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Job Description POSITION SUMMARY The Clinical Audit Manager is responsible for ensuring all UM/CM reporting is completed on or before due dates set by our contracted Health Plans. The Clinical Audit Manager is responsible for completing and passing all Health plan audits by due dates set by our contracted Health Plans. The Clinical Audit Manager will work directly with the UM Manager to ensure functions are conducted in a compliant manner. The Clinical Audit Manager is also responsible for confirming all Corrective Action Plans (CAPS) generated from deficiencies found in our reporting, and/or audits by the Health Plan auditors are completed and closed. Communication will be a high priority with the UM Manager and the Director of Clinical Operations of any CAPS received to ensure the deficiency is understood within the working departments, and improvements can be implemented to prevent further deficiencies resulting in further CAPS. RESPONSIBILITIES-DUTIES • Prepares and coordinates the completion of complex regulatory and compliance reports for submission., • Assists in audit preparations, analyzes information, identifies deficiencies, and tracks corrective action for completion. Processes additional data into the system, ensures that data is processed and researches any interruptions to the process., • Query, analyze, and interpret data for ad hoc analyses., • Participates in quality assurance process for all new department related system/application/process changes., • Ability to understand, work with and organize data from various systems and databases: facts, figures, narratives, and data analysis., • Demonstrate attention to detail and accuracy in work product. Support all levels of claims staff regarding Medicare Commercial, and Medi-Cal, adjudication and coding rules and requirements., • Locate and download all coding sources for system updating., • Ensures all reporting instructions (how to generate) are updated and listed in the corresponding P&P, • Assist UM Manager, Director of Clinical Operations to eliminate CAPs and/or operationalize process improvement techniques for better outcomes., • May assist with automating reports, • Performs as necessary to any departmental changes, workload and/or emergencies, • Understands the UM and CM Departments’ Policies/Procedures, • Ensure templates are accurate per Health Plan including but not limited to new and update information from ICE Website, • Ensures the privacy and security PHI (Protected Health Information) as outlined in AMM policies and procedures relating to HIPPA compliance, • Develop strategies to meet goals, • Set goals and objectives for the team/department, • 4+ years of experience within an MSO, IPA or Health Plan environment, • Must be highly organized and able to perform multiple tasks efficiently, be computer literate and must be very knowledgeable of all claims processing rules and guidelines, • Must have knowledge of CPT Codes and ICD10 Codes, • Must have Knowledge on all lines of business Medicare, Medi-Cal, and Commercial, • Familiar with regulatory agencies such as CMS, DMHC, DHCS (State of Cal), • Familiar with required laws pertaining to HIPPA Security & Privacy, Fraud Waste and Abuse, • Knowledge of health plans, medical groups, and managed care operations and related functions and regulations., • Relevant bachelor’s degree: or equivalent work experience required., • Ability to work in a fast-paced environment., • Knowledge of software applications such as EZCAP., • Must be able to efficiently prioritize multiple high priority tasks. When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first: • Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan., • Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe., • Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future., • Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work., • Career Development: Tuition reimbursement to support your education and growth.

