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Job DescriptionDescription: Position Summary: The Hospice RC Specialist is responsible for managing, reviewing, validating and coordinating all Room & Board, GIP/Respite invoicing for hospice operations. This role ensures accurate billing, timely payments, strong vendor relationships, and compliance with Medicare and Medicaid billing standards. This position ensures that company’s claims billed to payors are processed in compliance with the States Medicaid and Managed Care Organization (MCO) regulations, verify patient eligibility, monitor authorizations, resolve denied claims, and support the financial operations of the hospice organization. The Specialist serves as a key point of communication between hospice agencies, vendors, clients and will report directly to the Director of Revenue Cycle Management. Key Responsibilities: Medicaid Invoicing & GIP Claims Management • Verify that patient benefit periods, levels of care, and election information are correct prior to billing., • Prepare, submit, and track Medicaid room and board charges according to state and federal guidelines, including rate changes and patient liability., • Manage all aspects of Room & Board invoicing for assigned hospice agencies to include verifying correct R&B billing rates and invoice accuracy., • Review, update, validate and approve GIP/Respite invoices and prepare for AP processing., • Monitor claim status, follow up on unpaid Medicaid or denied claims, and assist with actions required to correct claims as needed, • Verify resident eligibility and enrollment in Medicaid programs such as managed care plans or traditional Medicaid at admission and regular intervals throughout a patient’s benefit period., • Coordinate with admissions, clinical teams, social workers, and facility partners to ensure accurate billing information., • Identify discrepancies and work with facility partners or internal departments to resolve them., • Communicate effectively with clients, vendors and internal teams, including corporate billing and agency leadership., • Participate in internal meetings, team discussions as requested., • Perform other related duties as assigned or incidental to the essential functions of the position. Requirements: Required Qualifications: • High school diploma or equivalent; -Minimum 2 years medical billing experience related to room & board, long-term care, managed care hospice billing., • Familiarity with hospice levels of care; routine home care, respite and continuous care and general inpatient (GIP), • Strong knowledge of Medicaid billing guidelines, coding, and reimbursement processes., • Excellent communication skills and ability to work collaboratively with facility partners and internal teams., • Strong attention to detail and accuracy., • Full-time position, • Remote, hybrid, or on-site depending on organizational needs, • Fast paced healthcare billing environment requiring consistent attention to deadlines

Job Description Specialty Senior Medical Coder– General Surgery Location: Irving, TX COMPENSATION & SCHEDULE • $35.75/hr (Non-CGSC Certified) | $42.00/hr (CGSC Certified – General Surgery), • Monday–Friday | 8:00 AM–5:00 PM, • W2 | Temp to Perm, • Start Date: 03/16/2026 ROLE IMPACT: The Specialty Coder Senior – General Surgery ensures accurate, compliant coding for high-dollar inpatient and outpatient professional services. This role drives revenue integrity by reducing denials, supporting clean claims, and maintaining a minimum 95% coding accuracy rate. Success is defined by precise code assignment, strong documentation review, and consistent productivity in a remote environment. Key Responsibilities • Assign ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes in accordance with Official Coding Guidelines and AMA CPT standards, • Code inpatient and outpatient Evaluation & Management (E/M) and surgical/operative procedures, generating accurate MS-DRG and APR-DRG groupings, • Review clinical documentation, diagnostic results, admit orders, and discharge dispositions to ensure billing integrity, • Resolve coding denials, manage work queues, abstract data into the EMR, and collaborate with HIM and CDI teams to query providers as needed, • Participate in audits, identify hospital-acquired conditions (HAC), and support process improvements to reduce backend errors Required Qualifications • 2+ years of multi-specialty physician operative and procedural coding experience in an acute care hospital and/or outpatient clinic setting, including General Surgery, • 1+ year of professional billing, claims denials, appeals, and/or revenue cycle experience, • Active CPC, CCS, or CCA certification; completion of an AAPC or AHIMA-approved Coding Certificate Program; High School Diploma or GED required (CGSC required for higher pay rate) Core Tools & Systems • EPIC (required) and Meditech (preferred) electronic medical record (EMR) systems, • Microsoft Excel, Word, and PowerPoint, • ICD-10-CM/PCS, CPT, HCPCS Level II coding systems, • Medicare, Medicaid, and commercial payer guidelines including LCDs (Local Coverage Determinations) and NCDs (National Coverage Determinations), • Denial management and revenue cycle workflow systems APPLICATION PROCESS INCLUDES • In-person interview, • Background check (criminal record, education, and employment verification), • Drug screen, • Clerical testing Legal Notice This position requires completion of an in-person interview, background check (criminal, education, and employment verification), drug screen, and clerical testing as part of the pre-employment process. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from CornerStone and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy at: #IRVING123

