<h3>Job Description</h3>
Salary: $15 - $18/per hour DOE
We are looking for Claims Examiners to join our rapidly growing team in Tampa. Experience is preferred but not necessary. Candidates with the right aptitude and desire to learn will be given the required training to be successful. We are excited for this limited opportunity to train candidates that have a phenomenal work ethic and want to learn a new trade. You will receive in-depth training on industry standards, coding, and metrics. Please apply if you exhibit the focus and desire to do great things!
MUST BE LOCAL TO TAMPA
This position is based in our Tampa office. However, employees who consistently meet performance metrics are eligible for a flexible work arrangement that allows working from home. To qualify, employees must:
<ol>
<li>Consistently meet or exceed all productivity and quality metrics for their role over a 3-month period</li>
<li>Demonstrate the ability to collaborate effectively and maintain strong communication with team members while working remotely</li>
<li>Have no active performance improvement plans or disciplinary issues</li>
<li>Once the above criteria are met, the employee may submit a request to work from home. Approval will be at the manager's discretion based on business needs and the employee's proven performance. </li>
</ol>
We strive to provide flexibility where possible to employees who have demonstrated success in their role!

Job Description
<ul>
<li> Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services</li>
<li> Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria</li>
<li> Review different lines of business to include Medicare, Medicaid and Commercial services adherence to the contracts and timeliness guidelines</li>
<li> Authorize claim payments within established limits; otherwise forward to Claims Manager</li>
<li> Potentially process refunds appeals, disputes and adjustments (when applicable)</li>
<li> Identify process improvement opportunities within the claim department and recommend system enhancements</li>
<li> Handles any additional responsibility which may be assigned</li>
</ul>
Education:  High School Diploma or equivalent required
Experience:
<ul>
<li> Preference for minimum of one-year experience working closely with healthcare claims or in a claims processing/adjudication environment</li>
<li> Open to training candidates without experience</li>
</ul>
Technical Skills / Qualifications:
<ul>
<li> Understanding of health claims processing/adjudication</li>
<li> Ability to perform basic to intermediate mathematical computation routines</li>
<li> Medical terminology strongly preferred</li>
<li> Understanding of ICD-9 &amp; ICD-10</li>
<li> Basic MS office computer skills</li>
<li> Ability to work independently or within a team</li>
<li> Time management skills</li>
<li> Written and verbal communication skills</li>
<li> Attention to detail</li>
<li> Must be able to demonstrate sound decision-making skills</li>
</ul>
Salary: $15.00 - $18.00 per hour based on experience.

Benefits:
We offer great benefits, flexible hours, and the opportunity for remote work for self-disciplined candidates who can perform well under limited supervision. Imagenet offers unlimited opportunities for candidates looking for upward mobility. Our leaders are always promoted from within and there is not a minimum employment time frame if you qualify for promotions. We appreciate referrals and always look to reward employees who help us grow.

<ul>
<li>Dental insurance</li>
<li>Health insurance</li>
<li>Vision insurance</li>
<li>Performance Bonus</li>
<li>Referral Bonus</li>
<li>PTO</li>
<li>401K Savings Plan</li>
</ul>

Job Type: Full-time
Schedule:
<ul>
<li>8 hour shift</li>
<li>Monday to Friday</li>
<li>Flexible schedule</li>
</ul>

Work Location: Hybrid remote in Tampa, FL 33618
Ability to commute/relocate:

<ul>
<li>Tampa, FL 33618: Reliably commute or planning to relocate before starting work (Required)</li>
</ul>


COMPANY OVERVIEW

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers. 

The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers.  The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually.  The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly-owned global delivery center in the Philippines.

Imagenet LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Healthcare Claims Processor with Possibility of Remote Work - Tampa

Molina Healthcare is hiring in New Mexico for several Billing &amp; Claims, Tribal Liaisons.   These roles are specifically responsible for working with tribal entities regarding billing and claims support and resolution activities.
Highly qualified candidates will have strong communication skills, excellent Microsoft Office product knowledge, and experience with Native American provider relationship management. 
These roles are remote, candidate must reside in New Mexico, as there may need to travel within the state according to business needs. 
Strong claims knowledge and IHS is required.
Job Summary Responsible for continuous quality improvements regarding member engagement and member retention.  Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the development/maintenance of Member Materials. 
Knowledge/Skills/Abilities Assists Molina Healthcare in promoting Native American's access to healthcare coverage and educates communities about the general and value added services provided by Molina Healthcare. Responsible for building and maintaining relationships with tribal community leaders, community-based organizations and providers within tribal lands and reservations through a combination of direct and indirect outreach and engagement activities directed toward building enrollment for all Health Plan lines of business. Establishes formal working relationships with and acts as a central point of contact to the Indian Health Services (IHS) facilities and tribal 638 facilities. Interacts with other Molina Healthcare departments to improve services provided to Native American members, prospective members, IHS and tribal 638 providers. As requested, helps support Molina Healthcare's relationship with IHS and tribal 638 facilities and establishes relationships with tribal employers.
<ul>
<li>Develops liaison engagement strategy to maximize growth opportunities for the Health Plan.</li>
<li>Establishes and maintains relationships with assigned providers in tribal communities including Provider outreached (Indian Health Services and 638 Clinics).</li>
<li>Achieves net growth goals by assigned territory; measures and tracks productivity.</li>
<li>Develops community and school outreach strategies including school-based engagement with key tribal schools; measures and tracks program results.</li>
<li>Identifies effective engagement opportunities through key Tribal Governments and TCBOs; measures and tracks results.</li>
<li>Serves as primary point of contact to the Native American Community, and other representatives as appropriate.</li>
<li>Holds semi-annual meetings with Native American representatives from around the State that represent geographic and member diversity. Minutes of such meetings shall be transmitted to the HSD/MAD within thirty (30) days of such meetings</li>
<li>Makes documented efforts to contract with the appropriate urban Indian clinics, Tribally owned health centers, and IHS facilities for the provision of medically necessary services.</li>
<li>Ensures that translation services are reasonably available when needed, both in providers' offices and in contacts with the contractor.</li>
<li>Ensures appropriate medical transportation for Native American members residing in rural and remote areas for members.</li>
<li>Ensures that culturally appropriate materials are available to Native Americans.</li>
<li>In-state travel required. </li>
<li>Specialized skills such as claims or billing  </li>
</ul>
Job Qualifications Required Education:   High School Diploma or GED Preferred Education: Bachelor's Degree preferred
Required Experience: 3-5 years experience in healthcare industry, preferably in the Medicaid Managed Care Programs Previous healthcare marketing and/or grassroots/community outreach experience
Preferred Experience: Experience in the Medicaid Managed Care Programs Experience with behavioral health and/or coordination of Long-Term Services preferred
Required License, Certification, Association: Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Key Words: Billing, Claims, Reconcile, IHS, Indian Health Services, Tribal Liaison, Medicaid, MCO, Managed Care, Tribal, Value Added, Community, Tribal 638, Tribal Governments, TCBOs, HSD/MAD, Claims Examiner, Auditor, Claims Processor, 
#PJHPO
#LI-AC1
 Pay Range: $40,851.44 - $88,511.46 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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