<div></div><div><div><p>Facility Support</p></div><div><br>
<ul><li>Evaluate current facility CR Nurses&rsquo; skills sets and provide observations, assessments, and recommendations.</li></ul>
<ul><li>Serve as a resource to CR staff for problem solving and real time education as needed.</li></ul>
<ul><li>Review and assist in all ARD requests from third party payers.</li></ul>
<ul><li>Conduct onsite audits and reviews of entire CR process. Conduct exit review with facility staff with findings and clear objectives.</li></ul>
<ul><li>Review and audit PASRR/NOMNC submissions</li></ul>
<ul><li>Review respiratory compliance and effectiveness.</li></ul>
<ul><li>Assist facilities with QM ratings objectives.</li></ul>
<ul><li>Participate in end of month activities as required.</li></ul>
<ul><li>Cover other regional&rsquo;s facilities as needed.</li></ul></div><div><br>
</div></div><br>
</div></div><div></div><div><div><div><div><p>Personnel Functions</p></div><div><br>
<ul><li>Follows work assignments, and/or work schedules to complete assigned tasks. Performs all assigned tasks in accordance with established policies and procedures.</li></ul>
<ul><li>Cooperates with interdepartmental personnel, as well as other departments within the facility to assure that services are properly maintained to meet the needs of the residents.</li></ul>
<ul><li>Develops and maintains a good working rapport with interdepartmental personnel.</li></ul></div></div></div></div></div><div></div>

Regional Clinical Reimbursement Specialist

VCU Health System

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

Reimbursement Specialist Supervisor - Remote

Navitus Health Solutions / Lumicera Health Services

<div>Company: Lumicera About Us: Lumicera - Lumicera Health Services Powered by Navitus - Innovative Specialty Pharmacy Solutions- Lumicera Health Services is defining the &ldquo;new norm&rdquo; in specialty pharmacy to optimize patient well-being through our core principles of transparency and stewardship. Here at Lumicera, our team members work in an environment that celebrates creativity and fosters diversity. ._____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. ______________________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap. Pay Range: USD $18.67 - USD $21.96 /Yr. STAR Bonus % (At Risk Maximum): 0.00 - Ineligible Work Schedule Description (e.g. M-F 8am to 5pm): M-F 10:30AM-7PM Remote Work Notification: ATTENTION: Lumicera is unable to offer remote work to residents of Alaska, Connecticut, Delaware, Hawaii, Kansas, Kentucky, Maine, Massachusetts, Mississippi, Montana, Nebraska, New Hampshire, New Mexico, North Dakota,Rhode Island, South Carolina, South Dakota, Vermont, West Virginia, and Wyoming. Overview:
<div>
Lumicera Health Services is seeking a Reimbursement Specialist I to join our team!</div><div></div><div><br>
Under direction from the Assoc. Manager, Specialty Pharmacy Services, Reimbursement Team Lead, and pharmacists in the Specialty Pharmacy, the Reimbursement Specialist I is primarily responsible for following standard operating procedures to obtain and process manufacturer copay assistance program reimbursement. The Reimbursement Specialist I shall have knowledge of billing procedures and work to reduce discrepancies, inaccuracy, and outstanding balances. The Reimbursement Specialist I may also assist in contacting patients with an outstanding balance to communicate billing options.</div><div></div><div><br>
Is this you? Find out more below!</div>
Responsibilities:
<div><b>
How do I make an impact on my team?</b></div><ul><li>
Responsible for ongoing monitoring of claims activity for accuracy and successful submission</li><li>
Responsible for ensuring that patient billing information is set up appropriately in the pharmacy software</li><li>
Participate, as necessary, in conferences and meetings related to reimbursement/billing</li><li>
Responds to employee/patient/client questions or complaints regarding reimbursement and/or billing</li><li>
Works with internal teams to review and resolve claim issues</li><li>
Maintains accurate reference information relating to reimbursement and copay assistance</li><li>
Responsible for accurate and thorough documentation of information, insurance and prescriptions/orders within the patient profile</li><li>
The Employee will act in accordance with all applicable federal and state laws and with the highest ethical standards that we consistently strive to achieve. Thus, legal and ethical compliance is an essential duty of each employee</li><li>
Other duties as assigned</li></ul>
Qualifications:
<div><b>
What our team expects from you?
</b></div><ul><li>High School Diploma or equivalent GED. Some college preferred</li><li>
CPhT preferred</li><li>
Pharmacy technician license or pharmacy technician trainee license is strongly preferred in states requiring pharmacy technician licensure</li><li>
Experience with pharmacy, health plan or clinical insurance claims billing, benefit assessments, billing/claims documentation, or claims auditing is preferred</li><li>
Participate in, adhere to, and support compliance program objectives</li><li>
The ability to consistently interact cooperatively and respectfully with other employees</li></ul><div><div><b>
What can you expect from Navitus?</b></div></div><div><ul><li>
Top of the industry benefits for Health, Dental, and Vision insurance</li><li>
20 days paid time off</li><li>
4 weeks paid parental leave</li><li>
9 paid holidays</li><li>
401K company match of up to 5% - No vesting requirement</li><li>
Adoption Assistance Program</li><li>
Flexible Spending Account</li><li>
Educational Assistance Plan and Professional Membership assistance</li><li>
Referral Bonus Program &ndash; up to $750!</li></ul></div><div></div><div><br>
#LI-Remote</div>
Location : Address: Remote Location : Country: US</div>

