NewMedical Billing Specialist-Accounts Receivable New England Cancer SpecialistsMedical Billing Specialist-Accounts ReceivableWestbrook, MEYou are responsible for the full accounts receivable life cycle, including analyzing and researching unpaid claims, assisting in the resolution of denials, partial payments, and over-payments as well as communicating with payers, patients and other team members. Identify and resolve denials and improper payments by accessing payer web applications, completing forms and telephoning account representative per New England Cancer Specialists policies.
Special Investigation Unit (SIU) Manager CVS Health CorpSpecial Investigation Unit (SIU) ManagerME$54,300–$159,120 / yearThe Certified Professional Coder (CPC) Manager will oversee a team of medical coders within the Special Investigations Unit (SIU) to ensure compliance with coding practices through comprehensive record reviews for medical, behavioral, transportation, and other healthcare providers. Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates findings effectively to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, and state regulators.
Specialty Coder - Medical Records Central Maine Healthcare CorporationSpecialty Coder - Medical RecordsLEWISTON, MaineFull timeCoder Auditor finalizes the coding and abstracting of the medical record upon ensuring the assignment of International Classifications of Diseases, Ninth Revision (ICD-9-CM) or Tenth revision (ICD-10/PCS), Current Procedural Terminology (CPT), and Health Care Procedure Coding System (HCPCS), are accurate and supported by the clinical documentation of the respective medial record. Responsibilities: The Specialty Coder reviews and analyzes documentation present in the medical record for both inpatient and outpatient visits to ensure accuracy of diagnosis and procedure codes assigned by the Coders or Clinical Documentation Specialists (CDS) or Computer Assisted Coding (CAC) software.
Care Management Associate, Engagement Hub CVS Health CorpCare Management Associate, Engagement HubME$18.50–$31.72 / hourStrong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members, adhering to care management processes (to include, but not limited to, privacy and confidentiality, quality management processes in compliance with regulatory, accreditation guidelines, company policies and procedures). Aetna's Medicaid Care Management Engagement Outreach Hub is a new initiative focused on prioritizing Medicaid member interaction, maximizing inbound and outbound touchpoints to solve members' needs and create behavioral change.
Specialty Coder Medical Records Prime Healthcare Services IncSpecialty Coder Medical RecordsLewiston, MECoder Auditor finalizes the coding and abstracting of the medical record upon ensuring the assignment of International Classifications of Diseases, Ninth Revision (ICD-9-CM) or Tenth revision (ICD-10/PCS), Current Procedural Terminology (CPT), and Health Care Procedure Coding System (HCPCS), are accurate and supported by the clinical documentation of the respective medial record. The Specialty Coder reviews and analyzes documentation present in the medical record for both inpatient and outpatient visits to ensure accuracy of diagnosis and procedure codes assigned by the Coders or Clinical Documentation Specialists (CDS) or Computer Assisted Coding (CAC) software.
Case Control Quality Technician State of MaineCase Control Quality TechnicianWinthrop, Maine$19.02–$26.48 / hourThe Case Control Quality Tech reviews and analyzes Disability Determination Services (DDS) and Social Security Administration (SSA) disability claims data to ensure proper receipt and closure of claims. The Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders.
Coder I - Medical Records Central Maine Healthcare CorporationCoder I - Medical RecordsLEWISTON, MaineFull timeThe system includes Central Maine Medical Center (CMMC) in Lewiston, a 250-bed, not-for-profit regional referral hospital that is home to the region's only Cancer Care Center, an orthopedic ambulatory surgery center, and the Central Maine Heart and Vascular Institute. Utilizing the International Classifications of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT), the Coder I translates the documented diagnosis and procedural information into coded data.
Business Development Executive (MedInsight) Milliman IncBusiness Development Executive (MedInsight)Portland, MERemote$120,635–$199,065 / yearMedInsight is a subsidiary of Milliman; a global, employee-owned consultancy providing actuarial consulting, retirement funding and healthcare financing, enterprise risk management and regulatory compliance, data analytics and business transformation as well as a range of other consulting and technology solutions. Primary Responsibilities: Develop deep expertise in MedInsight's risk adjustment software and analytics, and in the surrounding market (CMS-HCC models, RADV, quality programs, value-based care, and the competitive landscape) to engage prospects as a credible advisor.