Job DescriptionCompany Description Company Description: CareFlite is a 501(c)(3) nonprofit ambulance service sponsored by Baylor Scott & White Health, JPS Health Network, Methodist Health System, Parkland, and Texas Health Resources. CareFlite provides medical transport by helicopter, airplane, and ground ambulance, and non-medical transport via wheelchair van. Job Description Position Summary The Billing Auditor plays a critical role in ensuring the accuracy, completeness, and compliance of all patient care documentation prior to billing. This position requires strong analytical ability, independent judgment, and exceptional attention to detail when reviewing electronic Patient Care Records (ePCRs), Physician Certification Statements (PCS), face sheets, and related documentation. A core responsibility of this role is the continuous improvement of PCR quality. The Billing Auditor ensures each record meets payer, regulatory, and internal standards before submission to CareFlite’s third-party billing partner. Equally essential is the maintaining strong, collaborative relationships with ground crews by providing clarification, education, and real-time support to reinforce the importance of accurate billing documentation and its direct impact on CareFlite’s mission, patient advocacy standards, and documentation integrity. The Billing Auditor serves as a key link between field operations, the Integrated Billing Services team, and external billing partners. This position ensures compliance with Medicare, Medicaid, commercial insurance requirements, HIPAA, state EMS regulations, and CareFlite policies, while supporting audits, reporting, and departmental process-improvement initiatives. Key Responsibilities Documentation Review & Pre-Billing Audits • Review daily ePCRs and associated documentation to ensure accuracy, completeness, compliance, and readiness for billing., • Conduct pre-billing audits and return PCRs to crews for correction or clarification as necessary., • Identify documentation trends affecting billing performance and communicate findings to Integrated Billing Services leadership., • Communicate daily with crew members who have pending, missing, or incomplete PCRs to ensure timely completion before the end of their shift., • Assist crews with documentation or billing questions and provide clarification on payer requirements and documentation standards., • Participate in education initiatives, meetings, or targeted follow-ups to reinforce proper documentation practices., • Obtain, scan, and attach required documents to the ePCR or billing software when not automatically linked., • Support the Integrated Billing Services Manager, Billing Coordinator, and Custodian of Records with departmental needs as required., • Ensure adherence to federal, state, and organizational billing procedures, including Medicare, Medicaid, commercial payor requirements, and HIPAA., • Maintain working knowledge of ambulance billing regulations, state EMS rules (including TAC 157), and internal CareFlite processes., • Communicate professionally and respectfully with internal staff, field crews, external partners, healthcare facilities, and third-party billing entities., • Demonstrate regular attendance, punctuality, and the ability to perform duties independently., • Attend at least 75% of quarterly staff meetings., • Represent CareFlite in a courteous, professional manner with a positive customer service demeanor., • Teamwork: Collaborates effectively with departments, field crews, and leadership to support accurate billing processes., • Communication: Communicates clearly, respectfully, and professionally with internal and external stakeholders., • Problem Solving: Applies critical thinking and resourcefulness to resolve documentation discrepancies., • Integrity: Maintains confidentiality and adheres to organizational policies and ethical standards. Hours of Work • Completion of all required CareFlite remote onboarding and training programs., • Participation in ongoing compliance, HIPAA, and billing training as required. Physical Demands • Prolonged sitting, frequent use of computers, occasional reaching or lifting up to 20 pounds (e.g., documents, equipment)., • Must be able to set up and maintain a safe and ergonomic home workstation (desk, chair, monitor height, keyboard/mouse setup)., • Ability to perform computer-based tasks for extended periods without injury or strain., • Ability to use a computer and office equipment, with adequate lighting and minimal distractions in the home workspace., • Ability to use assistive technology if needed (screen readers, voice recognition, adaptive keyboards, etc.)., • Must have access to a quiet and well-lit workspace suitable for focused work and video/phone meetings., • Must maintain a stable and secure internet connection to complete work tasks efficiently., • Ability to manage multiple tasks independently, handle confidential information, and maintain focus in a remote environment., • Must demonstrate professional communication and resilience when addressing billing or documentation concerns., • Self-motivation and time management skills to work independently., • Ability to maintain professional communication virtually and handle confidential information responsibly., • Adaptability to changing priorities, systems, or processes in a remote environment.Qualifications Required Qualifications • Must be 18 years of age or older., • High school diploma or equivalent., • Prior EMS field experience (EMT or paramedic) or previous experience in ambulance pre-billing, EMS ePCR review, or emergency medical documentation auditing., • Proficient in computer systems, electronic data processing, and modern office practices., • Working knowledge of Medicare, Medicaid, and other public health plan billing requirements., • Strong understanding of medical terminology and basic medical documentation standards., • Ability to communicate clearly and professionally, both verbally and in writing., • Ability to manage multiple tasks, meet deadlines, and work effectively under pressure with minimal supervision., • Ability to maintain professionalism and composure when interacting with difficult, distressed, or frustrated individuals., • Commitment to maintaining confidentiality and compliance with HIPAA regulations., • Experience with EMS or ambulance billing systems., • Familiarity with ImageTrend, Ambulance Commander, or similar billing management/ePCR systems., • Experience with third-party payors, hospitals, or claims follow-up processes., • Ability to work effectively with diverse populations and across language barriers., • Prior EMS, clinical, or prehospital exposure (field or administrative). Additional Information All your information will be kept confidential according to EEO guidelines. The statements contained in this position description reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered a detailed description of all the work requirements that may be inherent in the position.

