Hays Code Guidelines Jobs in Usa

Knows, understands, incorporates and demonstrates the mission, vision and core values of Trinity Health and the Ministry Organization in leadership behaviors, practices and decisions.

Maintains a working knowledge of applicable federal, state and local laws, regulations and industry standards.  Complies with Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects ethical and professional integrity.

Performs PM procedures on multiple types of general and specialized clinical equipment.

Performs PM procedures using manufacturer’s recommendations, standards or code requirements, as well as industry acceptable processes as guidelines.

Performs services on specialized equipment in one or more of the following categories:  anesthesia machines, sterilizers, ventilators, ultrasound, laser, laboratory analyzers, etc.

Performs corrective maintenance procedures including diagnosing problems using thermodynamic, electronic/electrical, mechanical, pneumatic, hydraulic, and/or other sciences and documents results of activities performed to comply with all regulatory and standard requirements.

Notifies equipment users and Clinical Engineering Management of repair status and delays as necessary.

Interacts with clinical staff to understand and resolve operational problems in scheduling and completing PM procedures while minimizing interference to hospital departments.

Determines need for replacement parts and supplies, selects the most cost effective source, and submits properly completed parts request using established policies and guidelines.

Completes corrective and planned maintenance work order documentation per policy.

Promotes teamwork by keeping others informed, participating effectively in group decision making, while working to accomplish team objectives and projects, and by soliciting feedback about one's effectiveness as a team member. 

Continually improves processes by seeking ways to eliminate and reduce waste.

Has authority (based on deprartment guidelines)  to order parts and supplies required for  emergency service or repair of  radiological and general medical equipment. Recommends  test equipment and spare equipment parts to the CE Manager or Lead Technician.

Provide on-call service coverage after normal business hours on a rotating basis.

Provides assistance and training to Bio-Medical Equipment Techs I and II as assigned by Clinical Engineering Manager.

May be assigned duties as Lead Bio-Medical Equipment Technician, as needed.

Performs other duties as assigned or requested by the CE Manager.

Minimum of an Associates of Applied Sciences Degree in related field of medical electronics, electronic technology or equivalent military related training required.  CBET or CLET certification preferred.

Five or more years experience or equivalent performing corrective and planned  maintenance on medical devices and/or clinical equipment.

Specialized training by manufacturer or third party equipment repair in such areas as

      anesthesia machines, sterilizers, ultrasound, ventilators, laser, laboratory analyzers, etc.

Ability to demonstrate a high level of proficiency in specialty area.

Must have a basic understanding of anatomy, physiology, and medical terminology.

Working knowledge  and ability to use basic hand tools and  test equipment specific to the field.  Ability to train CE associates on  use and application of test equipment.

Must have knowledge and understanding of OSHA, NFPA, The Joint Commission, EOC, and other specific regulations and standards pertaining to clinical equipment service and repair.

Must possess a personal presence that is characterized by a sense of honesty, integrity and caring with  ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values of Trinity Health, Ministry Organizations, and Clinical Engineering. 

Ability to operate complex test equipment, analyze and interpret information provided by equipment and clinical staff to determine equipment operational condition.

Must have basic understanding of personal computer operation, applications, and the ability to input data using keyboard.  Technician must be able to  follow complex written instructions, perform tasks and document actions taken.

 Strong customer service and communications skills are required to interact with hospital  personnel and vendors to achieve positive outcomes.

Maintain up to date understanding of The Joint Commission and NFPA standards as well as state and federal regulations.

Ability to provide or coordinate in-service training to clinical/professional staff on medical device  operations and safety functions.

          .

Must be physically able to balance, bend, climb, crawl, crouch, kneel, reach, sit, squat, stand, twist, and walk.

Possess ability to mentally concentrate while being subject to stress, interruptions and changing work priorities.

Must be able to work and follow OSHA guidelines while in a hazardous environment(s) such as electrocution potentials, mechanical energies, bloodborne/airborne pathogens, dust and inclement weather, marked changes in temperature and/or humidity, radiation, fumes/vapors, sharp instruments/tools, hazardous liquids, and operating devices. 

Must be able to hear speech, distinguish sounds, and speak.

Must have near vision, far vision, depth perception, and be able to distinguish colors.

Must have sensory ability to distinguish hot, cold, range of temperature, surfaces, fine motor skills, manual dexterity, and detect/distinguish odors.

Must be able to carry or lift up to 50 pounds routinely (50% of the time) and on occasion (5% of the time) up to 100 pounds.

Must be able to push or pull over 100 pounds frequently (20% of the time). Maintains safe working environment for self, other associates, patients, visitors, and medical staff in accordance with applicable standards and procedures relevant to  job duties.

Must be able to adapt to frequently changing work priorities.

Must be able to travel to the various Trinity Health, Ministry Organizations, subsidiaries, and/or training facilities.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are 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, veteran status, or any other status protected by federal, state, or local law.

Within assigned service area, provides Planned Maintenance (PM), safety testing, repairs, calibration, installation, routine and emergency service, to general and specialized diagnostic, therapeutic, and support medical equipment, such as anesthesia machines, sterilizers, ventilators, ultrasound, laser, laboratory, etc., as assigned by Clinical Engineering (CE) Manager.

