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Contract Jun 16, 2025 Administrative Job Title: Document Preparation Clerk
Location: 401 N. Shadeland, Indianapolis, IN 46219
Hourly Rate: $18.29/hr
Job Type: Full-Time
Shift: Monday – Friday, 7:00 AM – 3:30 PM
Position Overview:
Professional Management Enterprises is seeking a skilled and meticulous Document Preparation Clerk to join our team in Indianapolis, IN. The Document Preparation Clerk will be responsible for converting paper documents into digital formats while ensuring high levels of accuracy and quality. This role requires attention to detail, proficiency with scanning equipment, and a strong understanding of document management processes.
Responsibilities:
Operate and maintain high-volume document scanning equipment to digitize paper documents.
Ensure that all documents are scanned at the appropriate resolution and format as specified.
Perform quality checks on scanned documents to verify accuracy and completeness.
Organize and prepare documents for scanning, including sorting, labeling, and removing staples or bindings as needed.
Manage and store digital files in an organized manner, adhering to established protocols for file naming and storage.
Troubleshoot and resolve scanning equipment issues to minimize downtime.
Maintain a clean and organized workspace to ensure efficient workflow and document handling.
Collaborate with team members to meet project deadlines and maintain high standards of quality.
Qualifications:
High school diploma or equivalent.
Previous experience in document scanning, data entry, or a related field is preferred.
Strong attention to detail and accuracy.
Proficiency with document scanning equipment and basic computer applications.
Excellent organizational and time management skills.
Ability to handle sensitive and confidential information with discretion.
Strong problem-solving skills and the ability to troubleshoot technical issues.
Professional Management Enterprises, inc. is an Equal Opportunity Employer and is committed to diversity in the workplace. We encourage all qualified individuals, including those with diverse backgrounds and those with disabilities, to apply.
Contract Jun 16, 2025 Administrative Job Title: Shipping/Receiving Clerk
Location: 401 N. Shadeland, Indianapolis, IN 46219
Hourly Rate: $21.62/hr
Job Type: Full-Time
Shift: Monday – Friday, 7:00 AM – 3:30 PM
Position Overview:
Professional Management Enterprises is seeking a dependable and safety-conscious Shipping & Receiving Clerk to join our team in Indianapolis, IN. This position plays a key role in supporting inventory control operations including receiving and inspecting incoming and outgoing shipments, verifying and recording received items, unpacking and organizing materials, loading and unloading trucks, and operating pallet jacks or other equipment.
Responsibilities:
Verify and record incoming and outgoing shipments, ensuring accuracy in documentation and shipment quantities.
Load and unload pallets, trucks, and storage areas safely and efficiently.
Operate automated mail sorting equipment in accordance with standard operating procedures.
Perform general inventory control tasks such as labeling, sorting, and staging items for internal processing, archival, and shipment.
Maintain accurate records of inventory locations and movements using inventory management systems including barcode scanners, or logs.
Maintain cleanliness and safety of work areas and equipment.
Follow all safety and security guidelines and company protocols.
Organize and label boxes according to established protocols to ensure easy retrieval and tracking.
Qualifications:
• High school diploma or equivalent.
• Experience operating manual or electric pallet jacks required.
• Previous warehouse or material handling experience preferred.
• Ability to lift and move up to 50 lbs. regularly.
• Good communication and teamwork skills.
• Strong attention to detail and ability to follow directions.
• Comfortable working in a physically demanding and fast-paced environment.
Professional Management Enterprises, inc. is an Equal Opportunity Employer and is committed to diversity in the workplace. We encourage all qualified individuals, including those with diverse backgrounds and those with disabilities, to apply. Contract Jun 16, 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: Florence, SC
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 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 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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