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Member Liaison Specialist (Customer Service) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Member Liaison Specialist (Customer Service) and help shape the future of healthcare where you'll be an integral part of our CS - Member Liaison team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. You will provide member service to seniors, persons with disabilities or chronic conditions, persons without housing and persons under the age of twenty-one (21) who participate in the Whole-Child Model program. You will also serve as a liaison between members, health networks, providers and community-based organizations to facilitate access to services and help resolve health care and psychosocial issues. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>85% - Member Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Assesses members' concerns to identify psychosocial or health care issues and facilitate an appropriate resolution.</li>
<li>Intakes information from members, both over the phone and/or in person, to complete requests for assistance cases, grievances and appeals, per departmental guidelines.</li>
<li>Coordinates members' health care and social service needs within and outside the health network and CalOptima Health during the original interaction.</li>
<li>Addresses member and provider inquiries, questions and concerns in all areas, including enrollment, claims, benefit interpretation, coordination of care and referrals/authorizations for medical care related to services covered under the Whole-Child Model program.</li>
<li>Guides members in understanding and accessing the benefits under the Whole-Child Model program.</li>
<li>Maintains documentation of member cases within the FACETS system.</li>
<li>Initiates referrals to internal and external care management departments and government agencies.</li>
<li>Communicates with community-based organizations, health networks, providers and vendors on behalf of members to resolve disputes, helps coordinate access to care and investigates issues preventing members from receiving medical benefits and services. </li>
</ul>
</li>
<li>10% - Administrative Support
<ul>
<li>Collaborates with interdepartmental staff in call resolution as needed.</li>
<li>Identifies calls needing case management or escalation to a supervisor, manager or director and routes them according to established guidelines.</li>
<li>Meets all regulatory key performance indicators, first call resolution requirements and business objectives of CalOptima Health. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High school diploma or equivalent PLUS 2 years of experience as a call center agent or customer/member services representative in health care required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>2 years of experience working with the needs of persons with disabilities and chronic medical conditions in a customer/member service capacity. </li>
<li>Health maintenance organization (HMO), Medi-Cal/Medicaid and health services experience. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Office (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6757493&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 9, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6757493" target="_blank">https://jobs.caloptima.org/jobs/member-liaison-specialist-customer-service-505-city-parkway-west-california-united-states-33e8b0be-b4dd-42d0-9530-e2df2d63a939</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-537ce69475a85e4fb5e079ee955c18f2

Member Liaison Specialist (Customer Service)

PHI’s Senior Workforce Intervention Specialist works to improve job quality for direct care workers by contributing to the development, implementation, and evaluation of PHI’s practice-based employment and training models. As a part of PHI’s Workforce Innovations Team (WIT), they will specialize in leading engagements related to operationalizing and evaluating meaningful advancement opportunities that expand the direct care career ladder; additionally, they may support programs aimed at strengthening recruitment and retention practices, creating a coaching culture, developing adult-learner centered training, and assessing direct care job quality. Outstanding skills in critical thinking, proactive leadership, written and verbal communication, relationship building, and workforce and organizational development are essential for success in this role. &nbsp;
POSITION RESPONSIBILITIES
<ul>
<li>Lead the implementation of PHI practice-based job quality interventions, including creating and maintaining work plans and timelines, managing partner relationships, executing project activities, and reporting progress to PHI’s Vice President of Workforce Innovations through verbal and written communication.</li>
<li>Build and manage relationships with numerous strategic workforce partners – including long-term care employers, payors, advocates, and others - to support collaboration and the successful integration of job quality practices.</li>
<li>Provide technical assistance and consulting to project-based partners to support program design, implementation, and evaluation; this will include intensive, hands-on support to project partners to assess and modify organizational practices in support of implementing and maintaining workplace environments conducive to high-quality direct care jobs.</li>
<li>Routinely meet programmatic deadlines and proactively communicate impediments to the Vice President of Workforce Innovations.</li>
<li>Produce high-quality project deliverables in line with PHI and WIT acceptance criteria including PowerPoint slide deck presentations, external and internal reports, project worksheets, assessment tools, workflows, and other items as needed to meet project goals.</li>
<li>Plan, facilitate, and document meetings, informational sessions, webinars and other interactions with external partners; this could include coordinating planning with WIT and other PHI staff members, sending meeting invitations and conferencing information to attendees, creating and disseminating agendas, facilitation, documenting and archiving associated notes, and establishing next steps.</li>
<li>Collaborate with WIT staff to coordinate team roles, optimize efficiency, and meet project goals.</li>
<li>Work with WIT staff to support the development of PHI’s online and in-person workforce training curricula; act as a subject matter expert to inform the creation of contextualized content that reflects the lived experiences of workers within a PHI intervention.</li>
<li>Work with WIT to apply principles of diversity, equity, and inclusion to PHI’s job quality models; contribute to the development of new workforce training and practice strategies aimed at improving job quality for a diverse direct care workforce.</li>
<li>Collaborate with PHI’s Vice President of Research and Evaluation and Vice President of Workforce Innovations to develop and implement evaluation efforts that build the evidence base for sustained investment in direct care job quality interventions.</li>
<li>Collaborate with PHI’s Director of Philanthropy to provide project data and information as needed to support funder reporting and communication efforts.</li>
<li>Serve as a resource to PHI’s Policy Team on workforce and organizational development practices as needed.</li>
<li>Promote PHI’s school of thought and the dissemination of effective practice models through speaking at conferences, contributing to PHI’s blog, and cultivating external relationships to bring in new business. QUALIFICATIONS</li>
<li>Minimum five years’ experience in workforce and organizational development, preferably within the long-term care, aging, and/or disability sectors.</li>
<li>Proven experience successfully designing, leading, and evaluating complex interventions from inception to completion in alignment with organizational strategic impact aims.</li>
<li>Advanced ability to show proactive, independent leadership while maintaining communication and connection to team members.</li>
<li>Experience working within an Agile framework preferred, though not required.</li>
<li>Experience with adult-learner centered curriculum development and facilitation preferred though not required.</li>
<li>Experience with facilitating interactive adult-learner centered training in-person and online preferred but not required.</li>
<li>Experience working effectively with and facilitating collaboration among diverse individuals and groups.</li>
<li>Ability to manage several complex projects simultaneously, often under tight deadlines.</li>
<li>Excellent writing skills, including the ability to write in a variety of formats for a range of audiences.</li>
<li>Outstanding public speaking skills across a range of audiences.</li>
<li>Strong computer skills, including Microsoft Office Suite.</li>
<li>Commitment to – and experience with – racial, gender, and economic justice.</li>
<li>Moderate travel required.</li>
<li>Bachelor’s degree required, Master’s degree or equivalent experience preferred.</li>
</ul>
REPORTING RELATIONSHIP
The Senior Workforce Intervention Specialist reports to PHI’s Vice President of Workforce Innovations.
LOCATION
PHI’s national headquarters are at 261 Madison Avenue, Suite 913, New York, NY, 10016. This position is remote with a preference for candidates in the NYC area.
ABOUT PHI
PHI is a national organization committed to strengthening the direct care workforce by producing reliable research and analysis, leading federal and state advocacy initiatives, and designing groundbreaking workforce interventions and models. For 30 years, we have brought a 360-degree perspective on the long-term care sector to our evidence-informed strategies throughout the country.
SALARY AND BENEFITS
This is a full-time, salaried position with a base salary range of $90,000 - $105,000 per year, commensurate with skills and experience.
PHI provides a comprehensive benefits package effective on the date of hire. Health benefits include: a sponsored medical plan, an employer-paid dental plan, and an optional vision insurance plan. In addition, PHI offers basic life insurance, an EAP, a 401(k), flexible spending plans for medical, dependent care, and commuter expenses; 27 days of earned leave, paid holidays, a holiday break at the end of December, family leave, parental leave, professional development, and cell phone reimbursement.
TO APPLY
To apply, email a cover letter with your resumé to <a href="mailto:info@PHInational.org" target="_blank">info@PHInational.org</a>. Please indicate “Senior Workforce Intervention Specialist” in the subject line.
Application deadline: August 6, 2023

