Sr. Call Center Service Assoc Blue Cross and Blue Shield AssociationSr. Call Center Service AssocHopewell, NJ$52,787–$70,172 / yearThis compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. Responsibilities: Receive escalated customer inquiries and provide second level resolution by initiating or continuing investigation process, utilizing available resources and accurately documenting customer inquiry and actions taken in accordance with departmental quality guidelines.
Certified Medical Assistant (CMA) – Regional Drug Dependency Unit Akicita FederalCertified Medical Assistant (CMA) – Regional Drug Dependency UnitKearny, NebraskaThis role is responsible for assisting with patient care activities, performing routine clinical tasks, managing patient records, and supporting the overall operation of the unit, ensuring compassionate, culturally sensitive care for individuals undergoing substance abuse treatment. $50,000 - $65,000 a year Position Summary The Certified Medical Assistant (CMA) will provide clinical and administrative support to the healthcare team in the Regional Drug Dependency Unit (RDDU) at the Great Plains Area facility in Winnebago, NE.
Senior Certified Coder Abstractor St. Joseph's Healthcare SystemSenior Certified Coder AbstractorPaterson, NJThis role works closely with providers, clinical staff, and revenue cycle teams to review medical records, validate documentation completeness, apply correct CPT, ICD-10-CM, and HCPCS codes, and educate providers on documentation best practices. Strong knowledge of: CPT, ICD-10-CM, and HCPCS coding guidelines, E/M coding (including 2021+ E/M guidelines if applicable),CMS and major payer regulations, Provider education and relationship management.
Certified Coder St. Joseph's Healthcare SystemCertified CoderPaterson, NJThe combined efforts of the organization's outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation's "100 Best Places to Work in Health Care". This role works closely with providers, clinical staff, and revenue cycle teams to review medical records, validate documentation completeness, apply correct CPT, ICD-10-CM, and HCPCS codes, and educate providers on documentation best practices.
Documentation Review Nurse Hunterdon HealthDocumentation Review NurseFlemington, NJQualifications Minimum Education: Required: Registered Nurse (RN) with an active and unencumbered license Preferred: Bachelor of Science in Nursing (BSN) preferred Minimum Years of Experience (Amount, Type and Variation): Required: Minimum of three (3) years clinical nursing experience Preferred: Previous nursing experience in an emergency department License, Registry or Certification: Required: RN certification Preferred: Knowledge, Skills and/or Abilities: Required: Strong understanding of ICD-10, CPT and HCPCS coding principles Knowledge of Medicare reimbursement and coding structures/systems Preferred: Experience in clinical documentation improvement (CDI), coding or utilization review is highly desirable/preferred Excellent analytical, organizational and communication skills Proficient in electronic health records (EHRs) and clinical documentation systems High level creativity, judgment and initiative, tempered with flexibility to deal with rapidly changing healthcare environment and expanding technology Ability to maintain concentration with attention to detail even in areas containing multiple levels of distraction Self-motivated, well organized and possess confidence and ability to wor work independently and deal with ambiguity and ask critical questions to problem solve issues as required. Primary Position Responsibilities Clinical Documentation Review: Assess emergency department documentation using Emergency Department E/M and Critical Care Facility Charge Assessment tool to ensure the patient documentation accurately reflects the patients clinical presentation, diagnoses, and captures all treatment and services provided.
Pharmacy Care Technician - Work From Home (Fairfield, NJ) CVS Health CorpPharmacy Care Technician - Work From Home (Fairfield, NJ)NJ$17–$31.30 / hourPharmacy Care Technicians assist with inbound phone calls; interact with customers and cross functional team to answer questions, solve problems, provide education, and maintain our company's reputation for high-quality service. In this role, you will assist in accurately reading, interpreting and entering prescriptions into the computer system including calculation of doses and assignment of directions and accepting proper insurance payment in a timely fashion.
Billing Representative Penn MedicineBilling RepresentativeDoylestown, PA4. Enter insurance data, prepare and submit claims to all insurance companies and patients, receive remittance lists from insurance companies, identify payments and denials, apply payments to patient records for all sources, and investigate and follow up on denied claims. Develop an understanding of Medicare, Medicaid, intermediary and 3rd party pay rules and regulations as applied to Provider services to facilitate account resolution Receives, identifies and applies payments from all sources to patient accounts.
SIU Investigator Centene Corporation GroupSIU InvestigatorNJ$56,200–$101,000 / yearCollaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts. 2+ years Fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related investigative field required.
Special Investigation Unit Investigator Centene Corporation GroupSpecial Investigation Unit InvestigatorNJ$56,200–$101,000 / yearEducation/Experience: Bachelor's Degree Business, Criminal Justice, Healthcare Administration, Public Health, or a related field; or equivalent experience (or) An Associates or Bachelor's degree in criminal justice or a related field; (or) employment as an investigator in the MMCO's SIU on or before the effective date of this SubPart required. Minimum of five (5) years in healthcare field working in fraud, waste and abuse investigations and audits, (or) five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, (or) seven years of professional investigation experience involving economic or insurance related matters.
