• Perform medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. • Document decisions using indicated protocol sets or clinical guidelines. • Provide support and review of medical claims and utilization practices. • Makes reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets or clinical guidelines. • Determines medical necessity and appropriateness and/or reasonableness and necessity for coverage and reimbursement. • Monitors process’s timeliness in accordance with contractor standards. • Documents medical rationale to justify payment or denial of services and/or supplies. • Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines. • Participates in quality control activities in support of the corporate and team-based objectives. • Provides guidance, direction, and input as needed to LPN team members. • Provides education to non-medical staff through discussions, team meetings, classroom participation, and feedback. • Assists with special projects and specialty duties/responsibilities as assigned by management.

We are currently recruiting for a Estimate Reviewer to join our team remotely in Canada. The position location is flexible, and we can offer in-office, hybrid or fully remote working arrangements. The successful applicant will be required to review the estimates of the network contractors, ensure the technical accuracy of the bid, ensure that program guidelines are followed, and ensure that industry standards are followed. Performing quality checking of file documentation, proper use of estimating software and pricing as well as proposed estimating of repairs meets customer standards and requirements. Reviews additional repair specifications received and completes the secondary review process for technical accuracy and adherence to industry standards. The candidate will also be responsible for communication between contractors, the regional manager and with claims adjusters The salary range is $54,000 to $67,000 annually

Title: Medical Biller & Credentialing Specialist Location: Glen Rock, NJ Department: Billing Job Description: SportsMed Physical Therapy is seeking a Medical Biller/Credentialing Specialist to join our team. This position will begin training on site full-time in either Glen Rock, NJ or Franklin Lakes, NJ and will transition to Hybrid-Remote after 2-3 months at the discretion of the billing manager. Candidates for this role must be local to the New Jersey area. This is a dual-role that combines medical billing/AR with oversight of the provider credentialing process SportsMed is one of New Jersey’s leading providers of physical rehabilitation services. We can offer you a fast paced and challenging career opportunity. If you are passionate about healthcare, motivated and want to make a difference, SportsMed is the place for you. Responsibilities Credentialing Responsibilities - Oversee the credentialing and recredentialing process for providers and ensure completion in a timely manner - Maintain provider credentialing database - Communicate with providers to collect documentation and complete necessary credentialing steps - Communicate with insurance networks to coordinate provider enrollment - Monitor credentialing timelines and keep track of necessary recredentialing steps - Stay informed of industry regulations and credentialing requirements - Must have knowledge of Pecos, NPPES, and CAQH Billing Responsibilities - Review new patient records in billing software and initiate billing process - Work with clinic staff to resolve patient authorization issues - Review existing claims in billing software and follow up on outstanding issues - Review outdated claims in billing software to research and resolve as necessary - Review outdated claims in billing software and prepare for collection as necessary - Work with insurance companies to resolve billing issues - Work with patients to resolve billing and collection issues - Ensure all billing changes, charge offs, escalations, interactions etc. are correctly documented in billing and/or HRM software in a timely manner - Properly escalate billing issues where necessary - Follow company processes and procedures carefully - Prepare and update summary documentation as required - Other duties as assigned by management Qualifications - Minimum 4 years’ experience with medical billing required and minimum 2 years' experience with provider credentialing process required - Solid understanding of medical billing software and procedures preferred (Kareo, WebPT, Navinet, CMD, etc.) - Knowledge and understanding of Pecos, NPPES, and CAQH - Ability to multitask and manage time effectively with minimum supervision - Excellent written and verbal communication skills - Strong basic Excel skills - Outstanding problem-solving and organizational abilities - Keen attention to detail with strong analytical skills - A professional, courteous, enthusiastic, and conscientious attitude, willing to fulfill group goals and work requirements - Ability to deal positively with coworkers and supervisors, and support management decisions - Ability to function as a contributing team member while meeting deadlines and productivity standards - Out-of-network and in-network billing experience Benefits - Competitive pay based on experience - Medical, Dental, Vision insurance options - Life and disability insurance options - PTO, sick time, paid holidays. 401k - Excellent career growth opportunities - Pay Rate $22.00 - $26.00 per hour $22 - $26 an hour

Role Description Demand packages are the most important document in every case we work on, capturing the details of an incident to help clients recover outcomes that can help remedy some of the impact to their quality of life. Demand Reviewers ensure every demand package Finch produces is accurate, complete, and persuasive. You’ll combine proprietary AI tools with deep legal review to deliver best-in-class demands that maximize case value. - Review medical records, bills, and evidence for accuracy and completeness - Conduct verdict and settlement research to strengthen case valuation - Use Finch’s AI tools to accelerate drafting without sacrificing quality - Tailor each demand to the firm’s litigation strategy and style - Maintain a 0% error rate in final submissions Qualifications - 5+ years in personal injury legal work, with experience drafting or reviewing demands - Meticulous about details and accuracy - Understand how to present a case persuasively for maximum settlement value - Comfortable working with technology to enhance workflows Benefits - $70,000 – $100,000 annual salary + equity - 100% coverage for health, dental, and vision - 401(k) retirement plan - In-office snacks, drinks, and daily team lunch and dinners - Flexible PTO (we trust you to take the time you need) Company Description At Finch Legal, we believe in practicing what we advocate. As a company dedicated to upholding justice and protecting people in the workplace, we are equally committed to fostering a safe, inclusive, and equitable environment within our own walls. We welcome and support individuals from all backgrounds and lived experiences — regardless of race, ethnicity, gender identity, sexual orientation, religion, disability, or veteran status. We recognize that diversity strengthens our team, enriches our perspectives, and empowers us to better serve our clients and communities. At Finch Legal, inclusion isn’t just a value — it’s a practice.