Role Description The Billing Specialist will be responsible for managing all billing functions for the agency’s OMHC and Medication Management programs. This includes: - Claim creation, submission, payment posting, corrections, and denials management. - Ensuring compliance with state and federal regulations. - Maintaining accurate billing records and ensuring timely reimbursement. - Supporting leadership with billing-related reporting. Key Responsibilities: - Prepare and submit clean claims for OMHC and Medication Management services to Medicaid, Medicare, and commercial insurance payers. - Verify client insurance coverage and eligibility as needed. - Update all billing tracking documentation in real time. - Review documentation and ensure all services meet billing and compliance standards before claim submission. - Monitor accounts receivable and follow up on unpaid, underpaid, or denied claims. - Resolve billing issues, complete corrections, and resubmit denied claims. - Post payments, adjustments, and reconcile accounts for accuracy. - Maintain accurate, organized billing records and reports. - Communicate with clinical and administrative staff to clarify coding or documentation questions. - Ensure compliance with HIPAA, payer regulations, and behavioral health billing requirements. - Provide weekly billing summaries and financial reports to agency leadership. - Keep up-to-date with payer policy changes related to behavioral health, OMHC, and medication management services. Qualifications - Proven experience in behavioral health billing, preferably with OMHC and Medication Management programs. - Strong understanding of CPT codes, behavioral health service codes, and Medicaid requirements. - Experience with claim submission platforms, clearinghouses, and EMR systems. - Knowledge of HIPAA compliance and billing regulations. - Excellent attention to detail and accuracy. - Ability to work independently and meet deadlines. - Strong communication and problem-solving skills. Requirements - This is an Hourly position. - Contractor must provide their own equipment and workspace. - Compensation is based on experience or per-claim/per-project structure as agreed upon. - Flexible working hours; must meet agency deadlines and billing cycles.

Company: ClaimsPro LP (Remote) Temporary Billing Administrator / Full-time (Calgary, AB Canada) Loss Adjusting is a fast-paced, complex field of insurance with no 2 files quite the same. Whether it be a home fire, a fender-bender, or an injury caused by a major accident, the ClaimsPro team determines coverage, legal liability, and settles claims with excellent customer service. ClaimsPro relies on their Administrative Assistants to support the branch staff and producers in the delivery of quality service to our clients. We have an existing opportunity for a (Remote) Billing Administrator position. This will be a temporary position to cover a 12-month Maternity Leave. This position is for our ClaimsPro Centralized Services department. The key focus of the position is to provide effective and efficient administrative support within a fast paced environment. The position duties include typing, computer work on our internal software program and MS Office, billing/invoicing, and may also provide other administrative and clerical support to various branch staff. Other duties as may be required. Responsibilities - Daily review, correction and/or rejection of centrally billed invoices; Advise SCM staff on the necessary corrections to make them compliant to guidelines, with instructions to resubmit when completed. - Educate adjusters about task entries, WIP, formulas, rates and any specifics for their particular client - Ensure complete transfer of notes in task lines, case information & required attachments & if these items did not transfer, to manually enter same - Creation of compliant invoices - Ability to handle pressure of massive volumes of invoices to be processed at certain times of the month and still ensure each invoice receives the attention it requires to maximize chances of it's payment in a timely manner - Assist Centralized Manager in gathering information & preparation of spread sheets - Assistance to SCM staff as requested in areas of billings, Bottomline submissions or other requests - Ability to maintain professional attitude in repetitive duties, such as numerous changes by clients in billing requirements and carry out such changes in a positive manner Education, knowledge and experience required • Grade twelve diploma • A post-secondary diploma in Office Administration will be given preference. • Proven ability to contribute to and work well within a team environment • All prospective employees must pass a background check Environment/Working Conditions: We welcome and encourage applications from people with disabilities. Accommodations are available on request for candidates throughout the recruitment and assessment process. Unsolicited Outreach Statement – Recruitment Agencies We will not accept unsolicited resume submittals from third- party recruiters and hereby request agencies to not contact our employees or managers directly to present candidates. Be advised we will NOT pay a fee for any placement resulting from the receipt of an unsolicited resume and will consider any unsolicited resumes forwarded public information. We welcome resumes submitted directly from candidates.

