by twochickswithasidehustle | Jun 20, 2025 | Uncategorized
Join us for an exciting career with the leading provider of supplemental benefits!
Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.The Appeals and Grievances Coordinator serves as the primary point of contact for members, providers and clients regarding their appeals and grievances, providing updates and ensuring clear communication throughout the process. In this role, the Appeals and Grievance Coordinator will collaborate with internal teams, including claims, provider relations, and customer service, to resolve issues effectively. The Appeals and Grievance Coordinator is accountable for the timely, accurate, compliant, and complete review and resolution of Medicaid Dental and Vision Appeals and Grievances Cases.
Competencies:
Functional:
- Manage the full appeals process, ensuring timely and effective resolutions.
- Speak to members and providers regarding details of cases and requests or next steps, with empathy and compassion.
- Analyze case details and make informed decisions based on regulatory requirements.
- Maintain accurate and organized records of all appeals and grievance cases.
- Utilize electronic health records and claims processing systems.
- Apply regulatory guidelines and compliance standards related to dental and vision services.
- Stay current with policy changes and effectively implement them.
- Ability to prioritize tasks to ensure compliance with turnaround time requirements.
- Proficient in analyzing data trends to identify issues and recommend improvements.
Core:
- Excellent verbal and written communication skills, with the ability to convey complex information clearly.
- Strong interpersonal skills to effectively interact with members and internal teams.
- Strong analytical and critical thinking skills to assess situations and develop effective solutions.
- Ability to manage multiple cases and priorities efficiently.
- High level of attention to detail in reviewing case information and documentation.
- Ability to identify discrepancies and ensure compliance.
- Ability to work collaboratively with cross-functional teams to achieve common goals.
- Strong relationship-building skills to foster a supportive work environment.
Behavioral:
- Collegiality: building strong relationships with internal and external clients and customers, approachable and helpful, ability to mentor and support team growth.
- Initiative: readiness to lead or take action to achieve goals.
- Communicative: ability to communicate issues, concepts, and ideas effectively, both verbally and in writing.
- Member-focused: going above and beyond to make our members feel seen, valued, and appreciated.
- Detail-oriented and thorough: managing and completing details/documentation of case assignments with a risk-management mindset.
- Flexible and responsive: managing new demands, changes, and situations in a quality-centric manner.
- Critical Thinking: effectively troubleshoot complex issues, problem solve, and multitask.
- Integrity & responsibility: acting with a clear sense of accountability, maintaining the integrity of the organization, your work as well as the work you do on behalf of our clients, providers and enrollees.
- Collaborative: ability to represent departmental or individual interests and needs with a holistic, helpful, and collaborative approach.
Minimum Qualifications:
- High School Diploma or equivalent
- 2+ years of experience in appeals and grievances within the dental, vision, or insurance industry.
- Proficiency in Microsoft Office Suite and experience with claims processing systems.
- Must be flexible to work a Saturday shift if required.
- As this role is a remote role, you are required to maintain internet service that allows you to complete your essential job duties without issue. Rates of 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient.
Preferred Qualifications:
- Bachelor’s degree in healthcare administration, Business, or a related field.
- Fluent in communicating both verbally and in writing in both English and Spanish.
- 1+ year of experience in a dental and vision and/or optical office.
- Registered Dental Hygienist, Dental Assistant, or Expanded Function Dental Assistant. Ophthalmic Assistant, Certified Ophthalmic Assistant, or Optometric/Paraoptometric Assistant.
- Strong understanding of Medicaid and Medicare regulatory guidelines.
FLSA Status: Hourly / Non-Exempt
National Hourly Rate Range: $18.34 – $35.85
Bonus Eligible: Annual Hourly Incentive Plan (AHIP)
How To Stay Safe:
Avesis is aware of fraudulent activity by individuals falsely representing themselves as Avesis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.
Avesis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during our process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avesis recruiters will come from a verified email address ending in @Avesis.com.
We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to [email protected].
To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam). If you believe you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avesis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.
We Offer
- Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
- Competitive compensation package.
- Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
- Life and disability insurance.
- A great 401(k) with company match.
- Tuition assistance, paid parental leave and backup family care.
- Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
- Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
- Employee Resource Groups that advocate for inclusion and diversity in all that we do.
- Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.
by twochickswithasidehustle | Jun 20, 2025 | Uncategorized
Join us for an exciting career with the leading provider of supplemental benefits!
Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.The Billing & Collection Specialist plays a key role in the management of accounts receivable by
managing and overseeing the invoicing process, ensuring timely payment from customers and handling delinquent accounts. This position will work closely with the finance team, customers and other departments to resolve billing issues and maintain accurate financial records. The company supports a range of insurance types and products. This role is responsible for both the governmental and commercial accounts as well as both vision and dental within both types of accounts.
