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Medical Claims Follow- up Specialist

25DA6BBEFBAE0C1037116754243A913B · Paola Kansas - Paola, KS 66071; 100 Lakemary Drive, Paola, KS, 66071, USA · Active · $18–$21 / hour · Paycom ATS

Job facts

FieldValue
Company25DA6BBEFBAE0C1037116754243A913B
TitleMedical Claims Follow- up Specialist
Normalized title-
Department / teamAccounting
LocationPaola, KS, United States
Work model-
Employment typeFull Time
Salary$18–$21 / hour
Statusactive
ATS providerPaycom ATS
Posted / first seen2026-05-21 / 2026-05-31
Changed / last seen2026-05-31 / 2026-06-06

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Linked records

Company25DA6BBEFBAE0C1037116754243A913B
Source9d205830-b7ce-4fbb-85f7-a2c27a94813f
ATS providerPaycom ATS

Description

Description Medical Claims Follow- up Specialist Reports To:  Credentialing, Contracts & Medical Claims Manager Department:  Finance Pay Range: $18-$21 an hour Essential Duties & Responsibilities Claims Follow-Up & Resolution Perform active, high-volume follow-up on unpaid, delayed, and aging claims across all service lines and payers using payer portals, telephone, and written correspondence. Monitor claims aging reports to prioritize follow-up activity and prevent timely filing losses. Troubleshoot claim issues by researching payer responses, remittance advice, and system records to identify the root cause of non-payment or denial. Communicate with payers through appropriate channels to resolve outstanding balances and obtain payment status updates. Identify patterns in denials or payment delays and escalate trends to the Credentialing, Contracts & Medical Claims Manager. Support the appeals process with guidance from leadership; escalate complex or high-value appeals as needed. Maintain awareness of payer-specific follow-up requirements, timely filing windows, and claim dispute processes across multiple state Medicaid programs and managed care organizations. Payment Posting & Denial Management Post payments and denials into TherapyNotes and RevConnect accurately and within established turnaround standards. Reconcile posted payments against remittance advice and payer explanations of benefits (EOBs) to ensure accuracy. Identify underpayments, contractual adjustments, and erroneous denials and take appropriate action or escalate as needed. Ensure denial reason codes are accurately captured and documented to support reporting and root cause analysis. Claim Routing & Collaboration Route unpaid or denied claims requiring correction or resubmission to the Claims Specialist – Submission with clear, documented instructions regarding the required action. Collaborate with the Claims Specialist – Submission to ensure routed claims are resolved and resubmitted within payer timelines. Coordinate with the Credentialing, Contracts & Medical Claims Manager to resolve complex payer issues, authorization discrepancies, or contract-related denials. Communicate effectively with internal departments including admissions, clinical, and accounting to resolve documentation or eligibility issues contributing to non-payment. Documentation & Audit Support Log all follow-up activity, payment posting, and claim dispositions in TherapyNotes and RevConnect in a clear, complete, and audit-ready format. Maintain organized records of denial rationale, appeal submissions, and resolution outcomes. Support month-end close activities by ensuring outstanding claims and payment postings are current and accurately reflected in the claims system. Adhere to HIPAA requirements and internal policies governing the handling of confidential patient and financial information. Productivity & Continuous Improvement Meet or exceed weekly and monthly productivity, resolution, and posting turnaround standards established by leadership. Adapt to payer rule changes, new service line rollouts, and internal workflow improvements. Participate in cross-training and provide backup support to the Claims Specialist – Submission as directed. Contribute to process improvement efforts aimed at reducing denial rates, accelerating collections, and improving claims system accuracy. Qualifications High School Diploma or GED required. Minimum two years of medical claims follow-up, accounts receivable, or insurance billing experience required, with an emphasis in government payers. Experience in behavioral health billing and follow-up strongly preferred. Comfort with multi-state claims and payer guidelines preferred. Proficiency with Microsoft Office (Excel, Outlook, Teams) and EMR or claims management software required. Experience with TherapyNotes or RevConnect a plus. Knowledge, Skills, and Abilities Strong attention to detail and accuracy in payment posting and claim documentation. Persistence and sound judgment in navigating payer representatives, portals, and appeals processes. Ability to manage a high volume of outstanding claims simultaneously while maintaining accuracy and meeting deadlines. Working knowledge of Medicaid, managed care, and commercial payer billing requirements, denial codes, and remittance processes. Understanding of revenue cycle workflows, including the relationship between claims submission, follow-up, and payment posting. Excellent written and verbal communication skills, including comfort with payer-facing correspondence. High level of integrity and discretion when handling confidential patient and financial information. Team-oriented with a commitment to supporting organizational cash flow and billing compliance. Lakemary provides competitive compensation and benefit package including medical, dental, vision, and life insurance plans; paid time off; and a 401(k)-retirement plan Certifications: Lakemary provides training in program specific coursework. Special Considerations: Some environments/shifts require same sex staff due to regulatory requirements. All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. EEO Diversity, Equity, and Inclusion (DEI) Statement: For the last 50 years we have been working to create workplaces that reflect the communities we serve and a place where everyone feels empowered to bring their full, authentic selves to work. We embrace this from our mission.

