11 Healthcare Support Staff jobs in Lawnside

Our client is looking for a dedicated and compassionate Clinical Support Specialist to enhance patient care services in Philadelphia, Pennsylvania, US . This vital role involves providing direct support to healthcare professionals and patients within a community-focused setting. You will be responsible for coordinating patient appointments, managing medical records with utmost confidentiality, and assisting with the administration of care plans. Key duties include liaising between patients, families, and medical staff to ensure clear communication and timely resolution of queries. You will also play a role in patient education regarding treatment protocols and wellness programs. The successful candidate will be expected to maintain a positive and supportive environment for all individuals interacting with our services. This position requires a deep understanding of healthcare ethics and patient privacy regulations (HIPAA). A Bachelor's degree in a relevant field such as Social Work, Psychology, or Health Sciences is preferred, along with at least 3 years of experience in a healthcare or social care setting. Excellent interpersonal, organizational, and problem-solving skills are essential. The ability to empathize and communicate effectively with diverse populations is paramount. Experience with electronic health record (EHR) systems and proficiency in Microsoft Office Suite are required. This role offers a chance to contribute meaningfully to community well-being and develop your career in a rewarding sector. A commitment to patient advocacy and continuous improvement is highly valued.

Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Job Title: Accounts Resolution Specialist I

Department: Ophth Clinical Support

Location: Penn Presbyterian Medical Center- 51 N 39th Street

Hours: Full Time

Summary:

• The Account Resolution Specialist I reports to the Supervisor of Billing; primary responsibilities are to facilitate activities necessary to a successful resolution of accounts. This position will work out of assigned work queues handling claim edit work queue resolution as well as follow up work queue denials transferred from Professional Billing Office that require department intervention. Individuals will be responsible for investigating claim denials and underpayments by insurance carriers and appeal for payment or make appropriate adjustment. Exercising good judgement in escalating identified denial trends or root cause of denials to mitigate future denials, expedite the reprocessing of claims and maximize opportunities to enhance front end claim edits to facilitate a first pass resolution.

Responsibilities:

• Responsible for patient account research in relation to working accounts within the claim edit work queue and follow-up work queue

• Identifying untimely accounts and performing accurate and timely write offs adhering to policy guidelines

• Responsible for maintaining the highest level of billing standards following current guidelines from Medicare, Medicaid, and other insurance entities.

• Answering revenue cycle patient inquiries as well as front desk questions regarding patient accounts

• Meets or exceeds established performance targets (productivity and quality) established by the Supervisor of Billing

Credentials:

Education or Equivalent Experience:

• H.S. Diploma/GED (Required)

• 3+ years Working in health care (professional) billing, health insurance or equivalent

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

REQNUMBER:

**Description**
Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.
Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?
Job Title: Accounts Resolution Specialist I
Department: Ophth Clinical Support
Location: Penn Presbyterian Medical Center- 51 N 39th Street
Hours: Full Time
Summary:
+ The Account Resolution Specialist I reports to the Supervisor of Billing; primary responsibilities are to facilitate activities necessary to a successful resolution of accounts. This position will work out of assigned work queues handling claim edit work queue resolution as well as follow up work queue denials transferred from Professional Billing Office that require department intervention. Individuals will be responsible for investigating claim denials and underpayments by insurance carriers and appeal for payment or make appropriate adjustment. Exercising good judgement in escalating identified denial trends or root cause of denials to mitigate future denials, expedite the reprocessing of claims and maximize opportunities to enhance front end claim edits to facilitate a first pass resolution.
Responsibilities:
+ Responsible for patient account research in relation to working accounts within the claim edit work queue and follow-up work queue
+ Identifying untimely accounts and performing accurate and timely write offs adhering to policy guidelines
+ Responsible for maintaining the highest level of billing standards following current guidelines from Medicare, Medicaid, and other insurance entities.
+ Answering revenue cycle patient inquiries as well as front desk questions regarding patient accounts
+ Meets or exceeds established performance targets (productivity and quality) established by the Supervisor of Billing
Credentials:
Education or Equivalent Experience:
+ H.S. Diploma/GED (Required)
+ 3+ years Working in health care (professional) billing, health insurance or equivalent
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.
Live Your Life's Work
We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.
REQNUMBER:

Overview:

As a part of the customer service team, you will support eligible cancer patients and their caregivers through their journey. We are deeply committed to providing patients/caregivers with an exceptional service experience, so they are well-positioned for treatment and to receive care.

