New England Life Care

Role Description The Remote Authorization Specialist is responsible for obtaining and maintaining prior authorization status for NELC patient medications/therapies. The authorization specialist works closely with the clinical review department to obtain documentation needed to complete the authorization process. The authorization specialist also obtains needed documentation to support the billing department in meeting payer requirements for patient accounts. Career Ladders - Authorization Specialist – Represents an entry-level position into the department. Candidates who meet defined goals, objectives, and accomplishments can generally expect to be promoted in 2-3 years to: - Senior Authorization Specialist – Candidates who meet defined goals, objectives, and accomplishments and who demonstrate engagement and ownership of departmental and organization activities would generally expect to be promoted in 4-5 years to: - Lead Authorization Specialist – Candidates who are part of the department leadership team and who have responsibility for advanced departmental, company, and member hospital engagement. Responsibilities - Achieve performance appraisals with "meets expectations" or better. - Maintain a good record of attendance and punctuality. - No performance management deficiencies in the period. - Demonstrate independence and competence to follow Authorization Request process for all payers. - Demonstrate independence and competence to follow the Re-Authorization process. - Demonstrate independence and competence to follow the Specialty process. - Demonstrate independence and competence on all MOA's and therapies. - Demonstrate independence and competence and ability to authorize all services, document and communicate accurately on all changes of service, in CPR+ and to appropriate departments. - Demonstrate independence and competence and ability to work through a TO DO without the need for extended timeframes. - Demonstrates the ability to work within a team and independently with confident communication skills and exceptional customer service skills. - Completes three continuing education programs in the period specifically related to professional development, LEAN and/or leadership development. Qualifications - High School Diploma, or equivalent required. - Minimum of 2 years authorization, reimbursement or claims processing experience required. - Practical experience with medical terminology; CPT, ICD-9 and HCPC coding preferred. - Practical experience with Medicare, Medicaid and third-party payor contracts preferred. - Knowledge of HIPAA Privacy and Security requirements preferred. Skills - Excellent organizational skills required. - Basic accounting transaction/analyst skills required. - Demonstrated ability to identify, research, and solve problems required. - Ability to work independently as well as part of a team required. - Practical experience with Microsoft computer systems and applications, to include Word & Excel. Benefits - Remote position. - Room for growth and potential for advancement. - Health insurance. - Dental insurance. - Vision insurance. - Generous employer-matched 403b savings program. - Company paid: Life insurance, Short- and long-term disability insurance. - Paid time off. - And much more!

Role Description The Enteral PSR is responsible for assisting the clinical staff in the provision of clinical pharmacy services to NELC’s home infusion therapy enteral patients via ongoing communication with patients, caregivers, and Home Health Agency staff members. - Contacts Enteral patients at regularly scheduled intervals to review supply needs. - Documents and communicates changes in demographics, insurance, physicians, and patient’s orders in the Electronic Medical Record (EMR) and to appropriate departments. - Accurately enters delivery tickets into the EMR using Templates. - Manages all patient delivery timelines. - Communicates unexpected changes in product or supply usage to appropriate individuals (physician, home health agency, patient or caregiver). - Accurately and efficiently records important service information in the EMR. - Informs other members of NELC’s billing, reimbursement, and enteral team of changes in service. - Initial and ongoing assessments are timely and accurately completed and documented in EMR. - Keeps all Enteral orders on patient up to date and accurately recorded in the EMR. - Informs appropriate internal and external staff of changes in signed orders that are received from physicians. - Makes calls to patients regarding routine equipment swaps. - Accurately triages equipment issue calls to the appropriate staff member. - Communicates with nutritional support staff regarding patient’s formula or supply issues. - Provides assistance with follow-up activities as required by nutritional staff. - Assures patient compliance with payer regulations (i.e., Medicaid/Medicare) regarding use of approved supplies and product formula. - Makes Enteral Supply calls to patients following NELC guidelines. - Appropriately triages clinical nutrition questions and concerns to the appropriate staff member for assessment or follow-up by Registered Dietitian. - Follows NELC policies and procedures in the normal conduction of company business. - Assures that professional practice complies with state and federal regulations including, but not limited to the HIPAA Privacy and Security regulations and NELC’s Corporate Compliance Program. - Ensures that confidentiality of patient information is maintained in accordance with state and HIPAA Privacy and Security regulations. Qualifications - Previous experience in customer service field - Excellent customer service skills - Ability to communicate effectively with patients and all levels of NELC staff - Excellent organizational skills - Knowledge/practical experience with microcomputer systems such as Microsoft Office (Word, Excel, PowerPoint, Outlook) - Dependability in attendance and job performance Requirements - Previous experience in healthcare field (preferred) - Knowledge of HIPAA Privacy and Security regulations (preferred) - Knowledge of the Joint Commission process (preferred) Benefits - Remote position - Career Ladder - Health Insurance - Dental Insurance - Vision Insurance - Generous employer-matched 403b savings program - Company paid: Life insurance, Short- and long-term disability insurance - Paid Time Off - And much more!

