NewProgram Integrity Investigator (Healthcare Fraud Waste & Abuse) TriWest Healthcare AllianceProgram Integrity Investigator (Healthcare Fraud Waste & Abuse)Baltimore, MDRemoteFull timeComplies with the Veterans Affairs Community Care Network (CCN) and TRICARE T-5 contracts; DHA and TRICARE program guidelines and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies interfaces directly with Veterans, Military members and family (as warranted), providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters; prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals. The PI Investigator t is responsible for the identification, analysis, case development, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA), the Healthcare Finance Administration (HCFA) and the Department of Defense, Defense Health Agency for the TRICARE program; requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s).
Patient Financial Services Lead MedVanta Interco, LLC.Patient Financial Services LeadBethesda, MD$25 / hourPart timeThrough a combination of innovative technology, clinical expertise, data-driven insights, and care navigation services, MedVanta delivers solutions that support prevention, performance, treatment, recovery, and long-term musculoskeletal health. MedVanta is the nation's largest physician-owned musculoskeletal (MSK) platform, dedicated to helping individuals prevent injuries, improve movement, recover from musculoskeletal conditions, and access high-quality MSK care.
Patient Financial Services Lead MedVanta CareersPatient Financial Services LeadBethesda, MarylandThrough a combination of innovative technology, clinical expertise, data-driven insights, and care navigation services, MedVanta delivers solutions that support prevention, performance, treatment, recovery, and long-term musculoskeletal health. MedVanta is the nation's largest physician-owned musculoskeletal (MSK) platform, dedicated to helping individuals prevent injuries, improve movement, recover from musculoskeletal conditions, and access high-quality MSK care.
Payment Policy Analyst (Remote) Blue Cross and Blue Shield AssociationPayment Policy Analyst (Remote)DCRemote$58,320–$115,830 / yearQUALIFICATIONS: Education Level: Bachelor''s Degree in Health Administration, Business, Finance, Nursing or related discipline OR in lieu of a Bachelor''s degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
Marketing Physician Liaison Prism Vision GroupMarketing Physician LiaisonGreenbelt, Maryland$58,203.22–$120,883.61 / yearThe Marketing Specialist (Practice Liaison) is a key growth driver responsible for generating new business, expanding referral pipelines, and strengthening high-value partnerships with Physicians, Office Managers, community leaders, and other referral sources. With a focus on building strong connections, uncovering new opportunities, and delivering measurable results, the Marketing Specialist plays a critical role in practice growth and revenue expansion.
Insurance Authorization Specialist/ Medical Assistant Lifeline Vascular CareInsurance Authorization Specialist/ Medical AssistantColmar Manor, MarylandThe Insurance Authorization Specialist will verify patient insurance coverage, obtain pre-authorizations and Primary Care Provider referrals, schedule patient appointments, coordinate the patient intake process and provide administrative support to the center. Serves as liaison between physicians and referring facilities ensuring medical procedure results are forwarded to dialysis facility and or referring physician.
Patient Financial Advocate Firstsource SolutionsPatient Financial AdvocateEdgewood, MDThe Patient Financial Advocate is responsible for screening patients on-site at hospitals for eligibility assistance programs either bedside or in the ER. Essential Duties and Responsibilities: Review the hospital census or utilize established referral method to identify self-pay patients consistently throughout the day.
Coding Specialist (Multi -Specialty) Omm IT SolutionsCoding Specialist (Multi -Specialty)Linthicum Heights, Linthicum HeightsThe following statements describe the general nature and level of work performed and are not intended to be exhaustive: Reviews and analyzes physician documentation, operative reports, and hospital encounter records to accurately assign CPT and ICD-10-CM codes for professional services. Codes medical records for multi-specialty physician practices, with a strong focus on Orthopedic professional fee services, including hospital-based Evaluation & Management (E/M) services.
Regulatory Cybersecurity Specialist US Department of Health and Human ServicesRegulatory Cybersecurity SpecialistWashington, DC$143,913–$226,144 / yearThe Food and Drug Administration is the regulatory, scientific, public health, and consumer protection agency responsible for ensuring that all human and animal drugs, and medical devices are safe and effective, that cosmetics, foods, food additives, drugs and medicated feeds for food producing animals, and radiation emitting devices are safe, and that all such products marketed in the United States are adequately, truthfully and informatively labeled and safely and properly stored, transported, manufactured packaged and regulated. Foreign Education: If you are using education completed in foreign colleges or universities to meet the qualification requirements, you must show that the education credentials have been evaluated by a private organization that specializes in interpretation of foreign education programs and such education has been deemed equivalent to that gained in an accredited U.S. education program; or full credit has been given for the courses at a U.S. accredited college or university.