Part Time Physician Assistant (PA-C) in Dermatology Private Practice Philadelphia Center for DermatologyPart Time Physician Assistant (PA-C) in Dermatology Private PracticeJenkintown, PAPart timeWe are an established, physician‑owned dermatology clinic seeking a part‑time Physician Assistant who is clinically strong, personable, and eager to grow with our team. Order and interpret laboratory tests, imaging, and pathology reports ; communicate results promptly to patients.
Clinical Nurse Reviewer Zelis Healthcare, Inc.Clinical Nurse ReviewerMorristown, NJ$59,000–$75,050 / yearThe Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.
Director, Patient Access & Revenue Cycle RWJ Barnabas Health Medical IncDirector, Patient Access & Revenue CycleNewark, NJ$133,924–$189,167 / yearAchieve goal of reducing bill hold days below target by leading revenue cycle committee meetings with members of finance, clinical departments, coding, and revenue integrity. Job Overview: The Director of Patient Access and Revenue Cycle Services is responsible for the comprehensive leadership, management, and strategic direction of all hospital patient access/revenue cycle operations.
Prior Authorization Specialist GeneDX LLCPrior Authorization SpecialistNJRemote$29.56–$33.80 / hourGeneDx is at the forefront of transforming healthcare through its industry-leading exome and genome testing and interpretation services, fueled by the world's largest, rare disease data sets. We provide competitive compensation and benefits that reflect local market practices and legal requirements in each country where we operate, helping employees thrive both professionally and personally.
Claims Specialist- Liab Crawford & CoClaims Specialist- LiabBerkeley Heights, NJTo determine the actual offer, Crawford considers a wide range of factors including the candidate's previous experience and education, market rates, minimum pay requirements for the applicable jurisdiction, business segment, supply/demand, and scheduled hours. Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves within designed authority, as necessary, during the processing of the claim.
Oncology Authorization Specialist St. Joseph's Healthcare SystemOncology Authorization SpecialistPaterson, NJThe combined efforts of the organization's outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation's "100 Best Places to Work in Health Care". Key responsibilities include verifying insurance coverage, obtaining necessary authorizations, and providing clear cost estimates to patients, thereby promoting transparency and reducing financial uncertainty.
IBR Senior Analyst Zelis Healthcare, Inc.IBR Senior AnalystNJ$79,000–$99,750 / yearThis is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture. The Itemized Bill Review Senior Analyst will be responsible for analyzing hospital claims for adherence to proper billing guidelines and will work closely with Expert Claims Review staff to efficiently adhere to policies and procedures for claims processing.
Clinical Documentation Integrity Specialist - Remote Med-Metrix, LLCClinical Documentation Integrity Specialist - RemoteParsippany-Troy Hills, NJRemoteThe Clinical Documentation Integrity Specialist performs concurrent chart reviews to validate that the clinical documentation in the medical record appropriately describes the patient's severity of illness, complexity of care, and risk of mortality to facilitate appropriate coding. Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
Mgr - Multi-Facility CDI - SMNJ Medical Records FAC#1 Saint Michaels Medical CenterMgr - Multi-Facility CDI - SMNJ Medical Records FAC#1Newark, New JerseyFull timeCombining state-of-the-art technology, the latest diagnostic and therapeutic procedures, leading-edge research, and a network of highly qualified physicians, nurses, and allied health professionals, the hospital provides top-quality health care services delivered with compassionate care. Established by the Franciscan Sisters of the Poor in 1867, Saint Michael's Medical Center is a 358-bed regional tertiary-care, teaching, and research center in the heart of Newark's business and educational district and is accredited by The Joint Commission.
Community Pharmacy Team Lead (Thursday to Saturday, 10:00AM - 6:30PM ET) AnewHealthCommunity Pharmacy Team Lead (Thursday to Saturday, 10:00AM - 6:30PM ET)NJRemoteAbility to communicate effectively and professionally through written, verbal (e.g., face-to-face, telephonically and/or virtual communication platforms), and interpersonal skills as applied when interacting with employees, patients, healthcare professionals, clients, or agency representatives; successfully conveying and exchanging information at an appropriate level and in a positive and timely manner. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly.
Community Pharmacy Team Lead (Thursday to Monday, 10:00AM - 6:30PM ET) AnewHealthCommunity Pharmacy Team Lead (Thursday to Monday, 10:00AM - 6:30PM ET)New JerseyRemoteAbility to communicate effectively and professionally through written, verbal (e.g., face-to-face, telephonically and/or virtual communication platforms), and interpersonal skills as applied when interacting with employees, patients, healthcare professionals, clients, or agency representatives; successfully conveying and exchanging information at an appropriate level and in a positive and timely manner. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly.