Land your dream remote job

Outpatient Coder

locations

Remote – Nationwide

time type

Full time

job requisition id

R018134

Thank you for considering a career at Ensemble Health Partners!

Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference

The Opportunity:

Advanced outpatient coding position that reviews medical record documentation and accurately assign ICD-10-CM, ICD-10-PCS, as well as CPT IV codes based on the specific record type and abstract specific data elements for each case in compliance with federal regulations. This position codes all types of outpatient visits to include ancillary, urgent care, emergency department, observation, same day surgery, and interventional procedures. Follows the Official Guidelines for Coding and Reporting, the American Health Information Management Association, (AHIMA,) Coding Ethics, as well as the American Hospital Association, (AHA) Coding Clinics, CMS directives and Bulletins, Fiscal Intermediary communications. Utilizing Coding Applications in accordance with established workflow. Follows Policies and Procedures and maintains required quality and productivity standards.

Job Responsibilities:

• Reviews medical record documentation and accurately assigns appropriate ICD-9-CM, ICD-10, CPT IV, and HCPCS codes utilizing the 3M software tools for all OP Work Types (Ancillary, ED Charge/Code, Same Day Surgery, and Observation. The assigned codes must support the reason for the visit and the medical necessity that is documented by the provider to support the care provided. When applicable, apply the appropriate charges such as the Evaluation & Management, (E&M) level and injections and infusions, and/or other necessary requirements for Observation cases, using a third party software systems such as LYNX.
• Correctly abstract required data per facility specifications.

• Perform “medical necessity checks” for Medicare and other payers as required per payment guidelines.

• Responsible for monitoring and working of accounts that are Discharged Not Final Billed, failed claims, stop bills, and epremis as a team, ensure timely, compliant processing of outpatient claims in the billing system.

• Responsible for maintaining established productivity requirements, key performance indicators established for 3M 360 CAC for CRS & Direct Code as well as ensure accuracy to maintain established quality standards.

• Remain abreast of current requirements of the Centers for Medicare & Medicaid Services, (CMS,) to include National Coverage Determinations, (NCD) and Local Coverage Determinations, (LCD) guidelines, related to the assignment of modifiers, to ensure the submission of a clean claim the first time through.

• Maintains competency and accuracy while utilizing tools of the trade, such as the 3M encoder, Computerized Assisted Coding, (CAC,) Medical Necessity software, abstracting system, code books, and all reference materials. Reports inaccuracies found in Coding Software to HIM Management/Supervisor, reports any potential unethical and/or fraudulent activity per compliance policy.

Experience We Love:

• Previous outpatient coding experience

Certifications:

• RHIA, RHIT or CCA Certification Required

CRCR Required within 6 months of hire

Join an award-winning company

Three-time winner of “Best in KLAS” 2020-2022

2022 Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

• Innovation
• Work-Life Flexibility
• Leadership
• Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:

• Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
• Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble Health Partners provides reasonable accommodations to qualified iniduals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact [email protected].

Title: Assistant Nurse Manager (Remote)

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a specialized medical group focused on people with long-term home care needs. We help these iniduals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center.

Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others’ needs ahead of her own, keeping the hearth warm so the home and family can function.

We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. It’s an insurance covered benefit, so it’s available to most adults with Caregivers free of charge to them.

We seek team members who are passionate about making home the best place it can be for people with home care needs and see the important role Caregivers play. Our team members are collaborative data-driven optimists who always focus on doing what’s best for patients and their caregivers. We see ourselves as being here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids).

The ideal teammate would be

A nursing leader who is passionate about caring for our members, teammates, and clients and can leverage technology to create new programs, systems, and processes to drive exceptional clinical team performance. Someone who has a proven track record of using data to drive high quality and efficient clinical outcomes. Someone who ideally has experience in chronic care management, remote patient monitoring, and valuable based care of vulnerable populations. Love learning and helping others learn: you’re excited to bring your wisdom and coach others, and you’re equally energized to learn from other’s experience (such as product managers, software engineers, and data scientists), and then continue improving how Vesta does care management as we learn more together. They are comfortable working in an ambiguous environment within an organization that is growing and changing quickly. Curious about changing regulations within the space and how they can be leveraged to create additional revenue streams

The ideal teammate would be able to:

• Provide leadership, coaching, and development to a team of nurses and other multidisciplinary iniduals performing care management
• Identify inefficiencies and opportunities for quality improvement. Create process improvement to achieve member and clinician satisfaction
• Partner with Vesta’s data analytics team and clinical leadership to develop ongoing reporting and analysis to drive the efficiency, quality, and effectiveness of the clinical team and outcomes
• Serve as a subject matter expert for chronic care management (CCM), Transitions of Care (TOC) and remote patient monitoring (RPM)
• Continue to push the boundaries of what technology can do to empower our caregivers and clinicians to improve health outcomesfor our patients
• Support the development of strategies to help scale the program. Assist in evaluating capacity planning, hiring, training, and measuring and managing productivity including creating operational metrics and benchmarks
• Collaborate with cross departmental leads in analytics, product/engineering and business operations to drive efficiencies and quality improvement
• Assist manager with making sure team is appropriately staffed and find coverage when needed
• Assist in implementing new clinical programming across our clinical pods
• Support team to address escalated member challenges

Would you describe yourself as someone who has:

• Registered Nurse with unrestricted license within the United States (required)
• 4+ years of nursing experience within acute care, care management, and/or homecare (required)
• 2-3 years of experience leading/managing a clinical team of at least 15+ reports overseeing several complex projects simultaneously (required)
• Experience managing a remote team (preferred)
• Passionate about our mission to improve people’s lives
• An ability and humility to roll up your sleeves
• Detail- and process-oriented, ability to context- and mode-switch easily, fast learner
• Excellent communication skills, combined with the ability to collaborate across functions and use available tools
• Self-driven, self-starter and excited to support new technology

If yes, then we look forward to speaking to you!

Pay range is $100K-$110K based on experience. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

Vesta Healthcare is committed to leveraging the talent of a erse workforce to create great opportunities for our business and our people. Vesta Healthcare is an Equal Opportunity/Affirmative Action Employer. Candidates are selected without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.

Coder 1 (Risk Adjustment)

Job Locations: US-Remote

ID2023-11222

Category

Coding

Position Type

Full-Time

Overview

Cotiviti drives better healthcare outcomes through data analytics. Our payment accuracy, revenue integrity, risk assessment and stratification, and quality improvement solutions help organizations utilize their data so they can efficiently and cost-effectively succeed in the new era of healthcare.

We are currently looking for multiple Remote Risk Adjustment / HCC Coders (Coder 1) for full-time permanent positions.

See what it’s like to work as a Coder at Cotiviti:

Responsibilities

• Ability to review medical records for accurate, compliant, and complete diagnosis code abstraction for Medicare, Commercial and Medicaid risk adjustment from various chart types (physician, facility, and non-facility).
• May have special projects that will entail a full coding review.
• Ability to code following the ICD-10-CM Official Guidelines for Coding and Reporting, AHA’s Coding Clinic and well as Cotiviti and client specific coding guidelines.
• Intermediate skills and knowledge of computers with the ability to use the designated coding platform for coding processes with focus on both production and accuracyAbility to regularly and consistently achieve over 95% quality accuracy.
• Appropriately communicate with management regarding workload, production expectations and deliverables.
• Utilizes the Dispute Resolution’ process when disagreement occurs related to a coding determination.
• Stays current on coding guidelines necessary for the position by attending all Cotiviti required trainings, workshops, and personal research as appropriate.
• Professionally communicates finds, errors, and suggestions to Team Lead to facilitate on-going communications and efficient department operations as part of a continuous improvement process.
• Quick learner with positive attitude.
• Complete all responsibilities as outlined on annual Performance Plan.
• Complete all special projects and other duties as assigned.

Qualifications

Education: Minimum High School Diploma.

Certifications: Nationally certified coder in good standing through AAPC or AHIMA (CRC, CPC, CCS, etc.).

Experience:

• Coder 1: 1-2 years’ experience in medical risk adjustment / HCC coding.
• Experience in HCC record abstraction and coding requirements.

Knowledge, Skills & Abilities:

• Demonstrated high level of quality accuracy and productivity in clinical coding work.
• Adherence to official coding guidelines (including coding clinics, CMS, client specific guidelines and other regulatory compliance guidelines and mandates).
• Excellent written and verbal communication skills with the ability to understand and explain complex information.
• Strong knowledge of medical terminology and anatomy and physiology.
• Skills in organization and time management.
• Comfortable with computers and technology.
• Must be able to work in a fast-paced environment.
• Ability to manage and meet deadlines, adapt to changing priorities, flexible and open to new ideas.
• Must be able to perform duties with or without reasonable accommodation.
• Must participate in all required training.
• Must abide by all HIPAA and associated patient confidentiality requirements.
• This is a home-based position and requires iniduals to work within the continental US, have a place to work that is free from distractions and have a high-speed internet connection.
• This role is aligned to certain productivity and quality requirements.
• Required hours for training: Monday-Friday 8 AM 5 PM ET
• Required working hours: 40 hours per week, Monday-Friday 8-hour days; daytime schedule based on your time zone. This role is not intended to work nights, weekends or part-time.

Base compensation ranges from $20.00 Hr. to $26.00 Hr. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(K) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our careers page.

#LI-SL1

#junior

#LI-Remote

Cotiviti is an equal employment opportunity employer. Cotiviti recruits, hires and promotes iniduals based on their qualifications for a specific job. Cotiviti values its erse workforce and its selection of employees is made without regard to race, color, creed, sex, age, religion, pregnancy, childbirth or pregnancy-related conditions, national origin, sexual orientation, marital status, genetic carrier status, military service, veteran status, disability, or any other category of class protected by federal, state or local laws. All employment decisions and personnel actions, such as hiring, promotion, compensation, benefits, and termination, are and will continue to be administered in accordance with, and to further the principle of, equal employment opportunity.

Certified Coder

Remote

Molina Healthcare United States Job ID 2022215

Job Summary

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

Knowledge/Skills/Abilities

• Performs on-going chart reviews and abstracts diagnosis codes
• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly
• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff
• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment
• Builds positive relationships between providers and Molina by providing coding assistance when necessary
• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education
• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies
• Contributes to team effort by accomplishing related results as needed
• Other duties as assigned
• 2 years previous coding experience
• Proficient in Microsoft Office Suite
• Ability to effectively interface with staff, clinicians, and management
• Excellent verbal and written communication skills
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers
• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

Job Qualifications

Required Education

• Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)
• Certified Coding Specialist (CCS)

Preferred Education

• Bachelor’s Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model
• Background in supporting risk adjustment management activities and clinical informatics
• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder – (CRC)
• Certified Professional Payer – Payer (CPC-P)
• Certified Coding Specialist – Physician based (CCS-P)

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $41,264 – $80,465 a year*

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time

Nurse Practitioner Telemedicine

Job Status: Full Time

Job Reference #: 705721

Job Description

Nurse Practitioner – Via Telemedicine

Medical Director Services PC is looking to hire an experienced Nurse Practitioner to provide care via Telemedicine for nursing homes throughout multiple states. The ideal candidate will have previous skilled nursing experience.

Must have previous SNF experience

Mus be license in NY and GA. License in TX is a plus.

Work in the comfort of your home and service nursing homes throughout the U.S.

DUTIES:

• Assuring delivery of quality care services to all patients in a respectful and professional manner.
• Contributes to physician’s effectiveness by identifying short-term and long-range patient care issues that must be addressed; providing information and commentary pertinent to deliberations; recommending options and courses of action; implementing physician directives.
• Assesses patient health by interviewing patients; performing physical examinations; obtaining, updating, and studying medical histories.
• Documents patient care services by charting in patient and department records.
• Performs therapeutic procedures by providing treatments and prescribing medicine
• Instructs and counsels patients by describing therapeutic regimens; giving normal growth and development information; providing counseling on emotional problems of daily living; promoting wellness and health maintenance.
• Provides continuity of care by developing and implementing patient management plans.
• Maintains safe and clean working environment by complying with procedures, rules, and regulations.
• Protects patients and employees by adhering to infection-control policies and protocols.
• Complies with federal, state, and local legal and professional requirements by studying existing and new legislation; anticipating future legislation; enforcing adherence to requirements; advising management on needed actions.
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
• Develops health care team staff by providing information, educational opportunities, and experiential growth opportunities.
• Contributes to team effort by accomplishing related results as needed.
• Health Promotion and Maintenance, Thoroughness, Clinical Skills, Informing Others, Medical Teamwork, Bedside Manner, Infection Control, Administering Medication, Pain Management, Self-Development

REQUIREMENTS:

• Must have Skilled Nursing experience as an NP
• 12 Hour Shifts- AM or PM

LOCATION: Remote

ABOUT US:

Medical Director Services PC was founded in 2016 when SNF’s were shifting a focus on value at the same time treating residents with higher level of acuity. MDS PC puts an emphasis on quality and customer service first. Another crucial focus is treating in place when possible and reducing unnecessary hospitalizations.

Pathology Coder – Remote

• Rochester, MN
• Full Time
• Finance

Why Mayo Clinic

Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic. You’ll thrive in an environment that supports innovation, is committed to ending racism and supporting ersity, equity and inclusion, and provides the resources you need to succeed.

Responsibilities

Demonstrates expert job knowledge and applies current billing and coding regulations, policies, and procedures along with effective decision-making and problem-solving skills in the Anatomical Pathology physician coding process.

Knowledge of surgical pathology, special stains, consultations, immunohistochemistry, immunofluorescence CPT coding.

*This position is 100% remote work. Inidual may live anywhere in the US.

**This vacancy is not eligible for sponsorship / we will not sponsor or transfer visas for this position.

During the selection process, you may participate in an OnDemand (pre-recorded) interview that you can complete at your convenience. During the OnDemand interview, a question will appear on your screen, and you will have time to consider each question before responding. You will have the opportunity to re-record your answer to each question – Mayo Clinic will only see the final recording. The complete interview will be reviewed by a Mayo Clinic staff member and you will be notified of next steps.

Qualifications

High School diploma and 4 years pathology coding experience (non-Mayo) or 4 years non-pathology Mayo Clinic coding experience OR Associate’s Degree and 2 years pathology coding experience (non-Mayo) or 2 years non-surgical Mayo Clinic coding experience required; Bachelor’s Degree preferred.

Additional Qualifications:

1. Knowledge of professional/physician coding rules for anatomical pathology. Experience with National Correct Coding Initiative edits (NCCI), National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Outpatient coding guidelines for official coding and reporting.

2. In-depth knowledge of lab medicine, medical terminology, disease processes, patient health record content and the medical record coding process. 3. Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections. 4. Knowledge of coding and billing requirements for services furnished in a teaching settings. 5. Knowledge of coding and billing requirements for provider based billing facilities. 6. Ability to work independently in a teleworking environment, to organize/prioritize work, exercise excellent communication skills, is attentive to detail, demonstrate follow through skills and maintain a positive attitude.

Licensure or Certification:

Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist Physician (CCS-P) or a coding credential of a Certified Professional Coder (CPC) required.

Exemption Status

Nonexempt

Compensation Detail

$22.55 – $31.98 / hour. Education, experience and tenure may be considered along with internal equity when job offers are extended.

Benefits Eligible

Yes

Schedule

Full Time

Hours/Pay Period

80

Schedule Details

Monday Friday, business hours of 8:00 am 5:00 pm

Weekend Schedule

N/A

International Assignment

No

Site Description

Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives. Learn more about what each unique Mayo Clinic campus has to offer, and where your best fit is.

Affirmative Action and Equal Opportunity Employer

As an Affirmative Action and Equal Opportunity Employer Mayo Clinic is committed to creating an inclusive environment that values the ersity of its employees and does not discriminate against any employee or candidate. Women, minorities, veterans, people from the LGBTQ communities and people with disabilities are strongly encouraged to apply to join our teams. Reasonable accommodations to access job openings or to apply for a job are available.

Title: Coding Administrative Assistant

Location: US National

Function

Revenue Cycle Management

Location

US-Remote

Employment Status

Full Time

Overview

Medical Coders are responsible for properly coding provider encounters. The coding specialist, level I is an entry level coder certified by a recognized professional organization, or a coder with appropriate experience who is working toward gaining a recognized certification. The coder performs all coding functions assigned to an entry level coder based on their knowledge.

Job Highlights

Essential Duties and Responsibilities:

• Accurately code from available documents using current CPT, ICD-10, ASA and HCPCS codes as appropriate
  • Capture all billable charges
• Review billing records for supporting documentation as needed for accurate coding and to maximize revenue
  • Identify and split bill cosmetic or case rate cases as needed
• Review or facilitate review of facility medical records for supporting documentation as needed and as available for accurate coding and to maximize revenue.
• Understand the importance and the process of holding a claim as needed until sufficient information can be obtained for proper billing and to maximize reimbursement.
• Review charges that are sent back from the billing department for additional information and make necessary corrections.
• Maintain certification CEU requirements.

• Maintains strictest confidentiality.
• Adhere to all company policies and procedures.

Qualifications

The requirements listed below are representative of the knowledge, skill, and ability required.

Qualifications include:

• 0 2 years coding experience.
• High School graduate or equivalent.
• Associate degree preferred.
• Current CPC or CCS-P required or working toward certification as a condition of employment.
• Knowledge of CPT, ICD-10, ASA and HCPCS coding.
• Knowledge of all payer rules and regulations.
• Knowledge of medical terminology and anatomy.
• Ability to multi-task and prioritize needs in order to meet timelines.
• Knowledge of organization policies, procedures and systems.
• Skill in computer applications including MS Word, MS Excel.
• Skill in verbal and written communication.
• Skill in gathering and reporting information.
• Ability to work effectively with staff, physicians and external customers.
• Must have a pleasant disposition and be a team player.
• Ability to work independently with limited supervision.
• Must report to work consistently, on time, and for expected duration.
• Ability to read, write, and speak English.

Working conditions and physical requirements

The physical demands described here are representative of those that must be met by an employee to successfully preform the essential functions of this job. Reasonable accommodations may be made to enable iniduals with disabilities to perform the essential functions.

• Requires prolonged sitting, some bending, stooping and stretching.
• Must possess sufficient eye-hand coordination/manual dexterity to operate a keyboard, photocopier, telephone, calculator and other office equipment.
• Required normal range of hearing and eyesight to record, prepare, and communicate appropriate reports and evaluations.
• Requires lifting papers and boxes weighing up to 35 pounds occasionally.
• Requires dexterity to type at least 35 wpm.
• Work performed in office environment.
• Involves frequent contact with professional staff and managed care organizations.
• Work may be stressful at times.
• Interaction with others is frequent and often disruptive.

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Title: Nurse Practitioner

Location: Remote US

LetsGetChecked is a leading at-home health testing company, with a platform that allows consumers to discover and access personalized health information conveniently, confidentially and accurately. We empower people to take an active role in their health to live longer, happier lives. LetsGetChecked was founded in 2015 and has corporate offices located in New York City and Dublin.

Nurse Practitioner

Due to continued success and growth, we have the need to expand our team of clinicians. You will be joining Mammoth Health, LetsGetChecked’s exclusive partner in providing first class clinical care to our patients in the US.

You will be acting as a Nurse Practitioner interacting directly with patients and helping construct and drive evolving clinical care initiatives and pathways. MD supervision will be provided by Mammoth Health’s lead physician.

Responsibilities

• The role’s primary responsibility is to daily conduct virtual/remote visits with patients through telemedicine modalities to include asynchronous chat and video technologies
• Ask intuitive questions to patient’s to discover the root cause of illness
• Reach an informed diagnosis based on scientific knowledge and the patient’s medical history
• When appropriate, E-prescribe medications and provide comprehensive insight into medication
• management
• Maintain a comprehensive medical record of the patient’s complete health history using
• LetsGetChecked’s proprietary HALO electronic medical record platform.
• Cultivate an environment of trust and compassion between patients and clinician
• Contribute clinical content that will support business initiatives (website, ePrescriptions, client
• communications, care pathways)
• Ensure patient and nursing content is medically accurate, safe and accessible to the audience
• and will improve the overall quality and value of patient interactions.
• Protocol Development-Develop and maintain protocols and standard operating procedures for
• all new tests and programs offered by LGC.
• Improve the Quality and Value of Patient Interactions
• Be a Clinical resource and provide insight and support for other LetsGetChecked teams including
• but not limited to Nursing/Customer Support/Legal/ Compliance/Quality
• Liaise with Quality and Compliance to ensure issues are appropriately addressed and resolved
• and create policies with the view of mitigating against future errors. Work with Product to
• reduce technical related risk of error which impacts upon the patient experience and safety.

What we are looking for ..