Reimbursement Specialist I (10:30-7:00pm CST)

<div><p><b>Primary Geography: South Carolina
</b></p><p></p><p>ViiV Healthcare (VHC) is a global specialty HIV company, the only one that is 100% focused on researching and delivering new medicines for people living with, and at risk of, HIV. ViiV Healthcare is highly mission-driven in our unrelenting commitment to being a trusted partner for all people living with and affected by HIV. Our aim is to think, act, and connect differently through a focus on education for the prevention and treatment for HIV. We go to extraordinary lengths to deliver the sorts of breakthroughs, both in prevention, treatments, care solutions and communities, that really count. We go beyond the boundaries of medicine by taking a holistic approach to HIV through developing and supporting sustainable community programs and improving access to care. We are fully committed to push through every challenge until HIV/AIDS is eradicated. ViiV Healthcare has played a significant part in delivering breakthroughs that have turned HIV into a manageable health condition. We offer the largest portfolio of HIV medicines available anywhere, and we continue our work to cater for the widest possible range of needs in response to the HIV epidemic.
</p><p></p><p>We are aware of how much is at stake for those at-risk or affected by HIV and we show up every day 100% committed to the patients. Our work culture is fast-paced, diverse, inclusive, competitive, and caring. But ViiV Healthcare isn&rsquo;t just somewhere to work &ndash; it&rsquo;s a place to belong, an invitation to bring your very best, and a team full of impact-driven team members who are hungry to make a difference.
</p><p></p><p>The Associate Director, Field Reimbursement addresses a critical gap in the US healthcare system &ndash; the complexity of post-prescribing access barriers. In therapeutic areas such as HIV/AIDS, where PrEP and treatment access could involve multiple acquisition pathways, evolving payer policies, and intricate benefit determination processes, significant complexity can delay or disrupt patient access to prescribed therapies. The Associate Director, Field Reimbursement will simplify and accelerate: VHC Injectable implementation and user experience for Healthcare Providers, patients living with HIV, and people who can benefit from HIV Prevention within a specified geographic region.
</p><p></p><p>Field Reimbursement personnel serve as <b>field-based </b><b>customer facing </b>educational resources, equipping healthcare providers and office staff with the knowledge and tools to independently navigate these reimbursement complexities. By providing education to Customers this function helps prevent access disruptions before they occur to help ensure patients can access their prescribed medicine. When complex reimbursement issues do arise post-prescription, Field Reimbursement personnel provide specialized guidance to support resolution. The ADFR will operate as the subject-matter expert on reimbursement, access, and coverage issues affecting ViiV&rsquo;s long acting injectables to facilitate appropriate patient access.
</p><p></p><p><b>Key Responsibilities
</b></p><ul><li><p>Mitigate access and reimbursement disruptions through education of office staff on payer coverage and policies, and acquisition pathways.
</p></li><li><p>Educate offices in navigating access and reimbursement challenges independently through the post-prescribing phase.
</p></li><li><p>Support complex access and reimbursement issues as needed.
</p></li><li><p>Identify and prioritize implementation barriers for removal at customer campuses.
</p></li><li><p>Develop strategic plans that include next actions, action owners and completion dates.
</p></li><li><p>Drive implementation barrier closure.
</p></li><li><p>Orchestrate coordinated plans across internal partners for aligned customers, built from a shared diagnosis.
</p></li></ul><p></p><p>The ideal candidate must have the ability to thrive in a fast-paced, complex environment. In addition, the ability to partner cross-functionally both internally and externally while remaining highly adaptable in a changing ecosystem is critical. It is expected that the successful candidate will have demonstrated experience working within a diverse team, navigating multiple sites of care, and developing and implementing strategic business plans with specific, measurable, action-oriented objectives.<br>
</p><p></p><p><b>Why you?
</b></p><p></p><p><b>Basic Qualifications:
</b></p><ul><li><p>Bachelor&rsquo;s Degree
</p></li><li><p>5+ years of experience in pharmaceutical or healthcare reimbursement, specialty product support, payer marketing, patient support programs, or reimbursement HUB programs
</p></li><li><p>Experience with J codes, Q codes, and reimbursement billing requirements
</p></li><li><p>Ability to travel 50% plus of the time