Senior Workforce Intervention Specialist

<h3>Job Description</h3>
Job Description
GiaCare Inc., in anticipation of a future government contract award, is currently accepting applications for experienced, civilian Medical Administration Specialists to work alongside the federal government in support of the Air Force Academy (near Colorado Springs, Colorado).
 
Requirements
Degree/Education: A bachelor’s degree in health care administration, business, information management, or a related medical discipline is required
Certifications: Basic Life Support (BLS) certification.
Board Certification:N/A
Licensure: Current, full, active, and unrestricted license to practice medicine.
Experience:
<ul>
<li>Working knowledge of computers including the following software: Microsoft Word, Excel and PowerPoint, EHR Genesis and military database. management and must have the ability to type 30-40 words per minute.</li>
<li>Shall be able to read, understand, speak, and write English well enough to communicate effectively.</li>
<li>Shall perform duties in Refractive Surgery Center.</li>
<li>Requisitions forms required for daily operation of the Refractive Surgery Center. As required, type routine correspondence, progress reports medical statements, and memorandums.</li>
<li>Shall have experience with submitting budget proposals and managing an operating budget. Experience in ophthalmology clinic and/or supply management is required.</li>
</ul>
Duties
• Monitors health care delivery plans; market forces, patient and beneficiary demand and other issues impacting facility capabilities/capacity, access to care compliance and/or quality of care.
• Prepares presentations, project papers, staff and biometric reports and other medical administrative correspondence; delivers to senior management.
• Conducts studies in support of various projects, program, processes or initiatives covering military health care activities.
• Implements policy and initiatives to improve effectiveness, efficiency, productivity and customer satisfaction and quality improvement efforts.
 
As a GiaCare Inc. employee, you may enjoy the following benefits:
<ul>
<ul>
<li>Medical Insurance (GiaCare pays for employee's medical benefits)</li>
<li>Vision Insurance</li>
<li>Dental Insurance</li>
<li>Short-Term Disability Insurance</li>
<li>Life and AD&amp;D Insurance</li>
<li>Paid Time Off (PTO)</li>
<li>401k (Non-matching)</li>
<li>Employee Referral Program</li>
</ul>
</ul>
 
-Apply below or send resume to <a href="mailto:RECRUITMENT@GIACARE.COM" target="_blank">RECRUITMENT@GIACARE.COM</a>, or call (954) 651-9022 to speak with a recruiter immediately. 
 