Job DescriptionManager of Credentialing (Healthcare) Location: Remote (US) or Hybrid (City, State) Type: Full-time Reports to: Head of Operations / Director of Provider Operations (or similar) Comp: Competitive base + equity + benefits About the Company Our client is a venture-backed healthcare startup building a modern platform that makes it easier for patients to access high-quality care and for clinicians to practice at the top of their license. The team is scaling quickly, operating in multiple states, and credentialing is core to the ability to grow safely and compliantly. The Role Our client is hiring a Manager of Credentialing to own and scale the credentialing function. You’ll lead day-to-day credentialing operations, build repeatable systems, and partner cross-functionally with Operations, Clinical, Legal/Compliance, and Product to reduce time-to-credential while maintaining rigorous quality standards. This is a high-ownership role for someone who can execute in the details and improve the system. What You’ll Do * Own end-to-end credentialing for clinicians/providers across multiple states and payers (as applicable), including new credentialing, recredentialing, and ongoing maintenance. * Manage a small team and/or vendors (CVOs) and drive clear KPIs (time-to-credential, first-pass yield, aging, rework rate). * Create and maintain SOPs, checklists, and QA processes to ensure accuracy, completeness, and audit readiness. * Partner with Provider Operations to forecast pipeline needs and proactively manage throughput/capacity. * Serve as escalation point for complex cases (sanctions queries, gaps in work history, adverse actions, board issues, expiring coverage, etc.). * Build strong relationships with hospitals/health systems, payers, state boards, CAQH, and third-party credentialing partners. * Maintain credentialing files and documentation standards (primary source verification, attestations, NPDB queries where applicable, licensure, DEA, malpractice, education, references). * Collaborate with Compliance/Legal to ensure adherence to NCQA/URAC standards where required and internal policies. * Work with Product/Engineering to improve tooling: workflow automation, document collection, status transparency, integrations (CAQH, NPPES, PECOS, etc.), and reporting. * Lead continuous improvement initiatives that reduce cycle time and increase reliability as we scale. What We’re Looking For * 5+ years in provider credentialing and/or provider enrollment operations, including 1–3+ years in a lead/manager capacity. * Deep familiarity with credentialing best practices (primary source verification, file auditing, recredentialing cadence, documentation standards). * Experience working with CAQH and common verification sources (state boards, OIG/SAM exclusions, NPDB where applicable, malpractice carriers, education verification). * Track record building processes in a fast-moving environment (startup, high-growth healthcare org, or building a new function). * Strong operational rigor: you can manage multiple queues, deadlines, and stakeholders without dropping details. * Comfort with ambiguity and ownership—able to diagnose problems, propose fixes, and implement improvements. * Excellent written and verbal communication; able to work cross-functionally and manage escalations calmly. * Proficiency with tools like Google Workspace/Excel; experience with credentialing platforms (e.g., Modio, symplr, VeraSuite, Medallion, or similar) is a plus. Nice to Have * Experience credentialing across multiple specialties and state footprints. * Familiarity with NCQA/URAC standards and audits. * Experience with payer enrollment (commercial, Medicare/Medicaid) or delegated credentialing. * Prior experience managing a CVO relationship and negotiating SLAs. * Product-minded operator who’s helped implement or improve credentialing software/workflows. Why Join * Meaningful mission with direct impact on patient access and provider experience. * Opportunity to build and own a critical function at a high-growth, venture-backed company. * Competitive compensation, equity upside, and benefits. * High-trust environment with autonomy and room to grow.