We are looking for someone who is service-oriented with the ability to drive insights and operational enhancements in a dynamic environment, while remaining forward-thinking to proactively and reactively respond to patient and caregiver needs. A successful candidate must have excellent communication and critical thinking skills. This role represents a unique opportunity to directly assist patients/caregivers in close partnership with internal and external supplier partners.

The Patient Support Specialist will play a critical role in managing the day-to-day operations of the patient support program by assisting with patient/caregiver eligibility, enrollment, travel logistics and reimbursement where appropriate. To best support patients and their caregivers, the team will be set up as contact center with operating hours of 7:30AM to 8PM Monday through Friday in which you will be expected to work 8.5 hour shifts within operating hours.

The team operates on a hybrid/remote schedule, working 3 days in-office, 2 days remote.

MUST RESIDE IN OR NEAR HORSHAM, PENNSYLVANIA

This team operates on 4-week rotation schedule; all candidates must be comfortable with rotating shifts. Example of shifts:

-- 1 Week: 7:30 AM - 4:00 PM

-- 2 Weeks: 9:00 AM - 5:30 PM

-- 1 Week: 11:30 AM - 8:00 PM

You must welcome the challenge of working in a highly visible role where you can meaningfully impact the health and well-being of others. You should be a motivated self-starter and quick study who approaches assignments with urgency and diligence.

Responsibilities:

• Serve as the point person for a select number of patients/caregivers in supporting their treatment through an online case management system
• Respond to inquiries from patients/caregivers/sites regarding the patient support service offerings using a call guide resource
• Perform administrative functions of requesting and responding to travel and logistics, sometimes urgently since last minutes change is highly probable while staying calm and offering support to the patient/caregiver
• Validate patient travel expenditures in compliance with SOPs and provide reimbursement through third-party supplier partner
• Enter and maintain accurate data and records into the patient management tool in compliance with the program requirements
• Follow all SOPs to ensure program compliance in working with patients and capturing data requirements needed for the program
• Capture all required elements for enrolled patients to process reimbursement and ensure compliance with the program requirements
• Proactively work with patients/caregivers showing empathy and compassion throughout their treatment plan
• Work to monitor performance and help find operational improvements in the end-to-end patient experience so that we can continue to improve our service offerings over time in support patients
• Other duties as assigned

Qualifications:

• Associate Degree required; B.S. or B.A. degree preferred
• A minimum of 3 years of relevant experience is required, pharmaceutical/medical call center experience preferred
• Excellent oral and written communication skills with the ability to demonstrate patient empathy and support is required, bilingual capabilities are a plus
• Ability to learn and work within IT platforms to document patient cases
• Effectively collaborate in a team environment that will require you to coordinate activities and build partnerships across internal/external organizations
• Skilled in problem-solving and using personal knowledge and any other valuable resources to work through ambiguous situations and ensure a positive customer experience
• Demonstrates excellent care management and ability to maintain records, in accordance with the program design and compliance standards
• Eager to take ownership, be proactive, and see patients/caregivers through their entire CAR-T journey
• This position will be in Horsham, PA at the CAR-T contact center and may require limited travel to other locations for business meetings (temporarily remote)
• Willingness to flex in a dynamic fast-paced environment with changing patient/caregiver needs
• Demonstrated excellence in communication skills in speaking with patients/caregivers in caring manner so they feel supported throughout their treatment journey
• Demonstrates ability to complete tasks with sense of urgency while adhering to SOPs and established program business rules
• Strong understanding of the importance of adhering to SOPs to ensure compliance throughout the process
• Strong financial management skills to reconcile receipts for patient reimbursement
• Self-starter skilled in problem-solving and using personal knowledge and any other available resources to work through ambiguous situations to resolve issues for patients/caregivers and ensure their complete satisfaction
• Exhibits excellent organizational skills with the ability to prioritize activities to address patient travel, logistics and reimbursement support needs
• Effectively work in a team environment that will require you to coordinate activities, build partnerships across multiple stakeholders, both internally and externally
• Agile learner who is comfortable operating in complex environments and shielding patients/caregivers from the complexity
• Passionate about supporting cancer patients with multiple myeloma, with the ability to translate their needs and serve as a resource for our services