*MUST BE US CITIZEN

Medical Administration Specialist

<h3>Job Description</h3>
Job Description
Title: Medical Mgmt Intake Specialist - Medical Administration
Location: Remote
Contract: 12+ Months Contract
Will this position be required to work onsite for any reason at any time? Role can be performed offsite, but contractor may be required to come on site to pick up equipment Medical Management Intake Specialist Work Hours: • Schedule: Full-time, 40 hours per week • Hours: Monday through Friday, 8:00 AM to 5:00 PM • Flexibility: Schedules will include some Saturdays, Sundays, and Holidays; overtime may be necessary Required Skills and Experience: • Minimum of 2 years of experience in a healthcare, insurance, or related field • High school graduate and college or university experience • Medical terminology knowledge or a medical background is required • Strong understanding of health insurance processes, including claims management, benefits coordination, and prior authorization procedures • Customer service experience is required • Strong phone skills with experience handling inbound and outbound calls • Experience with healthcare management software and databases • Excellent verbal and written communication skills • Ability to explain complex information in a clear and concise manner • Strong problem-solving skills with the ability to analyze data and identify trends • Attention to detail and accuracy in all work • Ability to work collaboratively with cross-functional teams • Demonstrated ability to build and maintain positive relationships with colleagues, clients, and stakeholders Highly preferred: • Two years of college or associate level degree equivalent • Experience with providing high quality, provider focused servicing to facilities and doctors • Work collaboratively as a team member with peers and nurses • Concisely and accurately enter documentation into Care Advance • Effectively engage over the phone via both inbound and outbound with providers • Process provider requests as needed • Acts as providers first trusted source for UM Prior Auth programs • Assign faxes to designated staff • Process requests for compliance inquiries • Access various UM department mailboxes and voicemail as needed • Ability to function independently • Critical Thinking
About Kyyba:Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances. At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.Kyyba is recruiting for the below mentioned position with our direct client which is one of the major Healthcare Payers in the US.
Disclaimer:
Kyyba is an Equal Opportunity Employer.
Kyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. Minorities / Females / Protected Veterans / Individuals with Disabilities are encouraged to apply. All employment is decided on the basis of qualifications, merit, and business need.”
It is the policy of Kyyba to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact Kyyba at 248-813-9665
Rewards:
Medical, dental, vision
401k
Term life
Voluntary life and disability insurance
Optional Pre-paid legal plan
Optional Identity theft plan
Optional Medical and dependent FSA
Work-visa sponsorship
Opportunity for advancement
Long-term assignment with opportunity for hire by client
SELECT AWARDS
<ul>
<li>An INC 5000 company for 10 years</li>
<li>Corp! Michigan Economic Bright Spots</li>
<li>Crain’s Detroit Business Top Staffing Service Companies in Detroit</li>
<li>TechServe Alliance Excellence Award- IT and Engineering Staffing &amp; Solutions</li>
<li>Best of MichBusiness winner in HR Wizards &amp; Partnerships</li>
<li>Metro Detroit Elite Category: Recruitment, Selection &amp; Orientation for 101 Best &amp; Brightest</li>
<li>101 Best &amp; Brightest Companies to Work for in Michigan</li>
</ul>
Company DescriptionFounded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances. At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development. Kyyba is an Equal Opportunity Employer. Kyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other b 
<h3>Company Description</h3>
Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.\r\n\r\nAt Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.\r\n\r\nKyyba is an Equal Opportunity Employer.\r\n\r\nKyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other b