Job Description Job Title Sr. Executive Vice President of SW Operations – Home Health, Hospice, Personal Care Services & Therapy Location: Flexible within the region (Texas, New Mexico, Indiana); regular travel across all service areas. Reports To: Chief Executive Officer Direct Reports: 4 Vice Presidents of Operations (one for Home Health, one for Hospice, one for Personal Care Services and one for Therapy) Position Summary The Sr. Executive Vice President, Southwest of Operations is a strategic, outcomes-driven executive responsible for the operational, clinical, financial, and regulatory performance of the company’s Home Health, Hospice, Personal Care Services and Therapy across Texas, New Mexico, and Indiana. This leader translates strategy into execution, ensures exceptional patient/family experience, drives referral growth, and sustains high-quality, compliant care while optimizing efficiency and profitability. The role stewards a $129M portfolio with a $55M expense base and leads four VP-level operators, fostering a cohesive, data-informed, high-performance culture. Scope & Scale • Annual Revenue: ~$129 million, • Expense Budget: ~$55 million, • Geography: Multi-state operations (TX, NM, IN) 1. Strategic Leadership & Growth • Own regional strategy and annual operating plans for all four service lines; align resources to meet revenue, margin, and patient care goals., • Develop market expansion plans (de novos, tuck-in acquisitions, service mix optimization) and integrated care pathways across Home Health, Hospice, Personal Care and Therapy., • Lead referral development (health systems, physicians, post-acute networks, payers, MCOs, ACOs) and strengthen value-based partnerships., • Build a unified brand experience across states and service lines. 2. Financial & P&L Management • Deliver the P&L: meet/exceed targets for revenue, EBITDA margin, cash flow, and cost containment., • Budget ownership for the $55M expense plan; drive disciplined labor productivity, visit utilization, supply, and overhead management., • Revenue cycle performance: improve DSO, AR aging, authorization turnaround, and payer mix; partner tightly with Finance & RCM., • Capital allocation: prioritize investments (technology, clinical programs, talent) using ROI and payback analyses. 3. Operational Excellence • Standardize operating model and SOPs for intake, scheduling, case management, visit planning, interdisciplinary team coordination, and transitions of care., • Throughput & capacity management: optimize staffing models, productivity benchmarks, and census growth; reduce avoidable cancellations and missed visits., • Continuous improvement using Lean/Six Sigma tools; drive cost-to-serve reduction and process reliability. 4. Clinical Quality & Compliance • Accountable for quality outcomes:, • Home Health: OASIS accuracy, Star Ratings, risk-adjusted readmission rates, timely initiation of care, HHVBP measures., • Hospice: CHAPS/family satisfaction, symptom management, live discharge rate, length of stay (LOS), and interdisciplinary plan-of-care adherence., • Personal Care Services: care plan compliance, caregiver reliability, service continuity, customer satisfaction., • Therapy: functional outcome improvement (e.g., mobility and ADL performance), patient engagement and visit adherence, timely evaluations and reassessments, documentation accuracy and compliance, and payer-driven utilization management., • Regulatory stewardship: ensure federal and state compliance (e.g., CMS Conditions of Participation), survey readiness, corrective action plans, and policy adherence across TX, NM, IN., • Clinical governance: partner with Chief Clinical Officer/Medical Directors on evidence-based protocols, high-risk case review, and clinical education. 5. Workforce & Culture • Lead and develop four VPs of Operations; set clear KPIs, cadence, and accountability., • Succession planning and leadership bench building across branch administrators, DONs/clinical leaders, and market directors., • Talent strategy: recruiting, retention, incentive design, competency development, and engagement—especially for field clinicians and caregivers., • Culture of safety and Just Culture principles; reinforce mission-driven, patient-centered values. 6. Customer & Stakeholder Management • Voice of patient & family: champion service excellence and rapid issue resolution., • External relationships: health systems, referral sources, payers, state agencies; represent the organization in market forums., • Community presence: foster partnerships with senior services, community groups, and hospice volunteer networks. 7. Data, Technology & Innovation • Run the business by the numbers: build dashboards for census, productivity, quality, financials, and regulatory metrics; adopt a weekly/monthly ops cadence., • Digital enablement: leverage EMR/EHR capabilities, mobile documentation, scheduling optimization, telehealth/remote monitoring as appropriate., • Analytics-driven decision making: segment performance by market/service line; conduct root-cause analyses and implement corrective actions. 8. Risk Management & Safety • Clinical risk mitigation: sentinel event review, infection control, medication safety, and after-hours escalation protocols., • Operational risk: disaster readiness, supply chain stability, cybersecurity awareness, and business continuity across three states. 9. Cross-State Regulatory Nuance • Navigate state-specific requirements in Texas, New Mexico, and Indiana (licensure, staffing, supervision rules, emergency preparedness, scope of practice, Medicaid/MCO contracts), ensuring policies and training reflect state-level variations. Success Metrics (KPIs) Financial & Growth • Home Health Star Rating ≥ 4.0; HHVBP composite improvements; OASIS audit accuracy; 30-day readmission rate reduction., • Hospice CHAPS ≥ 85th percentile; stable/appropriate LOS; live discharge within benchmarks; condition-of-participation survey outcomes (no condition-level deficiencies)., • Productivity (visits per clinician FTE), on-time start-of-care, scheduling efficiency, missed visit rate, visit utilization vs. care plan, branch survey readiness scores. People & Culture • Voluntary turnover; time-to-fill; leadership bench strength; engagement scores; safety incident rate. Competencies • Strategic Agility & Execution – turns strategy into measurable outcomes., • Financial Acumen – manages budgets, margins, and RCM drivers., • Clinical & Regulatory Literacy – ensures safe, compliant, high-quality care., • Operational Excellence – process discipline and continuous improvement., • Leadership & Talent Development – builds strong teams and culture., • Relationship Management – trust-based partnerships with referrers and payers., • Data-Driven Decision Making – uses analytics to guide action., • Change Leadership – leads integration, standardization, and transformation. Working Conditions & Travel • Frequent travel (40–60%) across TX, NM, IN to branches, referral sources, payers, and regulatory engagements. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment based on race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other protected status in accordance with applicable federal, state, and local laws. New Day Healthcare’s Purpose Statement • Commitment to what is right for patients and caregivers., • Upholding an open spirit and treating everyone with honor and kindness., • Understanding that investment returns are essential and reasonable., • Building a long-term business with mission and purpose., • Partnering with those that are not short-sighted parties (clinical, financial, strategic or acquaintances)., • Adhering to the management methods of Jesus Christ (moral, ethical, righteousness)., • Leadership that bases decisions on prayer, commitment and thoughtful conversation always exhibiting patience, honor and kindness., • Demonstrating a commitment to a culture in which care comes first and as leaders we find a way to accommodate financial obligations under the guidance of stewardship., • Commitment to care, quality, compliance and reason at-all-times. Requirements • 10–15+ years of progressive leadership in post-acute or home-based care (Home Health and Hospice required; Personal Care/Private Duty and Therapy strongly preferred)., • Proven multi-site, multi-state P&L ownership at $100M+ scale., • Deep knowledge of CMS Conditions of Participation, HHVBP, OASIS, CHAPS, survey processes, and payer contracting (Medicare, Medicaid, MCOs, commercial)., • Demonstrated success in referral growth, clinical quality improvement, productivity optimization, and margin expansion., • Strong command of RCM (authorizations, billing, collections, denial prevention) and operational analytics., • Master’s in Healthcare Administration, Business (MBA), or related discipline., • Clinical licensure (e.g., RN) beneficial., • Lean/Six Sigma certification., • Experience with EMR/EHR platforms used in home health/hospice; telehealth/remote monitoring programs., • Home Health and Hospice – Wellsky, • Personal Care Services – Vesta and Netsmart, • Therapy Services - Wellsky