Get a complete career fit with Kelly®.

You’re looking to keep your career moving onward and upward, and we’re here to help you do just that. Our staffing experts connect you with top companies for opportunities where you can learn, grow, and thrive. Jobs that fit your skills and experience, and most importantly, fit right on your path of where you want to go in your career.

About Kelly:

Work changes everything. And at Kelly, we’re obsessed with where it can take you. To us, it’s about more than simply accepting your next job opportunity. It’s the fuel that powers every next step of your life. It’s the ripple effect that changes and improves everything for your family, your community, and the world. Which is why, here at Kelly, we are dedicated to providing you with limitless opportunities to enrich your life—just ask the 300,000 people we employ each year.

Kelly Services is proud to be an Equal Employment Opportunity and Affirmative Action employer. We welcome, value, and embrace diversity at all levels and are committed to building a team that is inclusive of a variety of backgrounds, communities, perspectives, and abilities. At Kelly, we believe that the more inclusive we are, the better services we can provide. Requests for accommodation related to our application process can be directed to Kelly’s Human Resource Knowledge Center. Kelly complies with the requirements of California’s state and local Fair Chance laws. A conviction does not automatically bar individuals from employment. Kelly participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.

Acerca de kelly

El trabajo lo cambia todo. Y en Kelly, estamos obsesionados con dónde te puede llevar. Para nosotros, se trata de algo más que simplemente aceptar su próxima oportunidad laboral. Es el combustible que impulsa cada próximo paso de tu vida. Es el efecto dominó que cambia y mejora todo para su familia, su comunidad y el mundo. Es por eso que, aquí en Kelly, estamos dedicados a brindarle oportunidades ilimitadas para enriquecer su vida; solo pregúntele a las 300,000 personas que empleamos cada año.

Kelly Services se enorgullece de ser un empleador que ofrece igualdad de oportunidades de empleo y acción afirmativa. Damos la bienvenida, valoramos y aceptamos la diversidad en todos los niveles y estamos comprometidos a construir un equipo que incluya una variedad de orígenes, comunidades, perspectivas y habilidades. En Kelly, creemos que cuanto más inclusivos seamos, mejores servicios podemos brindar. Las solicitudes de adaptaciones relacionadas con nuestro proceso de solicitud pueden dirigirse al Centro de conocimiento de recursos humanos de Kelly. Kelly cumple con los requisitos de las leyes locales y estatales de Oportunidad Justa de California. Una condena no excluye automáticamente a las personas del empleo.