ESSENTIAL FUNCTIONS

Knows, understands, incorporates and demonstrates the mission, vision and core values of Trinity Health and the Ministry Organization in leadership behaviors, practices and decisions.

Maintains a working knowledge of applicable federal, state and local laws, regulations and industry standards.  Complies with Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects ethical and professional integrity.

Performs PM procedures on multiple types of general and specialized clinical equipment.

Performs PM procedures using manufacturer’s recommendations, standards or code requirements, as well as industry acceptable processes as guidelines.

Performs services on specialized equipment in one or more of the following categories:  anesthesia machines, sterilizers, ventilators, ultrasound, laser, laboratory analyzers, etc.

Performs corrective maintenance procedures including diagnosing problems using thermodynamic, electronic/electrical, mechanical, pneumatic, hydraulic, and/or other sciences and documents results of activities performed to comply with all regulatory and standard requirements.

Notifies equipment users and Clinical Engineering Management of repair status and delays as necessary.

Interacts with clinical staff to understand and resolve operational problems in scheduling and completing PM procedures while minimizing interference to hospital departments.

Determines need for replacement parts and supplies, selects the most cost effective source, and submits properly completed parts request using established policies and guidelines.

Completes corrective and planned maintenance work order documentation per policy.

Promotes teamwork by keeping others informed, participating effectively in group decision making, while working to accomplish team objectives and projects, and by soliciting feedback about one's effectiveness as a team member. 

Continually improves processes by seeking ways to eliminate and reduce waste.

Has authority (based on deprartment guidelines)  to order parts and supplies required for  emergency service or repair of  radiological and general medical equipment. Recommends  test equipment and spare equipment parts to the CE Manager or Lead Technician.

Provide on-call service coverage after normal business hours on a rotating basis.

Provides assistance and training to Bio-Medical Equipment Techs I and II as assigned by Clinical Engineering Manager.

May be assigned duties as Lead Bio-Medical Equipment Technician, as needed.

Performs other duties as assigned or requested by the CE Manager.

MINIMUM QUALIFICATIONS

Minimum of an Associates of Applied Sciences Degree in related field of medical electronics, electronic technology or equivalent military related training required.  CBET or CLET certification preferred.

Five or more years experience or equivalent performing corrective and planned  maintenance on medical devices and/or clinical equipment.

Specialized training by manufacturer or third party equipment repair in such areas as

      anesthesia machines, sterilizers, ultrasound, ventilators, laser, laboratory analyzers, etc.

Ability to demonstrate a high level of proficiency in specialty area.

Must have a basic understanding of anatomy, physiology, and medical terminology.

Working knowledge  and ability to use basic hand tools and  test equipment specific to the field.  Ability to train CE associates on  use and application of test equipment.

Must have knowledge and understanding of OSHA, NFPA, The Joint Commission, EOC, and other specific regulations and standards pertaining to clinical equipment service and repair.

Must possess a personal presence that is characterized by a sense of honesty, integrity and caring with  ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values of Trinity Health, Ministry Organizations, and Clinical Engineering. 

Ability to operate complex test equipment, analyze and interpret information provided by equipment and clinical staff to determine equipment operational condition.

Must have basic understanding of personal computer operation, applications, and the ability to input data using keyboard.  Technician must be able to  follow complex written instructions, perform tasks and document actions taken.

 Strong customer service and communications skills are required to interact with hospital  personnel and vendors to achieve positive outcomes.

Maintain up to date understanding of The Joint Commission and NFPA standards as well as state and federal regulations.

Ability to provide or coordinate in-service training to clinical/professional staff on medical device  operations and safety functions.

          .

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

Must be physically able to balance, bend, climb, crawl, crouch, kneel, reach, sit, squat, stand, twist, and walk.

Possess ability to mentally concentrate while being subject to stress, interruptions and changing work priorities.

Must be able to work and follow OSHA guidelines while in a hazardous environment(s) such as electrocution potentials, mechanical energies, bloodborne/airborne pathogens, dust and inclement weather, marked changes in temperature and/or humidity, radiation, fumes/vapors, sharp instruments/tools, hazardous liquids, and operating devices. 

Must be able to hear speech, distinguish sounds, and speak.

Must have near vision, far vision, depth perception, and be able to distinguish colors.

Must have sensory ability to distinguish hot, cold, range of temperature, surfaces, fine motor skills, manual dexterity, and detect/distinguish odors.

Must be able to carry or lift up to 50 pounds routinely (50% of the time) and on occasion (5% of the time) up to 100 pounds.

Must be able to push or pull over 100 pounds frequently (20% of the time). Maintains safe working environment for self, other associates, patients, visitors, and medical staff in accordance with applicable standards and procedures relevant to  job duties.

Must be able to adapt to frequently changing work priorities.

Must be able to travel to the various Trinity Health, Ministry Organizations, subsidiaries, and/or training facilities.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are 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, veteran status, or any other status protected by federal, state, or local law.