</p></li></ul><p></p><p><b>Preferred Qualifications:
</b></p><ul><li><p>Strong knowledge of payer channels including Medicare Parts B, C, D, Medicaid, and commercial insurance.
</p></li><li><p>Experience with specialty injected or infused products in buy-and-bill settings across sites of care.
</p></li><li><p>Experience working with specialty pharmacy and reimbursement HUB services.
</p></li><li><p>Exceptional Communication skills with demonstrated ability to simplify complex systems and persuade
</p></li><li><p>Strong relationship management, problem-solving, and independent execution skills.
</p></li><li><p>Demonstrated ability to effectively educate offices on access and reimbursement processes.
</p></li><li><p>Proactive implementation execution excellence focused on streamlining and simplifying processes.
</p></li><li><p>Proven indirect/direct leadership with demonstrated peer collaboration effectiveness.
</p></li><li><p>Knowledge of aligned accounts and existing customer relationships.
</p></li></ul><p></p><p>#LI-Remote
</p><p></p><p>Please visit GSK US Benefits Summary to learn more about the comprehensive benefits program ViiV offers US employees. All ViiV employees receive the same benefits options and plans as GSK employee.
</p><p></p><p><b>Why Us?
</b></p><p>At ViiV Healthcare, we will not rest until we leave no person living with HIV behind. Until the 40 million people living with HIV is down to zero, we will continue searching for new ways to limit the impact of HIV.
</p><p></p><p>We are the only pharmaceutical company solely focused on combating, preventing, and ultimately eradicating HIV and AIDS. At ViiV Healthcare, we do things differently. Born out of a partnership between GSK and Pfizer in 2009, with Shionogi joining in 2012, we are determined to help end the HIV epidemic. We are guided by our mission to leave no person living with HIV behind and it is this mission that unites our employees located across the globe. We combine expertise in research, manufacturing, policy and more to push the boundaries of what people think is possible in HIV treatment and care. As a result of our connection with GSK, we are able to draw on their proud history and resources. This means that you would receive all the employee benefits offered by GSK.
</p><p></p><p>Living our mission of leaving no person living with HIV behind means keeping inclusion and diversity at the heart of everything we do - from our breakthrough innovation, to our diverse portfolio of medicines as well as the work we do to partner with HIV communities.
</p><p></p><p>Having a truly inclusive culture where we&rsquo;re all able to be ourselves and feel like we belong will make us an even stronger team, better able to perform as a business and deliver on our mission to leave no person living with HIV behind.
</p><p></p><p>If you require an accommodation or other assistance to apply for a job at GSK, please contact the appropriate Recruitment Staff by emailing us at - usrecruitment.adjustments@gsk.com
</p><p></p><p>ViiV is an Equal Opportunity Employer. This ensures that all qualified applicants will receive equal consideration for employment without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), military service or any basis prohibited under federal, state or local law.
</p><p></p><p><b>Important notice to Employment businesses/ Agencies
</b></p><p>ViiV does not accept referrals from employment businesses and/or employment agencies in respect of the vacancies posted on this site. All employment businesses/agencies are required to contact ViiV's commercial and general procurement/human resources department to obtain prior written authorization before referring any candidates to ViiV. The obtaining of prior written authorization is a condition precedent to any agreement (verbal or written) between the employment business/ agency and ViiV. In the absence of such written authorization being obtained any actions undertaken by the employment business/agency shall be deemed to have been performed without the consent or contractual agreement of ViiV. ViiV shall therefore not be liable for any fees arising from such actions or any fees arising from any referrals by employment businesses/agencies in respect of the vacancies posted on this site.
</p><p></p><p>Please note that if you are a US Licensed Healthcare Professional or Healthcare Professional as defined by the laws of the state issuing your license, ViiV may be required to capture and report expenses ViiV incurs, on your behalf, in the event you are afforded an interview for employment. This capture of applicable transfers of value is necessary to ensure ViiV&rsquo;s compliance to all federal and state US Transparency requirements. For more information, please visit the Centers for Medicare and Medicaid Services (CMS) website at https://openpaymentsdata.cms.gov/</p></div>

