New England Life Care (NELC) is one of the fastest growing home infusion therapy companies in New England and is the region’s only non-profit home infusion provider. NELC is a hospital collaborative serving more than 70 hospital systems in Maine, New Hampshire, and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality, and service. Like our owner hospitals, NELC provides patient focused care.
New England Life Care has and continues to build a diverse, inclusive, and authentic workplace, so if you’re energized by this opportunity, but your experience doesn’t support every qualification in the job posting, we encourage you to apply! You still may be the person we are looking for!
New England Life Care currently has a Remote Clinical Review Specialist opportunity available. This is a remote position with an ideal Monday – Friday from 8:30am until 5:00pm schedule. The ideal candidate for this position will excel in a fast-paced environment, have excellent communication and deductive reasoning skills.
**We are only hiring remote employees for this position that live in Maine, Massachusetts, and New Hampshire.**
Summary:
The Clinical Review Specialist will conduct regular utilization management reviews and provide clinical information as required in order to confirm coverage for each patient.
Benefits:
Career LadderHealth insuranceDental insuranceVision insuranceGenerous employer-matched 403(b) savings programCompany paid: Life insurance, Short- and long-term disability insurancePaid Time OffAnd much more!
Primary Responsibilities:
Apply clinical skills and expertise in conjunction with established medical criteria, members’ eligibility and benefit coverage information, in the review of therapy checklists & specialist drug authorization forms, to ensure high-quality, cost-effective careMaintain a thorough and comprehensive understanding of regulations, payer contracts, product lines, NELC policies & procedures.Serves as subject matter expert on complex specialty drugs clinical requirements. Review clinical documentation for long term government payers to ensure they still meet clinical coverage twice a year. Consulting with the Medical Director for all potential denials that do not meet medical necessity or NELC criteria. The decision for a medically necessary denial is within the Medical Director roleAct as a liaison between internal and external customers to resolve systems/process issues and ensure we are obtaining signed physician orders from participating MDs for government payers.Determine appropriateness and effectiveness of services requested using established medical coverage criteria, guidelines and departmental policies and proceduresContact appropriate physicians and medical facilities to obtain complete detailed written orders timely to complete Medicare DIFs and authorizationsResponsible for timely and comprehensive medical review with concise documentation of pertinent facts, decisions and rationale and facilitation of resolution to requests of “urgently needed, not yet rendered services” in compliance with state regulation. Effectively and accurately communicate coverage decisions to members, providers, and medical groups, following timelines established by regulations and accreditation standards. Identify and appropriately inform Manager/Supervisor of sensitive or complex casesMaintains a thorough and comprehensive understanding of state and federal regulations, accreditation standards and payer contracts to ensure compliance. Develop and maintain positive, effective working relationships with Medical Directors, physicians, vendors, managed care offices and other customersMaintain confidentiality of member and case information by following Corporate Privacy policies pertaining to protection of member PHIPerform other duties as assignedMandatory and Preferred Requirements:
Medical Assistant certification requiredMA or LPD preferredAssociate of Arts degree or higher are preferredHealthcare experience in a medical setting requiredPrior experience in care coordination, home health or home infusion preferredExperience in managed care environmentExperience in working with established criteria to determine medical necessity and appropriateness of careExperience in utilization review, utilization management, quality review Working knowledge of federal / state fraud and abuse laws requiredKnowledge of HIPAA Privacy and Security Regulations preferred.Skills:
Dependability in attendance and job performance requiredExcellent verbal and written communication and interpersonal skillsExcellent problem identification and solving skillsAbility to organize and prioritize multiple assignments within workloadAbility to function independently and take independent action, within scope of job responsibilitiesCompetency in computer skills including Microsoft work, outlook and internet''It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.''
EOE
New England Life Care (NELC) is one of the fastest growing home infusion therapy companies in New England and is the region’s only non-profit home infusion provider. NELC is a hospital collaborative serving more than 70 hospital systems in Maine, New Hampshire, and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality, and service. Like our owner hospitals, NELC provides patient focused care.
New England Life Care has and continues to build a diverse, inclusive, and authentic workplace, so if you’re energized by this opportunity, but your experience doesn’t support every qualification in the job posting, we encourage you to apply! You still may be the person we are looking for!
New England Life Care currently has a Remote Clinical Review Specialist opportunity available. This is a remote position with an ideal Monday – Friday from 8:30am until 5:00pm schedule. The ideal candidate for this position will excel in a fast-paced environment, have excellent communication and deductive reasoning skills.
**We are only hiring remote employees for this position that live in Maine, Massachusetts, and New Hampshire.**
Summary:
The Clinical Review Specialist will conduct regular utilization management reviews and provide clinical information as required in order to confirm coverage for each patient.
Benefits:
Career LadderHealth insuranceDental insuranceVision insuranceGenerous employer-matched 403(b) savings programCompany paid: Life insurance, Short- and long-term disability insurancePaid Time OffAnd much more!