Medical Mgmt Intake Specialist - Medical Administration

<h3>Job Description</h3>
Job Description
PLEASE NOTE - This position may require temporarily relocation to other TONHC Facilities: Sells Hospital, Santa Rosa Health Center, San Simon Health Center, and San Xavier Health Center.
Position Summary:
This position is located within the Tohono O'odham Nation Health Care (TONHC) Hospital and Clinics. The work involves developing new or improved solutions to complex technical problems; establishing criteria; formulating projects; assessing program effectiveness; investigating and analyzing unusual conditions, concerns, or questions for Health Information Management Services (HIMS).
Scope of Work: This is the senior Health Information Management Services position for TONHC Hospital and Clinics. Under the Director's general direction, the incumbent functions as the Health Information Management Services (HIMS) and has full program responsibility to set and carry out the strategic direction, mission, and vision for TONHC Hospital and Clinics Health Information Management Services.
Essential Duties and Responsibilities: (Depending on the area of assignment, an incumbent may not be required to perform some of the duties listed below): 
<ul>
<li>Interpret national health record policies and standards for application at the Hospital and Health Centers level. At local and national meetings, the incumbent represents Tohono O'odham Nation Health Care (TONHC) Hospital and Clinics.</li>
<li>Formulates health record policies specific to the Tohono O'odham Nation Health Care (TONHC) Hospital and Clinics and directs their application; writes policy and procedures for medical records and coding for electronic health records and paper records as applicable.</li>
<li>Evaluate Health Center level of compliance with the Joint Commission (TJC) applicable continuous quality improvement standards and monitors operation of Health Center record centers under HIPAA (Health Insurance Portability and Accountability Act), Privacy Act, and Freedom of Information Act.</li>
<li>Directs the overall operations of the HIMS program and provides leadership and guidance to the other TONHC Hospital and Clinics facilities; and ensures TONHC Hospital and Clinics has an integrated, consistent, and comprehensive patient health records system.</li>
<li>The incumbent develops, analyzes, and implements procedures for assuring proper inter-departmental and intra-departmental workflow. </li>
<li>Continually evaluates and reviews procedure adequacy; and, if necessary, modifies to meet latest technical requirements and techniques; evaluates statistical data identifying program adequacy to management.</li>
<li>Ensures departmental goals and objectives are consistent with the TONHC strategic plan and provides advice and assistance in health information requirements and medicolegal aspects to the Sells Hospital and Health Centers.</li>
<li>Serve as an advisor to management on all phases of health information management. Serve as the CO-Chair (with Medical Staff) of the TONHC Hospital and Clinics Health Information Management Committee (HIMC), composed of medical and professional services members. </li>
<li>Advise on the adequacy of health records and medicolegal aspects of health record operations at Health Centers. Responsible for medical statistical reports to assist hospital management and accrediting agencies in evaluating the quality of clinical care.</li>
<li>Assist Compliance Officer to train and educate staff on the key requirements of Privacy Standards, including limits on use and disclosure of protected health information, individual rights under regulations, and administrative requirements.</li>
<li>Accepts subpoena duces tecum, as custodian of the health record, reviews subpoenaed records for completeness with medicolegal requirements. Confers with TON attorney, when necessary, appears in court to fulfill legal requirements. Prepare records in tort claims.</li>
<li>Utilizing Electronic Health Record template approval criteria ensures that EHR templates are acceptable for use.</li>
<li>The incumbent is responsible for the administration and management of the TONHC Hospital and Clinics Medical Coding Program. Coordinates, manages, monitors, and performs all functions necessary to ensure coding complies with internal control standards.</li>
<li>Incumbent utilizes and implements various auditing mechanisms to ensure coding compliance. Develops and implements a comprehensive internal quality control system within the HIMS program. Determine the effectiveness of such controls and their impact on the program.</li>
<li>Responsible for the RPMS software packages managed by the HIMS discipline: Discharge and Transfer (ADT), Patient Care Component (PCC), Release of Infom1ation (ROI); Sensitive Patient Tracking (SPT), Text Integration Utility (TIU) of EHR, and other HIM package developed by TONHC. </li>
<li>Responsible for the review, analysis, and technical evaluation of clinical records concerning the Standards of the Joint Commission (TJC) and state and federal reporting requirements for vital statistics.</li>
<li>Assures that diagnoses are written in the language of Standard Terminology of Diseases and Operation, and coding of diseases and operations are in the proper grouping of International Classification of Diseases and Operations for research and administrative evaluation.</li>
<li>Aids in projects by advising on procedures to efficiently collect data and assisting staff in defining their objectives in terms of the available information. Collection of data may consist of searching files or recommending special computer reports.</li>
<li>Designs and administers the health information program, including managing work processes, personnel, and planning for transition to the EHR.</li>
<li>Responsible for conducting and submitting (to CEO) specific assessments related to Third Party Internal Controls self-assessment and audits.</li>
<li>The incumbent supervises a staff engaged in administrative and technical work. Ensure the timely performance of satisfactory quality and quantity of work through the following supervisory tasks.</li>
<li>Plans work to be done by subordinates; sets priorities and establishes schedules and deadlines. Assign work based on anticipated difficulty and the capabilities of available employees. Advises, counsels, and instructs employees on technical and administrative matters.</li>
<li>Ensures HR (competency) files are in place and up-to-date, meeting all TONHC Joint Commission requirements.</li>
<li>Recommends personnel actions such as promotion, reassignment, or termination. Recommends awards and disciplinary actions.</li>
<li>Submit requests for personnel action timely. Interviews applicants and recommends selections.</li>
<li>Hears and resolves employee complaints (or refers the complaint to the level of resolve.</li>
<li>Determines individual training and development needs and seeks out ways to satisfy them.</li>
<li>The incumbent is responsible for furthering the goals of Equal Employment Opportunity (EEO) by taking positive steps to ensure adherence to non-discriminatory employee practices regarding race, color, sex, religion, national origin, age, or handicap. </li>
<li>Contribute to a team effort.</li>
<li>Performs other job-related duties as assigned.</li>
</ul>
Knowledge, Skills, and Abilities:
<ul>
<li>Knowledge of the Tohono O'odham culture, customs, and traditions.</li>
<li>Thorough knowledge of medical records administration and management to apply established principles, concepts, and techniques of hospital operations.</li>
<li>Thorough knowledge of policies, procedures, applicable Federal statutes on legislation governing health records. </li>
<li>Advanced knowledge and understanding of health information management: including coding, medical terminology, documentation standards, electronic health record (EHR), and medicolegal issues of the health record.</li>
<li>Advanced analytic skills to be able to solve problems covering the diverse issues that are involved in the health records management field. </li>
<li>Advanced knowledge of medical terminology, understanding the standard practices of the clinical medical field and communicating effectively with the clinical .staff in interpreting and comprehending medical documentation in health records. Practical knowledge of anatomy, physiology, and medical procedures and diagnosis.</li>
<li>Ability to plan, organize and cope with complex management issues. Ability to handle technical problems analytically and systematically, especially in times of medical or administrative emergencies.</li>
<li>Ability to communicate effectively, orally, and in writing to all levels of personnel. Effective communication is needed to coordinate with various department personnel, patients, agency personnel, and outside entities requesting or requiring information related to health records.</li>
<li>Expert knowledge in developing procedures, planning, organizing, and monitoring studies involving data analysis and preparing reports. </li>
<li>Thorough knowledge of Public Law 94-437, Title IV of the Indian Health Care Improvement Act, PL 99-272, Federal Medical Care Cost Recovery Act, the Drug Abuse Office and Treatment Act of 1972; hospital policies and procedures governing the recovery of the cost of medical care provided to specific individuals.</li>
<li>Knowledge of reimbursable insurance procedures and requirements, including interpreting provisions of individual health plans and group plans.</li>
<li>Knowledge of proper coding procedures, ICD-10 and CPT.</li>
<li>Thorough knowledge of the Resource Patient Management System (RPMS). </li>
<li>Expert knowledge of regulatory, licensing, accrediting agency requirements, and medical/legal responsibilities of medical records (including electronic health records).</li>
<li>Expert knowledge of the interrelationships between medical records programs and other medical care services to evaluate and modify/adapt new procedures to meet changing regulatory requirements and health care practices.</li>
<li>Knowledge of supervisory personnel management responsibilities, including recruitment and staffing, training, incentive awards, discipline, position classification, pay administration. </li>
</ul>
Minimum Qualifications:
<ul>
<li>Associates in Medical Billing and Coding or closely related field, and</li>
<li>Three years of supervisory experience in Health Information Management Services (HIMS). </li>
</ul>
Licenses, Certifications, Special Requirements:
<ul>
<li>Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) is desirable.</li>
<li>Upon recommendation for hire, a criminal background and a National FBI fingerprint check are required to determine suitability for employment, including a 39-month driving record. </li>
<li>May require possessing and maintaining a valid driver's license (no DUIs or major traffic citations within the last three years). </li>
<li>If required, must meet the Tohono O'odham Nation tribal employer's insurance requirements to receive a driver's permit to operate program vehicles.</li>
<li>Based on the department's needs, incumbents may be required to demonstrate fluency in both the Tohono O'odham language and English as a condition of employment.</li>
</ul>

