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Insurance Follow-Up Rep – FCH (24-00869) – WI – Menomonee Falls

DUTIES:

  • Responsible for researching and resolving all unpaid insurance claims and following up on all customer inquiries/complaints related to unpaid balances.
  • Answers patient calls and researches and responds to patient concerns within 24 working hours.
  • Maintains knowledge of complex reimbursement methodologies in Managed Care contracts including DRG, per diem, per visit, fee schedule and surgical group methodologies.
  • Applies knowledge for accurate resolution of claims within contract terms.
  • Uses knowledge of hospital policy, department procedures, Wisconsin Uniform Billing Regulations (UB04 Mannual), HMO/PPO agreements and other contractual arrangements to maintain accounts receivable, manage commercial payors, and manage appeals.
  • Serves as back-up to person primary on taking incoming calls. Monitors que light to ensure minimal wait times for patients in call que.
  • Identifies denial trends and reports issues to Insurance Follow-up Coordinator/Insurance Follow-up Supervisor for escalation with payer liaisons
  • Participates in cross-training efforts for specific systems based on goals set by the PFS department.
  • Addresses accounts qualifying to workstation within one week utilizing system specific follow up procedures.
  • Coordinates efforts with ancillary departments as needed in a timely manner for effective resolution.
  • Updates new insurance information received on an account to reflect accurate insurance plan coding to ensure accurate statements are mailed to patients.
  • Uses transaction codes specific to each system and links those to UB 1500 bills and agreements to process follow-up functions.
  • Updates and verifies payor specific account information.

REQUIREMENTS:

  • Two years of business office experience in billing, customer service, or collections in a healthcare environment is required.
  • Five years experience in billing, customer service or collections in a healthcare environment is required.
  • Three to four years leadership experience is required.
  • Previous supervisory experience is preferred.
  • Demonstrated skills in planning, directing organizing and implementing projects.
  • Recent experience in healthcare reimbursement and knowledge of medical coding and billing.
  • Problem solving and well developed analytical skills required.
  • Effective written and verbal communication skills.
  • Well developed personnel management and leadership experience.
  • Experienced user in Excel and Word

Source: Job Diva – Job Listing

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Registrar (24-00823) – NY – Long Island City

Job Summary:
The Registrar is responsible for the business aspect of the department as well as the patient focused care delivery within the department. Activities include: registration, insurance verification and notification, updating of financial and demographic information, reception and other duties as assigned.

Essential Duties and Responsibilities
• Greet and direct patients, visitors, and staff.
• Answers telephones promptly and courteously. Directs calls to appropriate personnel and/or departments, takes messages and assures delivery of same.
• Collects and distributes patient referral information received from affiliated physicians.
• Escorts visitors and patients to appropriate areas; provides information to assist patient and/or visitors. • Is open and responsive to the diverse backgrounds and experience of other people and promotes an environment that is sensitive to cultural diversity.
• Distributes departmental reading material such as Emergency Department brochure, Health Care Proxy and Patient Bill of Rights. Ensures such documents are readily available.
• Registers patients by updating or entering patient demographic, financial information and emergency contact data into the computer system.
• Verifies demographic information and insurance coverage by interviewing patient/family member/friend.
• According to policy and established procedure generates patients' chart and attaches pertinent information such as Emerg Card, Medicaid threshold and EMS sheet, etc.
• According to policy and established procedure reviews discharged patient charts for diagnosis, physician signature, dictation code, menu and appropriate forms for completion.
• According to established policy and procedure processes specimens for laboratory(ies) by assuring that specimens are appropriately labeled, forms are competed and identification processes have been followed.
• File charts and retrieve old records.
• Retrieves completed charts, addressograph plate and all supporting documents from patient treatment area. • Enters data into required computerized system.
• Maintains patient recall file.
• According to policy and established procedures insured that all papers, forms, etc. are stamped appropriately.
• Logs patients on/in to the appropriate registration sheets/logs. Reconcile log books.
• Obtains signatures for consent.
• Makes clinic appointments.
• Other duties as assigned.