**Patient Support Specialist**
We are seeking a compassionate and detail-oriented **Patient Support Specialist** to join the MyCARVYKTI Call Center team. This role is critical in supporting patients throughout their treatment journey by managing casework, coordinating logistics, and ensuring compliance with program standards.
**Key Responsibilities**
**Case Management & Call Center Operations**
+ Serve as the point person on patient cases and perform day-to-day call center activities including patient enrollment, eligibility checks, travel/logistics arrangements, and incidental reimbursement.
+ Manage inbound/outbound calls and respond to inquiries from patients, caregivers, and treatment centers regarding support services.
+ Maintain accurate case records in Salesforce and Box.
+ Prioritize cases based on urgency and escalate appeals/exceptions to Gold/Navy Supervisors.
+ Collaborate with third-party vendors (Atlas and Connective) for travel, eligibility, and reimbursement support.
**Compliance & Operational Excellence**
+ Manage cases in accordance with SOPs and control documents.
+ Follow all SOPs, Work Instructions, and Call Guide protocols including caller verification, consent collection, and use of approved language.
+ Handle PHI with strict adherence to compliance standards.
+ Submit Adverse Events within 24 hours.
+ Use feedback from call monitoring and audits to improve performance.
**Customer Service Excellence**
+ Provide accurate and thorough program details to set expectations.
+ Communicate clearly and empathetically throughout the patient journey.
+ Send relevant program communications/resources.
+ Build rapport and trust with customers.
+ Use active listening and probing to resolve inquiries and generate insights.
**Training & Team Support**
+ Complete onboarding training before engaging with patients/caregivers/treatment centers.
+ Participate in ongoing education and identify training needs.
+ Complete Salesforce and SUMMIT training modules as required.
+ Model PSS responsibilities and support new team members through shadowing.
**Treatment Center Engagement**
+ Manage relationships with assigned treatment centers including onboarding, re-education, annual reviews, and ongoing collaboration.
+ Establish and document "ways of working" including distance policies and required interactions.
+ File policies and deviations per SOP with supervisor notification.
**Program Insights & Data Collection**
+ Submit 3-5 monthly entries to the Customer Insight Google Doc Form.
+ Share insights and recommendations with leadership.
+ Assist with treatment center data reviews to ensure no patient is missed.
+ Participate in QBR data collection and team meetings.
**Requirements**
+ Have an Associate's degree (B.S. or B.A. degree preferred)
+ A minimum of 3 years of relevant experience is required; pharmaceutical/medical call center experience is preferred.
+ Deep understanding of program rules and control documents.
+ Strong empathy and communication skills.
+ Excellent organizational and prioritization abilities.
+ Ability to assess urgency and escalate appropriately.
+ Calm and compassionate demeanor in high-pressure situations.
+ Willingness to seek supervisor guidance when SOPs are unclear.
+ Ability to route questions to appropriate leadership team members.
+ Provide customer testimonials as requested.
As part of our promise to talent, Kelly supports those who work with us through a variety of benefits, perks, and work-related resources. Kelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account. In addition, employees are entitled to earn paid sick leave under the applicable state or local plan. Click here ( for more information on benefits and perks that may be available to you as a member of the Kelly Talent Community.
Why Kelly ® ?
As a worker today, it's up to you to take charge of your career and look for opportunities to learn, grow, and achieve your potential. Helping you find what's next is what we're all about. We know what's going on in the evolving world of work-just ask the 440,000 people we employ each year. Connecting with us means getting the support, guidance, and opportunities needed to take your career where you may have never imagined.
About Kelly
Work changes everything. And at Kelly, we're obsessed with where it can take you. To us, it's about more than simply accepting your next job opportunity. It's the fuel that powers every next step of your life. It's the ripple effect that changes and improves everything for your family, your community, and the world. Which is why, here at Kelly, we are dedicated to providing you with limitless opportunities to enrich your life-just ask the 300,000 people we employ each year.
Kelly is committed to providing equal employment opportunities to all qualified employees and applicants regardless of race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or any other legally protected status, and we take affirmative action to recruit, employ, and advance qualified individuals with disabilities and protected veterans in the workforce. Requests for accommodation related to our application process can be directed to the Kelly Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment. Kelly participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.
Kelly Services is proud to be an Equal Employment Opportunity and Affirmative Action employer. We welcome, value, and embrace diversity at all levels and are committed to building a team that is inclusive of a variety of backgrounds, communities, perspectives, and abilities. At Kelly, we believe that the more inclusive we are, the better services we can provide. Requests for accommodation related to our application process can be directed to Kelly's Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment.