Associate Director, Field Reimbursement South Carolina

Vital Care Infusion Services, LLC

<div><div><b>Recognized as a &ldquo;Best Place to Work Modern Healthcare&rdquo; &ndash; Join a team where people come first.</b> At Vital Care, we are committed to creating an inclusive, growth-focused environment where every voice matters.</div>
<div></div><div>Vital Care (www.vitalcare.com) is the premier pharmacy franchise business with franchises serving a wide range of patients, including those with chronic and acute conditions. Since 1986, our passion has been improving the lives of patients and healthcare professionals through locally-owned franchise locations across the United States. We have over 100 franchised Infusion pharmacies and clinics in 35 states, focusing on the underserved and secondary markets. We know infusion services, and we guide owners along the path of launch, growth, and successful business operations.</div>
<div></div><div>What we offer:</div>
<ul><li>Comprehensive medical, dental, and vision plans, plus flexible spending, and health savings accounts.</li>
<li>Paid time off, personal days, and company-paid holidays.</li>
<li>Paid Paternal Leave.</li>
<li>Volunteerism Days off.</li>
<li>Income protection programs include company-sponsored basic life insurance and long-term disability insurance, as well as employee-paid voluntary life, accident, critical illness, and short-term disability insurance.</li>
<li>401(k) matching and tuition reimbursement.</li>
<li>Employee assistance programs include mental health, financial and legal.</li>
<li>Rewards programs offered by our medical carrier.</li>
<li>Professional development and growth opportunities.</li>
<li>Employee Referral Program.</li>
</ul>
<div></div><div><b><i>Job Summary:</i></b></div>
<div>Perform functions to plan for and train Specialist positions, involving initial intake, billing, and collections requirements. Will cultivate an environment of outstanding customer service as the voice of the company in all interactions with franchise partners, payers, and patients.
</div>
<div></div><div><b><i>Duties/Responsibilities:</i></b></div>
<div><ul><li>Train the team in processing new patient referrals, investigating and verifying insurance benefits, prior authorizations, billing, and collections.</li>
<li>First level of review for items being escalated to outside departments and other Revenue Cycle Leadership.</li>
<li>Review A/R adjustment forms to the maximum level allowed.</li>
<li>Assist in reviewing payer refunds and/or cost refunds when requested.</li>
<li>Track the distribution of workloads, conduct ongoing needs assessments to identify staffing opportunities, and report those to the Revenue Cycle Supervisor.</li>
<li>Serve as the team's primary escalation agent to resolve franchise partner or patient complaints. Report complaints to the Revenue Cycle Supervisor to provide continuous feedback to the Reimbursement Specialist.</li>
<li>Cultivate an environment of customer service orientation through training and mentoring staff in customer service and collection techniques.</li>
<li>Assisting the posting department with missing explanations of benefits on time to ensure properly reconciled revenue.</li>
<li>Monitor team activities and work with Reimbursement Specialist to provide guidance, training, and improved skills in patient insurance billing, collections, benefits investigation, and insurance authorizations.</li>