• A Board Certified Nurse Practitioner, licensed in 50 states
• Minimum of 2 years of primary care experience
• Telehealth experience strongly preferred
• Bilingual (Spanish/English language) a plus
• Strong understanding of examination methodologies and diagnostics
• Proficiency in common medication indications, side effects, and contraindications
• A caring, compassionate inidual who enjoys helping others and providing a positive care experience in a telemedicine platform
• Care providers who are flexible and interested in working in a telemedicine environment with frequent change / product improvements, and who are extremely comfortable using new technology and software
• Advanced computer skills including typing speed, email, internet research, downloading and uploading files, and working in multiple browser windows
• Excellent oral and written communication skills
• Respect for patient confidentiality
• Compassionate and approachable
• Responsible and trustworthy
• Willingness to be flexible about working hours and days as there may sometimes be a need to
• help out the clinical team on off hours and/or weekends.

Benefits:

Alongside base salary of $110,000-$130,000 per year, we offer a range of benefits including:

• Health, dental & vision insurance
• 401k Matching contribution
• Employee Assistance Programme
• Annual Compensation Reviews
• 15 days paid time off and 3 paid volunteer days per year
• Free monthly LetsGetChecked tests as we are not only focused on the well being of our patients but also the well being of our teams
• A referral bonus programme to reward you for helping us hire the best talent
• Internal Opportunities and Careers Clinics to help you progress your career
• Maternity, Paternity, Parental and Wedding leave

Why LetsGetChecked?

Together we have a common goal to help people live longer, happier lives.

We want our employees to be healthy, travel often, and have the financial resources and support they need to live a fulfilling life, both inside and outside of work. We encourage our employees to build their careers at LetsGetChecked. We run regular career training clinics, interview assistance, and encourage employees to apply for internal opportunities. We support Learning & Development through our partner Udemy.

Diversity, Equity & Inclusion:

As we continue to grow, LetsGetChecked is fully committed to creating an inclusive environment where erse backgrounds, perspectives and experiences are valued, where each and every one of our people feels that they belong and are empowered to do the best work of their career.

To learn more about LetsGetChecked and our mission to help people live longer, healthier lives please visit https://www.letsgetchecked.com/careers/

Triage Registered Nurse (Part-Time Nights)

REMOTE

CLINICAL STRATEGY AND SERVICES – CLINICAL TEAM

PART-TIME

The Remote Triage Registered Nurse / RN supports patients and their families by providing clear, safe and effective telephone triage using evidence-based processes and tools. The Registered Nurse on this team will blend critical thinking skills with a decision support tool enabling safe, standardized care to our patient population.

Two (2) Part-Time Night / Evening positions available!

Shift/Schedule:

PTE 1:

Week 1: Mon 7p-4a (8h), Thurs 7p-11p (4h), Fri 7p-4a (8h) PST

Week 2: Mon 7p-11p (4h), Sat and Sun 7p-4a PST

PTE 2:

Week 1: Mon 7p-11p (4h), Sat and Sun 7p-4a PST

Week 2: Mon 7p-4a (8h), Thurs 7p-11p (4h), Fri 7p-4a (8h) PST

Essential Job Duties:

• • Respond promptly to each incoming call and assist patients by providing standardized care and benefits navigation, while quickly developing a friendly, yet professional rapport over the phone
  • Conduct a thorough clinical assessment of symptoms and confidently determine the appropriate level of care required to safely meet the patient’s medical need, and refer them using established guidelines
  • Follow standard procedures and protocols related to the triage service
  • Educate and communicate recommendations to patients thoroughly in patient-friendly language
  • Successfully route members to additional internal/external benefits and community resources, when needed
  • Provides care based upon the Included Health Core Values
  • Provides triage and support for urgent member prescription needs
  • Serves as a central point of contact for all Included Health member emergency escalations
  • Participate in team meetings and continuous quality improvement

Requirements:

• • Bachelor of Science in Nursing required
  • Registered Nurse, currently residing and licensed in a compact state with eligibility to obtain RN licensure in all 50 states
  • 2+ years experience in a triage setting, preferably some of that experience being focused on phone triage, or 2+ years experience in an emergency room, or 4+ years experience in an ambulatory primary care role that included triage
  • Ability to work in PST Timezone
  • Rotating holiday and weekend rotation (every 3rd weekend for Full Time and every other weekend for Part Time)
  • Expertise in advanced clinical decision making
  • Comfortable working with a wide variety of medical conditions for both pediatric and adult populations
  • Experience in engagement in complex decision making, including situations of uncertainty
  • Excellent written and verbal communication skills. The ability to gather a clinical history, answer questions at a patient level, and succinctly summarize findings is critical.
  • Strong competence and ability to use multiple computer/medical record systems, as well as Google suite
  • Must be able to work efficiently. We are a fast growing company and we are busy. Our team is expected to meet role specific metrics without sacrificing quality. Good judgment for balancing priorities is a must.
  • Maintain current nursing licensure by completing applications for renewal in a timely manner and by complying with all requirements for continuing education.

Other Skills/Abilities:

• • Self-disciplined, energetic, passionate, innovative and flexible
  • Must be able to work independently remotely and work well under stress
  • A team player that can follow a system and protocol to achieve a common goal
  • Demonstrates sound judgment, independent decision-making and problem-solving skills
  • Maintain current nursing licensure by completing applications for renewal in a timely manner and by complying with all requirements for continuing education.
  • Maintains professional demeanor and service-oriented patient focus to prioritize the patient experience
  • Possess the ability to multitask, and using best judgement when to seek additional input from leadership

#LI-Remote

About Included Health

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.

Registered Dietician Part Time

REMOTE 

MEMBER EXPERIENCE – MEMBER SUPPORT

PART TIME

REMOTE

Sword Health is on a mission to free two billion people from pain as the world’s first and only endtoend platform to predict, prevent and treat pain.

Delivering a 62% reduction in pain and a 60% reduction in surgery intent, at Sword, we are using technology to save millions for our 2,500+ enterprise clients across three continents. Today, we hold the majority of industry patents, win 70% of competitive evaluations, and have raised more than $300 million from top venture firms like Founders Fund, General Catalyst, and Khosla Ventures.

Recognized as a Forbes Best Startup Employer in 2023, this award highlights our focus on being a destination for the best and brightest talent. Not only have we experienced unprecedented growth since our market debut in 2020, but we’ve also created a remarkable mission and valuedriven environment that is loved by our growing team. With a recent valuation of $2 billion, we are in a phase of hyper growth and expansion, and we’re looking for iniduals with passion, commitment, and energy to help us scale our impact.

Joining Sword Health means committing to a set of core values, chief amongst them to “do it for the patients” every day, and to always “deliver more than expected” on behalf of our members and clients.

This is an opportunity for you to make a significant difference on a massive scale as you work alongside 800+ (and growing!) talented colleagues, spanning two continents. Your charge? To help us build a painfree world, powered by technology, enhanced by people — accessible to all.

We are looking for a dedicated and qualified Dietitian to join our team. The ideal candidate will hold a Bachelor’s degree in nutrition and be a registered dietitian (RD). This role primarily involves providing member care treatment and contributing to the creation and curation of content related to nutrition, both written and in audio/video formats.As a Registered Dietitian, you will play a critical role in improving the health and wellbeing of our members through nutrition counseling and education. Your responsibilities will include creating nutritional plans, and providing nutrition guidance to patients. Additionally, you will contribute to the development and management of nutrition related content, including written, video, and audio materials.

What you’ll be doing:

Member Care Treatment:

• Collaborate with PTs to identify patients in need of nutrition counseling.
• Conduct inidual nutrition assessments and evaluations.
• Develop personalized dietary plans and recommendations for clients with various nutritional needs.
• Provide evidence based dietary counseling to address health issues, weight management and dietary restrictions.
• Offer ongoing support and education to clients.
• Refer patients to community resources as necessary to support their nutritional goals.

Content Creation and Curation:

• Collaborate with the content team to create written, audio, and video content related to nutrition.
• Develop engaging and informative content that aligns with the organization’s nutrition objectives.
• Ensure content is accurate, evidencebased, and accessible to a erse audience.
• Participate in content planning, brainstorming, and strategy meetings.
• Collaborate with the marketing and communications team to promote nutritionrelated content.
• Ensure compliance with all relevant nutrition and dietetics regulations and guidelines.

Collaboration:

• Collaborate with other healthcare professionals, including psychologists and physicians, to provide comprehensive care to members

What you need to have:

• Bachelor’s degree in nutrition, dietetics, or related field from an accredited institution.
• Registered Dietitian (RD/ RDN) credential.
• Minimum of 2 years experience providing nutritional and dietary counseling
• Strong understanding of nutrition science and its practical applications.
• Excellent communication skills, both written and verbal.
• Empathetic and clientcentered approach to care.
• Ability to work collaboratively in a teambased environment.
• Proficiency in creating written, audio, and video content is a plus.
• Eligibility for Essential benefits: Fulltime employees regularly working 25+ hours per week

US Sword Benefits:

• *Eligibility for Essential benefits: Fulltime employees regularly working 25+ hours per week
• Comprehensive health, dental and vision insurance
• Equity Shares
• 401(k)
• Discretionary PTO Plan
• Parental leave

US Sword Perks:

• Flexible working hours

Remotefirst Company

• Internet Stipend for remote working
• Paid Company Holidays
• Free Digital Therapist for you and your family

Portugal Sword Benefits:

• Health, dental and vision Insurance
• Meal Allowance
• Equity Shares

Portugal Sword Perks:

• Remote Work Allowance
• Flexible working hours
• Work from home
• Unlimited Vacation
• Snacks and Beverages
• English Class
• Unlimited access to Coursera Learning Platform

*US Applicants Only: Applicants must have a legal right to work in the United States, and immigration or work visa sponsorship will not be provided.*

SWORD Health, which includes SWORD Health, Inc. and Sword Health Professionals (consisting of Sword Health Care Providers, P.A., SWORD Health Care Providers of NJ, P.C., SWORD Health Care Physical Therapy Providers of CA, P.C.*) complies with applicable Federal and State civil rights laws and does not discriminate on the basis of Age, Ancestry, Color, Citizenship, Gender, Gender expression, Gender identity, Gender information, Marital status, Medical condition, National origin, Physical or mental disability, Pregnancy, Race, Religion, Caste, Sexual orientation, and Veteran status.

Title: Nurse Clinical Lead

Location: Remote

How will this role have an impact?

The Nurse Clinical Lead is a role within the Network Success team responsible for leadership and generalized oversight of Signify Health’s provider network conducting in-home and virtual health evaluations.

In this role, the Nurse Clinical Lead serves as a lead within Network Success and is responsible for the generalized oversight of ensuring the provider network is meeting quality standards. The Nurse Clinical Lead will serve as the clinical resource for the Diagnostic and Preventive Services department, pilot projects, and escalations related to the provider network. The Nurse Clinical Lead will be responsible for the Covid-19 provider escalations, recommendations and will be required to follow all Signify Health policy and protocols related to Covid-19 and escalate to other departments if additional leadership is needed.

Education/Licensing Requirements:

• RN state licensure (unencumbered) required with ability to apply for licensure in other states
• Bachelor’s degree in nursing, required
• Master’s degree in nursing, preferred

Essential Experience:

• Minimum 2 years RN management experience with remote staff
• Minimum 2 years experience working home health
• Minimum 2 years clinical experience pertinent to the member population(s) being served

Essential Skills Characteristics:

• Fluently speak, read, and write English
• Excellent clinical skills
• Excellent oral and written communication skills
• Ability to adapt to rapidly changing technology and apply to business needs
• Ability to identify, analyze, and resolve business issues through solution-oriented projects
• Demonstrated customer service/customer relationship management acumen
• Willingness to promote corporate goals and objectives to the provider network and staff throughout the Signify Health enterprise.
• Ability to perform in a high-pressure environment and/or crisis situation and render good decisions to resolve the problems
• Proven ability to prioritize and multi-task
• Demonstrated ability to achieve results through team-based efforts
• Willingness to challenge established practices and draw relevant conclusions
• Basic skills in MS Office; moderate skills in Google
• Ability to effectively direct and oversee the work of others remotely
• Ability to develop, read, analyze, and interpret complex documents
• Possess critical thinking skills
• Possess strong attention to detail and organization

Essential Job Responsibilities:

RN Clinical Lead:

• Generalized oversight of ensuring the provider network is meeting quality standards
• Serve as the clinical resource for the Diagnostic and Preventive Services department, pilot projects, and escalations related to the provider network
• Responsible for the Covid-19 provider escalations, recommendations and will be required to follow all Signify Health policy and protocols related to Covid-19 and escalate to other departments if additional leadership is needed
• Point of contact for clinical leadership to the provider network as needed
• Provide ancillary service training to clinicians as needed
• Provides general support to the Network Success team as needed

Additional Job Responsibilities:

• Participate in staff meetings, conference calls, and other meetings as needed
• Attend training sessions to acquire/enhance skills related to programs offered
• Complete reports/projects/tasks as requested by the Sr. Nurse Clinical Manager
• Daily troubleshooting of program/processes as indicated
• Ability to travel 20-30% of the time air/land travel, may include some overnights and weekends
• Perform other incidental and related duties as required

Essential Characteristics:

• Strategic thinker
• Results driven
• Detail-oriented
• Self-directed and organized
• Sound judgment in handling/escalating difficult situations
• Sense of urgency
• Good interpersonal and conflict resolution skills
• Discrete (i.e., ability to maintain confidentiality)
• Team player
• Ability to work under pressure
• Ability to take direction

Working Conditions:

• Fast-paced environment
• Requires working at a desk to use a phone and computer
• Use office equipment and machinery effectively
• Work effectively with frequent interruptions
• Ability to ambulate to various parts of the building
• Ability to bend, stoop
• Lifting requirements of 20 pounds occasionally unassisted
• May require additional hours to meet project deadlines

About Us:

Signify Health is helping build the healthcare system we all want to experience by transforming the home into the healthcare hub. We coordinate care holistically across iniduals’ clinical, social, and behavioral needs so they can enjoy more healthy days at home. By building strong connections to primary care providers and community resources, we’re able to close critical care and social gaps, as well as manage risk for iniduals who need help the most. This leads to better outcomes and a better experience for everyone involved. Our high-performance networks are powered by more than 9,000 mobile doctors and nurses covering every county in the U.S., 3,500 healthcare providers and facilities in value-based arrangements, and hundreds of community-based organizations. Signify’s intelligent technology and decision-support services enable these resources to radically simplify care coordination for more than 1.5 million iniduals each year while helping payers and providers more effectively implement value-based care programs. To learn more about how we’re driving outcomes and making healthcare work better, please visit us at www.signifyhealth.com.

Diversity and Inclusion are core values at Signify Health, and fostering a workplace culture reflective of that is critical to our continued success as an organization.

We are committed to equal employment opportunities for employees and job applicants in compliance with applicable law and to an environment where employees are valued for their differences.

#LI-RH1

Coding and QA Specialist (13222)

Functional Area

Teammate – Revenue Cycle

City

Remote

Work Location Type

Remote

Employment Type

Full-time (30+ hrs/week)/FULLTIME

PRACTICE OVERVIEW

Radiology Partners is the largest and fastest growing on-site radiology practice in the US. We are an innovative practice focused on transforming how radiologists provide consistently exceptional services to hospitals, imaging centers, referring physicians and patients. With our state-of-the art clinical technology, specialized expertise, access to capital, and retention of top physician talent, Radiology Partners reliably exceeds the expectations of our clients, patients, and partners. We serve our clients with an operational focus, and, above all, a devotion to quality patient care. Our mission is To Transform Radiology.

POSITION SUMMARY

Radiology Partners is seeking a Coding and QA Specialist to represent Radiology Partners by coding and correcting reports. Accurate coding of reports will provide customer satisfaction throughout the claim process and assure full collections for account resolution, providing the company with a firm foundation for growth potential and ensuring sustainability.

POSITION DUTIES AND RESPONSIBILITIES

Assign ICD and CPT codes to properly identify the procedures performed, while following Correct Coding Initiative and Medicare Local Coverage of Determination & NCD edits and Managed Care payer edits as needed, to ensure accurate coding for services. Review charges coded by vendor or autocoder, identifying coding or logic errors and sharing with Supervisor. Work with Supervisor, the Coding Team and outsource vendor to resolve coding issues. Review and correct coding denials, identifying trends in payer requirements and communicate findings back to Supervisor for coder education. Work with AR team to ensure denials are processed correctly. Process claim rejections from clearinghouse related to coding. Maintain regulatory compliance by staying abreast of current trends and regulations in the financial and healthcare industries. Promote a culture that reflects the organization’s values, encourages good performance, and enhances productivity. Contribute to team effort by accomplishing related results as needed. Perform other duties as assigned.

DESIRED PROFESSIONAL SKILLS AND EXPERIENCE

High School diploma or General Education Degree (GED) highly preferred or two years related experience and/or training Certification through the American Health Information Management Technician (AHIMA) as one of the following: Registered Health Information Management Technician (RHIT), Registered Health Information Management Technician (RHIA), Certified Coding Specialist (CCS), or Certified Coding Specialist-Physician Based (CCS-P), or certified through the American Association of Procedural Coders (AAPC) as a Certified Professional Coder (CPC) Intermediate computer proficiency is required in this role At least one year of Radiology coding and Interventional Radiology coding experience is necessary for this position Oncology Coding experience a plus Excellent communication skills and attention to detail Ability to deal with problems involving a few concrete variables in standardized situations Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources Must have knowledge of ICD-10 and CPT

Radiology Partners is an equal opportunity employer. We believe in creating and celebrating a culture of belonging and are committed to creating an inclusive environment for all teammates.

CCPA Notice: When you submit a job application or resume, you are providing the Practice with the following categories of personal information that the Practice will use for the purpose of evaluating your candidacy for employment: (1) Personal Identifiers; and (2) Education and Employment History.

Radiology Partners participates in E-verify.

Member Advocate

Remote

About us:

Parsley Health is a digital health company with a mission to transform the health of everyone, everywhere with the world’s best possible medicine. Today, Parsley Health is the nation’s largest health care company helping people suffering from chronic conditions find relief with root cause resolution medicine. Our work is inspired by our members’ journeys and our actions are focused on impact and results.

The opportunity:

As a Member Advocate, you will provide a high level of customer service to Parsley Health Members by corresponding to inquiries both via email, SMS, and over the phone, performing onboarding calls, managing cancellation requests, answering questions about the Program, and resolving member complaints in a professional and timely manner. This role works closely with our clinical and sales departments to ensure member satisfaction and loyalty. PST hours are preferred.

What you’ll do:

• Provide exceptional member service through prompt, accurate, and knowledgeable responses to member inquiries and complaints
• Maintain ownership of member issues from receipt of the initial request to resolution
• Follow up with members to ensure their issues have been resolved to their satisfaction
• Maintain a comprehensive understanding of the company’s products and services
• Utilize member feedback to identify opportunities for improvement and report trends
• Assist in developing initiatives to enhance member experience and satisfaction
• Manage inbound and outbound member inquiries via phone, SMS, and our online messaging platform.
• Escalate unresolved member questions to the appropriate department to ensure a quick turnaround for all member inquiries
• Ability to think on your feet and de-escalate member situations
• Assist members with renewal questions and encourage continued care
• Collect feedback from members and process cancellations
• Support members’ scheduling and member portal navigation needs and– troubleshooting as needed
• This is an evolving and growing department, and role requirements may change and expand as Parsley Health grows.
• Other duties as assigned

What you’ll need:

• At least one year of relevant work experience in a one-to-one client/patient-facing
• Healthcare tech/start-up experience preferred
• An empathetic customer-service approach that ensures your members feel heard and cared for
• Call management system experience preferred (i.e., Regal.io)
• A passion for helping others
• Excellent oral and written communication skills
• Can comfortably resolve issues over the telephone
• A detail-oriented mindset with a knack for organization and clarity – nothing slips through the cracks
• Proactivity, autonomy, and commitment to excellence in your work
• Flexibility as roles and responsibilities are subject to change and new ones may be assigned
• Ability to work from home in a quiet space to conduct phone calls.

Benefits and Compensation:

• Equity Stake
• 401(k) + Employer Matching program
• Remote-first with the option to work from one of our centers in NYC or LA
• Complimentary Parsley Health Complete Care membership
• Subsidized Medical, Dental, and Vision insurance plan options
• Generous 4+ weeks of paid time off
• Annual professional development stipend

Parsley Health is committed to providing an equitable, fair and transparent compensation program for all employees.

The starting salary for this role is $24.25/hour, depending on skills and experience. We take a geo-neutral approach to compensation within the US, meaning that we pay based on job function and level, not location.

