by twochickswithasidehustle | Jun 16, 2025 | Uncategorized
Description
From Intake to Outcomes, CareMetx is dedicated to supporting the patient journey by providing hub services, innovative technology, and decision-making data to pharmaceutical, biotechnology, and medical device innovators.
Job Title: Reimbursement Specialist
POSITION SUMMARY:
Under the general supervision of the operational program leadership, the Reimbursement Specialist is responsible for various reimbursement functions, including but not limited to benefit investigations, prior authorization support, and call triage. The Reimbursement Specialist responds to all provider account inquiries, appropriately documents all provider, payer and client interactions into the CareMetx Connect system and ensures that the necessary data for prior authorization request are obtained.
PRIMARY DUTIES AND RESPONSIBILITIES:
- Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program.
- Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications.
- Completes and submits all necessary insurance forms in a timely manner as required by all third party payors for prior authorizations. Tracks and follow up on prior authorization request.
- Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
- Maintains frequent phone contact with provider representatives, third party customer service representatives, and pharmacy staff.
- Reports any reimbursement trends/delays to supervisor.
- Processes any necessary insurance/patient correspondence.
- Provides all necessary documentation required to expedite prior authorization request. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians.
- Coordinates with inter-departmental associates as necessary.
- Communicates effectively to payors to ensure accurate and timely benefit investigations.
- Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action.
- Reports all Adverse Events (AE) disclosed in alignment with training and Standard Operational Procedures (SOP)
- Typically receives little instruction on day-to-day work, general instructions on new assignments.
- Other duties as assigned – Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
Requirements
Qualifications
EXPERIENCE AND EDUCATIONAL REQUIREMENTS:
- High School, Diploma, or GED required
- Previous 1+ years of experience in a specialty pharmacy, medical insurance, physician’s office, healthcare setting, and/or related experience.
MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
- Ability to communicate effectively both orally and in writing.
- Ability to build productive internal/external working relationships.
- Strong interpersonal skills.
- Strong negotiating skills.
- Strong organizational skills; attention to detail.
- General knowledge of pharmacy benefits, and medical benefits.
- Global understanding of commercial and government payers preferred.
- Ability to proficiently use Microsoft Excel, Outlook and Word.
- Ability and initiative to work independently or as a team member.
- Ability to problem solve.
- Strong time management skills.
- Customer satisfaction focused.
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.
- The employee must occasionally lift and/or move up to 10 pounds.
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.
Schedule
- Must be flexible on schedule and hours
- Overtime may be required from time to time
- Must be willing to work weekends if required to meet company demands
CareMetx considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply.
At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.
CareMetx is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.
Salary Description
$30,490.45 – $38,960.02
by twochickswithasidehustle | Jun 14, 2025 | Uncategorized
Experienced gift wrappers for holiday, remote and internship jobs. You must follow brand, be on brand, and love the creative and client experience.
Description
Full Job Description
Experienced gift wrappers for holiday, remote and internship jobs. You must follow brand, be on brand, and love the creative and client experience. Details matter and you will be a part of a growing company with other women across the nation. We work as a team remotely, presenting a professional appearance and not afraid to talk and be creative however, on brand. You will be responsible to wrap gifts of all different shapes and sizes, sometimes driving to the location and setting up to wrap. You will be responsible to communicate to the client and to the company.
This could be an internal destination, or into a shipping or delivery process. As a responsible and amazing person, you can be responsible for receiving, unpacking, processing, organizing, storing, packaging, labeling merchandise. and gift wrapping.
Experienced Gift Wrapper Associate Duties & Responsibilities
Duties and responsibilities include the following:
- Ensure that products all tags off, labeled properly, and properly distributed if needed.
- Ensure that products are safely packaged and gift wrapped.
- Organize the paper, ribbon, and ensure accurate labeling, logical placement, neat arrangement, and cleanliness and have fun!
Education, Training, & Certification
- Education: High school diploma or GED equivalent. Can be an intern job for a season.