Supervisory Medical Records Administration Specialist

<h3>Job Description</h3>
Job DescriptionOUR CORE PILLARS: Safety | Operational Excellence | Shareholder ValuePropulsion Controls Engineering has an opening for a Contracts Estimating Manager, with proven experience in ship repair/shipyard administration; familiar with standard concepts, practices, and procedures in estimating and contracts.&nbsp;&nbsp;PCE is a full service electro-mechanical repair and diesel repair contractor. PCE has garnered a wealth of extensive experience in successfully executing major system overhauls across numerous ports throughout the world on virtually every class of ship currently in operation.POSITION SUMMARY:The Contracts Estimating Manager, develops, maintains, and presents data and counsel necessary to assist Executive Management in monitoring the company’s strategic business plan, corporate goals, and objectives across the Enterprise. Provides managerial oversight of Contracts and Estimating, ensuring the timeliness and accuracy of proposal development, pricing, strategies, planning, and associated supply chain logistics. Acts as a primary negotiator, contracts specialist, and representative for company business relations.POSITION REQUIREMENTS:Education and Experience:
<ul>Bachelor’s Degree required (Business Administration preferred).Certification as CFCM by NCMA preferred.</ul>
Knowledge, Skills and Abilities:
<ul>Proven experience in ship repair/shipyard administration; familiar with standard concepts, practices, and procedures in estimating and contracts.Strong communication skills required to effectively interact with ship personnel, contractors, subcontractors, vendors, customers, and employees.Strong business acumen; capable of coaching and mentoring Business Office staff, maintaining open communication, and ensuring customer requests are fulfilled within required timeframes.Proficient in Microsoft Office applications, including Word, Excel, and PowerPoint.</ul>
Benefits:&nbsp;Health Insurance (medical, dental, vision, company paid life insurance, voluntary plans such as supplemental life insurance, critical illness, and hospital indemnity)&nbsp;Paid Time OffCompany paid holidaysRetirement savings plan (401(k) plan with company matching and an Employee Stock Ownership Plan&nbsp;Career development opportunitiesThis position may require access to U.S. government or military sites. As such, candidates must be eligible to obtain base access clearance, which includes passing a background check and presenting valid government-issued identification. Per federal requirements, acceptable ID must be REAL ID-compliant or an approved form of federal identification, such as a valid U.S. passport. CONTRACTS ESTIMATING MANAGEREEO/AA/Vet/Disabled&nbsp;#zr 
Compensation details: 138946.9-194525.66 Yearly Salary
 
