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Company : Highmark Inc. Job Description : JOB SUMMARY The incumbent is responsible for developing and maintaining an anti-fraud program which includes development and delivery of training and filing of Fraud Plans and Reports. The incumbent is responsible for conducting investigations of organizational or functional activities related to alleged fraud, waste and abuse perpetrated by providers, members, facilities, pharmacies, groups and/or employees of the organizations and Subsidiaries. The incumbent is responsible for interviews which might include providers and members and may be conducted onsite or offsite. The incumbent is also responsible for the field investigative work necessary to complete a review of a special project, potential fraud, waste and abuse case, conducting the initial investigations and coordinating the recovery/savings of money related to fraud, waste and abuse. Must be able to testify in a court of law, prepare cases for referral to various federal, state and local law enforcement entities and work with those agencies through closure of the case. Conduct audits for proactive and investigative purposes to comply with internal audit and regulatory requirements. For this role, we are looking for Clinical Nursing and/or Medical Coding experience. ESSENTIAL RESPONSIBILITIES * Performs investigations into potential and existing provider and member fraud, waste and abuse activities.Identifies parties involved by reviewing inquiries and complaints against providers, members, facilities, pharmacies, groups, and/or employees of Highmark and Subsidiaries.Conduct Interviews with providers, members or any other individual(s) necessary to complete an assigned investigation or special project.Determines the scope of the allegation or special project by assembling the necessary information, statistics, policies and procedures, licensure information, doctors' agreements, contract, etc. * Coordinates data extracts by assessing multiple databases both internally and externally.Takes action to prevent further improper payments.Forwards case to the Credentialing and/or Medical Review Committee, law enforcement and regulatory agencies. * Develop and maintain annual anti-fraud program which includes facilitating fraud training and fraud awareness day, as well as filing annual fraud plans and reports according to state regulations. Responsible for updating annually the changes in insurance laws with regard to lines of business. * Will be called upon as a subject matter expert for Investigators. Will provide guidance and help train/mentor other team members. Could serve as a project lead for special projects within the department. * Responsible for completing all necessary field (externally) investigative work for resolution or alleged fraud/waste and abuse cases or special projects. * Provides advisory support as needed to internal and external law enforcement and regulatory agencies, Credentialing or Medical Review Committee. * Engages in delivery of audit results and overpayment negotiations.Responsible for recovery/ savings of misappropriated funds paid by Highmark and affiliated companies and work with Finance to ensure proper recording the financial statements. * Conduct audits for proactive and investigative purposes to comply with internal audit and regulatory requirements. Audits consist of contract, commissions, surveillance, workers' compensation and IME. In addition, this position will complete Office of Foreign Asset Control (OFAC) to ensure payments are not issued to unauthorized parties. * Other duties as assigned or requested. EDUCATION Required Required * 5 years in the Health insurance industry and/or Healthcare fraud investigations * 1 year of leading projects of varying size and complexity Preferred * 3 years of financial analysis in an acute care hospital or health insurance setting * 3 years in professional billing, facility Patient Financial Services, HIM, Internal Audit, Professional/Facility Reimbursement or Provider Contracting LICENSES or CERTIFICATIONS Required Certified Fraud Examiner (CFE) * Certified Professional Coder (CPC) * Certified Outpatient Coder (COC) * Accredited Healthcare Fraud Investigator (AHFI) SKILLS * Must have knowledge of provider facility payment methodology, claims processing systems and coding and billing proficiency * Must have understanding of technical and financial aspects of the health insurance industry * Strong personal computer skills, along with the ability to use fraud/abuse data mining tools are required * Must possess excellent communication skills and be detailed oriented * Strong written and oral communication skills * Strong relationship building skills * Client focused with strong business acumen * Self-starter with the ability to work under pressure independently and as part of a team * Ability to think strategically and act proactively to create strong trust and confidence with business units * Strong innovative problem-solving capabilities Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $72,700.00 Pay Range Maximum: $116,600.00 Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J278197

