<h3>Job Description</h3>
Oversees and supports all Medicaid &amp; Medicare Part D operational tasks in compliance with applicable federal, state and local laws, rules, regulations and internal policies and procedures. Performs Account Management activities related to assigned Medicare and Medicaid clients.
Essential Tasks and Responsibilities Operations
<ul>
<li>Serves as a subject matter expert in all CMS guidelines and processes for both government programs: Medicare &amp; Medicaid.</li>
<li>Supports RFI and RFP submissions as well as pre-sales opportunities for Medicare Part D and Managed Medicaid clients.</li>
<li>Collaborates in the development and optimization of operational workflows to integrate Medicare &amp; Medicare requirements.</li>
<li>Responsible for maintaining oversight of all informative documents released by CMS and the claims processor including but not limited to the following: o Memos, call letters and regulatory guidance on HPMS, CMS communications and claims processor’s biweekly newsletters. o Submissions modules and manuals available on HPMS as applicable to the PBM. o Regulatory and guidance documents available on the CMS website. As a result, pertinent information should be communicated to all necessary parties within the organization.</li>
<li>Responsible for overseeing/managing the PDE full process in coordination with clients.</li>
<li>Responsible for overseeing/ensuring that the operational areas are performed according to the Medicare Prescription Drug Benefit Manual:</li>
<li>Monitors compliance of, but not limited to CMS Reporting Requirements as agreed with clients including: Formulary submissions, Pricing tools, Pharmacy network, EOB files, PDE, FIR, Data Validation, among others.</li>
<li>Oversees new plans being implemented for upcoming calendar years in coordination with internal departments.</li>
<li>Supports operational areas during CMS auditing processes.</li>
<li>Ensures processes are in place for claims processing, accurate timely and complete submissions to CMS and all compliance with CMS requirements as applicable (transition, formulary, P&amp;T attestations).</li>
<li>Provides support to EOB and FIR in order to report to client jointly with IT and Operations Departments.</li>
<li>Operational liaison between MC-Rx and their Medicare clients.</li>
<li>Liaison between MC-Rx PR and US Mainland, and the claims processor for Med D.</li>
<li>Provides oversight and support to a team responding to client and government audit needs. Provides guidance, compliance, operational expertise and issue management support to the team managing audit support activities.</li>
</ul>
U.S. Clients
<ul>
<li>Manages daily operations as they apply to clients in the U.S. mainland.</li>
<li>Oversees the delivery of periodic reporting packages.</li>
<li>Leads periodic meetings and conference calls with U.S. clients.</li>
<li>Ensures cross functional team is performing according to CMS guidelines, internal processes and procedures, and contractual agreements.</li>
</ul>
Education and/or Experience
<ul>
<li>Bachelor’s Degree in Science, Business Administration, Health or related field.</li>
<li>Minimum of three years of experience in Medicare/Medicaid Operations/Healthcare Industry.</li>
<li>Fully Bilingual: English and Spanish language.</li>
<li>Proficient knowledge of Windows including: Word, Excel, Power Point, Access.</li>
<li>In-depth understanding of laws, rules and regulations related to healthcare corporate governance.</li>
</ul>
Skills
<ul>
<li>Leadership</li>
<li>Problem-solving, project management, technical, and monitoring skills</li>
<li>Ability to write clear, concise reports, business correspondence and develop policies and procedures</li>
<li>Excellent communication skills to manage internal and external customers</li>
<li>Judgment and criterion for decision making</li>
<li>Detailed oriented and presentation skills</li>
<li>Ability to work in a fast-paced environment while demonstrating flexibility, commitment to teamwork, and a willingness to change assignments to meet clients' needs.</li>
</ul>
ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at (678) 248-4755 or email us at <a href="mailto:HR@procarerx.com" target="_blank">HR@procarerx.com</a>.
ProCare Rx is an Equal Opportunity Employer.

