Pay range: $22.30 - $30.11 per hour, based on experience. In addition, this role is eligible to work remotely from an approved state by St. Charles (please refer to the list). If you do not reside in an approved listed state (or do not plan to relocate to an approved listed state) we request, you do not apply for this particular position. Approved states by St. Charles: Oregon, Arizona, Arkansas, Florida, Idaho, Missouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Tennessee, Utah, and Wisconsin. About St. Charles Health System: St. Charles Health System is a leading healthcare provider in Central Oregon, offering a comprehensive range of services to meet the needs of our community. We are committed to providing high-quality, compassionate care to all patients, regardless of their ability to pay. Our values of compassion, excellence, integrity, teamwork, and stewardship guide our work and shape our culture. What We Offer: Competitive Salary Comprehensive benefits including Medical, Dental, Vision for you and your immediate family 403b with up to 6% match on Retirement Contributions Generous Earned Time Off Growth Opportunities within Healthcare ST. CHARLES HEALTH SYSTEM JOB DESCRIPTION TITLE: Insurance Biller 2 REPORTS TO POSITION: Claims Supervisor DEPARTMENT: Single Billing Office DATE LAST REVIEWED: August 2024 OUR VISION: Creating America’s healthiest community, together. OUR MISSION: In the spirit of love and compassion, better health, better care, better value OUR VALUES: Accountability, Caring and Teamwork DEPARTMENTAL SUMMARY: The Single Billing Office (SBO) at St. Charles Health System (SCHS) provides revenue cycle services to our multi-hospital and medical group organization focusing on billing, collecting, and posting revenue. The goal of the SBO is to deliver a delightful, transparent, and seamless experience to patients and customers that captures and collects the revenue earned by SCHS in a quality, efficient and timely manner. Services include but are not limited to: billing insurance claims, posting insurance and patient payments, resolving insurance denials, collecting unpaid insurance claims, maintaining payer contracts in the electronic health record (EHR), resolving under and over payments, identifying and resolving payer issues, processing refunds, processing financial assistance applications, billing patients, resolving patient accounts including patient questions, and vendor management: lockbox, clearinghouse, early out, collection agencies. POSITION OVERVIEW: The Insurance Biller 2 position is an intermediate position responsible for intermediate billing tasks including resolving claim edits, addressing billing related do not bill (DNB) and stop bills, resolving payer rejections (277 or DDE), and splitting or combining claims. The level 2 position requires an intermediate understanding of payer reimbursement methodologies, standard billing guidelines, and EHR functionality. This position may work with internal and external stakeholders including SBO teams, other St Charles departments, and community entities if appropriate. This position does not directly supervise any other caregivers. ESSENTIAL FUNCTIONS AND DUTIES: Bill facility (HB) and professional (PB) claims to insurance payers or other entities per SBO standard work. Submit basic itemized statements, medical records, and other required information to insurance payors via clearinghouse, mail, or other electronic means. Verify and update insurance coverage as applicable using EHR tools, payer websites, or via phone calls to payers. Resolve complex billing related claim edits within EHR, DNBs and Stop Bills. Resolve complex payer rejections including Medicare return to provider (RTP) and clearinghouse rejections (277’s). Split and combine claims as required by payer. Obtain ICN’s for pending corrected claims using EHR tools, payer websites, other resources (clearinghouse or lockbox), or via phone call to payers. Apply intermediate knowledge of current reimbursement methodologies as defined by department complexity matrix. Apply intermediate knowledge of billing requirements as defined by department complexity matrix. Process late charges using the late charge functionality. Generate and release medical records. Split charges to a separate HAR or liability bucket and combine charges to a single HAR as needed. Submit corrected claims. Update claim information including ICN, authorizations, billing information, or other required claim elements. Review and resolve billing correspondence. Enter clear and concise documentation in the patient health information system. Obtain and maintain knowledge of current billing requirements and any changes via payer newsletters, payer workshops, payer webinars, or other applicable source. Attend applicable meetings including payer meetings and educational opportunities as appropriate. Support the vision, mission, and values of the organization in all respects. Support Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change. Provide and maintain a safe environment for caregivers, patients, and guests. Conduct all activities with the highest standards of professionalism and confidentiality. Comply with all applicable laws, regulations, policies, and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings. Deliver customer service and/or patient care in a manner that promotes goodwill, is timely, efficient, and accurate. May perform additional duties of similar complexity within the organization, as required or assigned. EDUCATION Required: High school graduate or GED Preferred: Course work in medical terminology or other revenue cycle functions such as RHIT or medical coding. LICENSURE/CERTIFICATION/REGISTRATION Required: N/A Preferred: Certified Healthcare Financial Professional (CHFP), Certified Revenue Cycle Representative (CRCR), Certified