Shared Duties and Responsibilities Across Department
• Greet visitors and answer telephones promptly and courteously. Escort visitors to appropriate area, when necessary. Provide information and make referrals when appropriate.
• Answer Call System and refer to appropriate staff.
• Maintain a safe, clean and functional environment, including removing trash and bringing physical plant and equipment problems to the attention of the managers.
• Transport patients on stretchers or wheelchairs, as required.
• Assists in interpreting, as required by current protocols.

Skills:
• 6-9 months of health care experience in order to become familiar with institutional policies and procedures preferred. 
Source: Job Diva – Job Listing

Posted on

Program Coordinator (24-00803) – MA – Cambridge

Job Description:

  • Provides coordination of key R&D IT Programs and support for core team functions.
  • Focus on management of global software license inventory, coordination, and communication.
  • Serve as the liaison between IT teams and multiple vendors in a global operating environment.
  • Server as a member of the team reviewing license programs, ensuring value and identifying opportunities for efficiency.
  • Ensure success in other key recurring processes to ensure effective execution of IT Service Delivery for the team.

Responsibilities:

  • Partnering with the Global R&D IT Leadership to ensure effective coordination of IT services (internal or external) including:
  • License management (communication, survey, inventory, updates, timely coordination of renewal)
  • Maintenace agreement management (communication, timely coordination of renewal)
  • Vendor engagement and coordination (inquiries, quotes, and renewals)
  • Access and Asset management (processing requests, provisioning assets/access, managing capacity, inventory, and reporting)
  • Reporting (build, generate, deliver)
  • Procurement (purchasing, purchase order request, receiving, inventory, returns)
  • Communication (projects, services with customers, peers and vendors)
  • Onboarding of new staff (communication, managing checklist items)
  • IT Communications (internal and external) in support of G2D2 projects, services, and initiatives
  • Internship/Co-op program coordination (posting, administration of the review and interview process)
  • Process Documentation (Ensure accurate, repeatable delivery for recurring processes)
  • Office administration, communication, and document/file organization
  • Meeting coordination, both internal and will external collaborators/vendors, including some minutes as needed
  • Respond to and address to customer requests for defined IT services
  • Managing shared calendar resources for global IT teams
  • Additional project or task participation as needed

Knowledge/Skills/Abilities Required:

  • 3-5 years of professional experience, preferably in an IT or financial analysis environment
  • Illustrated success in management of large programs, preferably in an IT environment
  • Experience with IT software licensing contracts and models, including software as a service (SaaS).
  • Organized, analytical, and highly detail oriented
  • Strong verbal and written skills
  • Strong customer service acumen
  • Self-motivated and willing to take initiative
  • Must possess a desire to learn new roles, processes, technology

Source: Job Diva – Job Listing

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Financial Counselor (24-00726) – WI – Milwaukee