Full job record

Job ID159b34ce6f3f8a046012b961b79e7b8888e7be66
Org ID5ec2f430-2c1d-424a-a736-9e7093a27209
Source ID9d205830-b7ce-4fbb-85f7-a2c27a94813f
Board ID9d205830-b7ce-4fbb-85f7-a2c27a94813f
Providerpaycom
Provider Job Key326859
TitleMedical Claims Follow- up Specialist
Normalized Title
Statusactive
Activeyes
Location TextPaola Kansas - Paola, KS 66071; 100 Lakemary Drive, Paola, KS, 66071, USA
DepartmentAccounting
Team
Employment Typefull_time
Workplace Type
Remote Policy
CountryUnited States
RegionKS
CityPaola
Salary RawDescription Medical Claims Follow- up Specialist Reports To:  Credentialing, Contracts & Medical Claims Manager Department:  Finance Pay Range: $18-$21 an hour Essential Duties & Responsibilities Claims Follow-Up & Resolution Perform active, high-volume follow-up on unpaid, delayed, and aging claims across all service lines and payers using payer portals, telephone, and written correspondence. Monitor claims aging reports to prioritize follow-up activity and prevent timely filing losses. Troubleshoot claim issues by researching payer responses, remittance advice, and system records to identify the root cause of non-payment or denial. Communicate with payers through appropriate channels to resolve outstanding balances and obtain payment status updates. Identify patterns in denials or payment delays and escalate trends to the Credentialing, Contracts & Medical Claims Manager. Support the appeals process with guidance from leadership; escalate complex or high-value appeals as needed. Maintain awareness of payer-specific follow-up requirements, timely filing windows, and claim dispute processes across multiple state Medicaid programs and managed care organizations. Payment Posting & Denial Management Post payments and denials into TherapyNotes and RevConnect accurately and within established turnaround standards. Reconcile posted payments against remittance advice and payer explanations of benefits (EOBs) to ensure accuracy. Identify underpayments, contractual adjustments, and erroneous denials and take appropriate action or escalate as needed. Ensure denial reason codes are accurately captured and documented to support reporting and root cause analysis. Claim Routing & Collaboration Route unpaid or denied claims requiring correction or resubmission to the Claims Specialist – Submission with clear, documented instructions regarding the required action. Collaborate with the Claims Specialist – Submission to ensure routed claims are resolved and resubmitted within payer timelines. Coordinate with the Credentialing, Contracts & Medical Claims Manager to resolve complex payer issues, authorization discrepancies, or contract-related denials. Communicate effectively with internal departments including admissions, clinical, and accounting to resolve documentation or eligibility issues contributing to non-payment. Documentation & Audit Support Log all follow-up activity, payment posting, and claim dispositions in TherapyNotes and RevConnect in a clear, complete, and audit-ready format. Maintain organized records of denial rationale, appeal submissions, and resolution outcomes. Support month-end close activities by ensuring outstanding claims and payment postings are current and accurately reflected in the claims system. Adhere to HIPAA requirements and internal policies governing the handling of confidential patient and financial information. Productivity & Continuous Improvement Meet or exceed weekly and monthly productivity, resolution, and posting turnaround standards established by leadership. Adapt to payer rule changes, new service line rollouts, and internal workflow improvements. Participate in cross-training and provide backup support to the Claims Specialist – Submission as directed. Contribute to process improvement efforts aimed at reducing denial rates, accelerating collections, and improving claims system accuracy. Qualifications High School Diploma or GED required. Minimum two years of medical claims follow-up, accounts receivable, or insurance billing experience required, with an emphasis in government payers. Experience in behavioral health billing and follow-up strongly preferred. Comfort with multi-state claims and payer guidelines preferred. Proficiency with Microsoft Office (Excel, Outlook, Teams) and EMR or claims management software required. Experience with TherapyNotes or RevConnect a plus. Knowledge, Skills, and Abilities Strong attention to detail and accuracy in payment posting and claim documentation. Persistence and sound judgment in navigating payer representatives, portals, and appeals processes. Ability to manage a high volume of outstanding claims simultaneously while maintaining accuracy and meeting deadlines. Working knowledge of Medicaid, managed care, and commercial payer billing requirements, denial codes, and remittance processes. Understanding of revenue cycle workflows, including the relationship between claims submission, follow-up, and payment posting. Excellent written and verbal communication skills, including comfort with payer-facing correspondence. High level of integrity and discretion when handling confidential