Inidual compensation decisions are based on a number of factors, including experience level, skillset, and balancing internal equity relative to peers at the company. We expect the majority of the candidates who are offered roles at our company to fall healthily throughout the range based on these factors. We recognize that the person we hire may be less experienced (or more senior) than this job description as posted. If that ends up being the case, the updated salary range will be communicated with candidates during the process.

At Parsley Health we believe in celebrating everything that makes us human and are proud to be an equal opportunity workplace. We embrace ersity and are committed to building a team that represents a variety of backgrounds, perspectives, and skills. We believe that the more inclusive we are, the better we can serve our members.

Important note:

In light of recent increase in hiring scams, if you’re selected to move onto the next phase of our hiring process, a member of our Talent Acquisition team will reach out to you directly from an @parsleyhealth.com email address to guide you through our interview process.

Please note:

• We will never communicate with you via Microsoft Teams
• We will never ask for your bank account information at any point during the recruitment process, nor will we send you a check (electronic or physical) to purchase home office equipment

We look forward to connecting!

#LI-Remote

Remote Coder

locations

Remote – USA

time type Full time

posted on Posted Today

job requisition id R002756

Company:

AHI agilon health, inc.

Job Posting Location:

Remote – USA

Job Title:

Remote Coder

Job Description:

Essential Job Functions:

• Verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered.
• Review medical record information to identify all appropriate coding based on CMS HCC model.
• Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
• Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.
• Support and participate in process and quality improvement initiatives.
• Maintain a comprehensive tracking and management tool to track all HCC activities and ensure that all tasks are completed in a timely manner.
• Performs AHIMA compliant queries to providers when necessary
• Participate in ongoing training and education within assigned timeframe
• May participate in special project auditing as required
• All other duties as assigned

Other Job Functions:

• Understand, adhere to, and implement the Company’s policies and procedures.
• Provide excellent customer services skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients. Proactively ensuring that these needs are met or exceeded.
• Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.
• Engage in excellent communication which includes listening attentively and speaking professionally.
• Set and complete challenging goals.
• Demonstrate attention to detail and accuracy in work product by meeting productivity standards and maintaining a company standard of accuracy

Location:

Remote – TX

Pay Range:

$24.00 – $28.70

Salary range shown is a guideline. Inidual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.

Title: Triage Registered Nurse

Location: US National

CLINICAL STRATEGY AND SERVICES CLINICAL TEAM

PART-TIME/ REMOTE

The Remote Triage Registered Nurse / RN supports patients and their families by providing clear, safe and effective telephone triage using evidence-based processes and tools. The Registered Nurse on this team will blend critical thinking skills with a decision support tool enabling safe, standardized care to our patient population.

Two (2) Part-Time positions available!

Shift/Schedule:

Week 1: Mon, Tues, Thurs, and Fri 3p-7p PST

Week 2: Mon and Fri 3p-7p; Sat and Sun 11a-8p PST

Essential Job Duties:

• • Respond promptly to each incoming call and assist patients by providing standardized care and benefits navigation, while quickly developing a friendly, yet professional rapport over the phone
  • Conduct a thorough clinical assessment of symptoms and confidently determine the appropriate level of care required to safely meet the patient’s medical need, and refer them using established guidelines
  • Follow standard procedures and protocols related to the triage service
  • Educate and communicate recommendations to patients thoroughly in patient-friendly language
  • Successfully route members to additional internal/external benefits and community resources, when needed
  • Provides care based upon the Included Health Core Values
  • Provides triage and support for urgent member prescription needs
  • Serves as a central point of contact for all Included Health member emergency escalations
  • Participate in team meetings and continuous quality improvement

Requirements:

• • Bachelor of Science in Nursing required
  • Registered Nurse, currently residing and licensed in a compact state with eligibility to obtain RN licensure in all 50 states
  • 2+ years experience in a triage setting, preferably some of that experience being focused on phone triage, or 2+ years experience in an emergency room, or 4+ years experience in an ambulatory primary care role that included triage
  • Ability to work in PST Timezone
  • Rotating holiday and weekend rotation (every 3rd weekend for Full Time and every other weekend for Part Time)
  • Expertise in advanced clinical decision making
  • Comfortable working with a wide variety of medical conditions for both pediatric and adult populations
  • Experience in engagement in complex decision making, including situations of uncertainty
  • Excellent written and verbal communication skills. The ability to gather a clinical history, answer questions at a patient level, and succinctly summarize findings is critical.
  • Strong competence and ability to use multiple computer/medical record systems, as well as Google suite
  • Must be able to work efficiently. We are a fast growing company and we are busy. Our team is expected to meet role specific metrics without sacrificing quality. Good judgment for balancing priorities is a must.
  • Maintain current nursing licensure by completing applications for renewal in a timely manner and by complying with all requirements for continuing education.

Other Skills/Abilities:

• • Self-disciplined, energetic, passionate, innovative and flexible
  • Must be able to work independently remotely and work well under stress
  • A team player that can follow a system and protocol to achieve a common goal
  • Demonstrates sound judgment, independent decision-making and problem-solving skills
  • Maintain current nursing licensure by completing applications for renewal in a timely manner and by complying with all requirements for continuing education.
  • Maintains professional demeanor and service-oriented patient focus to prioritize the patient experience
  • Possess the ability to multitask, and using best judgement when to seek additional input from leadership

Title: Registered Nurse Care Manager – Remote, nationwide

Location: United States

Full time

Description

The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member’s physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations.

Responsibilities

The first 4 weeks of training will be from 8:30AM to 5:00PM EST. No time off is permitted during the first month of training. Following training, the start time is 10:00AM EST.

Our nurses are titled Care Managers, because our case management services are centered on the person rather than the condition. We contact members with multiple chronic conditions as well as financial and functional barriers in order to assist them in achieving and maintaining optimum health. We provide telephonic outreach to assess and support their health, offering education, identifying resources, and helping remove barriers to achieving health and independence, while using a multidisciplinary team.

This position will be part of our Special Needs Program (SNP) team. All of our SNP RN Care Managers are work at home associates, working from a dedicated home office space. Work at home care managers are responsible for meeting quality and productivity measures daily and maintaining working home internet at all time with demonstrated advanced communication and interpersonal skills.

This is a very compliance driven and highly visible program at Humana. The nature of the work requires telephonic interaction with members during the majority of the business day, primarily through an auto dialer system. Environment is fast paced and requires ability to engage quickly with member while concurrently navigating multiple computer applications. Due to the auto dialer process and compliance needs of the business there is limited day to day flexibility in care manager’s schedule.

Duties:

• Telephonically assess Medicare, Medicaid, and/or and Group Account members and create actionable and measurable care plans to help guide and track the members’ progress toward goals
• Use nursing judgment to assess and coordinate care for acute situations (APS, EMS)
• Discuss transitions of care to assist with safe discharge to the home and coordinate care for DME, home health, provider appointments, etc.
• Guide members and their families toward and facilitate interaction with resources appropriate for the care and wellbeing of members
• Assess member’s physical, environmental and psycho-social health issues and work in collaboration with a multi-disciplinary team, such as social workers, dietitians, pharmacists, etc., employing a variety of strategies/techniques to manage appropriately and provide timely intervention

#LI-Remote

This is a remote position

Required Qualifications

• Active Registered Nurse (R.N.) license with no disciplinary action.
• Hold an active Compact nursing license and reside in the state that holds your compact license.
  • The National Council of State Boards of Nursing (NCSBN) developed the Nursing Licensure Compact (NLC), which is an agreement between states that allows nurses to have one license and the ability to practice in all the states that participate in the program. License must be current with no disciplinary action.
• Minimum education of an Associates degree in Nursing.
• Minimum of 3 years of clinical nursing experience as a RN.
• Demonstrated clinical knowledge and expertise as evidenced by providing intervention to manage variety chronic conditions, including development and implementation of inidualized care planning.
• Intermediate to advanced computer skills as evidenced by ability to navigate multiple systems, utilizing dual computer monitors.
• Provide autonomous decision-making, troubleshooting and problem solving related to periodic system issues.
• Experience with Microsoft and Excel
• Ability to quickly learn and navigate software programs and applications.
• Capacity to manage multiple or competing priorities including use of multiple computer applications simultaneously.
• Effective communication and interpersonal skills.
• Effective problem solving and appropriate application of clinical knowledge
• Must have a separate room with a locked door that can be used as a home-office to ensure you and your members have absolute and continuous privacy while you work.
• Must possess advanced telephonic and virtual communication skills.

Preferred Qualifications

• BSN or MSN degree in nursing or equivalent
• CCM
• Bi-lingual in Spanish and English
• Previous adult chronic conditions care management
• Previous experience in care management including knowledge of complex care management and care management principles
• Experience with motivational interviewing
• Experience with MCG or CMS guidelines, assessment and documentation practice
• Inidual licenses in non-compact states

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates‘ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Additional Information – How we Value You

Benefits starting day 1 of employment Competitive 401k match Generous Paid Time Off accrual Tuition Reimbursement Parent Leave Go365 perks for well-being

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and inidual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$69,800 – $96,200 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or inidual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, Humana) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

CLINICAL AUDITOR, COMPLIANCE (RN) – REMOTE

Molina Healthcare

United States

Job ID 2022676

JOB SUMMARY

Molina Healthcare’s Compliance team supports compliance operations for all Molina product lines enterprise-wide. It is a centralized corporate function supporting compliance activities at inidual state health plans.

Reporting to the Compliance Manager, the Compliance Nurse Auditor is responsible for designing and conducting Compliance Clinical Audits that effectively prevents and/or detects violations of applicable federal, state and local laws, regulations and contracts. Ensures compliance with established internal control procedures by examining records, reports, operating practices, and documentation.

JOB DUTIES

• Performs on-going internal compliance clinical audits, regulatory validation audits and ad hoc audits, by developing audit tools and in some instances, building regulatory matrices.
• Works with key stakeholders (business areas, compliance officers et. al.) to identify and define audit scopes and criteria and Develop audit objectives, plans, and scope by reviewing available information and conducting research.
• Completes audit workpapers by documenting audit tests and findings.
• Appraises adequacy of internal department processes by reviewing cases, documentation, processes and/or other applicable documentation that supports the business.
• Appraises adequacy of internal control systems by reviewing monitoring and audit tools, key performance indicators, training documents and/or other applicable documentation.
• Maintains internal control systems by updating audit tools and questionnaires, and recommending new policies and procedures, key performance indicators and corrective actions when appropriate.
• Communicates audit findings by preparing a final report and discussing findings with the business areas, Compliance Officers and others as appropriate.

REQUIRED EDUCATION:

Registered Nurse

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

1-3 years

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

Registered Nurse

PREFERRED EDUCATION:

Bachelor‘s degree in health care related area.

PREFERRED EXPERIENCE:

3-5 years experience.

Medicaid & Medicare experience.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

LVN, LPN or Registered Nurse, R

Pay Range: $49,930 – $99,980 a year*

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time

Specialist-HIMS – Remote

Job ID 316290

Rochester, MN

Full Time

Health Information Management Services

Why Mayo Clinic

Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans – to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic. You’ll thrive in an environment that supports innovation, is committed to ending racism and supporting ersity, equity and inclusion, and provides the resources you need to succeed.

Responsibilities

Analyzes patient information to ensure compliance with standards established by Federal/State & Joint Commission & CMS regulations. Coordinates with clinicians to ensure documentation contains all required elements and is completed in a timely manner. Adheres to institutional policies regarding health care documentation. Utilizes independent analytical and critical thinking skills. Works independently and collaboratively across the enterprise with minimal supervision.

Adheres to guidelines with regard to accessing minimum necessary information to complete job function. Adheres to state and federal rules regarding privacy and confidentiality of protected health information. Leverages technology to serve the patients and practice. Professionally communicates through all electronic, written, and verbal methods. Ensures great customer service while assisting patients, care providers, allied health staff, attorneys, insurance companies, government audits, and others in a courteous, professional and confidential manner. Identified Candidate will train for 10-12 weeks on day shift before moving to permanent shift utilizing CORE/Variable hours. If you have any questions, please contact HR.

** Visa sponsorship is not available for this position; Also, Mayo Clinic DOES NOT participate in the F-1 STEM OPT extension program**

This Position is 100% Remote can work from anywhere within the United States

Qualifications

Associate of Science degree in a healthcare related discipline required (i.e., applied health sciences A.S. degree). Associate of Science degree in Health Information Technology preferred. Health Information Technology (HIT) program students actively completing the last semester of their associate degree program will be considered; successful completion of HIT Associate degree is required within 6 months of hire date for continued employment.Must possess knowledge of medical records format and content and be able to perform work in a fast paced, constant change, production environment with a focus on quality.

Must possess excellent customer service skills and be able to clearly, concisely and professionally communicate verbally and in written forms. Demonstrated ability to maneuver in multi technology environment and demonstrates proficiency in Microsoft Office (Excel, Word, and Outlook) applications. Keyboarding skills necessary, with intermediate typing/keyboard/computer skills. Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) preferred. Flexible, hard working, self-motivated

Exemption Status Nonexempt

Compensation Detail $18.59 – $25.50/hourly; Education, experience and tenure may be considered along with internal equity when job offers are extended.

Benefits Eligible Yes

Schedule Full Time

Hours/Pay Period 80

Schedule Details M-F, Rotating Weekends, CORE and Variable Hours; 3:00pm-3:00am / CORE hours 3:00pm-7:00pm

Weekend Schedule M-F, Rotating Weekends, CORE and Variable Hours; 3:00pm-3:00am / CORE hours 3:00pm-7:00pm

International Assignment No

Site Description

Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives. Learn more about what each unique Mayo Clinic campus has to offer, and where your best fit is.

Affirmative Action and Equal Opportunity Employer

As an Affirmative Action and Equal Opportunity Employer Mayo Clinic is committed to creating an inclusive environment that values the ersity of its employees and does not discriminate against any employee or candidate. Women, minorities, veterans, people from the LGBTQ communities and people with disabilities are strongly encouraged to apply to join our teams. Reasonable accommodations to access job openings or to apply for a job are available.

Virtual Nurse Practitioner or Physician Assistant (DC License Required)

• Req Number: 5316126

About Us

One Medical is a primary care solution challenging the industry status quo by making quality care more affordable, accessible and enjoyable. But this isn’t your average doctor’s office. We’re on a mission to transform healthcare, which means improving the experience for everyone involved – from patients and providers to employers and health networks. Our seamless in-office and 24/7 virtual care services, on-site labs, and programs for preventive care, chronic care management, common illnesses and mental health concerns have been delighting people for the past fifteen years.

In February 2023 we marked a milestone when One Medical joined Amazon. Together, we look to deliver exceptional health care to more consumers, employers, care team members, and health networks to achieve better health outcomes. As we continue to grow and seek to impact more lives, we’re building a erse, driven and empathetic team, while working hard to cultivate an environment where everyone can thrive.

The Opportunity:

The One Medical Virtual Medical Team (VMT) is a leading provider of virtual clinical care, providing world-class, convenient, evidence-based virtual medical care to One Medical patients in concert with their primary care providers. Through advanced technology and a team-based approach, we care for patients 24 hours a day, 365 days a year. Our team is united by intellectual curiosity, inclusiveness, and a powerful mission: transforming healthcare and bringing world-class primary care to everyone.

Employment type:

• Full time (32 hours minimum including evenings and weekends)

What you’ll be working on:

• Treating patients via tele-health visits, including telephonic triage calls, video visit appointments, and email follow-ups
• Continuous learning during weekly Clinical Rounds and through other modalities
• Ongoing collaboration with both virtual teammates via daily huddles
• Utilization ofyour specific clinical training and opportunities to give exceptional care to patients virtually

Education, licenses, and experiences required for this role:

• Completed an accredited FNP or PA program with a national certification
• Currently licensed in Washington DC with ability to obtain additional state licenses as needed
• In the past 5 years, practiced as an Advanced Practitioner for at least:

• 2 years in an outpatient primary care setting seeing patients of all ages (0+), OR 2 years in an urgent care or emergency medicine setting seeing patients of all ages (0+) Ability to work weekday and weekend shifts (every other Saturday and Sunday required)

• Ability to work afternoons and evenings
• Excellent clinical and communication skills

An example schedule for this role:

Week A:

Monday: 1pm-10pm ET

Tuesday: 1pm-10pm ET

Thursday: 1pm-10pm ET

Saturday: 1pm-10pm ET

Sunday: 1pm-10pm ET

Week B:

Monday: 1pm-10pm ET

Tuesday: 1pm-10pm ET

Thursday: 1pm-10pm ET

One Medical providers also demonstrate:

Benefits designed to aid your health and wellness:

Taking care of you today

Protecting your future for you and your family

Supporting your medical career

This is a full-time virtual role.

One Medical

is committed to fair and equitable compensation practices.

The base hourly range for this role is $53.50 per hour to $59.00 per hour based on a full-time schedule. Final determination of starting pay may vary based on factors such as practice experience and patient care schedule. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. The total compensation package for this position may also include RSUs, benefits and/or other applicable incentive compensation plans. For more information, visit https://www.onemedical.com/careers/

One Medical is an equal opportunity employer, and we encourage qualified applicants of every background, ability, and life experience to contact us about appropriate employment opportunities.

One Medical participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. Please refer to the E-Verification Poster (English/Spanish) and Right to Work Poster (English/Spanish) for additional information.

• A passion for human-centered primary care
• The ability to successfully communicate with and provide care to iniduals of all backgrounds
• The ability to effectively use technology to deliver high quality care
• Clinical proficiency in evidence-based primary care
• The desire to be an integral part of a team dedicated to changing healthcare delivery
• An openness to feedback and reflection to gain productive insight into strengths and weaknesses
• The ability to confidently navigate uncertain situations with both patients and colleagues
• Readiness to adapt personal and interpersonal behavior to meet the needs of our patients
• Paid sabbatical after 5 and 10 years
• Employee Assistance Program – Free confidential advice for team members who need help with stress, anxiety, financial planning, and legal issues
• Competitive Medical, Dental and Vision plans
• Free One Medical memberships for yourself, your friends and family
• Pre-Tax commuter benefits
• PTO cash outs – Option to cash out up to 40 accrued hours per year
• 401K match
• Credit towards emergency childcare
• Company paid maternity and paternity leave
• Paid Life Insurance – One Medical pays 100% of the cost of Basic Life Insurance
• Disability insurance – One Medical pays 100% of the cost of Short Term and Long Term Disability Insurance
• Malpractice Insurance – Malpractice fees to insure your practice at One Medical is covered 100%.
• UpToDate Subscription – An evidence-based clinical research tool
• Continuing Medical Education (CME) – Receive an annual stipend for continuing medical education
• Rounds – Providers end patient care one hour early each week to participate in this shared learning experience

Title: Pro Fee Coder- General Surgery

Location: United States

US – Remote (Any location)

Full time

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Do:

The General Surgery Coder must be proficient in surgical coding for all Trauma Surgery type cases. E/M experience is also required for associated providers. The coder will review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting, research as required, and regulatory compliance. Under the direction of the coding managerthe coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. The coder scope may involve reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines. This position is full time and 100% remote.

Demonstrates the ability to perform quality surgical coding on General and Trauma surgery chart types as assigned.

Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing. Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards. Achieves and maintains 95% accuracy in coding while maintaining a high level of productivity. Accuracy will be monitored during monthly reviews either within the facility. Works the review queue daily to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary. Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process. See re-bill policy in facility guidelines. Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility. Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request. Coders must maintain their current professional credentials while working for Guidehouse. Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility. Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy) It is the responsibility of each coder to review and adhere to the coding ision policy and procedure manual content. Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services.

What You Will Need:

Minimum 3-5 years General Surgery Coding experience, both IP and OP coding for physician claims.

2-3 years coding Trauma or other complex procedures.

CPC certification from AAPC EMR experience Must maintain credential throughout employment Must be able to work independently, multi-task well and interface with all levels of personnel as well as clients Excellent verbal, written and interpersonal communication skills Advanced knowledge of Excel, Word and PowerPoint High level of accuracy Strong Working Knowledge & experience with Federal & State Coding regulations and Guidelines

What Would Be Nice To Have:

COSC credential from AAPC

Multiple EMR and/or practice management systems experience E/M experience along with surgical coding experience (Office, OP and OR procedures

#LI- Remote

The annual salary range for this position is $40,200.00-$72,300.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a erse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Billing and Coding Specialist

Location: Virtual – Work From Home

Job Id: 1437

# of Openings: 1

About Revecore

Revecore is an innovative, technology-driven company that is committed to helping our clients, our employees, our company, and our communities thrive. An award-winning services firm, partnering with hospitals and health systems, providing the momentum they need to maintain a strong revenue cycle amid today’s evolving healthcare environment.

