Our team is growing, and we currently have an immediate opening for a Reimbursement Support Specialist-IVD Title Reimbursement Support Specialist-IVD Location Remote Reports To Director, Billing & Reimbursement Job Overview Reimbursement Support Specialist- IVD Products supports the company’s compliance with federal and state laws by preparing and distributing accurate billing and reimbursement educational materials related to in-vitro diagnostic (IVD) test kits. This role involves communicating reimbursement information to customers, assisting with provider education, and ensuring all activities align with regulatory requirements and internal policies. Essential Duties & Responsibilities - Provide timely and accurate support to customer inquiries via telephone and email. - Share publicly available coverage determinations such as Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs) and commercial payer policies. - Monitor and report status of individual Medicare Administrative Contractor (Mac) Local Coverage Determination applications. - Develop and distribute customized appeal templates incorporating peer-reviewed publications and NCCN guideline inclusions to support medical necessity. - Provide reporting on payer-specific LDT claim trends including denial and appeal resolution metrics. - Ensure all billing and reimbursement content is accurate, based solely on publicly available payer information. - Include standard disclaimers highlighting payer variations and emphasizing provider responsibility for coding and billing decisions. - Document all client interactions, inquiries, and resolutions accurately in the CRM system. - Promptly report any suspected violations of the company’s reimbursement policies or applicable laws to the Compliance Officer or confidential hotline. - Participate in periodic reviews and updates of reimbursement materials to ensure continued regulatory compliance. - Perform other duties as assigned to support team goals and operational needs. Qualifications & Requirements - Bilingual (English/Spanish) preferred. - Associates Degree in Business Administration or Health Information Management preferred or equivalent work experience of 3 years in Revenue Cycle Management - Knowledge of medical billing and coding systems, including CPT, HCPCS, ICD-10, and CMS fee schedules. - Familiarity with federal regulations affecting healthcare reimbursement, including FDA, CMS, Anti-Kickback, False Claims Act, and HIPAA rules. - Microsoft Excel proficiency - Solid analytical, mathematical, and research skills - Great interpersonal skills - Excellent communication skills (written and verbal) - Strong attention to detail and highly organized - Ability to handle multiple demands and to respond rapidly to changing priorities - Commitment to ethical standards and regulatory compliance. ​ Work Environment / Physical Requirements: - Ability to sit and/or stand and operate a computer with ability to multitask across many software communication and data entry programs while operating and communicating through telephone device for several hours a day. \ - This position may require involvement outside of standard business hours ----------------------------------------------- Cleveland Diagnostics, Inc., is developing highly efficacious, lab-friendly, affordable diagnostics tests using proprietary technology to improve cancer diagnostics. We pride ourselves in fostering a family-focused, friendly, and flexible organization that places our employee’s well-being and happiness as the primary reason for our success. Are you interested in building your career with a team of industry professionals while making a lasting impact to the lives of millions of people? Bring your talents to Cleveland Diagnostics. Cleveland Diagnostics offers an extremely robust benefits package which includes: - 100% Employer-paid medical for single coverage effective on your date of hire and 50% employer-paid medical for spouse/dependent coverage - 100% Employer-paid Dental & Vision for entire family - No cost for employee coverage for Group Term Life, Short & Long Term Disability - 4% retirement contribution Employer match - Incentive Performance Plan & Stock Option Program & Commission (Sales Account Execs) - Paid Family Leave Program - Generous PTO plan & holiday program - Flexible work schedule & lucrative employee referral program - Salary range may vary by work state/geographical region/territory - Easy to get to office location with newly built-out office space - Free coffee, snacks and other goodies all day long Cleveland Diagnostics is an equal opportunity employer and is committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because that is what drives curiosity, innovation, and the success of our business. EEO is the Law. Applicants can learn more about the company’s status as an equal opportunity employer by viewing the federal EEO is the Law poster on our careers page. Accommodations are available for applicants with disabilities.

Title: Life, Annuity, and Service Specialist - Entry Level Location: SAN ANTONIO Texas United States Type: Full-Time Job Description: Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. The Opportunity As a dedicated Life, Annuity, and Health Service Specialist, you will support company goals to become the financial services provider of choice and ensure financial security for our members by building relationships when assisting members with life, annuity, and health product or service requests and acquisition. We offer a flexible work environment that requires an individual to be in the office 5 days per week, with the opportunity to move to a hybrid schedule after 6 months. This position will be based in the San Antonio, TX and Phoenix, AZ campuses. Relocation assistance is not available for this position. What you'll do: - Acquires and applies foundational knowledge of complex life insurance, health insurance, and annuity products to assist with member requests and policy changes across channels while delivering on our service excellence commitments. - Asks questions to understand member's service request, discover key information and life events to understand the member need, and documents relevant information. - Utilizes the tools and resources available to process transactions accurately and compliantly to create exceptional member service experiences while minimizing transfers, escalations, and call backs with assistance as needed. - Recognizes member cues and opportunities to meet the member's needs through additional products or services and motivates member to act on recommendation(s). Overcomes objections using basic sales techniques and developing persuasion skills. - Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures. What you have: - Up to 1 year of relevant customer service or sales experience. - Ability to prioritize and multi-task, including navigating through multiple business applications, including a Windows operating system. - Strong interpersonal and communication skills. - Successful completion of a job-related assessment may be required. - Experience acquiring and applying new concepts and information. What sets you apart: - At least 6 months of Life Insurance and/or Annuity Service experience - Bachelor's degree in Accounting, Finance, or General Business (or related) from an accredited university. - Current Group 1 Life/Health License - 2+ years of customer contact experience in a call center environment where multi-tasking is required. - Experience cross selling or up-selling products - US military experience through military service or a military spouse/domestic partner Compensation range: The salary range for this position is: $43,680.00 - $59,980.00 Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. For more details on our outstanding benefits, visit our benefits page on USAAjobs.com Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. *Qualified candidates for this role must be available to work 9:30AM-6:00PM EST. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Position Purpose: The Pharmacy Resolution Specialist receives and responds to calls from members, provider/physician's offices, and pharmacies. This role makes outbound calls and enters pharmacy overrides into systems based on approved guidelines and approvals provided from clinical pharmacists. - Takes member/prescriber/pharmacist inquiry calls for benefit questions including prior authorization requests - Offers options including submission of a prior authorization request - Thoroughly researches issues and takes appropriate action to resolve them using the appropriate reference material within turnaround time requirements and quality standards - Logs, tracks, resolves, and responds to all assigned inquiries and complaints while meeting all regulatory, CMS, and Centene Corporate guidelines in which special care is required to enhance Centene relationships, while meeting and exceeding all performance standards - Maintains expert knowledge on all pharmacy benefits and formularies, including CMS regulations as they pertain to this position - Responsible for knowing and interpreting pharmacy and medical benefits - Answers and conducts inbound and outbound calls with members and provider offices to provide resolution to claims (i.e.: additional information requests and medication determination updates) - Actively involved in the initiation and providing status for prior authorization/coverage determination, appeal / redetermination phone calls - Responsible for ensuring outstanding attention to detail - Identify root cause issues to ensure enterprise solutions and communicate findings as needed to ensure first call resolution - Assists with special projects as assigned - Performs other duties as assigned - Complies with all policies and standards Education/Experience: High School Diploma / GED and 1 year of Job Specific call center/customer service. Pay Range: $15.87 - $27.25 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. Work Shift: 8 Hours - Day Shifts (United States of America) Scheduled Weekly Hours: 40 Salary Range: $16.50 - $23.00 Union Position: No Department Details Remote position working with clinics and insurance companies to provide care for our patients. Summary The Patient Access Specialist reviews and validates insurance eligibility, prior authorization and/or referral of medication, procedures, etc.; determines if insurance meets prior authorization criteria. Job Description Collects necessary documentation and communicates with third party payers, healthcare professionals and customers to prioritize requests. Verifies patient registration and confirms benefit coverage, including deductibles and out-of-pocket expenses; researches and verifies covered benefits for ordered tests, procedures, and other services. Responsible for assuring that prior authorization for medical services, including testing, procedures, surgery, Durable Medical Equipment (DME), and medications is completed and confirmed. Obtains diagnosis(es)/CPT code(s) from medical chart and/or provider office. Contacts third party payer to determine appropriate prior authorization process. Works closely with provider offices to obtain and clarify documentation to demonstrate medical necessity. If medical necessity criteria are not met, follows up with provider offices with guidance for Advanced Beneficiary Notices (ABN) or waivers that releases the financial burden of scheduled services from the facility to the patient. Reviews professional services denials; works with clinics and third party payers on appeal process. Assures all required referrals are in place; may work on outgoing referrals for care outside Sanford Health. May have minimal telephonic patient interaction concerning provider referrals. May notify appropriate insurance companies when patients have checked in for inpatient services and procedures requiring observation periods. Documents work in case management module; provides direction to utilization management, case management, and nursing regarding what action needs to be taken. Collaborates with case management, social work, utilization management, and other cross-functional teams across the enterprise. Assists with the design and management of data including the preparation of reports and presentations. Qualifications High school diploma or equivalent preferred; post-secondary education helpful. Minimum of two years of experience in a hospital or clinic setting required. Understanding of medical terminology, insurance background, office equipment and computers is required. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org.