patient and financial information. Team-oriented with a commitment to supporting organizational cash flow and billing compliance. Lakemary provides competitive compensation and benefit package including medical, dental, vision, and life insurance plans; paid time off; and a 401(k)-retirement plan Certifications: Lakemary provides training in program specific coursework. Special Considerations: Some environments/shifts require same sex staff due to regulatory requirements. All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. EEO Diversity, Equity, and Inclusion (DEI) Statement: For the last 50 years we have been working to create workplaces that reflect the communities we serve and a place where everyone feels empowered to bring their full, authentic selves to work. We embrace this from our mission.
Salary Min18
Salary Max21
Salary CurrencyUSD
Salary Periodhour
Source URLhttps://www.paycomonline.net/v4/ats/web.php/jobs/ViewJobDetails?job=326859&clientkey=25DA6BBEFBAE0C1037116754243A913B
Apply URLhttps://www.paycomonline.net/v4/ats/web.php/jobs/ViewJobDetails?job=326859&clientkey=25DA6BBEFBAE0C1037116754243A913B
First Seen At2026-05-31 19:06:57Z
Last Seen At2026-06-06 09:53:36Z
Last Checked At2026-06-06 09:53:36Z
Last Changed At2026-05-31 19:06:57Z
Inactive At
Source Posted At2026-05-21 00:00:00Z
Source Updated At
Raw Payload Uris3://job-postings-prod-raw-590183727216/raw/provider=paycom/board=25DA6BBEFBAE0C1037116754243A913B/date=2026-06-06/2026-06-06T09-53-35-399Z-f575bb5496fa3a80035b491a943d76064eee919f10a8ae03ece37ddb5a9c0b47.json
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    "description": "<p style=\"margin-bottom:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\"><b><span style=\"font-size:16pt;\"><span style=\"font-family:Arial, sans-serif;\">Medical Claims Follow- up Specialist</span></span></b></span></span></span></p>\n\n<div style=\"border-bottom:solid #aaaaaa 1pt;padding:0in 0in 1pt 0in;\">\n<p style=\"border:none;margin-top:8px;margin-bottom:8px;padding:0in;\"> </p>\n</div>\n\n<p style=\"margin-top:4px;margin-bottom:4px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\"><b><span style=\"font-family:Arial, sans-serif;\">Reports To: </span></b><span style=\"font-family:Arial, sans-serif;\">Credentialing, Contracts &amp; Medical Claims Manager</span></span></span></span></p>\n\n<p style=\"margin-top:4px;margin-bottom:4px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\"><b><span style=\"font-family:Arial, sans-serif;\">Department: </span></b><span style=\"font-family:Arial, sans-serif;\">Finance</span></span></span></span></p>\n\n<p style=\"margin-top:4px;margin-bottom:4px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\"><b><span style=\"font-family:Arial, sans-serif;\">Pay Range:</span></b><span style=\"font-family:Arial, sans-serif;\"> $18-$21 an hour</span></span></span></span></p>\n\n<h1 style=\"margin-top:32px;\"><strong><span style=\"font-size:14pt;\"><span style=\"line-height:115%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"color:#365f91;\">Essential Duties &amp; Responsibilities</span></span></span></span></strong></h1>\n\n<p style=\"margin-top:13px;margin-bottom:5px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:115%;\"><span style=\"font-family:Cambria, serif;\"><b>Claims Follow-Up &amp; Resolution</b></span></span></span></p>\n\n<ul style=\"margin-top:3px;margin-bottom:3px;\">\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Perform active, high-volume follow-up on unpaid, delayed, and aging claims across all service lines and payers using payer portals, telephone, and written correspondence.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Monitor claims aging reports to prioritize follow-up activity and prevent timely filing losses.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Troubleshoot claim issues by researching payer responses, remittance advice, and system records to identify the root cause of non-payment or denial.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Communicate with payers through appropriate channels to resolve outstanding balances and obtain payment status updates.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Identify patterns in denials or payment delays and escalate trends to the Credentialing, Contracts &amp; Medical Claims Manager.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Support the appeals process with guidance from leadership; escalate complex or high-value appeals as needed.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Maintain awareness of payer-specific follow-up requirements, timely filing windows, and claim dispute processes across multiple state Medicaid programs and managed care organizations.</span></span></span></li>\n</ul>\n\n<p style=\"margin-top:4px;margin-bottom:4px;\"> </p>\n\n<p style=\"margin-top:13px;margin-bottom:5px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:115%;\"><span style=\"font-family:Cambria, serif;\"><b>Payment Posting &amp; Denial Management</b></span></span></span></p>\n\n<ul style=\"margin-top:3px;margin-bottom:3px;\">\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Post payments and denials into TherapyNotes and RevConnect accurately and within established turnaround standards.