PI93dcd3dfbe96-25405-39252560

Contracts Estimating Manager

<h3>Job Description</h3>
Job Description
Billing Specialist - Behavioral Health – Exact Billing Solutions (EBS) Lauderdale Lakes, FL
Who We Are 
Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in the substance use disorder, mental health, and autism care fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies. 
EBS is poised for exponential growth, and we are building out our teams to support the expansion of global operations. 
Part of the ICBD family office portfolio, Exact Billing Solutions combines entrepreneurial speed with the financial discipline of a self-funded, founder-led organization. Our growth reflects a proven ability to solve complex healthcare challenges with operational precision, scalable systems, and client-first innovation. 
Our Origin Story 
Exact Billing Solutions was launched to address one of healthcare’s most persistent challenges: the burden of billing and insurance administration on providers. With firsthand knowledge of how inefficiencies in revenue cycle management drain resources from patient care, our founder built a company dedicated to removing obstacles, accelerating cash flow, and delivering peace of mind to clients across specialties. 
Recognition &amp; Awards
Exact Billing Solutions contributes heavily to the success of the broader ICBD family office ecosystem and benefits from the recognition awarded to other portfolio companies, including: 
<ul>
<li>Inc. 5000, 2024 – Top 5 Fastest-Growing Private Companies in America (ABA Centers of America) </li>
</ul>
<ul>
<li>EY Entrepreneur Of The Year® U.S. Overall </li>
</ul>
<ul>
<li>Florida Trend Magazine – 500 Most Influential Business Leaders </li>
</ul>
About the Role
Are you an experienced behavioral health collections professional ready to take your career to the next level with a growing, fast-moving company? You could be our Billing Specialist—Behavioral Health, responsible for effective communication and coordination with insurance companies and clients to obtain the maximum benefits for clients. 
We work with multiple expanding clinic locations, so timely collections are critical to our operations. The work you will do can make a real difference in the lives of client families and kids by allowing our partners to open clinics where they are desperately needed. 
Requirements
<ul>
<li>Review and manage assigned AR inventory to ensure timely follow-up on outstanding claims.</li>
<li>Investigate and resolve denials, rejections, and underpayments by working directly with payors, and internal teams.</li>
<li>Submit corrected claims, appeals, and additional documentation as required to secure reimbursement.</li>
<li>Document all collection activities clearly and accurately within our systems.</li>
<li>Monitor payor trends and escalate recurring issues to leadership.</li>
<li>Meet or exceed daily, weekly, and monthly productivity and quality standards.</li>
<li>Support special projects and process improvement initiatives as assigned.</li>
<li>Maintain effective communication with third-party insurance carriers to resolve issues that impede cash flow and detract from patient/member satisfaction </li>
<li>Monitor and create reports on key metrics such as cash collections, days outstanding, unbilled claims, denials, daily census, etc. </li>
<li>Status claims and add notes in the patient accounting system (CollaborateMD) </li>
<li>Escalate any payor or client claim issues to department leadership </li>
<li>Establish/maintain effective communications with the leadership team to ensure that all third-party guidelines are satisfied </li>
<li>Update patient demographics and insurance information as needed </li>
<li>Ability to meet KPI established metrics for productivity</li>
</ul>
Qualifications
<ul>
<li>Associate's degree (preferred) </li>
<li>Behavioral health out-of-network billing: 3 years of experience </li>
<li>Knowledge and experience with CollaborateMD EMR and billing software programs </li>
<li>Experience with ABA therapy preferred </li>
<li>Experience/knowledge with CPT and ICD10 codes preferred</li>
<li>Claims denial experience with follow up from payers including appeals</li>
</ul>
Benefits
<ul>
<li>21 paid days off (15 days of PTO, which increases with tenure, plus 6 holidays).  </li>
</ul>
<ul>
<li>Flexible Spending Account (FSA) and Health Savings Account (HSA) options.  </li>
</ul>
<ul>
<li>Medical, dental, vision, long-term disability, and life insurance.  </li>
</ul>
<ul>
<li>Generous 401(k) with up to 6% employer match.  </li>
</ul>
Exact Billing Solutions (EBS) Culture 
Integrity. Dependability. Attention to detail. All our team members exhibit these qualities when it comes to doing business. And when it comes to the business of supporting a team, as a company, we offer no less to our team members. We’re a fast-paced, growing company delivering services that allow our clients to spend more time helping people. At the end of the day, it’s people, not numbers, that drive our success. 
Exact Billing Solutions participates in the U.S. Department of Homeland Security E-Verify program.

Billing Specialist

<h3>Job Description</h3>
Job Description 
Job Summary
The Manager performs the administrative functions related to medical and resident credentialing. Oversee and supports Medical Staff committees. Under general direction, manages the credentialing process to ensure compliance with hospital policies, regulatory bodies, and TJC.
Primary Responsibilities
Credentialing and Privileging
<ul>
<li>Oversee all aspects of initial and reappointment credentialing for Medical Staff, AHPs, and residents / fellows.</li>
<li>Ensure that data necessary for credentialing and privileging is requested and collected in a timely manner from applicants and other parties.</li>
<li>Ensures that primary source verification of licensure, training, board certification, DEA, malpractice coverage, prior employment, and the National Provider Data Bank (NPDB) is performed.</li>
<li>Ensures timely file completion and coordinates approval workflows, ensuring presentation to the Credentials Committee, Medical Executive Committee (MEC), and Governing Body.</li>
<li>Maintains privilege delineations consistent with Medical Staff Bylaws and regulatory standards.</li>
<li>Maintains accurate files for all credentialed and privileged Medical Staff and AHPs.</li>
<li>Maintains the electronic credentialing database.</li>
<li>Works in conjunction with University of Maryland Medical System (UMMS) leadership and colleagues from other UMMS member organizations Medical Staff Offices to continuously improve all aspects of the Medical Staff Office, including the use of new technologies and processes to improve operational efficiency and reduce redundancy.</li>
</ul>
Regulatory Compliance
Ensures full compliance with Medical Staff Bylaws, TJC, CMS, NCQA, and state licensure requirements, including:
<ul>
<li>Credentialing and privileging audits</li>
<li>FPPE and OPPE completion, in conjunction with the Quality Department</li>
</ul>
Medical Staff Governance and Administration
Provides administrative support to the Medical Staff President, Officers, Credentials Committee, MEC, and other assigned committees:
<ul>
<li>Prepare agendas, minutes, and follow-up actions</li>
<li>Track committee approvals and corrective actions</li>
<li>Collaborate with clinical leaders (Division Chiefs) and hospital administration to support effective medical staff governance and provider onboarding.</li>
<li>Coordinate new provider onboarding and orientation, in collaboration with HR and clinical departments.</li>
</ul>
Leadership and Operational Management
<ul>
<li>Supervise and mentor Medical Staff Office personnel, ensuring efficient, high-quality workflows and excellent customer service.</li>
<li>Maintain courteous and effective relationships with co-workers and other members of the Hospital staff.</li>
<li>Develop and report performance metrics relate to credentialing timelines, provider onboarding, and regulatory readiness.</li>
<li>Establish and maintain professional, confidential, and collaborative relationships with providers, hospital departments, and external agencies.</li>
</ul>
 Qualifications 
Education &amp; Experience - Required
<ul>
<li>Associates degree or higher from an accredited college in health care administration, business, or related field.</li>
<li>Minimum of 5 years of credentialing/ Medical Staff experience, with at least two years in a hospital or health system setting. </li>
<li>Must have a stronghospital-based credentialing background</li>
</ul>
Education &amp; Experience - Preferred
<ul>
<li>Bachelor’s degree or higher</li>
<li>Supervisory experience</li>
<li>Certified Professional Medical Services Management (CPMSM) and/ or Certified Provider Credentialing Specialist (CPCS) Certifications.</li>
</ul>
Knowledge, Skills, &amp; Abilities
<ul>
<li>Expert knowledge of Medical Staff credentialing, privileging, and governance processes.</li>
<li>Thorough understanding of TJC, CMS, NCQA, and state regulatory requirements.</li>
<li>Proficient in credentialing software systems; experience with MD Staff preferred.</li>
<li>Strong interpersonal, written, and verbal communication skills</li>
<li>Work collaboratively with medical staff and administrative leadership.</li>
<li>Ability to manage confidential and sensitive information in compliance with hospital policy and HIPAA.</li>
</ul>
 Additional Information 
All your information will be kept confidential according to EEO guidelines.
Compensation:
<ul>
<li>Pay Range:$40.60 - $60.93</li>
<li>Other Compensation (if applicable): n/a</li>
<li>Review the 2025-2026 UMMS Benefits Guide</li>
</ul>
Like many employers, UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities. We will never ask for banking details, personal identification, or payment via email or text. If you suspect fraud, please contact us at <a href="mailto:careers@umms.edu" target="_blank">careers@umms.edu</a>.
PandoLogic. Keywords: Medical Affairs Manager, Location: Pasadena, MD - 21123

