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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 portfoaccdddclio 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.

Coder III – Day

Schedule & Location:

Full-Time: 80 hours, biweekly

Monday-Friday: Day shift

Remote work opportunity

Job Description:

Under general supervision, collects, reviews, retrieves and codes Evaluation & Management codes, and major procedures (surgical procedures, anesthesia reports, radiology reports/procedures) and other services for Medicine/Surgical practices, based on data from medical records and reports for quality assessment, audit and billing purposes.

Duties and Responsibilities:

1. Performs chart audits, reviewing for accuracy and compliance.
2. Reviews operative reports and other documentation and assigns appropriate diagnosis (ICD-10), procedure codes (CPT-4), and other services (HCPCS) for final billing.
3. Research and process invoice corrections.
4. Reviews and analyzes coding/billing procedures.
5. Presents training and feedback concerning medical coding, compliance, and reimbursement to physicians/providers.
6. Coordinates and implements reimbursement improvement activities with staff and providers.
7. Meets WellSpan Coding Compliance Guidelines.

Qualifications:

Minimum Experience:

• 3 years

Minimum Education:

• High School or GED

Required Certification:

• Certified Procedural Coder (CPC), Certified Coding Specialist-Physician (CCS-P) or Certified Medical Coder (CMC) AND a Specialty Coding Certification, Certified Anesthesia and Pain Management Coder (CANPC), must be obtained within one year

Skills:

• Knowledge of ICD-10-CM, CPT-4, and HCPCS coding; basic computer skills

Physician Coding Liaison II -Remote- Hematology and Oncology

locations

Aurora Medical Center Summit – 36500 Aurora Dr

time type

Full time

job requisition id

R65460

Department:

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 Physician Coding 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.

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.

Title: Medical Billing and Collections Specialist

Location: United States

Performs designated collection activities for assigned agencies to ensure receivables are reimbursed in an accurate and timely manner. Works directly with the payer and internal and external customers towards efficient and effective collection results. Works under moderate supervision.

Job Location: Anywhere in the United States. This role is eligible for work-from-home status. The majority of current Corridor staff work remotely, from their homes.

Essential Duties and Responsibilities: To perform this job successfully, an inidual must be able to perform the following satisfactorily; other duties may be assigned.

• Ensures the coordination of collection activities for designated accounts, leading to the timely reimbursement of receivables using available resources including internal/external databases, payer portals/websites, and telephone.
• Determines and initiates appropriate action to resolve denied/rejected invoices and prepares payer corrections and/or appeals in accordance with payer plan requirements using electronic and paper processes.
• Review EOPs/EOBs/RAs/EOMBs for accuracy of patient responsibility.
• Analyzes and clears payment variances. May prepare adjusted and corrected bills, adjust accounts receivable entries, or prepare refunds in accordance with existing operating procedures.
• Participates in payer webinars and conference calls covering a wide range of topics that enables the RCM team to effectively collect accounts receivable.
• Prepares special handling and/or reconciliation spreadsheets for payers and/or clients.
• Participates in special projects and performs other duties as assigned.

Qualifications: 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. Must have home health care collections experience.

Education/Experience:

High school diploma or general education degree (GED); or two-three years related experience and/or training; or equivalent combination of education and experience. Focus on Collections experience in the healthcare industry, emphasis on home health and hospice a plus.

Computer Skills:

Microsoft Office Applications – intermediate skill required.

Title: Clinical Documentation Specialist

Location: United States

Remote – Nationwide

Full time

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:

Facilitates and obtains appropriate physician documentation for any patient clinical condition or procedure to support the appropriate severity of illness, expected risk of mortality, and complexity of care as documented in patient medical records. Extensive medical record review and interaction with physicians, nursing staff, other patient care givers and HIM coding professionals is done to ensure the documentation is complete and accurate.