At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity. Learn more at no-style="text-align:left;">Job Function:

Customer Management

Job Sub Function:

Patient Education

Job Category:

People Leader

All Job Posting Locations:

Horsham, Pennsylvania, United States of America

Job Description:

Johnson & Johnson Innovative Medicine is searching for the best talent for a Patient Support Supervisor-CAR-T to be located in Horsham, PA.

About Oncology

Our expertise in Innovative Medicine is informed and inspired by Patients, whose insights fuel our science-based advancements. Visionaries like you work on teams that save lives by developing the medicines of tomorrow.

Our Oncology team is focused on the elimination of cancer by discovering new pathways and modalities to find treatments and cures. We lead where medicine is going and need innovators with an unwavering commitment to results.

Join us in developing treatments, finding cures, and pioneering the path from lab to life while championing Patients every step of the way.

Ciltacabtagene autoleucel (cilta-cel) is our groundbreaking cell therapy for treating specific types of cancer. This process involves collecting a Patient’s immune cells, genetically modifying them, and reinfusing them to create a highly personalized treatment. CAR-T therapy requires seamless collaboration across multiple stakeholders, including supply chain, commercial teams, and treatment facilities.

Learn more at looking for an exceptional Patient Support Supervisor (PSS) to join our CAR-T team, where science meets compassion, and every day is an opportunity to help patients and their families on their treatment journey while delivering best-in-class patient support.  Our groundbreaking CAR-T therapy, ciltacabtagene autoleucel (cilta-cel), is a cutting-edge cancer treatment. By joining our team, you’ll be at the forefront of leading a team that is tasked with delivering patient support to eligible patients by removing barriers so that patients can access CARVYKTI.  From welcoming eligible patients to ensuring they receive the logistical support they need, your work will have a direct impact on their lives.

As the Patient Support Supervisor, you will play a pivotal role in ensuring no patient is left behind. Your daily responsibilities will involve providing continuous support to eligible patients. This includes welcoming eligible patients and care partners, collaborating with our third-party travel partner to coordinate logistics, assisting with the reimbursement process and supporting program wrap-up. Responsibilities also include maintaining treatment center relationships and conducting annual treatment center reviews. You will lead by example—providing hands-on training, guidance, and support to your team to ensure efficient case management and empowering them to deliver exceptional, compassionate service. Part of your role will focus on reviewing recorded calls and analyzing interactions to uncover valuable customer insights to help improve the program and ensure compliance. Acting as a trusted resource and problem-solver for both your team and the patients, you will help create a meaningful impact on the lives of patients and their care partners. In this highly visible role, you will balance operational oversight with passionate leadership, ensuring the highest standards of service and support are consistently achieved.

You will be responsible for:

• Inspiring and Leading: Supervise and coach a team of patient support specialists, fostering a culture of empathy and compassion, to ensure every patient and their care partner(s) receives continuous, best-in-class patient support through program welcome, travel logistics, reimbursement support and program wrap-up.

• Driving Excellence: Oversee patient support call center operations, ensuring that every eligible patient who needs patient support receives support throughout their journey, leaving no patient behind

• Championing Quality and Compliance: Conduct audits, provide coaching, and implement processes to maintain high standards of service and adherence to SOPs to ensure the governance of the program

• Innovating for the Future:   Continuously identify and implement improvements to enhance operational efficiency, streamline processes, and ensure consistency, positioning the program for sustainable growth and success

Qualifications / Requirements:

• Associate Degree or equivalent higher education required; Bachelor of Science or Bachelor of Arts degree preferred

• Minimum of 3 years of relevant experience required, with a strong preference for pharmaceutical, biotech, or relevant customer experience preferred

• Demonstration of excellent case management and ability to maintain records in accordance with the program design and compliance standards required

• Excellent organizational skills with strong ability to prioritize work, multi-task, and flex as the needs to customers change, required

• Ability to align daily operations to standard operating procedures (SOP) to ensure compliance and oversight of the program, required