Duties: 
•To assess patient financial needs, assist patients and collect deposits according to the Client's Billing and Collection Policy in a professional and courteous manner. To screen patients and assist with applications for applicable governmental programs, the health insurance exchange, and/or the client's financial assistance program. To stress customer service and positive interpersonal relations while working closely with Admitting/Registration, Preauthorization, Care Management, and appropriate department personnel in Patient Financial Services and MCW Clinical Practice Services in addressing financial responsibilities. Other duties as assigned.
• For patients who are identified as self pay, claim financial hardship or the inability to pay, initiates timely account resolution activities to address the issue while attempting to allow elective patient care to proceed as scheduled.
 •Monitors applicable Financial Counselor work queues to ensure that all initial patient financial activities have been completed, and that account balances that have not been previously secured through insurance verification or other confirmed subsidy sources are addressed in a timely manner. Reviews Financial Counselor work queues on an ongoing basis to ensure payment source has been secured for all discharged self pay patients when applicable.
•Updates the patient accounting system as activities have been completed and as patient account problems and issues have been addressed, in accordance with Patient Financial Services policies/procedures.
 •Counsels with patients to guide them through the application and eligibility process with Medicaid offices, Victims of
•Crime, Insurance Exchange, and other resources available to patients to cover client services.
 Assists patients with the Financial Assistance application process according to the protocols set forth in the client,
•Community Physicians, and Medical College of Wisconsin Financial Assistance policies.
 •Based on the patient's ability to pay and the urgency of medical need, collects patient deposits after estimating the approximate costs of the anticipated care. Calculates, provides, and updates estimates upon necessity to various staff and patients.
 •Calculates provides, and updates estimates upon request to various staff, patients, and other potential customers.
 •Communicate with Social Services, Case Management, Admitting/Registration, appropriate department personal, and the physician as applicable to discuss those patient financial problems that cannot be resolved to determine the alternatives to the elective patient care plan.
• Enforces hospital patient accounting and compliance processes by confirming that required documents have been completed, insurance (re) verification has been performed, and pre-certifications/recertifications have been obtained.
• Cross trains and provides backup coverage for all Financial Counselor positions as determined by the Team Coordinator or •Patient Financial Services Manager to ensure adequate Financial Counselor coverage for all areas within department. This includes shifts extending into the PM shift and weekend or holiday coverage.
• Assist patients during open enrollment period to apply for a Qualified Health Plan (QHP) and/or Insurance Affordability Programs.
 •Adhere to document storage & destruction policies/procedures.
 •Adhere to all state and federal regulations along with client policies/procedures about the Certified Application Counselor responsibilities.
• Stay current on all regulatory updates and policy/procedure changes pertaining to Certified Application Counselors at client.

Skills: 
•One year of experience in healthcare/revenue cycle functions (or other business office), case management, or social work is required. 
•Experience using Microsoft Word, Excel and other software programs is preferred. Experience using Epic in a healthcare environment is preferred. Experience in social work or case management is preferred.

Education: 
•High School diploma or equivalent is required.
•Bachelor's degree in social work, case management, healthcare administration, business administration, or other related field is preferred.
•State of Wisconsin and Federal Certified Application Counselor Designation is required or must obtain within 12 months after hire.
Source: Job Diva – Job Listing

Posted on

Warehouse Supervisor- third shift (24-00662) – NJ – east windsor

Shift: 3rd shift hours: 9:00pm – 6:00am, Monday – Saturday

The Supervisior has aptitude in the following areas

  • Operations
  • Order Fulfillment/Shipping
  • Inbound Import Receiving
  • Inventory Control
  • Understand receiving documentation
  • Receive products in a compliant and audit friendly manner
  • Enter Goods and Receipts into the ERP
  • Create LPN(s) and complete verification of material being entered into the ASRS
  • Process freight with temperature monitors
  • Enter receiving metrics into Excel spreadsheets
  • Organize staff to operate and sustain controlled production
  • Execute tasks within the ASRS and a conventional warehouse environment
  • Oversee a team of Inventory Control Specialists to execute SOP(s) and to process claims received from the customer
  • Schedules outbound freight in compliance with warehouse SOPs and capacities.
  • Fill customer orders and delivers them to the delivery platform in a manner that meets standards for safety, security, and productivity.
  • Ensure completeness and correctness of all orders filled. Check outbound shipments for accuracy and readiness for customer delivery.
  • Cross docking of critical shipments by coordinating with Inbound and Scheduling team.
  • Collect all documentation for outbound freight and ensures that all documentation including receiving paperwork are filed appropriately.
  • Ensure Pick orders are shipped as needed, ensure proper labels and paperwork have been applied before shipping and examine outgoing shipments to ensure shipments meet specifications.
  • Plan routes and process shipments to customer's site, including packing lists and bills of lading.
  • Liaising and negotiating with shipping carriers/trucking companies for preferential rates.
  • Keep track of quantity, delivery times, transport costs and efficiency.
  • Meet cost, productivity, and accuracy with timeliness targets
  • Coordinate with LTL suppliers such as Fedex, ABF, UPS, and Old Dominion
  • Experience with load planning, trailer /load consolidation, and optimization