Manager, Government Programs Medicaid & Med D

<h3>Job Description</h3>
Health Advocates is seeking an Insurance Collector with prior healthcare collections experience for our main office in Chatsworth, CA. 
Job Summary The Insurance Collector is responsible for the timely follow up and collection efforts on outstanding receivable accounts that are billed to insurance companies, managed care entities, government programs, and other liable third parties. Responsibilities include reviewing accounts to determine patient eligibility for various forms of coverage, evaluating aged accounts for a basis to appeal unpaid or underpaid amounts, and performing miscellaneous related duties as needed. 
Qualifications 
<ul>
<li>High school diploma or GED equivalent required </li>
<li>Experience in healthcare claims processing and collections </li>
<li>Knowledge of Managed Care Contracts Interpretation and Calculations preferred </li>
<li>Familiar with UBO4 or HCFA 1500 claims and data elements </li>
<li>Excellent verbal and written communication skills </li>
<li>Detail-oriented with good organizational and time management skills </li>
<li>Basic office skills and computer literacy required </li>
<li>Must be able to type 35 WPM </li>
</ul>
Working Title: Collector I Pay Rate: $23.00 - $29.75 per hour (Depending on Relevant Experience) Position Type: Full-time; Non-exempt Schedule: Alternative work week schedule-Mon-Thurs 7:30 am-5:00 pm &amp;Fri 7:30 am-12:30 pm Other: We conduct assessment testing and post offer background checks
Benefits
Health Advocates offers a comprehensive benefits package to meet the needs of today's employees. They include: Healthcare and Insurance Benefits, Retirement Benefits, Employee Discounts, Employee Assistance Program, Credit Union, Rideshare Incentives, Employee Referral Program, Vacation/Holiday/Sick Leave and other time off.
About Us
Founded in 1990, Health Advocates is the largest privately funded public advocacy company in California providing Eligibility and Recovery services to California public health systems, private hospitals, clinics, health plans, government agencies, and individuals. We are dedicated to identifying medical coverage from third-party sources such as Medi-Cal, Social Security (SSI/SSDI), and other health insurance programs to minimize uncompensated care to the benefit of both our clients and the patients and applicants they serve. Our success is born from a very unique blend of resources, expertise, and an unwavering determination to identify coverage and recovery solutions on behalf of patients that simply have no ability to pay their increasing financial healthcare debts. Innovation and compassion are integral to Health Advocates’ identity and these attributes have historically served our clients very well. We are proud of our past, excited about our future, and confident of our continued success. 
This position requires access to confidential protected health information (PHI). Our employees are expected to protect the privacy of all PHI in accordance with Health Advocates’ privacy policies and procedures and as required by state and federal law including but not limited to the HIPAA Security and Privacy Rule. 
Health Advocates 21540 Plummer Street, Suite B Chatsworth, CA 91311 (818) 995-9500 p (818) 995-6872 f 
Health Advocates is an equal opportunity employer. We believe all of our employees should be treated fairly, consistently, and with dignity and respect. Our goal is to maintain a satisfied and productive team of employees. The keys to reaching that goal are effective leadership, fair and competitive wages and benefits, dedication to the job, and close attention to employee relations matters. 
Searchable words: Billing, Paralegal, Plan Claim adjudicator, Claims Processor, Collections, Patient Accounting, Patient Financial Services Representative, Patient Accounts Representative, Insurance Collector, Insurance Collector Specialist, Business Office Representative, Biller, Workers Compensation, Worker's Compensation, Third Party Liability, Recovery, Revenue, Claims, Analyst, TPL, Negotiation, Negotiator, Lien, Follow up, Follow-up, Commercial, Private, Insurance, Eligibility Representative, Hospital, Insurance, Healthcare, UBO4, HMO, PPO, POS, Managed Care, DME billing, HCFA-1500, CPT, EPIC, Paragon, Medisoft, Meditec, Citrix, Artiva, CareConnect, CMS1500, Med-Pay, negotiate settlements, issue refunds, Patient Rep, Appeals Specialist, Managed Care Collector, A/R., hospital Revenue cycle solutions, managed care account rep, collections, hospital, Insurance Follow-Up Specialist, Medical Bill Reviewer, Payment Recovery Specialist, Reimbursement Specialist, Insurance Claims Analyst, Insurance Claims Examiner, Insurance Verification Specialist, Patient Registrar, denial management services, Self-Pay Solutions, physician, lead insurance collector, Discrepancy Unit, Woodland Hills, San Fernando, Northridge, Canoga Park, Reseda, Granada Hills, West Hills, City of Hidden Hills, Calabasas, Tarzana, Encino, Sherman Oaks, Toluca Lakes, Universal City, Studio City, Valley Village, North Hollywood, Burbank, Glendale, Van Nuys, Panorama City, Sun Valley, Sunland, Tujunga, Lakeview Terrace, Pacoima, North Hills, Sylmar, Mission Hills, Pacoima, Arleta.