This role involves generating accurate invoices, resolving billing discrepancies, and collaborating with clients to address inquiries. The Billing & Collections Specialist will report to the Finance Operations Accounting Manager and will support management of the accounts receivable in the organization. This role will work with both internal and external customers to address and resolve any billing and cash application questions. The ability to understand the system generated bill and explain the logic behind how the bill was calculated is critical to being successful in this role.
Competencies:
Functional:
The position performs the following which will evolve as system implementations are completed:
- Generate accurate and timely invoices for clients both utilizing the system and manual inputs.
- Utilize strong organizational skills to manage multiple billing tasks and deadlines.
- Review and monitor customer accounts for outstanding balances and overdue payments.
- Identify delinquent accounts and initiate the collections process.
- Investigate and resolve disputes or discrepancies related to invoicing or payment.
- Collaborate with clients to address billing inquires and provide exceptional customer service.
- Process payments and reconcile accounts receivable on a regular basis.
- Work closely with other departments to obtain necessary information for billing.
- Participate in the implementation of billing and collection process improvements and maintain efficient billing and collection procedures.
- Manage assigned team mailbox: file, organize and ensure requests are addressed timely.
- Solid understanding of billing and collection processes.
- Ability to work with billing and collection systems, run billing processes, and correct for billing errors.
- Support audit requests as needed.
- Provide exceptional customer service to external and internal customers.
Core:
- Strong math skills, ability to understand relationships between various amounts flowing through accounts.
- Detail oriented – understand the billing details to address and resolve inquiries.
- Critical thinking – ability to reason through requests.
- Problem solving – tackle new items that involve, walk backwards through a process, or use current knowledge in a new way to resolve the request.
- Time management – efficient time management to meet deadlines and targets.
- Intermediate Excel – filtering, sorting, and creating basic formulas, using pivot tables and VLookup.
- Professional judgement – when to question, ask a question or make the decision.
- Ability to work independently and contribute to broader team objectives.
- Ability to multitask and manage time amid multiple deadlines.
- Capable of operating in a fast-paced and transformational environment.
- Excellent written and verbal communication skills to interact with customers, internal teams, and management.
Behavioral:
- Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth.
- Initiative: readiness to lead or take action to achieve goals.
- Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing.
- Member-focused: going above and beyond to make our members feel seen, valued, and appreciated.
- Detail-oriented and thorough: managing and completing details of assignments without too much oversight.
- Flexible and responsive: managing new demands, changes, and situations.
- Critical Thinking: effectively troubleshoot complex issues, problem solve and multi-task.
- Integrity & responsibility: acting with a clear sense of ownership for actions, decisions and to keep information confidential when required.
- Collaborative: ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable solution for all parties.
Minimum Qualifications:
- High School Diploma or Equivalent required.
- 2+ years of professional experience in billing & collections or accounts receivable required.
- Proficiency with MS Excel required.
- As this role is a remote role, you are required to maintain internet service that allows you to complete your essential job duties without issue. Rates of 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient.
- Associate degree in accounting or finance preferred.
FLSA Status: Hourly/ Non-Exempt
National Hourly Rate Range: $16.68 – $32.59/hour
Bonus Eligible: Annual Hourly Incentive Plan (AHIP)
by twochickswithasidehustle | Jun 20, 2025 | Uncategorized
Description
American Specialty Health, Inc. is seeking a Fitness Reimbursement Examiner to join our Fitness Reimbursement department. The primary purpose of this position is to enter data from fitness and exercise center billing reports into the Reimbursement Processing System. This position is responsible for the accurate review, input and adjudication of reimbursement requests in accordance with regulations, ASH standards and contractual obligations of the organization.
Responsibilities
- Processes reimbursement requests accurately and efficiently.
- Reviews all incoming reimbursement requests to verify necessary information.
- Enters reimbursement requests and information into a computerized request Processing System.
- Maintains all required documentation of reimbursement requests processed and reimbursement requests on hand.
- Adjudicates reimbursement requests in accordance with departmental policies, procedures, state and accreditation standards and other applicable rules.
- Maintains minimum production standard, 98.5%.
- Provides backup for other examiners within the department.
- Promotes a spirit of cooperation and understanding among all personnel.
- Attends organizational meetings, as required.
- Adheres to organizational policies and procedures.
- Maintains confidentiality of all files, reimbursement request reports, and reimbursement request related issues.
Qualifications
- High school diploma required.
- 10 key and word processing; minimum 10,000 key strokes per hour required with 95% accuracy.
- Data Entry Experience.
- Proficient in MS Office.
- Ability to recognize unique and/or problem situations and brings to attention of Supervisor.
- Demonstrated ability to meet department performance standards and quality improvement processes.
Core Competencies
- Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
- Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
- Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
- Ability to effectively organize, prioritize, multi-task and manage time.
- Demonstrated accuracy and productivity in a changing environment with constant interruptions.
- Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
- Ability to exercise strict confidentiality in all matters.