Primary Responsibilities:
Apply clinical skills and expertise in conjunction with established medical criteria, members’ eligibility and benefit coverage information, in the review of therapy checklists & specialist drug authorization forms, to ensure high-quality, cost-effective careMaintain a thorough and comprehensive understanding of regulations, payer contracts, product lines, NELC policies & procedures.Serves as subject matter expert on complex specialty drugs clinical requirements. Review clinical documentation for long term government payers to ensure they still meet clinical coverage twice a year. Consulting with the Medical Director for all potential denials that do not meet medical necessity or NELC criteria. The decision for a medically necessary denial is within the Medical Director roleAct as a liaison between internal and external customers to resolve systems/process issues and ensure we are obtaining signed physician orders from participating MDs for government payers.Determine appropriateness and effectiveness of services requested using established medical coverage criteria, guidelines and departmental policies and proceduresContact appropriate physicians and medical facilities to obtain complete detailed written orders timely to complete Medicare DIFs and authorizationsResponsible for timely and comprehensive medical review with concise documentation of pertinent facts, decisions and rationale and facilitation of resolution to requests of “urgently needed, not yet rendered services” in compliance with state regulation. Effectively and accurately communicate coverage decisions to members, providers, and medical groups, following timelines established by regulations and accreditation standards. Identify and appropriately inform Manager/Supervisor of sensitive or complex casesMaintains a thorough and comprehensive understanding of state and federal regulations, accreditation standards and payer contracts to ensure compliance. Develop and maintain positive, effective working relationships with Medical Directors, physicians, vendors, managed care offices and other customersMaintain confidentiality of member and case information by following Corporate Privacy policies pertaining to protection of member PHIPerform other duties as assignedMandatory and Preferred Requirements:
Medical Assistant certification requiredMA or LPD preferredAssociate of Arts degree or higher are preferredHealthcare experience in a medical setting requiredPrior experience in care coordination, home health or home infusion preferredExperience in managed care environmentExperience in working with established criteria to determine medical necessity and appropriateness of careExperience in utilization review, utilization management, quality review Working knowledge of federal / state fraud and abuse laws requiredKnowledge of HIPAA Privacy and Security Regulations preferred.Skills:
Dependability in attendance and job performance requiredExcellent verbal and written communication and interpersonal skillsExcellent problem identification and solving skillsAbility to organize and prioritize multiple assignments within workloadAbility to function independently and take independent action, within scope of job responsibilitiesCompetency in computer skills including Microsoft work, outlook and internet''It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.''
EOE
New England Life Care (NELC) is one of the fastest growing home infusion therapy companies in New England and is the region’s only non-profit home infusion provider. NELC is a hospital collaborative serving more than 70 hospital systems in Maine, New Hampshire, and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality, and service. Like our owner hospitals, NELC provides patient focused care.
New England Life Care has and continues to build a diverse, inclusive, and authentic workplace, so if you’re energized by this opportunity, but your experience doesn’t support every qualification in the job posting, we encourage you to apply! You still may be the person we are looking for!
New England Life Care currently has a Remote Clinical Review Specialist opportunity available. This is a remote position with an ideal Monday – Friday from 8:30am until 5:00pm schedule. The ideal candidate for this position will excel in a fast-paced environment, have excellent communication and deductive reasoning skills.
**We are only hiring remote employees for this position that live in Maine, Massachusetts, and New Hampshire.**
Summary:
The Clinical Review Specialist will conduct regular utilization management reviews and provide clinical information as required in order to confirm coverage for each patient.
Benefits:
Career LadderHealth insuranceDental insuranceVision insuranceGenerous employer-matched 403(b) savings programCompany paid: Life insurance, Short- and long-term disability insurancePaid Time OffAnd much more!
Primary Responsibilities:
Apply clinical skills and expertise in conjunction with established medical criteria, members’ eligibility and benefit coverage information, in the review of therapy checklists & specialist drug authorization forms, to ensure high-quality, cost-effective careMaintain a thorough and comprehensive understanding of regulations, payer contracts, product lines, NELC policies & procedures.Serves as subject matter expert on complex specialty drugs clinical requirements. Review clinical documentation for long term government payers to ensure they still meet clinical coverage twice a year. Consulting with the Medical Director for all potential denials that do not meet medical necessity or NELC criteria. The decision for a medically necessary denial is within the Medical Director roleAct as a liaison between internal and external customers to resolve systems/process issues and ensure we are obtaining signed physician orders from participating MDs for government payers.Determine appropriateness and effectiveness of services requested using established medical coverage criteria, guidelines and departmental policies and proceduresContact appropriate physicians and medical facilities to obtain complete detailed written orders timely to complete Medicare DIFs and authorizationsResponsible for timely and comprehensive medical review with concise documentation of pertinent facts, decisions and rationale and facilitation of resolution to requests of “urgently needed, not yet rendered services” in compliance with state regulation. Effectively and accurately communicate coverage decisions to members, providers, and medical groups, following timelines established by regulations and accreditation standards. Identify and appropriately inform Manager/Supervisor of sensitive or complex casesMaintains a thorough and comprehensive understanding of state and federal regulations, accreditation standards and payer contracts to ensure compliance. Develop and maintain positive, effective working relationships with Medical Directors, physicians, vendors, managed care offices and other customersMaintain confidentiality of member and case information by following Corporate Privacy policies pertaining to protection of member PHIPerform other duties as assignedMandatory and Preferred Requirements:
Medical Assistant certification requiredMA or LPD preferredAssociate of Arts degree or higher are preferredHealthcare experience in a medical setting requiredPrior experience in care coordination, home health or home infusion preferredExperience in managed care environmentExperience in working with established criteria to determine medical necessity and appropriateness of careExperience in utilization review, utilization management, quality review Working knowledge of federal / state fraud and abuse laws requiredKnowledge of HIPAA Privacy and Security Regulations preferred.Skills:
Dependability in attendance and job performance requiredExcellent verbal and written communication and interpersonal skillsExcellent problem identification and solving skillsAbility to organize and prioritize multiple assignments within workloadAbility to function independently and take independent action, within scope of job responsibilitiesCompetency in computer skills including Microsoft work, outlook and internet''It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.''
