The case manager acts as a liaison between patients, payers, and the healthcare team to support the revenue cycle and help close the gap between a healthcare’s finance and clinical departments.

Job Duties and Responsibilities

• Develops, plans, organizes, and implements business strategies
• Bills customers and processes payments
• Works to minimize debt and improve cash flow
• Manages overall health of the company’s receivables
• Oversees all operations with a focus on billing department functions
• Tracks and monitors key performance metrics and targets
• Initiates processes to provide regular communication with team members
• Interviews, selects, hires, and trains team members

Education and Qualifications

• HS Diploma or GED
• Bachelor’s degree in healthcare administration
• 5+ years of revenue cycle experience
• 3+ years of supervisory or management level experience
• Strong knowledge of insurance companies
• Some experience with DME billing
• Knowledge of cash receipts, reconciliation, and remittance posting

A data entry specialist enters information into a computer database for adequate record keeping. Data entry specialists must be able to type quickly and accurately and possess strong attention to detail.

Job Duties and Responsibilities

• Enters patient information into the computer system in an accurate and timely manner
• Prepares various reports as requested by management
• Communicates effectively with staff
• Keeps records of payments, co-pays, prior-authorizations, etc.
• Evaluates and processes expense reports
• Maintains accurate and thorough vendor records
• Analyses data for errors
• Reports problems found with data

Education and Qualifications

• High School diploma or GED
• 3+ years of data entry experience
• Maintain confidentiality regarding financial matters
• Excellent organizational skills
• Strong verbal, written, and typing skills
• Proficient in MS Office (Word, Outlook, and Excel)
• Must be personable, professional, and polished
• Ability to work in a high-paced, high-volume data entry environment

Patient financial counselor’s (PFC) advises patients and other parties of their financial obligations by compassionately working with them and their families to address questions and concerns they have regarding insurance coverage and related charges. The PFC typically works in a hospital, dental office, medical practice, or other private practice.

Job Duties and Responsibilities

• Monitor and collect all financial balances owed by patients during the course of treatment
• Review the patient’s services for diagnoses and correct insurance coverage
• Examine all payment/financial options
• Answer all patient’s questions and concerns
• Arrange installment plans that meet the healthcare facilities policies
• Work with patients and their families to bring delinquent accounts current

Education and Qualifications

• High school diploma or GED equivalent
• 2+ years in a healthcare field
• Must have experience explaining treatment costs, insurance coverage, and patient financial responsibility
• Must be knowledgeable about insurance requirements, medical terminology, and coding
• Computer literate
• Excellent written and phone skills
• Strong customer service skills

Medical coding involves assigning special codes to medical diagnoses and services. While many healthcare facilities hire medical coders to work in offices, some choose to outsource the work to remote coding specialists. These specialists perform their duties, oftentimes, around their schedule and from the comfort of their own homes.

Job Duties and Responsibilities

• Receive medical charts and records that need to be coded from various healthcare facilities
• Determine and assign the most appropriate and accurate codes
• Keep in constant communication with insurance companies for billing purposes
• Work on several different accounts from numerous healthcare facilities
• Must be able to complete many deadlines at different times
• Maintain patient confidentiality and information security

Education and Experience

• High school diploma or GED equivalent
• Associates degree
• 2+ years of medical coding experience
• Must maintain accurate, organized records
• Proficient in medical coding software
• Effective communication skills are a must
• Strong attention to detail

The coding analyst is responsible for reviewing claims and medical records for correct billing, as well as processing and responding to any necessary incoming appeals and requests regarding determinations with providers.

Job Duties and Responsibilities   

• Applying up-to-date documentation/guidelines when responding to appeals
• Creating custom, professional appeal letters
• Handling telephone/email appeal inquiries correlating to the determination of the appeal
• Mentoring and assisting with junior coding analysts
• Maintaining awareness of and ensuring adherence to the healthcare facility’s privacy standards
• Performing other related tasks as assigned

Experience and Qualifications

• High school diploma or GED equivalent
• Some college experience preferred
• Proficiency in medical coding and use of diverse research materials used to deliver savings conclusions on behalf of clients
• 3+ years healthcare and medical claims processing experience
• Appeals experience preferred
• Excellent customer service skills both over the phone and by email
• Exceptional professionally written communication skills
• Strong research and organizational skills
• Detail-oriented with the ability to multi-task
• Knowledge of Microsoft Office applications including Word, Excel, PowerPoint, and Outlook

HEDIS, a tool used by more than 90 percent of America’s health plans, measures performance on important ranges of care and service. HEDIS coordinators perform different tasks to ensure HEDIS data and reports are accurate, including investigation, auditing, and improvement opportunities.