• Lead and support call center quality assurance through regular call monitoring, case audits, 1:1 coaching, etc. to ensure exceptional delivery of program required

• Manage customer expectations by helping call center team de-escalate situations, submit for appeals, and promptly following through on commitments required

• Ability to learn and work within new IT platforms (Salesforce) and networked call systems to manage patient cases, evolving processes as new technology is introduced is required

• Generate and report patient, care partner, and treatment center insights to evolve the program and business is required

• Effectively collaborate in a mostly virtual team environment that will require you coordinate activities, build partnerships across internal/external stakeholders is required

• Skilled at problem-solving and any other provided resources to work through ambiguous situations and make recommendations to leadership is required

• Excellent oral and written communication skills with the ability to demonstrate patient empathy and support is required, bilingual capabilities are preferred

• Eager to be accountable, take ownership, and be proactive in seeing patients and their care partners through their entire MyCARVYKTI patient journey is required

• Ability to demonstrate professional phone and interpersonal skills, adapting to customer needs, active listening, phone etiquette to deliver best-in-class patient experience are required

• Knowledge of Microsoft tools, capability to accurately document calls in a CRM platform with a strong comfort level of wor king with technology required

• Strong ability to motivate and retain call center team while professionally developing them for future growth is required

• Experience in case management, quality assurance, or team training is highly desirable

• Availability to work 8.5-hour rotational shifts within contact center hours (8:00 AM–8:00 PM, Monday–Friday)

Be Part of the Future of Oncology
At J&J Innovative Medicine, we’re raising the bar for what it means to care for Patients. Join us in shaping a world where personalized, empathetic healthcare is the norm. Together, we can eliminate cancer and transform lives — starting with yours.

Johnson & Johnson is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, protected veteran status or other characteristics protected by federal, state or local law. We actively seek qualified candidates who are protected veterans and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act. 

Johnson & Johnson is committed to providing an interview process that is inclusive of our applicants’ needs. If you are an individual with a disability and would like to request an accommodation, please contact us via or contact AskGS to be directed to your accommodation resource

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.**
Clinical Advocacy & Support has an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage health care costs.
The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible for the initial clinical review of service requests for Enterprise Clinical Services. The Medical Director collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services.
The Medical Director collaborates with a multidisciplinary team and is actively involved in the management of medical benefits. The collaboration often involves the member's primary care provider or specialist physician. It is the primary responsibility of the medical director to ensure that the appropriate and most cost-effective quality medical care is provided to members.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
**Primary Responsibilities:**
+ Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations
+ Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements
+ Engage with requesting providers as needed in peer-to-peer discussions
+ Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
+ Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy
+ Communicate and collaborate with other internal partners
+ Call coverage rotation
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
**Required Qualifications:**
+ M.D or D.O.
+ Active unrestricted license to practice medicine
+ Board certification in an ABMS specialty with Internal Medicine, Family Medicine, Hematology - Oncology, General Surgery, ENT, Rheumatology, or PM&R preferred
+ 3+ years of clinical practice experience after completing residency training
+ Demonstrated sound understanding of Evidence Based Medicine (EBM)
+ Proven solid PC skills, specifically using MS Word, Outlook, and Excel
**Preferred Qualifications:**
+ CA, OR, WA or AZ licensure or willing to obtain
+ Experience in utilization and clinical coverage review
+ Proven excellent oral, written, and interpersonal communication skills, facilitation skills
+ Proven data analysis and interpretation aptitude
+ Proven innovative problem-solving skills
+ Proven excellent presentation skills for both clinical and non-clinical audiences
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Compensation for this specialty generally ranges from $238,000 - $357,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.
**Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._
_UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._
_UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._