EOE
New England Life Care (NELC) is one of the fastest growing home infusion therapy companies in New England and is the region’s only non-profit home infusion provider. NELC is a hospital collaborative serving more than 70 hospital systems in Maine, New Hampshire, and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality, and service. Like our owner hospitals, NELC provides patient focused care.
New England Life Care has and continues to build a diverse, inclusive, and authentic workplace, so if you’re energized by this opportunity, but your experience doesn’t support every qualification in the job posting, we encourage you to apply! You still may be the person we are looking for!
New England Life Care currently has a Remote Clinical Review Specialist opportunity available. This is a remote position with an ideal Monday – Friday from 8:30am until 5:00pm schedule. The ideal candidate for this position will excel in a fast-paced environment, have excellent communication and deductive reasoning skills.
**We are only hiring remote employees for this position that live in Maine, Massachusetts, and New Hampshire.**
Summary:
The Clinical Review Specialist will conduct regular utilization management reviews and provide clinical information as required in order to confirm coverage for each patient.
Benefits:
Career LadderHealth insuranceDental insuranceVision insuranceGenerous employer-matched 403(b) savings programCompany paid: Life insurance, Short- and long-term disability insurancePaid Time OffAnd much more!
Primary Responsibilities:
Apply clinical skills and expertise in conjunction with established medical criteria, members’ eligibility and benefit coverage information, in the review of therapy checklists & specialist drug authorization forms, to ensure high-quality, cost-effective careMaintain a thorough and comprehensive understanding of regulations, payer contracts, product lines, NELC policies & procedures.Serves as subject matter expert on complex specialty drugs clinical requirements. Review clinical documentation for long term government payers to ensure they still meet clinical coverage twice a year. Consulting with the Medical Director for all potential denials that do not meet medical necessity or NELC criteria. The decision for a medically necessary denial is within the Medical Director roleAct as a liaison between internal and external customers to resolve systems/process issues and ensure we are obtaining signed physician orders from participating MDs for government payers.Determine appropriateness and effectiveness of services requested using established medical coverage criteria, guidelines and departmental policies and proceduresContact appropriate physicians and medical facilities to obtain complete detailed written orders timely to complete Medicare DIFs and authorizationsResponsible for timely and comprehensive medical review with concise documentation of pertinent facts, decisions and rationale and facilitation of resolution to requests of “urgently needed, not yet rendered services” in compliance with state regulation. Effectively and accurately communicate coverage decisions to members, providers, and medical groups, following timelines established by regulations and accreditation standards. Identify and appropriately inform Manager/Supervisor of sensitive or complex casesMaintains a thorough and comprehensive understanding of state and federal regulations, accreditation standards and payer contracts to ensure compliance. Develop and maintain positive, effective working relationships with Medical Directors, physicians, vendors, managed care offices and other customersMaintain confidentiality of member and case information by following Corporate Privacy policies pertaining to protection of member PHIPerform other duties as assignedMandatory and Preferred Requirements:
Medical Assistant certification requiredMA or LPD preferredAssociate of Arts degree or higher are preferredHealthcare experience in a medical setting requiredPrior experience in care coordination, home health or home infusion preferredExperience in managed care environmentExperience in working with established criteria to determine medical necessity and appropriateness of careExperience in utilization review, utilization management, quality review Working knowledge of federal / state fraud and abuse laws requiredKnowledge of HIPAA Privacy and Security Regulations preferred.Skills:
Dependability in attendance and job performance requiredExcellent verbal and written communication and interpersonal skillsExcellent problem identification and solving skillsAbility to organize and prioritize multiple assignments within workloadAbility to function independently and take independent action, within scope of job responsibilitiesCompetency in computer skills including Microsoft work, outlook and internet''It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.''
EOE
New England Life Care (NELC) is one of the fastest growing home infusion therapy companies in New England and is the region’s only non-profit home infusion provider. NELC is a hospital collaborative serving more than 70 hospital systems in Maine, New Hampshire, and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality, and service. Like our owner hospitals, NELC provides patient focused care.
New England Life Care has and continues to build a diverse, inclusive, and authentic workplace, so if you’re energized by this opportunity, but your experience doesn’t support every qualification in the job posting, we encourage you to apply! You still may be the person we are looking for!
New England Life Care currently has a Remote Authorization Specialist position available. The normal schedule is Monday – Friday from 8:30am to 5:00pm.
