Role Description The incumbent reviews medical bills utilizing professional knowledge and clinical experience to determine the relationship of services billed to the covered injury; applies appropriate review guidelines, assesses appropriate use of medical coding; identifies over-utilization of treatment and makes appropriate reimbursement recommendations. The incumbent is also responsible for the quality, timeliness, and customer service for assigned accounts. Essential Functions - Reviews medical bills and documentation according to guidelines and RW policies and procedures. - Determines if treatment is related and necessary to the covered injury. - Advises reimbursement recommendations are appropriate. - Provides customer service to adjusters, providers, and claimants regarding bill review. - Assesses appropriateness and duration of care provided, for possible utilization review. - Recommends independent medical evaluations (IME) to adjusters when necessary. - Acts as a resource to other staff members to facilitate completion of a quality product. - Uses appropriate reference material as necessary to perform professional review. - Meets company productivity standards. - Meets company quality standards. Qualifications - Certified Professional Coder – a plus but not required. - 1+ years medical coding experience – CPT, ICD-10 - preferred. - 1+ years’ experience in Medical Bill Repricing – preferred. - Michigan Workers' Compensation experience - preferred. Skills and Abilities - Ability to apply clinical knowledge and/or coding expertise in bill review. - Ability to read, write, speak, and understand English well. - Ability to understand and follow written and oral instructions. - Possess strong verbal and interpersonal skills. - Ability to multi-task. - Possess problem-solving skills. - Ability to sit for long periods at a computer terminal keyboarding. - PC skills – required. - Knowledge of Microsoft Office Products – required. - Ability to operate standard office equipment including telephone. Personal Characteristics - Initiative, drive, creativity, and persistence. - Good organizational skills. - Highest professional ethics. - Ability to work independently. EEOC Statement Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.

Role Description Nuna is expanding how it provides care to its users. We are looking for one or more part-time, contract nurses to help us ensure we’re providing the right care to the right patients. Our understanding of our needs, and those of our patients, will evolve (and our nurses will help us develop that understanding), so the scope and the number of hours may optionally expand in the future. This is a contract role, starting with a 6-month term with the option to renew; this role will not offer benefits. We expect around 5 hours per week at the start. If you have more time and we have more work, we may increase your hours. Within certain timeframes, work can be done at your convenience. We may occasionally invite you to meetings with our team. What you’ll do - Chart Review: review patient records to ensure that patients are a good fit for the Nuna app. This will involve: - Comparing diagnoses, prescription activity, test results, and medical records from a variety of sources - Reconciling discrepancies - Support the Nuna app’s medication management features (non-prescribing) - Review medication lists for completeness, appropriateness, and potential issues (e.g. adherence concerns, duplication, gaps, etc.) - Help patients communicate with their clinical teams about potential opportunities to improve medication experience - Liaise with clinical teams about patient medication experience - Support Nuna’s Medical Director in developing programs and processes to best support the care of Nuna patients - Assist in the design of future clinical tasks and responsibilities - Provide product feedback to Nuna product teams - Participate in quality improvement efforts Qualifications - Licensure in Illinois (required) - 6 months of clinical chart review experience - Comfortable learning new technology Bonus Points - Licensure in California and/or Tennessee - Experience with cardio-metabolic care - Interest in digital health and informatics - Experience with risk adjustment review of medical records

Role Description Responsible for identifying, researching, processing, resolving, and responding to inquiries from internal and external customers with emphasis on excellence, privacy, compliance and versatility within the health insurance industry. Qualifications - REQUIRED QUALIFICATIONS - 2 years of experience in clinical field of practice, health insurance, or other health care related field - Associate’s Degree in general field of study or Post High School Nursing Diploma or Certification (LPN only) from an approved program - Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC, LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN, OR an active, current, and unrestricted license to practice in the State of Arizona as an LPN. - PREFERRED QUALIFICATIONS - 3 years of experience in clinical field of practice, health insurance, or other health care related field - Bachelor's Degree in Nursing or related field of study - Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse Requirements - Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person. - Answer a diverse and high volume of health insurance related customer calls or correspondence on a daily basis. - Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests. - Maintain complete and accurate records per department policy. - Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations. - Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc. - Demonstrate ability to apply plan policies and procedures effectively. - Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries. - Collaborate with team to distribute workload/work tasks. - Monitor and report team tasks. - Communicate team issues and opportunities for improvement to supervisor/manager. - Support/mentor team members. - Participate in continuing education and current developments in the fields of medicine and managed care. - Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements. - The position has an onsite expectation of 5 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements. - Perform all other duties as assigned. Company Description Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. - Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week - Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week - Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month - Onsite: daily onsite requirement based on the essential functions of the job - Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This remote work opportunity requires residency, and work to be performed, within the State of Arizona.

Role Description Provide medical safety expertise, directly and indirectly, to Sponsors of drugs, devices, and combination products, in the post marketing period. - Undertake primary medical review of cases, including medical assessment of the case for seriousness, listedness/labeling, causality, adverse event coding and narrative review. - Update and document daily case data, case-feedback in appropriate trackers/tools to facilitate tracking and workflow management. - Assume complete responsibility for all assigned deliverables in line with expected quality, compliance, and productivity SLAs and KPIs. - Provide training and guidance to the case processing team on medical aspects of case processing, only after a tenure of 1 year. - Perform aggregate and signal analysis activities, as required in support of single case processing. - Create, maintain, and assume accountability for a culture of high customer service. Qualifications - Bachelor’s degree in medical science or MD or DO or equivalent degree. - Fortrea may consider relevant and equivalent experience in lieu of educational requirements. - Language Skills: Speaking: English at ILR level 3+ or higher. - Writing / Reading: English at ILR level 4+ or higher. Requirements - Working knowledge of medical sciences, diagnosis and therapeutics including drug treatments and procedures. - Knowledge and understanding of regulatory requirements for Clinical Research. - Knowledge and understanding of ICH-GCP guidelines. Preferred Qualifications Include - 1 to 2 years of Clinical practice experience. Physical Demands/Work Environment - Office or home-based environment, as requested by the line manager.