Imagenet LLC

Imagenet LLC is a premier healthcare technology company that has taken medical claims processing and document management to new levels of service, security and efficiency. Our core business is helping our clients reduce costs and increase productivity by providing efficient document imaging, data validation, adjudication and on demand retrieval of documents and data. JOB OVERVIEW  We are seeking an experienced Healthcare Claims Director to oversee our claims processing operations and drive data-driven process improvements. This leadership role will manage a team of claims managers and analysts, ensure compliance, and leverage data analytics to enhance claims performance.  RESPONSIBILITIES Provide strategic direction and operational oversight for healthcare claims processing across multiple lines of business Manage a team of claims managers, analysts and supporting staff across multiple locations Develop and implement policies, procedures and workflows for efficient claims adjudication Monitor performance metrics and identify opportunities for process optimization Leverage data analytics tools to analyze claims data, identify trends and generate actionable insights Develop reporting dashboards and visualizations to share key metrics with leadership Ensure adherence to regulatory compliance, coding guidelines and revenue cycle best practices Collaborate with IT, clinical, and business teams on systems improvements and integrations Manage relationships and resolve escalated issues with healthcare providers and payers Mentor, coach and provide professional development for team members Technical Skills/Knowledge Bachelor's degree in healthcare administration, business or related field 7+ years of management experience in healthcare claims processing Deep understanding of claims operations, revenue cycle management and compliance Strong data analytics skills and experience using tools like Tableau, SQL, PowerBI Proven ability to analyze data, synthesize insights and drive process improvements Excellent communication, presentation and leadership abilities Motivated team player with a customer-focused mindset   Job Type: Full-time Experience: claims or claims processing, managing: 7+ years (Required) Work authorization: United States (Required) Job Type: Full-time Pay $90,000-$100,000 per year Benefits: We offer a competitive compensation and benefits package commensurate with experience as well as PTO. This is an office-based position Schedule: 8 hour shift Day shift Monday to Friday Ability to commute/relocate: Tampa, FL 33618: Reliably commute or planning to relocate before starting work (Required) Experience: 7+ years of management experience in healthcare claims processing Deep understanding of claims operations, revenue cycle management and compliance Strong data analytics skills and experience using tools like Tableau, SQL, PowerBI Work Location: In person

Imagenet is a premier healthcare technology company that has taken medical claims processing and document management to new levels of service, security and efficiency. We are looking for Claims Examiners to join our rapidly growing team in Tampa. Experience is preferred but not necessary. Candidates with the right aptitude and desire to learn will be given the required training to be successful. We are excited for this limited opportunity to train candidates that have a phenomenal work ethic and want to learn a new trade. You will receive in-depth training on industry standards, coding, and metrics. Please apply if you exhibit the focus and desire to do great things! We offer great benefits, flexible hours, and the opportunity for remote work for self-disciplined candidates who can perform well under limited supervision. Imagenet offers unlimited opportunities for candidates looking for upward mobility. Our leaders are always promoted from within and there is not a minimum employment time frame if you qualify for promotions. We appreciate referrals and always look to reward employees who help us grow. MUST BE LOCAL TO TAMPA Do not apply if you are not local to Tampa This position is based in our Tampa office. However, employees who consistently meet performance metrics are eligible for a flexible work arrangement that allows working from home. To qualify, employees must: Consistently meet or exceed all productivity and quality metrics for their role over a 3-month period Demonstrate the ability to collaborate effectively and maintain strong communication with team members while working remotely Have no active performance improvement plans or disciplinary issues Once the above criteria are met, the employee may submit a request to work from home up to 2 days per week. Approval will be at the manager's discretion based on business needs and the employee's proven performance. Any decrease in productivity or engagement may result in the flexible arrangement being discontinued. We strive to provide flexibility where possible to employees who have demonstrated success in their role. This policy is subject to ongoing review and may be updated or discontinued based on business requirements. Job Description Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria Review different lines of business to include Medicare, Medicaid and Commercial services adherence to the contracts and timeliness guidelines Authorize claim payments within established limits; otherwise forward to Claims Manager Potentially process refunds appeals, disputes and adjustments (when applicable) Identify process improvement opportunities within the claim department and recommend system enhancements Handles any additional responsibility which may be assigned Education :  High School Diploma or equivalent required Experience : Preference for minimum of one-year experience working closely with healthcare claims or in a claims processing/adjudication environment Open to training candidates without experience Technical Skills / Knowledge: Understanding of health claims processing/adjudication Ability to perform basic to intermediate mathematical computation routines Medical terminology strongly preferred Understanding of ICD-9 & ICD-10 Basic MS office computer skills Ability to work independently or within a team Time management skills Written and verbal communication skills Attention to detail Must be able to demonstrate sound decision-making skills Salary: $15.00 - $18.00 per hour based on experience. Job Type: Full-time Benefits: Dental insurance Health insurance Vision insurance Performance Bonus Referral Bonus PTO   Schedule: 8 hour shift Monday to Friday Flexible schedule Work Location: Hybrid remote in Tampa, FL 33618   Ability to commute/relocate: Tampa, FL 33618: Reliably commute or planning to relocate before starting work (Required)