The ideal candidate for this role will have at least three years of authorization or billing experience.
**Only hiring for this remote role in the following states: Maine, Massachusetts, New Hampshire, Maryland, North Carolina, Connecticut, and Florida**
Job Summary:
The Remote Authorization Specialist is responsible for obtaining and maintaining prior authorization status for NELC patient medications/therapies. The authorization specialist works closely with the clinical review department to obtain documentation needed to complete the authorization process. The authorization specialist also obtains needed documentation to support the billing department in meeting payer requirements for patient accounts.
Career Ladders: NELC’s reimbursement department offers career ladders to Authorization Specialists. Candidates who achieve excellent performance in their job duties, who demonstrate a commitment to personal development, participation in department and company strategic programs and projects, who develop superior working relationships inside and outside the department and who show a commitment to the success of the department are eligible for promotion to the following positions:
Authorization Specialist– represents an entry level position into the department. Candidates who meet defined goals, objectives and accomplishments can generally expect to be promoted in 2-3 years to:
Senior Authorization Specialist – Candidates who meet defined goals, objectives, and accomplishments and who demonstrate engagement and ownership of departmental and organization activities would generally expect to be promoted in 4-5 years to:
Lead Authorization Specialist – Candidates who are part of the department leadership team and who have responsibility for advanced departmental, company and member hospital engagement.
Benefits:
Remote positionRoom for growth and potential for advancementHealth insuranceDental insuranceVision insuranceGenerous employer-matched 403b savings programCompany paid: Life insurance, Short- and long-term disability insurancePaid time offAnd much more!
Responsibilities:
Achieve performance appraisals with "meets expectations" or betterMaintain a good record of attendance and punctualityNo Performance management deficiencies in the periodDemonstrate independence and competence to follow Authorization Request process for all payers.Demonstrate independence and competence to follow the Re-Authorization processDemonstrate independence and competence to follow the Specialty processDemonstrate independence and competence on all MOA's and therapiesDemonstrate independence and competence and ability to Authorize all services, document and communicate accurately on all changes of service, in CPR+ and to appropriate departments.Demonstrate independence and competence and ability to work through a TO DO without the need for extended timeframes.Demonstrates the ability to work within a team and independently with confident communication skills and exceptional customer service skills.Completes three continuing education programs in the period specifically related to professional development, LEAN and/or leadership development.Education:
High School Diploma, or equivalent required.Minimum of 2 years authorization, reimbursement or claims processing experience required.Practical experience with medical terminology; CPT, ICD-9 and HCPC coding preferred.Practical experience with Medicare, Medicaid and third-party payor contracts preferredKnowledge of HIPAA Privacy and Security requirements preferred.Skills:
Excellent organizational skills required.Basic accounting transaction/analyst skills required.Demonstrated ability to identify research and solve problems required.Ability to work independently as well as part of a team required.Practical experience with Microsoft computer systems and applications, to include Word & Excel
''It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment.
An employer who violates this law shall be subject to criminal penalties and civil liability.''
EOE
New England Life Care (NELC) is one of the fastest growing home infusion therapy services companies in New England and is the region’s only non-profit home infusion provider. NELC is a hospital collaborative serving more than 70 hospital systems in Maine, New Hampshire and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality and service. Like our owner hospitals, NELC provides patient focused care.
New England Life Care has and continues to build a diverse, inclusive, and authentic workplace, so if you’re energized by this opportunity, but your past experience doesn’t support every qualification in the job posting, we encourage you to apply! You still may be the person we are looking for!
The Accounts Receivable Specialist is a REMOTE POSTION and is responsible for the follow-up, collections, and recovery of problematic accounts due from health insurance payers. The normal schedule will be Monday - Friday from 8:00am until 4:30pm.
Career Ladders: NELC’s auditing department offers career ladders to auditors. Candidates who achieve excellent performance in their job duties, who demonstrate a commitment to personal development, participation in department and company strategic programs and projects, who develop superior working relationships inside and outside the department and who show a commitment to the success of the department are eligible for promotion to the following positions:
Accounts Receivable Specialist – represents an entry level position into the department. Candidates who meet defined goals, objectives and accomplishments can generally expect to be promoted in 2-3 years to:
Senior Accounts Receivable Specialist – Candidates who meet defined goals, objectives and accomplishments and who demonstrate engagement and ownership of departmental and organization activities would generally expect to be promoted in 4-5 years to:
Lead Accounts Receivable Specialist – Candidates who are part of the department leadership team and who have responsibility for advanced departmental, company and member hospital engagement.
**Only hiring remotely in the following states: Connecticut, Florida, Maine, Massachusetts, Maryland, New Hampshire, North Carolina, Ohio, Rhode Island, Texas, and Vermont**
Benefits:
Remote / Hybrid PositionCareer LaddersHealth InsuranceCareer ladders and opportunities for advancementDental insuranceVision insuranceGenerous employer-matched 403b savings programCompany paid: Life insurance, Short- and long-term disability insurancePaid time offAnd much more!