• Follows established operational policies and procedures to ensure the effective and efficient delivery of legal services for General Sessions, Circuit, and Juvenile Courts.
• Makes independent, neutral, and detached decisions in accordance with legal standards.
• Issues warrants for individuals suspected of criminal activity within Sevier County.
• Ensures compliance with established legal standards and procedures for the issuance of warrants, summons, search warrants, orders of protection, and other legal documents.
• Conducts initial appearance duties, including advising defendants of charges, setting arraignment dates, establishing bail, ordering conditions of release, issuing orders granting bail, GPS and bond conditions per Tennessee Code Annotated.
• Issues ex-parte orders of protection and petitions for orders of protection.
• Performs Initial Appearances within the secured area of the jail, ensuring compliance with legal standards while maintaining professionalism in an environment that may involve exposure to profane language, violent outbursts, and yelling.
• Interacts with mentally ill defendants, employing de-escalation techniques, patience, and sound judgment to address their unique needs while upholding judicial procedures.
• Transfers summons, warrants, and orders of protection to the appropriate department or agency.
• Signs warrants on behalf of federal magistrates under Federal Rules of Criminal Procedure (Rules 3,4, and 5) when a federal magistrate is unavailable.
• Issues juvenile petitions for criminal charges and conduct initial appearances for juveniles in custody, including setting bail and issuing appropriate orders.
• Logs, maintains, and updates records of warrants and other legal documents issued.
• Attends required training with the Judicial Commissioners Association of Tennessee to stay current on proposed and enacted legislation relevant to the role (Minimum of 12 hours annually).
• Maintains detailed records and documentation of all job-related activities, including issued warrants, bonding arrangements, and work hours.
• Issues failure-to-appear warrants for individuals who fail to meet court appearance obligations.
• Assesses probable cause and evidence to determine whether to issue warrants, citations, or orders of protection.
• Provides assistance to the public by answering calls, explaining court proceedings, and offering information related to General Sessions, Circuit, Juvenile Criminal, and Juvenile Civil operations.
• Collaborates with court officers, law enforcement personnel, and other stakeholders to ensure accurate and timely processing of legal documents.
• Utilizes and maintain knowledge of Tennessee Code Annotated to ensure proper citation and legal accuracy in all documentation.
• Performs other incidental and related duties as required and assigned.

• Annual appointment to the position by the Sevier County Board of Commissioners.
• High school diploma or general education degree (GED) or an equivalent combination of education and experience.
• Must be a resident of Sevier County, citizen of the United States, and at least 21 years of age or older.
• Possession of a valid Tennessee Driver's License and the ability to obtain insurance at standard vehicle liability rates.
• Ability to pass a physical and drug screen administered through a licensed physician.
• No convictions, guilty pleas, or pleas of nolo contendere to any felony or violations of federal, state, or local laws relating to force, violence, theft, dishonesty, gambling, liquor, or controlled substances.
• Cannot have been discharged under other than honorable conditions from any branch of the United States Armed Forces.
• Membership in or eligibility to obtain membership in the Judicial Commissioner Association of Tennessee.

• A Bachelors degree or coursework in criminal justice, law enforcement, public administration, or a closely related field.
• A minimum of three years of experience in court operations, law enforcement, or a related area, demonstrating knowledge of judicial procedures and legal processes.

• Comprehensive knowledge of Tennessee Code Annotated Sections 40-1-111 through 40-5-201, legal processes in General Sessions, Juvenile, Circuit, Chancery, and Probate Courts, and applicable Local Court Rules.
• Understanding of laws related to the rights of defendants, victims, and witnesses, as well as regulations for civil, criminal, and juvenile cases, including probation and public service.
• Familiarity with Tennessee Supreme Court Rule 10 ensuring impartiality and ethical decision-making.
• Ability to evaluate evidence and determine probable cause accurately and timely.
• Knowledge of victim support services and judicial resources, with the ability to provide appropriate referrals.
• Knowledge of modern office practices, procedures, systems, and equipment including computers and software.
• Ability to apply standard operating procedures and guidelines in a consistent and impartial manner.
• Strong organizational, decision-making, and interpersonal skills, with the ability to make impartial decisions under pressure, prioritize tasks, and ensure efficient court operations.
• Proven ability to interact professionally with all parties and respond effectively to inappropriate or violent behavior, defusing difficult situations with composure.
• Ability to communicate clearly, concisely, and convincingly both orally and in writing.
• Ability to read and interpret legal documents, policies, procedures manuals, and regulatory materials relevant to judicial duties
• Effectiveness in presenting information clearly and confidently in front of groups, including court staff, law enforcement, and the public.
• Ability to identify and define legal or procedural issues, gather relevant data, establish facts, and draw valid, impartial conclusions.
• Capability to approach others in a polite and tactful manner, maintain composure and react well under pressure, treat others with respect and consideration, follow through on commitments, and uphold the reputation of the organization through ethical business practices and responsible behavior both on and off the job.
• Demonstrated expression of professional judgement when applying guidelines, policies and procedures, and in adapting standard methods to fit facts and conditions.
• Demonstration of a strong work ethic and positive attitude, while maintaining an atmosphere of honesty and integrity.
• Effectiveness in working as part of a team to promote the achievement of individual and group goals.