Your Future is our Future At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact. Position: Credentialing Specialist Position Summary: The Credentialing Specialist is responsible for coordinating and executing credentialing and re credentialing activities for contracted providers and Health Delivery Organizations (HDOs) in accordance with health plan requirements, state and federal regulations, and NCQA standards. This role ensures the accuracy, integrity, and completeness of credentialing data, supports Credentialing Committee review, and serves as a key liaison with providers, internal partners, vendors, and clients. Job Description: Key Responsibilities Credentialing Operations - Monitor ongoing provider compliance, professional license sanctions, and quality indicators. - Maintain accurate, complete, and timely credentialing records within credentialing software systems. Data Integrity & Verification - Prepare, validate, and submit credentialing data files to the Credentialing Verification Organization (CVO). - Review, validate, and document the accuracy of CVO‑completed work. - Identify discrepancies, outstanding issues, or risks within credentialing files and work collaboratively to resolve them. - Validate credentialing data used for Credentialing Committee materials and reporting. Collaboration & Communication - Communicate effectively with providers, physicians, vendors, and internal stakeholders to obtain required documentation. - Partner cross‑functionally with contracting, client services, and internal departments to exchange provider information and drive efficiency. - Assist clients, internal partners, and vendors with credentialing‑related questions, outreach, and documentation needs. - Provide regular (weekly) status updates to assigned clients. Reporting & Compliance - Prepare Credentialing Committee materials, including documentation of issues and resolutions. - Assist with monthly file sampling, audits, SDMC/QMC reporting, and re‑credentialing reports. - Prepare denial and “criteria not met” notification letters to providers, as applicable. - Maintain a strong working knowledge of federal, state, and local credentialing regulations across supported markets. Quality & Confidentiality - Ensure strict confidentiality of privileged and sensitive information. - Demonstrate exceptional attention to detail and accuracy across all credentialing activities. - Support delegated credentialing assessments and ongoing monitoring activities. - Perform additional duties as assigned to support credentialing and organizational goals. Qualifications Required - High school diploma, GED, or equivalent - 1+ year of experience in healthcare operations, credentialing, or a related field (or equivalent knowledge, skills, and abilities) - Familiarity with health plan or credentialing systems - Proficiency in Microsoft Office and Adobe Acrobat - Strong verbal and written communication skills - Exceptional attention to detail and commitment to accuracy - Strong organizational, multitasking, and time‑management skills - Ability to prioritize workload and meet deadlines in a fast‑paced, collaborative environment Preferred - Associate or Bachelor’s degree in healthcare administration, public health, or a related field - Credentialing or licensure experience - Working knowledge of industry standards and regulations (e.g., NCQA, state and federal requirements) #LI-REMOTE Pay Transparency: Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements. The hiring range for this position is: $39,000.00-$48,150.00 Benefits of working at Lumeris - Medical, Vision and Dental Plans - Tax-Advantage Savings Accounts (FSA & HSA) - Life Insurance and Disability Insurance - Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days) - Employee Assistance Program - 401k with company match - Employee Resource Groups - Employee Discount Program - Learning and Development Opportunities - And much more... Be part of a team that is changing healthcare! Member Facing Position: No- Not Member or Patient Facing Position Location: Remote, USA Time Type: Full time Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment. Disclaimer: - The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities. Lumeris is an EEO/AA employer M/F/V/D.

Position Summary: The primary responsibilities of an Enrollment Services Specialist I are to support learners with enrollment processes, provide general guidance regarding academic requirements and schedules, and ensure accurate and timely completion of enrollment-related tasks. Role and Responsibilities: - Provides guidance to learners regarding academic requirements, schedules, and graduation requirements - Refers learners to appropriate specialized staff for such issues as financial assistance, etc. - Assists learners who are voluntarily withdrawing from the College by providing process guidance and completing required paperwork - Provides consistent advising and outreach to learners throughout foundational courses - Facilitates the matriculation of learners from foundational courses into their chosen program - Responds to routine learner inquiries in a timely, professional, and accurate manner across communication channels - Maintains consistent availability and professionalism during assigned phone coverage responsibilities - Accurately and thoroughly documents all contacts with learners within the system of record - Follows established policies, procedures, and guidelines to ensure accuracy and compliance - Actively participates in team meetings including weekly meetings, 1:1s, trainings, etc. - Stays informed of updates to processes, deadlines, and requirements as communicated by leadership - Collaborates with team and communicates effectively to support learner needs - Maintains a working knowledge of institutional policies, program requirements, and the college catalog - Understands and adheres to FERPA regulations for the release of learner information Qualifications and Education Requirements: - Some college experience required, bachelor’s degree preferred. - 1-2 years of customer service, student services, higher education, or related experience. Budgeted Hiring Range $25.71—$27.98 USD All new hires are required to attend New Collaborator Orientation (NCO) in Salt Lake City, Utah. The College will cover travel, lodging, and other accommodations. Nightingale’s commitment to diversity and inclusion is reflected both in our learners and collaborators because we believe the best outcomes for learners from underserved and diverse populations are achieved through collaborators with similar backgrounds and cultures. Nightingale Education Group is an equal opportunity employer. Our Mission (not just words on the wall, we live it, love it, and daily contribute to it): With the primary focus on higher learning in healthcare professions, Nightingale Education Group contributes to elevating education, health, and employment systems through facilitation of academic achievement, personal growth, and professional development of its learners, alumni, and collaborators, while serving diverse communities. At Nightingale Education Group, our Innovative Education model helps transform rural health landscapes through our blended-distance learning platform. Every person involved with Nightingale Education Group helps to change the lives of our learners, our communities, and ultimately the world by adding to the quality of healthcare. We are proud to have graduated nearly 5,000 nurses serving communities in need. We are serious about our outcomes and have a little bit of fun getting there. The professional and personal development of our learners and our collaborators is our company’s foundation. Not only do we develop strategies that promote a positive work-life integration, but we also create an environment that invites you to become an expert in your field, be it through higher education or professional development. Put simply, we elevate employment, elevate health, and elevate education. We’re so happy that you’ve found us! Employment is contingent upon successful completion of a background check and drug screen.