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Contract Jun 13, 2025 Healthcare Claims Processor I to be responsible for the accurate and timely processing of claims. Support the overall quality effectiveness to ensure that all claims are processed accurately and complete to ensure appropriate adjustment code usage, and payment rate.
Schedule: Monday-Friday, 8:00 AM-5:00 PM
Location: 8733 Highway 17 Bypass, Myrtle Beach, SC 29575
Pay: Weekly pay
Research and processes claims according to business regulation, internal standards and processing guidelines.
Verifies the coding of procedure and diagnosis codes.
Resolve system edits, audits and claims errors through research and use of approved references and investigative sources.
Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary.
Required Skills and Abilities:
Strong analytical, organizational and customer service skills. Strong oral and written communication skills. Proficient spelling, punctuation and grammar skills. Good judgment skills. Basic business math skills.
Required Software and Tools:
Basic office equipment. Proficient in word processing and spreadsheet applications. Proficient in database software.
Required Education:
High School Diploma or equivalent
Required Work Experience:
1 year-of experience in a healthcare or insurance environment.
Preferred Skills and Abilities:
Ability to use complex mathematical calculations.
Contract Jun 12, 2025 Healthcare Job Summary - Performs complex work of an administrative nature supporting a team of Executives, including record keeping. Adheres to the company’s/department’s confidentiality and HIPAA compliance programs. Prioritizes management/client requests to meet business objectives. Supports the day-to-day administrative operations of the Executive and department.
Essential Functions:
Composes and type routine memos and correspondence.
Copies, faxes and routes information as requested.
Establishes and maintains official documents and records in appropriate files.
Provide excellent organizational and time management skills; must adhere to and meet all deadlines.
Responds independently to a broad range of inquiries.
Keeps Supervisor’s calendar up to date.
Makes necessary arrangements to ensure details for meetings are completed.
Takes shorthand and speed writing efficiently.
Participates in outside research, as necessary, for some projects.
Prepares recurring and special reports and presentations by gathering data, interpreting data and assembling reports using PowerPoint, Excel, etc. for Executive’s review and distribution.
Proofreads and edits materials.
Provides confidential administrative and clerical support to Executive.
Receives, opens, sorts, reads and prioritizes Executive’s mail.
Schedule appointments, meetings, conferences, luncheons, hotel reservations and travel plans.
Serves as a receptionist for Executive, receiving and screening visitors and telephone calls.
Serves as recording secretary for committees(s), scheduling meetings, distributing materials, recording and transcribing meeting minutes.
Strong call-screening capabilities in dealing with salespeople and non-essential calls.
Types documents, memos, correspondence, presentations, forms, charts, tables and the like from rough draft.
Knowledge/Skills/Abilities:
Excellent knowledge of Microsoft Office Suite (Word/Excel/Access/Power Point) including mail merges and the ability to type 65+ wpm
General knowledge of industry related issues particularly Medical Managed care/Medicaid program
Ability to deal with all levels of staff; must be professional and diplomatic
Excellent interpersonal, verbal and written communication skills
Ability to abide by policies ? Ability to maintain attendance to support required quality and quantity of work
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
Required Education:
Associate’s Degree of equivalent experience
Required Experience:
2+ years Executive Assistant experience
Additional needs want someone who is a go-getter, experience managing multiple executives. Excellent ability to proactively manage calendars, meeting organization, agenda preparation, slide prep, notes/action items, and support administrative needs. Contract Jun 11, 2025 Healthcare Job Summary
Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers.
Work Location: Remote
Work Schedule: M-F, 8am-5pm
Pay: $42.00 hourly
• Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which an appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing.
• Identifies and reports quality of care issues.
• Assists with Complex Claim review including DRG Validation, Itemized Bill Review, Appropriate Level of Care, Inpatient Readmission, and any opportunity identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience
• Documents clinical review summaries, bill audit findings and audit details in the database
• Provides supporting documentation for denial and modification of payment decisions
• Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care.
• Reviews medically appropriate clinical guidelines and other appropriate criteria with Medical Directors on denial decisions.
• Supplies criteria supporting all recommendations for denial or modification of payment decisions.
• Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals.
• Provides training and support to clinical peers.
• Identifies and refers members with special needs to the appropriate Healthcare program per policy/protocol.
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
• Minimum 3 years clinical nursing experience.
• Minimum one year Utilization Review and/or Medical Claims Review.
• Minimum two years of experience in Claims Auditing, Medical Necessity Review and Coding experience
• Familiar with state/federal regulations
Required Years of Experience
• Minimum 3 years clinical nursing experience.
• Minimum one year Utilization Review and/or Medical Claims Review.
• Minimum two years of experience in Claims Auditing, Medical Necessity Review and Coding experience
• Familiar with state/federal regulations
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
Active, unrestricted State Registered Nursing (RN) license in good standing. Contract Jun 11, 2025 Healthcare Care Review Clinician I work with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing members’ ultimate care. MUST be licensed RN or LPN in Texas or Compact. This position is FULLY REMOTE. Schedule M-F 8am-5pm EST or CST.
Day to Day Responsibilities:
Review Prior auth/Inpatient/Skilled Nursing requests for medical necessity using State/Policy or MCG criteria.
KNOWLEDGE/SKILLS/ABILITIES
• Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
• Identifies appropriate benefits and eligibility for requested treatments and/or procedures.
• Conducts prior authorization reviews to determine financial responsibility for members.
• Processes requests within required timelines.
• Refers appropriate prior authorization requests to Medical Directors.
• Requests additional information from members or providers in consistent and efficient manner.
• Makes appropriate referrals to other clinical programs.
• Collaborates with multidisciplinary teams to promote Care Model
• Adheres to UM policies and procedures.
Must Have Skills:
at least 1 year UM experience in a HP setting
RN or LPN
The ability to work remote in a high pace/high demand environment.
The ability to complete 15-20 authorization in a day
Previous experience using QNXT/UMK2/PEGA preferred
MCG Experience preferred.
Required Years of Experience:
1 Required
Licensure / Education:
RN or LPN
Direct Hire Jun 11, 2025 Healthcare Physician must be SOUTH CAROLINA board licensed in Family Medicine. SC residency is required. The scope of practice is Family Medicine. Family Medicine Board Certification is required. Chart Reviews will be completed via Telehealth. The Physician will be required to complete 2 hours per assigned Nurse Practitioner per month for a total of 8 hours per month.
Position will require the following:
Conduct a monthly Quality Chart reviews of a 10% representative sample or a minimum of two (2) chart reviews, whichever is greater.
Comply with state requirements to meet with assigned NPs to review and discuss chart documentation and quality of care.
Be available by phone or electronic means of communication during the NP’s working hours (40 hours per week).
Serve as a supervising and collaborating physician in accordance with applicable law and terms and conditions of the NP Collaborative Practice Protocol Agreement.
Liability insurance will be provided for physicians’ claims arising solely and exclusively from Physician’s delivery of professional services relating to Physician’s Supervision and Collaboration services provided to NP’s.
Requirements
Physician must be SC board licensed in family medicine. SC residency is required.
Contract Jun 2, 2025 Healthcare Job Title: CT Technologist
Location: 601 Highway 6 West, Iowa City, IA 52246
Department: Radiology/Imaging
Job Type: Full-Time
Position Summary:
We are seeking a skilled and detail-oriented CT Technologist to join our diagnostic imaging team. The CT Technologist is responsible for performing high-quality computed tomography (CT) scans using state-of-the-art equipment to assist physicians in diagnosing medical conditions. The ideal candidate has a strong understanding of cross-sectional anatomy, excellent patient care skills, and a commitment to safety and quality.
Key Responsibilities:
Perform CT procedures in accordance with physician orders and established protocols.
Position patients accurately to ensure optimal image quality while maintaining their comfort and safety.
Operate CT equipment and related technology to produce diagnostic images.
Evaluate images for technical quality, ensuring proper identification and documentation.
Administer contrast materials intravenously as required, monitoring for adverse reactions.
Maintain accurate patient records and document all procedures performed.
Comply with safety, infection control, and radiation protection policies.
Collaborate with radiologists, referring physicians, and other healthcare staff.
