NewMedical Coding Quality Team Lead PacificSource Health PlansMedical Coding Quality Team LeadBoise, ID$65,296.83–$111,004.62 / yearOversee and support the Claims Refunds team with adjusting claims for refunds, sending refund letters and follow-up, sending to PRS for collection, posting refunds, balancing daily deposit and month end report. Skills: Accountable leadership, Collaboration, Communication (written/verbal), Critical Thinking, Decision Making, Influencing, Listening (active), Organizational skills/Planning and Organization.
NewMedical Coding Quality Team Lead PacificSourceMedical Coding Quality Team LeadBoise, IdahoOversee and support the Claims Refunds team with adjusting claims for refunds, sending refund letters and follow-up, sending to PRS for collection, posting refunds, balancing daily deposit and month end report. Accountable leadership, Collaboration, Communication (written/verbal), Critical Thinking, Decision Making, Influencing, Listening (active), Organizational skills/Planning and Organization Compensation Disclaimer .
Medical Coder - In-Patient & Out-Patient - Surgical Hospital - Treasure Valley Hospital Surgical Care Affiliates LLCMedical Coder - In-Patient & Out-Patient - Surgical Hospital - Treasure Valley HospitalBoise, IDAs part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Here, you'll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America.
Medical Coder - In-Patient & Out-Patient - Surgical Hospital - Treasure Valley Hospital SCA HealthMedical Coder - In-Patient & Out-Patient - Surgical Hospital - Treasure Valley HospitalBoise, IdahoAs part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Here, you’ll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America.
Medical AR Specialist - Denials Norco Inc.Medical AR Specialist - DenialsMeridian, ID$18.50–$19.50 / hourAreas of focus include submissions of claims, claim rejections, denial management, collection of current and aged insurance receivables, account adjustments, audits, account status changes, posting payments, refunds, and patient phone calls. Responsible for processing claim denials within company established timelines for a variety of denial reason codes and as well as working Accounts Receivable through reports, system programs, audits, etc.
Senior Product Manager (PM/RCM) - Full Time - Remote Experity IncSenior Product Manager (PM/RCM) - Full Time - RemoteIDRemote$107,750–$151,400 / yearResponsibilities: Own day-to-day execution of the Revenue Cycle Management product roadmap, ensuring on-time delivery of capabilities across charge capture, coding, claim creation and submission, payer processing, payment posting, denial management, accounts receivable, patient balances, reporting, and related billing workflows. Deep knowledge of healthcare revenue cycle management, including charge capture, coding, claim submission, clearinghouses, payer adjudication, remittance processing, denial management, accounts receivable, and payment posting.
Customer Service Representative Quantum RecruitersCustomer Service RepresentativeBoise, IDWork efficiently in multiple systems simultaneously while effectively utilizing critical thinking and problem solving skills. Work Experience: One-year medical insurance, other healthcare related field, call center or customer service experience required.
Program Integrity Investigator (Healthcare Fraud Waste & Abuse) TriWest Healthcare AllianceProgram Integrity Investigator (Healthcare Fraud Waste & Abuse)Boise, IDRemoteFull 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).
Program Integrity Investigator TriWest Healthcare AllianceProgram Integrity InvestigatorBoise, IDRemoteFull 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).
NewCertified Professional Coder, Special Investigations Unit (Aetna SIU) CVS Health CorpCertified Professional Coder, Special Investigations Unit (Aetna SIU)ID$43,888–$102,081 / yearThe Certified Professional Coder (CPC) will perform medical claim reviews to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
Charge Master Analyst Sutter HealthCharge Master AnalystBoise, ID$106,745.60–$160,118.40 / yearPosition Overview: Serves as a subject matter expert for Charge Description Master (CDM) regulatory requirements and guidelines and payer contractual obligations in order to ensure CDM line items are aligned with current billing, coding regulations, guidelines, and contractual obligations. Maintains the CDM data elements (billing description, Current Procedural Terminology/Healthcare Procedure Coding System codes, revenue codes for Inpatient/Outpatient and appropriate modifiers) in the CDM software.