<li>Monitor team results to evaluate compliance with quality and productivity expectations and identify improvement opportunities.</li>
<li>Work alongside the Revenue Cycle Supervisor to actively identify payer issues and perform process analysis to ensure effective intake/billing/collection efforts.</li>
<li>Review denial trends to implement training and clean claim turnaround time.</li>
<li>Evaluate performance and provide counseling, cross-training, and coaching to associates. Maintain mutually respectful employer relations.</li>
<li>Perform other related duties as assigned.
</li>
</ul><div></div><div><b><i>Required Skills/Abilities:</i></b></div>
<div><ul><li>Highly effective communicator with superior listening, understanding, speaking, and writing skills.</li>
<li>Solid business knowledge and ability to analyze data to identify actions to be taken.</li>
<li>Lead by example and strong team-building skills, with the ability to influence, lead, teach, train, counsel, and coach to accomplish organizational goals.</li>
<li>Ability to identify training requirements and develop and implement training models to improve results.</li>
<li>Demonstrated knowledge of current pharmacy applications and MS Office software, including strong Excel proficiency.</li>
<li>Strong customer service and leadership skills to develop a customer-centric culture and instill ownership of the customer/patient experience. Ability to foster care and compassion for the patients while instilling price to exceed performance objectives.</li>
<li>Ability to work collaboratively across functional teams and manage projects.</li>
<li>Analytical skills and business acumen demonstrated through proven problem-solving and the ability to exercise solid professional judgment in analyzing business issues and exploring options for resolution.</li>
</ul>
<div></div><div><b><i>Education and Experience:</i></b></div>
<div><ul><li>High school diploma or equivalent is required.</li>
<li>2-3 years of experience is required in an infusion setting.</li>
<li>Working knowledge of all Vital Care systems, including CareTend and the RCM Portal.</li>
<li>Knowledge of Payer Compliance.</li>
</ul>
<div></div><div><b><i>Physical Requirements</i></b>:</div>
<div><ul><li>Sitting: Prolonged periods of sitting are typical, often for the majority of the workday.</li>
<li>Keyboarding: Frequent use of a keyboard for typing and data entry.</li>
<li>Reaching: Occasionally reaching for items such as files, documents, or office supplies.</li>
<li>Fine Motor Skills: Precise movements of the fingers and hands for tasks like typing, using a mouse, and handling paperwork.</li>
<li>Visual Acuity: Good vision for reading documents, computer screens, and other detailed work.</li>
</ul>
<div></div><div><div>Be part of an organization that invests in you! We are reviewing applications for this role and will contact qualified candidates for interviews.<br>
<br>
Vital Care Infusion Services is an equal-opportunity employer and values diversity at our company. We do not discriminate on the basis of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans&rsquo; status, or any other basis protected by applicable federal, state, or local law.<br>
<br>
Vital Care Infusion Services participates in E-Verify.</div>
<div></div><div>This position is full-time and remote. The salary for this position is $21.75-$27.36</div></div></div></div></div></div></div>