Primary Responsibilities:
Achieve performance appraisals with "meets expectations" or betterDemonstrate independence and competence to work basic denialsDemonstrate independence and competence in payer requirements for basic appealsDemonstrate independence and competence and ability in submitting correct claims for payersDemonstrate independence and competence in refund processingDemonstrate independence and competence and ability to teach how to check claim status via phone or websiteDemonstrate ability to complete on average 20 accounts per dayDemonstrate ability to work accounts timely within 2 weeks of receiving denial or needing follow upMaintain audit percentage of 98%Follows NELC policies and procedures in the normal conduction of company business.Assures that professional practice complies with state and federal regulations including, but not limited to the HIPAA Privacy and Security regulations and NELC’s Corporate Compliance Program. Ensures that confidentiality of patient information is maintained in accordance with state and HIPAA Privacy and Security regulations.Effectively communicates both verbally & in writing inside and outside the organization; selects appropriate means of communication; questions to seek clarification and understanding; maintains confidentiality; listens actively to others; conveys appropriate information to others.Takes the initiative to meet internal and external customer needs in a timely and courteous manner; maintains a high level of customer satisfaction; follows up on customer complaints/concerns.Establishes and maintains good working relationships; shows respect and concern for the feelings of others; interfaces effectively with all levels of the organization; focuses on situations rather that personalities in relating to others; works cooperatively within a group; accepts constructive feedback.Displays good judgment; takes the initiative rather than waiting to be told; make practical suggestions; learns from past experiences and uses those insights to handle new situations effectively; defines problems logically and develops appropriate solutions; uses creative approaches.Completes appropriate amount of work in a timely manner without jeopardizing quality; uses time effectively to consistently accomplish objectives and meet deadlines; organizes workload for requirements of the job; set priorities and discriminates between important and unimportant matters; anticipates needs/problems; maintains attention to detail.Required Qualifications:
A minimum of 3 years’ experience with third party health insurance claims office or plan administrator involved in processing health provider claims required.A working knowledge of government health insurance plan benefits and the rules & regulations for obtaining reimbursement required.Experience with healthcare patient accounting/billing/collections computer applications including electronic claims processing preferred.Working knowledge of Home Infusion Therapy billing & collection preferred.Practical experience with Medicare; Medicaid; and third-party payer contracts.Preferred Experience:
Associates Degree or bachelor’s degree in Business Administration preferred.
Regulatory requirements:
Knowledge of HIPAA Privacy and Security requirements.Working knowledge of federal / state fraud and abuse laws required.Skills:
Demonstrated knowledge of medical terminology; CPT; ICD9; and HCPC coding required.Excellent customer service skills required.Excellent communications (verbal and written) skills required. Excellent organizational skills required.Ability to work independently as well as part of a team required.Practical experience with microcomputer systems and applications to include Microsoft Word and Excel required.Demonstrated ability to identify, research and solve problems required.''It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.''
EOE
New England Life Care (NELC) is one of the fastest growing home infusion therapy services companies in New England and is the region’s only non-profit home infusion provider. NELC is a hospital collaborative serving more than 70 hospital systems in Maine, New Hampshire and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality and service. Like our owner hospitals, NELC provides patient focused care.
New England Life Care has and continues to build a diverse, inclusive, and authentic workplace, so if you’re energized by this opportunity, but your past experience doesn’t support every qualification in the job posting, we encourage you to apply! You still may be the person we are looking for!
The Accounts Receivable Specialist is a REMOTE POSTION and is responsible for the follow-up, collections, and recovery of problematic accounts due from health insurance payers. The normal schedule will be Monday - Friday from 8:00am until 4:30pm.
Career Ladders: NELC’s auditing department offers career ladders to auditors. Candidates who achieve excellent performance in their job duties, who demonstrate a commitment to personal development, participation in department and company strategic programs and projects, who develop superior working relationships inside and outside the department and who show a commitment to the success of the department are eligible for promotion to the following positions:
Accounts Receivable Specialist – represents an entry level position into the department. Candidates who meet defined goals, objectives and accomplishments can generally expect to be promoted in 2-3 years to:
Senior Accounts Receivable Specialist – Candidates who meet defined goals, objectives and accomplishments and who demonstrate engagement and ownership of departmental and organization activities would generally expect to be promoted in 4-5 years to:
Lead Accounts Receivable Specialist – Candidates who are part of the department leadership team and who have responsibility for advanced departmental, company and member hospital engagement.
**Only hiring remotely in the following states: Connecticut, Florida, Maine, Massachusetts, Maryland, New Hampshire, North Carolina, Ohio, Rhode Island, Texas, and Vermont**
Benefits:
Remote / Hybrid PositionCareer LaddersHealth InsuranceCareer ladders and opportunities for advancementDental insuranceVision insuranceGenerous employer-matched 403b savings programCompany paid: Life insurance, Short- and long-term disability insurancePaid time offAnd much more!
