Role Description Muller's Solutions is seeking a Core Insurance Subject Matter Expert (SME) to drive process advisory, system optimization, and escalation support within the insurance domain. The ideal candidate will bring deep insurance expertise, advising on best practices, optimizing core insurance systems, and providing escalation support to ensure efficient operations. - Serve as the go-to SME for core insurance processes, including policy management, underwriting, claims, and risk assessment. - Advise on process improvements, ensuring insurance operations align with industry best practices. - Provide strategic input on system optimizations, ensuring core insurance platforms are efficient, scalable, and aligned with business needs. - Lead advisory sessions with business stakeholders to identify gaps and opportunities for system enhancements. - Support escalation and issue resolution by acting as a subject matter escalation point for complex insurance system challenges. - Work closely with IT and business teams to implement changes and ensure smooth system transitions. - Facilitate training and knowledge transfer to ensure teams understand new processes and system functionalities. Qualifications - Bachelor’s degree in Business, Finance, Insurance, or a related field. - Minimum 8+ years of experience in the insurance industry, with a focus on core insurance systems and processes. - Proven experience optimizing insurance platforms and providing system advisory. - Deep understanding of policy, claims, underwriting, and risk workflows. - Strong problem-solving skills, with the ability to analyze complex issues and drive resolutions. - Excellent communication skills to liaise between business and technical teams. - Experience with insurance system implementations and escalations. Preferred Qualifications - Professional certification in insurance (e.g., CPCU, ACII). - Experience working with digital insurance transformation projects. - Familiarity with Skadina or other insurance technology platforms.

Role Description Muller's Solutions is seeking a Core Insurance Subject Matter Expert (SME) to drive process advisory, system optimization, and escalation support within the insurance domain. The ideal candidate will bring deep insurance expertise, advising on best practices, optimizing core insurance systems, and providing escalation support to ensure efficient operations. - Serve as the go-to SME for core insurance processes, including policy management, underwriting, claims, and risk assessment. - Advise on process improvements, ensuring insurance operations align with industry best practices. - Provide strategic input on system optimizations, ensuring core insurance platforms are efficient, scalable, and aligned with business needs. - Lead advisory sessions with business stakeholders to identify gaps and opportunities for system enhancements. - Support escalation and issue resolution by acting as a subject matter escalation point for complex insurance system challenges. - Work closely with IT and business teams to implement changes and ensure smooth system transitions. - Facilitate training and knowledge transfer to ensure teams understand new processes and system functionalities. Qualifications - Bachelor’s degree in Business, Finance, Insurance, or a related field. - Minimum 8+ years of experience in the insurance industry, with a focus on core insurance systems and processes. - Proven experience optimizing insurance platforms and providing system advisory. - Deep understanding of policy, claims, underwriting, and risk workflows. - Strong problem-solving skills, with the ability to analyze complex issues and drive resolutions. - Excellent communication skills to liaise between business and technical teams. - Experience with insurance system implementations and escalations. Preferred Qualifications - Professional certification in insurance (e.g., CPCU, ACII). - Experience working with digital insurance transformation projects. - Familiarity with Skadina or other insurance technology platforms.

Role Description Join Pennant’s dynamic insurance authorization team as the Insurance Authorization Coordinator! We are looking for an exceptional team player to orchestrate the crucial function of securing timely and accurate insurance authorizations for our patients. Your expertise will be key to ensuring uninterrupted care and optimizing our financial health. You will be responsible for all aspects of payer authorization. This role demands deep knowledge of payer requirements, strong ownership skills, and meticulous attention to detail to ensure every patient's services are appropriately covered from admission through discharge. Key Responsibilities - Initial Authorization: Oversee the timely and accurate submission and tracking of all initial insurance authorization requests for home health and hospice patients. - Collaboration and Communication: Work closely and effectively with the scheduling teams to coordinate start of care and ensure clinical services are only delivered after authorization is confirmed. - 485 and Add-On Authorization: Direct the process for obtaining authorization following the 485 (Plan of Care) submission and managing all add-on insurance authorizations when required for changes in the patient's plan of care (e.g., increased visits, new services). - Ongoing Eligibility Management: Establish and monitor the process for the team to re-verify eligibility on the 1st and 5th of each month for all active patients to proactively identify and resolve any changes in insurance status. - Payer Relations: Serve as the escalation point for complex authorization denials or issues, communicating directly with various insurance carriers. - Compliance and Reporting: Ensure all authorization processes are compliant with payer contracts and regulatory standards. Generate reports on authorization status, denial rates, and turnaround times. Qualifications - Required: - Minimum of 3 years of dedicated experience in insurance verification and authorization, specifically within Home Health or Hospice. - Expert knowledge of Medicare, Medicaid, and commercial insurance authorization processes and documentation requirements for episodic and per diem payments. - Proficiency in using electronic medical record (EMR) systems and authorization tracking software. - Preferred: - Associate's or Bachelor's degree in Business, Finance, Healthcare Administration, or a related field. - Experience with utilization review and appeals processes. Skills and Competencies - Superior analytical and organizational skills with an unwavering attention to detail. - Exceptional ability to navigate complex payer portals and communication channels. - Excellent interpersonal skills for effective collaboration with clinical and scheduling staff. - Proven ability to lead a team in a high-volume, deadline-driven environment. - Strong commitment to regulatory compliance and ethical billing practices. Company Description The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at http://www.pennantgroup.com .

Role Description - Receive and review all insurance and patient refund requests, prepare refund and document the account appropriately. - Bill claims as necessary. - Process all refund checks once received back from accounting by adjusting and documenting the account. - Mail out checks or credit card receipts to patients and insurance companies. - Transfer payments by completing a conveyance. - Complete the daily balancing for all clinics and Corporate. Review the “POP” Patient Overpayment Report and apply all payments as requested. Qualifications - High School Diploma or GED required. - An accounting background is preferred. - A strong insurance billing background in a healthcare provider business office is strongly preferred. - Ability to review accounts for proper posting of payments. - Ability to figure discounts accurately and adjust accounts appropriately. - Experience in calling insurance companies regarding refund requests with the ability to dispute any incorrect refund request. - Ability to speak to patients in a professional and caring manner. - Must be detail-oriented and be able to do multiple tasks. - Please be sure to fully complete the application sections. (a resume is strongly preferred but does not substitute for the application information) Requirements - Background, drug, and nicotine screens are required. - All offers of employment are contingent upon clear results of a thorough background screening. - FCS requires all new hires to receive various vaccinations, including the influenza vaccine, barring an approved exemption. - FCS is a drug-free workplace, and all new hires will be subject to drug/nicotine testing. - Medical Marijuana cards are not recognized. EEOC - FCS is committed to helping individuals with disabilities to participate in the workforce and ensure equal opportunity to compete for jobs. - If you require an accommodation to submit a resume for positions at FCS, please email FCS Recruitment (Recruiter@FLCancer.com) for further assistance. - Please note this email address is intended to request an accommodation as part of the application process. Any other correspondence will not receive a response. - FCS is an EEO/Affirmative Action Employer and does not discriminate on the basis of age, race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, protected veteran status, disability or any other legally protected status.