As a Remote Refunds Specialist at Community Health Systems (CHS) - Shared Services Center, you’ll play a vital role in quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including: - Paid Time Off (PTO) - Comprehensive Health Benefits - Medical, Dental & Vision - 401k with company match - Tuition reimbursement The Remote Medical Refunds Specialist processes refunds to patient and insurance accounts and prepares daily credit balance reports, using computer systems, databases and ledgers. Supports in the reconciling, correction, and/or completion of contractual adjustments, insurance refunds, and patient refunds. Responsible for Web based discrepancy refunds and RN lines to logging system. Is flexible in work priorities and performs other duties as assigned. Essential Functions - Processes refunds to patient and insurance accounts. - Maintaining appropriate knowledge and understanding of all Managed Care Contracts and Federal payors. - Work overpayments, request for refund letters, faxes and telephone requests. - Utilizes various computer systems and databases to complete analyze accounts. - Reviews daily Credit Balance reports to analyze issues causing credit balances. Corrects contractual adjustment amount, if needed. Compiles refund request with appropriate documentation, if applicable. - Ensures compliance procedure for prompt recording/processing of all refunds. - Communicates any refund issues with Reimbursement Manager/Supervisor as needed. - Answer questions via email from the Facilities, TSSC Customer Service and PASI regarding credits, refunds, and account discrepancies. - Statutes Government credit for reporting to Corporate. - Identifies accounts to be escheated to the state. - Monitors accounts for State Statue Waiting Period. - Researches credit balance accounts to determine if a payor or patient has overpaid on the account. - Prices claims using contracts, pricers, and payment methodologies to validate refund requests from payors. - This is a fully remote opportunity. Qualifications - H.S. Diploma or GED required - 1-3 years of experience in accounts receivable experience in hospital or medical setting, required - 1-3 years of experience in experience working with Managed Care Contracts preferred and Federal programs, preferred - Experience with payer reimbursement policies, claim adjudication, and healthcare revenue cycle operations preferred Knowledge, Skills and Abilities - Ability to analyze account balances, identify discrepancies, and apply appropriate adjustments. - Proficiency in electronic health records (EHR), billing software, and reimbursement systems. - Strong problem-solving and critical-thinking skills, ensuring accurate claims resolution. - Effective communication and collaboration skills, working with payers, revenue cycle teams, and internal departments. - Knowledge of HIPAA, compliance regulations, and healthcare reimbursement standards. We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.

• Perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment (DME). • Perform projects or duties as assigned as a Medical Review Specialist. • Conduct in-depth claims analysis utilizing ICD-10-CM, AMA-CPT, and HCPCS Level II coding principles. • Utilize electronic health information imaging and input medical review decisions by electronic database module. • Ensure departmental compliance with quality management system and ISO requirements.

Overview GENERAL SUMMARY Nationwide Search-Incumbent can reside anywhere in the United States Position – Disease Specific Care Stroke Field representative. The Disease Specific Care Field Representative applies sophisticated analysis skills and inductive reasoning skills to determine a health care organization's degree of compliance with applicable program standards. They must be able to employ advanced and sometimes nuanced communication skills to engage health care organization staff in interactive dialogues on a broad array of health care issues to assess compliance and to identify opportunities for improving compliance. Responsibilities - Conducts a thorough evaluation of assigned services and programs that meet DSC certification eligibility criteria. Plans, reviews and apportions review time so that all review requirements are addressed thoroughly per program. Reviews and evaluates pre-review information; researches, collects, organizes, and interprets a large volume of information from multiple sources. Interviews staff and patients to determine level of compliance with standards. Analyzes documents, such as performance data and clinical practice guidelines, to assess the level of compliance with The Joint Commission standards, evidence of performance improvement, and quality of care. - Using established review protocols: - Analyzes written self-descriptive program information. - Participates in and/or conducts all required conferences and interviews; analyzes all data submitted by the organization. - Documents all recommendations, providing adequate indication on non-compliance. Submits review findings in a complete, accurate, and timely manner to the Central Office. - Interprets and explains the intent of the standards to the organization’s personnel. Consults with staff during review re: non-compliance, opportunities for improvement, and remedial action required. Recommends publications and other resources that clarify standards and/or demonstrates compliance with standards. Qualifications Advanced Degree in Nursing or Licensure as a Physician required. Board Certification in Neurology required. You must hold a CPHQ certification (Certified Professional in Healthcare Quality) through National Association for Healthcare Quality (NAHQ) at time of hire or attain by December 31, 2028. Five years clinical experience with the care of Stroke patients required. Experience with a Joint Commission Comprehensive Stroke Center strongly preferred, however will consider those with Joint Commission Primary Stroke Center experience. All positions require 100% nationwide travel. We are currently looking for candidates who are available to work .48 FTE (2 weeks per month). Extensive nationwide travel required. We are currently hiring for our next orientation class to take place on June 8, 2026 Min USD $115,000.00/year Max USD $115,000.00/year

Site: Mass General Brigham Incorporated Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary The Nurse Reviewer is responsible for the coordination, facilitation, and appeal of the clinical components of charge audits and forensic review findings. This includes audits conducted at Mass General Brigham (MGB) facilities in accordance with the MGB Charge Audit Policy and established departmental policies/procedures. The Nurse Reviewer plays an important role in appealing challenges to charging policy and practice. The increased use of pre- and post-payer audits impacts MGB net revenue, to which the incumbent responds. Essential Functions -Coordinates the scheduling of audits with external third-party audit representatives/payors to initiate the audit process. -Prepares detailed packages for cases selected by audit representatives, including necessary documents needed to initiate the audit process. -Prepares audit responses and appeals for complex charge and forensic audits. -Documents, summarizes, and defends audit findings in a clear, concise, and effective manner to preserve MGB appeal rights. -Conducts post-audit research to support and defend cited charges by obtaining additional documentation. -Updates internal systems used for tracking and reporting findings, including but not limited to patient accounting systems, spreadsheets, and databases, to facilitate monthly management reporting. -Provides subject matter knowledge on various billing, coding, and clinical topics to the audit representatives and other key customers as needed. Qualifications - Bachelor's Degree in Nursing required - Registered Nurse [RN - MA State License] - required - 3+ years of experience in clinical nursing required - 2+ years of experience in a quality assurance or clinical review role required Skill for Success - Strong analytical skills with the ability to interpret clinical data and identify trends. - Excellent communication and interpersonal skills, with the ability to collaborate effectively with multidisciplinary teams. - Proficient in electronic health record (EHR) systems and clinical documentation tools. - Strong organizational skills and attention to detail. - Ability to provide constructive feedback and facilitate training for nursing staff. Working schedule: - Remote, M-F eastern standard business hours. Requires a quiet, secure, HIPAA-compliant working station Additional Job Details (if applicable) Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $79,560.00 - $115,720.80/Annual Grade 7 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.