Maintain equipment cleanliness and perform routine maintenance checks.
Participate in on-call rotation and/or work flexible hours as needed.
Qualifications:
Education: Graduate of an accredited Radiologic Technology program.
Certification/Licensure:
ARRT (R) certification required.
ARRT (CT) certification or eligibility strongly preferred.
BLS certification (American Heart Association or equivalent).
Experience: 1–2 years of CT experience preferred, but new graduates with strong clinical rotations are welcome to apply.
Skills and Competencies:
Strong knowledge of human anatomy and cross-sectional imaging.
Proficiency in operating CT scanners and radiologic equipment.
Excellent communication and interpersonal skills.
Ability to work independently and under pressure in a fast-paced environment.
Detail-oriented with a focus on patient safety and confidentiality.
Commitment to continuous learning and professional development.
Work Environment:
Exposure to radiation, infectious diseases, and potentially stressful situations.
Frequent standing, walking, lifting, and positioning of patients and equipment.
Use of protective equipment such as lead aprons and gloves.
Contract May 19, 2025 Administrative Job Summary
Data Capture Specialist is responsible for the accurate keying of information and scanning various documents.
Onsite Position - Indianapolis, IN
Duties and Responsibilities
The responsibilities of the Data Capture Operator are outlined as follows and no intended to be all inclusive:
Accurately entering alphabetic and numeric data from electronic images with speed and accuracy utilizing software application to capture the appropriate data.
Reading, analyzing, and classifying documents based on certain assigned criteria.
Operating and maintaining scanning equipment, including processing documents through scanner and making appropriate adjustments to improve image capture.
Reviewing completed work and administering the company’s quality control procedures to ensure work is at or above required accuracy rates.
Assisting entire team in meeting daily and monthly KPIs and SLAs.
Following proper procedures, rules, and processes for data capture and quality assurance of data.
Utilizing appropriate and compliant safeguards to reasonably prevent the improper use or disclosure of confidential and protected information which may include Protected Health Information (PHI) and/or Personally Identifiable Information (PII) and reporting any concerns to manager.
Knowledge, Skills, and Abilities
High School Diploma or equivalent required.
Proficiency is MS Office (Word, Outlook, Teams, SharePoint).
Excellent typing skills—touch, 10 key, 45 wpm
Ability to pass reference checks, drug screen, and background checks.
Contract May 14, 2025 Healthcare
Outreach Resources: Provide resources who are trusted members of the communities served and/or have an unusually close understanding of the communities to facilitate access to health care services, improve the quality and cultural competency of those services, and improve member health outcomes. Outreach Coordinator Resources work to increase health literacy, reduce costs of services, and improve care.
Pay Rate $20.00 hrly.
Monday - Friday 8:00-5:00 pm
Work remotely and local Travel is required
Job Description
The overall approach for outreach workers is fluid and flexible based on identified quality and member outcome needs. The primary focus of the Outreach resources will be as follows:
Understand Member history and the physical, behavioral, and social factors that may be leading to less-than-ideal health outcomes or persistent gaps in care.
Utilize a whole health approach when interacting with Members and caregivers.
Working with Case Management to place outreach resources at point of care facilities to better facilitate member engagement and action.
Facilitate real time gap closure initiatives including but not limited to immunizations, telehealth visits, A1c tests, lead tests, and blood pressure readings.
Pivot priorities as necessary month to month based on HEDIS performance.
Engage member in care coordination and case management as necessary.
Educate member on health care benefits and services and monitor for over and/or underutilization.
Requirements:
Community Outreach Experience preferred
CHW Certification and/or CNA/HHA preferred
Vaccinated
Home Visits
Driver’s License required
High School Diploma/GED required
Contract Apr 30, 2025 Administrative Job Summary
Data Capture Specialist is responsible for the accurate keying of information and scanning various documents.
Pay: 14.85/hour
Onsite Position - Marion, IN
Duties and Responsibilities
The responsibilities of the Data Capture Operator are outlined as follows and no intended to be all inclusive:
Accurately entering alphabetic and numeric data from electronic images with speed and accuracy utilizing software application to capture the appropriate data.