Specialist Account and Finance (CSAF), Certified Specialist Payment and Reimbursement (CSPR), Registered Health Information Technician (RHIT), Certified Coding Specialist Physician Based (CCS-P), Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Professional Coder (CPC), Certified Professional Biller (CPB). EXPERIENCE Required: Three years of healthcare experience, of which two years must have been in billing or equivalent role. One year of healthcare experience may be substituted with an applicable certification (RHIT, Medical coding, etc.). One year of Epic experience. Preferred: Two years of Epic experience. PERSONAL PROTECTIVE EQUIPMENT Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely. ADDITIONAL POSITION INFORMATION: Knowledge of standard billing requirements. Intermediate knowledge of payer reimbursement methodologies. Basic skills in Microsoft Office applications including Excel, One Note, Outlook, and Word. Problem solving and research skills. Strong communication skills including ability to articulate complex technical issues impacting billing. PHYSICAL REQUIREMENTS: Continually (75% or more): Sitting, keyboard operation, use of clear and audible speaking voice and the ability to hear normal speech level. Frequently (50%): Standing, lifting 1-10 pounds, grasping/squeezing. Occasionally (25%): Bending, reaching overhead, carrying/pushing or pulling 1-10 pounds. Rarely (10%): Walking, stooping/kneeling/crouching, climbing stairs. Never (0%): Climbing ladder/step-stool, lifting/carrying/pushing or pulling 11-50 pounds, operation of a motor vehicle, ability to hear whispered speech level. Exposure to Elemental Factors Never (0%): Heat, cold, wet/slippery area, noise, dust, vibration, chemical solution, uneven surface. Blood-Borne Pathogen (BBP) Exposure Category No Risk for Exposure to BBP . Schedule Weekly Hours: 40 Caregiver Type: Regular Shift: Is Exempt Position? No Job Family: INSURANCE BILLER Scheduled Days of the Week: Monday-Friday Shift Start & End Time: 40 hours

About Abby Care Making family care possible. At Abby Care, we are tackling one of the most important and unsolved challenges of our time: family caregiving. Over 50 million Americans are family caregivers for loved ones without pay, tools, or support. Our mission is clear and ambitious: to train and employ family caregivers so they can get paid for the care they already provide at home. Abby Care is building a tech-powered, family-first care platform to efficiently deliver care, improve health outcomes, and provide the best-in-class experience nationwide. We are rapily expanding our mission and looking for passionate team members to join. Abby Care has partnered with leading insurance plans, healthcare providers, and community organizations. We’re supported by top, mission-driven VCs to empower families throughout the country. The Role We're looking for a passionate and detail-oriented expert to join us as a Payer Authorization Operations Manager. This is a Full-Time Remote opportunity based in Denver, Colorado. You are a strategic authorization operator who turns complex Colorado LTSS and LTHH requirements into seamless patient care—navigating Colorado Medicaid systems and building trust with case managers, internal stakeholders, and HCPF to ensure uninterrupted services for vulnerable populations. Key Responsibilities:  - Master Colorado's LTHH landscape. Lead authorization operations for Colorado's HCBS waiver programs (CHCBS, EBD, SLS, CES, CFC) and Long Term Home Health services, ensuring 100% compliance with HCPF policies and ColoradoPAR system requirements. - Oversee end-to-end prior authorization. Own prior authorization process while leading and managing the team of Doc Collectors and Re-Authorization Associates, maintaining current knowledge of payer requirements and ensuring adherence to all guidelines and timelines.  - Manage Reauthorizations. Build out the process and manage the team handling all reauthorization submissions for Colorado's waiver programs (CHCBS, EBD, SLS, CES, CFC) and Long Term Home Health services to ensure patients have no lapse in care.    - Internal Coordination. In cases where appeals are needed, act as an expert to help families navigate the appeals process as and when appropriate. Coordinate with our internal teams to troubleshoot and resolve any issues around authorizations impacting the revenue lifecycle.  - Lead complex case resolution. Serve as the escalation point for disputed Colorado Medicaid authorizations, appeals, and emergency requests, working directly with HCPF and Acentra (Kepro) to advocate for timely patient care approvals. - Navigate dual eligibility complexities. Build expertise in Medicaid coordination for Colorado beneficiaries; manage intricate authorization scenarios involving and ensure seamless care transitions. - Drive team excellence. Create and execute training programs on Colorado-specific prior authorization requirements, mentor staff on LTHH waiver nuances, and establish performance metrics that drive strong approval rates and sub-10-day processing times. The Requirements: - 5+ years Colorado Medicaid authorization experience (LTHH, LTSS or waiver programs) with a proven track record of managing complex authorization portfolios and achieving high approval rates. - Bachelor's degree in Healthcare Administration, Business, or equivalent is preferred. Colorado Medicaid certification and LTHH authorization training strongly preferred. - Existing deep knowledge of Colorado's LTHH ecosystem including HCPF policies, prior auth operations, case coordination, and ColoradoPAR system; can demonstrate successful navigation of Colorado waiver program transitions and appeals. - Expert relationship builder with strong communication, problem-solving, and stakeholder management skills; proven ability to work effectively with state agencies, payer entities, and provider networks. - High-agency operator who executes cross-functional work in ambiguous regulatory environments; process-driven and metrics-focused with experience in CRM systems, data analysis, and Indiana-specific compliance requirements.   