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Job Description JOB-19203 Claims Processing Analyst-25465 Work Schedule: M-F 8:30am – 5:00pm (40 Hour Work Week) OR 9:00am – 5:00pm (37.5 Hour Work Week) Telecommuting: This position may be eligible for telecommuting up to 50% hours scheduled to work in a two (2) week pay period. For new hires, it is typical that the first six (6) weeks of the assignment would be on site, with the possibility of applying for a telecommuting work schedule at that point. All requests are reviewed based on operation need. A laptop and docking station would be provided for remote work use at that time. Duties: • Determine appropriate routing for reimbursement of AIHP medical providers;, • Process AIHP Nation pharmacy and vision memberships;, • Support accounts/payable process (key vouchers for AIHP/OHEHR);, • Provide administrative support (minutes, field calls from claims hotline) to AIHP contractors;, • Assist in preparation of periodic reports and analysis;, • Assist in the implementation and maintenance of policies and procedures related to control and processing of payment requests;, • Manage the Unit's workflow, troubleshoot and report to supervisor when necessary;, • Respond to inquiries from providers and Nation billing clerks. Skills required: • General/Basic Understanding of the medical claims’ submission process, which includes analyzing Explanation of Benefits (EOB) forms to interpret payment information, ability to read and interpret Medicaid billing schedules and policies, as well as Current Procedural Terminology (CPTs) and Healthcare Common Procedural Coding System (HCPCS);, • General knowledge of automated accounting systems;, • Ability to analyze data and apply basic Generally Accepted Accounting Principles (GAAP) when necessary;, • Proficiency in Microsoft Excel and Word programs;, • Good written and oral communication skills, as well as good organizational skills. Preferred Skills: Our extensive consultant placements cover a variety of roles, from Technical Architects and Specialists to Developers, Project Managers, Analysts, Executive Secretaries, Nurses, Dietitians, Paralegals, Computer Operators, Food Preparation Workers, and many other occupations. To date, KBI has successfully placed over 1,000 consultants across more than 100 private sector companies and public sector agencies in New York State and throughout the country. We are dedicated to recruiting candidates who consistently exceed our customers’ expectations. We provide equal employment opportunity for all applicants and employees regardless of race, color, sex, gender identity, gender expression, religion, age, national origin, citizenship, disability, medical condition, family care status, marital status, domestic partner status, sexual orientation, genetic information, military/veteran status, or any other protected basis.Established in 2005, Knowledge Builders Inc. (KBI) offers a wide range of services, including Information Technology Consulting, Administrative and Health Care Staffing solutions, Payrolling, and Call Center services to organizations of all sizes, including both private companies and governmental entities. KBI is a certified Woman-Owned Business Enterprise (WBE) recognized by New York State, New York City, and the Port Authority of New York and New Jersey.\r\n\r\nOur extensive consultant placements cover a variety of roles, from Technical Architects and Specialists to Developers, Project Managers, Analysts, Executive Secretaries, Nurses, Dietitians, Paralegals, Computer Operators, Food Preparation Workers, and many other occupations. To date, KBI has successfully placed over 1,000 consultants across more than 100 private sector companies and public sector agencies in New York State and throughout the country.\r\n\r\nWe are dedicated to recruiting candidates who consistently exceed our customers’ expectations.\r\n\r\nWe provide equal employment opportunity for all applicants and employees regardless of race, color, sex, gender identity, gender expression, religion, age, national origin, citizenship, disability, medical condition, family care status, marital status, domestic partner status, sexual orientation, genetic information, military/veteran status, or any other protected basis.