Requirements:

  • HS Diploma required
  • 3+ years of experience with distribution, packaging, warehousing, and/or operations in pharmaceutical environment
  • Strong interpersonal and communication skills, both oral and written
  • Strong team building and problem-solving skills, with an ability to work effectively cross-functionally
  • Able to multi-task effectively utilizing strong organizational skills

Source: Job Diva – Job Listing

Posted on

USA – Expert Data Science (24-00364) – NJ

Title: Insights and Analytics Generalist

*Work format Hybrid (Need a local candidate)
* Pay Rate *** – ***
*This is a temp to perm opportunity!!!
• Provide support across multiple teams – seeking a “Utility Player”
• Deliver best-in-class actionable insights to drive better data-driven decisions
• Leverage internal & external data assets to make better data-driven decisions on where-to-play and how-to-win
• Develop, execute & maintain forecast and analytical models
• Evaluate business performance
• Define & track KPIs
• Develop new analytics techniques
• Explore and utilize innovative data assets
• Drive standardization across the I&A organization.
• Simplify complex analyses and create clear & concise stories to motivate the organization to make better data-driven decisions, developing promotional campaigns, and business cases.
• Be the Sanity (a customized version of Salesforce) super-user for the Client&L team, and help route projects through a pre-defined workflow
• Systems and process superuser
Skills
• 3-5 years of industry experience
• Organized with extreme attention to detail
• Strong learning agility to utilize internal systems process
• Strong forecasting and analytics background
• Understanding of pharma contracting; both channel/ customer contracting and discounts and allowances
• Ability to support multiple internal teams
• Audit experience
• MS Office (Excel, Teams, Word)
• Self starter, driven
• Exceptional communication skills
Education
• Bachelor Degree
Source: Job Diva – Job Listing

Posted on

COMMERCIAL ACCOUNTS SPECIALIST (24-00232) – NJ – east windsor

Job Overview 
The Commercial Account Specialist serves as the primary contact for all day to day customer interactions. It is this candidate that serves as the front line when creating, maintaining and building relationships with both our internal and external customers.

  • Responsible for maintaining a high level of professionalism with customers while working to establish a positive rapport with every customer/stake holder.
  • The specialist is responsible for responding to customer inquiries by email, phone, and fax, as well as processing customer purchase orders, and resolving documentation or claim requests.
  • Responsibilities will also include customer setup, on-boarding, and maintenance.
  • Produce and distribute reports to internal and external stakeholders as required.
  • Responsible for understanding and following corporate policy and procedures.
  • Perform other duties as assigned

  • 1-3 years of work experience is preferred
  • General computer proficiency and advanced knowledge with Microsoft Office applications.
  • Excellent record keeping and organizational skills.
  • Must work well with others in a team based environment
  • Excellent and professional verbal and written communication skills.
  • Excellent attention for detail.
  • Ability to meet accelerated timelines and manages priorities as necessary.
  • Must be able to type at least 50 words per minute

  • Associates Degree and up

OFFICE POSITION – While performing the duties of this job the employee is required to:

  • Stand, sit; talk, hear, and use hands and fingers to operate a computer and telephone keyboard reach, stoop kneel to install computer equipment
  • Specific vision abilities required by this job include close vision requirements due to computer work
  • Light to moderate lifting is required
  • Moderate noise (i.e. business office with computers, phone, and printers, light traffic).
  • Ability to sit at a computer terminal for an extended period of time Sedentary work Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Source: Job Diva – Job Listing

Posted on

Key Account Manager (24-00086) – NJ – East Windsor

Responsibilities:

 