Job Description Hi, we're Oscar. We're hiring an Associate, Delegate Oversight to join our Delegation Oversight team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: The Associate, Delegate Oversight supports the enterprise's compliance program and activities. You will assist in the development of all compliance program activities to ensure understanding of healthcare regulatory requirements. You will assess business unit compliance to laws, regulations, standards, and their procedures by conducting audit and monitoring activities. You will report into the Sr. Manager, Compliance Audit and Monitoring. Work Location: This is a remote position, open to candidates who reside in: Dallas, TX. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote Pay Transparency: The base pay for this role is: $87,188 - $114,434 per year. You are also eligible for employee benefits, monthly vacation accrual at a rate of 15 days per year and annual performance bonuses. Responsibilities: • Help create a risk-based audit and monitoring plan for the healthcare organization., • Review healthcare regulations, including HIPAA, Medicare, Medicaid and NCQA regulations to ensure compliance., • Conduct assigned audits based on departmental audit plans., • Partner with teams to understand their business operations and test their compliance with regulations., • Evaluate compliance effectiveness and identify areas for improvement., • Draft and complete accurate audit reports, ensuring that the audit findings and conclusions are communicated to the business unit., • Help identify compliance gaps and risks, and contribute to the development of proactive strategies to address them., • Help maintain compliance policies, procedures, and controls with regulatory requirements., • Provide regular updates to leadership on compliance audit and monitoring activities and recommendations., • Compliance with all applicable laws and regulations, • Bachelor's Degree or equivalent work experience, • 3+ years experience working in health care or related field, • 3+ years experience in health plan compliance, • 3+ years driving compliance with regulatory and accreditation audit/policy requirements, • 3+ years experience working with regulation and translating into operational procedures, • Certification in Healthcare Compliance (CHC), Certified Compliance and Ethics Professional CCEP, or similar, • Fluency with State DOI audit and/or reporting obligations, • State DOI audit management experience, • Experience in a start-up and/or health tech environment At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Job Description: The Associate Medical Director at Parkland Community Health Plan will take a hands-on approach in overseeing and supporting clinical activities, ensuring the delivery of comprehensive care to PCHP members. This need will be FULLY remote while the provider is working locums, but they will need to transition to a hybrid model once they go perm. This is a 13-week locum assignment with the hope that the provider will transition into a permanent role. Responsibilities: Reviews prior authorization and appeals request for approval or denial of claims payment based on medical necessity. Performs peer to peer calls as necessary to support the utilization management process. Provides clinical oversight for utilization management, disease management and quality management activities as assigned by the PCHP Chief Medical Officer or Sr. Medical Director including participation in development of medical policies and procedures for coverage and authorization and clinical standards and guidelines based on evidence-based medicine. Analyzes data to establish health care provider profiles and define acceptability of physician performance, conducts review of provider applications and qualifications, and participates in the review process of providers who fail to meet required standards, site and medical record reviews, as appropriate, to ensure adherence to managed care and PCHP policies. Assists the Sr. Medical Director and the Pharmacy Director of PCHP in overseeing and administering the pharmacy benefit for PCHP members including coordination of care between the Medical and Pharmacy benefits. Assists the Sr. Medical Director in oversight, evaluation, and administration of the clinical aspects of PCHP fraud, waste and abuse programs. Participates in development, implementation, and monitoring of annual goals and objectives for PCHP that support the mission and objectives of Parkland. Assists in identifying member and provider needs for education and health promotion. Participates in assessment of existing education programs offered to providers, developing and evaluating such programs, as required, to ensure that managed care service area and PCHP needs are appropriately served. As assigned by the Chief Medical Officer or Senior Medical Director assists in representing PCHP on clinical activities with relevant State and local bodies such as the Texas Department of Insurance, Texas Health and Human Services Commission, and Texas Medical Association. Participates in identification and analysis of process improvement of jobs design, work processes, and work flows for the clinical area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of the managed care delivery system and PCHP. As assigned by the Chief Medical Officer or Sr. Medical Director, serves as chairperson or member of managed care committees, and participates on various community and interdisciplinary committees. Not open to 1099 candidates Not open to visa candidates Not open to candidates who have lapsed Board Certification(s) and need to obtain them again Clean malpractice and license are required. Job Accountabilities • They will be responsible for providing clinical oversight and reviewing services that need prior authorization for procedures, medications and hospital stays., • Identifies and analyzes the design of jobs, work processes, work flows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of the department and Parkland., • Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices., • Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding., • Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department., • Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of Parkland., • Must be philosophically oriented to the managed care concept of health delivery., • Must have a working knowledge of managed care principles., • Must demonstrate strong leadership, organizational, interpersonal, and verbal skills including demonstrated ability to work efficiently and communicate with executive management, physicians groups, community and provider organizations, and persons of diverse socioeconomic backgrounds., • Must be able to demonstrate a working knowledge of Texas Medicaid Regulations and their interpretation., • Must demonstrate effective supervisory, administrative and management skills including computer literacy., • Must be able to demonstrate patient centered/patient valued behaviors., • Must understand and demonstrate knowledge of principles of care coordination and collaboration, population health and social determinants of health, clinical evaluation of evidence based care and value based purchasing., • Must be familiar with the role of pharmacy and behavioral health in managing health care., • Ability to create, review and interpret treatment plans., • Ability to adapt to changing priorities., • Demonstrated ability to deal with confidential information., • Demonstrated negotiation skills., • Ability to remain calm under pressure., • Ability to apply medical knowledge and principles to business challenges, achieving significant member, business, and quality outcomes. ALL OF THE FOLLOWING SHOULD BE NOTED IN ADDITIONAL SUBMISSION DETAILS. REQUIRED PRIOR TO CLIENT PRESENTATION UNLESS OTHERWISE NOTED • Board Certification in OB/GYN (or relevant medical specialty) - REQUIRED no exceptions, • Texas medical license (or willingness to obtain) - REQUIRED, • Clean malpractice/license history - HIGHLY PREFERRED, • Experience in managed care and prior authorization - REQUIRED, • Participation in a managed care UM committee - PREFERRED, • Ability to adapt to the managed care delivery model and oversee a multi-disciplinary team - REQUIRED Weekend Requirements : None On Call Requirements : None