With a 20+ year history, Revecore is the leading provider of revenue integrity and complex claims solutions for hospitals.

We offer a dynamic and flexible work environment, full of opportunity for motivated, hands-on team players. We strive each day to solve complex business problems and find new ways to enhance the efficiency, effectiveness, and quality of our services. If those attributes resonate with you, regardless of where you are locatedwe want you on our team!

Position Summary

Performs retrospective outpatient coding and both inpatient and outpatient billing reviews in coordination with internal staff in our mission to capture full, fair, and accurate reimbursement for our hospital clients

Duties and Responsibilities

• Support internal and external customers by providing accurate and timely responses to coding and billing questions
• Perform retrospective coding and billing reviews on inpatient and outpatient hospital claims
• Provide correction recommendations to internal associates or clients, and support recommendations with rationale that may include coding guidelines, industry standard billing guidelines, or payer specific guidelines
• Research and stay current on industry changes with regards to coding guidelines and payer specific billing guidelines for commercial and government payers
• Ability to comprehend payment methodologies and how they apply to billing and coding scenarios
• Build strong, lasting relationships with Revecore personnel
• Attend department and company meetings as required
• Comply with federal and state laws, company and department policies and procedures
• Assist with other related responsibilities to meet the needs of the business

Skills and Experience

• Coding certification required, with 1+ years hospital coding/ auditing experience i.e. CPC, COC, CIC, CCS-P, CCS
• Entry level understanding of Managed Care, Medicare and Medicaid billing and reimbursement guidelines
• Entry level understanding of inpatient and outpatient hospital reimbursement methodologies a plus
• Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook
• Mathematical skills sufficient to apply the concepts of claim payment methodologies
• Ability to read and interpret an extensive variety of documents such as claims, instructions, policies and procedures in written (in English) and diagram form
• Ability to present ideas on complex, detailed issues with ease
• Ability to define problems, collect data, establish facts and draw valid conclusions
• Strong team player, with willingness to adapt to changing priorities

Physical Demands and Work Environment

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable iniduals with disabilities to perform the essential functions.

• Physical Demands: While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to handle or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
• Work Environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time. The noise level in the work environment is usually moderate.

Title: Full Time Bilingual Pennsylvania (PA) Licensed Nurse Practitioner (NP) – (English/Spanish) (Remote)

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a Series B startup with a simple mission: Delivering extraordinary outcomes by unlocking the power of caregivers. We enable people with personal assistance to thrive at home, in their community by assuring their caregivers have the resources, data, and support they need. We achieve this through a combination of analytics, technology, services, and deep healthcare expertise.

Our program monitors in real-time, identifying issues before they become health events, and helping connect those in need with those who can help via technologies such as video, chat, and telephone. Our technology platform includes home-based mobile applications, a clinical dashboard, and data analytics on data not previously available to health professionals. We are disrupting a $109 billion industry and have recently closed our latest funding round with a blue-chip list of investors.

We’re looking to add to our team of experts who care deeply about our mission.

Our team is passionate, driven, collaborative, intellectually curious, and excited about the opportunity to transform our healthcare system. We’re inspired by caregivers and seek to create a platform that recognizes, utilizes and supports the vital role they play. We strive to continuously learn, explore, experiment and achieve results. We are here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids)

The ideal teammate would be…

A person who’s passionate about working closely with a clinical team to ensure the best clinical outcomes for those we serve. A person who enjoys a fast paced clinical environment, performing telephonic and virtual visits related to proactive chronic care management, remote patient monitoring, and/or resolving more urgent clinical issues quickly. Lastly, someone who aspires to work with a company who is on the leading edge of community health working with partners to allow our elderly to remain at home and free of avoidable hospitalizations.

The ideal teammate would be able to:

• Conduct video visits for chronic care management and remote patient monitoring to create an appropriate care plan for the member
• Conduct care coordination and recommend/identify cost effective research based treatment and intervention
• Utilize strong clinical skills in physical assessment and chronic disease management for at risk adults and apply member specific Care Management and inidualized care planning
• Be comfortable with advanced care planning discussions with caregivers and members
• Serve as a consulting resource on care management practice as needed
• Attend meetings, training sessions and participates on committees as needed
• Possess a strong knowledge of clinical procedures, standards and quality control checks
• Possess a strong knowledge of medical conditions, interventions and treatment
• Provide members, caregivers and facility education
• Monitor the quality of member’s care and updates plan of care

Would you describe yourself as someone who has:

• Certified and licensed as a Nurse Practitioner in good standing in the state of Pennsylvania (required)
• Master’s or doctoral degree from an accredited institution for nurse practitioners (required)
• Bilingual in English and Spanish (required)
• Certification from ANCC (or equivalent) as an Adult, Family, Geriatric, and/or Acute Nurse practitioner (required)
• 1+ years of Nurse Practitioner Experience (required), qualified for independent practice in your licensed jurisdiction (preferred)
• 1+ years of telephonic triage or equivalent experience (required)
• 2+ years of clinical experience working with complex adult populations (required)
• Ability to practice independently with little clinical support (required)
• Comfort using technology like Google Suite, multiple EMRs, Slack (required)
• Experience working in home care and/or family medicine, geriatrics (preferred)
• Experience working within a clinical team environment
• The ability to work remotely and has a private area with a computer in their home/workspace (required)
• Strong organizational skills, including the ability to prioritize
• Passionate about our mission to improve people’s lives
• Comfortable in a dynamic and always evolving startup environment

Pay range is $125K – $130K annually. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

If yes, then we look forward to speaking to you!

Vesta Healthcare is committed to leveraging the talent of a erse workforce to create great opportunities for our business and our people. Vesta Healthcare is an Equal Opportunity/Affirmative Action Employer. Candidates are selected without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.

At Vesta, we are constantly searching for the most dynamic and best talent to join our team with a mission of empowering caregivers in the home! If you are ever contacted by e-mail from any domain other than https://vestahealthcare.com, please do not respond, as there is a likelihood it could be a scam as it is not a legitimate Vesta email. You might see things from a similar domain address, but with a slight misspelling, for example. We have no responsibility for any communication that does not come from the https://vestahealthcare.com domain, and we strongly advise that you not provide information or respond if not from the legitimate Vesta domain. If you have any concerns that outreach might not be legitimate, please reach out to [email protected] for confirmation.

MEI Support Specialist

US-Remote

2023-32908

# of Openings: 2

Administrative

Employee Full-Time

Overview

Who we are…

Ciox Health merged with Datavant in 2021, creating the nation’s largest health data ecosystems, powering secure data connectivity on behalf of thousands of providers, payers, health data analytics companies, patient-facing applications, government agencies, research institutions and life science companies. The combined company is focused on improving patient outcomes and reducing costs by removing impediments to the secure exchange of health data. Ciox, a Datavant company will offer the ability to access, exchange, and connect data among the thousands of organizations in its ecosystem for use cases ranging from better clinical care and value-based payments to health analytics and medical research.

What we offer

At Ciox Health we offer all employees a place to grow and expand their current skills to create a career that you can be proud of. We offer you complete training and long-term career goals. Our environment is what most of our employees are the proudest of. Give us just a few moments to explain why we need you and hope you will help us change how the health Industry manages its’ medical records.

What we need

The MEI Support Specialist position serves as a key role within the Service Operation Division within Ciox. This position will support the Manager of Embedded Support (MEI) Team with performing daily administrative and clerical tasks that will enable the MEI and Service Operations teams to meet customer SLAs and to focus on critical client tasks. The position has specific responsibility for maintaining communication with MEI Leadership at a specific project level, to ensure the strategic plan is executed, as well as incorporating escalation as needed to facilitate completion of retrieval method identified.

Responsibilities

What You Will Do…

• Work closely with MEIs to understand project needs and assist with successful completion of same.
• Ensure timely delivery of reports to MEIs on a daily, weekly and/or monthly basis.
• Perform basic online research, move providers, create new Outreaches, Resolve SH Codes, Set Retrieval Methods, etc. within Ciox Chartfinder platform.
• Perform basic research in Ciox Healthsource platform.
• Log all transactions into the designated Ciox platform.
• Maintain accurate record keeping and data management
• Maintain an excel spreadsheet of daily work as directed.
• Other duties as assigned

Qualifications

What You Need…

• 6-12 months experience in a role similar to ROI medical record retrieval preferred
• Basic computer skills including Windows based applications (Excel and Outlook) and the ability to perform other basic computer functions.

To ensure the safety of patients and staff, many of our clients require post-offer health screenings and proof and/or completion of various vaccinations such as the flu shot, Tdap, COVID-19, etc. Any requests to be exempted from these requirements will be reviewed by Ciox Human Resources and determined on a case-by-case basis. Depending on the state in which you will be working, exemptions may be available on the basis of disability, medical contraindications to the vaccine or any of its components, pregnancy or pregnancy-related medical conditions, and/or religion.

For remote work, this position requires that you provide a high-speed internet connection, subject to applicable expense reimbursement requirements (if any), and a work environment free from distractions.

Title: Triage Registered Nurse (Nights)

Location: Remote

Type: Full-time

Workplace: remote JobDescription:

The Remote Triage Registered Nurse / RN supports patients and their families by providing clear, safe and effective telephone triage using evidence-based processes and tools. The Registered Nurse on this team will blend critical thinking skills with a decision support tool enabling safe, standardized care to our patient population.

Shift/Schedule:

Sunday-Thursday 7p-4a PST (Pacific Standard Timezone)

Essential Job Duties:

• Respond promptly to each incoming call and assist patients by providing standardized care and benefits navigation, while quickly developing a friendly, yet professional rapport over the phone
• Conduct a thorough clinical assessment of symptoms and confidently determine the appropriate level of care required to safely meet the patient s medical need, and refer them using established guidelines
• Follow standard procedures and protocols related to the triage service
• Educate and communicate recommendations to patients thoroughly in patient-friendly language
• Successfully route members to additional internal/external benefits and community resources, when needed
• Provides care based upon the Included Health Core Values
• Provides triage and support for urgent member prescription needs
• Serves as a central point of contact for all Included Health member emergency escalations
• Participate in team meetings and continuous quality improvement

Requirements:

• Bachelor of Science in Nursing required
• Registered Nurse, currently residing and licensed in a compact state with eligibility to obtain RN licensure in all 50 states
• 2+ years experience in a triage setting, preferably some of that experience being focused on phone triage, or 2+ years experience in an emergency room, or 4+ years experience in an ambulatory primary care role that included triage
• Ability to work in PST Timezone
• Rotating holiday and weekend rotation (every 3rd weekend for Full Time and every other weekend for Part Time)
• Expertise in advanced clinical decision making
• Comfortable working with a wide variety of medical conditions for both pediatric and adult populations
• Experience in engagement in complex decision making, including situations of uncertainty
• Excellent written and verbal communication skills. The ability to gather a clinical history, answer questions at a patient level, and succinctly summarize findings is critical.
• Strong competence and ability to use multiple computer/medical record systems, as well as Google suite
• Must be able to work efficiently. We are a fast growing company and we are busy. Our team is expected to meet role specific metrics without sacrificing quality. Good judgment for balancing priorities is a must.
• Maintain current nursing licensure by completing applications for renewal in a timely manner and by complying with all requirements for continuing education.

Other Skills/Abilities:

• Self-disciplined, energetic, passionate, innovative and flexible
• Must be able to work independently remotely and work well under stress
• A team player that can follow a system and protocol to achieve a common goal
• Demonstrates sound judgment, independent decision-making and problem-solving skills
• Maintain current nursing licensure by completing applications for renewal in a timely manner and by complying with all requirements for continuing education.
• Maintains professional demeanor and service-oriented patient focus to prioritize the patient experience
• Possess the ability to multitask, and using best judgement when to seek additional input from leadership

#LI-Remote

About Included Health

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It s all included. Learn more at includedhealth.com.

Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.

Manager, Coding

Location: Remote, United States

Surgical Notes is hiring for a Manager, Coding who is responsible for client management and managing the coding team. The ideal candidate has excellent organizational skills, communication skills, with the desire and ability to learn quickly. Working as a part of the team to meet deadlines, but also being able to work independently is crucial to the success in this position. Our organization prides itself on being built upon a set of strong core values. We are looking for candidate who will actively exhibit these core values: Service Excellence, Transparency, Teamwork, Accountability, Hardwork, and Positive Attitude.

Reports to: Director, Coding

Responsibilities:

• Client management, including emails, phone calls, and video meetings with client staff as well as physicians
• Aid clients in denial management and coding reviews
• Manage a coding team consisting of Team Leads and production coders
• Approve employee time and contractor payroll entries
• Provide training and ongoing education to coders
• Participate in meetings, trainings, and conferences as needed
• Other responsibilities as assigned

Role Information:

• Full-Time
• Salaried
• Exempt
• Eligible for Benefits
• Remote: The minimum bandwidth requirements are 10 Mbps upload and 50 Mbps download speeds. The recommended bandwidth requirements are 20 Mbps upload and 100 Mbps download speeds.

Job Requirements:

Required Knowledge, Skills, Abilities & Education:

• Coding certification through AAPC or AHIMA (CPC, COC, RHIT, CCS, etc., no apprentice designation)
• High school diploma or equivalent
• 5+ years of surgical coding experience (ASC or Same-Day Surgery)
• 3+ years management experience
• Extensive knowledge of medical terminology, anatomy, and physiology
• Ability to stay on task, working independently
• Must have a dedicated home office space with reliable high-speed internet (desktop computer will be provided)
• Experience managing a remote team
• ASC revenue cycle knowledge
• Presentation experience
• Ability to work independently and as part of a team
• Strong attention to detail and speed while working within tight deadlines
• Exceptional ability to follow oral and written instructions
• A high degree of flexibility and professionalism
• Excellent organizational skills
• Outstanding communications skills; both verbal and written

Preferred Knowledge, Skills, Abilities & Education:

• Bachelor’s Degree in healthcare related field
• 4-6 years management experience

Physical Demands:

• Sitting and typing for an extended period of time
• Reading from a computer screen for an extended period of time
• Speaking and listening on a telephone
• Working independently
• Frequent use of a computer and other office equipment
• Work environment of a traditional fast-paced and deadline-oriented office

Key Competencies:

• Leadership
• Job Knowledge/Technical Knowledge
• Communication
• Initiative/Execution
• Quality Control

Compensation Information

$57,600 – $72,000 based on skills and qualifications.

US Pay Ranges

$59,287.50—$71,493.75 USD

About Surgical Notes

Surgical Notes is the premier ASC revenue cycle management and billing services partner. Our expert teams with ASC-specific experience provide scalable billing, transcription, coding, and document management services and solutions that fully integrate with all leading ASC practice management systems. The largest management companies and hundreds of ASCs that partner with Surgical Notes experience and benefit from immediate operational and financial improvements that exceed industry performance levels.

Surgical Notes is an equal opportunity employer. We celebrate ersity and are committed to creating an inclusive environment for all employees.

Privacy Statement

We use the personal information collected for the purpose of processing job applications, evaluating candidates for employment, and/or carrying out and supporting HR functions and activities We may share your personal information in connection with, or during negotiations of, any merger, sales of Company assets, or acquisition of a portion or of all of our business to another company. If you have any questions regarding this California Job Applicant Privacy Notice or our privacy practices, please contact us at [email protected].

Title: Nurse Care Manager

Location: Remote

Company Description

This is an exciting opportunity in a fast-paced, growing digital health startup. The Clinic by Cleveland Clinic, a joint venture between Cleveland Clinic and Amwell, was launched in 2019 to unlock access to the world’s best healthcare expertise so no one is left behind. This startup company’s initial focus is transforming the $5 billion global second opinion market, with additional digital health solutions in development. The Clinic offers virtual care from Cleveland Clinic’s highly-specialized experts through Amwell’s leading-edge digital health technology platform. Learn more at www.theclinic.io.

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey.

Amwell is a leading telehealth platform in the U.S. and globally, connecting and enabling providers, insurers, patients, and innovators to deliver greater access to more affordable, higher quality care. Amwell solutions are used by 240 health systems and 55 health plan partners, covering over 150 million lives.

The position is remote. The role reports to the Director, Clinical Operations.

Brief Overview:

We are looking for an experienced and dynamic nurse committed to delivering empathetic, concierge services to our consumers of the Virtual Second Opinion Services. You will be responsible for establishing a relationship with patients via online/telephone intake through active listening and questioning process, documenting these encounters and providing instruction and creating an opinion timeline based on established protocol.

A strong background in an ambulatory, hospital or telehealth with the ability to function independently in an organized fashion managing a portfolio of patients through the virtual second opinion process is essential to success in this position.

Core Responsibilities:

• Responsible for establishing a relationship with patients and effectively triaging and providing care guidance and resolution to all contacts and patients.
• Assesses patient needs, determines and initiates appropriate action or response to meet identified needs.
• Assesses patient and physician needs, provides requested information and/or guidance or service as appropriate or forwards to the appropriate person on the clinical management team.
• Initiates and independently implements appropriate clinical activities, including communication with patient/caregiver, physician (as applicable) and complete documentation of events.
• Maintains consistent communication with patients.
• Assists, reviews, researches, and resolves active patient and referral concerns and complaints and records outcomes accordingly to meet regulatory compliance standards.
• Other duties as assigned.

Qualifications:

• Graduate of an accredited school of professional nursing. BSN preferred or other allied health professional degree.
• Current Ohio RN and/or multistate compact license
• Other Allied Health license
• Good clinical judgment, careful listening, critical thinking skills and assessment skills.
• Strong customer service skills, including both verbal and written communication skills.
• Strong computer skills
• Ability to be self-directed, excel in critical thinking and problem solving skills.
• Minimum of 2 years nursing or clinical experience (preferred in ambulatory, hospital, med/surg, long term care, home care, hospice or palliative care setting)
• Prior phone triage or telehealth services.
• Manual dexterity to operate office equipment. May require periods of sitting or standing for long periods of time.
• Requires good visual acuity through normal or corrected vision. Must be able to hear normal conversation. Must be able to lift at least 20 pounds.

Additional information

Working at The Clinic

This Clinic is a partnership between American Well and Cleveland Clinic, where the two parent organizations founded the company on the mission of To make it easier for patients to get the best care by aligning world-class clinical expertise with innovative digital technology.’ The vision for The Clinic is to unlock access to the world’s best healthcare expertise so no one is left behind. We are a group of visionaries defining and realizing the global possibilities of digital health. We believe in: patient centricity; being bold, daring, and decisive; having a passion to win; teamwork and collaboration; transparency and trust. The pace is fast, the work rewarding and the outcomes, deeply satisfying.

Benefits

• The Clinic offers a competitive benefits package that includes health, dental, and vision insurance, paid holidays, and paid vacation.

Compliance Team Assistant

remote type

Fully Remote

Allina Commons

Part time

Shift Length:

Hours Per Week:

32

Union Contract:

Non-Union

Weekend Rotation:

None

Job Summary:

Coordinates the day-to-day activities for office support and management, scheduling and staffing, and data management. Collaborates with leaders to address questions and resolve issues.

Key Position Details:

32 Hours a week-64 Hours in a pay period

4 Days/flexible day off

No Weekends

8:00AM-4:30PM

Remote Role

Job Description:

Principle Responsibilities

• Obtains information for insurance authorization
• Faxes information to companies as requested
• Follows up to obtain authorization responses
• Reports results to Care Manager and puts in computer
• Advises clinicians of need for Auth action/completion
• Ensures clinical is completed so data can be processed in a timely manner
• Tracks date status so Recert clinical are sent timely to MD as necessary.
• Runs and prepares quarterly insurance reports as directed.
• Maintains other reports as needed for the team
• Assists Supervisor in projects as needed

Job Requirements

• Must be 18 years of age with education and/or experience needed to meet required functional competencies as listed on the job description, and High school diploma or GED preferred
• Associate’s or Vocational degree preferred or
• Bachelor’s degree preferred
• 0 to 2 years healthcare/home care and/or hospice experience preferred and
• 0 to 2 years Strong customer service, office and computer skills preferred
• Certified Nursing Assistant (CNA), Licensed Practical Nurse (LPN) or Health Unit Coordinator (HUC) Certified Nursing Assistant (CNA, Licensed Practical Nurse (LPN) or Health Unit Coordinator (HUC) Upon Hire preferred

Functional Competencies

• Analytical Thinking: Practices investigative techniques to determine the best approach.
• Business Impact: Role has impact on the department.
• Collaboration: Develops partnerships with internal team members.
• Communication Skills: Able to communicate well in straight-forward situations.
• Problem Solving: Uses common sense to solve routine issues.

