Role Description The Appeal Specialist II - RN reviews, analyzes, and resolves insurance denials to ensure accurate reimbursement and regulatory compliance. This role logs and reviews denials for trend reporting, provides feedback to facilities, and communicates payer updates to relevant stakeholders. The Appeal Specialist II collaborates with internal teams to ensure timely and thorough appeal resolution and supports initiatives that improve denial prevention and recovery processes. Essential Functions - Reviews and resolves pre-payment insurance denials in collaboration with follow-up teams. - Coordinates with Denial Coordinators, Facility Denial Liaisons, and Managed Care Coordinators to ensure payer accountability and identify education opportunities. - Provides feedback to facilities regarding denials resulting in retractions or reimbursement impacts. - Monitors payer billing and coding updates and communicates changes to SSC and ancillary departments. - Tracks and logs denials and appeal activity according to established documentation and reporting guidelines. - Prepares and distributes reports summarizing appeal trends, project updates, and payer response activity. - Recommends process improvements to enhance appeal efficiency and reduce recurring denials. - Maintains up-to-date knowledge of payer policies, billing and coding practices, and reimbursement regulations. - Utilizes practice management systems and maintains documentation of appeal activity in compliance with departmental standards. - Performs other duties as assigned. - Maintains regular and reliable attendance. - Complies with all policies and standards. Qualifications - H.S. Diploma or GED required - Bachelor's Degree in Nursing preferred - 2-4 years of experience in healthcare revenue cycle or business office required - 1-3 years of experience in healthcare insurance or medical billing preferred Requirements - Proficiency in word processing, spreadsheet, and database applications. - Working knowledge of billing, coding, and reimbursement principles. - Strong analytical, research, and problem-solving skills. - Ability to communicate effectively with payers, facility staff, and leadership. - Strong organizational and documentation skills with attention to detail. - Ability to work independently and manage multiple priorities in a fast-paced environment. - Understanding of insurance claims processing and denial management workflows. Benefits - Comprehensive Health Coverage – Medical, dental, and vision plans to keep you and your family healthy. - Future Security: 401(k) with matching - Student Loan Support – Up to $10,000 repayment assistance, because we invest in your future. - Educational Tuition Assistance - Competitive Pay & Full Benefits – A salary and package designed to reward your expertise and dedication. Company Description Community Health Systems is one of the nation's leading healthcare providers. With healthcare delivery systems in 36 distinct markets across 14 states, CHS operates 69 affiliated hospitals with more than 10,000 beds and approximately 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, imaging centers, cancer centers, and ambulatory surgery centers.

Role Description As a Certified Recovery Specialist, you will follow defined processes and protocols to ensure our patients receive consistent, high-quality care. You will engage directly with Ophelia patients, providing holistic support across a wide range of areas, including: - Resource Connection: Helping patients access vital community resources, benefits and social services. - Care Navigation: Clarifying care plans and helping patients stay actively engaged in their treatment. - Clinical Partnership: Working closely with the clinical team to flag concerns early and facilitate warm handoffs and referrals that actually land. What Success Looks Like: - This is a good fit for someone who is comfortable building trust with patients through consistent, purposeful contact over time. - Understanding that in a virtual care setting, good documentation is part of good care. Reporting Structure: - This role reports to the Program Manager for Care Navigation. In this role, you will: - Manage an active caseload of patients with open social needs, developing and maintaining individualized care plans. - Reach patients by SMS and phone to assess needs, clarify barriers, and keep cases moving — building rapport through consistency, but maintaining efficiency and ease for the patient. - Research targeted resources for each patient based on their specific situation, like insurance status, location, income, and the actual barrier they’re facing. - Follow cases through to confirmed resolution. - Practice active listening, empathy, and solution-focused approaches to collaboratively engage with patients seeking support on a wide range of issues. - Prioritize effectively across multiple channels: switching between calls, messages, meetings, texts, and Slack to deliver patient-centered care. - Interact and problem-solve with multi-disciplinary teams such as Enrollment Coordinators, Financial Counselors, Clinicians and Tech team to ensure a safe and excellent patient experience. - Resolve issues related to prescriptions and insurance/pharmacy authorizations. - Follow Ophelia's policies and maintain all confidentiality, compliance, and ethical standards. - Work autonomously and as part of a team within established procedures and practices. - Consistently practice our cultural values: champion our patients, communicate with kindness, learn and share freely, and get results. Qualifications - An attention to detail, and a commitment to high quality documentation to deliver a seamless patient journey through care navigation. - An ability to move patients along a care continuum, from identifying a barrier to full issue resolution; with steps clearly and concisely documented and communicated along the way. - Experience delivering outstanding patient experience or customer support, ideally at a telehealth or direct to patient healthcare company. - Experience de-escalating highly emotional conversations and communicating with empathy and respect to vulnerable patient populations. - A collaborative mindset and ability to build rapport in a remote first work environment. - High integrity, honesty, ability to build trust and maintain a strong sense of accountability. - A bias for action and getting things done: proactively taking on work without prompting, swiftly implement solutions, and achieving results efficiently and effectively. - Experience solving problems that do not have clear or obvious solutions. Requirements - Meets criteria for CRS as outlined below, or has CRS certification already. Important Role Note: We are looking for someone who is, or is willing to become a Certified Recovery Specialist. If needed, we will reimburse training costs for certification. Please note that there are several requirements to enroll in a Certified Recovery Specialist program: - Must either live or work in Pennsylvania. - A minimum of 18 months of recovery in a continuous manner of personal, lived experience. - Minimum high school diploma/GED. Veterans may provide discharge documentation in lieu of a high school diploma/GED. Benefits - Competitive medical, vision, and health insurance (many plans are fully covered for the employee!). - Start with 20 days (4 weeks) of PTO, increasing to 5 weeks after 2 years and 6 weeks after 5 years of tenure. - 10 company holidays. - Work From Home Stipend. - 401k Contribution Platform. - Additional benefits offered through our benefits provider such as life insurance, short and long term disability, financial wellness, virtual primary care, among others! Company Description Ophelia is a venture-backed, healthcare startup that helps individuals with OUD by providing FDA-approved medication and clinical care through a telehealth platform. Our approach is discreet, convenient, and affordable. We've been successfully operating in 14 states for almost six years and we're excited to continue our growth. We are a team of physicians, scientists, entrepreneurs, researchers and White House advisors, backed by leading technology and healthcare investors working to re-imagine and re-build OUD treatment in America.

