MRT Validation Specialist Summary of Position: The MRT Validation Specialist is responsible for supporting the intake and validation of MRT requests into Verisma Release Manager. This role is a crucial link between the MRT processing team and the Monitored Retrieval Tool to ensure accuracy of the tool and an optimized turnaround time. Duties & Responsibilities: - Review and intake all MRT requests into VRM accurately and timely - Intake requests utilizing Verisma software applications - Read and interpret forms and authorizations - Support the resolution of HIPAA-related release issues - Utilize reference material provided by Verisma to ensure compliance and confidentiality is always maintained - Attend training sessions, as required - Perform other duties, as assigned, to ensure effective operation of the department and the Company - Live by and promote Verisma Core Values Minimum Qualifications: - High school diploma or equivalent, some college preferred - Minimum 2 years’ medical records experience - Minimum 2 years’ clerical or office work - Experience using general office equipment including desktop computer, scanner, Microsoft - Office Suite to complete tasks - Experience in a healthcare setting, preferred - Knowledge of HIPAA and state regulations related to the release of PHI, preferred - Must be able to work independently

Role Description The Lead Infusion Reimbursement Specialist is responsible for providing thought leadership, quality assurance, and advanced expertise in billing and collections within Prochant’s Infusion Division. In addition to managing reimbursement tasks, the lead infusion reimbursement specialist acts as a mentor and trainer for other reimbursement specialists, supporting their professional growth and development. Serving as a liaison between reimbursement specialists and the Reimbursement Manager, they help streamline operations, resolve challenges, and assist with complex projects. This position is crucial in fostering a collaborative, high-performing team environment while supporting the division’s strategic growth objectives. - Overseeing timely and accurate processing of infusion reimbursement claims, ensuring clean claim submission and follow-up with health plans. - Utilizing billing software, payer portals, and data reporting tools to manage outstanding A/R and enhance cash collections. - Mentoring and training reimbursement specialists, providing guidance on best practices and strategies for resolving billing challenges. - Acting as a liaison between team members and management, assisting with escalated client concerns, and freeing up manager time. - Conducting quality assurance checks to ensure claim accuracy, compliance, and efficiency in reimbursement processes. - Proactively identifying potential roadblocks affecting clients or Prochant, escalating or resolving them in a timely manner. - Maintaining strong relationships with clients, responding to inquiries with professionalism and clarity. - Prioritizing responsibilities, managing workload effectively, and adapting to changing priorities while maintaining focus on deadlines. - Collaborating with offshore teams and participating in efforts to support organizational needs. Qualifications - High School diploma or equivalent required. - Minimum 2 years of experience in home infusion billing and collections. - Experience using Brightree, CPR+, CareTend, or WeInfuse software preferred. - Strong written and verbal communication skills with an ability to mentor and train others. - Demonstrated initiative and problem-solving ability. - Deep knowledge and experience billing and collecting major medical claims for home infusion, ambulatory infusion, and/or specialty pharmacy. - Ability to demonstrate a clear understanding of CMS 1500 and 837 claim formatting and billing process. Benefits - Health Insurance - Gap Insurance - Dental Insurance - Vision Insurance - Short Term / Long Term Disability (company paid) - Term Life Insurance (company paid, employee can elect additional) - Full suite of CHUBB supplemental insurance plans, including: Disability Income, Level Term Life, Accident Insurance, & Critical Illness Insurance - Floating holidays and paid time off - 401K with company match

Description FLSA CLASSIFICATION: Non-exempt REPORTS TO: Coordinator of Adult Services POSITIONS SUPERVISED: NA POSITION OVERVIEW: The Warm Line Peer Specialist is responsible for providing telephone support / resource information to Warm Line callers. The Peer is also responsible for completing required documentation on each call received. ESSENTIAL POSITION RESPONSIBILITES: - Provides telephone support / resource information to Warm Line callers and refers callers to community resources when appropriate. - Refers crisis calls to COMCARE CRISIS through 3-way calling feature. - Completes required documentation on all calls received during the shift. - Reports any situations / concerns during shift to the on call, Warm Line support staff. - Meets deadlines as established by the department for submission of documentation and electronic timesheet. OTHER POSITION RESPONSIBILITES: - Maintains acceptable overall attendance record, to include department staff meetings, agency meetings, and trainings as required. Ensures appropriate notification to supervisor for absences, and ensures that work is covered. Flexible in work schedule when needed. - Exhibits appropriate level of technical knowledge for the position. - Produces quantity of work necessary to meet job requirements. - Works well with a team, keeps others informed of information needed. Treats others with respect, maintaining a spirit of cooperation. - Maintains effective and professional verbal and written interactions with peers, customers, supervisors, and other staff. Uses diplomacy and tact in dealing with difficult situations or people. Demonstrates effective listening skills. Is receptive to constructive feedback. - Demonstrates the ability and willingness to handle new assignments, changes in procedures and business requirements. Identifies what needs to be done and takes appropriate action. - Completes assigned work, meets deadlines without reminders/follow-up from supervisor or others. - Performs work conscientiously with a high degree of accuracy. - Meets goals and objectives as mutually agreed upon during last performance review (if applicable). Requirements POSITION REQUIREMENTS: The Warm Line Operator must identify as a Peer and is required to have an agency phone and laptop. Operators are expected to exhibit an interest in providing telephone support, demonstrate problem-solving skills, and possess both oral and written communication skills sufficient to interact effectively with both callers and staff. Operators must have the availability to attend all required training sessions and must be willing to work a minimum of one shift per week after successfully completing training. PHYSICAL REQUIREMENTS: * Sitting for an extended period of time. * Manual dexterity to operate the telephone and computer. All of the above duties and responsibilities are considered essential job functions subject to reasonable accommodation. All job requirements listed indicate the minimum level of knowledge, skills and/or ability deemed necessary to perform the job proficiently. This job description is not to be construed as a detailed statement of duties, responsibilities or requirements. Employees may be required to perform any other job related instructions as requested by their supervisors, subject to reasonable accommodation. EEO race, color, religion, sex, parental status, national origin, age, disability, genetic information, political affiliation, military service, or other non-merit based factors.