• This is a light to moderate work position requiring the exertion of up to 25 pounds occasionally, up to 15 pounds frequently, and up to 5 pounds constantly.
• Work requires the ability to sit for extended periods while performing tasks, with occasional standing, walking, and bending to access files, office equipment, and court records.
• Work requires finger dexterity and manual dexterity for operating computers, handling legal documents, and performing clerical duties accurately.
• Work demands attention to detail and the ability to maintain focus for extended periods to ensure accuracy and thoroughness of court proceedings.
• Vocal communication is required for expressing and exchanging ideas by means of spoken word, especially during hearings, meetings, and interactions with court staff, law enforcement, and the public.
• Hearing is necessary to receive information in both quiet and noisy environments, including during court sessions and conversations with various parties.
• Visual acuity, including close vision, color perception, and depth perception, is required for reading legal documents, reviewing case files, and ensuring the accuracy of information presented in court.

• Operates in a professional office environment with moderate noise, requiring routine use of standard office equipment, including computers, phones, and printers.
• Occasional work in a courtroom setting or other environments related to judicial processes may be required.
• General work hours are dependent upon assigned shifts, which may include Monday through Friday, weekends, or night shifts; flexibility is required to meet office coverage needs as work in a variety of shifts is needed to ensure 24-hour coverage is available every day; training periods may require additional hours for part-time Judicial Commissioners to gain experience and work independently; reliable transportation is required as travel might be needed.
• Appointment status is temporary until recommended by General Sessions Judges and approved by the County Commission; term lengths are renewed annually based on legislative action.

• Yes
• No

• High school graduate, diploma or the equivalent (GED)
• Associate degree
• Bachelor's degree
• Master's degree
• Professional degree
• Doctorate degree

• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No

• Yes
• No

Hybrid: Applicants must be a California resident as of their first day of employment.

PRINCIPAL RESPONSIBILITIES:

Member Services Representatives (MSR) are the first point of contact for our members' primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a timely manner. Respond to all communications coming into Member Services in the form of email, fax, letters, chat and phone calls. Timely responses to all member communication are essential. Must effectively prioritize and flex the workload as new communication and tasks are submitted. Identify the caller's needs, clarify information, research issues, and provide solutions and/or alternatives whenever possible. Accurately and consistently document all conversations in the electronic database. This position is a liaison between the plan, the provider network, and other community agencies. The MSR positions are flexibly staffed classification and work is expected to be performed minimally at the MRS II level. However, the initial selection will be made at the entry level MSR I. Our more advanced level position of the series is the MSR III who will be required to perform a variety of complex matters.

Member Services Representatives are under the direction of a Member Services Supervisor, Manager and Director, and service our members through our call center as well assisting other departments with responses to member issues by initiating communication between departments to ensure action, cooperation, and compliance of managed care operations.

Member Services Representative I

This position which requires the ability to work as a team player within the Alliance and with external contacts, make sound judgments based on analysis of information, be an effective communicator, active listener and balance advocacy for the member with the policy provisions such as plan policies, EOC, regulatory guidelines, and DMHC/DHCS rules and regulations. The MSR provides courteous, professional, and accurate responses to incoming inquiries regarding network, plan benefits, eligibility, authorizations, plan services and guidelines, as well make decisions with the goal of ensuring member satisfaction and retention. The MSR performs a variety of complex functions and is also responsible for maintaining accurate and complete inquiry/grievance records in the electronic database. Maintains compliance with DMHC regulatory requirements and DHCS contractual obligations. MSR I staff who demonstrate proficiency in meeting, maintaining and exceeding principal performance objectives and metrics may be eligible to be promoted to a Member Services II or III role. Member Services Representative I staff may be eligible for promotion to Member Services Representative II or III positions once they have worked as a MSR I for a minimum of 12 months to be proficient with program and system knowledge in addition to meeting performance matrix requirements.

Principle duties and responsibilities

* Serve as the primary contact for members, providers and others for questions related to claims, benefits, authorizations, pharmacy, member eligibility and other questions related to Alameda Alliance and provide accurate, satisfactory answers to their inquiries or concerns.

* Respond to and resolve member service inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims, behavioral health, and care coordination.

* Answer incoming calls, emails, chats, and other requests for assistance in a timely manner in accordance with departmental performance targets and provide excellent customer service while doing so. May include assisting members in person.

* Recognize and understand the difference between calls that require quick resolutions and calls which will require follow-up and handle each appropriately.

* De-escalate situations involving dissatisfied customers, offering patient assistance and support.

* Accurately document all contacts per department standards/guidelines in the Customer Relationship Management (CRM) system.

* Accurately and consistently document (electronic database) and resolve Exempt Grievances (any expression of dissatisfaction that are not coverage disputes, disputed health care services involving medical necessity, or experimental or investigational treatment and that are resolved by the next business day following receipt).

* Interface with Grievance and Appeals, Claims, Enrollment, IT, Network Management, Pharmacy, Authorizations, and other internal departments to provide Service Excellence to our members.