Role Description The Controlled Documents Specialist is responsible for managing the controlled document lifecycle within the Veeva Quality platform, ensuring compliance with regulatory requirements, internal processes, and quality management standards. - Manage the lifecycle of controlled documents in Veeva including creation, review, approval, issuance, periodic review, and archival. - Ensure controlled documents comply with applicable regulatory requirements and internal standards. - Route documents for review and approval, ensuring timely completion and escalation as needed. - Support stakeholders through document creation, review, and revision. - Support inspection and audit readiness by ensuring controlled documents are organized, accurate, and accessible. - Maintain accurate metadata and document classification within Veeva. - Partner with system administrator and vendor to support system enhancements and configuration updates. - Develop SOPs, quick reference guides, and training materials related to document management. Qualifications - Bachelor’s degree in Life Sciences or a related scientific field and 1-3 years experience working in a regulated environment. - 1-3 years experience using electronic document management systems such as Veeva (Preferred). - 1-3 years experience supporting audits and inspections (Preferred). - Understanding of controlled documents and QMS. - Attention to detail. - Analytical and critical thinking. - Written and verbal communication. - Ability to prioritize critical tasks and provide a high level of responsiveness and timely service. - Ability to effectively manage stakeholders and maintain collaborative relationships in a cross-functional, global environment. - Microsoft Office proficiency. Company Description Emmes Group is transforming the future of clinical research, bringing the promise of new medical discovery closer within reach for patients. Emmes Group was founded as Emmes more than 47 years ago, becoming one of the primary clinical research providers to the US government before expanding into public-private partnerships and commercial biopharma. Emmes has built industry leading capabilities in cell and gene therapy, vaccines and infectious diseases, ophthalmology, rare diseases, and neuroscience. We believe the work we do will have a direct impact on patients’ lives and act accordingly. We strive to build a collaborative culture at the intersection of being a performance and people driven company. We’re looking for talented professionals eager to help advance clinical research as we work to embed innovation into the fabric of our company. If you share our motivations and passion in research, come join us!

ROLE SUMMARY Everything we do, every day, is in line with an unwavering commitment to the quality and the delivery of safe and effective products to patients. Our science and risk-based compliant quality culture is innovative and customer oriented. Whether you are involved in manufacturing, testing, or compliance, your contribution will directly impact patients. All over the world, Pfizer colleagues work together to positively impact health for everyone, everywhere. Our colleagues have the opportunity to grow and develop a career that offers both individual and company success; be part of an ownership culture that values diversity and where all colleagues are energized and engaged; and the ability to impact the health and lives of millions of people. Pfizer, a global leader in the biopharmaceutical industry, is continuously seeking top talent who are inspired by our purpose to innovate to bring therapies to patients that significantly improve their lives. The Vaccines Health and Science Professional (HSP) is responsible for the promotion of a Vaccines Portfolio across customers and channels. This position will require regular live in field customer engagement in addition to virtual engagements. The HSP is accountable for launching new products, deciding upon the best strategies to manage business relationships, understanding, and securing formulary access, and engaging in product promotion within the assigned geography. In addition, the HSP is charged with sales efforts and relationship development with customers and accounts, including Therapeutic Area Specialists, and Key Opinion Leaders (KOLs). The HSP should possess customer, market and business acumen combined with strong product and disease state knowledge; demonstrate strong sales, strategic business development, account management skills and in-depth customer engagement expertise in both virtual and in-person settings; utilize a systematic approach to virtual engagement (e.g., clear agenda, next steps/follow ups); have outstanding communications skills; be adept in the operation of digital and virtual tools/multi-platforms skills. Effective at working remotely in collaboration with cross-functional internal teams to address customer needs and compliantly deliver on Pfizer business objectives. ROLE RESPONSIBILITIES • Drive sales in assigned territory to maximize approved business objectives • Engages with customers both face to face and virtually • Develops and implements effective business and territory call plans; effectively identifies and implements live/virtual engagement strategies with customer to maximize overall effectiveness and impact • Effectively builds rapport and relationships with customers in both live and virtual environments; uses judgment to maintain customer engagement by successfully utilizing existing and ever-changing digital tools effectively for successful customer engagement • Understands and leverages internal reports and analytics to assist with identifying, developing, and implementing