VP Pharmacy Services Martin's Point Health Care LLCVP Pharmacy ServicesPortland, MEDirects the full scope of pharmacy operations, including formulary management, prior authorizations, formulary exceptions, medication adherence, patient accounting, billing practices, vendor billing oversight, and daily systems operations to ensure efficient, effective, and high-quality service delivery. Partners collaboratively across Pharmacy, Finance, Nursing, Medicine, Population Health, Practice, and other MPHC divisions to align clinical, administrative, and business processes, support patient-centered care, and promote appropriate prescribing, documentation, coding, reconciliation, and reimbursement practices.
BioMed Engineer I Prime Healthcare Services IncBioMed Engineer ILEWISTON, MEProvide technical assistance and support for proper utilization and maintenance of all Prime Healthcare Management, Inc.s medical equipment including equipment used in the Emergency Room (open 24 hours a day, every day of the year), equipment for heart treatments such as EKG, doppler, cardiac catheterization, angioplasty, open-heart surgical devices, equipment used in cardiac rehabilitation and exercise conditioning programs, equipment used for occupational and physical therapy, equipment used for in-patient and out-patient surgical techniques including laser surgery, arthroscopy and laparoscopic procedures, MRI machines, CT Scanners, Ultrasound equipment, Echo/Vascular equipment, Nuclear Medicine equipment, Mammography machines, and equipment used in our Intensive Care Unit. Join our team of dedicated professionals who provide services and operational support to award winning hospitals through roles in supply chain, IT and cybersecurity, clinical engineering, capital procurement, medical coding, project management and more.
Field Reimbursement Manager - Kidney (New England - ME, VT, NH, MA, RI, CT) Vertex Pharmaceuticals IncField Reimbursement Manager - Kidney (New England - ME, VT, NH, MA, RI, CT)ME$136,000–$204,000 / yearKey Duties and Responsibilities: Compliantly establish strong connections with key nephrology office personnel, including members of the care team and administrative staff responsible for prior authorizations and patient access to specialty medications, to support patient access to prescribed medications. At Vertex, our Total Rewards offerings also include inclusive market-leading benefits to meet our employees wherever they are in their career, financial, family and wellbeing journey while providing flexibility and resources to support their growth and aspirations.
Coder I Medical Records Prime Healthcare Services IncCoder I Medical RecordsLEWISTON, MEOther system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine''s southern Maine base, the Central Maine Comprehensive Cancer Center and other high-quality clinical services. Utilizing the International Classifications of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT), the Coder I translates the documented diagnosis and procedural information into coded data.
*Registered Nurse Centralized Services - Hybrid after onsite training in Portland - $2,000 sign-on bonus! Martin's Point Health Care LLC*Registered Nurse Centralized Services - Hybrid after onsite training in Portland - $2,000 sign-on bonus!Portland, MEKnowledge Knowledge of healthcare operations, especially in a primary care setting Knowledge of quality measures and how to improve patient outcomes through quality gap closure Understanding or interest in expanding knowledge of clinical quality measures (HEDIS) and coding concepts (CPT, ICD10, and HCC) preferred Understanding of EHR documentation and quality reporting preferred. Skills Strong critical thinking, problem-solving, and project management skills Exceptional organizational, written and verbal communication, and attention to detail skills Computer proficiency in Microsoft Office software Proficient in working within an electronic medical record (EMR).
Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)ME$46,988–$122,400 / yearAnticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse Required Qualifications 3 years working on health care fraud, waste, and abuse investigatory and audits required.
Medical Director - ENT CVS Health CorpMedical Director - ENTME$174,070–$374,920 / yearLeads all aspects of utilization review/quality assurance, directing case management Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
BioMed Engineer I PHS Bio-Medical ServicesBioMed Engineer ILEWISTON, MaineFull timeResponsibilities: Provide technical assistance and support for proper utilization and maintenance of all Prime Healthcare Management, Inc.’s medical equipment including equipment used in the Emergency Room (open 24 hours a day, every day of the year), equipment for heart treatments such as EKG, doppler, cardiac catheterization, angioplasty, open-heart surgical devices, equipment used in cardiac rehabilitation and exercise conditioning programs, equipment used for occupational and physical therapy, equipment used for in-patient and out-patient surgical techniques including laser surgery, arthroscopy and laparoscopic procedures, MRI machines, CT Scanners, Ultrasound equipment, Echo/Vascular equipment, Nuclear Medicine equipment, Mammography machines, and equipment used in our Intensive Care Unit. Overview: Join our team of dedicated professionals who provide services and operational support to award winning hospitals through roles in supply chain, IT and cybersecurity, clinical engineering, capital procurement, medical coding, project management and more.