Accounts Receivable Specialist United Wound HealingAccounts Receivable SpecialistBoise, IDRemote$24–$27.25 / hourClaims Knowledge:Strong ability to read and understand EOBs; deep understanding of insurance denials and unresolved claims resolution; knowledge of ICD-10, CPT, HCPCS, and CMS-1500 claim format. Soft Skills: Critical thinker with strong problem-solving skills; high attention to detail; excellent organization and time management; ability to prioritize and manage time-sensitive situations with urgency.
Supervisor, Utilization Management TriWest Healthcare AllianceSupervisor, Utilization ManagementBoise, IDRemoteFull timeTechnical Skills: Thorough knowledge of policies and procedures, knowledge of managed care principles and methods; medical terminology; proficiency in the application of clinical criteria: InterQual, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, current Procedural Terminology, and Healthcare Common Procedural Coding System, and American Dental codes; working knowledge with medical management systems; proficient with Microsoft Office; knowledge of UM Process; reporting techniques. • Prepares work schedules and monitors staff caseloads to ensure adequate staffing levels at all times and accurate data entry and application of the medical management system.
Intake Specialist - Meridian, MS Vital Care Infusion ServicesIntake Specialist - Meridian, MSMeridian, IdahoRequired Skills/Abilities: Excellent communication skills: listening, speaking, understanding, and writing English while influencing patients, caregivers, and payer representatives, answering questions, and advancing reimbursement and collection efforts. Obtain prior authorizations; initiate requests, follow up to provide the additional required information, track progress, expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed.
Intake Specialist Vital Care Infusion ServicesIntake SpecialistMeridian, IdahoRequired Skills/Abilities: Excellent communication skills: listening, speaking, understanding, and writing English while influencing patients, caregivers, and payer representatives, answering questions, and advancing reimbursement and collection efforts. Obtain prior authorizations; initiate requests, follow up to provide the additional required information, track progress, expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed.
NewAccount Follow-Up Representative I Harris Computer SystemsAccount Follow-Up Representative IBoise, IDRemote$18–$26 / hourTimely follow-up on hospital patient accounts that are outstanding for insurance payment, including but not limited to the following processes: verify claim payment status, rebill to patient's insurance, proration to correct financial class and notation of patient accounts with steps taken for resolution. As a wholly owned subsidiary of Constellation Software Inc. ("CSI", symbol CSU on the TSX), Harris has become the cornerstone for CSI's investment in utility, local government, school districts, public safety, and healthcare software verticals.
Pharmacy Care Technician - Work From Home (Idaho) CVS Health CorpPharmacy Care Technician - Work From Home (Idaho)ID$17–$25.65 / 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.
Primary Care Functional Medicine - Nurse Practitioner OnePeak Medical ProvidersPrimary Care Functional Medicine - Nurse PractitionerNampa, IdahoFunctional Medicine Training & Mentorship: Comprehensive onboarding, clinical mentorship, and ongoing training in functional and integrative medicine to support professional growth in OnePeak’s care model. Read our white paper on Evidence, Patient Demand, and the Rise of Functional Medicine to explore the research, growing patient demand, and the future of whole-person healthcare.
Claim Benefit Specialist CVS Health CorpClaim Benefit SpecialistID$17–$28.46 / hourAnalyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department. Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims.
Clinical Inpatient Pharmacy Technician - Audit & Review Cambia Health Solutions IncClinical Inpatient Pharmacy Technician - Audit & ReviewBoise, IDRemoteAs a member of the Post Service Claim Review team, our Clinical Inpatient Pharmacy Technicians conducts post-service audits to ensure billing accuracy, analyzes billings for consistency with medical records and reimbursement policies, and performs projects as requested by supervisors - all in service of making our members' health journeys easier. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.