The laboratory specimen processor is responsible for a variety of tasks, which include specimen receiving and sorting, lab support, and test data entry. This position requires a considerable amount of flexibility, attention to detail, and accuracy.

Job Duties and Responsibilities  

• Receive and open specimen bags
• Enter inventory, patient demographics, and test codes into computer system
• Prepare specimens for laboratory testing and analysis
• Ensure specimens and requisitions are correctly labeled
• Validate requisitions against specimens before scanning into the system
• Will be responsible for cross-contamination potentials
• Must clean and maintain laboratory and all equipment

Education and Qualifications

• HS Diploma, GED, or 1+ years of similar work experience
• Must possess excellent organizational skills, attention to detail, and PC experience
• Previous laboratory experience is a plus
• Should be able to work independently and in a team
• Needs to be able to handle working in a fast pace, repetitive environment
• Have a flexible schedule to accommodate business needs
• Must be dependable and punctual

The enrollment representative serves as a liaison between the company and its members and providers. You will be expected to respond to and resolve questions and issues from current and prospective members or their representatives, providers, and other relevant parties.

Job Duties and Responsibilities

• Responds to member and provider inquiries by phone, email, or walk-in
• Demonstrates appropriate soft-skills including empathy, active listening, courtesy, politeness, helpfulness, etc.
• Records, investigates, and resolves member complaints
• Educates new members and re-educates existing members regarding health plan procedures
• Logs, tracks, and documents all issues in accordance with all applicable guidelines
• Demonstrates skills necessary to perform exceptional customer experience
• Works error and exception reports in a timely manner
• Processes and creates eligibility lists and reports

Education and Qualifications   

• HS diploma or GED
• 6+ months of healthcare call center or customer service experience
• Strong background in enrollment/eligibility
• Knowledge of claims processing
• Strong ability to multitask
• Good telephone skills
• Knowledge of Microsoft programs

As an enrollment representative, you will work to ensure members receive a level of service that goes beyond their expectations.

As a health coach, you are responsible for guiding members through any diet and lifestyle changes. You will provide patients with the necessary tools needed to meet their preventative, chronic, and acute care needs by engaging and encouraging them to take responsibility for their health through the adoption of lifelong healthy behaviors.

Job Duties and Responsibilities

• Acts as a health coach for patients
• Meets minimum standards for productivity and clinical results
• Provides assessments of new participants for determining clinical risk
• Maintains accurate and timely documentation in member management software
• Acts as a case manager when integrating with other health care service vendors
• Completes required reports in a timely manner
• Enhances clinical and counseling knowledge by attending training sessions
• Handles confidential forms appropriately

Education and Qualifications

• HS diploma or GED
• Must be a Registered Dietician
• Must possess excellent phone, written, and computer skills
• Experience in a service environment is a plus
• Needs to be compassionate, kind, and open-minded

Health coaches have an especially impactful role by assisting in ongoing care, which can enhance patient experiences and improve outcomes overall.

The grievance and appeals representative is responsible for reviewing, analyzing, and processing policies associated to claim events to establish what the company’s liability and entitlement will be. Grievances are complaints made regarding providers or how a benefit decision was determined.

Job Duties and Responsibilities

• Research complaints (grievances) and log and track the information as it moves through the clinical process or is tasked through internal contacts
• Contact customers to collect information and communicate disposition of the case, document all interactions
• Review cases to determine if it needs further review by a clinician
• Use sound, fact-based decision-making skills to render a decision for non-clinical complaints
• Use appropriate templates to complete necessary documentation for final appeals or grievance determination
• Relay appeal or grievance information to members, providers, and internal/external parties within the appropriate timeframe
• Create weekly statistical reports and prepares appeal hearings

Education and Qualifications

• HS diploma or GED
• 1+ year of work experience in a similar environment
• Strong written communication skills, especially with grammar and spelling
• Attention to detail and accuracy
• Strong computer skills, must be able to run reports and manipulate/track/log data
• Knowledge of Microsoft programs and CMS Guidelines
• Experience with healthcare, medical, or pharmacy terminology is preferred

To be successful in the appeals and grievance representative role, you’ll need to possess strong analytical skills and effectively interact with other departments to attain original claims processing details.

Accounts receivable representatives provide financial, clerical, and administrative services to ensure efficient, timely, and accurate payment of accounts.

Job Duties and Responsibilities

• Collect on refunding/crediting balances, workers compensation, corporate billing accounts, self-pay, travel health insurance claims, and insurance collections
• Collect on drug screens and pre-employment physicals for corporate accounts
• Accurately and thoroughly document the relevant collection activity performed
• Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers
• Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory
• Inform management of any issues such as payer, system, or escalated account.
• Respond promptly to telephone messages and emails as needed

Education and Qualifications

• High school diploma or GED equivalent
• (6) months- 1+ years of healthcare insurance collections
• 2+ years of medical AR/collections and billing experience
• Experience with processing refunds and denials
• Great data entry skills
• Organized with great attention to detail

General math skills

A phlebotomist draws blood from patients. After the blood is drawn, a phlebotomist takes the blood samples to the laboratory to check for further health issues such as disease, bacteria, cholesterol, etc.