Job Description Healthcare Fraud Investigator – Medicare Los Alamitos, CA hybrid (OR) Work from Home in CA, AZ, ID, NV, OR, UT, or WA @Orchard LLC is retained by a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Our Client is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities. Ensures the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with various stakeholders to gather relevant information for successful resolution and closure. Identifies opportunities to target fraud, waste, and abuse or discrepancies in claims submissions. Adheres to industry regulations and policies for managerial follow-up. Analyzes data in order to effectively assess the validity of claims. Provides accurate recommendations to management for claim resolution and closure. Documents and inputs all findings, while preparing comprehensive reports that may be used for legal or audit/investigative purposes. Essential Duties and Responsibilities: • Conducts routine and impartial audits/investigations from start to closure into customer claims, ensuring accurate and fair assessments of claims validity., • Provides customer service by addressing inquiries and concerns, and escalates audit/investigation, as needed., • Compiles detailed and organized records of audit/investigation findings, ensuring accuracy and compliance with legal and regulatory requirements., • Applies functional knowledge to create and implement strategies to identify and prevent fraudulent activities, safeguarding the integrity of the claims process., • Conducts interviews with relevant witnesses, claimants, and other stakeholders to gather additional information and perspectives on claims., • Communicates with appropriate internal teams to ensure the proper processing of audits/investigations, while adhering to legal and regulatory standards., • Communicates audit/investigation findings clearly and professionally to customers, claimants, and other stakeholders, managing expectations and providing updates., • Assists in providing training and support to other auditors/investigators, contributing to the continuous improvement of investigative processes. Education and /or Skills and Experience Required: • Minimum Bachelor's Degree, • Minimum of 2-4 years experience in fraud investigation/detection; 5-7 years experience preferred, • Must possess prior experience in federal or state healthcare programs or a related field that demonstrates expertise in reviewing, analyzing, and making appropriate decisions related to fraud, waste and abuse. Preferred Skills/Experience: • Certified Fraud Examiner or Accredited Healthcare Anti-Fraud Investigator, • Prior successful experience with CMS and OIG/FBI or similar agencies, • Medicare investigation experience strongly preferred If you match the requirements for this opportunity and believe you have the experience and talent to succeed in the role, we need to hear from you! Compensation for the role of Investigator will be determined based on experience and qualifications. The salary range is expected to be $64,000 - $80,000, plus benefits. Established in 2010, @Orchard LLC, also known as, Talent Orchard has an exceptional reputation, providing staffing solutions to time-sensitive, talent scarcity issues to deliver better talent management ROI. Our specialty lies in the critical area of program talent acquisition and resource management, not in one narrow skillset, but across many areas of technical and functional delivery. To learn more about our other exciting opportunities, visit our Jobs Page at .

Job Description At Hyundai Carson, we’re proud to represent one of the most innovative and rapidly growing brands in the automotive industry. We are committed to delivering exceptional service and creating a positive customer experience at every turn. As we continue to grow, we are looking for a highly motivated and detail-oriented Warranties Administrator to join our Hyundai service team. Position Overview: The Hyundai Warranties Administrator ensures accurate and timely submission of warranty claims to Hyundai Motor America (HMA) and applicable third-party providers. This role is crucial in maintaining manufacturer compliance, maximizing warranty reimbursement, and supporting our service team in delivering excellence. Key Responsibilities: • Accurately process and submit warranty claims in accordance with Hyundai Motor America (HMA) policies and procedures, • Audit repair orders for accuracy, proper documentation, and warranty eligibility, • Monitor open claims and follow up on unpaid or rejected submissions, • Maintain up-to-date knowledge of Hyundai technical service bulletins, recalls, and warranty coverage changes, • Liaise with HMA personnel to resolve disputes or