Overview Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. We are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth. If you want to make a difference and contribute to the improvement of healthcare payment integrity, consider an opportunity to join our healthcare recovery team as a Payment Accuracy Specialist 2. Cotiviti's Data Mining team configures custom claim reviews to investigate untapped billing compliance issues specific to regulations and contracted policies across product, market, and provider types. The Specialist 2 is responsible for developing new and existing audit concepts, gaining client acceptance, training all Specialist levels to execute audit projects, and evaluating the effectiveness of audit concepts. Audits client data and generates high quality recoverable claims for the benefit of Cotiviti and our clients. Conducts and trains more complex audit projects with some to limited supervision. Considered a mentor, trainer, and developer of less-tenured team members. Displays a high degree of independent judgment and professional skepticism that enhances the work performed in order to achieve success in the position. Responsibilities - This individual will work under moderate supervision and will be monitored for efficiency in production and quality review of assigned work. - Has the ability to build and maintain a basic understanding of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish the correct order of liability. - Advanced with Cotiviti audit tools Recovery Management System (RMS), specific client systems) to complete auditing, review simple - medium proprietary reports, and have an expert understanding of Microsoft Excel and client applications. - Utilizes healthcare experience to perform audit procedures that include identifying and defining issues, developing criteria, reviewing, and analyzing evidence with the intent to audit medium and complex reports. Work is advanced in scope and complexity. Knowledge is applied to resolve routine issues, as necessary. The scope may include Data Mining, Claim Adjudication, Contract Compliance, Provider Billing & Duplicate Payment Reviews, Policy & Reimbursement Analysis, and Quality Assurance. - Advanced analysis of paid claims and identification of audit findings including documentation for training and knowledge sharing. Works with Engineering to increase the efficiency of tools and reporting. - May update current reports, develop and run custom queries, and validate the accuracy of current reports used. Makes determinations based on prior knowledge and experience of client contract terms with the likelihood of recovery acceptance. - Meets or Exceeds Standards for Productivity in addition to regular and predictable attendance, maintains production goals and standards set by the audit for the auditing concept. Achieves the expected level of quality and quantity for assigned work (i.e. hit rate, claims written, vendor/project volume completion, ID and/or fees per hour). - Meets or Exceeds Standards for Quality by Achieving the expected level of quality set by the audit for the auditing concept, for valid claim identification and documentation. - Highly proficient, subject matter expert in responding to inquiries and disputes received on all claims written. Provides verification of claims validation and confirmation, in a concise written manner, utilizing facts and details for justification purposes. - Demonstrates aptitude in reviewing transaction types, client contracts/vendor agreements, and client data with limited supervision of how to identify potential over or underpayments. Makes recommendations on medical policy applications, state and federal statutes, and other reimbursement methodologies as it applies to the audit concept. - Considered a skilled resource in onboarding new hires and/or training existing staff on new concepts and processes. - Identifies New Claim Types & Concept Expansion by using proven methodologies to research and substantiate claims outside the audit concept. Enlists others internally or externally to help validate, suggest, develop, and analyze high-quality, high-value concepts and/or process improvements, tool enhancements, etc. Strong driver and voice in the development of audit concepts. - Recommends New Concepts & Processes based on experience and in-depth knowledge of client contract terms and complex claim types. Has a proven record of developing and implementing new ideas, approaches, and/or technological improvements that support and enhance audit production. Uses advanced validation methods to test and produce a desired/intended result of the new concept. Regularly collaborates with Engineering in the development of new reports and tool functionality. - Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements. - Ensures confidentiality and security of all data, adhering to all HIPAA (Health Insurance Portability and Accountability) laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is safe, complying with industry standards. This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change. Qualifications - High School Diploma - Required. - Bachelor’s degree (Preferred) and/or a minimum of at least (4 - 6) year/s related experience in healthcare. - At least 3 - 4 year/s of Cotiviti experience is recommended for individuals seeking their next opportunity internally. - Healthcare industry experience, including knowledge of claim adjustments, provider contracts, reimbursement policies and payment integrity. (strongly preferred). - Computer proficiency including Microsoft Office (Word, Excel, Outlook, Access). - Previous SQL experience strongly preferred. - Excellent verbal and written communication skills. - Strong interest in working with large data sets and various databases. - Ability to work well in an individual and team environment demonstrating self–motivation to deliver success. - Understands and embodies Cotiviti Core Values, Strategic Pillars, and Operations Disciplines to achieve successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally. Mental Requirements: - Communicating with others to exchange information. - Assessing the accuracy, neatness, and thoroughness of the work assigned. Physical Requirements and Working Conditions: - Remaining in a stationary position, often standing or sitting for prolonged periods. - Repeating motions that may include the wrists, hands, and/or fingers. - Must be able to provide a dedicated, secure work area. - Must be able to provide high-speed internet access/connectivity and office setup and maintenance. - No adverse environmental conditions are expected. Base compensation ranges from $29.00 to $33.00 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration. Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law. Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page. #LI-Remote#LI-KB1#senior