• Evaluate telephone, fax, or web requests for authorization of coverage of molecular and genetic laboratory requests • Comparing requests against established clinical protocols • Authorizing coverage of services or referring requests for expert clinical review • Be available as an expert advisor for physicians and labs on the appropriate use of genetic testing

Role Description Evolent is currently seeking Rheumatologist Physicians to join our Radiology department. As an FMD, Radiology, you will be a key member of the utilization management team, offering a meaningful way to make a difference in patients' lives in a non-clinical environment. Enjoy better work-life balance on a team that values collaboration and continuous learning while providing better health outcomes. Collaboration Opportunities: - Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician's input is needed or required. What You Will Be Doing: - Serve as the Physician match reviewer in Imaging cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert. - Discuss determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provide clinical rationale for standard and expedited appeals. - Utilize medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU's policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. - Aid and act as a resource to Initial Clinical Reviewers. - Ensure documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. - May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines, and/or system support. - Participate in ongoing training per inter-rater reliability process. Qualifications - MD/DO/MBBS - Minimum of five (5) years’ experience in the practice of Medicine, post residency, with active clinical practice within the last 2 years preferred. - Current, unrestricted clinical license in home state medicine or required specialty. - Obtaining and maintaining medical licenses in the state you reside, as well as any license required per business needs. - Active Board Certification by an accredited organization. - Strong clinical, management, communication, and organizational skills. - Energetic and curious with a passion for quality and value in health care. - Computer Proficiency. - Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid. - No history of a major disciplinary or legal action by a state medical board. Requirements - To ensure a secure hiring process, we have implemented several identity verification steps, including submission of a government-issued photo ID. - Conduct identity verification during interviews; final interviews may require onsite attendance. - All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment. - The use of artificial intelligence tools during interviews is prohibited and monitored. - Misrepresentation will result in immediate disqualification from consideration. Benefits - The expected base salary/wage range for this position is $95-109/hr. - Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. - All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.

Title: Medical Reimbursement Specialist (Remote in Wisconsin) Location: United States Remote SUMMARY: A Reimbursement Specialist is responsible for the timely and accurate billing and insurance processing for Atos Medical products by preparing and submitting claims, verifying coverage, resolving denials, and maintaining compliant patient records. They collaborate with insurers, healthcare providers, and internal teams to support reimbursement outcomes and deliver a seamless experience for patients and clinicians. JOB RESPONSIBILITIES: Billing and Invoice Management - Print and review invoices from the billing system to ensure completeness and accuracy in accordance with company, department, and insurance guidelines. - Prepare invoices and patient insurance details for entry into claims filing software. - Enter all required information into claims software to generate electronic, paper, or faxed claims. - Prepare and submit secondary and tertiary claims as needed. - Review accounts receivable and aging reports, taking appropriate action to keep accounts current Claims Processing and Insurance Coordination - Contact insurance companies to verify claim status and provide any required documentation. - Determine when claims must be forwarded to secondary or tertiary insurance. - Review Medicare and commercial EOBs to confirm proper claim processing. - Submit corrected claims or request refunds and write-offs as appropriate. - Initiate contractual write-off requests and prepare and submit appeals when necessary. Record Management and Compliance - Maintain accurate and current billing files and patient insurance records. - Update patient information as needed and follow up on missing or incomplete insurance details. - Ensure all records comply with Medicare, HIPAA, and departmental requirements. - Participate in surveys and inspections conducted by authorized agencies Customer and Team Support - Provide professional and courteous assistance to patients and clinicians regarding the reimbursement process. - Collaborate with Customer Service and Customer Support teams to help expedite patient orders. - Communicate discrepancies, issues, or complaints to the Reimbursement Supervisor. - Prepare reports on billing activities as requested. - Support department operations by backing up colleagues and performing additional duties assigned by the Payor Reimbursement Supervisor BASIC QUALIFICATIONS: - Two years of medical billing and/or transferable healthcare experience - Exceptional customer focus and ability to work under tight deadlines - Demonstrated ability to review and process complex billing information and resolve discrepancies independently while coordinating effectively with team members and other departments. PREFERRED QUALIFICATIONS: - 3-5 years of related experience within the DME or Life Science industry - Medicaid, Medicare and commercial insurance knowledge preferred - Brighttree experience preferred SKILLS & ABILITIES: - Strong decision-making skills with sound judgment in complex situations. - Excellent analytical and problem-solving abilities with keen attention to detail. - Effective verbal and written communication skills across diverse audiences. - Demonstrated commitment to providing exceptional customer service. - Proficient in Microsoft Office Suite (Word, Excel, Outlook) and general computer applications. - Ability to prioritize, manage, and complete multiple tasks in a fast-paced environment. - Quick learner with strong technical aptitude and the ability to understand data flow and system interactions. - Working knowledge of medical terminology, billing processes, office procedures, and basic mathematics. - Ability to maintain strict confidentiality of sensitive information. - Skilled in accessing and using database and billing software applications. - Demonstrated competencies in customer service, judgment, organization, quality, professionalism, and adaptability. WE OFFER Atos Medical is a global leader headquartered in Sweden, united by a shared purpose and strong values. Guided by our superpowers—patient-centric, dedication, agile, and the belief that you never walk alone—we support and empower our users, our colleagues, and our partners every day. We believe in working together, growing together, and treating everyone we interact with—patients, coworkers, health care professionals, and partners—with respect and integrity. Health & Wellness: - - Comprehensive medical, dental, and vision coverage for you and your family. - Access to company-sponsored wellness programs and mental health resources - Paid leave for qualifying events, and generous parental leave for both birthing and non-birthing parents. - Health Savings Account (HSA) with employer contributions Financial Security: Competitive 401(k) with a dollar-for-dollar match up to 6% and immediate vesting, financial planning services, and corporate discounts. State-of-the-art facility: Hybrid and onsite employees work from our state-of-the-art facility, thoughtfully designed with sit-stand desks, large monitors, and premium onsite amenities, including a gym and golf simulator. Work-Life Balance: Flexible work options, Generous PTO plan, 10 paid holidays, and summer hours to help you recharge. Professional Development: Ongoing learning and career growth opportunities through training, mentorship, and tuition reimbursement.

Role Description Dane Street wants you to join our dynamic team of expert reviewers! In this role, you will have the opportunity to utilize your medical expertise to conduct thorough reviews of clinical cases. This telework opportunity allows you to customize your schedule as a 1099 independent contractor. - Evaluate medical records - Provide clinical summaries - Engage in peer communications - Answer specific questions posed by clients Be a part of a team that values your skills and dedication to improving patient care. Your expertise is vital to helping us deliver high-quality healthcare assessments. Qualifications - Current, unrestricted medical license in Massachusetts - Board Certification in Colorectal Surgery - Experience in conducting Disability Peer Reviews, recommended but not required - 5 plus years of clinical practice/actively practicing Requirements - Independent consultant role allows for schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct this work based on your scheduled availability - No doctor/patient relationship is established and no treatment is provided; these are advisory-only opinions - Typical TAT is 7 business days depending on the level of review - Dane Street keeps you apprised of required turn-around time and carefully coordinates all administrative tasks so your time is spent on clinical decision-making - Dane Street offers a streamlined case flow and a user-friendly work portal - We facilitate all communication, organize and sort all medical records, support all administrative processes, prep cases extensively, and ensure the quality and timely delivery of all determinations/reports - Dane Street offers initial training as well as an ongoing point of contact should you have any questions about completing reviews