* Help guide and educate members about the fundamentals and benefits of managed health care topics, to include managing their health and well-being by selecting the best benefit plan service options, maximizing the value of their health plan benefits, and choosing a quality care provider.

* Intercede with care providers (doctor's offices) on behalf of the member, assisting with appointment scheduling; connect members with internal Case Management Department for assistance as needed.

* Assist members in navigating , the Member Portal, and other health care partner online resources and websites to encourage/reassure them to use self- service tools that are available.

* Manage any issues through to resolution on behalf of the member, either on a single call or through comprehensive and timely follow-up.

* Research complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issues.

* Provide education and status on previously submitted pre-authorizations or pre- determination requests for both medical and pharmaceutical benefits.

* Meet the performance goals established for the position in the areas of compliance, efficiency, call quality, member satisfaction, first call resolution, punctuality, and attendance.

* Always maintain a professional level of service to members.

* Always maintain confidentiality of information.

* Consistently support the Alliance's approach to Service Excellence by adhering to established department and company standards for all work-related functions.

* Interact positively with all Alliance Departments.

* Accurately and consistently document (electronic database) and resolve Exempt Grievances (any expression of dissatisfaction that are not coverage disputes, disputed health care services involving medical necessity, or experimental or investigational treatment and that are resolved by the next business day following receipt).

* Process MS Dept projects

* Serve as a back-up to manage the escalated calls.

* Perform other duties as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

* Contacts: Receive, manage, and document telephone calls, emails, and other sources of contacts from members, potential members, and providers, and explain health plan benefits and plan rules. Describe the types of services the Alliance offers to the Member within the managed care system. Provide clarification about issues regarding patient and physician rights and how the plan operates.

* Conflict resolution: Resolve member problems/conflicts by convening with other departmental staff as needed.

* Member communications: Create and/or mail appropriate member materials and communications as needed.

* Computer: Perform ongoing data entry which assists in the maintenance of the Member Services department database to ensure data integrity.

* Comply with the organization's Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

* Constant and close visual work at desk or computer.

* Constant sitting and working at desk.

* Constant data entry using keyboard and/or mouse.

* Constant use of multi-monitor setup

* Frequent use of telephone and headset.

* Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.

* Frequent lifting of folders, files, binders, and other objects weighing between 0 and 30 lbs.

* Frequent walking and Standing

Number of Employees Supervised: 0

MINIMUM QUALIFICATIONS:

* Bachelor's degree or equivalent experience preferred.

* High school diploma, GED required.

* The ability to speak and understand-bilingual: Spanish/English, Cantonese/English, Vietnamese/English, Tagalog/English are required as designated.

* A bilingual proficiency exam will be administered to ensure the candidate possesses the appropriate skill level to meet requirements. The successful candidate must score 90% or higher.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

* Minimum one year of direct customer service experience. Call center experience and managed care experience a plus

* Experience determining eligibility for financial assistance, insurance benefits, unemployment and/or other social services programs.

* Demonstrated knowledge expert of AAH Member Services policies and procedures

* Consistent record of meeting, maintaining, or exceeding monthly Departmental performance metrics.

* Consistent track record of documenting Service Requests accurately and clearly and monitoring open Service Requests to ensure responses and closure.

* Consistent record of high quality of work as demonstrated through call and documentation auditing, appropriate Call Disposition coding, as well as an overall acceptable monthly Member Satisfaction Survey result as assessed by Member Services Quality Specialist, MS Trainer and Member Services Supervisor.

* Demonstrated proficiency in current Customer Relationship Management (CRM) tool, phone system software Quality Management Solution, Pharmacy Benefits Management applications (PBM), Interpreter vendor scheduling software, delegate portal solutions and the Alliance's Member portal.

* Demonstrated ability to effectively handle the department's key special projects: Member Portal Request Processing, Kaiser PTE Requests, PCP retroactive and same month requests.

* Demonstrated ability to help members face-to-face in the field and/or at the Alliance offices (walk-ins). Also highly skilled at handling issues related to member bills, transportation set-up and benefit coordination with providers and pharmacy needs.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

* Ability to prioritize and adapt to changing situations in a calm and professional manner.

* Ability to maintain composure in stressful situations.

* Excellent problem-solving skills

* Ability to exhibit cooperation, flexibility, and provide assistance when talking to members, providers, and staff.

* Skill in basic data entry

* Ability to type 40 net words per minute: multi-task

* Manual dexterity to operate telephone, computer keyboard equipment.

* Speak English proficiently, clearly, and audibly.

* Memorize and retain information quickly; meet physical requirements

* Spell correctly

* Learn the policies, regulations, and rules applicable to business operations.

* Follow instructions, reason clearly, analyze solutions accurately, act quickly and effectively in emergency situations; operate office equipment including computers and supporting word processing, spreadsheet, and database applications.

* Excellent phone etiquette and ability to communicate clearly and concisely, both orally and in writing.

* Excellent interpersonal skills with the ability to interact with diverse individuals and flexibility to customize approach to meet all types of member communication styles and personalities.

* Strong verbal and written communication skills.