Physical Demands

Sedentary: Lifting weight Up to 10 lbs. occasionally, negligible weight frequently

Physician Coding Liaison II – Urgent Care

Remote

Full time

10395 Revenue Cycle – Coding & HIM Clinician Support

Status:Full time

Benefits Eligible:Yes

Hours Per Week:40

Schedule Details/Additional Information:First Shift

This is a REMOTE Opportunity

Major Responsibilities:

• Provides service line/specialty specific coding/documentation education and feedback related to coding changes (CPT including E&M, modifiers, ICD-10-CM, and HCPCS), annual code updates, payer requirements, and payer rejection resolution to assigned Physicians/APCs. Partners with CMOs to standardize coding processes across a specific specialty. Shares and/or presents coding/documentation education presentations to Chief Medical Officers (CMOs), Physicians/APCs, Senior Director Administrators across the organization. Coordinates with PSA Liaisons to provide adequate Physician/APC and/or clinical team member support.
• Conducts orientations for all Physicians/APCs, residents/students and clinical team members on specialty specific coding and documentation related education. Performs new clinician documentation reviews for specialty specific coding, and documentation feedback, as requested.
• Coordinates responses to Physicians/APCs, Locum Tenens, residents/student’s questions and feedback from various sources and partners, including Senior director administrators, CMOs, Medical Group Compliance, Internal Audit, Physician Compensation, Clinical Informatics/Clinical Informatics Educators, Quality Improvement Coordinators, and/or other external partners.
• Queries Physician/APC, Locum Tenens, residents/students when prompted by Professional Coding Department production coders to assist in resolving coding and documentation questions. Relays any coding changes, feedback, and education to Physician/APC, Locum Tenens, residents/students and/or clinic leadership, as appropriate.
• Monitors and works to resolve charge sessions requiring additional information for assigned clinicians and/or service line/specialty in the Epic work queues and/or other transfer work queues to ensure Clinicians are completing work timely to ensure proper supporting documentation for billing and timely filing.
• Attends and provides service line/specialty specific coding and documentation information, as requested, to CMOs, Physicians/APCs and/or Clinic/Site Department meetings. These may be virtually and/or in-person. Virtually attends Physician/APC education that include coding and/or documentation topics, such as Documentation Specialist clinician low risk review meetings, Risk Adjustment/HCC meetings, and/or Medical Group Compliance reviews/meetings.
• Collaborates with PSA Liaison to review and provide coding/documentation guidance on Epic order entry, diagnosis, and charge capture preference lists as well as SmartSets and templates.
• Develops Physician/APC monthly service line/specialty newsletters to continually educate and communicate updates from various coding resources including specialty society organizations. Communicates new services performed by Physician/APCs to Professional Coding department leadership.
• Identifies service line/specialty specific trending data and opportunities to capture revenue through documentation improvement. Attends service line/specialty specific coding and/or society conferences, as requested, to gain further knowledge that is uniquely relevant to that specialty and how coding, documentation, and billing are affected. Maintains expert knowledge of Medicare, Medicaid, and other regulatory requirements pertaining to nationally accepted coding policies and standards.

Licensure, Registration, and/or Certification Required:

• Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), or
• Coding Specialist – Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), or
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or
• Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), or
• Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC), and
• Specialty Medical Coding Certification issued by the American Academy of Professional Coders (AAPC) needs to be obtained within 1 year.

Education Required:

• Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist.

Experience Required

• Typically requires 5 years of experience in expert-level professional coding and least 3 years educating/training licensed clinicians.

Knowledge, Skills & Abilities Required:

• Specialty Medical Coding Certification must be held in the area(s) you will support.
• Excellent communication (oral and written), adult education, and interpersonal skills. Ability to develop rapport and maintain positive, professional partnerships primarily with employed Physicians, APCs, CMOs, Senior director administrators, Medical Group Operations, and physician coding team members.
• Advanced computer skills including the use of Microsoft office products, electronic mail, video/web conferencing, including exposure or experience with electronic coding and EHR systems or applications.
• Excellent/comprehensive skills in organization, prioritization, problem solving, facilitation skills as well as the ability to have meaningful, albeit, difficult conversations with CMOs/Physicians/APCs and/or Senior Director Administrators.
• Highly proficient in critical thinking and analytical skills with an extensive attention to detail.
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment.
• Ability to work in multiple work environments (ie virtual, office, clinic/hospital, other).

Physical Requirements and Working Conditions:

• Exposed to normal office environment.
• Position requires travel which will result in exposure to road and weather hazards.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Remote Pro Fee Coder (Denials Review)

Location: LOUISVILLE Kentucky; United States

Job Description & Requirements

Pay Rate: $26.00 – $34.00

TYPE OF JOB ORDER: Remote Pro Fee Coder (Denials Review)

REQUIRED SKILLS: 3- 5 Yrs.

Pro Fee Experience. Denials exp a plus

Academic Level -1 – IP and OP settings

#OF WEEKS: 20 + Weeks

SHIFT/HOURS: M-F Flexible hours

EXPECTED HOURS: 40

LICENSE/CRED. REQ: Prefer a CPC

SYSTEMS: 3M EPIC, Cerner

NOTES: Must be comfortable with Trauma 1 Academic Medical Centers, Remote Work Setting. Appeals and Denials Coding Specialist Profee (Physician-based). Within RCM Dept

Job Benefits

Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary but the perks don’t stop there. There are many additional benefits to enjoy, including:

• Medical, dental and vision benefits
• Earned time off and paid holidays
• Paid continuing education time
• 401(K) retirement planning
• Short-term disability, life insurance, paid jury duty
• Access to the largest network of facilities and providers in the country
• Industry experienced workforce management team
• Licensure and certification reimbursement

CERTIFIED CODER

REMOTE

• Molina Healthcare
• United States
• Job ID 2020989

Job Summary

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes
• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly
• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff
• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment
• Builds positive relationships between providers and Molina by providing coding assistance when necessary
• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education
• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies
• Contributes to team effort by accomplishing related results as needed
• Other duties as assigned
• 2 years previous coding experience
• Proficient in Microsoft Office Suite
• Ability to effectively interface with staff, clinicians, and management
• Excellent verbal and written communication skills
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers
• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)
• Certified Coding Specialist (CCS)

Preferred Education

Bachelor’s Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model
• Background in supporting risk adjustment management activities and clinical informatics
• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder – (CRC)
• Certified Professional Payer – Payer (CPC-P)
• Certified Coding Specialist – Physician based (CCS-P)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time

Coder II-Anesthesia

locations

Remote

time type

Full time

job requisition id

R82520

Department:

10271 Revenue Cycle – Professional Production Coding Specialty

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

First Shift

This is a REMOTE Opportun

Anesthesia experience preferred.

Major Responsibilities:

• Reviews medical documentation at a proficient level from clinicians, qualified health professionals and hospitals in order to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations an EMR and/or Computer Assisted Coding software.
• Adheres to the organization and departmental guidelines, policies and protocols.
• Reviews all clinician documentation to support assigned codes in the health information record so that all significant diagnoses and procedures may be captured for reimbursement and data purposes.
• Conduct independent research to promote knowledge of coding guidelines, regulatory policies and trends.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement.
• Maintains the confidentiality of patient records. Reports any perceived non-compliant practices to the coding leader or compliance officer.
• Meets then exceeds departmental quality and productivity standards.
• Recommend modifications to current policies and procedures as needed to coincide with government regulations.
• Responsible for processing Coding Claim Denials and Coding Claim Rejections, when applicable

Licensure, Registration, and/or Certification Required:

• Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), or
• Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), or
• Coding Specialist -Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA)

Education Required:

• Advanced training beyond High School in Medical Coding or related field (or equivalent knowledge)

Experience Required:

• Typically requires 3 years of experience in professional coding that includes experiences in either hospital or professional revenue cycle processes and health information workflows.

Knowledge, Skills & Abilities Required:

• Advanced knowledge of ICD, CPT and HCPCS coding guidelines. Advanced knowledge of medical terminology, anatomy and physiology.
• Intermediate computer skills including the use of Microsoft officeproducts, electronic mail, including exposure or experience with electronic coding systems or applications.
• Advanced communication (oral and written) and interpersonal skills.
• Advanced organization, prioritization, and reading comprehension skills.
• Advanced analytical skills, with a high attention to detail.
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment.
• Ability to take initiative and work collaboratively with others.

Physical Requirements and Working Conditions:

• Exposed to a normal office environment.
• Must be able to sit for extended periods of time.
• Must be able tocontinuously concentrate.
• Position may be required to travel to other sites; therefore, may be exposed to road and weather hazards.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Advocate Aurora Health is one of the 10th largest not-for-profit, integrated health systems in the U.S. with nearly 3 million patients served at more than 500 sites of care in Illinois and Wisconsin, including 28 hospitals. We’re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in a variety of specialties. Advocate Aurora Health is one of the 10th largest not-for-profit, integrated health systems in the U.S. with nearly 3 million patients served at more than 500 sites of care in Illinois and Wisconsin, including 28 hospitals. We’re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in a variety of specialties.

MEDICAL CODING SPECIALIST

WORK AT HOME

MultiPlan United States of America (Remote) Full-Time

Job Details

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company that helps our customers thrive by interpreting our client’s needs and tailoring innovative cost management solutions.

We are MultiPlan and we are where bright people come to shine!

JOB SUMMARY: The Medical Coding Specialist is responsible for providing billing analysis of claims and applying coding standards and federal regulations to ensure correct billing practices. In this role, you will perform bill and chart reviews in identifying any variation from quality of billing as well as monitor patient bills for accuracy and compliance.

JOB ROLES AND RESPONSIBILITIES:

1. Review and analyze inpatient, outpatient, and provider billing for medical appropriateness of treatment; analysis of charges of various revenue centers with consideration to patient diagnosis, procedures, age and facility type; and any additional information relevant to the negotiation process.
2. Apply recommendation of national coding and regulation standards to claims billed.
3. Prepare clear, concise and legible findings.
4. Research, review and provide internal response based on receipt of itemized bills, claims, operative notes and other documentation as needed.
5. Assist with, create or enhance internal claim and review recommendations.
6. Communicate with co-workers and management regarding clinical and reimbursement findings.
7. Assist with clinical education of staff as it relates to clinical aspects of claims, suggesting additional negotiation talking points or tools, and communicating overall industry or regulatory changes which affect the department.
8. Monitor, research, and summarize trends, coding practices, and regulatory changes.
9. Research and review inidual claims, claim trends or detailed itemized bills, operative notes and other documentation as needed.
10. Collaborate, coordinate, and communicate across disciplines and departments.
11. Ensure compliance with HIPAA regulations and requirements.
12. Demonstrate commitment to the Company’s core values.
13. Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
14. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Job Scope: This position works independently with general supervision in order to complete the outlined responsibilities. The incumbent balances several projects at a time and work is varied and complex. Complex issues are referred up to higher levels. The incumbent will use established procedures and uses knowledge of the Company’s general business principles, industry dynamics, market trends, and specific operational details when performing all aspects of the job.

The salary range for this position is $60,000-$75,000. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

Job Requirements:

JOB REQUIREMENTS (Education, Experience, and Training):

• Minimum completion of educational curriculum required of medical license or coding certification held with Bachelor’s Degree preferred; or minimum Bachelor’s Degree in healthcare related field and at least 2 years of coding experience.
• Current nursing certification and/or current certified coder (CCS, CCS-P or CPC), Registered Health Information Technician (RHIA/RHIT).
• Minimum 2 years experience in direct patient care, medical procedure billing, medical insurance auditing, line item review, audits, coding, and/or reimbursement.
• Knowledge of inpatient/outpatient hospital billing requirement including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD-9/10 diagnoses and procedure codes, DRG, APCs.
• Knowledge of professional claim billing requirements including HCFA­1500s, CPT codes and ICD-9/ICD-10 diagnoses codes.
• Knowledge of payer reimbursement policies, state and federal regulations, medical necessity criteria and applicable industry standards.
• Knowledge of commonly used medical data resources such as MDR, Medical Fees in the US, etc.
• Auditing and health information management experience in a healthcare setting preferred.
• Excellent communication (verbal and written), teamwork, training, presentation, negotiation and organizational skills.
• Ability to use hardware, software and peripherals related to job responsibilities, including MS Office Suite and database software.
• Ability to handle multiple tasks in a fast paced environment.
• Ability to read and abstract medical records.
• Knowledge of medical terminology, anatomy, and physiology.
• Ability to interact and discuss audit results with providers.
• Required licensures, professional certifications, and/or Board certifications as applicable.
• Inidual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

BENEFITS

We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

• Medical, dental and vision coverage with low deductible & copay
• Life insurance
• Short and long-term disability
• 401(k) + match
• Generous Paid Time Off
• Paid company holidays
• Tuition reimbursement
• Flexible Spending Account
• Employee Assistance Program
• Summer Hours

EEO STATEMENT

MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please

Job Snapshot

Employee Type

Full-Time

Location

United States of America (Remote)

Job Type

Health Care

Experience

Not Specified

Title: Inbound Engagement Specialist (Bilingual)

Location: Remote

Position Description:

This is a rare chance to have a significant personal impact in changing the lives of people and communities dealing with the effects of addiction. In this role, you are responsible for engaging with iniduals who may be struggling with substance use disorders and helping them understand the whole-person care and inidualized support that Eleanor Health provides. Through these interactions, you will lay the foundation of trust and understanding which lets them know that Eleanor Health is there for them when they need us. You will also help guide them to the appropriate Eleanor Health services if they choose to seek our help.

This role will report to Eleanor’s Access Team Supervisor

Candidate Responsibilities:

• Understand Eleanor Health’s care mode and be able to communicate it’s value in a clear, compassionate and non-judgmental way
• Understand how insurance works, including the plans our patients have, and be able to effectively verify insurance eligibility and communicate patient cost sharing responsibility
• Field inbound communications through various intake channels inquiring about the nature of Eleanor Health’s services, qualify patients for Eleanor Health’s care, and schedule them with the appropriate appointments in EMRs.
• Facilitate successful telehealth by performing virtual intakes, communicating with members to remind them about upcoming telehealth sessions and coaching them on accessing their sessions.
• Collaborate online with other care team members to facilitate the enrollment of new members to Eleanor Health, including making appointments, verifying insurances and collecting co-payments
• Outreach to iniduals identified as having Substance Use Disorders to establish a relationship and let them know about Eleanor Health’s services

You’ll be a good fit if you:

• Are Bilingual English/Spanish
• Have 3-4 years of customer facing experience, preferably in a healthcare setting, particularly behavioral health or substance use treatment
• Have experience working from home in a contact center environment, fielding a high number of calls each day
• Have experience and comfortable using technology such as computer telephony & EMR software to document patient interactions & schedule patients for appointments
• Have strong interpersonal communication skills, written communication skills, and active listening abilities
• Are highly empathetic, non-judgmental, open-minded and resilient
• Are able to build trust quickly and can translate complex concepts such as insurance and care into easily understood conversations that put potential patients at ease.
• Strong interpersonal and written communication skills, active listening abilities, and motivational interviewing skills
• Are highly motivated and self-directed with the ability to multitask between phone calls, documentation, and collaboration with other team members
• Enjoy working in a fast-paced, collaborate environment
• Our current hours are Monday – Friday from 8am-8pm EDT you must be available to work any shift during these hours

Benefits:

The total target compensation range for this position is $20-22 an hour. The actual compensation offered depends on a variety of factors, which may include, as applicable, the applicant’s qualifications for the position; years of relevant experience; specific and unique skills; level of education attained; certifications or other professional licenses held; other legitimate, non-discriminatory business factors specific to the position; and the geographic location in which the applicant lives and/or from which they will perform the job.

Eleanor Health offers a generous benefits package to full-time employees, which includes:

• Flexible time off that includes 80 annual hours of PTO accrued monthly + 10 wellness days granted on day 1 – unplug, relax, and recharge!
• 9 observed company holidays + 3 floating holidays- if you need a mental health day, celebrate a special holiday, or just want to take your birthday off and celebrate!
• Fully covered medical and dental insurance plan, with affordable vision coverage.– We are a health first company and we strive to make our plans affordable and accessible
• 401(k) plan with 3% match. We want our team members to be excited about their future and retirement
• Short-term disability- We understand that things happen, we want you to feel comfortable to take the time to recover. Fully paid by Eleanor!
• Long Term Disability – Picks up where Short Term Disability leaves off.
• Life Insurance – Both Eleanor and employee-paid options are available.
• Family Medical Leave- Eleanor Health’s Paid Family & Medical Leave ( PFML ) is designed to provide flexibility and financial peace of mind for approved family and medical reasons such as the birth, adoption, or fostering of a child, and for serious health conditions that they or a family member/significant other might be facing.
• Wellness Perks & Benefits- Mental Health is important to us and we want our employees to have the accessibility they deserve to talk things through, zen with a mindfulness app, or seek assistance from health advocates
  • Mindfulness App Reimbursement
  • 1 year subscription to TalkSpace
  • Paid Membership to Health Advocate, One Medical, and Teladoc

About Eleanor Health:

Eleanor Health is the first outpatient addiction and mental health provider delivering convenient and comprehensive care through a value-based payment structure. Committed to health and wellbeing without judgment, Eleanor Health is focused on delivering whole-person, comprehensive care to transform the quality, delivery, and accessibility of care for people affected by addiction.

To date, Eleanor Health operates multiple clinics and a fully virtual model statewide across Louisiana, Massachusetts, New Jersey, North Carolina, Ohio, Texas, Florida, and Washington, delivering care through population and value-based partnerships with Medicare, Medicaid, and employers.

If you are passionate about providing high quality, evidence based care for iniduals with substance use disorder through an innovative practice and about building a great business that makes a difference, Eleanor Health is an ideal opportunity for you. We seek highly skilled, motivated and compassionate iniduals who take responsibility and adapt quickly to change to join our deeply committed and collaborative team.

Job Types: Full-time

Title: Triage Unit Manager – Registered Nurse (RN) (NY/Compact License) (Remote)

Location: Remote US

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a startup with a simple mission: Delivering extraordinary outcomes by unlocking the power of caregivers. Caregivers are one of the largest, most untapped resources in the healthcare delivery system and are the unsung heroes of their care recipients. Yet despite their vital role, they are largely unsupported and invisible to the healthcare ecosystem.

At Vesta Healthcare, we enable people with personal assistance to thrive at home, in their community by assuring the people they rely on, their caregivers, have the resources, data, and support they need. We achieve this through a combination of analytics, technology, services, and deep healthcare expertise. Our analytics help identify and target the right people and populations. Our technology creates real-time connectivity and actionable data out of observations. Our services connect to real people who can help when needs arise, and our healthcare expertise helps us understand how we create value for both payers and providers.

Our program monitors in real-time, identifying issues before they become health events, and helping connect those in need with those who can help via technologies such as video, chat, and telephone. Our technology platform includes home-based mobile applications, a clinical dashboard, and data analytics on data not previously available to health professionals. We are disrupting a $109 billion industry and have recently closed our latest funding round with a blue-chip list of investors.

We’re looking to add to our team of experts who care deeply about our mission.