Mobility
Primarily sedentary, able to sit for long periods of time.
Physical Requirements
Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.
Environmental Conditions
Work-from-home (WFH) environment.
American Specialty Health is an Equal Opportunity/Affirmative Action Employer.
All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law.
Please view Equal Employment Opportunity Posters provided by OFCCP here.
If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.
ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.
by twochickswithasidehustle | Jun 20, 2025 | Uncategorized
Join Our Team at Peachtree Orthopedics and Help Others “Get Better”
At Peachtree Orthopedics, we’re on a mission to make a difference in healthcare, and we’re looking for dedicated individuals to join our team. With nine convenient offices across Greater Atlanta, we’re committed to providing top-notch care and your skills and passion can make a real impact. We’re not the largest practice in Atlanta, but we take pride in delivering dedicated and compassionate care to everyone who walks through our doors. If you’re ready to be part of a team that values your contribution and offers room for growth, consider joining us in our mission to help others “Get Better.”
Our Culture
Peachtree Orthopedics has a rich history of 70 years in business and has earned recognition as a Top Workplace by the Atlanta Journal Constitution for 6 consecutive years. We take pride in our family-oriented, dedicated, passionate, and hardworking culture. When you join our team, you become a part of a community that values excellence in healthcare while working in a supportive and nurturing environment.
Why Choose Peachtree Orthopedics?
At Peachtree Orthopedics, we offer more than a job; we offer an opportunity to be part of something extraordinary:
- Limitless Growth: Propel your career with abundant professional development opportunities within our dynamic organization.
- Empathetic Culture: Immerse yourself in a supportive, lively work culture that values your well-being and celebrates your contributions.
- Dedication to Excellence: Join a team of like-minded individuals who share your commitment to delivering top-notch care to our cherished patients.
Your Impactful Role
The Credentialing Clerk is responsible for assisting with filing/maintaining the files of physicians, allied health professionals, data entry into credentialing software Credential My Doc, and other key clerical functions of the Credentialing Department. The credentialing clerk will be assisting with attestations for Council for Affordable Quality Healthcare (CAQH) Universal Data Base and creating files for providers, answering requests for any documents needed with proper discretion as well as filing any documents received.
- Communicating with external and internal customers of completing requests for practice verifications on required excel spreadsheets for providers and practice locations such as Paradigm, Corvel, Coventry or all other insurance plans.
- Printing and faxing documents upon request as needed.
- Assisting with restructuring the Credentialing files of providers at the Credentialing Manager’s discretion.
- The credentialing clerk will be assisting with attestations for CAQH Universal Data Base and creating files for providers, answering requests for any documents needed with proper discretion as well as filing any documents received.
Qualifications
- High School Degree or College Degree preferred
- Knowledge of MS Word, MS Excel, Outlook, Anodyne Analytics, and Athena software.
- Certified Professional Coder (CPC) preferred
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit; use hands to handle or feel; reach with hands and arms; and to talk or hear. The employee is occasionally required to stand, walk; and stoop, kneel, crouch, or crawl. These duties could require the ability to lift files, open file cabinets and bend or stand as necessary. The employee must occasionally lift and/or move up to 30 pounds. The employee will operate a keyboard, calculator, telephone, copy machine, computer and other office equipment as necessary. Specific vision abilities required by this job include close vision.
It is necessary to view and type on computer screens for long periods of time and to work in an environment which can be very stressful.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Must be able to deal with aggressive, hostile and sometimes irrational behavior of patients and family members and have the ability to respond to all patients in a calm and professional manner.
Peachtree Orthopedics is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees..
by twochickswithasidehustle | Jun 20, 2025 | Uncategorized
Job Details
Description
The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel.
This is a remote position.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
- Receives claims, confirms policy coverage and acknowledgment of the claim
- Determines validity and compensability of the claim
- Establishes reserves and authorizes payments within reserving authority limits
- Manages non-complex and non-problematic medical only claims and minor lost-time workers’ compensation claims under close supervision
- Communicates claim status with the customer, claimant and client
- Adheres to client and carrier guidelines and participates in claims review as needed
- Assists other claims professionals with more complex or problematic claims as necessary
- Requires regular and consistent attendance
- Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program (“IIPP”)
- Additional projects and duties as assigned
KNOWLEDGE & SKILLS:
- Excellent written and verbal communication skills
- Ability to learn rapidly to develop knowledge and understanding of claims practice
- Ability to identify, analyze and solve problems
- Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets
- Strong interpersonal, time management and organizational skills
- Ability to meet or exceed performance competencies
- Ability to work both independently and within a team environment
EDUCATION & EXPERIENCE:
- Bachelor’s degree or a combination of education and related experience
- Minimum of 1 year of industry experience and claims management preferred
- State Certification as an Experienced Examiner
PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $51,807 – $83,551
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
ABOUT CORVEL
CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
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