Building Location: Fargo Distribution Serv Center Department: 1006080 PROFESSIONAL BILLING - EH SS Job Description: Processes paper and electronic claims to payers with full and complete information to satisfy and facilitate the claim for payment. Produces accurate and timely claims in order to prevent denials and maximize reimbursement. Responsible for working assigned work queues within the patient accounting system and claim scrubber edits prior to final submission. Responsible for optimizing the claim submission operations including prospectively reviewing submissions and making corrections to expedite first time payment to the extent possible. He/ she is also responsible for research and communication of payer, HIPAA or other regulatory changes affecting the billing of health insurance claims and making recommendations regarding billing and system operations to improve payment turnaround. This position works closely with insurance companies, credentialing, access and managed care and other internal and external stakeholders tied to the billing system. Makes recommendations regarding system changes to improve the revenue cycle process and quality, and works to assist in the development of training. Position requires high level of customer service skills to establish and enhance positive relationships with patients, colleagues, and others. Depending upon location responsibilities may vary and may include a variety of duties of similar scope and responsibility. Work Experience: 1 year healthcare experience in healthcare billing/revenue services Education Qualifications: None Licensure/Certification Qualifications: None FTE: 1 Possible Remote/Hybrid Option: Remote Shift Rotation: Day Rotation (United States of America) Shift Start Time: 8:00 Shift End Time: 4:30 Weekends: No weekends Holidays: No Call Obligation: No Union: Union Posting Deadline: Compensation Range: $17.63 - $26.45 Employee Benefits at Essentia Health: At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability insurance, along with supplemental options to fit your needs. We offer a 401(k) plan with employer contributions to help you plan for the future, and we invest in your professional development through training, tuition reimbursement, and educational programs. To help you thrive both at work and at home, we provide flexible scheduling, generous time off, and wellness resources focused on your physical, mental, and emotional health. Please note that benefit eligibility may vary. For full details, refer to your benefit summary or contact our HR Service Center at (218) 576-0000.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Radiology Authorization Specialist plays a critical role in obtaining pre-certification of Radiology imaging for PCI patients. This position involves: - Performing timely and accurate insurance and benefits verification, and pre-certification of Radiology imaging. - Coordinating with clinic staff to add and update insurance and perform verification and reverification of insurance benefits. - Determining eligibility, coverage details, and benefits using online resources or phone calls with the insurance company. - Communicating status of verification/authorization process with appropriate team members in a timely and efficient manner. - Documenting verification details for all Radiology Authorization services in the patient’s record. - Verifying completeness and accuracy of all information prior to resolving tasks in the work queue. - Working productively and efficiently from a task-based work queue. - Acting as liaison between clinical staff, patients, and insurance by informing all parties of coverage issues. - Contacting insurance companies to determine preauthorization requirements for outpatient imaging studies. - Reviewing and submitting clinical information to support medical necessity of Radiology orders. - Analyzing, investigating, and resolving all authorization denials and peer-to-peer requests. - Filing appeals and reconsiderations for denied authorizations. - Utilizing reports to initiate preauthorization on Radiology scans and communicate across functional areas. - Identifying problems or trending issues and providing suggestions for findings and resolutions. - Responding timely to emails and telephone messages as appropriate. - Regularly meeting with Practice Manager to discuss and resolve verification issues or preauthorization obstacles. - Abiding by the Health Insurance Portability and Accountability Act (HIPAA) when handling any and all protected health information (PHI). Qualifications - High school diploma (or equivalent) is required; collegiate education preferred. - Hematology/Oncology Authorization experience a plus. - Three + years of medical office experience preferred. - Demonstrated skills in problem solving, attention to detail, and effective written and verbal communication skills. - Advanced technical skills including PC and MS Outlook. - Advanced knowledge of health insurance benefits including In-network & out-of-network services. - Advanced knowledge of CPT, HCPCs, and ICD-10 codes. - Advanced knowledge of medical terminology and business office processes. - Strong interpersonal skills. - Customer service experience and the ability to prioritize and work accurately. - Must be able to sit 8 hours/day; work may be stressful at times. Requirements - Precertifications completed within three to five business days before date of service. Benefits - 401(k) - Dental insurance - Employee assistance program - Employee discount - Health insurance - Life insurance - Paid time off - Referral program - Vision insurance

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As a member of the Evernorth Finance team, you will edit, bill, and collect payment on standard outstanding claims with a goal of positively impacting the company's revenue and accounts receivable balance. You will communicate opportunities for best practices based on issues identified. Enabled by a robust training curriculum, clear policies, and team support, you will contribute toward the important functions of billing and collections and contributing toward our growth strategy. To achieve our collective success, a working knowledge of the billing and collection processes and accountability for quantity and quality metrics are key expectations of the role. - Investigate reason for unpaid balances from insurance companies - Troubleshoot both internal and external issues and insurance denials - Work independently to research and resolve the unpaid balance - Collaborate effectively with internal business partners and external payers to drive timely and accurate reimbursement Qualifications - High School Diploma or GED required - Associates degree or equivalent work experience strongly preferred - Accounts receivable background preferred - Self-motivated and goal-oriented - Problem-solving skills - Solid written and verbal communication skills - Strong research and analytical skills - Team player with a positive attitude - Detail oriented - Solid organizational skills - Proficient in Microsoft Office with working knowledge of Microsoft Excel - Must meet work at home company requirements - Must have strong ability to stay engaged in a virtual environment Requirements - If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. Company Description Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This role involves acting as the enrollment liaison between Gainwell Technologies, Idaho Department of Health & Welfare (Medicaid Division), and the Idaho Medicaid provider community. - Review and process initial provider enrollment applications per State requirements - Update provider changes, certifications, and license updates - Navigate multiple systems, licensing, and medical certification websites to obtain updates - Follow up with providers on outstanding issues within contractual guidelines - Provide excellent customer service with professional verbal and written abilities while meeting documented quality standards Qualifications - Highly motivated self-starter with 3+ years’ experience working in the healthcare industry, preferably credentialing or regulatory - Strong Microsoft Office skills and experience working with business solutions software - Proven experience with issue resolution focused on research, provider enrollment, requirement compliance, and customer service - Ability to investigate complex inquiries while leveraging requirements to promote successful outcomes - Strong written and verbal communication skills - Strong organization and time management skills Requirements - This is a 100% remote position with 8-hour shifts scheduled Monday through Friday during standard business operating hours - Fast-paced, high-volume, highly visible role requiring strong attention to detail while delivering documented, high-quality analytical support within established service level agreement (SLA) timelines and operational standards - Utilize claims systems, reporting tools, and operational documentation to review pharmacy claims, validate reimbursement logic, and support claims accuracy and process improvement initiatives - Investigate complex inquiries, communicate findings and resolutions to internal and external stakeholders via secure messaging, email, or verbal communication, and document all activity within designated system tools - Work both independently and collaboratively with cross-functional teams while supporting operational goals and performance expectations Benefits - Eligible employees may participate in Gainwell’s comprehensive benefits program, which includes medical, dental, vision, 401(k), paid time off, and other employee wellness and support programs - Generous, flexible vacation policy - 401(k) employer match - Comprehensive health benefits - Educational assistance - Leadership and technical development academies to help build your skills and capabilities