  • General management of assigned sales territory involving the promotion and advancing of the Company's interests.
  • Discovering and implementing initiatives and opportunities to continue growing the business.
  • Working with customers on various business development partnership activities.
  • Preparing customer/product proposals.
  • Leveraging customer relationship to drive sales and acquire market intelligence for successful product launches.
  • Working with order management teams to ensure adequate and timely order throughput.
  • Conducting in-person customer business reviews by visiting some customers at their places of work (10-20% travel required).
  • Working with Supply Chain to ensure adequate supply of product, which includes providing accurate data for Supply Chain to work from.
  • Working with Finance on various customer claims resolutions.

 

 

Qualifications:

 

  • Proven track record of sales growth performance
  • Experienced sales professional with superb presentation skills
  • Must have experience in managing similarly extensive and growing portfolio
  • Must have excellent written and oral communication skills
  • Must have exceptional organization and prioritization skills
  • Must have outstanding negotiation skills
  • Microsoft Excel experience necessary

 

 

Source: Job Diva – Job Listing

Posted on

Project Manager- Associate Public Health- Intermediate (23-01705) –

Project Manager- Associate Public Health- Intermediate

"

Project Manager Associate Public Health
Minimum Qualifications

Requires a bachelors degree or higher plus two years of related experience, or an equivalent combination of education and experience.

Role Description:This individual will be responsible for managing and coordinating projects and staff located within the Pennsylvania Department of Health, Bureau of Epidemiology.

The Bureau of Epidemiology is comprised of four Divisions that are providing support to specific settings or providing broader subject matter expertise to the commonwealth in the areas of COVID-19 response, healthcare-associated infection prevention, infectious diseases, community epidemiology, and environmental health.

Specific tasks may include, but not limited to:
Work with supervisors and staff to coordinate and track all project related activities
Work with others to identify and develop contracts, work orders, purchase orders etc. related to program activities as needed
Monitor and report on budgetary spending for project activities
Ensure the project related materials are disseminated to partners
Assist with managing incoming information and data and ensure entry into appropriate systems.
Work with others to organize outreach efforts related to assigned projects
Support the preparation of grant materials and project reports
Participate in project related calls and conferences
Organize regularly scheduled internal project review meetings
Perform other duties as assigned.

"
Source: Job Diva – Job Listing

Posted on

Certified Nursing Assistant (CNA)- Expert (23-01682) –

Certified Nursing Assistant (CNA)- Expert

Minimum Qualifications
Six (6) months of experience as an Aide Trainee; or one year of paid experience in the care and treatment of geriatric or physically ill patients/residents; and graduation from high school or equivalent.
Resources assigned to these positions in a Long-Term Care Unit must be registered and certified by the Pennsylvania Department of Health as having met the competency requirements for performing nurse aide work.
Basic Computer Skills to include, but not limited to, Microsoft Office Products.
Role Description:
This is non-professional nursing work in the care of patients/residents and their quarters in a hospital, infirmary, and long-term care unit, or a domiciliary care unit.
A resource performs non-professional nursing services in the direct and daily care and rehabilitation of ambulatory and non-ambulatory patients/residents and the maintenance of their quarters. Nurse aide duties are of limited scope and are performed in accordance with established rules and regulations and under specific instructions from registered nurses and/or physicians.
Resource participates on the job, in service and formal training in nursing care procedures to update and maintain non-professional nursing care expertise.
The work includes assisting and encouraging patients/residents to participate in prescribed rehabilitative and recreational activities as individuals and as members of a group.
Work is performed under the close supervision of a licensed professional supervisor who reviews work through reports, ward inspections, and observation, but resources are expected to perform the more routine duties independently.
Source: Job Diva – Job Listing