inconsistencies, • Coordinate with technicians, service advisors, and management to ensure clear communication and efficient processing, • Attention to Detail: Accuracy in documentation and submission is essential to success in this role, • Diligent and Hard-Working: You’re thorough, persistent, and committed to getting it right the first time, • Team-Oriented Under Pressure: You remain calm and collaborative in a fast-paced dealership environment, • Strong Work Ethic: You take pride in your work and follow through consistently, • Previous experience with Hyundai warranty systems (WebDCS) or dealership DMS platforms (Dealertrack DMS, CDK, Reynolds & Reynolds, etc.) is highly desirable, • Strong organizational, communication, and computer skills, • Competitive pay between $60,000 – $100,000, commensurate with experience, • Health, dental, and vision insurance, • Paid time off, holidays, and 401(k) with match, • Employee discounts on vehicles, parts, and services, • Professional training and growth opportunities within the Hyundai network

Job Description POSITION SUMMARY Strong background on Medi-Cal, Commercial, and Medicare benefits, including coordination of benefits. Works closely with all departments necessary to ensure that processes, programs and services are accomplished in a timely and efficient manner in accordance with AMM policies and procedures and in compliance with applicable state and federal regulations including CMS, MediCal, and DMHC. Claims audit manager ensures incoming claims are processed in accordance with policies, procedures and guidelines , as outlined by AMM and contractual agreements; within mandated timeframes; and according to rate as reflected in respective provider contracts. Manager will be responsible for prepayment, post payment validations and the management of operational reporting, testing and data submissions. RESPONSIBILITIES-DUTIES • Prepares and coordinates the completion of complex regulatory and compliance reports for submission., • Assists in audit preparations, analyzes information, identifies deficiencies, and tracks corrective action for completion. Processes additional data into the system, ensures that data was processed and researches any interruptions to the process., • Query, analyze, and interpret data for ad hoc analyses., • Apply Medicare Claim Payment rules and requirements, including the application of National Coverage Decisions, Local Coverage Decisions, and National Correct Coding requirements to claims received for payment., • Gather information needed for compliance related activities., • Participates in quality assurance process for all new department related system/application/process changes., • Perform pre-payment audits and post payment audits to validate claims for appropriate coding and documentation and validate accurate claim adjudication rules and fee schedules were applied, • Ability to understand, work with and organize data from various systems and databases: facts, figures, narratives, and data analysis., • Demonstrate attention to detail and accuracy in work product. Support all levels of claims staff regarding Medicare Commercial, and Medi-Cal, adjudication and coding rules and requirements., • Locate and download all coding sources for system updating., • Must have excellent verbal and written communication skills., • Performs other duties as assigned / necessary. MINIMUM REQUIREMENTS • Minimum of five years’ experience in healthcare claims processing, or an equivalent combination of education, training, and experience, • Medi-Cal and Medicare claim processing experience preferred, • Strong understanding of claims processing workflow and payment rules, • Detailed knowledge of electronic billing processes and universal billing forms, • Knowledge of CMS pricers and vendor pricing software, • 3+ years of experience within an MSO, IPA or Health Plan environment, • Must be highly organized and able to perform multiple tasks efficiently, be computer literate and must be very knowledgeable of all claims processing rules and guidelines, • Must have knowledge of CPT Codes and ICD9 Codes, • Must have experience in processing all lines of business Medicare, Medi-Cal, and Commercial claims, • Proficient in RBRVS, HCPCS, and CPT coding practices, • Familiar with regulatory agencies such as CMS, DMHC, DHCS (State of Cal), • Familiar with required laws pertaining to HIPPA Security & Privacy, Fraud Waste and Abuse, • Knowledge of health plans, medical groups, and managed care operations and related functions and regulations., • Relevant Bachelor’s degree; or equivalent work experience required., • Ability to work in a fast-paced environment., • Knowledge of software applications such as EZCAP.