Job Duties and Responsibilities

• Coordinate, complete, and update management on all HEDIS processes and results
• Organize and maintain a plan of action to improve HEDIS scores
• Request and evaluate reports for member compliance and improvement opportunities for each HEDIS measure
• Work with providers and internal departments on rate investigation and validation activities, which includes maintaining all evidence, documentation, and changes
• Oversee the HEDIS project for quality and timeliness regarding nurse assignments, vendor oversight, and timeline adherence
• Ensure compliance by conducting quality audits and maintaining all data and process controls

Education and Qualifications

• Bachelor’s degree in related field or equivalent experience
• 3+ years of quality improvement or healthcare related experience
• HEDIS requirements preferred
• Must be organized with the ability to keep accurate notes and records
• Excellent verbal/written communication skills
• Proficient in Microsoft Word, Excel, and Outlook
• Should possess leadership capabilities

Referral specialists generally work in an office setting and are responsible for making sure patients are approved by their insurance company to see a specialist. They also handle pre-authorization for specific procedures and gather financial information on patients, ensuring they are aware of costs and have a plan for payment set in place.

Job Duties and Responsibilities

• Schedule appointments, surgeries, and medical consultations
• Maintain referral records and data reports
• Prepare patients medical records before their visit
• Communicate with insurance companies
• Manage follow-up appointments

Education and Qualifications

• HS Diploma
• Associates degree or higher
• 1+ years of medical office experience
• Must be very organized and detail oriented
• Needs to be able to work under pressure
• Excellent written and oral communication skills
• Basic knowledge of email and computer programs
• Should be familiar with medical terminology

Usually, referral specialists work full-time, but hours can vary depending on the employer. Because much of the work is done using a computer and telephone, this is mostly a sedentary position.

The prior authorization nurse is responsible for administering prospective reviews of authorization requests, which may include treatments, services, admissions, home care, and referrals. The nurses will also assist in preparing documentation, performing audits of patient records, and helping management with tasks as needed.

Job Duties and Responsibilities

• Provides clear documentation for approving requests
• Coordinate care and services for members
• Update clinical information utilizing various medical management systems
• Handles telephone requests in a timely and accurate manner
• Help with interdepartmental projects as needed
• Develop and update health plan resources and forms
• Provide training to prior authorization technicians

Education and Qualifications

• RN/LPN
• 2+ years clinical nursing experience in an intense care setting
• Experience with prior authorizations
• Basic knowledge of computers and working with software programs
• Excellent verbal and written skills
• Must be organized
• Should be a team player and have a great attitude
• Strong service orientation and professionalism

Medical technologists are licensed healthcare professionals who work in hospitals or independent labs, and use sophisticated procedures and equipment to perform tests on blood and bodily fluids. The samples are then analyzed for chemical content, cell count, drug levels, blood type, and any microorganisms like bacteria or parasites.

Job Duties and Responsibilities

• Prepare samples for examination
• Use automated equipment and specialized instrumentation
• Perform numerous tests simultaneously
• Interpret results accurately
• Deliver test results to physicians, researchers, or patients
• Cross-match blood for transfusions

Education and Qualifications

• HS Diploma or GED
• Bachelor’s Degree
• Licensure and certification vary by state
• Professional certification preferred
• Must have excellent communication skills and be detail-oriented
• Need to have the ability to use sophisticated medical equipment
• Have a flexible schedule with the ability to be on call
• Must be able to handle standing for long periods of time

Laboratory assistants work in medical laboratory settings, such as a physician’s office, research lab, clinic, or hospital under the supervision of a physician or lab personnel to collect, prepare, and assist with the examination of specimens. Many individuals accept this entry-level position to gain experience to become laboratory technicians in the future.

Job Duties and Responsibilities

• Prepare slides or cultures
• Collect specimens
• Assist with tests or experiments
• Ensure lab complies with all laws and regulations
• Control infections
• Record results and maintain logs
• Prepare various types of laboratory equipment for use
• Clean and organize lab
• Operate microscopes, machinery, meters, filters, pumps, etc.

Education and Qualifications

• HS Diploma or GED
• Phlebotomy experience
• Strong attention to detail
• Must be organized
• Should be able to understand measurements and basic mathematical calculations
• Computer skills are critical
• Can follow verbal and written instructions