Insurance Collector I

<h3>Job Description</h3>
Christensen Farms is one of the largest, family-owned pork producers in the United States, marketing approximately 3 million hogs per year. Headquartered in Sleepy Eye, Minnesota, the company operates throughout the Midwest with facilities in Minnesota, Iowa, Nebraska, Illinois and South Dakota. Christensen Farms owns four feed mills, manages 145,000 sows on 44 farms, and oversees more than 350 nurseries and grow-finish sites. The company employees nearly 1,000 people and maintains 1,500 contract partnerships. 

The company is vertically integrated with a strong presence across the pork value chain - from farm to fork. Christensen Farms is the largest shareholder of Triumph Foods LLC, a producer-owned primary pork processing plant in St. Joseph, Missouri. In turn, Triumph Food members own 50 percent of Daily's Premium Meats, a specialty pork processor bacon and other premium pork products. Triumph Foods also holds a 50 percent partnership in Seaboard Triumph Foods, LLC of Sioux City, Iowa, a primary pork processing plant. 

Position Overview &amp; Responsibilities: 
The Workers Compensation and Safety Specialist is responsible for managing Christensen Farms workers' compensation program efficiently while also providing organization reporting on key performance indicators as well as project coordination/management of safety initiatives. A qualified person will have a solid understanding of workers' compensation regulations, OSHA regulations and experience in project management related to safety programs.

This position will be located in the Sleepy Eye office and will have some travel to meet the objectives needed.

Major Areas of Accountability:

<ol>
<li>Workers' Compensation Management:
<ul>
<li>Serve as the primary point of contact for all workers' compensation claims, ensuring prompt reporting and accurate documentation.</li>
<li>Coordinate with insurance carriers, healthcare providers, and legal counsel to facilitate the resolution of claims effectively.</li>
<li>Monitor claim costs and outcomes, identifying trends and opportunities for improvement.</li>
</ul>
</li>
<li>Reporting and Analysis:
<ul>
<li>Compile and analyze data related to workers' compensation claims, safety incidents, and compliance metrics.</li>
<li>Prepare comprehensive reports and presentations on safety performance, trends, and recommendations for management review.</li>
<li>Utilize data insights to drive continuous improvement efforts and enhance overall safety effectiveness.</li>
</ul>
</li>
<li>Regulatory Compliance:
<ul>
<li>Stay current on federal, state, and local regulations governing workers' compensation and safety practices.</li>
<li>Ensure compliance with regulatory requirements by implementing and executing appropriate policies, procedures, and training programs required by state and federal OSHA agencies.</li>
</ul>
</li>
<li>Safety Project Coordination/Management:
<ul>
<li>May lead the planning and implementation of safety initiatives and projects aimed at reducing workplace hazards and promoting a culture of safety.</li>
<li>Develop project plans, timelines, and ensure adherence to established goals and objectives.</li>
<li>Collaborate with cross-functional teams to execute safety projects, including coordinating training sessions, procuring necessary resources, and overseeing implementation.</li>
</ul>
</li>
</ol>
Education, Training and Experience Requirements:
<ul>
<li>Bachelor's degree or equivalent work experience in Business Administration, Risk Management, Occupational Health and Safety, or preferred. </li>
<li>Minimum of 3 years of experience in workers' compensation management.</li>
<li>Strong administrative and/or project management skills with the ability to prioritize tasks, manage timelines, and track progress effectively.</li>
<li>Excellent communication and interpersonal skills, with the ability to engage and influence stakeholders at all levels.</li>
<li>Proficiency in data analysis and reporting tools.</li>
<li>Knowledge of workers' compensation laws and regulations.</li>
<li>Certification in workers' compensation (e.g., CWCP) or project management (e.g., PMP) is a plus.</li>
<li>Bilingual in English and Spanish - ability to read, write and interpret highly preferred. </li>
</ul>
Job Posted by ApplicantPro

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