Reading, analyzing, and classifying documents based on certain assigned criteria.
Operating and maintaining scanning equipment, including processing documents through scanner and making appropriate adjustments to improve image capture.
Reviewing completed work and administering the company’s quality control procedures to ensure work is at or above required accuracy rates.
Assisting entire team in meeting daily and monthly KPIs and SLAs.
Following proper procedures, rules, and processes for data capture and quality assurance of data.
Utilizing appropriate and compliant safeguards to reasonably prevent the improper use or disclosure of confidential and protected information which may include Protected Health Information (PHI) and/or Personally Identifiable Information (PII) and reporting any concerns to manager.
Knowledge, Skills, and Abilities
High School Diploma or equivalent required.
Proficiency is MS Office (Word, Outlook, Teams, SharePoint).
Excellent typing skills—touch, 10 key, 45 wpm
Ability to pass reference checks, drug screen, and background checks.
Work Schedule
Monday: 9:00 a.m. - 6:00 p.m.
Tuesday: 9:30 a.m. - 5:30 p.m.
Wednesday through Friday: 9:00 a.m. - 5:30 p.m.
Contract Apr 25, 2025 Healthcare Outreach Resources: Provide resources who are trusted members of the communities served and/or have an unusually close understanding of the communities to facilitate access to health care services, improve the quality and cultural competency of those services, and improve member health outcomes. Outreach Coordinator Resources work to increase health literacy, reduce costs of services, and improve care.
Pay Rate $20.00 hrly.
Monday - Friday 8:00-5:00 pm
Work remotely and local Travel is required
Job Description
The overall approach for outreach workers is fluid and flexible based on identified quality and member outcome needs. The primary focus of the Outreach resources will be as follows:
Understand Member history and the physical, behavioral, and social factors that may be leading to less-than-ideal health outcomes or persistent gaps in care.
Utilize a whole health approach when interacting with Members and caregivers.
Working with Case Management to place outreach resources at point of care facilities to better facilitate member engagement and action.
Facilitate real time gap closure initiatives including but not limited to immunizations, telehealth visits, A1c tests, lead tests, and blood pressure readings.
Pivot priorities as necessary month to month based on HEDIS performance.
Engage member in care coordination and case management as necessary.
Educate member on health care benefits and services and monitor for over and/or underutilization.
Requirements:
Community Outreach Experience preferred
CHW Certification and/or CNA/HHA preferred
Vaccinated
Home Visits
Driver’s License required
High School Diploma/GED required
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Contract Mar 4, 2025 Administrative Title: Quality Analyst
Location: Indiana
Hours: Monday-Friday 8am-5pm
Pay: $19.50hr **weekly pay**
Job Description
• Responsible for activities involving quality assurance and compliance with all applicable company and regulatory requirements.
• Adheres to the QMMP (Quality Metric Management Plan).
• Conducts quality performance audits by evaluating trainee output.
• Reviews/analyzes data and documentation.
• Provides analytical reports and makes process improvement recommendations.
• Implements key process improvement efforts and influences cross-functional efforts.
• Assists in the development of systematic approaches for assuring high quality services.
• Provides feedback based on approved process documentation to improve key activities of the organization.
• Some travel may be required.
• All other duties as assigned.
• Completing SPR’s for the Indiana Eligibility Project trainees.
Requirements
• Extensive knowledge of the Indiana Public Assistance Programs (Supplemental Nutrition Assistance Program (SNAP), Medicaid, and Temporary Assistance for Needy Families (TANF) policy and guidelines including IEDSS online help.
• Experience using IEDSS.
Education and Experience (Preferred)
• Associate degree.
• Typically requires a minimum of 1 year of Indiana Eligibility Case Processing.
• Ability to synthesize and analyze complex information.
• Strong ability to read and interpret written information.
• Strong oral communication and group presentation skills.
• Clear and professional written communication.
• Proficiency in Microsoft Applications (Word, Excel, Outlook).
PME is an equal opportunity employer. We prohibit discrimination and harassment against any applicant or employee based on any legally recognized basis, including, but not limited to: veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy, national origin or ancestry, citizenship status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law.