**Job Family** **:**
Strategy & Transformation Consulting
**Travel Required** **:**
Up to 50%
**Clearance Required** **:**
None
Job Posting
**What You Will Do** **:**
The Patient Services team provides program design, implementation, and monitoring services to pharmaceutical, biotechnology, and medical device, companies. We support our clients across the lifecycle of a product to determine the right suite of Patient Support Programs (PSPs), bring them to life through strong partnerships with both manufacturers and third-party vendors through implementation, and ensuring that they are achieving their strategic intent through nuanced and bespoke program monitoring solutions.
In this role you will be accountable for growing and managing client relationships while managing client expectations. You will become the client's trusted advisor that contributes to the "key client" business development strategy. You will be accountable to develop business with new buyers within key client/s, drawing upon industry and client connections as well as trends and Guidehouse solutions. As you sell and deliver great work you will also identify and evaluate issues of risk for both Guidehouse and for Guidehouse's relationships with clients. You will oversee multiple projects simultaneously of all varying sizes and durations to ensure quality control and key client's perceived value while supervising, mentoring and developing Guidehouse personnel. As a member of the Patient Services leadership team, you will be tasked with the identification and development of new offerings based on evolving industry needs and team capabilities. You will also be involved in non- client related firm- building activities as a leader in the firm.
Common projects include:
+ Develop Patient Services Program Blueprints and detailed program designs, including defining the desired customer and customer experience, the mix of programs and services, and level of support provided
+ Identify emerging digital technologies to optimize Patient Services offerings and identify novel ways to address persistent patient and customer challenges
+ Advise client partners on the optimal PS operating model to address unique product and TA needs, including identification, assessment, and selection of vendor partners to deliver innovative customer experiences
+ Defining methodologies to measure and benchmark the effectiveness of PS program performance; analyze metrics to provide strategic insights
+ Supporting the requirements definition and operational build out of both in-house and outsourced PS HUBs & additional related programs (e.g., financial support, treatment management support)
+ Supporting the identification of business development opportunities & subsequent pull through of business development activities (e.g., proposal development, scoping)
**What You Will Need:**
+ BA/BS degree in Science, Biomedical Engineering, Healthcare, Business or related course of study.
+ 10 years of Life Sciences (Pharmaceutical, Biotech, Specialty Pharma and/or Medical Technology) consulting experience or blend of consulting & industry experience.
+ Subject matter expertise in patient services programs, including Patient Services program design, PS regulatory / compliance issues, patient journey development particularly for specialty medications (e.g., high cost, biologics, CAR-T, REMs, drug-device combinations), Organizational design and change management, and Primary research.
+ Ability to work independently but with oversight from management. Experience in managing components of projects, ownership of workstreams and/or analytics and supervising, coaching or mentoring others in daily tasks is required.
+ Must possess strong analytical skills (Excel, Access, etc.) and leverage analytic techniques to use data to guide client and team decision-making.
+ Must have advanced data collection, research, information finding experience and explore solutions that challenge critical thinking.
+ Proven track record generating revenues with existing clients demonstrating a passion for developing high value client relationships and executing on an account penetration strategy that results in account growth directly or indirectly.
+ Experience managing projects to timeline, scope and budget on multiple teams simultaneously.
+ Must be willing and able to travel to client sites across the US, up to 33% of the time.
+ Authorized to work for any US employer without sponsorship.
**What Would Be Nice To Have:**
+ MBA / PhD / PharmD / MD degree preferred.
+ Demonstrated commitment and passion for the Healthcare and Life Science industries.
+ Excellent written and oral communication skills and ability to produce client ready deliverables including PowerPoint presentations.
+ Ability to grasp and communicate clinical and business implications of technically complex products and services.
+ Excellent attention to detail and ability to review work product of self and others and produce work product and deliverables that require minimal re-work or editing.
+ Collaborative and a team player.
The annual salary range for this position is $206,000.00-$343,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.
**What We Offer** **:**
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Benefits include:
+ Medical, Rx, Dental & Vision Insurance
+ Personal and Family Sick Time & Company Paid Holidays
+ Position may be eligible for a discretionary variable incentive bonus
+ Parental Leave and Adoption Assistance
+ 401(k) Retirement Plan
+ Basic Life & Supplemental Life
+ Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
+ Short-Term & Long-Term Disability
+ Student Loan PayDown
+ Tuition Reimbursement, Personal Development & Learning Opportunities
+ Skills Development & Certifications
+ Employee Referral Program
+ Corporate Sponsored Events & Community Outreach
+ Emergency Back-Up Childcare Program
+ Mobility Stipend
**About Guidehouse**
Guidehouse is an Equal Opportunity Employer-Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.
If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse's Ethics Hotline. If you want to check the validity of correspondence you have received, please contact . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant's dealings with unauthorized third parties.
_Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee._