Job DescriptionGet to Know Rivia Mind At Rivia Mind, we believe great mental health care begins with a human connection. Where We Are: We are a psychiatrist-owned mental health practice rooted in New York City, serving individuals across New York, New Jersey, Connecticut, Florida, and Massachusetts through both virtual and hybrid appointments. How We Support: With a 360°ree; view of each individual, we provide compassionate, science-based care that honors the full complexity of a person's biology, psychology, and life circumstances. We go beyond symptom management with an interdisciplinary care model grounded in collaboration, personalization, and delivered with warmth, respect, and clinical integrity. We bring a high-touch, human-centered approach to every aspect of care, from clinical treatment to operational coordination. Click Here to learn more about our services. Thrive Together: 🌟 Our shared North Star unites us to provide the best patient experience. At Rivia Mind, we cultivate a collegial culture rooted in: • A foundation of shared values and reciprocal support, • A mindset of curiosity, learning, and growth Job Summary Under the direct supervision of the Revenue Cycle Supervisor, the Revenue Cycle Coordinator serves as a key support role within the billing department. This position contributes to claim processing, denial resolution, insurance follow-up, and patient invoicing. It also plays a critical role in handling communication across billing channels, including emails, phone calls, and chat messages, with an emphasis on timely and professional follow-through. The Coordinator leverages prior billing experience to help maintain accuracy, efficiency, and responsiveness across all core revenue cycle functions. Application Window: Until February 9th Anticipated Start Date: April, 2026 Job Responsibilities & Qualifications Responsibility Composition Claim Processing & Follow-Up – 40% • Submitting, reviewing, and following up on claims to ensure timely payment and resolution.Denials & Rejections – 20%, • Investigating denied claims, updating claim statuses, and collaborating with supervisors or payers for appeal/resubmission.Account Management – 15%, • Reviewing patient accounts, reconciling balances, managing invoicing, and payment plans.Provider & Patient Communication – 15%, • Communicating with providers for clarification on billing details; responding to patients' questions around balances or billing errors.Reporting, Internal Projects, & Documentation – 10%, • Prepare, review, and transmit claims using billing software in an accurate and timely manner, • Document billing-related interactions and resolutions in alignment with department SOPs and compliance requirements., • Support insurance eligibility troubleshooting by flagging inconsistencies or missing information for resolution, • Follow up on denied or rejected claims, including supporting the collections process in accordance with department standards, • Support patient invoice procedures, including billing inquiries and basic account clarification, • Review and validate claims for completeness, coding accuracy (CPT/ICD-10), and payer-specific rules before submission, • Monitor claims for timely filing deadlines and escalate any risks to the Revenue Cycle Supervisor, • Effectively utilize the EMR system (IntakeQ) and other platforms to support claim, payment, and patient account workflows, • Investigate billing discrepancies and errors, and assist with resolution of denied claims when appropriate, • Check each insurance payment for accuracy and compliance with contracted rates; call payers to address discrepancies if necessary, • Flag potential secondary insurance coverage for further review or follow-up, • Escalate complex denial trends, unresolved claim issues, or recurring payer discrepancies to the Senior Revenue Cycle Specialist or Supervisor, • Collaborate with the Revenue Cycle Supervisor and Specialists to provide support as needed (e.g., special projects, ad-hoc reports, process improvements), • Collaborate cross-functionally with other operational teams to support efficient billing workflows and issue resolution, • Assist with specialty focus areas (e.g., mailed correspondence, provider coordination) as needed to maintain workflow continuity, • Provide responsive support to patients, providers, and internal departments by managing billing-related phone calls, emails, and chat inquiries; ensure timely and accurate resolution in line with department standards, • Maintain clear, empathetic, and professional communication with patients and providers regarding billing concerns to uphold patient trust and care continuity., • Maintain compliance with HIPAA, insurance billing guidelines, and all internal processes, • Adhere to department Standard Operating Procedures (SOPs) and contribute to continuous improvement efforts, • Promote a collaborative work culture that supports growth, teamwork, and continuous learning, • Expected to contribute to weekly claims submission and denial resolution goals as set by the Revenue Cycle Supervisor Education: • Required: High school diploma or GED, • Three (3) or more years of experience in medical billing, including claim submission and insurance follow-up, • Experience in remote healthcare customer service or patient support, including phone-based communication, • Competent understanding and interpretation of Explanation of Benefits (EOBs), • Knowledge of EMR/EHR platforms (e.g., IntakeQ), • Data entry experience with strong attention to detail, • Knowledge of insurance guidelines, including HMO/PPO, in-network/out-of-network (IN/OON) benefits, and Medicare rules, • Proficiency with Google Suite and the ability to navigate multiple platforms (e.g., Salesforce, EMRs), • Intermediate computer skills and solid technical aptitude, • Behavioral health billing experience, • One (1) or more years of telehealth billing and coding experience Benefits That Support You, Personally and Professionally At Rivia Mind, we know that providing exceptional care starts with caring for our team. That's why we offer a comprehensive, thoughtfully designed benefits package that supports your health, financial wellness, growth, and overall well-being—so you can thrive in work and life. • 3 weeks of front-loaded PTO + 9 paid holidays, • Annual office closure (Dec 25–Jan 1), • Annual Impact Days for volunteering or professional development, • 401(k) with employer match, • Referral bonus potential, • Annual Flexible Benefit Reimbursement, • Medical, dental, and vision insurance — with EAP and additional wellness programs, • Voluntary benefits, HSA, DCA, FSA (based on plan), transit & parking options Compensation Determination: The pay range listed reflects the minimum and maximum base salary for this role, determined through an internal compensation assessment that considers similar labor markets to our practice across the United States. Actual compensation is influenced by compensable factors such as location, role responsibilities, required skills, relevant experience, qualifications, role level, and applicable credentials. It is uncommon for an individual to be hired at or near the top of the posted range. In addition to base salary, total compensation may include bonuses, commissions, or other incentives depending on the role. Location Eligibility: At this time, we are only able to consider applicants whose primary residence is in one of the following states within the United States of America: Connecticut, Florida, Massachusetts, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Texas. Because this is not a solely on-site role, your primary residence must remain in one of these approved states. Please note that residing outside of these states—even temporarily—may result in employment eligibility issues, tax implications, or other regulatory concerns. If your location changes or you're based elsewhere, we encourage you to stay connected for future openings. Equal Opportunity Employer: Rivia Mind is an Equal Employment Opportunity Employer. It is the policy of Rivia Mind to provide equal employment opportunities without regard to race, color, ancestry, religion, sex, gender identity or expression, pregnancy, age, ethnic or national origin, immigration or citizenship status, hair, weight, height, disability, marital status, veteran status, sexual orientation, genetic information/GINA, political affiliation or activity, or any other protected characteristic under applicable law. It is also the policy of Rivia Mind that qualified individuals with disabilities receive equal opportunity regarding job application procedures, hiring, and all aspects of the employment process. Rivia Mind is committed to the full inclusion of all qualified individuals. Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, it is the policy of Rivia Mind to provide reasonable accommodations when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, pre-employment testing, to otherwise participate in the selection process, to perform the essential job functions, and/or to receive other benefits and privileges of employment, please contact us directly. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Applicants must be authorized to work in the United States. We are unable to sponsor work visas at this time. This is in accordance with applicable federal, state, and local laws, including Title VII of the Civil Rights Act, the Americans with Disabilities Act, the Age Discrimination in Employment Act, and the Genetic Information Nondiscrimination Act. If you need assistance or accommodation due to a disability during the application process, please contact our Talent Acquisition team at .