Manager, Meaningful Day Services (Monday-Friday, 8:30am-4:30pm) Ardmore Enterprises, Inc.Manager, Meaningful Day Services (Monday-Friday, 8:30am-4:30pm)Lanham, MDPart timeThis role facilitates strategic service delivery designed to increase, improve, and maintain employment opportunities, community participation, and inclusion for adults with disabilities through a hybrid model that includes both community-based and virtual supports. Partner with Directors, Person-Centered Planning Specialists, Coordinators, Managers, Direct Support Professionals, families, and external stakeholders to ensure seamless service delivery.
Accounting Technician US Department of Health and Human ServicesAccounting TechnicianWashington, DC$45,409–$65,599 / yearGS-07: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level (GS-06) in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: Independently performing accounts receivable and accounting technician duties involving reconciliation of financial transactions and reports; researching, analyzing, and resolving discrepancies in accounting records or automated financial systems; processing collections, deposits, reimbursements, or refunds in accordance with accounting regulations and procedures; utilizing financial management systems such as UFMS, RPMS, FBIS, or similar automated accounting systems to process and reconcile financial data; and preparing financial reports, worksheets, or supporting documentation related to accounts receivable operations. MINIMUM QUALIFICATIONS: GS-06: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level (GS-05) in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: Processing and reconciling accounts receivable transactions; preparing and maintaining financial records, reports, deposits, or collection documentation; utilizing automated accounting or financial systems to enter, track, and verify financial data; researching and resolving discrepancies in financial or accounting records; and providing customer service related to billing, collections, reimbursements, or financial transactions.
Senior Medical Coding Specialist (Remote) Blue Cross and Blue Shield AssociationSenior Medical Coding Specialist (Remote)DCRemote$67,464–$133,991 / yearThis role utilizes coding expertise, combined with medical policy, credentialing, and contracting rules knowledge, to build effective guidelines and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not compromising payment integrity. Consults with various teams, including the Practice Transformation Consultants, Medical Policy Analysts and Provider Networks colleagues to interpret coding and documentation language and respond to inquiries from providers.
Patient Service Representative Patient FirstPatient Service RepresentativeBowie, MarylandBeing available to assist as needed (breaks and mealtimes may be interrupted at any time to provide necessary patient care or to maintain center operations). Collecting money and issuing receipts for a patient’s visit, diagnostic studies, and supplies as prompted by the electronic medical record system.
NewCertified Professional Coder, Special Investigations Unit (Aetna SIU) CVS Health CorpCertified Professional Coder, Special Investigations Unit (Aetna SIU)MD$43,888–$93,574 / yearThe Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. Uses department resources regularly and follows workflows with minimal assistance or intervention to perform daily work to meet metrics.
Business Development Specialist Veterans Sourcing GroupBusiness Development SpecialistBaltimore, MDThis role works closely with cross-functional teams to ensure accurate data handling, support sales operations, and maintain compliance with utility requirements. We are seeking a detail-oriented and organized Business Development Specialist to support pricing, contracting, and customer data management activities within a dynamic energy-focused environment.
Pharmacy Reimbursement Coordinator II Johns Hopkins HospitalPharmacy Reimbursement Coordinator IIBaltimore, MDWe are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices. This role is responsible for accurate and timely billing to government payors, international and domestic third-party payors, patients, and Johns Hopkins programs to ensure optimal reimbursement.
Laboratory Supervisor - Inpatient/Specimen Receiving Endeavor HealthLaboratory Supervisor - Inpatient/Specimen ReceivingWashingtonOur more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals – Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) – all recognized as Magnet hospitals for nursing excellence. Under administrative direction, the supervisor assumes responsibility for overseeing the operation of Phlebotomy Services and Specimen Receiving at the Hospital with the goal of providing consistent, patient focused service to our patients.
Nurse Coordinator - Bundled Rates Contracts Johns Hopkins HospitalNurse Coordinator - Bundled Rates ContractsColumbia, MDWe are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices. You will focus on managing bone marrow transplant, solid organ transplant, reproductive endocrinology and infertility, joint replacement, spine and bariatric surgery patients.
LTSS Specialist II The Arc Montgomery CountyLTSS Specialist IIDerwood, MDMaster's degree plus two years of relevant professional experience, or bachelor's degree plus four years of relevant professional experience, or high school diploma plus eight years of relevant professional experience. The LTSS Specialist II is expected to demonstrate LTSS and database expertise, in addition to excellent problem-solving skills, and to work independently and collaboratively across teams.
Benefits Eligibility Specialist HEALTH CARE FOR THE HOMELESS, INC.Benefits Eligibility SpecialistBaltimore, MDAssist with enrollment into Qualified Health Plan (QHP) and Qualified Dental Plan (QDP) options, Insurance Affordability Programs, Medicare, Medicare Savings programs (Qualified Medicare Beneficiary and Specified Low-Income Medicare Beneficiary). Provide Health Choice/MCO Navigation and Medicare education in accordance with all state and/or federal guidelines, including explanation of plan options available, program functions, requirements and limiting conditions, affordability and cost-sharing structure, fees and penalties, as well as consumer rights.