**Patient Support Medical Claims Processing Representative**
_Contract Remote Role - Location (Open to Remote US)_
As the only global provider of commercial solutions, IQVIA understands what it takes to deliver nationally and internationally. Our teams help biopharma, medical device and diagnostic companies get their therapies to the people who need them. We help customers gain insight and access to their markets and ultimately demonstrate their product's value to payers, physicians, and patients. A significant part of our business is providing patient support programs on the behalf of our customers. With the right experience, you can help provide support to patients in need of available therapies.
IQVIA has the world's largest Commercial Sales & Medical Solutions (CSMS) organization dedicated to the launch and marketing of pharmaceutical and medical products. With a focus on providing talent for patient support, field/inside sales, medical device support, clinical support, and medical affairs our CSMS division has 10,000+ field professionals in more than 30 countries addressing physician and patient needs.
We are excited to announce that currently we are looking for a 100% remote (work from home-WFH) contact **Patient Support Medical Claims Processing Representative** to join our team. In this position, you will provide payment assistance solutions such as co-pay cards or vouchers. The **Patient Support Call Center Representative** is primarily responsible for receiving medical claims from HCPs or patients and vetting the claim against program specific business rules to determine if the claim should be paid or rejected. This role will be a contract role with IQVIA managed by an external agency, with the opportunity to be converted to an IQVIA full-time employee.
**Job Responsibilities:**
+ Primary responsibilities involve receiving medical claims from HCPs or patients, ensuring the adequate supporting documentation has been provided, interpreting the EOB/CMS1500, vetting the claim against program specific business rules and ultimately determining if the claim should be paid or rejected
+ Exceptional organizational skills are required
+ May provide support as needed for customer requests via telephone, email, fax, or other available means of contact to the Support Center
+ Requires the ability to recognize operational challenges and suggest recommendations to management, as necessary
+ Ability to work 40 hours per week (shifts available: 9:00 am - 6:00 pm EST or, 10:00 am - 7:00 pm ET or, 11:00 am EST - 8:00pm EST) under moderate supervision
**Minimum Education & Experience:**
+ High School Diploma or equivalent
+ Experience in claim processing required
+ Medical Billing Certification required
+ Coding Certification required
+ Ability to interpret Explanation of Benefits (EOB)
+ HIPPA certified
+ Customer Service Experience preferred
+ Pharmacy Technician experience preferred
+ Bi-lingual (English/Spanish) preferred
**The pay range for this role is $23.00 per hour. To be eligible for this position, you must reside in the same country where the job is located.**
**IQVIA** is an Equal Opportunity Employer. We cultivate a diverse corporate culture across the 100+ countries where we operate, celebrating and rewarding teamwork and inclusiveness. By embracing our differences, we create innovative solutions that are good for IQVIA, our clients, and the advancement of healthcare everywhere. This role will be a contract role with IQVIA managed by an external agency, with the opportunity to be converted to an IQVIA full-time employee.
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IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable law. potential base pay range for this role is $23.00 per hour. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.
IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create connections that accelerate the development and commercialization of innovative medical treatments. Everything we do is part of a journey to improve patient outcomes and population health worldwide.
To get there, we seek out diverse talent with curious minds and a relentless commitment to innovation and impact. No matter your role, everyone at IQVIA contributes to our shared goal of helping customers improve the lives of patients everywhere. Thank you for your interest in growing your career with us.
EEO Minorities/Females/Protected Veterans/Disabled