Responsibilities:

• Completes initial patient medical record review within 24-48 hours of patient’s admission; completes subsequent reviews of patient’s medical record reviews every 24-48 hours and enters review findings in CDE software system
• Assigns Principal diagnosis, CC/MCC (complication and comorbidity/major complication and comorbidity), evaluate for Severity of Illness (SOI) and Risk of Mortality (ROM) on all patients while in-house. Assigns working ICD-10-CM and PCS codes and DRG (Diagnosis Related Group) using encoder in CDE software.
• Clarifies with physicians regarding missing, unclear, unsupported or conflicting health record documentation by requesting and obtaining additional documentation from physicians when needed. Face to face physician interaction and written clarifications are used.
• Educates key healthcare providers such as physicians, nurse practitioners, allied health professionals, nursing and care coordination regarding clinical documentation improvement, documentation guidelines and the need for accurate and complete documentation in the health record.
• Partners with coding professionals to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine the working and final DRG assignment. Reviews DRG denial letters and writes denial appeal letters.
• Collaborates with care coordination, nursing staff and other ancillary staff regarding interaction with physicians on documentation and to resolve physician clarifications prior to patient discharge.
• Maintains and upholds all clinical documentation regulatory guidelines
• Formulates and submits timely, well prepared appeals for reconsideration by third party administrators (payors). Including supporting documented clinical evidence, Coding/CDE Guidelines and other regulatory standards/guidelines as appropriate. Works collaboratively with co-works and management to effectively resolve root cause issues that impact payor contracts, hospital operations, or departmental to maintain reimbursement and minimize appeal requests and/or denials.

Requirements:

• 4 year/ Bachelors Degree in Nursing
• Current RN Licensure
• Minimum of five years acute care nursing experience with specific medical/surgical, Intensive Care, or Emergency Department experience
• Excellent interpersonal skills including excellent verbal and written communication skills; proficient in and demonstrate excellent physician relations
• Ability to organize and present information clearly and concisely; excellent computer and keyboarding skills; high degree of prioritization skills
• CCDS (Certified Clinical Documentation Specialist) certification, preferred

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.

Title: Client Coordinator (US)

Location: Remote

What you’ll do

In a few words

Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning

The Client Success team oversees the implementation of new clients, products, and services. The team manages client relationships for all our accounts, looking for ways to satisfy every single client need and delivering excellence in all matters relating to client support and relationships. They provide guidance, attend to daily needs and identify new pathways for business expansions.

As our Client Coordinator, you are the face representing Abarca and the foundation of Client Success operational support. Your job is to identify and respond proactively and quickly to any situation pertaining to clients. You will identify, respond, and triage any situation our clients bring up, ensuring that excellent service is delivered to our pharmacies, payers, health plans, and unions. Your strategic and enthusiastic solution-driven mind will put our clients at the core of everything to maintain and guarantee the best experience for them, ensuring a positive relationship between client and organization.

The fundamentals for the job

• Follow up on pending topics and reach out to other business areas to provide timely resolutions.
• Support and identify special projects and process improvement opportunities to enhance organizational processes and service deliveries. Manage and document project tasks.
• Be the first-tier support for Darwin Users; this requires a good understanding of Darwin Platform logics and functionality as well as client business requirements and benefit rules.
• Service Level Agreement oversight, including understanding and ensuring change requests from clients are submitted through CRM and confirmed to client within the agreed times.
• Maintenance and tracking of customer relationship management systems deliverables per areas/clients assigned. Use of dashboards and reports to track client or internal agreed upon service level agreements, at-risk projects, or timelines and escalate appropriately within Client Success.
• Prepare and/or request client reports from other operational departments within Abarca.
• Generate and analyze reports to make recommendations internally and to clients as well as identify proactively any issues with output content.
• Manage client communication on Darwin global alerts as well as Darwin development release notes.

What we expect of you:

The bold requirements

• Bachelor’s Degree in, Business, Science or a related field. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 1+ year of experience within Client Management or related position.
• Project coordination experience.
• Experience in handling client relations with attention to detail and customer service skills.
• Excellent time management and prioritization skills.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)

Nice to haves

• Knowledge of pharmacy benefit manager, health care, and/ or health insurance.