Job Description Tesis Laboratory is seeking a billing professional. Remote work is available. This position is responsible for all molecular genetic laboratory billing and revenue cycle management, thorough insurance benefit investigation of new referrals, a small assignment of collections with a variety of payers, authorization requests, and claim submission. ESSENTIAL DUTIES: • Accurately interprets patient insurance, prescription, and other health-related documentation., • Conducts medical insurance verification and investigations for commercial and government payors., • Communicates with insurance companies, patients, providers, and prescribers to coordinate reimbursement and access solution., • Reviews unpaid accounts to determine status and taking appropriate action to ensure payment., • Reviews all claims for compliance and completeness for claims submissions., • Researches available alternative funding options to reduce patient's financial burden, • Always maintains a high degree of confidentiality due to access to sensitive information., • Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department., • Works with customers and affiliates on reporting, best practice, and strategic planning to optimize growth within a compliant environment., • Reviews and designs KPI to ensure proper financial performance of assigned Laboratory clients., • Follows all Medicare, Medicaid, and HIPAA regulations and requirements., • High school diploma or equivalent is required; Undergraduate degree is preferred., • Experience in Genetic Lab Billing, Accounts Receivables, and/or Collections within a healthcare or insurance environment is required., • Computer proficiency -- MS Office and Web-enabled applications strongly preferred, • Customer service skills required., • Understanding of the requirements of Medicaid, Medicare, and Insurance billing for genetic laboratories in all MAC’s is required., • 5 years’ experience with Laboratory medical billing., • 3 years minimum with Cancer Genomics billing., • 1 year with R & D of molecular genetics panels., • Certified Medical coder or biller with AHIMA or affiliated organization., • Experience with managing clients and/or employees preferred.

Identify and resolve coding discrepancies while maintaining compliance with established guidelines. Document coding decisions and maintain organized, detailed records. Collaborate with internal teams to support coding quality and consistency initiatives.

Certified Professional Coder / Bill Review Expert Responsibilities: • Review medical bills related to MVA injuries sustained for NJ and or NY covered insureds, • Conduct reviews of medical bills and supporting documentation to ensure proper codes assigned, • Assign proper codes as needed based on review outcome, • Use various resources, IE: eBooks, 3M software to support reviews, • Interpret fee schedule guidelines and apply those guidelines in daily reviews, • Document review outcomes for customer in a professional easy to understand manner, • Participate in conference calls as needed with customer and/or attorneys, • Assist with various special projects and other duties as assigned Qualifications and Experience: • 3-5 years of medical billing experience specifically NJ / NY PIP fee schedules, • Strong communicate skills, must be able to explain outcome of review, both written and verbally, • Extensive knowledge of coding /documentation requirements, • Thorough knowledge of CPT, HCPCs, ICD-10, • CPC/AAPC certification required, • Ability to multi-task and meet critical timelines, • Computer experience, • Excel experience beyond beginner, • Independent worker, • Ability to manage time when working remotely, • Must be able to travel to Hamilton NJ office as needed, • Ability to effectively communicate with team

Certification as a medical coder or training/courses in medical coding, billing, and understanding of medical terminology. Experience in healthcare, medical coding, medical billing, and customer service. Strong working knowledge of medical coding and billing processes.