Job Description Please be aware that this job requisition serves as a repository for our talent pool. About Wildpack Wildpack is a rapidly growing and established co-packaging and co-manufacturer with multi-site facilities for both non-alcoholic and alcoholic beverages. Wildpack produces and packages ready-to-drink beverages for a variety of brand owners in the retail CPG space. The company specializes in aluminum can beverage sleeving, filling, and third-party logistics. We are looking for someone who is a natural leader and is committed to delivering high quality service with high-performance results. Bring an entrepreneurial spirit and come grow your career in a fun, inclusive, and established business that is supportive with lots of opportunity for advancement. The Company recently went public on the Canadian Toronto Stock Exchange Venture, bringing massive opportunities to its employees for career progression and a variety of learning opportunities. Wildpack has continued to expand its team and clientele base year-after-year and expects to continue its growth through training, developing, and opening opportunities to its team through career advancement. About this role Wildpack is looking for a dedicated, full-time canning line associate with an interest in supporting a rapidly growing company. We are looking for someone who is committed to delivering high quality service with high-performance results. We are looking for you to take charge of projects and to confidently navigate competing deadlines in a fast-paced environment. Bring an entrepreneurial spirit and come grow your career in a fun, inclusive, and established business that is supportive with lots of opportunity for advancement. A day in the life: What you do • Daily setup, CIP and SIP of a canning line, • Daily operation of canning line and supporting equipment (automated depalletizer, laser ink date coder, in-line labeler, conveyors, and can rinse), • Ensure all beverage is in the proper condition (temperature, carbonation level, etc.) prior to canning, • Ensure all canning activity is done according to SOPs regarding yield, can fill-height, dissolved oxygen levels, seaming standards, and material loss, • Maintain proper canning records and logs, • Ensure regular maintenance of canning equipment, • High School Diploma or equivalent, • Technical/professional training in mechanical and/or electrical field a plus, • Experience working in a production/packaging brewery or manufacturing environment, • Mechanically inclined with the ability to troubleshoot and problem solve quickly, • Ability to lift 55lbs and move 165lbs occasionally, • Operate a forklift and complex machinery (training can be provided), • Work in a temperature-controlled environment, • Strong work ethic and a team player that is looking for a position at a fast- growing company, • Ability to manage multiple projects simultaneously, • Willingness to assist with tasks outside key responsibilities, • Energy - How we show up impacts everything we do so we show up with Wildpack energy., • Grit - Work through challenges, make use of what we have, and survive-at-all-costs attitude., • Problem Solving - Strives to understand contributing factors, works to resolve complex situations., • Team First - Work as One Pack to create teammates and reduce friction, internally and externally. Wildpack Benefits; What you get We invest in our people, support their growth through mentorship, professional development, and education opportunities. We strive to offer a work-life balance, creating a culture that is people-focused and fun. Here are some of the benefits you can expect as part of our team: • Salary based on experience, • Medical, Dental and Vision Insurance, • 401k matching program up to 4% of contribution, • Paid Time Off We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

Job Description Freenet Health Corp. is a healthcare management services company that works exclusively for telehealth and mobile practice providers, including medical billing services. Freenet Health Corp is now hiring a billing team to service the mobile wound care practice Woundlocal. Hiring: a clinical back certified medical billing professional with extensive experience in Medicare billing and commercial and federal insurance benefits verification. Must be able to perform, train, and oversee verifying patient benefits, reviewing provider documentation, provide real-time feedback to the medical team, ensure timely submission to payers, review claim denials, submit appeals, and bill secondary insurance. All claims are made for advanced wound care services and allograft skin substitutes. Manager Responsibilities: • Direct peers on work queues, assignments and priorities, • Culture leader and attention to team dynamic, • Coordinate internal training and third party strategic learning sessions, • Provide accurate answers to queries from providers, management, and internal staff., • Identifies internal process problems, researches where they are occurring, and provides recommendations for solutions., • Manages expert remote coder to ensure properly assigned difficult codes and/or complex coding scenarios using modifiers., • Analyzes aging accounts receivables and lost client revenue, provides recommended actions., • Liaison to third-party billing company while also building an internal team., • Grow a culture of excellence, integrity, and collaboration., • Greater responsibilities are available should the candidate experience match the responsibilities., • Duties, Responsibilities, and Compensation will be adjusted to the individual hire's experience level and expertise. Daily Competency: • Review and analyze medical documentation to ensure accurate coding and billing processes., • Assign appropriate codes for diagnoses, procedures, and services according to the guidelines and regulations., • Stay up-to-date with coding standards and insurance requirements, including ICD-10, CPT, and HCPCS coding systems., • Collaborate with healthcare providers to clarify documentation and ensure completeness., • Identify and resolve discrepancies in medical records and coding for accurate claims processing., • Evaluate and re-file appeals of patient claims that were denied., • Stay up-to-date on new coding ruleas and code changes., • Assist in audits and provide necessary documentation for compliance and quality assurance activities., • Collect and distribute coding related information and billing issues to management and provider when changes happen., • Accurate classification of wound care and graft encounters in skilled nursing facilities, long term acute care, home health, hospice, assisted and independent living, and home visits., • Reviews provider charts for completion and following practice standards., • Performs some of the insurance benefits verifications with in network and out of network payers, • Analyzes claims rejections and initiates appeals if applicable. Start Date:Immediate Job Type: Full-time Pay: comp package $30.00 - $50.00 per hour, based on experience Work Location: In person, either Boerne or Austin office (no remote work) Requirements Qualifications: • 2+ years of college or advanced education, • 4+ years employed in a private medical practice, • 2+ years managing employees, • 4+ years of insurance verification, • 4+ years using billing portals, • 4+ years experience with ICD-10, CPT, & HCPCS codes, • Proficiency in EMR systems, • Proficiency in Microsoft Office (Word, Excel, Outlook), • Strong computer skills, • Experience with home health and/or skilled nursing facilities a plus, • Competitive nature, • Happy disposition #zr Benefits Why this job is AWESOME: Join us and you will see, we don’t do things like everyone else. We are the newest and fastest-growing in popularity for online healthcare. It’s no secret how we're accomplishing this... it’s our incredible team members and the culture we’re building! If you are looking for an amazing place to work, grow, learn, and have a blast - this is it. • Great team! We spend a ton of time investing in our people and our culture including frequent company sponsored events., • Great pay! We pay well and your pay scales based on performance., • Great opportunities! We're growing and we like to promote from within including company sponsored career development., • Great office! High end Boerne office location right off I-10 with company sponsored massages and free lunch on Fridays. Benefits: • Health insurance, • Free telehealth visits through askmindi, • On-the-job training, • Company sponsored career development, • Opportunities for advancement, • Paid time off

