Role Description Lumicera Health Services is seeking a Reimbursement Specialist I to join our team! Under direction from the Assoc. Manager, Specialty Pharmacy Services, Reimbursement Team Lead, and pharmacists in the Specialty Pharmacy, the Reimbursement Specialist I is primarily responsible for following standard operating procedures to obtain and process manufacturer copay assistance program reimbursement. The Reimbursement Specialist I shall have knowledge of billing procedures and work to reduce discrepancies, inaccuracy, and outstanding balances. The Reimbursement Specialist I may also assist in contacting patients with an outstanding balance to communicate billing options. Responsibilities - Responsible for ongoing monitoring of claims activity for accuracy and successful submission - Responsible for ensuring that patient billing information is set up appropriately in the pharmacy software - Participate, as necessary, in conferences and meetings related to reimbursement/billing - Responds to employee/patient/client questions or complaints regarding reimbursement and/or billing - Works with internal teams to review and resolve claim issues - Maintains accurate reference information relating to reimbursement and copay assistance - Responsible for accurate and thorough documentation of information, insurance and prescriptions/orders within the patient profile - The Employee will act in accordance with all applicable federal and state laws and with the highest ethical standards that we consistently strive to achieve. Thus, legal and ethical compliance is an essential duty of each employee - Other duties as assigned Qualifications - High School Diploma or equivalent GED. Some college preferred - CPhT preferred - Pharmacy technician license or pharmacy technician trainee license is strongly preferred in states requiring pharmacy technician licensure - Experience with pharmacy, health plan or clinical insurance claims billing, benefit assessments, billing/claims documentation, or claims auditing is preferred - Participate in, adhere to, and support compliance program objectives - The ability to consistently interact cooperatively and respectfully with other employees Benefits - Top of the industry benefits for Health, Dental, and Vision insurance - 20 days paid time off - 4 weeks paid parental leave - 9 paid holidays - 401K company match of up to 5% - No vesting requirement - Adoption Assistance Program - Flexible Spending Account - Educational Assistance Plan and Professional Membership assistance - Referral Bonus Program – up to $750!

Role Description A new Australian telehealth clinic preparing for launch is looking to partner with a Nurse Practitioner who values a more personalised, preventative and patient-focused approach to healthcare. This opportunity sits within the evolving longevity, wellness and preventative health space and offers the chance to be involved in building a modern telehealth model focused on education, ethical practice, continuity of care and long-term patient outcomes. Importantly, this is not designed to be a high-volume transactional telehealth environment. The founders are intentionally building a clinic model centred around thoughtful patient care, professionalism, strong clinical governance and evidence-informed healthcare delivery. The clinic is being developed around a collaborative practitioner model involving both Nurse Practitioners and Medical Practitioners to support strong clinical governance, continuity of care and patient safety. Qualifications - Currently registered with AHPRA - Confident in communicating with patients compassionately and professionally - Comfortable within telehealth and digital healthcare environments - Highly organised and detail-oriented - Aligned with ethical and compliant healthcare delivery - Interested in preventative health, wellness and longevity-focused medicine - Collaborative, adaptable and proactive - Passionate about patient education and long-term care Requirements - Values continuity of care and meaningful patient relationships - Enjoys preventative and wellness-focused healthcare - Wants to work within a modern telehealth environment - Enjoys autonomy while working within a collaborative and clinically governed care model - Is interested in innovation within healthcare delivery - Wants to contribute to shaping a modern patient experience from the early stages Benefits - Fully remote telehealth-based role - Flexible scheduling available - Initially anticipated around 2–3 days per week, flexibility is available depending on practitioner availability and preferred structure - Opportunity to grow alongside the clinic as patient demand increases - Flexible remuneration structure with rates and incentive models open for discussion depending on experience, prescribing scope, availability and overall fit for the clinic Areas of Clinical Interest - Metabolic health - Preventative healthcare - Weight management support - Longevity and healthy ageing - Recovery and wellness optimisation - Hormone health - Sleep and recovery support - Performance and vitality The Role - Telehealth consultations - Reviewing onboarding questionnaires and patient histories - Conducting clinical assessments - Assessing pathology and blood work, where clinically appropriate - Developing personalised patient care plans - Supporting practitioner-led prescribing pathways within the clinic’s collaborative care framework - Ongoing patient monitoring and follow-up care - Patient education and guidance - Maintaining accurate clinical documentation - Supporting safe, ethical and compliant patient journeys The Environment - Patient-first care - Ethical and evidence-informed healthcare - Personalised treatment planning - Education and transparency - Continuity of care - Collaborative practitioner relationships - Modern telehealth systems and workflows - Professionalism, integrity and patient well-being