Job Duties and Responsibilities

• Collect blood samples from patients
• Verify test demands by comparing information with nursing station log, as well as informing unit personnel of any discrepancies
• Read patient identification to verify patient
• Use the best method for drawing blood depending on the patient
• Collect therapeutic drug monitoring analysis
• Practice infection control requirements at all times when working with patients and equipment
• Track collected specimens and initial, date, and note times of collection
• Monitor glucose levels, record results, and report them to the unit nurse manager
• Contact the physician, pathologist, nursing station, or reference laboratory to resolve unusual test orders

Education and Qualifications

• High school diploma or GED equivalent (Associates degree preferred)
• Must possess a valid state phlebotomy certification
• Strong attention to detail

Excellent patient service and relationship skills

A Durable Medical Equipment (DME) nurse case manager is responsible for coordinating with medical providers, injured workers, and carriers through the management of the DME process. The goal of the case manager is to facilitate DME needed for medical purposes by patients for self-care in a home setting.

Job Duties and Responsibilities

• Requests for prior authorization of DME
• Review provider requests by telephone or through fax to ensure medical necessity for services that require pre-authorization
• Assist in ordering medical equipment needed for patient during recovery from surgery or for long-term use
• Apply nationally recognized criteria to determine medical necessity of services requested
• Refer provider requests appropriately to the medical director when medical obligation of services is not met based on criteria

Education and Qualifications

• High school diploma or GED equivalent
• Possess good communication skills
• Attention to detail
• Must have previous DME/Utilization Review/Prior Authorization experience
• Management experience is preferred
• Must be computer proficient: Microsoft Office, Word, and Excel, typing skills 30 WPM or above

A biller submits and follows up on claims with health insurance companies to receive payments for services performed by a healthcare provider. Biller’s may work in physician offices, hospitals, nursing homes, or other healthcare facilities.

Responsibilities

• Process and follow up on claims that have been sent to health insurance companies
• Assemble all data concerning a healthcare bill
• Communicate with physicians and other healthcare professionals
• Implement best practices for insurance and patient collections
• Review patient bills for accuracy and completeness
• Call insurance companies regarding discrepancies in payments
• Set up payment plans for patients and work collection accounts

Skills

• Knowledge of billing/collection practices
• Must be able to read medical records
• Effective communication and customer service skills
• Must be well organized and detail-oriented
• Answer calls in a pleasant and helpful manner
• Must be able to operate a computer and basic office equipment
• Understand various types of insurance carriers along with claim requirements

Education and Experience

• High school diploma or GED
• Experience with a medical office setting
• Knowledge of business and accounting processes

The financial health of a practice depends significantly on the work done by the billing office. Billers must understand all areas involving medical insurance to maximize the revenue performance of a practice successfully.

Document specialists are in charge of storing data and records for document retrieval and archives. Certain documents can aid in legal matters where company compliance is concerned involving internal and external policies and procedures.

Responsibilities

• Store, catalog, and retrieve documents
• Maintain the integrity of documents through a quality assurance process
• Update document revisions
• Check for accuracy and prevent mistakes before submitting documents
• Manage document storage and retrieval systems
• Make time sensitive outbound calls to members
• Prepare and scan health assessments
• Train employees on how to run an efficient operation

Skills

• Must be well-organized and detailed-oriented
• Should be able to handle a high volume of documents
• Possess excellent written, verbal, and listening skills
• Must be able to work in a fast-paced environment
• Communicate efficiently and professionally over the phone and in person

Education and Experience

• High school diploma or GED
• (1) year or more of administrative experience
• (6) months or more of experience scanning forms and paperwork

A licensed insurance agent helps generate new business by contacting potential customers, selling different types of insurance, and assisting clients in choosing plans that will fit their lifestyle needs. Various types of insurance may include life, property, casualty, and health.

Responsibilities

• Complete enrollment and plan change applications
• Aid clients with questions regarding premiums, effective dates, and policies
• Interview prospective clients to determine specific needs
• Track leads, client status, and follow-ups
• Perform administrative tasks

Skills

• Must be able to multi-task
• Possess excellent written, verbal, and listening skills
• Communicate efficiently and professionally over the phone and in person
• Must be efficient and organized
• Calculate insurance premiums or awards

Education and Experience

• High school diploma or GED
• Must be computer literate
• 215, 218, or 240 Agent Department of insurance license required
• (6) months or more of previous sales or call center experience
• Previous experience in the insurance industry