Job Description ???? Immediately Hiring – Director of Health Economics, Outcomes & Reimbursement (HEOR) ???? Remote | ???? Full-Time | ✈️ 20–30% Travel Ready to take the next step in your Market Access or HEOR career? At CDL Nuclear Technologies, we’ve been delivering innovative cardiac imaging solutions for over 30 years. Since 1992, we’ve supported more than 850 healthcare facilities nationwide and have led the way in Cardiac PET imaging for over 15 years. We offer a stable, growth-oriented environment where your expertise directly impacts patient access and clinical decision-making. ???? What You’ll Do As Director of HEOR, you’ll lead payer value communication strategies that support access and reimbursement for CDL’s cardiac imaging services across Commercial, Medicare, and Medicaid markets. You’ll drive impact by: * Translating clinical, real-world, and economic data into compelling payer value narratives * Developing payer value decks, cost-impact tools, and summary materials * Leading cost-effectiveness and budget impact analyses * Partnering with Marketing, Finance, Reimbursement, and Commercial teams * Creating objection handlers, FAQs, and field enablement tools * Monitoring payer trends (MACs, commercial insurers, CMS) * Supporting value-based contracting and payer segmentation strategies * Ensuring all materials meet legal, regulatory, and compliance standards ???? Qualifications Required: * 12+ years in pharma, biotech, or medical technology * 5+ years in HEOR, Market Access, or payer value communications * Strong understanding of U.S. payer dynamics and Medicare Part B * Ability to translate complex data into payer-facing tools * Strong communication and leadership skills Preferred: * Advanced degree (PharmD, MPH, MHA, PhD, or MBA) * Cardiovascular therapeutic experience * Experience in Market Access Strategy or Payer Account Management * Experience building health economic models * Established payer relationships ???? Critical Skills * Strategic thinking * Decision making & problem solving * Cross-functional leadership * Organization & planning * Communication excellence * Adaptability & creativity ???? Working Conditions * Primarily desk-based with periodic travel * Indoor work environment * Ability to lift/move up to 10–50 lbs * Ability to manage peak workload stress ???? What CDL Nuclear Offers * Competitive compensation * Medical, Vision & Dental Insurance * Short-Term Disability * Company-paid Long-Term Disability * Company-paid Life & AD&D Insurance * 401(k) with company match * Paid Holidays & PTO * Training & professional development * Career advancement opportunities * Employee referral program CDL Nuclear Technologies is an Equal Opportunity Employer. All employment decisions are based on individual merit and business needs.