Physical requirements

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate ersity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify. Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time

All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of gender, race/ethnicity, gender identity, sexual orientation, protected veteran status, disability, or other protected group status.

#LI-NO1 #LI-REMOTE

Title: Bilingual Health & Wellness Advisor

Location: Remote, United States

Who We Are:

Calm is the leading mental health brand, on a mission to support everyone on every step of their mental health journey. With the #1 app for sleep, meditation and relaxation, Calm’s transformational mindfulness content supports users across seven languages in more than 190 countries.

What We Do:

Calm is the world’s #1 brand for mental fitness and our Calm Business team is furthering our mission to make the world happier and healthier by bringing our offering into the employee benefits space. Calm Business is helping companies build a more resilient organization by promoting better sleep, reducing stress and anxiety, and developing consistent mindfulness practices. We offer accessible and effective content to meet the needs of any erse workforce. With our proven launch strategy and marketing resources, plus ongoing engagement programs and account support, we take the stress out of employee benefits.

What You’ll Do:

As a member of our team, you will help create and deliver workshops to our customers virtually and occasionally in person. You’ll partner with our clients to uphold their wellness and DEIB strategies through education and training utilizing adult learning techniques and coaching skills.

• Develop and deliver engaging and interactive workshops and trainings from our catalog of sessions to our B2B partners virtually and occasionally in-person
• Assist the development of existing workshops into Spanish
• Project manage workshop initiatives. This includes but is not limited to preparing materials, providing frequent updates, utilizing our project management system, and other administrative tasks
• Provide outstanding customer service during clients calls, scheduling, and feedback sessions
• Manage and lead projects independently providing timely updates to the team and cross-functional peers
• Create internal trainings using our LMS system
• Focus on continued growth by training and qualifying on new sessions and attend external training programs
• Maintain the buildout of new services under our services umbrella
• Create and build new trainings focused on the learner through methods such as ADDIE as well as coaching skills such as motivational interviewing and strengths identification

Who You Are:

• A go-getter who is comfortable working in a startup environment
• Comfortable with delivering trainings based on a specific curriculum
• Can create engaging and interactive workshops with a focus on the learner
• A team player who can collaborate and share information with others while also being able to work independently
• Excel with time management and can produce deliverables based on internal roadmaps
• Know the difference between presenting, facilitation, and coaching
• You love technology and can learn new systems and processes quickly
• Available to occasionally work until 8:00 PM Pacific

Nice to Haves:

• Experienced with ZenDesk, Salesforce, gSuite, Prezi, Slack, Zoom, Microsoft Teams, WebEx, or Workramp
• Master’s degree or higher
• More than one certification or designation listed below

Minimum Requirements:

• Bilingual (Native Spanish and English)
• 4+ years in adult group facilitation or coaching experience
• Have one of the following certifications or trainings: NBC-HWC or ICF ACC designation, Certified Diversity Practitioners, MBSR, MBCT or MSC Certification (Level 1 Teacher Certification or higher), or a Health Education with at least 4 years of professional experience

The anticipated salary range for this position is $102,300 – $143,200. The base salary range represents the low and high end of Calm’s salary range for this position. Not all candidates will be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate’s skills, experience and other qualifications. This role is also eligible for equity + comprehensive benefits + 401k + flexible time off.

We believe that mental health is health, and every person should be considered in the discussion. That’s why we’re proud to be an equal opportunity workplace, committed to providing equal employment opportunities to all applicants and employees regardless of race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, medical condition, genetic information, military or veteran status, gender identity or expression, sexual orientation, or any other characteristic protected by applicable federal, state or local law.

Calm is deeply committed to ersity, equity and inclusion. We strive to create a mindful and respectful environment where everyone can bring their authentic self to work, and experience a culture that is free of harassment, racism, and discrimination.