Primary Responsibilities:
Achieve performance appraisals with "meets expectations" or betterDemonstrate independence and competence to work basic denialsDemonstrate independence and competence in payer requirements for basic appealsDemonstrate independence and competence and ability in submitting correct claims for payersDemonstrate independence and competence in refund processingDemonstrate independence and competence and ability to teach how to check claim status via phone or websiteDemonstrate ability to complete on average 20 accounts per dayDemonstrate ability to work accounts timely within 2 weeks of receiving denial or needing follow upMaintain audit percentage of 98%Follows NELC policies and procedures in the normal conduction of company business.Assures that professional practice complies with state and federal regulations including, but not limited to the HIPAA Privacy and Security regulations and NELC’s Corporate Compliance Program. Ensures that confidentiality of patient information is maintained in accordance with state and HIPAA Privacy and Security regulations.Effectively communicates both verbally & in writing inside and outside the organization; selects appropriate means of communication; questions to seek clarification and understanding; maintains confidentiality; listens actively to others; conveys appropriate information to others.Takes the initiative to meet internal and external customer needs in a timely and courteous manner; maintains a high level of customer satisfaction; follows up on customer complaints/concerns.Establishes and maintains good working relationships; shows respect and concern for the feelings of others; interfaces effectively with all levels of the organization; focuses on situations rather that personalities in relating to others; works cooperatively within a group; accepts constructive feedback.Displays good judgment; takes the initiative rather than waiting to be told; make practical suggestions; learns from past experiences and uses those insights to handle new situations effectively; defines problems logically and develops appropriate solutions; uses creative approaches.Completes appropriate amount of work in a timely manner without jeopardizing quality; uses time effectively to consistently accomplish objectives and meet deadlines; organizes workload for requirements of the job; set priorities and discriminates between important and unimportant matters; anticipates needs/problems; maintains attention to detail.Required Qualifications:
A minimum of 3 years’ experience with third party health insurance claims office or plan administrator involved in processing health provider claims required.A working knowledge of government health insurance plan benefits and the rules & regulations for obtaining reimbursement required.Experience with healthcare patient accounting/billing/collections computer applications including electronic claims processing preferred.Working knowledge of Home Infusion Therapy billing & collection preferred.Practical experience with Medicare; Medicaid; and third-party payer contracts.Preferred Experience:
Associates Degree or bachelor’s degree in Business Administration preferred.
Regulatory requirements:
Knowledge of HIPAA Privacy and Security requirements.Working knowledge of federal / state fraud and abuse laws required.Skills:
Demonstrated knowledge of medical terminology; CPT; ICD9; and HCPC coding required.Excellent customer service skills required.Excellent communications (verbal and written) skills required. Excellent organizational skills required.Ability to work independently as well as part of a team required.Practical experience with microcomputer systems and applications to include Microsoft Word and Excel required.Demonstrated ability to identify, research and solve problems required.''It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.''
EOE
New England Life Care (NELC) is one of the fastest growing home infusion therapy services companies in New England and is the region’s only non-profit home infusion provider. NELC is a hospital collaborative serving more than 70 hospital systems in Maine, New Hampshire and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality and service. Like our owner hospitals, NELC provides patient focused care.
New England Life Care has and continues to build a diverse, inclusive, and authentic workplace, so if you’re energized by this opportunity, but your past experience doesn’t support every qualification in the job posting, we encourage you to apply! You still may be the person we are looking for!
The Accounts Receivable Specialist is a REMOTE POSTION and is responsible for the follow-up, collections, and recovery of problematic accounts due from health insurance payers. The normal schedule will be Monday - Friday from 8:00am until 4:30pm.
Career Ladders: NELC’s auditing department offers career ladders to auditors. Candidates who achieve excellent performance in their job duties, who demonstrate a commitment to personal development, participation in department and company strategic programs and projects, who develop superior working relationships inside and outside the department and who show a commitment to the success of the department are eligible for promotion to the following positions:
Accounts Receivable Specialist – represents an entry level position into the department. Candidates who meet defined goals, objectives and accomplishments can generally expect to be promoted in 2-3 years to:
Senior Accounts Receivable Specialist – Candidates who meet defined goals, objectives and accomplishments and who demonstrate engagement and ownership of departmental and organization activities would generally expect to be promoted in 4-5 years to:
Lead Accounts Receivable Specialist – Candidates who are part of the department leadership team and who have responsibility for advanced departmental, company and member hospital engagement.
**Only hiring remotely in the following states: Connecticut, Florida, Maine, Massachusetts, Maryland, New Hampshire, North Carolina, Ohio, Rhode Island, Texas, and Vermont**
Benefits:
Remote / Hybrid PositionCareer LaddersHealth InsuranceCareer ladders and opportunities for advancementDental insuranceVision insuranceGenerous employer-matched 403b savings programCompany paid: Life insurance, Short- and long-term disability insurancePaid time offAnd much more!