Role Description We are seeking a highly organized, systematic, and articulate Virtual Prior Authorization Specialist to lead the clinical administrative gateway for a fast-paced medical practice. This role is specifically designed for a dedicated insurance navigation expert who understands how to bridge the gap between complex payer guidelines, clinical documentation, and seamless patient scheduling. The primary anchor of this position is Obtaining Prior Authorizations and Managing Denial Appeals. You will be responsible for ensuring that all upcoming procedures, specialty medications, and advanced diagnostics are fully authorized before services are rendered. Because you will be communicating extensively with Texas-based insurance providers, clinical staff, and patients, you must possess exceptional, accent-free verbal English clarity, an authoritative command of insurance jargon, and a polished, professional phone demeanor. Core Responsibilities - Prior Authorizations & Denial Appeals (Primary Focus) - End-to-End Authorization Management: Submit and successfully secure prior authorizations for complex procedures, specialty medications, high-level imaging, and specialty referrals. - Clinical Review Coordination: Review clinical charts within ModMed/EMA to ensure medical necessity documentation perfectly supports specific payer requirements prior to submission. - Proactive Payer Follow-Up: Manage authorization tracking pipelines aggressively, following up with insurance medical directors and utilization management teams to prevent treatment delays. - Appeals & Denials Processing: Research, write, and submit technical appeals for denied authorizations, leveraging provider clinical notes to overturn adverse determinations. - Insurance Verification & Utilization Tracking - Front-End Benefit Auditing: Execute deep-dive eligibility checks and verify coverage limitations, tracking specific deductibles and policy exclusions. - Expiration Safeguarding: Track pending authorization expiration dates, utilization caps, and required renewal cycles to protect the practice from retroactive claim rejections. - Patient Communication & Administrative Alignment - High-Clarity Phone Support: Manage outbound and inbound call workflows via the Optum phone system, conveying delicate coverage updates to patients with empathy and extreme professionalism. - Provider & Clinic Synergy: Partner directly with on-site clinicians and providers to secure required clinical notes, peer-to-peer review scheduling data, and updated CPT/ICD-10 codes. - Precision Charting: Document all authorization confirmation numbers, approved lines of service, and payer correspondence paths within the patient’s permanent EMR record. Qualifications - Domain Expertise: Minimum 2+ years of dedicated prior authorization and insurance appeals experience inside a U.S. medical practice. - Linguistic Excellence: High-level bilingual fluency (English/Spanish). Must possess clear, highly articulate English verbal communication with little-to-no accent, tailored for our Texas-based patient demographic and provider market. - Coding Literacy: Solid, operational understanding of CPT codes, ICD-10 codes, and standard medical necessity documentation rules. - Remote Accountability: Agreement to work under a mandatory automated time-tracker, maintaining a quiet, highly secure home office setup compliant with HIPAA regulations. Strongly Preferred Experience - Direct, daily operational familiarity with ModMed (Modernizing Medicine) / EMA EHR. - Prior experience managing communication queues through the Optum VoIP phone system. - Specialized background reviewing clinical charts for surgical specialties or advanced diagnostic imaging authorizations.

• Be the lifeline for our customers – Respond with courtesy and empathy to those requesting roadside assistance. • Negotiate with confidence – Connect with providers to secure fair and favorable service rates. • Keep customers in the loop – Provide timely updates via phone and chat, ensuring every client feels supported. • Ensure accuracy and trust – Maintain precise records of actions and decisions to deliver seamless service every time. • Problem-solve quickly and effectively – Assess situations, think critically, and offer the best possible solutions under pressure. • Stay calm under pressure – Handle stressful or emergency situations with composure and professionalism. • Adapt and multitask – Manage multiple requests and provider communications efficiently while maintaining excellent service. • Demonstrate strong communication skills – Explain solutions clearly and professionally to both customers and providers. • Exhibit reliability and accountability – Consistently follow processes, meet performance standards, and take ownership of outcomes.