* Demonstrated ability to quickly build rapport and respond to members in a compassionate manner by identifying and exceeding member expectations (responding in respectful, timely manner, consistently meeting commitments).

* Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests, and identify the current and future needs of the member.

* Must be self-motivated and able to work with minimal supervision

* Must be team-oriented and focused on achieving organizational goals.

* Proficient problem-solving approach to quickly assess current state and formulate recommendations.

* Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions which members can understand and act upon.

* Proficient conflict management skills to include ability to resolve issues during stressful situations and demonstrating personal resilience.

* Ability to work regularly scheduled shifts within the Alliance's hours of operation including the training period, with scheduled lunches and breaks, flexibility to adjust daily schedules; and to work over-time and/or weekends as needed.

* Medical terminology knowledge preferred

* Ability to work within a broad systems perspective

* Experience in use of various computer systems software as well as Microsoft Windows, and Microsoft Suite, especially Outlook, Word, Excel.

* Must have reliable and stable internet connection for remote work (50-100 Mbps download speeds).

Employees who interact with members of the public may be required to be tested for Tuberculosis and fully vaccinated against COVID-19 and influenza. Successful candidates for those positions/ classifications may be required to submit proof of vaccination against influenza and/or COVID-19, a negative Tuberculosis test, or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates should not present proof of vaccination until instructed to do so by the Human Resources department.

SALARY RANGE $22.88-$34.33 HOURLY

The Alliance is an equal opportunity employer and makes all employment decisions on the basis of merit and business necessity. We strive to have the best-qualified person in every job. The Alliance prohibits unlawful discrimination against any employee or applicant for employment based on race, color, religious creed, sex, gender, transgender status, age, sexual orientation, national origin, ethnicity, citizenship, ancestry, religion, marital status, familial status, status as a victim of domestic violence, assault or stalking, military service/veteran status, physical or mental disability, genetic information, medical condition, employees requesting accommodation of a disability or religious belief, political affiliation or activities, or any other status protected by federal, state, or local laws.

Job Title: Sr React JS Architect (React, TypeScript, Node.js)

Location: Denver, CO

Duration: Long Term

Must Have Skills:

• React
• Material UI
• TypeScript
• Storybook
• SASS
• AEM Cloud with SPA Editor experience

Principal Accountabilities:

• Focus on application development and tools. Ability to write code and test new and innovative web applications, integrate web tools or new features, develop or integrate new code, maintain and address existing code.
• Application development of global websites using C++, Java, XML, HTML, CGI, JSP, Javascript, AJAX, multimedia applications, database and data modeling tools and other languages or software tools as needed. Maintaining web standards and best practices.
• Design user interfaces within existing style guidelines. Actively participate in user interface implementation from initial planning/design to project release. Effectively communicate conceptual ideas, design rationale and the specifics of user centered design process.
• Actively plan, analyze and review functional and technical specification documents. Create holistic design solutions that address design, layout and maintenance, and web performance.

Job Complexity:

• Requires in-depth knowledge and experience
• Solves complex problems; takes a new perspective using existing solutions
• Works independently; receives minimal guidance
• Acts as a resource for colleagues with less experience
• Represents the level at which career may stabilize for many years or even until retirement
• Contributes to process improvements
• Typically resolves problems using existing solutions
• Provides informal guidance to junior staff
• Works with minimal guidance

Job Description:

Senior React / Frontend Architect (React, TypeScript, Node.js)

We are looking for a Senior React/Frontend Architect with expertise in React, Material UI, TypeScript, and Node.js to help build and optimize high performance web applications. The ideal candidate has a strong foundation in front-end development, best practices, advanced TypeScript skills, and experience with modern JavaScript build tools like Webpack. Experience in Node.js library packaging, design systems, and optimizing front-end performance is highly desirable.

Responsibilities:

• Architect, Develop and optimize React components, ensuring reusability, maintainability, and performance.
• Architect and maintain a scalable React application structure, following best practices for long-term sustainability.
• Build and package Node.js libraries to be reusable across multiple projects.
• Write clean, efficient, and scalable TypeScript code, ensuring strong type safety and maintainability.
• Build UI components using Material UI, ensuring consistency with design guidelines.
• Integrate and consume RESTful APIs or GraphQL endpoints efficiently.
• Implement and manage front-end testing using frameworks such as Jest, Cypress, or React Testing Library.
• Optimize Webpack configurations for faster builds, better bundling, and improved performance.
• Ensure adherence to best practices for performance optimization, accessibility, and security.
• Collaborate closely with backend teams to integrate APIs and optimize data fetching strategies.
• Debug and resolve complex issues across the front-end stack, including state management and caching strategies.
• Stay updated with the latest trends in React, TypeScript, and front-end development to deliver best-in-class solutions.
• Participate in code reviews, mentor junior developers, and contribute to technical discussions.