Our team is passionate, driven, collaborative, intellectually curious, and excited about the opportunity to transform our healthcare system. We’re inspired by caregivers and seek to create a platform that recognizes, utilizes and supports the vital role they play. We strive to continuously learn, explore, experiment and achieve results. We are here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids)

The ideal teammate would be

• A nursing leader who is passionate about caring for our members, teammates, and clients and can leverage technology to create new programs, systems, and processes to drive exceptional clinical team performance
• Someone who has a proven track record of using data to drive high quality and efficient clinical outcomes
• Someone who has experience with triage, telehealth, remote patient monitoring, and valuable based care of vulnerable populations
• Love learning and helping others learn: you’re excited to bring your wisdom and coach others, and you’re equally energized to learn from other’s experience (such as product managers, software engineers, and data scientists), and then continue improving how Vesta does care management as we learn more together
• Comfortable working in an ambiguous environment within an organization that is growing and changing quickly
• Enjoy moving back and forth between direct care management with members when needed to helping us build out a care management program
• Curious about changing regulations within the space and how they can be leveraged to create additional revenue streams

The ideal teammate would be able to:

• Provide leadership, coaching, and development to a team of nurses and eventually additional multidisciplinary iniduals performing triage
• Develop triage protocols following evidence based guidelines while helping patients stay healthy at home
• Develop and maintain strong relationships with our provider and vendor partners, identifying inefficiencies and creating and implementing process improvement to achieve member satisfaction and provider satisfaction
• Partner with Vesta’s data analytics team and clinical leadership to develop ongoing reporting and analysis to drive the efficiency, quality, and effectiveness of the clinical team and outcomes
• Participate in prioritization efforts and help shape the clinical roadmap
• Continue to push the boundaries of what technology can do to empower our caregivers and clinicians to improve health outcomesfor our patients
• Support the development of strategies to help scale the program. Assist in evaluating capacity planning, hiring, training, and measuring and managing productivity including creating operational metrics and benchmarks

Would you describe yourself as someone who has:

• Registered Nurse License with unrestricted license within NY and/or compact states with ability to obtain additional licenses within 1 month (required)
• 4+ years of nursing experience within acute care, triage, and/or RPM (required)
• 2+ years of experience leading/managing a clinical team overseeing several complex projects simultaneously (required)
• 3-4 years of experience working in an ER or Urgent Care (required)
• 2-3 years of experience managing a clinical team (required), ideally remotely (preferred)
• Bachelor’s degree from an accredited institution (preferred)
• Passionate about our mission to improve people’s lives
• Digital health or hybrid digital health experience (preferred)
• An ability and humility to roll up your sleeves
• Detail- and process-oriented, ability to context- and mode-switch easily, fast learner
• Excellent communication skills, combined with the ability to collaborate across functions and use available tools
• Self-driven, self-starter and excited to support new technology

In addition to amazing teammates, we also offer:

• Health, dental, and vision insurance with a choice of many different plans/costs partially subsidized by us
• Paid vacation
• Paid Sick/personal days
• 12 paid holidays
• One time reimbursement to set up your home office
• Monthly reimbursement for internet or other home office expenses
• Monthly gym reimbursement to be used for gyms, home equipment, online classes, etc
• Basic Life & AD&D, Short-term and Long-term Disability Benefits paid fully by us
• Voluntary benefits such as Pet, Home and Auto, Legal Insurance plus more
• Pre-tax Flex Spending/Dependent Care/Transit accounts
• 401k + match

Pay range is $110K-$130K based on experience. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

We look forward to speaking with you!

Vesta Healthcare is committed to leveraging the talent of a erse workforce to create great opportunities for our business and our people. Vesta Healthcare is an Equal Opportunity/Affirmative Action Employer. Candidates are selected without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.

Senior Clinical Trial Manager

Remote US

The Senior Clinical Trial Manager (Senior CTM) plays a key role in leading Glooko’s Clinical Research projects. The Senior CTM will manage existing clinical projects and should have specialist knowledge of applicable regulations, nationally and internationally as appropriate. The Senior CTM will provide operational management skills in the planning and execution of multiple studies.

Areas of Responsibility:

• Responsible for supporting external, internal, decentralized, and virtual clinical trials and registries.
• Responsible for ensuring clinical trials are conducted, recorded, and reported in accordance with the protocol, standard operating procedures (SOPs), ICH-GCP, and all applicable regulatory requirements.
• Leading operational aspects of clinical trials, including the development of study and source materials (SOPs, IRB forms, etc.).
• Supporting internal departmental quality compliance.

Core Responsibilities:

• Manage multiple ongoing clinical research studies.
• Coordinate clinical study materials, including scope definition documents, study procedure guidelines, informed consent forms, IRB submissions/approvals, monitoring plans and tools, case report forms, data management plans, safety plans, close-out plans, and clinical study reports.
• Responsible for developing and implementing training for study sites.
• Ensure compliance with SOPs and regulatory requirements (e.g., GCP and US and OUS guidelines).
• Work closely with the Customer Support, Product/Engineering, and Data Science teams to ensure the quality of clinical trials.
• Responsible for ensuring trials are ready for audit.
• Coordinate activities of associates and investigators to ensure compliance with protocol and overall clinical objectives.
• Participate in project and departmental team meetings.
• Participate in meetings with customers and partners as needed.
• Work closely with major device, pharma companies, and CROs to support external clinical research studies and Glooko’s Clinical Research Product Team, including clinical operations, data management, and auditors.
• Track and record safety concerns and adverse events/SAEs.
• Understand diabetes and comorbid conditions.

Qualifications and Requirements:

• Excited to work on a team that cares deeply about helping those living with chronic conditions.
• Advanced degree in a health-related field is preferred with 7+ years of experience in clinical trials.
• Clinical research certification from DIA, ACRP, or SOCRA is preferred.
• Experience with running decentralized or virtual trials using remote data collection tools like wearables, devices, smartphones.
• Strong knowledge of the clinical research process including working knowledge of all functional areas of clinical trials.
• Excellent organization and customer service skills and is comfortable communicating with key stakeholders internally and externally.
• Possess problem-solving skills, attention to detail, and resourcefulness; respect and responsibility are critical to success in this role.
• Broad understanding of applicable Good Clinical Practices (GCP), International Conference of Harmonization (ICH), and Code of Federal Regulations (CFR).
• Able to work independently to manage clinical tasks and deliverables to meet timelines with a customer service orientation.
• Strong interpersonal and communication skills across all levels of the organization.
• Ability to collaborate cross-functionally with internal and external key stakeholders including the clinical studies team, data management, clinical site investigators, global clinical, and other internal customers.
• Commitment to inidual and team success.
• Is responsive and approaches work with a bias for action. Will thrive in a fast-paced, changing environment with limited structure that requires flexibility, resourcefulness, efficiency, and communicate effectively in a remote environment.
• Travel for customer meetings and conferences may be required for up to 10%.

About Glooko:

There are over 420 million people in the world with diabetes and Glooko helps them, as well as their physicians and care team, manage the disease more easily and cost effectively. Glooko is the Unified Platform for Diabetes Management and provides an FDA cleared, HIPAA compliant Web and Mobile (iOS and Android) application for people with diabetes and the clinicians who treat them. The platform seamlessly unifies data from over 80 of the leading blood glucose meters, insulin pumps, continuous glucose monitors, activity trackers, and biometric devices to deliver insights that improve personal and clinical decision support.

Glooko’s mobile app and web dashboard enable patients to easily track and proactively manage all aspects of their diabetes care. Glooko’s Population Tracker and APIs offer diabetes-centric analytics and supply insightful reports, graphs and pattern-triggered notifications to patients, health systems, and payers. The Glooko platform also allows customers and third-party developers to create branded modules for Glooko users.

Launched in 2010, Glooko is funded and managed by visionary technologists and leaders in healthcare.

Glooko Benefits Include:

• Having a meaningful impact on people’s lives
• Competitive salary based on experience
• Pre-IPO stock incentives
• Full benefits: medical, dental, vision, and transportation incentives
• Annual reimbursement on fitness expenses (gym memberships, running shoes, yoga classes, etc.)
• 401(k) matching program
• Have a meaningful impact on people’s lives

Glooko provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, or disability. In addition to federal law requirements, Glooko complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Posted positions are not open to third party recruiters/agencies and unsolicited resume submissions will be considered free referrals.

Position: Events and Operations Associate

Location: Philadelphia, PA

Job Id: 1626

# of Openings: 1

Events and Operations Associate

Headquartered in Brisbane, CA, CareDx, Inc. is a leading precision medicine solutions company focused on the discovery, development, and commercialization of clinically differentiated, high-value healthcare solutions for transplant patients and caregivers. CareDx offers products, testing services, and digital healthcare solutions along the pre- and post-transplant patient journey, and is the leading provider of genomics-based information for transplant patients.

The Events and Operations Associate with support CareDx’ presence at various medical conferences and customer events including RFP execution, vendor evaluation, contract negotiation, and budget management. Additionally, the candidate will oversee the Healthcare professionals (HCP) business process and operational management, ensuring compliance, accurate data analysis, and documentation completion, while also supporting reporting and facilitation/training activities. This role is a US remote-based role with travel 20%.

Responsibilities:

Events Management (50% of time)

• Manage and execute CareDx’s presence at national, regional and local medical conferences, as well as CareDx-led customer events and internal meetings.
• Execute RFPs, venue sourcing and site selection for best fit locations; evaluate vendor services and venues according to industry standards and stakeholder requirements.
• Effectively manage contracts and hotels, venues, production, audio-visual, and food and beverage vendors.
• Produce pre-event communications (eg on-site materials), and post-event analysis to drive general improvement and efficiency recommendations.
• Manage event budgets including creating accurate budgets, tracking costs, initiating purchase orders &invoice approval, tracking spend against budget, and driving accountability for accurate budget reconciliation.

Business Process and Operational Management (50% of time)

• Manage contracts and agreements with healthcare professionals (HCP) and sponsorship agreements of healthcare organizations (HCO), ensuring compliance with relevant activities for certification.
• Oversee payment processes and ensure accurate & complete data analysis and documentation.
• Manage the purchase order process for payments to HCPs and HCOs based on agreed work agreements, including setting up contracts in the company’s system and monitoring expenses.
• Collaborate cross functionally to facilitate engagement process activities, ensure compliance and provide process improvement feedback.
• Review and verification of aggregate spend data to ensure accuracy and completeness as required per Stark Law tracking process.
• Other duties as assigned.

Qualifications:

• 3+ years of related experience in event management, hospitality, or related fields with exposure to executives
• Bachelors degree or equivalent experience
• Ability and flexibility to travel and perform weekend work, as needed for the position (20% of time)
• Experience working in highly regulated environment, pharmaceutical/Medical Device experience preferred.
• Strong interpersonal skills, including written and verbal communication skills, collaboration, and empathy with stakeholders
• Ability to project manage, including effective management of cross-functional teams and adherence to project timelines
• Recent experience working with Microsoft Office applications.

Additional Details:

Every inidual at CareDx has a direct impact on our collective mission to improve the lives of organ transplant patients worldwide. We believe in taking great care of our people, so they take even greater care of our patients.

Our competitive Total Rewards package includes:

• Competitive base salary and incentive compensation
• Health and welfare benefits including a gym reimbursement program
• 401(k) savings plan match
• Employee Stock Purchase Plan
• Pre-tax commuter benefits
• And more!

In addition, we have a Living Donor Employee Recovery Policy that allows up to 30 days of paid leave annually to a full-time employee who makes the selfless act of donating an organ or bone marrow.

With products that are making a difference in the lives of transplant patients today and a promising pipeline for the future, it’s an exciting time to be part of the CareDx team. Join us in partnering with transplant patients to transform our future together.

CareDx, Inc. is an Equal Opportunity Employer and participates in the E-Verify program.

By proceeding with our application and submitting your information, you acknowledge that you have read our U.S. Personnel Privacy Notice and consent to receive email communication from CareDx.

******** We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.

Title: Inpatient Coder

Remote

C: 13.54

Contract

The Judge Group is currently hiring fully remote inpatient coders.

Job Duties

• Identify appropriate assignment of ICD-10-CM and ICD-10-PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC/MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
• Abstract additional data elements during the Chart Review process when coding, as needed.
• Adhere to and maintain required levels of performance in both coding quality and productivity as established by
• Provide documentation feedback to providers and query physicians when appropriate Participate in coding department meetings and educational events.

Required Experience:

• High school diploma or equivalent required.
• 3+ years of Inpatient medical coding experience (hospital, facility, etc.)
• Professional coder certification from AHIMA and/or AAPC
• DRG coding experience

Nurse Health Specialist, Virtual Care Center

Location: Remote-US, California US

Job Number: 5995

Remote-US,California

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

RN Health Specialist, VCC

Position Summary:

Provides triaging service for patients who call into the virtual care center. Expected to escalate patient calls to APC when appropriate. Responsible for managing patient care and treatment in collaboration with the Physician and Nurse Practitioner/Physician Assistant.

General Duties/Responsibilities:

(May include but are not limited to)

• Answering all in bound calls into the virtual care center
• Expected to use clinical judgement to address patient concerns
• Collaborates with primary care physician, Extensivist, and Nurse Practitioner/PA, and Case Manager to develop care plan for members. For non care anywhere patients
• Conduct outbound calls and virtual visits to complete patient follow up
• Daily review of vitals for patients enrolled in remote patient monitoring program
• Support disease management referrals
• Interprets and evaluates diagnostic tests to identify and assess patients’ clinical problems and health care needs.
• Educates members on topics such as disease process, end of life, medication, and compliance.
• Discusses case with physician/Nurse Practitioner/PA when appropriate.
• Use of Electronic Medical Records required.

Minimum Requirements:

To perform this job successfully, an inidual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable iniduals with disabilities to perform the essential functions.

1. Minimum Experience:
2. Knowledge of clinical standards of care
3. Minimum 1 year experience as an RN
4. Education/Licensure:
5. Requires successful completion of an accredited Nursing Program; BSN preferred, Registered Nurse preferred
6. Current, unrestricted license in the state for which you are applying
7. Must have CPR certification
8. Other:
9. Experience in gerontology, adult care, preferred
10. Experience in palliative/hospice and complex care management, preferred
11. Experience in Home Health including wound care, preferred
12. Knowledge of Medicare Managed Care Plans, preferred
13. Excellent administrative, organizational and verbal skills
14. Effective communication skills with seniors
15. Computer literate and able to navigate the internet
16. Ability to work independently
17. Detail oriented
18. Dependable and reliable
19. EMR experience is strongly preferred
20. Bilingual skills valued (Spanish preferred)
21. Must be flexible with schedule position is active 24 hours 7 days a week
22. Work Environment:
23. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable iniduals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable iniduals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Alignment requires all new hires to follow local and/or state requirements regarding the COVID-19 vaccine and booster. If applicable, proof of vaccination and booster will be required as a condition of employment subject to legal exemptions. This policy, which Alignment reserves the right to modify, is part of Alignment’s ongoing efforts to ensure the safety and well-being of its staff and community and to support public health efforts.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for ersity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where iniduals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].

Title: Remote Inpatient Claims Edit Medical Coder

Location: United States

Full-Time

Job Details

Description

Position Summary:

This is a remote coding position. As an experienced IP/OP Claims Edit coder you will be responsible for providing coding and abstracting services for clients IP/OP records using ICD-10 CM/PCS and CPT/HCPCS coding systems. You will use established coding principles, software and your knowledge and experience to assign diagnostic and procedural codes after a thorough review of the medical record.

The coding editor will be responsible for correcting and final coding accounts. These accounts are primarily outpatient to inpatient patient class change accounts. Work will include:

• Checking diagnosis codes when appropriate
• Adding POA indicators on diagnoses
• Coding within the encoder to determine a DRG for inpatient stay
• Approving and completing OP to IP accounts
• Medical necessity clarification
• Reviewing denied claims
• Performing observation charge reviews
• Review/correcting account errors for final bill
• Reviewing modifiers/bundling/unbundling of accounts/edits

Essential Functions:

-Reviews medical records to identify pertinent diagnoses and procedures relative to the patient’s health care encounter.

-Selects the principal diagnosis and principal procedure, along with other diagnoses and procedures using UHDDS definition.

-Ensures appropriate DRG assignment.

-Abstracts appropriate information from the medical record based on the guidelines provided by the client and after a thorough review of the medical record.

-Solicits clarification from the physician regarding ambiguous or conflicting documentation in the medical record using guidelines provided by the client.

-Maintains current knowledge of the information contained in the Coding Clinic, CPT Assistant, and the Official Guidelines for Coding and Reporting.

Requirements:

-Strong working knowledge of inpatient claim edits

-EPIC & 3M experience preferred

-Must have a minimum of 3 years of IP claim edits experience; 5-7 years preferred.

-Some understanding of laboratory CPT codes

-Understands medical terminology, anatomy, physiology, surgical technology, pharmacology and disease processes.

-Extensive knowledge of ICD-10 CM/PCS and CPT/HCPCS coding principles and guidelines, reimbursement systems, federal, state and payor-specific regulations and policies pertaining to documentation, coding and billing.

-Must pass coding proficiency test.

Why Work for Aquity? We offer competitive benefits such as:

-Competitive salary

-Three weeks of paid time off (120 hours) annually

-Seven paid holidays annually

-Job related education reimbursement, CEU and credentials

-Opportunity to work remotely and can work flexible hours contingent on clients needs.

Qualifications

Experience

Required

3 years: Experience with E-request, Meditech, HPF.

3 years: At least 3 years of IP facility coding experience as well as experience with IP claim edits.

Licenses & Certifications

Required

Regd. Health Info Tech

Cert. Coding Specialist

Preferred

Regd. Health Info Admin

HIM Coder III – Inpatient (Fully Remote)

Remote Location

Full time

227844

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

We all have the power to help, heal and change lives beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

Location Cleveland

Facility Remote Location

Department HIM Coding-Finance

Job Code U99927

Shift Days

Schedule 8:00am-4:30pm

Job Summary

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

The Coder III position is dedicated to either hospital inpatient or hospital outpatient coding. Codes and abstracts clinical information from inpatient or outpatient charts for the purpose of reimbursement, research, and compliance with federal regulations and other agencies utilizing established coding principles and protocols. Inpatient: Identifies, reviews, and assigns complex ICD-10-CM codes, PCS, POA and PSI indicators for inpatient charts.

Outpatient: Identifies, reviews, and assigns complex ICD-10-CM codes and CPT for ambulatory surgery and observation charts.

The ideal caregiver is someone who:

• Has excellent critical thinking skills.
• Has EPIC experience.

Our HIM Coder III’s have the opportunity to advance to Coding Reimbursement Coordinators (CRC’s), Auditors and Supervisors based on background and coding knowledge. We have a dedicated education team that provides monthly education and CEUs for AHIMA and AAPC credential holders.

At Cleveland Clinic, we know what matters most. That’s why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you’ll find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future.

When you join Cleveland Clinic, you’ll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare.

Job Details

Responsibilities:

• Clarifies complex discrepancies in documentation and coding and assures accurate ICD-10-CM and PCS coding/abstracting assignment for inpatient to expedite the billing process and to facilitate data retrieval for physician access and ongoing patient care.
• Follows up on complex coding of medical records as a result of internal or external reviews which have identified Coding or DRG discrepancies.
• Supports special studies in relation to coding and abstracting information according to policies and procedures.
• Maintains knowledge and skills via written coding resources, clinical information, videos, etc.
• Meets or exceeds productivity and quality standards and established department benchmarks.
• Extracts pertinent information from clinical notes, operative notes, radiology reports, laboratory reports, (including Pathology), procedure records, specialty forms, etc.
• Determines complex code assignment pertinent to diagnostic workups, surgical techniques, advanced technology and special services.
• Identifies medical and surgical complications and untoward events for accurate MS-DRG / APR-DRG for inpatient charts or APC assignment for outpatient charts.
• Other duties as assigned.

Education:

• High School Diploma is required.

Certifications:

• Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) is required and must be maintained. The Certified Outpatient Coder (COC) by American Academy of Professional Coders will be considered for the outpatient Coder III role.

Complexity of Work:

• Coding assessment relevant to the work may be required.
• Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision.

Work Experience:

• A minimum of two years of experience abstracting, identifying, reviewing, and assigning complex ICD-10-CM, PCS codes, POA and PSI indicators, surgical complications for inpatient charts or CPT for outpatient charts is required.
• Successful completion of the Cleveland Clinic Coder Trainee Program with a focus on moderately complex cases may offset the experience requirement.

Physical Requirements:

• Ability to perform work in a stationary position for extended periods.
• Ability to travel throughout the hospital system.
• Ability to work with physical records, such as retrieving and filing them.
• Ability to operate a computer and other office equipment.
• Ability to communicate and exchange accurate information.
• In some locations, ability to move up to 25 lbs.

Personal Protective Equipment:

• Follows Standard Precautions using personal protective equipment.

Nurse Case Manager

remote type

Hybrid

locations

United States – Remote

time type

Full time

job requisition id

R2313945

You are a driven and motivated problem solver ready to pursue meaningful work. You strive to make an impact every day & not only at work, but in your personal life and community too. If that sounds like you, then you’ve landed in the right place.

As Nurse Case Manager, we seek to improve on our patients’ abilities! This position is part of a dynamic, fast-paced team of experienced Nurse Case Manager located remotely across the United States. The ideal candidate for the Nurse Case Manager role will oversee Workers’ Compensation claims with complex medical conditions referred for medical assessment, clarification of limitations/restrictions or case management. On average, a Nurse Case Manager shall manage 50-60 cases with a moderate degree of complexity and acuity of medical condition. This inidual will have the opportunity to collaborate with claims staff, the injured worker, an employer, and other healthcare professionals to promote quality medical care with a focus on returning our patients back to work. Our goal is to achieve optimum, cost-effective medical and vocational outcomes.