strategic business opportunities • Compliantly leverages product and disease state knowledge using approved clinically oriented disease state information and patient resources, as applicable • Demonstrates market knowledge, uncovering barriers and drivers across all relevant business channels (Public Health, Private Market, Retail, etc.) • Collaborate effectively and compliantly with cross-functional colleagues, including Field Medical and Account Management, to address customer inquiries and advance Pfizer objectives • Completes all administrative expectations on time and compliantly (e.g., entering customer calls appropriately, submitting expenses, responding to all requests from sales leadership, managers and/or Pfizer internal partners) BASIC QUALIFICATIONS • Bachelor's Degree • Minimum 2 years of experience in one or more of the following OR an associate's degree with 6+ years of experience; OR high school diploma (or equivalent) with 8+ years of relevant experience: • Professional Sales or Promotional Activity • Small Business Owner or other Entrepreneurial experience, Marketing, Customer Service and/or Account Management • Relevant Healthcare/Scientific roles (e.g., RN, Pharmacist, PT, OT, etc.) • Educator (e.g., Teacher, Principal) • Full time Military experience • Must live within 25 miles of the border of the territory • Valid US driver's license and driving record in compliance with company standards. Any DUI/DWI or other impaired driving citation within the past 7 years will disqualify you from being hired. PREFERRED QUALIFICATIONS • At least 1 year of pharmaceutical, biotech, medical sales and/or medical related marketing • Strong track record of sales or marketing success, strong territory management skills, outstanding communications skills, as well as demonstrated teamwork, leadership ability and accountability • Experience with Vaccines therapeutic area and products • Knowledge of posted territory customers and markets (prescribers/HCPs/institutions/organizations) • Reside within the territory boundaries Other Job Details Last Date to Apply: June 16, 2026 The annual base salary for this position ranges from $76,000 - $199,600. During initial new hire sales training, you will be classified as a salary non-exempt employee which entitles you to overtime pay. Upon your training certification, you will become an overtime exempt employee. In addition, this position offers an additional quarterly Sales Incentive bonus. We offer comprehensive and generous benefits and programs to help our colleagues lead healthy lives and to support each of life's moments. Benefits offered include a 401(k) plan with Pfizer Matching Contributions and an additional Pfizer Retirement Savings Contribution, paid vacation, holiday and personal days, paid caregiver/parental and medical leave, and health benefits to include medical, prescription drug, dental and vision coverage. Learn more at Pfizer Candidate Site - U.S. Benefits| (uscandidates.mypfizerbenefits.com). Pfizer compensation structures and benefit packages are aligned based on the location of hire. The United States salary range provided does not apply to any location outside of the United States. Relocation assistance may be available based on business needs and/or eligibility. Candidates must be authorized to be employed in the U.S. by any employer. U.S. work visa sponsorship (such as TN, O-1, H-1B, etc.) is not available for this role now or in the future. Sunshine Act Pfizer reports payments and other transfers of value to health care providers as required by federal and state transparency laws and implementing regulations. These laws and regulations require Pfizer to provide government agencies with information such as a health care provider's name, address and the type of payments or other value received, generally for public disclosure. Subject to further legal review and statutory or regulatory clarification, which Pfizer intends to pursue, reimbursement of recruiting expenses for licensed physicians may constitute a reportable transfer of value under the federal transparency law commonly known as the Sunshine Act. Therefore, if you are a licensed physician who incurs recruiting expenses as a result of interviewing with Pfizer that we pay or reimburse, your name, address and the amount of payments made currently will be reported to the government. If you have questions regarding this matter, please do not hesitate to contact your Talent Acquisition representative. EEO & Employment Eligibility Pfizer is committed to equal opportunity in the terms and conditions of employment for all employees and job applicants without regard to race, color, religion, sex, sexual orientation, age, gender identity or gender expression, national origin, disability or veteran status. Pfizer also complies with all applicable national, state and local laws governing nondiscrimination in employment as well as work authorization and employment eligibility verification requirements of the Immigration and Nationality Act and IRCA. Pfizer is an E-Verify employer. This position requires permanent work authorization in the United States. Pfizer endeavors to make www.pfizer.com/careers accessible to all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process and/or interviewing, please email disabilityrecruitment@pfizer.com . This is to be used solely for accommodation requests with respect to the accessibility of our website, online application process and/or interviewing. Requests for any other reason will not be returned. To learn more about acceptable and prohibited uses of AI during the recruitment process, please review our candidate AI-use guidelines available on Pfizer Careers . Sales