Job DescriptionDescription: Soleo Health is seeking a Full time, Remote, Clearance Specialist to support our Specialty Infusion patients. Join us in Simplifying Complex Care! Soleo Health Perks: • Competitive Wages, • 401(k) with a Match, • Referral Bonus, • Paid Time Off, • Great Company Culture, • Annual Merit Based Increases, • No Weekends or Holidays, • Paid Parental Leave Options, • Affordable Medical, Dental, & Vision Insurance Plans, • Company Paid Disability & Basic Life Insurance, • HSA & FSA (including dependent care) Options The Clearance Specialist is responsible for processing new referrals including but not limited to verifying patient eligibility, test claim adjudication, coordination of benefits, and identifying patient estimated out of pocket costs. They will also be responsible for preparation, submission, and follow up of payer authorization requests. Responsibilities include: • Perform benefit verification of all patient insurance plans including documenting coverage of medications, administration supplies, and related infusion services, • Responsible to document all information related to coinsurance, copay, deductibles, authorization requirements, etc, • Calculate estimated patient financial responsibility based off benefit verification and payer contracts and/or company self-pay pricing, • Initiate, follow-up, and secure prior authorization, pre-determination, or medical review including reviewing and obtaining clinical documents for submission purposes, • Communicate with patients, referral sources, other departments, and any other external and internal customers regarding status of referral, coverage and/or other updates as needed, • Refer or assist with enrollment any patients who express financial necessity to manufacturer copay assistance programs and/or foundations, • Generate new patient start of care paperwork Schedule: • Must be able to work remote, Monday-Friday 9am-5:30pm, CST- 40 hours per week, • Must have experience with Specialty Infusion for Prior authorization/Benefits VerificationRequirements:, • High school diploma or equivalent, • At least 2 years of home infusion specialty pharmacy and/or medical intake/reimbursement experience preferred, • Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines including ability to interpret payor contract fee schedules based on NDC and HCPCS units, • Strong ability to multi-task and support numerous referrals/priorities while ensuring productivity expectations and quality are met, • Ability to work in a fast-paced environment, • Knowledge of HIPAA regulations, • Basic level skill in Microsoft Excel & Word Soleo’s Core Values: • Improve patients’ lives every day, • Be passionate in everything you do, • Encourage unlimited ideas and creative thinking, • Make decisions as if you own the company, • Do the right thing Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor. Keywords: Prior Auth, Insurance, Referrals, Now hiring, hiring now, immediately hiring, hiring immediately