RESPONSIBILITIES:

• Through the use of clinical tools, telephonic interviews, and clinical information/data, completes assessments that will take into account information from various sources to address all conditions including biopsychosocial, co-morbid and multiple diagnoses that impact recovery and return to work.
• Leverages critical thinking, extensive clinical knowledge, experience, and skills in a collaborative process to develop a comprehensive strategy for the injured worker to become medically stable and/or return to work.
• Independently identifies complex situations where communication with internal and/or external partners is needed to reach a full understanding of the factors involved with the assessment of the mechanism of injury, causality, and ability to return to work.
• Application, Interpretation and Compliance with clinical criteria and guidelines, applicable policies and procedures, regulatory standards, and jurisdictional guidelines to determine eligibility and integration with available internal/external resources and programs.
• Using holistic approach to focus on medical and ability management activities resulting in accurate and timely treatment and return to work.
• Consults with supervisor and others to address and problem solve barriers to meeting goals and objectives, participate in roundtables and claim meetings with claim partners to focus and benefit overall claim management.

QUALIFICATIONS:

• RN with current unrestricted state licensure required.
• Associate degree in Nursing required.
• 3 years clinical practice experience required.
• Bachelor’s degree in nursing preferred, but not required.
• Certification as a CCM (CDMS, CRC, CVE and/or current CRRN), or willingness to pursue.
• Workers Compensation case management experience preferred.

Key Competencies:

• Basic Computer proficiency (Microsoft Office Products including Word, Outlook, Excel, Power Point); which includes navigating multiple systems.
• Ability to effectively communicate telephonically and in written form.
• Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer.
• Work requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor.
• Ability to synthesize large volumes of medical records & facilitate multi-point care coordination.
• Must meet productivity & quality expectations.
• Ability to organize and prioritize daily work independently and effectively.

Additional Competencies:

• Strategic thinking
• Customer focus
• Business knowledge
• Problem solving
• Collaboration – partnership
• Decision making skills
• Communication skills

Additional Information:

*This role can be Hybrid or Remote as aligned with the Hartford’s Return to Office initiative:

• Hybrid: If you live within 25 miles an office, you will work in office at least 2 days a week
• Remote: If beyond 25 miles from an office, this role will be 100% Remote, with the expectation of occasional in-office presence as business needs dictate.

For full-time, occasional, part-time, or remote positions: (1) high speed broadband internet service is required, we do not recommend or support DSL, wireless, Mifi, Hotspots, Fiber without a modem and Satellite; (2) Internet provider supplied modem/router/gateway is hardwired to the Hartford issued computer with an ethernet cable; and (3) minimum upload/download speeds of 5Mbps/30Mbps will be required. To confirm whether your Internet system has sufficient speeds, please visit http://www.speedtest.net from your personal computer.

Compensation

The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford’s total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:

$66,000 – $99,000

Equal Opportunity Employer/Females/Minorities/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age

About Us | Culture & Employee Insights | Diversity, Equity and Inclusion | Benefits

Medical Case Manager – CT08GE

About Us

Human achievement is at the heart of what we do.

We believe that with the right encouragement and support, people are capable of achieving amazing things.

We put our belief into action by ensuring iniduals and businesses are well protected, and by going even further – making an impact in ways that go beyond an insurance policy.

Nearly 19,000 employees use their unique talents in careers that span a variety of disciplines – from developing the latest technology to creating and promoting our products to evaluating future financial risks.

We’re also committed to programs that drive education and support volunteerism, which put human beings first. We do it because it’s the right thing to do, and because when our customers, communities and employees succeed, we all do.

Nurse Advocate

REMOTE

CANDIDATE EXPERIENCE

FULL-TIME (REMOTE)

REMOTE

What is Trusted Health?

Trusted, Inc. is the leading digital labor marketplace and workforce management solution for the healthcare industry. We are headquartered in San Francisco but we’ve taken a digital-first approach to building our workforce and the majority of our team resides across the US and abroad.

Trusted was founded in 2017 with a focus on the largest profession in healthcare: nursing. Since then, we’ve taken a process dominated by recruiters and phone calls and converted it to a fully digital experience, connecting nurses directly to job opportunities and handling benefits, payroll, onboarding, and compliance. Our platform provides full employer of record services for employers in all 50 states and the District of Columbia.

In 2020, we launched our proprietary staffing platform, Works. Works helps hospitals solve one of their biggest challenges: filling every shift in an environment where demand for healthcare services and labor costs are increasing exponentially. With Works, facilities can create their own on-demand nursing workforce and manage all the details from a single system. Using predictive insights and recommendations, Works helps hospitals react to fluctuations in demand, while its staffing marketplace creates competition to fill open job requisitions with high-quality, active talent.

Trusted has support from top institutional investors such as Craft Ventures, Felicis Ventures, StepStone Group, and Founder Collective, as well as healthcare innovators like Texas Medical Center, Mercy Health, Intermountain Ventures, Town Hall Ventures, and Healthbox. Most recently we closed a $149 million Series C round to fund our next stage of growth.

What we’re looking for:

We’re seeking a nurse who is not only passionate about embarking on a unique transition to Trusted, but also possesses a strategic approach to work that is focused on customer service, sales and negotiation skills. You are self-motivated, learn quickly, and take initiative, routinely demonstrating a positive attitude and doing whatever it takes to get the job done. You adapt easily when faced with adversity, seizing at any opportunity to take on a challenge or problem to solve. Your curiosity, innovative mindset, and drive to push yourself and others’ to show up as the best version of yourselves each day makes you a natural leader and contributor to the greater good of the team.

You have a natural enthusiasm and ability to connect with clinicians to get them excited about working with Trusted. Your unique relatability to the clinicians on our platform will foster relationships that build trust, ensure our clinicians feel informed as to why Trusted is different, and consistently leave them feeling excited, energized, and inspired to work with us many times during their career journey in healthcare.

You will be adaptable to frequent changes in our processes and have an innovative mindset that contributes valued feedback to optimize our workflows. Your willingness to lean into challenges while preserving an optimistic perspective is an empowering and uplifting contribution to the team culture. Your clinical insight, communication expertise, and clinician-first outlook will supplement our technology to provide the best experience possible for clinicians as you help them navigate their job search, landing them their dream job with Trusted time and time again.

Your responsibilities

• • Quickly connect and foster strong relationships with clinicians while ensuring they feel excited and understand how Trusted works and what to expect throughout their journey
  • Placing candidates in jobs: Job Search Win Rate + Rebooking Rate + Conversions utilizing outreach points
  • Utilize clinical insight and expertise to supplement the Trusted matching and qualification process to recognize opportunities for advocacy and ensure clinicians are qualified and competent for their desired roles, being tactical as they move through our job funnel
  • Effectively educate clinicians on the unique aspects of the Trusted process and autonomy in navigating their career in order to foster a collaborative and successful partnership throughout the job search process
  • Consistently engage with clinicians throughout their job search, understanding their intent so you can strategically advocate for an outcome that aligns with their desires. Continue engagement throughout their working staff period, to keep them working with us through extension or through a new placement
  • Strategically coordinate with teammates to help clinicians move quickly through the job search funnel to placement
  • Contribute to the team culture in a positive way and regularly surface feedback in a productive manner that has an impact on the growth and success of the organization
  • Ability to cover the Emergency phone line (after hours) about 4 days per quarter

Who you are

• • Communicator. You have a natural passion and way of connecting with others. Your tone is genuine and friendly, encompassing empathy while exuding confidence and clarity. You are engaging, ensuring you gauge others’ intent and understanding by asking open-ended questions. When faced with difficult conversations, you remain poised, respectful, and provide clear direction or next steps – always leaving the listener feeling supported and cared for. You are able to teach, tailor, and take control in conversations with clinicians, and use your experience in negotiation and sales to advocate for the right job for the clinician.
  • Contributor. You’re genuinely a team player, striving to help and support your fellow teammates in their work to contribute to overall team success. You identify and push for solutions, habitually keep others’ informed, sharing your own knowledge and expertise to drive the team forward through continuous improvement. You go above and beyond what’s expected of you without being asked, seek out ways to take on additional responsibilities and exude a sincere positive attitude towards getting things done.
  • Resilient. Like other early-stage startup companies, Trusted moves at a very fast pace encountering a wide variety of both challenging and rewarding situations each day. It’s very important that you are able to separate the emotions that derive from the stresses of the job versus what needs to be done each day to drive successful outcomes necessary for your job. As every day is an opportunity for growth, you search for and handle feedback productively and immediately are able to put it into action. You are self aware and are able to regulate your own thoughts, actions and emotions, coping especially well in times of high stress. Your mental agility and aptness to maintain an optimistic perspective, enable you to bounce back quickly from a failure or challenge. You demonstrate a constructive approach to conflict, engaging in a calm, forthright and direct way.
  • Self-motivated. You act with speed and accuracy. Working for an early-stage startup is exciting to you and you thrive when there is a little bit of ambiguity in the air. You’re excited about picking up new things and you think learning curves are more like runways. You understand that getting started is always the first step in and don’t hesitate to do so. You thrive in fast-paced environments, feed off growth, and are motivated by the energy of others. You don’t wait for direction, you seize the opportunity and want to be on a team that thinks the same way.

You have

• • 3+ years of experience in a clinical setting; charge and/or preceptor experience are a plus and an active nursing license; travel experience is a plus
  • Experience in sales or recruitment preferred
  • Experience in tech and/or high-growth customer focused start up highly preferred
  • Highly organized and able to manage many relationships, issues, and projects simultaneously
  • Customer / patient service and relations, including conflict management, resolution and de-escalation
  • Knowledge of clinical practice across various specialties and care settings to ensure Candidates’ success on-assignment and promote retention
  • A high level of comfort and ease learning and managing different technology systems
  • Extensive practice with time management, critical thinking, and decision making in a fast-paced and dynamic setting

We offer

• • Paid vacation & sick time, paid family leave, and flexible work hours
  • Employer-paid health insurance, vision, and dental
  • Employer-paid life insurance
  • Mindfulness and fitness reimbursement
  • Monthly cell phone reimbursement
  • Employer-sponsored 401k

$65,000 – $72,000 a year

Trusted reasonably anticipates the salary range for this role to be $65,000-$72,000 annually, plus bonus and equity. The final compensation for this position will vary based on geographic location and candidate experience relative to what Trusted reasonably anticipates for this position. We are committed to transparency, and any compensation questions will be addressed early in our recruitment process.

#LI-Remote #LI-EK1

Travel Nurse Recruiter, Long Term Care

at Aya Healthcare (View all jobs)

Remote, US

Join Aya Healthcare, winner of multiple Top Workplace awards!

The Recruiter will cultivate relationships with healthcare professionals interested in travel career opportunities within the long term care service line. He or she will provide the best possible experience for our travel healthcare professionals through initiating contact, maintaining exceptional rapport and providing extraordinary customer service.

WHO WE ARE:

We’re a $10+ billion, rapidly growing workforce solutions provider in the healthcare industry. We deliver tech-enabled services that help healthcare organizations meet and manage their contingent labor needs. We build and manage tech-enabled marketplaces for national and local healthcare talent and deliver contingent labor management solutions through our proprietary software platform.

At Aya, we’re obsessed with creating exceptional experiences for our clients, clinicians and employees. In fact, we put employee satisfaction above all else. Our team members are responsible for incomparable customer experience and we know that happy employees are critical to maintaining happy clients. We foster an entrepreneurial, high-energy, low-bureaucracy culture and value innovative thinking and creative problem solving. We embrace ersity in thought and backgrounds unified by a commitment to high achievement. When you join Aya, you’ll be surrounded by teammates who care about you as an inidual and leaders who will help you grow both personally and professionally.

RESPONSIBILITIES:

• Identify and recruit qualified healthcare professionals for short-term career assignments for long term care facilities
• Proactively contact and recruit prospective candidates to establish relationships, understand their needs and qualify them for job opportunities
• Educate prospective candidates on the personal and professional benefits of a temporary healthcare career move
• Generate leads through various recruiting channels, strategic planning and referrals
• Build and maintain unique relationships with travel healthcare professionals
• Strive for continuous improvement and career advancement
• Strong motivation to achieve results and meet recruiting goals
• Ability to work in fast-paced environment and maintain a sense of urgency
• Client-centered mentality and passion for customer service

REQUIRED QUALIFICATIONS:

• Bachelor’s Degree
• MUST have a minimum 1 year of proven success in a metrics driven sales or recruitment environment
• Obsessed with creating great experiences for travel healthcare professionals
• Outside the box thinkers
• Career oriented with a desire for advancement
• Enthusiastic about being part of an recruiting organization that recognizes your talent

WHAT WE OFFER:

• Free premium medical, dental, life and vision insurance
• Generous 401(k) match
• Aya also offers other benefits to those that are eligibleand where required by applicable law, including reimbursementsand discretionary bonuses
• Aya provides paid sick leave in accordance with all applicable state, federal, and local laws. Aya’s general sick leave policy is that employees accrue one hour of paid sick leave for every 30 hours worked. However, to the extent any provisions of the statement above conflict with any applicable paid sick leave laws, the applicable paid sick leave laws are controlling
• Celebrations! We hit our goals and reward ourselves.
• Company-sponsored virtual events, happy hours and team-building activities are always on the horizon plus, you get a special treat on your birthday!
• UnlimitedDTO we believe in time off!
• Virtual yoga, meditation or boot camp classes offered daily

COMPENSATION: Aya reasonably anticipates the pay scale for this position to be $70,000 starting annually, plus commissions.

The pay scale for this position may vary if applicant possesses experience outside of what Aya reasonably anticipates for this position. Bonuses are subject to the role and your manager’s discretion.

Aya is an Equal Opportunity Employer (EEO), including Disability / Vets,and welcomes all to apply. Please clickherefor our EEO policy.

Outpatient Coder III

Job ID

2023-129379

Department

HIM Outpatient Coding

Site

HMH Hospitals Corporation

Job Location

US-NJ-Hackensack

Position Type

Full Time with Benefits

Standard Hours Per Week

40

Shift

Day

Shift Hours

Day Shift

Weekend Work

Every Other Weekend

On Call Work

No On-Call Required

Holiday Work

As Needed

Overview

Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better – advancing our mission to transform healthcare and serve as a leader of positive change.

The Outpatient Coder III is responsible for accurately abstracting data following the Official International Classification of Diseases (ICD)-10-Clinical Modification (CM), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) Guidelines for Coding and Centers for Medicare and Medicaid Services (CMS) directives across Hackensack Meridian Health (HMH) network. Performs data entry of required abstracted patient information into the electronic medical record system. Queries physicians when appropriate.

This is a fully remote position.

Responsibilities

A day in the life of an Outpatient Coder III includes:

• Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines and coding conventions.
• Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
• Analyzes medical records and identifies documentation deficiencies.
• Reviews and verifies documentation supports existing diagnoses, procedures and other charges.
• Identifies reportable elements, complications, and other quality measures.
• Communicates with physicians to clarify information via the physician query process
• Assign CPT, HCPCS and ICD-10-CM codes.
• Knowledge of and ability to address National Correct Coding Initiative (NCCI) and National Coverage Determinations (NCD) / Local coverage determinations (LCD) edits.
• Maintains required productivity and quality requirements.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• High School Diploma or higher.
• Minimum of 2+ years of coding experience, Trauma Level 1 and Academic Teaching facility.
• Strong understanding of physiology, medical terms and anatomy.
• Proficiency in computer skills including typing speed and accuracy.
• Excellent written and verbal communication skills.
• Proficient computer skills including but not limited to Microsoft Office and Google Suite platforms.
• Proficient in coding Observation and Procedure Room such as Endoscopies and Cardiac Cath.
• Proficient in coding Emergency Department and Infusion based services such as Oncology.
• Proficient in coding Ancillary Accounts such as Diagnostic Radiology and Cardiology.

Licenses and Certifications Required:

• An approved American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) coding credential.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

Title: Full Time NY Licensed Bilingual Triage Nurse Practitioner (NP) (Remote) (English/Spanish)

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a Series B startup with a simple mission: Delivering extraordinary outcomes by unlocking the power of caregivers. We enable people with personal assistance to thrive at home, in their community by assuring their caregivers have the resources, data, and support they need. We achieve this through a combination of analytics, technology, services, and deep healthcare expertise.

Our program monitors in real-time, identifying issues before they become health events, and helping connect those in need with those who can help via technologies such as video, chat, and telephone. Our technology platform includes home-based mobile applications, a clinical dashboard, and data analytics on data not previously available to health professionals. We are disrupting a $109 billion industry and have recently closed our latest funding round with a blue-chip list of investors.

We’re looking to add to our team of experts who care deeply about our mission.

Our team is passionate, driven, collaborative, intellectually curious, and excited about the opportunity to transform our healthcare system. We’re inspired by caregivers and seek to create a platform that recognizes, utilizes and supports the vital role they play. We strive to continuously learn, explore, experiment and achieve results. We are here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids)

The ideal teammate would be…

A person who’s passionate about working closely with a clinical team to ensure the best clinical outcomes for those we serve. A person who enjoys a fast paced clinical environment, performing telephonic and virtual visits related to proactive chronic care management, remote patient monitoring, and/or resolving more urgent clinical issues quickly. Lastly, someone who aspires to work with a company who is on the leading edge of community health working with partners to allow our elderly to remain at home and free of avoidable hospitalizations.

The ideal teammate would be able to:

• Conduct video visits for chronic care management and remote patient monitoring to create an appropriate care plan for the member
• Conduct care coordination and recommend/identify cost effective research based treatment and intervention
• Utilize strong clinical skills in physical assessment and chronic disease management for at risk adults and apply member specific Care Management and inidualized care planning
• Be comfortable with advanced care planning discussions with caregivers and members
• Serve as a consulting resource on care management practice as needed
• Attend meetings, training sessions and participates on committees as needed
• Possess a strong knowledge of clinical procedures, standards and quality control checks
• Possess a strong knowledge of medical conditions, interventions and treatment
• Provide members, caregivers and facility education
• Monitor the quality of member’s care and updates plan of care

Would you describe yourself as someone who has:

• Certified and licensed as a Nurse Practitioner in good standing in the state of New York (required)
• Master’s or doctoral degree from an accredited institution for nurse practitioners (required)
• Fluency in English and Spanish language (required)
• Certification from ANCC (or equivalent) as an Adult, Family, Geriatric, and/or Acute Nurse practitioner (required)
• Prior Emergency Room or relatable experience? (required)
• 1+ years of Nurse Practitioner Experience (required), qualified for independent practice in your licensed jurisdiction (preferred)
• 1+ years of telephonic triage or equivalent experience (required)
• 2+ years of clinical experience working with complex adult populations (required)
• Ability to practice independently with little clinical support (required)
• Comfort using technology like Google Suite, multiple EMRs, Slack (required)
• Experience working in home care and/or family medicine, geriatrics (preferred)
• Experience working within a clinical team environment
• The ability to work remotely and has a private area with a computer in their home/workspace (required)
• Strong organizational skills, including the ability to prioritize
• Passionate about our mission to improve people’s lives
• Comfortable in a dynamic and always evolving startup environment

Pay range is $125K – $135K annually. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

If yes, then we look forward to speaking to you!

Vesta Healthcare is committed to leveraging the talent of a erse workforce to create great opportunities for our business and our people. Vesta Healthcare is an Equal Opportunity/Affirmative Action Employer. Candidates are selected without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.

At Vesta, we are constantly searching for the most dynamic and best talent to join our team with a mission of empowering caregivers in the home! If you are ever contacted by e-mail from any domain other than https://vestahealthcare.com, please do not respond, as there is a likelihood it could be a scam as it is not a legitimate Vesta email. You might see things from a similar domain address, but with a slight misspelling, for example. We have no responsibility for any communication that does not come from the https://vestahealthcare.com domain, and we strongly advise that you not provide information or respond if not from the legitimate Vesta domain. If you have any concerns that outreach might not be legitimate, please reach out to [email protected] for confirmation.

The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level.

Virtual Care Nurse Practitioner

(California Licensed)

at Tia

Remote

About Us:

Founded in 2017 by Carolyn Witte and Felicity Yost, Tia is the modern medical home for women. We are trailblazing a new paradigm for women’s healthcare that treats women as whole people vs. parts or life stages. Blending in-person and virtual care services, Tia’s “Whole Woman, Whole Life” care model fuses gynecology, primary care, mental health and evidence-based wellness services to treat women comprehensively. By making women’s health higher quality and lower cost, Tia makes women healthier, providers happier, and the business of care delivery stronger — setting a new standard of care for women everywhere.

Tia has raised more than $132 Million in venture capital funding to date, including a recent $100 Million Series B investment, one of the largest early-stage rounds ever for a healthcare company focused on women. Tia has ambitious plans to scale its “whole-woman, whole-life” model to more than 100,000 women by 2023. We’ll do this by growing virtual and in-person operations in existing and new markets while expanding its service lines to care for women throughout their entire lives — from puberty to menopause. Since launching in 2017, Tia has grown to serve thousands of women aged 18-80 with blended in-person and virtual care in New York City, Los Angeles, Phoenix and soon San Francisco.