Job DescriptionBenefits: • 401(k), • Health insurance, • Competitive Compensation, • Great Work Environment Responsibilities • Assist clients with processing insurance claims through both private insurance and Medicaid/Medicare, • Note and process all necessary forms from the insurance, • Assist patients in navigating the billing and insurance landscape, including collecting all necessary forms and signatures, • Work with doctors offices and hospitals to obtain charge information and billing details, • Enter all billing and payment information into the system properly and without errors, • Follow up with clients and payments, as needed, • Answer phones, assist clients with questions, take messages, and screen calls, • Maintains the highest level of confidentialityQualifications, • Strong customer service skills, • Previous experience with medical coding and billing a must, • Strong organization skills, • Excellent attention to detail, • must be able to work in office in Long Beach near LBM

Job Description Position Summary The Senior Manager of Claims Operations is responsible for overseeing the intake, adjudication, and processing of medical claims in compliance with ERISA, CMS, and health plan guidelines. This leadership role ensures strategic operational excellence, fosters vendor and partner collaboration, and drives continuous process improvements. The Senior Manager will provide mentorship to a growing team of claims and appraisal staff, develop and implement policies, and ensure high levels of service delivery for stakeholders. Key Responsibilities Department Leadership & Oversight • Manage day-to-day operations of the claims department, ensuring claims are processed accurately, timely, and in compliance with regulatory requirements., • Supervise and develop appraisal and examination staff while providing technical guidance to claims teams, producers, and account managers., • Ensure compliance with ERISA, CMS, HIPAA, state regulations, and internal health plan policies., • Develop and enforce claims policies and procedures that align with company objectives and legal requirements., • Manage relationships with third-party administrators, vendors, and technology partners to ensure service levels and operational efficiency., • Provide mentorship, coaching, and performance evaluations to team members to foster professional growth and improve retention., • Serve as a point of escalation for stakeholders, including providers, members, and internal departments., • Analyze claims data to identify trends, detect irregularities, and develop strategies to improve efficiency and reduce costs., • Education: Bachelor’s degree required in Healthcare Administration, Business Administration, Finance, or a related field; Master’s degree (MBA, MHA, or equivalent), or equivalent years of experience, • Experience: Minimum of 8–10 years of progressive experience in medical claims operations within a health plan, TPA, or managed care organization, including 5+ years in a leadership/management role., • Technical Expertise: Strong knowledge of ERISA, CMS regulations, Workers’ Compensation statutes, HIPAA, and state-specific health plan requirements. Proficiency with claims adjudication systems (e.g., EZ-CAP, Facets, QNXT, or similar)., • Skills:, • Demonstrated ability to lead and develop high-performing teams., • Strong vendor and partner management experience., • Exceptional analytical and problem-solving abilities., • Excellent communication and negotiation skills., • Proficiency with Microsoft Office Suite, Teams, and reporting tools. When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first: • Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan., • Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe., • Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future., • Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work., • Career Development: Tuition reimbursement to support your education and growth.

Job Description Healthcare Fraud Investigator I – Medicare Los Alamitos, CA hybrid (OR) Work from Home in CA, AZ, ID, NV, OR, UT, or WA @Orchard LLC is retained by a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Our Client is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities. Serves as an entry level professional who develops baseline plans for ensuring the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with various stakeholders to gather relevant information for successful resolution and closure. Identifies opportunities to target fraud, waste, and abuse or discrepancies in claims submissions. Adheres to industry regulations and company policies for managerial follow-up. Analyzes data in order to effectively assess the validity of claims. Provides accurate recommendations to management for claim resolution and closure. Documents and inputs all findings, while preparing comprehensive reports that may be used for legal or audit/investigative purposes. Essential Duties and Responsibilities: • Conducts routine and impartial audits/investigations from start to closure into customer claims, ensuring accurate and fair assessments of claims validity., • Provides customer service by addressing inquiries and concerns, and escalates audit/investigation, as needed., • Compiles detailed and organized records of audit/investigation findings, ensuring accuracy and compliance with legal and regulatory requirements., • Applies functional knowledge to create and implement strategies to identify and prevent fraudulent activities, safeguarding the integrity of the claims process., • Conducts interviews with relevant witnesses, claimants, and other stakeholders to gather additional information and perspectives on claims., • Communicates with appropriate internal teams to ensure the proper processing of audits/investigations, while adhering to legal and regulatory standards., • Communicates audit/investigation findings clearly and professionally to customers, claimants, and other stakeholders, managing expectations and providing updates., • Assists in providing training and support to other auditors/investigators, contributing to the continuous improvement of investigative processes. Education and /or Skills and Experience Required: • Minimum Bachelor's Degree, • Certified Fraud Examiner or Accredited Healthcare Anti-Fraud Investigator, • Prior successful experience with CMS and OIG/FBI or similar agencies, • Medicare investigation experience preferred If you match the requirements for this opportunity and believe you have the experience and talent to succeed in the role, we need to hear from you! Compensation for the role of Investigator will be determined based on experience and qualifications. The salary range is expected to be $55,000 - $71,000, plus benefits. Established in 2010, @Orchard LLC, also known as, Talent Orchard has an exceptional reputation, providing staffing solutions to time-sensitive, talent scarcity issues to deliver better talent management ROI. Our specialty lies in the critical area of program talent acquisition and resource management, not in one narrow skillset, but across many areas of technical and functional delivery. To learn more about our other exciting opportunities, visit our Jobs Page at .