Medical Staff Office Manager

<h3>Job Description</h3>
Job Description 
Job Summary
The Manager performs the administrative functions related to medical and resident credentialing. Oversee and supports Medical Staff committees. Under general direction, manages the credentialing process to ensure compliance with hospital policies, regulatory bodies, and TJC.
Primary Responsibilities
Credentialing and Privileging
<ul>
<li>Oversee all aspects of initial and reappointment credentialing for Medical Staff, AHPs, and residents / fellows.</li>
<li>Ensure that data necessary for credentialing and privileging is requested and collected in a timely manner from applicants and other parties.</li>
<li>Ensures that primary source verification of licensure, training, board certification, DEA, malpractice coverage, prior employment, and the National Provider Data Bank (NPDB) is performed.</li>
<li>Ensures timely file completion and coordinates approval workflows, ensuring presentation to the Credentials Committee, Medical Executive Committee (MEC), and Governing Body.</li>
<li>Maintains privilege delineations consistent with Medical Staff Bylaws and regulatory standards.</li>
<li>Maintains accurate files for all credentialed and privileged Medical Staff and AHPs.</li>
<li>Maintains the electronic credentialing database.</li>
<li>Works in conjunction with University of Maryland Medical System (UMMS) leadership and colleagues from other UMMS member organizations Medical Staff Offices to continuously improve all aspects of the Medical Staff Office, including the use of new technologies and processes to improve operational efficiency and reduce redundancy.</li>
</ul>
Regulatory Compliance
Ensures full compliance with Medical Staff Bylaws, TJC, CMS, NCQA, and state licensure requirements, including:
<ul>
<li>Credentialing and privileging audits</li>
<li>FPPE and OPPE completion, in conjunction with the Quality Department</li>
</ul>
Medical Staff Governance and Administration
Provides administrative support to the Medical Staff President, Officers, Credentials Committee, MEC, and other assigned committees:
<ul>
<li>Prepare agendas, minutes, and follow-up actions</li>
<li>Track committee approvals and corrective actions</li>
<li>Collaborate with clinical leaders (Division Chiefs) and hospital administration to support effective medical staff governance and provider onboarding.</li>
<li>Coordinate new provider onboarding and orientation, in collaboration with HR and clinical departments.</li>
</ul>
Leadership and Operational Management
<ul>
<li>Supervise and mentor Medical Staff Office personnel, ensuring efficient, high-quality workflows and excellent customer service.</li>
<li>Maintain courteous and effective relationships with co-workers and other members of the Hospital staff.</li>
<li>Develop and report performance metrics relate to credentialing timelines, provider onboarding, and regulatory readiness.</li>
<li>Establish and maintain professional, confidential, and collaborative relationships with providers, hospital departments, and external agencies.</li>
</ul>
 Qualifications 
Education &amp; Experience - Required
<ul>
<li>Associates degree or higher from an accredited college in health care administration, business, or related field.</li>
<li>Minimum of 5 years of credentialing/ Medical Staff experience, with at least two years in a hospital or health system setting. </li>
<li>Must have a stronghospital-based credentialing background</li>
</ul>
Education &amp; Experience - Preferred
<ul>
<li>Bachelor’s degree or higher</li>
<li>Supervisory experience</li>
<li>Certified Professional Medical Services Management (CPMSM) and/ or Certified Provider Credentialing Specialist (CPCS) Certifications.</li>
</ul>
Knowledge, Skills, &amp; Abilities
<ul>
<li>Expert knowledge of Medical Staff credentialing, privileging, and governance processes.</li>
<li>Thorough understanding of TJC, CMS, NCQA, and state regulatory requirements.</li>
<li>Proficient in credentialing software systems; experience with MD Staff preferred.</li>
<li>Strong interpersonal, written, and verbal communication skills</li>
<li>Work collaboratively with medical staff and administrative leadership.</li>
<li>Ability to manage confidential and sensitive information in compliance with hospital policy and HIPAA.</li>
</ul>
 Additional Information 
All your information will be kept confidential according to EEO guidelines.
Compensation:
<ul>
<li>Pay Range:$40.60 - $60.93</li>
<li>Other Compensation (if applicable): n/a</li>
<li>Review the 2025-2026 UMMS Benefits Guide</li>
</ul>
Like many employers, UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities. We will never ask for banking details, personal identification, or payment via email or text. If you suspect fraud, please contact us at <a href="mailto:careers@umms.edu" target="_blank">careers@umms.edu</a>.
PandoLogic. Keywords: Medical Affairs Manager, Location: Owings Mills, MD - 21117