Role Description New England Life Care is hiring a Full Time Central IV Patient Service Representative (PSR) to support our growth. The ideal candidate for this position enjoys a fast-paced environment and provides excellent customer service. If you have previous customer service and call center experience, this may be the position you have been looking for! If not, don't let that discourage you! We will train you on everything you need to know in order to be successful. This position is responsible for: - Timely and accurate patient refills, compassion and care. - Engaging clinical staff to provide pharmacy services to NELC’s patients. - Ongoing communication with patients, caregivers, and Home Health Agency staff members. This is a 40 hour per week position with a rotating weekend and holiday schedule. Weekend shifts will be paid an additional differential, and holidays worked will be 2.5 x the normal rate of pay. This is a remote position, but will require occasional travel to a branch location for training (usually once per year). Only hiring remotely in the following states: - Maine - Massachusetts - North Carolina - Rhode Island - Florida - New Hampshire Qualifications - Previous experience in customer service and/or contact center field. - Excellent customer service skills. - Ability to communicate effectively with patients and all levels of NELC staff. - Ability to manage multiple tasks simultaneously and contribute to strengthening the team environment. - Well-organized with strong attention to detail; consistently delivering quality and care. - Knowledge/practical experience with microcomputer systems such as Microsoft Office (Word, Excel, PowerPoint, Outlook). - Ability to learn internal systems to effectively perform job. - Dependability in attendance and job performance. - Displays empathy, care, and compassion. Requirements - Accurately enters delivery tickets into CPR+ to ensure accurate & timely deliveries. - Manages all patient delivery timelines and communicates unexpected changes in product or supply usage. - Accurately and efficiently records important service information within Patient’s account in CPR+ per standard operating procedures. - Makes calls to patients regarding routine equipment swaps and triages equipment issue calls. - Communicates with clinical staff regarding adverse drug reactions or supply issues & documents within CPR+. - Assures patient compliance with payer regulations regarding use of approved supplies and product formula. - Ensures patient confidentiality at all times. - Monitors all patients for delivery intervals and follows up with patients or HHA when no delivery has been requested within the past 45 days. - Demonstrates the ability to troubleshoot problems verbalized by customers. - Actively engages with internal partners to improve customer experience. - Other duties as assigned. Benefits - Career Ladder - Health Insurance - Dental Insurance - Vision Insurance - Generous employer-matched 403(b) savings program - Company paid: Life insurance, Short- and long-term disability insurance - Paid Time Off - And much more!