Our Values - Families First Redefining healthcare starts with how we treat the parents and children we serve. We go above and beyond for every family, building strong, lasting relationships. We continually ask ourselves, “Would we want this for our own families?” - Urgency with Precision Millions of families are waiting for care, and they cannot wait, therefore this is not your typical 9 to 5 job. We match their urgency with our own, delivering exceptional care without compromise. Here, speed and excellence go hand in hand. - Relentlessly Resourceful As an ambitious startup, we adapt quickly and make the most of limited time and resources. We solve challenges with creativity to deliver results without unnecessary complexity. - Purpose with Positivity We take our mission seriously while never losing sight of the people behind the work. Respect, kindness, memes, and coffee make us stronger as a team and better for the families we serve. Driven to Redefine What’s Possible We are here to make healthcare better, which means asking hard questions, challenging outdated systems, and finding smarter, more compassionate ways to deliver care.  Benefits: - Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work. - Comprehensive health coverage that works for you. We cover 90% of your premiums and 70% for your dependents, with multiple PPO plan options to choose from for medical, vision, dental, life, and short-term disability. - Generous paid time off. We provide policies that allow you to recharge along with 10 paid company holidays.  - Team bonding. We love bringing our teams together. As a full-time employee, you’ll get to connect, collaborate, and have fun through team activities and our annual company retreat. - Financial savings benefits to support your future. We support your financial well-being with HSA contributions, optional FSA and commuter benefits, and full coverage of all 401(k) account fees (employer match not currently offered).  - Paid parental leave to support your growing family. We provide paid leave, so you can focus on bonding and adjusting to life as your family grows.   We are an equal opportunity employer and welcome applicants from all backgrounds, consistent with applicable laws. Employment is contingent upon successful completion of a background check, satisfactory references, and any required documentation.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Claims Operations Supervisor leads a high-performing team of claims processors, driving accuracy, productivity, and service excellence. This role is responsible for daily team operations, performance management, and continuous improvement while ensuring compliance with policies and alignment to organizational and client objectives. - Lead and manage the daily operations of a claims processing team (approximately 17–20+ employees) to achieve quality, productivity, and service goals. - Translate organizational strategies into clear expectations that engage employees and drive desired behaviors. - Develop, coach, and motivate team members using active performance management tools, with a strong focus on accuracy, quality, and results. - Utilize Management Operating System (MOS) tools and KPI dashboards to monitor performance, identify gaps, and drive continuous improvement. - Partner with capacity planning, resource management, and matrix stakeholders to meet operational, financial, and client commitments. - Act as a change leader by identifying and removing barriers, improving workflows, and enhancing efficiency and quality. - Ensure compliance with all corporate policies, procedures, and regulatory requirements related to claims processing. - Collaborate with Human Resources on staffing, performance management, employee development, engagement, and employee relations. - Foster an inclusive, diverse, and collaborative team environment. - Stay informed of changes in the healthcare and claims environment and adapt processes as needed. - Communicate effectively in a virtual setting, delivering clear, transparent, and timely messages. Qualifications - High School Diploma or GED required. Bachelor’s degree preferred. - 1+ years’ of direct people‑management experience, including responsibility for coaching, performance management, and day‑to‑day supervision of a team preferred. - Demonstrated experience leading a team to meet or exceed productivity, quality, or performance metrics preferred. - Proven ability to provide regular feedback, conduct performance discussions, and address performance gaps preferred. - Experience managing workload distribution, scheduling, and priority setting for a team environment preferred. - Experience with Facets is highly preferred. - Strong customer focus with a commitment to quality and accuracy. - Excellent communication, interpersonal, and problem-solving skills. - Demonstrated ability to drive change, process improvement, and operational outcomes. - Strong organizational and time management skills. Requirements - If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. Benefits - Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs. - 401(k) plan. - Company paid life insurance. - Tuition reimbursement. - A minimum of 18 days of paid time off per year and paid holidays. - Annual salary of 56,500 - 94,100 USD / yearly, depending on relevant factors, including experience and geographic location. - Eligibility to participate in an annual bonus plan. Company Description At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