Primary Responsibilities:
Achieve performance appraisals with "meets expectations" or betterDemonstrate independence and competence to work basic denialsDemonstrate independence and competence in payer requirements for basic appealsDemonstrate independence and competence and ability in submitting correct claims for payersDemonstrate independence and competence in refund processingDemonstrate independence and competence and ability to teach how to check claim status via phone or websiteDemonstrate ability to complete on average 20 accounts per dayDemonstrate ability to work accounts timely within 2 weeks of receiving denial or needing follow upMaintain audit percentage of 98%Follows NELC policies and procedures in the normal conduction of company business.Assures that professional practice complies with state and federal regulations including, but not limited to the HIPAA Privacy and Security regulations and NELC’s Corporate Compliance Program. Ensures that confidentiality of patient information is maintained in accordance with state and HIPAA Privacy and Security regulations.Effectively communicates both verbally & in writing inside and outside the organization; selects appropriate means of communication; questions to seek clarification and understanding; maintains confidentiality; listens actively to others; conveys appropriate information to others.Takes the initiative to meet internal and external customer needs in a timely and courteous manner; maintains a high level of customer satisfaction; follows up on customer complaints/concerns.Establishes and maintains good working relationships; shows respect and concern for the feelings of others; interfaces effectively with all levels of the organization; focuses on situations rather that personalities in relating to others; works cooperatively within a group; accepts constructive feedback.Displays good judgment; takes the initiative rather than waiting to be told; make practical suggestions; learns from past experiences and uses those insights to handle new situations effectively; defines problems logically and develops appropriate solutions; uses creative approaches.Completes appropriate amount of work in a timely manner without jeopardizing quality; uses time effectively to consistently accomplish objectives and meet deadlines; organizes workload for requirements of the job; set priorities and discriminates between important and unimportant matters; anticipates needs/problems; maintains attention to detail.Required Qualifications:
A minimum of 3 years’ experience with third party health insurance claims office or plan administrator involved in processing health provider claims required.A working knowledge of government health insurance plan benefits and the rules & regulations for obtaining reimbursement required.Experience with healthcare patient accounting/billing/collections computer applications including electronic claims processing preferred.Working knowledge of Home Infusion Therapy billing & collection preferred.Practical experience with Medicare; Medicaid; and third-party payer contracts.Preferred Experience:
Associates Degree or bachelor’s degree in Business Administration preferred.
Regulatory requirements:
Knowledge of HIPAA Privacy and Security requirements.Working knowledge of federal / state fraud and abuse laws required.Skills:
Demonstrated knowledge of medical terminology; CPT; ICD9; and HCPC coding required.Excellent customer service skills required.Excellent communications (verbal and written) skills required. Excellent organizational skills required.Ability to work independently as well as part of a team required.Practical experience with microcomputer systems and applications to include Microsoft Word and Excel required.Demonstrated ability to identify, research and solve problems required.''It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.''
EOE
NELC is one of the fastest growing home infusion therapy service companies in New England and is the region’s only non-profit home infusion provider. NELC is a hospital collaborative serving more than 57 hospital systems in Maine, New Hampshire, and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality, and service. Like our owner hospitals, NELC provides patient focused care.
NELC is rapidly expanding the number of hospitals it serves and is participating with its hospital members in the implementation of several new population health and disease management programs.
Do you have a passion for nursing education that will inspire generations of nurses? Do you welcome the challenge of creating educational content for senior, mid-level and early-level nurses? Do you have the commitment to nursing education to inspire the best care for our patients?
If so, New England Life Care currently has an opening for a Clinical Nurse Educator. This is a remote position, with travel expected 2-3 days per week to train new nurses on Home Infusion Therapy processes and procedures, conduct co-visits, and evaluate tenured staff to ensure compliance with NELC policies. This position is Monday – Friday 8AM – 5PM. Visits to the Woburn branch will be needed to perform inspections and evaluations. This position is needed to support the orientation, education, and competency for our NELC nursing and VNA partners clinical staff who provide care for our patients.
Summary: The Senior Clinical Nurse Educator ensures the highest quality patient care, service, and satisfaction through education of new and existing NELC employees with a particular focus on the on-boarding, initial training and continuing professional development of clinical liaison staff. Develops and conducts educational programs for home health agency staff to promote quality patient care. Develops and conducts CEU programs to support the implementation and advancement of NELC strategic plans and initiatives.
Benefits:
Health InsuranceDental InsuranceVision InsuranceGenerous employer-matched 403b savings programCompany paid: Life insurance, Short- and long-term disability insurance.Paid Time OffAnd much more!Primary Responsibilities:
Ensure the highest quality patient care, service, and satisfaction through the continuing education of new and existing employees.Present a standardized orientation program for clinical nurses and ensure timely and effective orientation and training on new nursing employees.Maintain and update educational programs to ensure nursing staff knowledge, skill sets, and understanding of company and nursing policies, procedures, and general scope of practice standards.On an ongoing basis, assess the quality, effectiveness, and appropriateness of orientation/ continuing education materials.Works with the department Director to purchase necessary orientation/education materials.Develop and present new educational programs and competencies to ensure staff knowledge and understanding of new clinical techniques or the proper use of new equipment and supplies.Coordinate and oversee the utilization of outside resources and consultants that may be deployed for staff education and training.Actively participates and provides support to staff to form and maintain positive relationships aimed at fostering a team atmosphere and effective, collaborative relationships between nursing service lines as between all departments within NELC.Actively participates in “Hot-line” rotation participation which may include being on-call for weekends/holidays as needed to provide staff support.Works closely with the Clinical Director of Nursing to ensure compliance of the nursing division with Joint Commission, state and federal laws and regulations. Participates in department and company strategic planning for the purposes of developing effective training programs in support of the implementation of strategic plans.In conjunction with the Director of Clinical Liaisons and the Executive Director of Partnership Development, develops and implements training and education programs in support of the implementation of the Care Coordination Resource Center (CCRC) and future NELC service lines.Uses performance data and personal experience to identify opportunities to improve the productivity and effectiveness of nursing resources and actively participates in quality improvement activities to develop and implement improved processes and flows.Participates with trainers and leaders of other NELC departments ensure a coordinated, comprehensive, and effective training program for all NELC employees is maintained.Develops new hire and ongoing staff training programs that are scalable and that can support the orientation and training of multiple staff simultaneously in multiple different geographies.Benchmarks training programs within and outside healthcare to adopt best practices for training and education within NELCProvide training and mentorship to nursing staffProfessional Requirements:
Current, active, valid nursing licenseBachelor of Science in NursingMinimum of two (2) years in education, training, or equivalent Demonstrated leadership, employee engagement & coaching skillsPreferred skills:
Master’s DegreeMinimum of three (3) years home infusion therapy (HIT) Minimum of four (4) years’ experience in nursing practice with an emphasis in hospital, home infusion, and home health preferred.For more information, visit our website at www.nelifecare.org.