Role Description New England Life Care currently has multiple Remote Biller positions available. The normal schedule is Monday - Friday from 8:00am until 4:30pm. The biller is responsible for the billing of insurances and patients. Career Ladders - Biller – Represents an entry-level position into the department. Candidates who meet defined goals, objectives, and accomplishments can generally expect to be promoted in 2-3 years to: - Senior Biller - Candidates who meet defined goals, objectives, and accomplishments and who demonstrate engagement and ownership of departmental and organization activities would generally expect to be promoted in 4-5 years to: - Lead Biller – Candidates who are part of the department leadership team and who have responsibility for advanced departmental, company, and member hospital engagement. Responsibilities - Demonstrate independence and competence and ability to review and navigate patient accounts and delivery tickets. - Demonstrate independence and competence and ability to create and accept claims from clearing houses and work claim rejections. - Demonstrate independence and competence in working daily billing reports. - Demonstrate independence and competence and ability to teach basic billing knowledge, splitting claims, recognize billing and account errors, work To Do's and send out daily goal emails. - Demonstrate independence and competence and ability to bill 20 or more clean claims a day. - Demonstrate independence and competence and ability to bill using the payor sheets. - Demonstrate independence and competence and ability to teach how to navigate through patient accounts and delivery tickets. - Maintain an average of 95% or better in claim audits. - All billing queues reviewed weekly. - Billing rejections worked daily from queue. - To do's completed within 2 days. Qualifications - 3 years’ experience in healthcare setting processing healthcare provider claims or comparative experience in a healthcare setting required. - A working knowledge of government health insurance plan benefits and the rules & regulations for obtaining reimbursement required. Requirements - Knowledge of HIPAA Privacy and Security requirements. - Working knowledge of federal/state fraud and abuse laws required. - Demonstrated knowledge of medical terminology; CPT; ICD9; and HCPC coding required. - Excellent customer service skills required. - Excellent communications skills required. - Excellent organizational skills required. - Ability to work independently as well as part of a team required. - Practical experience with microcomputer systems and applications to include Microsoft Word and Excel required. - Demonstrated ability to identify, research, and solve problems required. Preferred Qualifications - Associate degree or higher. - Experience with healthcare patient accounting/billing/collections computer applications including electronic claims processing preferred. - Working knowledge of Home Infusion Therapy billing & collection preferred. Benefits - Career Ladder. - Health insurance. - Dental insurance. - Vision insurance. - Generous employer-matched 403b savings program. - Company paid: Life insurance, Short- and long-term disability insurance. - Paid time off. - And much more!

• Apply clinical skills and expertise in conjunction with established medical criteria • Maintain a thorough and comprehensive understanding of regulations, payer contracts, product lines, NELC policies & procedures • Review clinical documentation for long term government payers twice a year • Act as a liaison between internal and external customers • Determine appropriateness and effectiveness of services requested • Responsible for timely and comprehensive medical review with concise documentation • Effectively communicate coverage decisions to members, providers, and medical groups • Identify and appropriately inform Manager/Supervisor of sensitive or complex cases • Develop and maintain positive working relationships with Medical Directors, physicians, vendors • Maintain confidentiality of member and case information

Role Description New England Life Care currently has an opening for a Clinical Resource Nurse to be a lifeline, as-needed for our patients during the overnight hours. These nurses must reside in either New Hampshire, Maine, or Massachusetts. We would like these nurses to eventually be licensed in MA/NH/ME, although not an initial requirement. NELC will reimburse any costs associated with attaining additional licenses outside of the home license. The RN in this position is responsible for providing patient and VNA triage as well as subsequent coordination of care services. In addition, the RN in this position is competent in the duties of the Infusion Nurse as described by NELC, Inc. Responsibilities - Accepts patient phone calls and provides appropriate triage interventions, determines if a nursing visit is needed based on the unique situation of the patient. - If necessary, the resource nurse will coordinate a nursing visit (with NELC or Home Health Agency (HHA) nurse) in the appropriate time frame to meet the healthcare needs of the patient. - Accurately performs initial and ongoing patient assessments of home infusion/enteral therapy patients. - Provides comprehensive initial and ongoing patient and caregiver education relating to the prescribed home infusion/enteral therapy. - Effectively communicates with the scheduling team to facilitate adequate and timely PRN nursing visits. - Effectively communicates ongoing patient requirements, concerns, and/or changes in patient status / level of care to appropriate members of NELC multidisciplinary teams and on-call staff, as well as the HHA staff involved in meeting the patient’s home health needs. - Actively participates as a member of the patient’s care management team to identify and provide care coordination and/or guidance to care team, providers, and patients referred to NELC for infusion/enteral therapy, providing updated patient information as needed. - Comprehensively documents all interactions with patient and members of the healthcare team in the patient record and/or electronic progress notes. - Demonstrates competency in the use and troubleshooting of all equipment and/or supplies dispensed by NELC. - Demonstrates competency in home infusion medication administration, side effects, goals of therapy, and patient care expectations to include aseptic administration and monitoring of all therapy types provided by NELC. - Reviews needs and abilities of the patient and caregivers, participates in development and implementation of a patient specific training plan when appropriate as needed to assist Out-patient Resource team. - Assists in coordinating services with other home health agencies. - Acts as resource between NELC and all care providers. This includes, but is not limited to, the medical staff, care coordination team, and social services as needed. Qualifications - Associate degree or diploma in Nursing required. - BS in Nursing preferred. - Two (2) years intravenous therapy experience in hospital or homecare required. - Oncology experience preferred. - CRNI preferred. - R.N. license in good standing in the state(s) where providing care / services required. - Current BLS Certification required. Requirements - Valid driver’s license required. - Excellent driving record required. - Knowledge of HIPAA Privacy and Security Regulations preferred. - Knowledge of the Joint Commission accreditation process and overall JC standards preferred. - Excellent patient assessment skills required. - Working / practical knowledge of home infusion therapy administration / equipment use preferred. - Ability to communicate effectively with all customers and members of the healthcare team verbally and in writing. - Good interpersonal skills required. - Good organizational skills required. - Ability to work independently as well as a part of a team required. - Working / practical knowledge of microcomputer systems including patient documentation systems, Microsoft Office (Word, Excel, Outlook). - Dependability in attendance and job performance required. Benefits - Remote / Work From Home Position - Room for growth and potential for advancement - Generous employer-matched 403(b) savings program - Paid time off - And much more!