Job Description POSITION SUMMARY We are looking for a Provider Dispute Resolution Specialist (PDR Specialist) to manage and resolve disputes between our organization and healthcare providers regarding reimbursement, claims processing, and contractual agreements. The Provider Dispute Resolution Specialist will be responsible for investigating provider disputes, facilitating communication between parties, and negotiating resolution agreements. The ideal candidate will have strong analytical skills, experience in healthcare reimbursement, and a commitment to maintaining positive provider relationships. RESPONSIBILITIES-DUTIES • Triage incoming appeals and properly distinguish between PDRs and appeals, analyze provider disputes regarding reimbursement, claims, or contractual agreements and transfer issues to the correct departments., • Use internal tracking mechanisms to ensure proper processing timelines and the appropriate actions that need to be taken., • Review and process PDRs according to CMS guidelines., • Create proper acknowledgement letters, • Send to appropriate departments for additional information as needed, • Reprocess claims as needed for overturned PDRs, • Create proper resolution letters to close PDRs timely, • Assist in preparing and reviewing PDRs for health plan audits, • Assist in training of other members of the PDR team as needed, • Education: High School Degree required, • 3+ years experience processing and examining claims and PDRs, • Experience with EZCAP software a plus, • Understand different payment methodology and financial responsibility contracts/DOFRs, • Problem solving skills, • Analyze claims issues and communicating any changes needed with other AMM departments, • Expert analytical skills, • Ability to plan and organize things effectively When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first: • Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan., • Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe., • Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future., • Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work., • Career Development: Tuition reimbursement to support your education and growth., • Team Fun: Paid company outings and lunches because we work hard, but we also know how to have fun!

Job Description Johnson Service Group is seeking Member Services Representatives. This is a remote position. Bilingual Required: Mandarin, Cantonese, Korean, Vietnamese, and Spanish. Must live in Texas, New Mexico, Nevada, Arizona or CA. Work schedule: Training: 7 weeks M-F, 8:00 am-4:00 pm Work hours available: 6 am-8 pm, PST, weekend rotation, and some holidays required. Pay rate: $21/hr. Bilingual Pay rate: $20/hr. Non-Bilingual Job Summary: Serves members by being an advocate and point of contact for member questions and concerns regarding benefits, eligibility, referrals, claims, and any other aspects of plan benefits and services. Ensures member satisfaction by providing superior customer service and willingness to help at all times while maintaining a professional demeanor. Responsibilities: • Provides quality customer service: Educates members, family, providers, and caregivers regarding benefits and plan options., • Accurately explains benefits and plan options in person, via email, or telephonically., • Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required., • Consistently meets and/or exceeds the departmental standards, including, but not limited to: quality, productivity, and adherence to schedule and attendance., • Responds appropriately and in a timely fashion to member/internal staff/providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims, and all other issues following departmental policies and procedures and job aids. Takes ownership of the issue, focusing on providing solutions and options for members, as necessary, through the resolution of member issues., • Increases member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely, and accurate fashion; coordinates resolution with providers and other departments as needed., • Participates in member calling projects as assigned by management to support the overall goal of membership retention., • Follows all appropriate Federal and State regulatory requirements and guidelines applicable to company operations, as documented I company policies and procedures. Follows all HIPAA requirements., • Documents transactions by completing applicable member forms and summarizing actions taken in the appropriate computer system and following standards set by the department or by other authorized individuals., • Temporarily responds to routine member questions and concerns on specific medical group call queues as part of skill development., • Contributes to team effort by accomplishing related results as needed., • Bilingual Requirement: Korean, Mandarin, Cantonese, Vietnamese, Spanish, • 1-2 years of call center or related customer service experience is required., • 1-2 years of prior experience with Medicare benefits, including Medicare Advantage Plans preferred., • Experience in the healthcare, insurance, or pharmacy industry is highly desirable., • Ability to maintain a calm demeanor at all times, including during highly charged situations., • Data entry and general computer skills (word processing, e-mail) required., • Effective communication (oral and written) skills. Professional/pleasant telephone manner required., • Ability to handle large call volume, while providing excellent customer service at all times required. Johnson Service Group, Inc. (JSG) is a North American leader in the staffing and consulting services industry, with 40 years of experience investing in people and companies. We are always looking for great people to join our team—we want to see your success here at JSG! We can be found locally in more than 30 offices throughout the United States and Canada. JSG continues to work diligently to offer our clients and candidates world-class service and diversified offerings to fit their evolving needs. We offer medical, dental, vision, life insurance options, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.Our people and culture make JSG a great place to work. JSG’s mission is to empower people, help our clients reach their goals, and hire motivated individuals.\r\n\r\nJohnson Service Group, Inc. (JSG) is a North American leader in the staffing and consulting services industry, with 40 years of experience investing in people and companies. We are always looking for great people to join our team—we want to see your success here at JSG! We can be found locally in more than 30 offices throughout the United States and Canada. JSG continues to work diligently to offer our clients and candidates world-class service and diversified offerings to fit their evolving needs.\r\n\r\nWe offer medical, dental, vision, life insurance options, 401(k), weekly pay, and more.\r\n\r\nJohnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.

Job Description Position Title: Program Operations Supervisor I, II or III Department: Recovery Support Reports To: Program Director POSITION SUMMARY Responsible for overall day-to-day supervision of assigned staff and the shift-to-shift or day to day operations of program or unit. This includes oversight of patient activities and staff responsibilities as they relate to patient functions. Implement the treatment philosophy of Tarzana Treatment Centers, Inc. (TTC). HOURS 8 per Day / 5 Days per Week CATEGORIES OF DUTIES • Responsible for supervision of staff as assigned by Director. Depending on the nature or type of department, office, program, or unit, this may include counselors, case managers, outreach workers, intake specialists, technicians, dietary, maintenance, housekeeping, or front office staff., • Specific areas of responsibility may include revenue cycle training, credentialing registration, claims management, billing, collections, patient insurance, data processing, integrity of patient accounts, accounts receivable management, practice management system file maintenance, and third-party revenue cycle vendors., • Performs and/or oversees regular chart audits, record keeping, and other reporting and documentation functions as assigned to ensure that all records are maintained in accordance with all applicable TTC policies, procedures, and external regulations and standards to include but not limited to JCAHO, State, County, City sources., • Completes or participates in the development and submission of various reporting requirements as assigned. Such reporting may include Continuous Quality Assurance reports, various performance improvement reports, data reports of various types, prevention, repair, and other maintenance reports to include fire life safety and other environment of care reporting., • Responsible for provider reimbursement programs, policies, and strategies to ensure unit cost controls meet or exceed corporate objectives., • Attending in-service training and educational workshops., • Attending all required staff meetings., • Cooperates and communicates fully with other staff members and supervisors regarding patient and/or staff behavior, progress, activities, as appropriate., • Conducts self in a professional manner in areas of dress, language, attitude, and behavior. At all times is a role model for other staff and patients., • Exhibits full knowledge and support of the philosophy and objectives of the Agency., • Fully understands and maintains policies regarding professional ethics, including appropriate boundaries and patient confidentiality., • Participation in medical record and other report and record reviews as assigned., • Utilization review