<h3>Job Description</h3>
Job Description
Medical Billing Specialist—Behavioral Health – Exact Billing Solutions (EBS) Lauderdale Lakes, FL
Who We Are 
Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in the substance use disorder, mental health, and autism care fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies. 
EBS is poised for exponential growth, and we are building out our teams to support the expansion of global operations. 
Part of the ICBD family office portfolio, Exact Billing Solutions combines entrepreneurial speed with the financial discipline of a self-funded, founder-led organization. Our growth reflects a proven ability to solve complex healthcare challenges with operational precision, scalable systems, and client-first innovation. 
Our Origin Story 
Exact Billing Solutions was launched to address one of healthcare’s most persistent challenges: the burden of billing and insurance administration on providers. With firsthand knowledge of how inefficiencies in revenue cycle management drain resources from patient care, our founder built a company dedicated to removing obstacles, accelerating cash flow, and delivering peace of mind to clients across specialties. 
Recognition &amp; Awards
Exact Billing Solutions contributes heavily to the success of the broader ICBD family office ecosystem and benefits from the recognition awarded to other portfolio companies, including: 
<ul>
<li>Inc. 5000, 2024 – Top 5 Fastest-Growing Private Companies in America (ABA Centers of America) </li>
</ul>
<ul>
<li>EY Entrepreneur Of The Year® U.S. Overall </li>
</ul>
<ul>
<li>Florida Trend Magazine – 500 Most Influential Business Leaders </li>
</ul>
About the Role
Are you an experienced behavioral health collections professional ready to take your career to the next level with a growing, fast-moving company? You could be our Medical Billing Specialist—Behavioral Health, responsible for effective communication and coordination with insurance companies and clients to obtain the maximum benefits for clients. 
We work with multiple expanding clinic locations, so timely collections are critical to our operations. The work you will do can make a real difference in the lives of client families and kids by allowing our partners to open clinics where they are desperately needed. 
Requirements
<ul>
<li>Review and manage assigned AR inventory to ensure timely follow-up on outstanding claims.</li>
<li>Investigate and resolve denials, rejections, and underpayments by working directly with payors, and internal teams.</li>
<li>Submit corrected claims, appeals, and additional documentation as required to secure reimbursement.</li>
<li>Document all collection activities clearly and accurately within our systems.</li>
<li>Monitor payor trends and escalate recurring issues to leadership.</li>
<li>Meet or exceed daily, weekly, and monthly productivity and quality standards.</li>
<li>Support special projects and process improvement initiatives as assigned.</li>
<li>Maintain effective communication with third-party insurance carriers to resolve issues that impede cash flow and detract from patient/member satisfaction </li>
<li>Monitor and create reports on key metrics such as cash collections, days outstanding, unbilled claims, denials, daily census, etc. </li>
<li>Status claims and add notes in the patient accounting system (CollaborateMD) </li>
<li>Escalate any payor or client claim issues to department leadership </li>
<li>Establish/maintain effective communications with the leadership team to ensure that all third-party guidelines are satisfied </li>
<li>Update patient demographics and insurance information as needed </li>
<li>Ability to meet KPI established metrics for productivity</li>
</ul>
Qualifications
<ul>
<li>Associate's degree (preferred) </li>
<li>Behavioral health out-of-network billing: 3 years of experience </li>
<li>Knowledge and experience with CollaborateMD EMR and billing software programs </li>
<li>Experience with ABA therapy preferred </li>
<li>Experience/knowledge with CPT and ICD10 codes preferred</li>
<li>Claims denial experience with follow up from payers including appeals</li>
</ul>
Benefits
<ul>
<li>21 paid days off (15 days of PTO, which increases with tenure, plus 6 holidays).  </li>
</ul>
<ul>
<li>Flexible Spending Account (FSA) and Health Savings Account (HSA) options.  </li>
</ul>
<ul>
<li>Medical, dental, vision, long-term disability, and life insurance.  </li>
</ul>
<ul>
<li>Generous 401(k) with up to 6% employer match.  </li>
</ul>
Exact Billing Solutions (EBS) Culture 
Integrity. Dependability. Attention to detail. All our team members exhibit these qualities when it comes to doing business. And when it comes to the business of supporting a team, as a company, we offer no less to our team members. We’re a fast-paced, growing company delivering services that allow our clients to spend more time helping people. At the end of the day, it’s people, not numbers, that drive our success. 
Exact Billing Solutions participates in the U.S. Department of Homeland Security E-Verify program.

10,183 medical-administration-specialist Jobs