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Reconcile posted payments against remittance advice and payer explanations of benefits (EOBs) to ensure accuracy.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Identify underpayments, contractual adjustments, and erroneous denials and take appropriate action or escalate as needed.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Ensure denial reason codes are accurately captured and documented to support reporting and root cause analysis.</span></span></span></li>\n</ul>\n\n<p style=\"margin-top:4px;margin-bottom:4px;\"> </p>\n\n<p style=\"margin-top:13px;margin-bottom:5px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:115%;\"><span style=\"font-family:Cambria, serif;\"><b>Claim Routing &amp; Collaboration</b></span></span></span></p>\n\n<ul style=\"margin-top:3px;margin-bottom:3px;\">\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Route unpaid or denied claims requiring correction or resubmission to the Claims Specialist – Submission with clear, documented instructions regarding the required action.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Collaborate with the Claims Specialist – Submission to ensure routed claims are resolved and resubmitted within payer timelines.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Coordinate with the Credentialing, Contracts &amp; Medical Claims Manager to resolve complex payer issues, authorization discrepancies, or contract-related denials.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Communicate effectively with internal departments including admissions, clinical, and accounting to resolve documentation or eligibility issues contributing to non-payment.</span></span></span></li>\n</ul>\n\n<p style=\"margin-top:4px;margin-bottom:4px;\"> </p>\n\n<p style=\"margin-top:13px;margin-bottom:5px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:115%;\"><span style=\"font-family:Cambria, serif;\"><b>Documentation &amp; Audit Support</b></span></span></span></p>\n\n<ul style=\"margin-top:3px;margin-bottom:3px;\">\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Log all follow-up activity, payment posting, and claim dispositions in TherapyNotes and RevConnect in a clear, complete, and audit-ready format.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Maintain organized records of denial rationale, appeal submissions, and resolution outcomes.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Support month-end close activities by ensuring outstanding claims and payment postings are current and accurately reflected in the claims system.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Adhere to HIPAA requirements and internal policies governing the handling of confidential patient and financial information.</span></span></span></li>\n</ul>\n\n<p style=\"margin-top:4px;margin-bottom:4px;\"> </p>\n\n<p style=\"margin-top:13px;margin-bottom:5px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:115%;\"><span style=\"font-family:Cambria, serif;\"><b>Productivity &amp; Continuous Improvement</b></span></span></span></p>\n\n<ul style=\"margin-top:3px;margin-bottom:3px;\">\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Meet or exceed weekly and monthly productivity, resolution, and posting turnaround standards established by leadership.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Adapt to payer rule changes, new service line rollouts, and internal workflow improvements.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Participate in cross-training and provide backup support to the Claims Specialist – Submission as directed.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Contribute to process improvement efforts aimed at reducing denial rates, accelerating collections, and improving claims system accuracy.</span></span></span></li>\n</ul>\n\n<p style=\"margin-top:4px;margin-bottom:4px;\"> </p>\n\n<div style=\"border-bottom:solid #aaaaaa 1pt;padding:0in 0in 1pt 0in;\">\n<p style=\"border:none;margin-top:8px;margin-bottom:8px;padding:0in;\"> </p>\n</div>\n\n<h1 style=\"margin-top:32px;\"><strong><span style=\"font-size:14pt;\"><span style=\"line-height:115%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"color:#365f91;\">Qualifications</span></span></span></span></strong></h1>\n\n<ul style=\"margin-top:3px;margin-bottom:3px;\">\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">High School Diploma or GED required.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Minimum two years of medical claims follow-up, accounts receivable, or insurance billing experience required, with an emphasis in government payers.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Experience in behavioral health billing and follow-up strongly preferred.</span></span></span></li>\n\t<li style=\"margin-top:3px;margin-bottom:3px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:normal;\"><span style=\"font-family:Cambria, serif;\">Comfort with multi-state claims and payer guidelines 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