• Design, develop, and maintain the enterprise data warehouse architecture to support reporting, analytics, and business intelligence initiatives. • Develop dimensional data models including fact tables, dimension tables, surrogate keys, and slowly changing dimensions using industry best practices. • Design and implement ETL/ELT pipelines to extract, transform, and load data from multiple operational systems into staging, transformation, and warehouse layers. • Ensure efficient processing on an ongoing basis including data consistency of data attributes, naming conventions, and element value types. • Optimize SQL queries, indexing strategies, and database performance to ensure efficient data retrieval and warehouse processing. • Automate, schedule, and monitor data integration jobs to ensure reliable and consistent data loading processes. • Ensure data accuracy, consistency, and integrity by implementing validation checks and reconciliation processes between source systems and the data warehouse. • Collaborate with business analysts, data analysts, and technical teams to translate business requirements into scalable data models and warehouse solutions. • Provide technical expertise for business intelligence and reporting tools such as Microsoft Power BI and other analytics platforms. • Document data warehouse architecture, data models, ETL processes, and data definitions to support long-term maintainability and governance. • Identify opportunities to improve data integration processes, warehouse performance, and reporting capabilities. • Support ongoing data governance and data quality initiatives across the organization.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This position typically works Monday – Friday 8:00am until 5:00pm, 1 weekend a month and 1 holiday a year! This position will allow you to work autonomously and have a more predictable schedule. The Liaison has three primary job responsibilities: - Provides clinical assessment of patients referred by the member hospitals for home infusion therapy to determine their capabilities to safely receive services at home with NELC. - Responsible for developing and implementing strategies to capture all referrals from the member hospital’s system of care (e.g. inpatient, ambulatory, etc.). - Responsible for relationship building with hospital staff for quality coordination of care between hospital and home. NELC prides itself on fostering an environment where our nurses feel respected, appreciated, supported, and empowered to make decisions. Come join our team and see for yourself! Qualifications - Associate degree or diploma in Nursing - Two (2) years intravenous therapy experience in hospital or homecare - Excellent patient assessment skills - RN or LPN license in good standing in the state(s) where providing care/services - Valid driver’s license - Excellent driving record Requirements - BS in Nursing preferred - Current BLS Certification preferred - Knowledge of HIPAA Privacy and Security Regulations preferred - Knowledge of JCAHO accreditation process and overall JCAHO standards preferred - Working/practical knowledge of home infusion therapy administration/equipment use preferred Benefits - Commission Bonus Program - Health Insurance - Dental insurance - Vision insurance - Generous employer-matched 403(b) savings program - Company paid: Life insurance, Short- and long-term disability insurance - Discretionary Paid time off - And much more!