Revenue Cycle Lead - Collections

Encompass Health

<div><p><b>Join us on the heart-warming journey with a team that is a top leader in the rehabilitation industry</b></p><p>
</p><p>Encompass Health is the leader in the inpatient rehabilitation industry, you'll feel the Encompass Health difference as soon as you join. We collaborate and provide high-quality, compassionate, individualized care for our patients, allowing us time to get to know them and help them achieve their goals during their rehabilitation journey.
</p><p></p><p><b>POSITION PURPOSE</b></p><p>
The <b>Reimbursement Manager</b> is responsible for cost reporting, hospital support, and audit support for hospitals in assigned regions and functional areas such as top downs, bad debts, Home Office, DTDF, LIP, CRIP/Propapers, and review tool.</p><p>
</p><p><b>RESPONSIBILITIES AND TASKS</b></p><p>
</p><ul><li><p>Files Medicare and Medicaid cost reports; oversees assigned cost report, including add-on payments.
</p></li><li><p>Participates in audit/reviews conducted by governmental agencies, contractors, and audit firm(s).
</p></li><li><p>Ensures audit impacts are calculated and accounted for, while contesting disputed adjustments.
</p></li><li><p>Supports personnel in identifying and resolving reimbursement issues.
</p></li><li><p>Conducts complex research independently with high accuracy and efficiency.
</p></li><li><p>Monitors compliance with Medicare and policies related to reimbursement; resolves concerns.
</p></li><li><p>Leads projects to obtain results while managing productivity/development of staff.
</p></li><li><p>Oversees projects which may include LIP, DTDF, Home Office, Review Tool, and hospital onboarding.
</p></li><li><p>Stays current on cost reports, LIP/bad debt, state reimbursement, and provider enrollment.
</p></li><li><p>Understands cost report drivers and operational impacts; communicates technical information upward.
</p></li><li><p>Reviews work; constructively review strengths and opportunities to develop direct reports.
</p></li><li><p>Possesses detailed working knowledge of all software applications and reports.
</p></li><li><p>Uses technology applications to accomplish department goals.
</p></li><li><p>Researches, analyzes, and reconciles data and complete complex hospital cost reports and assigned projects.</p></li><li><p>
Completes day-to-day responsibilities; identifies and resolves issues; follows chain of command.</p></li><li><p>
Possesses industry, organizational, and position knowledge and skills.
</p></li><li><p>Stays current in job knowledge through departmental regulation summaries, CMS/state/hospital association websites, MediRegs, and other industry related materials.
</p></li><li><p>Uses company resources where appropriate; shares information and resources with peers.
</p></li><li><p><i>This position must sit at our Home Office in Birmingham, AL</i>
</p></li></ul><p></p><p><b>Minimum Qualifications</b></p><ul><li><p>
Bachelor's degree in Accounting (preferred) or Finance
</p></li><li><p>7 years of hospital reimbursement experience
</p></li><li><p>At least two years of supervisor experience or project management experience
</p></li></ul><p></p><p><b>A little about us</b></p><p>
We're confident you'll see the difference the moment you join our team. Working at Encompass Health means working with a growing national inpatient rehabilitation leader. We're proud of our career growth opportunities and how our team members work together for the greater good of our patients. We've been named one of the &quot;World's Most Admired Companies&quot; and a Fortune 100 Best Companies to Work For&reg; Award, among others, which is pretty amazing.
</p><p></p><p><b>Our benefits start day one</b></p><ul><li><p>
Affordable medical, dental and vision plans for full-time and part-time employees and their families.</p></li><li><p>
Generous paid time off that accrues over time.</p></li><li><p>
Tuition reimbursement and continuing education opportunities.</p></li><li><p>
Company-matching 401(k) and employee stock purchase plans.</p></li><li><p>
Flexible spending and health savings accounts.</p></li><li><p>
A community of people who love what they do. Yes, we see that as a benefit.</p></li></ul><p>
</p><p></p><div><b>The Encompass Health Way
</b></div><div>We proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing!
</div><div>At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification.</div></div><p></p>

Reimbursement Manager

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