Imagenet, LLC is seeking an experienced Quality Manager, Claims Processing to join our team. In this role, you will be responsible for overseeing the performance and quality of our claims processing department.   Responsibilities: Develop and implement quality assurance policies, procedures, and standards for claims processing. Monitor claims processing metrics such as productivity, accuracy, turnaround times, and customer satisfaction Identify areas for improvement in claims processing and develop solutions Conduct audits on a sample of processed claims to ensure adherence to regulations, guidelines, and quality standards Analyze performance data, identify trends and root causes of defects, and suggest process improvements Coach and mentor claims processing staff on performance, compliance, and career development Create and manage quality assurance training programs for claims staff Track quality standards and report on quality goals and progress to senior management Requirements: Previous claims processing quality management or related field preferred 5+ years of experience in claims processing, including 3+ years in a quality assurance role Expert knowledge of claims processing procedures, quality standards, and regulatory requirements Strong analytical and problem-solving skills Ability to interpret data and generate detailed reports (daily/weekly/monthly) in graphs & presentations Experience developing and conducting quality audits Leadership skills with the ability to influence outcomes and drive change Excellent communication and presentation abilities This is an opportunity to oversee quality for a growing claims processing provider . If you have the required claims processing and quality assurance experience, please apply with your resume.  

We are seeking a detail-oriented and experienced Medical Claims Auditor to join our team. As a Medical Claims Auditor, you will be responsible for reviewing and auditing medical claims to ensure accuracy, compliance with regulations, and adherence to company policies and procedures. You will work closely with the claims processing team to identify discrepancies, resolve issues, and improve overall claims accuracy. Key Responsibilities   Conduct audits of medical claims to verify accuracy, completeness, and compliance with regulatory requirements. Review claim documentation, including medical records and billing codes, to ensure proper coding and billing practices. Identify errors, discrepancies, and potential fraud or abuse in claims submissions. Investigate and resolve discrepancies through communication with internal departments, and clients. Collaborate with the claims processing team to implement process improvements and ensure consistent adherence to company policies and procedures. Prepare audit reports detailing findings, recommendations, and corrective actions taken. Stay current with industry regulations, coding guidelines, and best practices related to medical claims processing and auditing.   Qualifications   Bachelor's degree or equivalent experience in healthcare administration, business administration, or a related field. Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification preferred. Minimum of 5 years of experience in medical claims processing, billing, or auditing. Strong understanding of medical terminology, ICD-10, CPT, and HCPCS coding systems. Knowledge of healthcare regulations, including HIPAA, Medicare, and Medicaid guidelines. Excellent analytical and problem-solving skills with a keen attention to detail. Effective communication skills, both verbal and written, with the ability to communicate complex information clearly and concisely. Proficiency in Microsoft Office applications, especially Excel, and experience with claims processing software preferred.    

Imagenet LLC is a premier healthcare technology company that has taken medical claims processing and document management to new levels of service, security and efficiency. Our core business is helping our clients reduce costs and increase productivity by providing efficient document imaging, data validation, adjudication and on demand retrieval of documents and data. JOB OVERVIEW Ensure compliance will all corporate and departmental standards. Meet with employees on a regular basis to discuss performance and quality. Report on Key Performance Metrics (KPIs) to the Executive Director of Claims and the Director of Operations to ensure adequate resources and technology are in place. Develop and implement departmental standards and expectations. Analyze and process a variety of claim files to ensure the execution of standardized claim protocol and claim handling. RESPONSIBILITIES Oversee the claims adjudication process to assure that the examiners are following all CMS rules and regulations in conjunction with the insurance company guidelines Ensure that the department practices meet or exceed the client’s processing standards, procedures and service level agreements Responsible for new Claims Analyst training and auditing of trainee claim processing Review Medicare services for appropriateness of charges and will apply pre-existing guidelines during claims processing; Pend claims and order Medical records for review and investigation of possible gross misrepresentation Authorize claim payments within established limits; otherwise forward to Claims Analyst 2 Oversee and provide secondary review of pending cases and Medical Records ordered by Claims Analyst 1 for appropriate processing; Process refunds and letters of dual coverage (when applicable); Must be knowledgeable in CPT-4, ICD-9 and be familiar with medical terminology; Identify process improvement opportunities within the claim department and recommend system enhancements Handles any additional responsibility which may be assigned Technical Skills/Knowledge Health claims processing Basic to intermediate math Medical terminology; ICD-9 & ICD-10 MS Office Ability to work independently or within a team Time management Written and verbal communication Attention to detail Must be able to demonstrate sound decision-making Must be local to Tampa area and work out of the Tampa office Job Type: Full-time Experience: claims or claims processing, managing: 3 years (Required) Work authorization: United States (Required) Job Type: Full-time Pay: $60,000.00 - $80,000.00 per year Benefits: Disability insurance Schedule: 8 hour shift Day shift Monday to Friday Ability to commute/relocate: Tampa, FL 33618: Reliably commute or planning to relocate before starting work (Required) Experience: Medical billing: 5 years (Required) Management: 5 years (Required) Work Location: In person