Job Description This role is a direct hires only, we appreciate independent recruiters and per our policy we kindly request NO SOLICIATIONS or STAFFING AGENCIES including Billing RCM companies contacting us during the hiring process. About the Role: We are seeking a highly motivated and detail-oriented Medical Billing Accounts Receivable professional to join our Internal Medicine team, our clinic is located 20 minutes South of Downtown Dallas. As a key member of our team, you will be responsible for managing the billing and collections process, ensuring timely and accurate payment from insurance companies and patients. Your attention to detail with ability to multitask and work collaboratively with other team members will be critical to your success in this role. You will have the opportunity to work with a diverse patient population and make a meaningful impact on their healthcare experience. This is an in-person, Full-time (40 hours per week) position Monday to Friday from 8am to 5pm, and 1 Saturday per month 9am to 5pm. IN PERSON POSITION ONLY. NO REMOTE or Hybrid CANDIDATES WILL BE ACCEPTED Benefits: 401K/ Profit Sharing/ Medical, Vision, Dental Insurance, Life Insurance, Short and Long Term Plans Minimum Qualifications: • High school diploma or equivalent, • 2+ years of experience in medical billing and Medical Accounts Receivable collections (required), • Knowledge of medical billing codes and terminology, • Knowledge and experience of insurance benefits, • Experience interpreting and working ERA & EOB's, • Prior-Authorization in diagnostic testing, • Strong Collections skills, • Billing experience in an Internal Medicine and /or Family Medicine setting, • Proficiency in Microsoft Office, specifically Excel and EMR PM software, • Experience with identifying reasons for denials and appealing denials, • Experience with electronic medical records (EMR) systems eClinicalWorks is a plus, • Appointment Scheduling, • Insurance Verification, • Medical Account Receivable Collections, • Patient Accounts Collections, • Prior Authorizations for Diagnostic Medical services, • Denial Management, • Understand payer contracts, fee schedules to ensure the claims have been processed accordingly, • Experience working with healthcare insurance codes and documentation, • Manage the billing and review aged accounts, identify, and appeal unpaid/denied claims, • Verify insurance coverage and obtain necessary Prior-authorizations for services, • Communicate with insurance companies and patients to resolve billing issues, • Maintain accurate and up-to-date patient records and billing information, • Provide administrative support to the Front Office, answering phones, updating patient demographics and scheduling appointments, • Post Payments accurately, and charge entry, • Responsible for answering all patient billing questions arising from services rendered, • Generate A/R reports, weekly, and monthly billing summary reports for weekly meetings, • Timely follow-up and resolution of all outstanding A/R including unpaid claims for all payers, • Manage patient accounts and monitor account details for non-payment, and other irregularities, • Collaborate with other team members to ensure balances are accurate and generate patient statements, • Investigate and document actions taken to resolve billing discrepancies, as well as unusual charges and credits In this role, you will utilize your strong attention to detail, analytical skills, and ability to work collaboratively with others to ensure accurate and timely payment for medical services. You will also use your knowledge of medical billing codes and terminology, as well as your proficiency in PM software and Microsoft Office, to manage the billing and collections process. Additionally, your experience with electronic medical records (EMR) systems and certification in medical billing and coding (e.g. CPC, CCS-P) will be beneficial in this role.

Job Description Korzen Health is partnering with one of the nations most prestigious Telepsychiatry organizations to expand access to high-quality behavioral health services for adult and geriatric patients within a managed care model. We are currently seeking licensed Psychiatrists to join our growing team in a full-time, fully remote capacity. Position Overview The Psychiatrist will play a key role in patient start-of-care, including initial psychiatric evaluations and ongoing clinical oversight. Providers will collaborate closely with an experienced interdisciplinary team while delivering care through a telehealth platform. Key Responsibilities • Conduct initial psychiatric evaluations and participate in ongoing patient care., • Provide approximately 30 hours of direct patient care and 10 hours of administrative collaboration weekly with the PMHNP team., • Collaborate with a multidisciplinary treatment team consisting of Physicians, PMHNPs, LCSWs, and Medical Assistants., • Utilize telehealth/video platforms to deliver patient care., • Oversee patient care plans while PMHNPs assist with follow-ups and medication management.Patient Volume, • Approximately 6–7 new patient intakes per week, • 16–18 follow-up visits per week (primarily supported by experienced Nurse Practitioners)Work Schedule, • Monday – Friday, • 8:00 AM – 5:00 PM EST, • No nights, weekends, or call responsibilitiesCompensation & Benefits, • Competitive W-2 compensation package, • Comprehensive medical benefits, • 401(k) with company match, • CME allowance, • Licensure reimbursement, • Sign-on bonus eligibility, • Paid Time Off:, • 4 Weeks PTO, • 5 Sick Days, • 9 Paid Holidays, • 2 Floating HolidaysAdditional Details, • Fully remote position with company-provided training and technology, • Patient population includes private payers only (no Medicaid)

We're currently looking for individuals across the country to take part in remote paid research, including remote focus groups, product trials, and consumer studies. Most research studies are conducted remotely at home, though some may be in-person. Comfort participating in remote, part-time studies

Remote position with visibility across procurement, operations, and executive leadership.

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We're currently looking for individuals across the country to take part in remote paid research, including remote focus groups, product trials, and consumer studies. Comfort participating in remote, part-time studies. Most research studies are conducted remotely at home, though some may be in-person

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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

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Administrative Assistant / Remote] - Anywhere in U.

Administrative Assistant / Remote] - Anywhere in U.

LHH Talent - - Responsibilities: Resolving discrepancies in information and obtaining further information for incomplete documents; Creating data backups as part of a contingency plan; Responding to information requests from clients and customers; Testing new database systems and software updates;