SUMMARY: Under general supervision of the Claims Administration Follow-up Supervisor, perform all clerical duties necessary to properly process patient bills to customers taking appropriate follow-up steps to obtain timely reimbursement of each 3rd party claim and ensure the financial stability of the Hospital. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: Consistently applies the corporate values of respect, honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a comprehensive integrated academic health system. Responsible for knowing and acting in accordance with the principles of the Brown University Health Corporate Compliance Program and Code of Conduct. Review claim forms for all required data fields depending on the specific 3rd party requirements. Review patient account for demographic accuracy. Process all necessary system adjustments or changes as needed, such as adding/deleting insurance information, insurance priority changes, balance transfers, demographic changes, contractual allowances, and any other routine patient accounting adjustments not requiring supervisory approval ensuring accurate financial data. Analyze all assigned claims received from various sources to ensure accurate and timely reimbursement based on the individual payer’s contracts or Federal reimbursement methods. Contact insurer via online systems, call centers, written correspondence, fax or appropriate electronic or paper billing of claims to secure payment. Maintains an understanding of the most current contract language in order to consistently ensure reimbursement in accordance with contract language. Continually maintains knowledge of payer specific updates via payer’s listservs, provider updates, webinars, meetings and websites. Review payer’s settlements for correct reimbursement and proceed with contact to insurer if claim is not adjudicated correctly based on working knowledge of the various payer’s policies and each individual related contract. Identifies and analyzes denials and payment variances and enacts corrective measures as needed to effectively communicate and resolve payer errors. Understands and maintains compliance with HIPAA guidelines when handling patient information Initiate adjustments to payer’s as appropriate after analyzing under or over payments based on contract, Federal regulation, late charge corrections or inappropriate denials. Submits appeals to payers as appropriate to recover denied revenue Contact internal departments to acquire missing or erroneous information on a claim resulting in adjudication delays or denials. Run reports as necessary to quantify various variances on patient accounts related to identified issues within the payers or as the result of known charging errors or procedural breakdown. Reports to supervisor identification of trends resulting in under/over payments, inappropriate denials or charging/billing discrepancies. Answer telephone inquiries from 3rd parties and interdepartmental calls. Refer all unusual requests to supervisor. Retrieve appropriate medical records documentation based on third party requests. Initiate the accurate and timely processing of all secondary and tertiary claims as needed according to specific 3rd party regulations. Process all incoming mail and follow up on all rejections received according to specific 3rd party regulations. Refer all accounts to supervisor for additional review if the account cannot be resolved according to normal patient accounting procedures. Works with supervisor, management and the patient accounting staff to improve processes, increase accuracy, create efficiencies and achieve the overall goals of the department. Maintain quality assurance, safety, environmental and infection control in accordance with established policies, procedures, and objectives of the system and affiliates. Perform other related duties as required. WORK LOCATIONS/EXPECTIONS: After orientation at the Corporate facilities, work is performed based on the following options approved by management and with adherence to a signed telecommuting work agreement and Patient Financial Services Remote Access Policy and Procedure.. Full time schedule worked in office Full time schedule worked in a dedicated space in the home Part time schedule in office and in a dedicated space within the home Schedules must be approved in advance by management who will allow for flexibility that does not interfere with the ability to accomplish all job functions within the said schedule. Staff are required to participate in scheduled meetings and be available to management throughout their scheduled hours. Staff must be signed into Microsoft Teams during their entire shift and communicate with Supervisor as directed. MINIMUM QUALIFICATIONS: BASIC KNOWLEDGE: Equivalent to a high school graduate Knowledge of 3rd party billing to include ICD, CPT, HCPCS, UB and HCFA 1505 claim form Demonstrated skills in critical thinking, diplomacy and relationship-building Highly developed communication skills, successfully demonstrated in effectively working with a wide variety of people in both individual and team settings Demonstrated problem-solving and inductive reasoning skills which manifest themselves in creative solutions for operational inefficiencies. EXPERIENCE: One to three years of relevant experience in medical collections or professional/hospital billing preferred INDEPENDENT ACTION: Incumbent generally establishes own work plan based on pre-determined priorities and standard procedures to ensure timely completion of assigned work. Problems needing clarification are reviewed with supervisor prior to taking action. SUPERVISORY RESPONSIBILITY: None Pay Range: $19.97-$32.96 EEO Statement: Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment. Location: Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903Work Type: Monday-Friday 7am-330pmWork Shift: DayDaily Hours: 8 hoursDriving Required: No