Qualifications:

• 12+ years of experience in front-end development, with at least 8+ years of hands-on React experience.
• Advanced TypeScript skills, with a focus on type safety and best practices.
• Strong experience with Material UI for building accessible, consistent UIs.
• Solid understanding of Node.js and experience with Node.js library packaging.
• Hands-on experience with front-end test frameworks (Jest, Cypress, React Testing Library).
• Deep understanding of Webpack, including performance optimizations, tree shaking, and bundle splitting.
• Familiarity with state management solutions such as Redux, Zustand, or Recoil.
• Experience with performance tuning, lazy loading, and optimizing Lighthouse scores.
• Familiarity with CI/CD pipelines and DevOps practices for front-end deployments.
• Strong knowledge of RESTful APIs and GraphQL, with experience in efficient data fetching strategies.
• Excellent problem-solving skills and the ability to debug complex front-end issues.
• Strong communication skills, with the ability to collaborate effectively with designers, backend developers, and stakeholders.

Payment Accuracy Manager, Outpatient Facility

Overview

As a Payment Accuracy Policy Manager, you will serve as a critical bridge between healthcare payment expertise in our facility capability. This role combines deep subject matter knowledge with strategic influence—driving the development of payment integrity policies that protect our clients while advancing Rialtic's platform capabilities.

You'll lead the research, evaluation, and implementation of new policies based on CMS guidelines, Medicaid requirements, industry standards, and emerging medical cost trends in the facility space of our offering. Working closely with client management, product, engineering, and content leadership teams, you'll translate complex payment policy concepts into actionable strategies that deliver measurable value. This is an opportunity to shape how health plans approach payment integrity and to build the content foundation that powers our enterprise platform.

Responsibilities

• Serve as the SME for outpatient facility editing policy development, leading the research, scoping, and creation of new claims editing policies for the facility capability
• Source, interpret, and scope new payment integrity policies to expand Rialtic's claims editing content library from outpatient facility claims
• Prioritize policy updates based on savings potential, client impact, and strategic alignment with platform goals
• Leverage CMS, Medicaid, clinical guidelines, and industry trends to identify opportunities for new content development for facility claims
• Quantify and communicate policy value through data-driven analysis and clear financial impact assessments in the facility space
• Work closely with product and engineering teams to ensure client needs inform platform development, building out our facility capability
• Collaborate with content leadership to maintain consistency, quality, and relevance across the policy library
• Perform investigation of current facility policy defects and unexpected claim outcomes, performing root cause analysis and policy research to identify corrective actions and improve policy accuracy and performance
• Serve as the facility payment accuracy SME in client discussions, presenting policy concepts and addressing facility-related questions when needed

Qualifications

Required

• 5-7 years of experience in payment integrity at a health plan, claims editing vendor, or similar healthcare organization with focus in outpatient facility claims editing and reimbursement methodologies
• Active coding certification (COC, CPC, CCS, or equivalent specialty certification) — required for this position
• Proven expertise in:
• Interpreting medical and payment policies
• Applying CMS and Medicaid reimbursement guidelines
• Professional and outpatient coding standards
• Common claims payment error identification and resolution
• Demonstrated ability to advise clients and explain complex payment accuracy concepts in clear, accessible terms
• Strong analytical skills with experience quantifying policy impact and ROI
• Track record of managing claims editing implementations or similar client-facing initiatives
• Intermediate Excel skills (i.e., formulas, v-lookups, pivot tables, etc)

Preferred

• Expertise across both professional and institutional claims environments
• Advanced proficiency with Google Suite or similar collaboration tools
• Experience working cross-functionally with product and engineering teams in a SaaS or health tech environment
• Exceptional written and verbal communication skills with the ability to influence stakeholders at all levels

Position: Scheduling Coordinator

Location: Remote, ORL Area (1 hr radius from downtown ORL)

• Have to go onsite first day to pick up equipment

Duration: 6 month contract to hire

PR: $18hr

Start Date: April 13th

Hours: M-F 4p-8p- 20 HRS GAURANTEED. Will have opportunity to work more hours, when converting perm will not work more than 32hrs.

Must Haves:

• 2+ years of customer service experience
• 1+ year of call center experience
• Healthcare experience
• Strong experience with Microsoft Products- have to pass typing test
• HS Diploma or GED

Plus:

• Scheduling, Insurance Verification, Referrals experience

Day to Day

The Scheduling Coordinator is responsible for coordinating and scheduling patient appointments through proactive outbound communication while delivering exemplary customer service aligned with Patient First Philosophy. This role ensures accurate appointment placement, clear communication of preparation instructions, and proper documentation within Epic and other scheduling systems. The Scheduling Coordinator consistently meets productivity, quality, and customer service standards while supporting efficient clinic and departmental operations.

Essential Functions

• Provide accurate, department- and procedure-specific scheduling information to ensure appropriate patient preparation, correct arrival location, and scheduled arrival time.
• Perform primarily outbound scheduling calls to patients who have requested appointments, with the goal of successfully scheduling services in a timely and efficient manner.
• Demonstrate proactive customer engagement by actively listening, maintaining a caring and professional demeanor, and offering appropriate alternatives when necessary.
• Exhibit excellent telephone etiquette, professional verbal communication skills, and a strong team-player attitude in all interactions.
• Maintain a basic understanding of medical needs and screening requirements necessary to appropriately schedule patient appointments.
• Utilize Epic scheduling workflows and related systems to document outreach attempts, scheduling outcomes, and required follow-up in accordance with training and established procedures.
• Consistently review daily schedules and communicate all changes, cancellations, or updates to appropriate clinical and administrative staff.
• Identify customer service concerns and independently resolve issues or initiate appropriate follow-up when required.
• Demonstrate working knowledge of registration systems, scheduling platforms, and web-based resources.
• Maintain a working knowledge of ICD-9/ICD-10 and CPT codes as required for accurate scheduling and documentation.
• Ensure compliance with all policies, procedures, and professional appearance standards.