Posted on

Medicaid Proposal Writer (23-01472) –

Sr Proposal Writer – Medicaid Behavioral Health and Care Management

Position Description

Great sales are the result of strong purpose, conviction and pride – pride in your ability and your product. Health Care Company offers a portfolio of products that are greatly improving the life of others. Bring along your passion and do your life's best work.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Coordinates proposal development activities including drafting proposals for new and existing clients (e.g., employers, government), gathering related statistical and system – related reports, and directing the preparation of supporting documents and analyses

  • Works closely with sales, product, legal, pricing, and other functions to tailor contractual provisions to reflect prospect's needs, company interests, and appropriate resources and timelines

  • Managing and coordinating proposal development activities including working with proposal writers and SMEs to draft proposals for new and existing State partners

  • Often required to write content regarding the management and delivery of behavioral health and Care Management services. Must possess a thorough understanding of these areas and be able to write in a clear and concise fashion

  • Must be able to understand RFP questions and create outlines for responses

  • Ensure proposals are developed in a professional manner as efficiently as possible, in compliance with

procedural requirements

  • Develop and display knowledge of the Medicaid market in order to assist in the growth of public sector business for Client

  • Demonstrate outstanding project management skills in order to keep proposal response teams on target for on – time delivery of proposals

  • Lead group proposal reviews and direct approach to incorporating changes

  • Ensure final document is compliant with RFP requirements, including all direct, derived and implied

    requirements

  • Collaborate with the proposal production team to address proposal layout and publishing issues, and to provide concepts for creating supporting graphics for proposals

  • Escalate conflicts and issues to the VP Proposal Management as required

  • Ensure that work by the team is completed according to defined deadlines

  • Adhere to established Optum proposal process including use of required tools and documents

  • Demonstrate flexibility when timelines and requirements dictate

  • Participate in ongoing continuous improvement of the Optum proposal development process

  • Other duties as assigned

Required Qualifications:

  • Undergraduate degree or equivalent experience

  • 5+ years of experience leading and developing proposals and responses to RFP / RFR / RFI requests

  • 3+ years of experience in professional and management roles within a Medicaid behavioral health

and / or care management service delivery organization

  • Excellent leadership skills with the ability to multi – task and direct project outcomes based on business objectives

  • Strong Microsoft Word and Excel knowledge

  • Capable of managing a variety of complex projects while driving momentum on key projects

  • Persuasive writing style with the ability to write succinct and compelling messages

  • Excellent writing / editing / proofreading skills

  • Strong communication (written and verbal) and analytical skills

  • Team player

  • Able to work evenings and weekends as proposal schedule requires

  • Demonstrate initiative and a strategic business focus

  • Demonstrate clear and concise verbal and written skills with the ability to convert technical information into easy to understand documents

  • Possess exceptional technical / marketing writing skills and ability to integrate complex ideas, strategies and operational models

  • Is a change agent / self – starter; able to adapt to rapidly changing priorities; continually seeks ways to

improve processes; demonstrates creative, cost – effective solutions; generates ideas with confidence and is persuasive in selling ideas

  • Demonstrate organizational and personal influencing skills; creates, builds and maintains relationships that enhance the performance of the business, including those outside direct control; obtains commitments from individuals or groups to ensure organization's success; ability to influence individuals at all levels of the organization

  • Develop strong relationships with internal customers to produce high – quality work; focus on understanding the needs of the customer and manages to the customer's expectations

  • Demonstrate strong organizational, planning, coordination and project management skills

  • Display excellent communication skills and consensus building abilities

  • Complete multiple projects under extremely tight time frames with little to no supervision

  • Develop and maintain proficient business knowledge of Health Care Company, its family of businesses and their products and services

  • Maintain proficient operational knowledge in functional areas such as claims, information systems, member / provider services, finance, compliance, quality assurance and health services management.

  • Model and support effective team building – able to work independently, as part of a team or as team leader

  • Meet deadlines consistently

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the Health Care Company family of businesses, brings together some of the greatest minds

and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.

*All Telecommuters will be required to adhere to Health Care Company's Telecommuter Policy.

Source: Job Diva – Job Listing