We’re building a world class team to reimagine women’s healthcare. We’re an interdisciplinary team of clinicians, researchers, designers, technologists and operators who have seen firsthand how broken the healthcare system is for women. We’re united by a powerful mission to enable every woman to achieve optimal health, as defined by herself, as well as a shared set of values and principles that define our business, products, and culture.

Tia is building a culture of excellence — in people, process and product. This is our northstar value;

What is excellence, exactly?

Excellence about constantly elevating yourself, it is the process of constantly striving to perform to the best of your abilities, and identifying your top potential through constant learning, experimentation and evolution. Excellence is not about achieving perfection, as that insinuates a pinnacle. Instead, in our terms, excellence is about the pursuit of constant improvement. We’re looking for people who want to go on that hard journey of constantly setting new personal records, and organizational records.

We practice excellence at Tia by demonstrating the following types of behaviors: We chose (and actively choose) excellence as Tia’s highest order value because it crystalizes into one word several behaviors that we hold dear, specifically:

1. A drive to constantly improve through experimentation, reflection. and an insatiable growth mindset — said another way, we’re energized by the possibility of invention, innovation, and iteration
2. Being present in and grateful for the journey — not just the goal line. Perfection is static. Excellence is a process (more on this important distinction below)
3. Asking why, then why again — because accepting “this is just the way it is” is not good enough
4. Grit & perseverance — a maker mentality that involves “rolling up your sleeves”, but also deep care for oneself and for others
5. A commitment to uncovering talents to unlock “rock star” potential across every inidual

Furthermore, excellence reflects the “bigness” and the “boldness” of Tia’s mission and vision — a world in which every woman can achieve optimal health, as defined by herself.

Said another way, Tia’s mission is NOT to make healthcare incrementally better for women. Instead, we’ve intentionally set out to create a fundamentally new paradigm for modern women’s healthcare that’s truly excellent. We believe that creating a company that operates in a culture of excellence will manifest in our product. Reaching this goal is not an overnight pursuit or a “one and done.” We have not and will not “get it right” with the first swing. Rather, this higher order goal is a moving target — one we have not and will not ever fully “achieve.” By design, we will never be “done” with this work, but instead, we will be continuously in pursuit of our mission. It is this continuous pursuit — the journey, not the finish line — that truly embodies excellence.

Location: This is a fully remote position. (Active NP license for the state of CA required for this role but you may live outside of CA with the active CA license)

About the role:

We’re looking for a Full-Time Nurse Practitioner (active NP license for the state of CA) passionate about women’s health for Tia’s Virtual Care Team. As a Virtual Nurse Practitioner, you will be an integral part of the care delivery system. You will see patients virtually and deliver comprehensive and integrative care spanning across gynecology and primary care services: from virtual annual visits to birth control consults to flu/cold consults and dermatology management. Further, you will remotely triage, diagnose, and treat patients via our proprietary chat software.

Nurse Practitioners are integral to the formation and iteration of our technology development and care model. In addition to your clinical role, you’ll have an opportunity to shape the Tia care model and improve our technology tools. You’ll collaborate with our product & engineering teams to share insights and feedback.

Schedule is set with some flexibility. Start times are 7a-9a for early shifts and or 10a-12p for later shifts. Expectation is that you take two evening shifts per week. However we do have some flexibility depending on availability.

A bit about you:

Values and abilities you’ll bring to Tia:

• You’re motivated to elevate women’s care by bringing a shared-decision making approach to women’s health.
• You believe that each woman knows her body best, though she may need help interpreting what the signs mean. Your mission as a woman’s healthcare provider is to help your patients understand those signs and develop robust, multi-faceted treatment plans to reach health goals. You practice this by being a true partner on a patient’s health journey, never dogmatic, rigid or glued to institutions.
• You are an incredibly good question-asker & prober, this allows you to identify nuances of a patient’s life that could be pertinent to their story. You’re like a detective — but you do this with an elegance that makes the patient feel at ease sharing deeply personal information.
• You’re facile with technology, comfortable and experienced providing high quality care digitally via telemedicine and interested in the process of developing new technology to support the highest quality clinical care..
• You’re data driven and consistently incorporate new and evolving research into your day-to-day practice
• You’re a high functioning multi-tasker who has an incredible ability to stay calm and focused under pressure – this is a given – you are a NP after all! .
• You are a tolerant and inclusive thinker. You believe in sex-positive, no judgement and radically inclusive healthcare for every person, and espouse these values in your everyday life.

Skills and assets you’ll bring to Tia:

• You’re a board certified Nurse Practitioner (family nurse practitioner or women’s health nurse practitioner), with active and unrestricted licenses in the state of California and able to provide primary care and support of all aspects of women’s health with compassion and empathy. You have experience and a passion for delivering high quality integrated care via telemedicine and are highly tech savvy. While experience as a direct digital care provider in the past is not a must – it is highly desired!
• Deep clinical expertise in providing primary care and women’s health experience (at least 2 years of post-graduate clinical experience) including: STD screens, UTI & Vaginal infections consults, Pelvic Pain, Vaginal Bleeding, Birth Control counseling, annual exams and urgent care concerns (coughs, sore throat, abdominal pain, basic dermatological conditions) with an ability to take this brick and mortar experience and translate it to virtual delivery.
• Exceptional written and verbal communication skills.
• Demonstrated excellence in Interpreting and act on clinical labs + ultrasound results
• Willingness to work evenings + weekends as needed by schedule
• Authorized to work in the US

Other “nice to have” skills:

• As an organization that seeks to create an environment for all women to feel safe, heard, recognized and avowed in their health, bodies and lives, we are consistently seeking providers with backgrounds that are meaningfully different from those already forming our team. You bring a erse background, a range of care experiences in different communities or various modalities.
• Formal professional training in the following areas is highly valued: care delivery for women who have experienced trauma including having a lived experience of abuse, decision making support for low-income women, care delivery for LGBTQ identified folks, care delivery for immigrant or migrant or english-as-a-second-language support populations.
• A strong understanding of & interest in chronic stress and trauma as it relates to immune system compromise and inflammatory response systems is a plus.
• Experience or formal training weaving integrative medicine practices into your care plan development.
• Contracted with major payers (BCBS / Anthem, Cigna, Aetna, United)

Benefits

• Remote role with flexibility to work from home
• Market competitive salary ( 120-140K depending on experience for 40 hour work week)
• Annual CME stipend
• Medical and dental benefits
• Paid holidays, vacation, and sick leave

This position may require attendance at company and team off-sites and is subject the Company’s vaccine requirement, as permitted by law and subject to reasonable accommodation.

Tia is an equal opportunity employer. We are proud to foster a workplace free from discrimination. We strongly believe that ersity of experience, perspectives, and background will lead to a better environment for our employees and a better product for our users and patients. We strongly encourage people of color and members of the LGBTQ+ community to apply.

If you are committed to collaborative problem solving, creating high-quality and user-centric products, and want to make waves in women’s healthcare, join us!

Coding Auditor

Remote – Nationwide

Full time

R017002

Thank you for considering a career at Ensemble Health Partners!

Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference

The Opportunity:

Duties/Responsibilities:

• Performs quality reviews of coders ensuring accuracy with coding guidelines and policies for complete, precise, and consistent coding.
• Reviews include Outpatient ICD-10, CPT, Modifiers, ED E&M and professional coding and E&M assignments.
• Knowledge expert and maintains up-to-date working knowledge of coding guidelines in order to act as a resource and point person for issues and question for coders, customers or project teams.
• Provides education to our coding associates and leaders as required by the deliverables of our SLA
• Reviews physician documentation for coding appropriateness and accuracy following coding guidelines.
• Provides feedback to coders and providers on coding corrections, appropriately citing authoritative resources.
• Assists with the interpretation of codes and other information requested for accurate code assignment.
• Communicate with management regarding clinical, coding, and reimbursement issues as needed.
• Function in a professional, efficient, and positive manner with strong critical thinking and decision-making skills.
• Utilizes our client’s electronic medical record (EMR), encoder, and computer-assisted coding (CAC) software as directed.
• Ensures optimal reimbursement while maintaining compliance with CMS and third-party payor policies and guidelines.
• Maintains compliance with Ensemble and client’s coding policies, procedures, and guidelines.
• Consistently maintains 95% or above accuracy rate while meeting established productivity standards.
• Completes daily production log and daily time keeping requirements.
• Attends and participates in Ensemble and client meetings as requested.
• Completes coding continuing education and maintains auditing credentials.
• Ensures HIPAA compliance at all times.

Minimum Requirements:

• 5+ years of coding experience.
• 3+ years of auditing experience.
• Proficiency in multiple EMR’s, encoders, and the Microsoft Office suite.
• Educated in HIPAA regulations; must maintain strict confidentiality of patient and client information.
• Consistently achieves quality and productivity standards.
• Ability to organize and complete work in a timely manner.
• Ability to read, write and effectively communicate in English.
• Ability to understand medical/surgical terminology.
• Above average written and verbal communication skills.

Required Certifications:

Candidates must have and keep current at least one of the following professional certifications (CPC, CPMA or CCS Preferred):

• CPC (Certified Professional Coder)
• CCS-P (Certified Coding Specialist-Phys Based)
• CCS (Certified Coding Specialist)
• CMPA (Certified Professional Medical Auditor)
• RHIA (Registered Health Information Administrator)
• RHIT (Registered Health Information Technician)

#LI-LS1

#LI-REMOTE

Join an award-winning company

Three-time winner of Best in KLAS 2020-2022

2022 Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

• Innovation
• Work-Life Flexibility
• Leadership
• Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:

• Associate Benefits We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Our Culture Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
• Growth We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• Recognition We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble Health Partners provides reasonable accommodations to qualified iniduals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law.

Coding Quality Coordinator, Inpatient Coding

Location: Denver, CO, United States

Category: Professional/Management

Job Type: Full Time

Job ID: 139754

Description

Coding Quality Coordinator, Inpatient Coding

This is a full-time, remote/work from home, exempt/salary position on UCHealth’s Inpatient Coding team based in Denver, CO. Potential opportunity for eligible out-of-state applicants.

Responsible for coding data integrity by reviewing diagnosis and procedure code assignments, and validating MS-DRG and APR-DRG designations. Works closely with Leadership, CDI, Physician Advisors and other internal quality departments, providing answers to coding questions and correctly applying Official Coding guidelines, Coding Clinics and other official guidance which support your recommendations.

Job Duties

• Conducts internal quality reviews, in accordance with the Coding Compliance Plan. Reviews government, commercial and other external audits. Performs internal audits as requested by other departments. Monitors and reports issues/trends.
• Presents coding education to staff, leadership and others throughout the Health System. Provides training as necessary. Assists with developing and guiding SMEs responsibilities.
• Responds to coding questions submitted throughout the Health System. Reviews physician queries for appropriateness, and related correspondence.
• Reviews coded claims data in response to denials and customer service requests. Provides thorough rationale and explanation for proper code assignments.

Requirements

• High School Diploma or GED
• Coding-related certification from AHIMA or AAPC
• 3 years of relevant coding experience

Preferred

• Associate’s Degree
• CCS

The pay range for this position is: $29.54 – $44.31 / hour. Pay is dependent on applicant’s relevant experience.

UCHealth offers a Five Year Incentive Bonus to recognize employee’s contributions to our success in quality, patient experience, organizational growth, financial goals, and tenure with UCHealth. The bonus accumulates annually each October and is paid out in October following completion of five years’ employment.

UCHealth offers their employees a competitive and comprehensive total rewards package:

Loan Repayment: UCHealth is a qualifying employer for the federal Public Service Loan Forgiveness (PSLF) program! UCHealth provides employees with free assistance navigating the PSLF program to submit their federal student loans for forgiveness through Savi.

• Full medical, dental and vision coverage
• Retirement plans to include pension plan and 403(b) matching
• Paid time off. Start your employment at UCHealth with PTO in your bank
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition and continuing education reimbursement
• Wellness benefits
• 5 year incentive bonus
• Full suite of voluntary benefits such as identity theft protection and pet insurance
• Education benefits for employees, including the opportunity to be eligible for 100% of tuition, books and fees paid for by UCHealth for specific educational degrees. Other programs may also qualify for up to $5,250 pre-paid by UCHealth or in the form of tuition reimbursement each calendar year

Title: Nurse Care Manager

Location: Remote – United States

About Quartet Health

Quartet is a purpose driven value-based behavioral healthcare company, building the nation’s leading behavioral health home. We deliver integrated care and better outcomes to improve the health of communities across America. Quartet is a trusted partner of health insurance plans, health systems, community behavioral health centers, certified community behavioral health clinics, and federally qualified health centers in 36 states across the country. We identify people in need of care and connect them directly to high quality behavioral care providers, including Quartet’s own medical group.

At Quartet, our values guide the way that we work together, starting with our commitment to putting patients first, and our shared focus on collaboration and innovation, so that we together can improve lives, one person at a time.

Quartet is backed by top investors like Oak HC/FT, GV (formerly Google Ventures), F-Prime Capital Partners, Polaris Partners, Deerfield Management, Centene Corporation, Independence Health Group, and Echo Health Ventures.

Our Benefits

We’re proud to offer the following benefits to all clinicians:

• Competitive compensation
• 100% cost coverage for a ll required licensing /credentialing fees
• IT equipment and support
• Mental health benefits via our EAP, with up to 5 free counseling sessions per concern

W e offer additional benefits to our team members working full time:

• A generous accrued PTO policy
• T en paid holidays each year
• R obust medical, dental and vision insurance plans
• A 401 (k ) plan with employer match
• 100% employer-paid life insurance , short-term and long-term disability insurance
• Annual continuing education unit (CEU) budge t
• Up to 12 weeks of paid maternity leave

The Behavioral Health Nurse Care Manager works to assess, evaluate, and support members who are challenged by both severe mental illness and complex medical situations. The Behavioral Health Care Manager follows established guidelines and procedures and collaborates with other departments. They will work as part of a multidisciplinary team that assesses, facilitates, plans, and coordinates an integrated delivery of care across the continuum. The goal of the Behavioral Health Care Manager is to support members to achieve or maintain optimal health in both mind and body.

The Behavioral Health Care Manager employs their clinical judgment with inidualized strategies to manage a member’s physical, environmental and psycho-social health issues. The Behavioral Health Care Manager monitors members’ progress towards desired outcomes and helps to ensure the member receives quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

By continuously monitoring patient care, the Behavioral Health Care Manager conducts regular assessments and identifies and resolves barriers that hinder effective care. The Behavioral Health Care Manager will create and update member care plans and participate in the Interdisciplinary Care Team as needed.

Responsibilities

• Completes clinical assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member’s health or psychosocial wellness, and triggers from the HRA
• Develops and implements a care management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member’s support network to address the member needs and goals.
• Conducts telephonic outreach as needed
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventional achievement, and suggest changes accordingly.
• Maintains ongoing member case load for regular outreach management
• Promotes integrations of services for members including behavioral health care and long -term services and supports to enhance the continuity of care for Troy members.
• Facilitates interdisciplinary care team meetings and informal ICT collaboration.
• Uses motivational interviewing to educate, support, and motivate change during member contacts.
• Assesses for barriers to care, provides care coordination and assistance to members to address concerns
• Collaborates with other care managers/supervisors as needed
• Participates in CM and company wide meetings as directed.

Qualifications

• Current, unrestricted NC RN license or Compact License Preferred.
• Previous Behavioral Health Experience
• Minimum 2 years experience required with Dual Special Needs Plans (D-SNP)
• Certified Case Manager (CCM), preferred
• Basic understanding of insurance products, benefits, coverage limitations, laws and regulations as it applies to the health plan.
• Proficient in Google Suite as well as ability to work with multiple applications
• Strong counseling or customer service background and can implement functional treatment plans
• Experience in managing members with both Medical and Behavioral Health needs and/or Substance Abuse needs.

Quartet actively encourages applicants of all backgrounds to apply and is proud to be an equal opportunity employer. We do not discriminate on the basis of race, color, ancestry, religion, national origin, sexual orientation, age, citizenship, marital or family status, disability, gender, gender identity or expression, pregnancy or caregiver status, veteran status, or any other legally protected status. To perform this job successfully, an inidual must be able to perform essential job duties – reasonable accommodations may be made to enable qualified iniduals with disabilities to perform essential job functions. If you require assistance in completing this application, interviewing, or otherwise participating in the employee selection process, please direct your inquiries to [email protected]

Have someone to refer? Email [email protected] to submit their details to us.

Title: REMOTE Full Time NY and Texas Licensed Nurse Practitioner (NP) – Remote

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a Series B startup with a simple mission: Delivering extraordinary outcomes by unlocking the power of caregivers. We enable people with personal assistance to thrive at home, in their community by assuring their caregivers have the resources, data, and support they need. We achieve this through a combination of analytics, technology, services, and deep healthcare expertise.

Our program monitors in real-time, identifying issues before they become health events, and helping connect those in need with those who can help via technologies such as video, chat, and telephone. Our technology platform includes home-based mobile applications, a clinical dashboard, and data analytics on data not previously available to health professionals. We are disrupting a $109 billion industry and have recently closed our latest funding round with a blue-chip list of investors.

We’re looking to add to our team of experts who care deeply about our mission.

Our team is passionate, driven, collaborative, intellectually curious, and excited about the opportunity to transform our healthcare system. We’re inspired by caregivers and seek to create a platform that recognizes, utilizes and supports the vital role they play. We strive to continuously learn, explore, experiment and achieve results. We are here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids)

The ideal teammate would be…

A person who’s passionate about working closely with a clinical team to ensure the best clinical outcomes for those we serve. A person who enjoys a fast paced clinical environment, performing telephonic and virtual visits related to proactive chronic care management, remote patient monitoring, and/or resolving more urgent clinical issues quickly. Lastly, someone who aspires to work with a company who is on the leading edge of community health working with partners to allow our elderly to remain at home and free of avoidable hospitalizations.

The ideal teammate would be able to:

• Conduct video visits for chronic care management and remote patient monitoring to create an appropriate care plan for the member
• Conduct care coordination and recommend/identify cost effective research based treatment and intervention
• Utilize strong clinical skills in physical assessment and chronic disease management for at risk adults and apply member specific Care Management and inidualized care planning
• Be comfortable with advanced care planning discussions with caregivers and members
• Serve as a consulting resource on care management practice as needed
• Attend meetings, training sessions and participates on committees as needed
• Possess a strong knowledge of clinical procedures, standards and quality control checks
• Possess a strong knowledge of medical conditions, interventions and treatment
• Provide members, caregivers and facility education
• Monitor the quality of member’s care and updates plan of care

Would you describe yourself as someone who has:

• Certified and licensed as a Nurse Practitioner in good standing in the state of New York and Texas (required)
• Master’s or doctoral degree from an accredited institution for nurse practitioners (required)
• Medicare participation and ability to have the company bill for services on your behalf (required)
• Certification from ANCC (or equivalent) as an Adult, Family, Geriatric, and/or Acute Nurse practitioner (required)
• 1+ years of Nurse Practitioner Experience (required), qualified for independent practice in your licensed jurisdiction (preferred)
• 1+ years of telephonic triage or equivalent experience (required)
• 2+ years of clinical experience working with complex adult populations (required)
• Ability to practice independently with little clinical support (required)
• Comfort using technology like Google Suite, multiple EMRs, Slack (required)
• Experience working in home care and/or family medicine, geriatrics (preferred)
• Experience working within a clinical team environment
• The ability to work remotely and has a private area with a computer in their home/workspace (required)
• Strong organizational skills, including the ability to prioritize
• Passionate about our mission to improve people’s lives
• Comfortable in a dynamic and always evolving startup environment

Pay range is $125K – $135K annually for FT and $70-$80 hourly for PD based on experience

If yes, then we look forward to speaking to you!

Vesta Healthcare is committed to leveraging the talent of a erse workforce to create great opportunities for our business and our people. Vesta Healthcare is an Equal Opportunity/Affirmative Action Employer. Candidates are selected without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.

At Vesta, we are constantly searching for the most dynamic and best talent to join our team with a mission of empowering caregivers in the home! If you are ever contacted by e-mail from any domain other than https://vestahealthcare.com, please do not respond, as there is a likelihood it could be a scam as it is not a legitimate Vesta email. You might see things from a similar domain address, but with a slight misspelling, for example. We have no responsibility for any communication that does not come from the https://vestahealthcare.com domain, and we strongly advise that you not provide information or respond if not from the legitimate Vesta domain. If you have any concerns that outreach might not be legitimate, please reach out to [email protected] for confirmation.

The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level.