EOE
NELC is one of the fastest growing home infusion therapy service companies in New England and is the region’s only non-profit home infusion provider. NELC is a hospital collaborative serving more than 57 hospital systems in Maine, New Hampshire, and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality, and service. Like our owner hospitals, NELC provides patient focused care.
NELC is rapidly expanding the number of hospitals it serves and is participating with its hospital members in the implementation of several new population health and disease management programs.
Do you have a passion for nursing education that will inspire generations of nurses? Do you welcome the challenge of creating educational content for senior, mid-level and early-level nurses? Do you have the commitment to nursing education to inspire the best care for our patients?
If so, New England Life Care currently has an opening for a Clinical Nurse Educator. This is a remote position, with travel expected 2-3 days per week to train new nurses on Home Infusion Therapy processes and procedures, conduct co-visits, and evaluate tenured staff to ensure compliance with NELC policies. This position is Monday – Friday 8AM – 5PM. Visits to the Woburn branch will be needed to perform inspections and evaluations. This position is needed to support the orientation, education, and competency for our NELC nursing and VNA partners clinical staff who provide care for our patients.
Summary: The Senior Clinical Nurse Educator ensures the highest quality patient care, service, and satisfaction through education of new and existing NELC employees with a particular focus on the on-boarding, initial training and continuing professional development of clinical liaison staff. Develops and conducts educational programs for home health agency staff to promote quality patient care. Develops and conducts CEU programs to support the implementation and advancement of NELC strategic plans and initiatives.
Benefits:
Health InsuranceDental InsuranceVision InsuranceGenerous employer-matched 403b savings programCompany paid: Life insurance, Short- and long-term disability insurance.Paid Time OffAnd much more!Primary Responsibilities:
Ensure the highest quality patient care, service, and satisfaction through the continuing education of new and existing employees.Present a standardized orientation program for clinical nurses and ensure timely and effective orientation and training on new nursing employees.Maintain and update educational programs to ensure nursing staff knowledge, skill sets, and understanding of company and nursing policies, procedures, and general scope of practice standards.On an ongoing basis, assess the quality, effectiveness, and appropriateness of orientation/ continuing education materials.Works with the department Director to purchase necessary orientation/education materials.Develop and present new educational programs and competencies to ensure staff knowledge and understanding of new clinical techniques or the proper use of new equipment and supplies.Coordinate and oversee the utilization of outside resources and consultants that may be deployed for staff education and training.Actively participates and provides support to staff to form and maintain positive relationships aimed at fostering a team atmosphere and effective, collaborative relationships between nursing service lines as between all departments within NELC.Actively participates in “Hot-line” rotation participation which may include being on-call for weekends/holidays as needed to provide staff support.Works closely with the Clinical Director of Nursing to ensure compliance of the nursing division with Joint Commission, state and federal laws and regulations. Participates in department and company strategic planning for the purposes of developing effective training programs in support of the implementation of strategic plans.In conjunction with the Director of Clinical Liaisons and the Executive Director of Partnership Development, develops and implements training and education programs in support of the implementation of the Care Coordination Resource Center (CCRC) and future NELC service lines.Uses performance data and personal experience to identify opportunities to improve the productivity and effectiveness of nursing resources and actively participates in quality improvement activities to develop and implement improved processes and flows.Participates with trainers and leaders of other NELC departments ensure a coordinated, comprehensive, and effective training program for all NELC employees is maintained.Develops new hire and ongoing staff training programs that are scalable and that can support the orientation and training of multiple staff simultaneously in multiple different geographies.Benchmarks training programs within and outside healthcare to adopt best practices for training and education within NELCProvide training and mentorship to nursing staffProfessional Requirements:
Current, active, valid nursing licenseBachelor of Science in NursingMinimum of two (2) years in education, training, or equivalent Demonstrated leadership, employee engagement & coaching skillsPreferred skills:
Master’s DegreeMinimum of three (3) years home infusion therapy (HIT) Minimum of four (4) years’ experience in nursing practice with an emphasis in hospital, home infusion, and home health preferred.For more information, visit our website at www.nelifecare.org.
EOE