activities, as required., • Develop, implement, and maintain revenue cycle standard operating procedures (SOPs) in area of responsibility., • Conducts or participates in performance evaluations of interns and other staff, as required., • Attends clinical and administrative committee meetings, as requested., • Manage projects which may include revenue cycle projects and provide upper management with audit findings, metrics, and presentations., • Additional functions as specifically requested by the Program Director and/or Administrator., • Staff Supervision, • Orientation of new employees, • Scheduling staff coverage, time-off requests, etc., • Evaluations, • Assisting Director with Hiring, • Assisting Director with Discipline, • E-Time, • Support to staff, • Ongoing supervision of documentation compliance in medical records., • Chart and other record audits with others on Management team, • Taking outcome of chart/record audits back to those on each shift to manage compliance., • Administration, • Active participation in agency-wide committees as assigned., • Support the management team and to act as an agent of the organization in all situations- utilize management team meetings as a forum to resolve differences., • Attends weekly management meetings with Program Director, • Attending in-service training and educational workshops., • Attending all required staff meetings., • Other, • Work closely with staff to monitor adherence to organizational philosophy goals and objectives., • EDUCATION/EXPERIENCE/QUALIFICATIONS GUIDELINES Title Approximate Number of Employees supervised Degrees/ certification Experience may be substituted for education with CEO approval Approximate Years of supervisory experience, other factors may be considered with CEO approval. Operations Supervisor I 1 to 5 High School Diploma/GED Academic counseling certificate 0-2 Operations Supervisor II 6 to 12 State approved Counseling Certificate, AA, or BA 4 Operations Supervisor III Over 12 May supervise a Level I or Level II Supervisor Bachelor’s or Master’s Degree 6 SETTING Tarzana Treatment Centers, Inc. is a non-profit corporation, which provides behavioral healthcare services, including chemical dependency. EQUAL OPPORTUNITY EMPLOYER Tarzana Treatment Centers, Inc. does not discriminate as to race, nationality, religion, gender, sexual orientation, and disability in its hiring practices. ADA REQUIREMENT Tarzana Treatment Centers, Inc. supports the Americans with Disabilities Act. Discrimination is prohibited in all aspects of employment against disabled persons, who, with reasonable accommodations, can perform the essential functions of a job. #SJ2021

Job Description Position Summary The Senior Program Manager, MSO Operations is responsible for overseeing the ongoing optimization and seamless functioning of the MSO’s operational units, with a strong focus on Claims Operations, EDI, Eligibility, Capitation, and other core MSO functions. This role ensures that operational processes run efficiently, are technologically enabled, and remain compliant with regulatory standards under Medicare Advantage full-risk value-based care contracts. The Senior Program Manager will play a central role in transitioning new clients into the MSO, leading project management for operational and technology initiatives (e.g., EFT automation, retroactive kickouts (RKK) optimization, mailroom efficiencies), and enabling the future state of fully tech-enabled MSO operations. This individual serves as the bridge between operational leadership, technology teams, and client-facing functions, ensuring projects are executed on time, within scope, and aligned with the strategic vision of the MSO. Key Responsibilities Operational Oversight & Optimization: • Monitoring of the day-to-day operations of Claims, EDI, Eligibility, and Capitation units to ensure smooth functioning and resolution of escalated issues., • Drive continuous improvement in operational workflows, ensuring efficiency, accuracy, and scalability to support growth., • Monitor key performance indicators (KPIs) across Claims, Eligibility, and Capitation, providing data-driven insights to leadership., • Lead the operational integration and transition of new IPA clients into the MSO platform., • Collaborate with cross-functional teams (Credentialing, Contracting, Provider Relations, IT) to ensure seamless onboarding., • Develop standardized transition playbooks and timelines to manage risks, dependencies, and deliverables., • Lead project management efforts for operational improvement initiatives, including but not limited to:, • EFT automation and optimization (payment workflows)., • Mailroom and document management efficiencies., • System integrations and tech enablement of Claims/MSO operations., • Establish project timelines, budgets, deliverables, and success