Job Title: RN Quality Navigator (Must be located at SC, NC, or GA) Location: Columbia, SC, 29229 (Travel is required 80% of the time across the state of SC and occasionally out of town) Duration: 6 months assignment with possible extension Shift: Mon-Fri, 8:00 am - 5:00 pm Responsibilities: 50% Abstracts and reviews medical records for HEDIS for both prospective and retrospective seasons to ensure that our Company complies with NCQA standards and achieves its CMS Star rating. Researches and stays up to date on all HEDIS clinical measures and NCQA standards/guidelines. Performs quality improvement activities to monitor/maintain quality of care and compliance with applicable standards/regulations. Tracks/trends/investigates quality concerns and complaints. 30% Educates network providers on HEDIS clinical measures and coding accuracy. Keeps providers up to date on HEDIS clinical measures. Works with providers to collect medical records and provides support to...

A Remote Insurance Follow-Up Representative (MediCal) will be responsible for all collection functions for hospital and physician services. This primary responsibility of this position is account resolution which includes the following duties: reviewing accounts, following up with Medi-Cal and various insurance companies on claim status, gathering and submitting any missing information, rebilling, appeals, and billing out secondary electronic or paper claims to all payers as needed. Duties/Responsibilities Provide customer service to various healthcare contract customers Prepare, research and collect from Medi-Cal and various contracted health insurance payers Research remits and Explanation of Benefits (EOBs) for complete accurate payments or denials Provide or arrange for additional information when needed Submit corrected claims or appeals Request appropriate adjustments, when required Identify items that require client assistance Gather payor trends and provide feedback Other...

eGroup | Enabling Technologies is looking for a Sales Operations Specialist to join our team and help eGroup | Enabling Technologies extend our delivery of solutions throughout the nation. This is an excellent opportunity for the sales professional with a positive, “can do” attitude. The right individual will be responsible for engaging customers, vendors, distributors, and manufacturers to assist eGroup | Enabling Technologies in building, maintaining, and delivering its sales pipeline. This will include vendor engagement, proposal development, pipeline management, and customer follow-up. This is a fantastic opportunity to work within a growing organization while mastering your sales and operations skills. As an eGroup | Enabling Technologies Sales Operations Specialist, you will utilize your skills and drive to assist our Outside Sales team in extending eGroup | Enabling Technologies’ products, services, and solutions to customers and prospects. You must be motivated to provide...

Potentia Search are working with a leading manufacturer of industrial equipment in the US who are seeking a 'Field Service Technician' with case packing & accumulation experience. The role will be responsible for performing in-house, on-site, and/or telephone troubleshooting, repairs, and support of equipment on an as-needed basis for clients in the U.S. If you are a technical candidate with a strong PLC background (Allen-Bradley) & experience in equipment maintenance/troubleshooting, we'd love to hear from you! Additional Responsibilities: Provide customer service and support during field visits. Satisfy customer needs by making appropriate recommendations and using appropriate field automation systems, procedures, and protocols. Able to make required adjustments, performing audits, installing upgrades, and follow-up training. Provide status reports of the ongoing project, document installations, inspections, and repair work. Responds to emergency...