Denials Management Analyst - Medical Records Central Maine Healthcare CorporationDenials Management Analyst - Medical RecordsLEWISTON, MaineFull timeThe system includes Central Maine Medical Center (CMMC) in Lewiston, a 250-bed, not-for-profit regional referral hospital that is home to the region's only Cancer Care Center, an orthopedic ambulatory surgery center, and the Central Maine Heart and Vascular Institute. Basic understanding of provider credentialing and third party payer contracts, Familiar with the use of CPT and ICD-9 manuals, Familiar with UB and HCFA 1500, Ability to request and research information regarding billing procedures from Medicaid, Commercial and other third party payers.
NewSenior Software Development Engineer CVS Health CorpSenior Software Development EngineerME$83,430–$222,480 / yearCVS Health Digital is looking for hands-on, passionate people who want to join a high energy and growing team to make a difference in customers' lives and who want to be on the forefront of digital innovation that aims to reinvent what a pharmacy and a health care company can be in the digital world. Currently, we are seeking a Senior Software Development Engineer with deep expertise in Java/JEE, Spring Boot, RESTful microservices, and Kafka to lead the design and development of scalable, secure cloud-native solutions.
Care Manager RN - Per Diem UnitedHealth Group IncCare Manager RN - Per DiemPortland, MEIreland & UK ›India ›Philippines ›Culture of Belonging›Employee Benefits›BlogJob seeker resources Login Bookmarked jobs 0 Career areas Clinical PhysiciansAdvanced practice cliniciansPharmacyBehavioral healthNursingMedical codingClinical support Corporate and business operations Administrative supportConsultingFinance and business analyticsLegal and complianceMarketing and communicationsPeople teamProject management Customer and support services BillingClaimsCustomer ServiceData entryEarly careers Sales and account management Account managementSalesSales management Technology and data Artificial intelligenceArchitectureBusiness systems analysisData analyticsData engineeringData scienceNetwork infrastructureProduct management & developmentSecurity and riskSoftware engineering Life here U.S. Culture of BelongingEmployee BenefitsMilitary Fellowship Program Ireland & UK Culture of BelongingEmployee Benefits India Culture of BelongingEmployee Benefits Philippines Culture of BelongingEmployee BenefitsJoin our talent communityOpen search formKeyword or job numberLocationGoExplore remote jobsPursue your passion and potentialCare Manager RN - Per Diem Portland Maine Apply Internal apply Bookmark job Jump to Our values Job description Benefits Testimonial Awards & recognitions Related content Caring. serves as an educational resource to all Health System staff regarding utilization reviewAssumes roles in assessment physical psychosocial & economic needs for transition of care planning to a variety of levels of care delegates to others as appropriateDocuments verifies and validates specific data required to monitor and evaluate interventions and outcomesInterviews and collects patient specified data and chart review related to readmission and appropriately notifies care teamCommunicates telephonically and electronically with outpatient providers to enhance the continuum of careIntegrates performance improvement principles and customer service excellence principles into all aspects of job responsibilities practice and governmental commercial payer guidelinesAdheres to the policies procedures rules regulations and laws of the hospital and all federal and state regulatory bodiesAssume responsibility for Health System required continued education and owns professional growthPerforms tasks of a clinical nature within scope of assigned duties and clinical expertiseCommunicate effectively in both oral and written form as appropriate for the needs of the audiencePerforms other duties as assigned or requiredYoull be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Denials Management Analyst Medical Records Prime Healthcare Services IncDenials Management Analyst Medical RecordsLEWISTON, MEInsurance knowledge including basic coding, claims submission, collections, and prior authorization processes, Familiarity with multiple insurances and their medical policies, professional and facility billing requirements, Experience and understanding of working with billing reports and aged accounts Basic understanding of provider credentialing and third party payer contracts, Familiar with the use of CPT and ICD-9 manuals, Familiar with UB and HCFA 1500, Ability to request and research information regarding billing procedures from Medicaid, Commercial and other third party payers. The system includes Central Maine Medical Center (CMMC) in Lewiston, a 250-bed, not-for-profit regional referral hospital that is home to the region''s only Cancer Care Center, an orthopedic ambulatory surgery center, and the Central Maine Heart and Vascular Institute.
Medical Receptionist ConvenientMDMedical ReceptionistAuburn, MaineWorking alongside the clinical team, you will be responsible for greeting patients and visitors, completing patient registration, updating new and existing patient records, collecting payment, and ensuring patients with or without pre-existing reservations are seen in a timely manner. To support this belief, we’re building a team of dedicated professionals who genuinely care about improving lives, are passionate about work that can make a difference, and are driven to learn from one another.