metrics., • Manage cross-departmental teams, ensuring accountability and clear communication of project goals., • Partner with IT, vendors, and internal stakeholders to ensure the deployment of technology solutions that streamline MSO operations (claims adjudication, eligibility verification, EDI transactions, document management, analytics dashboards)., • Serve as business lead for system upgrades, implementations, and automation efforts in MSO operations., • Identify and prioritize areas where technology can drive efficiency, accuracy, and scalability in claims and related functions., • Develop and maintain a roadmap for operational technology enablement aligned with organizational strategy. Leadership & Collaboration: • Provide mentorship and operational guidance to managers and supervisors within Claims, Eligibility, and Capitation teams., • Cultivate a culture of accountability, process improvement, and cross-functional collaboration., • Work closely with Compliance and Audit teams to ensure adherence to CMS, HIPAA, and other regulatory standards. Education & Experience • Bachelor’s degree in Healthcare Administration, Business Administration, or related field (Master’s preferred)., • 7+ years of experience in healthcare MSO or health plan operations, with significant exposure to Claims, Eligibility, EDI, and Capitation functions., • 5+ years of progressive leadership or program/project management experience., • Demonstrated experience in managing large-scale operational transitions and client onboarding., • Deep understanding of Medicare Advantage full-risk value-based care operations and compliance requirements., • Strong program and project management skills (PMP certification preferred)., • Excellent analytical skills with ability to interpret data, identify trends, and drive process improvements., • Strong communication, stakeholder management, and cross-functional leadership skills., • Proficiency with claims adjudication systems, EDI platforms, eligibility/capitation systems, and reporting tools., • Operational KPIs: Claims turnaround time, accuracy rates, EDI transaction success rates, eligibility reconciliation timeliness, capitation accuracy., • Successful client onboarding within agreed-upon timelines and satisfaction benchmarks., • Completion of key initiatives (EFT, RKK, mailroom, tech enablement) within scope, budget, and timelines., • Improvement in operational efficiency, cost savings, and scalability. When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first: • Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan., • Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe., • Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future., • Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work., • Career Development: Tuition reimbursement to support your education and growth.

Job Description SUMMARY The Billing/Finance Clerk provides administrative and clerical support to the billing and finance department. This entry-level role focuses on assisting with daily billing operations, payment processing, data entry, and customer service tasks while maintaining accuracy, confidentiality, and compliance with organizational and regulatory standards. PRIMARY RESPONSIBILITIES • Perform accurate data entry for patient accounts, invoices, and billing records., • Process and post payments, co-pays, and adjustments into the billing system., • Assist with generating and mailing patient statements, and insurance claims., • Help answer phones in a professional manner., • Support the department by filing, scanning, and organizing billing and financial records., • Prepare and reconcile daily deposits and assist with month-end reports., • Maintain confidentiality in accordance with HIPAA and organizational policies., • Provide administrative support for meetings, reports, and departmental communications. SKILLS AND CORE COMPETENCIES • Communication/Customer Service, • Computer Skills/Job Knowledge, • Dependability/Flexibility, • Mission/Objectives, • Productivity/Quality of work, • Team & People Relations EDUCATION AND EXPERIENCE • High school diploma or equivalent required; additional coursework in accounting, finance, or medical billing preferred., • No prior billing experience required; 1+ years of office or administrative experience preferred., • Basic understanding of billing, finance, or healthcare operations a plus., • Proficiency in Microsoft Office (Word, Excel, Outlook)., • Strong organizational and multitasking skills., • Excellent written and verbal communication skills., • Ability to work independently and collaboratively in a team environment., • Attention to detail and accuracy in data entry. The physical demands of this position are those necessary to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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