New England Life Care

Role Description New England Life Care is seeking a qualified Data Warehouse Developer to support the design, development, and ongoing maintenance of the organization’s enterprise data warehouse and analytics infrastructure. The Data Warehouse Developer will play a key role in building scalable data warehouse architecture, dimensional data models, and data integration pipelines that support enterprise reporting, analytics, and operational decision-making. This role will work closely with business stakeholders, analysts, and application teams to transform data from multiple operational systems into reliable and accessible information for business intelligence platforms. The ideal candidate will possess strong SQL development skills, ETL experience, and expertise in dimensional modeling (star and snowflake schemas) to support reporting and analytics initiatives across the organization. Qualifications - Bachelor’s degree in computer science, information systems, engineering, or other related discipline and/or equivalent combination of education and relevant experience. - 3+-7+ years of experience in data warehouse development. - Strong experience with Microsoft SQL Server or other enterprise relational databases. - Experience developing ETL pipelines using SSIS, Azure Data Factory, or comparable ETL tools. - Demonstrated experience designing and implementing dimensional data models. - Strong experience designing fact tables, dimension tables, surrogate keys, and slowly changing dimensions (SCD). - Advanced SQL development and query optimization skills. - Experience working with large datasets and complex data transformations. - Experience supporting business intelligence and reporting platforms such as Power BI, Tableau, or similar tools. Requirements - Knowledge of HIPAA Privacy and Security requirements. - Working knowledge of federal/state fraud and abuse laws required. - Valid driver’s license with excellent driving record required. Benefits - 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! Additional Job-Related Duties - 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. - Follow New England Life Care policies and procedures in the normal conduct of company business. - Maintain a strong understanding of software development lifecycle (SDLC) and data engineering best practices. - Ensure professional practices comply with HIPAA Privacy and Security regulations and the organization’s Corporate Compliance Program. - Build strong working relationships across departments and collaborate effectively with business and technical teams. - Demonstrate strong problem-solving skills by identifying data issues, diagnosing root causes, and implementing effective solutions. - Participate in the company Performance Improvement Program and provide recommendations for improvements based on data insights. - Assist in training or mentoring staff on data warehouse concepts, reporting tools, or data access processes as needed. - Participate in ongoing professional development through departmental meetings, technical training, and industry learning opportunities. - Perform additional duties or special projects as assigned by the direct supervisor. - Travel to remote sites as needed.

Role Description The Accounts Receivable Specialist is a REMOTE POSITION and is responsible for the follow-up, collections, and recovery of problematic accounts due from health insurance payers. The normal schedule will be Monday - Friday from 8:00am until 4:30pm. - Achieve performance appraisals with "meets expectations" or better - Demonstrate independence and competence to work basic denials - Demonstrate independence and competence in payer requirements for basic appeals - Demonstrate independence and competence and ability in submitting correct claims for payers - Demonstrate independence and competence in refund processing - Demonstrate independence and competence and ability to teach how to check claim status via phone or website - Demonstrate ability to complete on average 20 accounts per day - Demonstrate ability to work accounts timely within 2 weeks of receiving denial or needing follow up - Maintain audit percentage of 98% - Follow NELC policies and procedures in the normal conduction of company business - Assure that professional practice complies with state and federal regulations including HIPAA Privacy and Security regulations - Ensure that confidentiality of patient information is maintained in accordance with state and HIPAA Privacy and Security regulations - Effectively communicate both verbally & in writing inside and outside the organization - Take the initiative to meet internal and external customer needs in a timely and courteous manner - Establish and maintain good working relationships - Display good judgment and take initiative - Complete appropriate amount of work in a timely manner without jeopardizing quality Qualifications - A minimum of 3 years’ experience with third party health insurance claims office or plan administrator involved in processing health provider claims required - A working knowledge of government health insurance plan benefits and the rules & regulations for obtaining reimbursement required - Experience with healthcare patient accounting/billing/collections computer applications including electronic claims processing preferred - Working knowledge of Home Infusion Therapy billing & collection preferred - Practical experience with Medicare; Medicaid; and third-party payer contracts Requirements - Associates Degree or bachelor’s degree in Business Administration preferred - Knowledge of HIPAA Privacy and Security requirements - Working knowledge of federal/state fraud and abuse laws required Benefits - Remote / Hybrid Position - Career Ladders - 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!

• Obtain and maintain prior authorization status for NELC patient medications/therapies • Work closely with the clinical review department to obtain documentation needed to complete the authorization process • Obtain needed documentation to support the billing department in meeting payer requirements for patient accounts

Role Description New England Life Care is seeking a qualified Data Warehouse Developer to support the design, development, and ongoing maintenance of the organization’s enterprise data warehouse and analytics infrastructure. The Data Warehouse Developer will play a key role in building scalable data warehouse architecture, dimensional data models, and data integration pipelines that support enterprise reporting, analytics, and operational decision-making. - Work closely with business stakeholders, analysts, and application teams to transform data from multiple operational systems into reliable and accessible information for business intelligence platforms. - Possess strong SQL development skills, ETL experience, and expertise in dimensional modeling (star and snowflake schemas) to support reporting and analytics initiatives across the organization. Qualifications - Bachelor’s degree in computer science, information systems, engineering, or other related discipline and/or equivalent combination of education and relevant experience. - 3+-7+ years of experience in data warehouse development. - Strong experience with Microsoft SQL Server or other enterprise relational databases. - Experience developing ETL pipelines using SSIS, Azure Data Factory, or comparable ETL tools. - Demonstrated experience designing and implementing dimensional data models. - Strong experience designing fact tables, dimension tables, surrogate keys, and slowly changing dimensions (SCD). - Advanced SQL development and query optimization skills. - Experience working with large datasets and complex data transformations. - Experience supporting business intelligence and reporting platforms such as Power BI, Tableau, or similar tools. Requirements - Knowledge of HIPAA Privacy and Security requirements. - Working knowledge of federal/state fraud and abuse laws required. - Valid driver’s license with excellent driving record required. Benefits - 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! Additional Job-Related Duties - Follow New England Life Care policies and procedures in the normal conduct of company business. - Maintain a strong understanding of software development lifecycle (SDLC) and data engineering best practices. - Ensure professional practices comply with HIPAA Privacy and Security regulations and the organization’s Corporate Compliance Program. - Build strong working relationships across departments and collaborate effectively with business and technical teams. - Demonstrate strong problem-solving skills by identifying data issues, diagnosing root causes, and implementing effective solutions. - Participate in the company Performance Improvement Program and provide recommendations for improvements based on data insights. - Assist in training or mentoring staff on data warehouse concepts, reporting tools, or data access processes as needed. - Participate in ongoing professional development through departmental meetings, technical training, and industry learning opportunities. - Perform additional duties or special projects as assigned by the direct supervisor. - Travel to remote sites as needed.

• Oversees all financial and accounting activities. • Responsible for budget management, financial analysis, payroll, forecasting, accounts payable, and financial reporting. • Works closely with senior management to maintain company goals. • Oversee key business functions such as accounting, accounts payable, and payroll. • Creates and monitors budgets, budget variances, and forecasts. • Provide analytical, forecasting, reporting, and project support to the executive management team. • Prepares and presents financial reports and risk analysis. • Establishes and maintains financial controls within the accounting department. • Manages annual audit with outside audit firm. • Manage corporate insurance policies and renewals; interface with broker as necessary. • Analyze, document, and improve finance-related business processes. • Mentor and develop finance staff members. • Ensures compliance with state and federal regulatory requirements and professional standards. • Provides timely, constructive feedback, coaching, and progressive discipline to employees, as needed.

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