- Background checks: This position can have access to large quantities of new merchandise, so most employers will require some combination of criminal, background, credit, and driving record screenings. A valid driver’s license and a clean driving record will also be required if driving is required for the job.
- Experience:This could be an entry level position. Previous gift wrapping, stock, receiving, inventory, or retail experience is preferred but not required
Gift Wrapping Skills & Competencies
- Organization and multitasking skills: High levels of efficiency and engagement are required while performing repetitive tasks although fun and creative.
- Communication skills:You should be able to clearly communicate specifications to co-workers, orally and in writing.
- Computer skills:A basic understanding of Microsoft programs such as Excel, Access, and Outlook would be helpful, along with experience with other inventory-specific software programs. Best would be Canva, photography and social media.
Work Environment
This isn’t a career for those who prefer to avoid physical exertion. The job usually requires standing or walking for up to eight hours at a time and requires the handling of merchandise, supplies, and materials, which can be physically demanding.
Salary
$18 – $20 per hour
by twochickswithasidehustle | Jun 13, 2025 | Uncategorized
Department:
Revenue Integrity
Job Description:
General Description: Under general supervision, may participate in any or all aspects of the patient processing and accounts receivable functions of the organization including billing, charge entry, collection, registration, scheduling, follow-up, coding, payment posting and credit balance resolution. May reconcile daily IDX system receivables reports. May balance monthly transactions and provide summaries to faculty and department administration.
Essential Responsibilities:
- Patient scheduling
- Patient registration
- Review patient admitting records and extracts relevant information
- Records patient identification and demographic information in the computerized billing system
- Contacts agency representatives to verify type and extent of coverage.
- Charge entry
- Performs preliminary review of source documents to determine that sufficient data are present for processing
- Using alphanumeric keyboard, transcribes and/or verifies data from source documents to the medium used for entering data into the computer
- Batch charges
- Generate cash totals
- Enter charges
- Balances batches by comparing batch proofs to source documents and hash totals
- Billing
- Works with all areas of the organization in getting any necessary or requested documentation for patients, insurance carriers or other areas.
- May interact with hospital patient accounting or records personnel to obtain patient demographic or other billing information
- Operates hospital information system terminal to obtain patient demographic information, patient insurance information and status of approvals or denials
- Completes processing of all inpatient and outpatient documents received on a daily basis
- Assists in resolving department problems with IDX billing
- Maintains records of charges, payments, third party charges, etc.
- Collection
- Answers patient’s questions regarding statements, agency coverage, etc.
- Handles correspondence regarding collection activity and records results
- Identify patient accounts for collection action when accounts become delinquent or when unable to contact patient or responsible party
- May receive patient payments and/or issue payment receipts
- Coding
- Record CPT codes on billing form
- Record ICD-9 codes on billing form
- Follow-up
- Initiates contact with patients and/or third party carriers if there is a delay in responding to statements or claims
- May process incoming and outgoing mail
- May receive incoming telephone calls and resolve issues communicated
- Records results of mail and telephone contacts on the computer billing system
- Contacts insurance carriers regarding non-payment and/or improper payment of claims
- Reviews denials
- Interfaces with patients, physicians, and others regarding professional billing operations and funds
- Payment posting
- Post receipts to proper patient accounts
- Posts denials
- Compare batch proofs and source documents for accuracy
- Reporting
- Assists in reviewing and balancing IDX transaction reports for administration
- Reconciles daily IDX receivables reports
- Prepares billing statements from statistical data
- Credit balance resolution
- Review daily billing and accounts receivable credit balance reports
- Prepare daily refund check requests
- Prepare other daily credit balances other than refunds
- Post refund checks to patient accounts
- Mail refund checks with supporting documentation
General Responsibilities:
- Performs other duties as assigned.
Minimum Requirements:
Education: High School Diploma or GED.
Experience: 3-5 years of experience in Medical Billing, Medical Collections, Medical Billing Systems (IDX or other billing system) required.
Licensure/Certifications/Registrations Required: None required.
Knowledge, Skills, and Abilities:
- Attention to detail
- Excellent verbal and written communication skills
- Proficient with the use of Microsoft Office tools
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