Job Description Freenet Health Corp. is a healthcare management services company that works exclusively for telehealth and mobile practice providers, including medical billing services. Freenet Health Corp is now hiring a billing team to service the mobile wound care practice Woundlocal. Hiring: a clinical back certified medical billing professional with extensive experience in Medicare billing and commercial and federal insurance benefits verification. Must be able to perform, train, and oversee verifying patient benefits, reviewing provider documentation, provide real-time feedback to the medical team, ensure timely submission to payers, review claim denials, submit appeals, and bill secondary insurance. All claims are made for advanced wound care services and allograft skin substitutes. Manager Responsibilities: • Direct peers on work queues, assignments and priorities, • Culture leader and attention to team dynamic, • Coordinate internal training and third party strategic learning sessions, • Provide accurate answers to queries from providers, management, and internal staff., • Identifies internal process problems, researches where they are occurring, and provides recommendations for solutions., • Manages expert remote coder to ensure properly assigned difficult codes and/or complex coding scenarios using modifiers., • Analyzes aging accounts receivables and lost client revenue, provides recommended actions., • Liaison to third-party billing company while also building an internal team., • Grow a culture of excellence, integrity, and collaboration., • Greater responsibilities are available should the candidate experience match the responsibilities., • Duties, Responsibilities, and Compensation will be adjusted to the individual hire's experience level and expertise. Daily Competency: • Review and analyze medical documentation to ensure accurate coding and billing processes., • Assign appropriate codes for diagnoses, procedures, and services according to the guidelines and regulations., • Stay up-to-date with coding standards and insurance requirements, including ICD-10, CPT, and HCPCS coding systems., • Collaborate with healthcare providers to clarify documentation and ensure completeness., • Identify and resolve discrepancies in medical records and coding for accurate claims processing., • Evaluate and re-file appeals of patient claims that were denied., • Stay up-to-date on new coding ruleas and code changes., • Assist in audits and provide necessary documentation for compliance and quality assurance activities., • Collect and distribute coding related information and billing issues to management and provider when changes happen., • Accurate classification of wound care and graft encounters in skilled nursing facilities, long term acute care, home health, hospice, assisted and independent living, and home visits., • Reviews provider charts for completion and following practice standards., • Performs some of the insurance benefits verifications with in network and out of network payers, • Analyzes claims rejections and initiates appeals if applicable. Start Date: Immediate Job Type: Full-time Work Location: In person, either Austin or Boerne office (no remote work) Requirements Qualifications: • 2+ years of college or advanced education, • 4+ years employed in a private medical practice, • 2+ years managing employees, • 4+ years of insurance verification, • 4+ years using billing portals, • 4+ years experience with ICD-10, CPT, & HCPCS codes, • Proficiency in EMR systems, • Proficiency in Microsoft Office (Word, Excel, Outlook), • Strong computer skills, • Experience with home health and/or skilled nursing facilities a plus, • Competitive nature, • Happy disposition Benefits Why this job is AWESOME: Join us and you will see, we don’t do things like everyone else. We are the newest and fastest-growing in popularity for online healthcare. It’s no secret how we're accomplishing this… it’s our incredible team members and the culture we’re building! If you are looking for an amazing place to work, grow, learn, and have a blast - this is it. • Great team! We spend a ton of time investing in our people and our culture including frequent company sponsored events., • Great pay! We pay well and your pay scales based on performance., • Great opportunities! We're growing and we like to promote from within including company sponsored career development. Benefits: • 100 % employer paid medical, dental, vision Work setting: • No less than 40 hours per week, • Monday to Friday

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of between $25/hr.There is no payment required in order to apply or to work as an In-Home Usage Tester.You do

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of between $25/hr.There is no payment required in order to apply or to work as an In-Home Usage Tester.You do

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of between $25/hr.There is no payment required in order to apply or to work as an In-Home Usage Tester.You do

This opportunity is ideal for certified Professional Fee coders with hands-on experience in mental health and/or primary care who are confident navigating E/M guidelines and complex provider documentation. CSI Companies is seeking an experienced Professional Fee (ProFee) Coder with a strong backgrou

Our client, a Global Fortune 50 organization and one of world’s largest distributors of Healthcare systems, Medical supplies & Pharmaceutical products, seeks an accomplished.Position: Clinical Coding Specialist.Location: Houston, TX (REMOTE).Duration: 6 months+ Contract with high possibility of ex

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