Field Service Specialist III PHS Bio-Medical ServicesField Service Specialist IIILEWISTON, MaineFull timePrimary duties include, but are not limited to, performing preventive maintenance inspections, installation support, testing, calibration, troubleshooting and maintenance on multiple high-end specialty imaging modalities (MRI, CT, Cath Lab, X-ray, Nuc-med) and on low end modalities (Ultrasound, injectors) as needed. Overview: Join our team of dedicated professionals who provide services and operational support to award winning hospitals through roles in supply chain, IT and cybersecurity, clinical engineering, capital procurement, medical coding, project management and more.
Field Service Specialist I PHS Bio-Medical ServicesField Service Specialist ILEWISTON, MaineFull timePrimary duties include, but are not limited to, performing preventive maintenance inspections, installation support, testing, calibration, troubleshooting and maintenance on multiple low to medium-end specialty imaging modalities (CT, Cath Lab, X-ray, Ultrasound, Injectors). Overview: Join our team of dedicated professionals who provide services and operational support to award winning hospitals through roles in supply chain, IT and cybersecurity, clinical engineering, capital procurement, medical coding, project management and more.
Nurse Practitioner (Per Diem) ComplexCare SolutionsNurse Practitioner (Per Diem)Portland, Maine$2,400–$10,000 / yearPer diemAbility to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making sound clinical decisions without direct on-site supervision. Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income.
Staff Software Development Engineer CVS Health CorpStaff Software Development EngineerME$106,605–$284,280 / yearFurthermore, the Staff Engineer role includes closely working with a team of engineers to drive delivery excellence, partner with business and other IT leaders to build digital assets, provide expert level support to resolve complex issues and provide RCA, identify gaps in systems in current digital eco system and provide solutions to enhance overall performance. CVS Health Digital is looking for hands-on, passionate people who want to join a high energy and growing team to make a difference in customers' lives and who want to be on the forefront of digital innovation that aims to reinvent what a pharmacy and a health care company can be in the digital world.
Application Security Engineer Ryder System IncApplication Security EngineerAugusta, MECompensation Information: The compensation offered to a candidate may be influenced by a variety of factors, including the candidate's relevant experience; education, including relevant degrees or certifications; work location; market data/ranges; internal equity; internal salary ranges; etc. Current Employees: If you are a current employee at Ryder, please click here ( http://wd5.myworkday.com/ryder/d/task/1422$3.htmld ) to log in to Workday to apply using the internal application process.
Staff Development Engineer - Fulfillment CVS Health CorpStaff Development Engineer - FulfillmentME$106,605–$284,280 / year7+ years of software development in enterprise / web / cloud applications • 5+ years of backend software development experience with programming languages/tools including: Java, Spring Boot, Kafka • 3+ years of distributed caching experience • 3+ years of experience having a track record developing in AWS or GCP or Azure or similar public cloud environments (GCP preferred) • 3+ years of experience in design, development and operationalizing microservices based web/webservices application in cloud native environment • 3+ years of technical lead experience within a matrixed environment, including mentoring junior engineers and working cross collaboratively between architecture, product, etc. • Understand security threats and patterns and ensure adherence to all regulatory initiatives, HIPAA, PHI, PII, locational and contractual data restrictions • Experience with build automation technologies like Maven, Gradle, Jenkins, Harness • Expert knowledge with functional, imperative and object-oriented languages and methodologies • Experience with Cassandra and Postgres - preferred • Experience with test-driven development and automated testing frameworks • Experience with Scrum/Agile development methodologies.
NewMedical Director - Radiation Oncology - MD or DO CVS Health CorpMedical Director - Radiation Oncology - MD or DOME$174,070–$374,920 / yearThe Radiation Oncology Medical Director supports the CVS Health Specialty oncology business in managing oncology specific utilization of providers, clinical reviews of oncology specific data, and assist with growing our oncology footprint. In the Medical Director role, you will provide oversight for medical policy implementation; you will support the ensuring timely and consistent responses to members and providers; you will focus on prior authorization cases and consultation cases.
Data Conversion Lead MaximusData Conversion LeadPortland, MEFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at applicantaccom@maximus.com.
Salesforce Architect Unity Environmental UniversitySalesforce ArchitectMEAlthough at Unity Environmental University Enterprise employees are generally scheduled to work at their base location, there are times when travel is necessary and employees are required from time to time to attend events, meetings or work temporary assignment at any Unity Environmental University location. Just a half hour from Portland, Unity Environmental University Headquarters, Unity Environmental University Enterprise Education, Unity at Pineland, and the School of Environmental Business & Sustainable Ventures are based at the Pineland Farms campus.