Productivity and Performance Expectations

• This role is primarily outbound-focused, with limited de-escalation required.
• Expected productivity is approximately 7–10 outbound calls per hour, recognizing that:
• Approximately 30% of outbound calls connect with patients.
• Approximately 70% of calls result in voicemail messages.
• Connected calls average approximately 6 minutes.
• Profile creation calls may take 10–12 minutes.
• Downtime between calls is self-managed due to the outbound nature of the role; productivity is evaluated based on call type and complexity rather than volume alone.
• Performance evaluation emphasizes “Not Ready Time”, defined as time when the coordinator is unavailable to take or place calls.
• Consistently meets departmental goals for productivity, quality, and customer service

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Position: Referral Coordinator

Openings: 8

Location: Remote, ORL Area (1 hr radius from downtown ORL)

• Have to go onsite first day to pick up equipment

Duration: 6 month contract to hire

PR: $18 /hr

Start Date: April 13th

Hours: M-F 4p-8p- 20 HRS GAURANTEED. Will have opportunity to work more hours, when converting perm will not work more than 32hrs.

Must Haves:

• 2+ years of customer service experience
• 1+ year of Data Entry experience
• Healthcare experience
• Strong experience with Microsoft Products- have to pass typing test
• HS Diploma or GED

Plus:

• Scheduling, Insurance Verification, Referrals experience
• Call Center Experience

Day to Day

The Referral Coordinator supports clinical teams, patients, and family members by managing internal and external referrals and insurance authorizations within the outpatient ambulatory setting. This role is responsible for accurately processing referrals and authorizations prescribed by providers in the Electronic Health Record (EHR), ensuring timely coordination of care, accurate documentation, and compliance with payer guidelines. The Referral Coordinator plays a key role in facilitating patient access to services while upholding Orlando Health’s commitment to exemplary customer service.

Essential Functions

• Completes accurate entry of referrals and authorizations into the Electronic Health Record (EHR)- EPIC
• Processes referrals and related documentation received through the OnBase fax queue by reviewing faxed orders, transcribing required information, and entering data into Epic.
• Works with dual systems (OnBase and Epic) to ensure referral information is accurately transferred from source documents.
• Creates new patient profiles in Epic when necessary, using transferred information from referral documentation (not from memory).
• Files referral-related documents into the appropriate patient chart in accordance with established procedures.
• Completes patient registration and obtains insurance authorizations for new patients, diagnostic testing, and hospital-based diagnostics.
• Verifies insurance coverage using electronic verification tools, payer web portals, and telephone communication when online verification is unavailable.
• Contacts insurance companies to follow up on authorizations, confirm coverage, and resolve authorization-related issues.
• Communicates with patients as needed to verify insurance information, obtain required details, or complete the referral process.
• Coordinates follow-up care when referrals or authorizations are nearing expiration.
• Ensures financial and insurance information is current, accurate, and active in the EHR.
• Confirms Primary Care Provider (PCP) information is accurate and compliant with payer-specific guidelines.
• Initiates and tracks referral and authorization status to ensure timely completion of services.
• Coordinates with scheduling departments, clinical teams, and other internal departments to facilitate patient visits.
• Provides patients with referral details for physicians, specialists, and facilities as appropriate.
• Communicates effectively with internal and external customers, including providers, patients, insurance representatives, and clinical departments, to obtain required authorizations.
• Maintains current knowledge of referral and authorization requirements based on payer-specific guidelines.
• Maintains a working knowledge of ICD‑10 and CPT codes.
• Demonstrates a basic understanding of third-party reimbursement requirements and regulations.
• Exhibits competency in the use of registration systems, electronic verification tools, Epic, OnBase, and web-based payer resources.
• Performs all duties in a manner that supports departmental productivity, quality, and customer service goals

Customer Service and Professional Standards

• Understands and supports commitment to providing exemplary customer service.
• Demonstrates a positive, professional, and respectful approach in all interactions with patients, families, and team members.
• Communicates clearly and effectively, both verbally and in writing.
• Maintains flexibility in work schedule availability to meet departmental operational needs.

Knowledge, Skills, and Abilities

• Strong data entry, typing, and transcription skills with high attention to detail.
• Ability to manage high volumes of faxed and electronic documentation accurately.
• Proficiency with EHR systems (Epic preferred), document management systems (OnBase), and insurance web portals.
• Effective organizational and time‑management skills.
• Ability to communicate professionally with insurance representatives, patients, and clinical staff.
• Understanding of medical terminology related to referrals, diagnostics, and authorizations.