Calm is also committed to providing reasonable accommodations for qualified iniduals with disabilities, including disabled veterans. Please contact Calm’s Recruiting team if you need a reasonable accommodation or any assistance completing any forms or to otherwise participate in the application process.

Professional Fee Coder II (Fully Remote)

Location: US National

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.

Remote Location

Shift Days

Schedule 7:00am-4:00am

Job Summary

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as the No. 4 hospital in the nation, according to the U.S. News & World Report. 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.

As a Remote Professional Fee Coder II, you will monitor, review, and apply correct coding principles to clinical information received from ambulatory areas for the purpose of reimbursement, research, and compliance. You will identify and apply diagnosis codes, cot codes, and modifiers as appropriately supported by the medical record in accordance with federal regulations. Lastly, you will ensure that billing discrepancies are held and corrected.

The ideal future caregiver is someone who:

• Has a minimum of 2 years of coding experience in a multi-specialty facility.
• Has critical thinking and analytical skills.
• Can work under pressure.
• Demonstrates a strong work ethic.

This opportunity offers up the possibility to advance into Coder III, Senior Coder or Supervisor positions.

Cleveland Clinic provides what matters most: career growth, delivering world-class care to our patients, continuous learning, exceptional benefits and working for an organization that offers many long-term career paths. Join us and experience a culture where opportunities to advance and the support to get there go hand-in-hand.

Job Details

Responsibilities:

• Compares and reconciles daily patient schedules, census, and registration to billing and medical records documentation for accurate charge submission, which includes processing of professional charges, facility charges, manual data entry. Investigates and resolves charge errors.
• Meets coding deadlines to expedite the billing process and to facilitate data availability for CCF providers to ensure appropriate continuity of care.
• Works held claims and claim edits in the CCF claims processing system.
• Maintains proficiency in related CCF billing systems, productivity standards, and records to be used for reconciliation and charge follow up. Utilize ICD#9, ICD#10 and CPT-4 coding systems and materials.
• Maintains current knowledge and skills through reading and utilizing coding resources. Attends and participates in coding education systems.
• Other duties as assigned.

Education:

• High School Diploma / GED or equivalent required.
• Specific training related to CPC procedural coding and ICD9, ICD10 diagnostic coding through continuing education programs/seminars and/or community college.
• Working knowledge of human anatomy and physiology, disease processes and demonstrated knowledge of medical terminology.

Certifications:

• Certified Professional Coder (CPC), Certified Coding Specialist Physician (CCS-P), Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Associate (CCA) by American Health Information Management Certification (AHIMA) or Certified Outpatient Coder (COC) by American Academy of Professional Coders is required and must be maintained.
• Existing CCF employees credentialed with CMC may be required to obtain CPC (or CCS-P, RHIT, or CCA) within 12 months.

Complexity of Work:

• Coding assessment relevant to the work may be required.
• Requires critical thinking and analytical skills, decisive judgment and work with minimal supervision.
• Applicant must be able to work under pressure to meet imposed deadlines and take appropriate actions.

Work Experience:

• Minimum of 2 years of coding experience in a health care environment and or medical office setting required.
• Internal candidate must currently be employed as a Professional Fee Coder I at the Cleveland Clinic or have met all the training, quality and productivity benchmarks of Professional Fee Coder I for six months to apply for a Professional Fee Coder II position.

Physical Requirements:

• Typical physical demands involve prolonged sitting and/or traveling through various locations in the hospital and dexterity to accurately operate a data entry/PC keyboard.
• Manual dexterity required to locate and lift medical charts.
• Ability to work under stress and to meet imposed deadlines.

Personal Protective Equipment:

• Follows Standard Precautions using personal protective equipment as required for procedures.

Keywords: Pro Fee, CPC, CPT, CCA, CCS, RHIT, RHIA, health information management, medical billing and coding, outpatient

Cleveland Clinic Health System administers an influenza prevention program as well as a COVID-19 vaccine program. You will be required to comply with both programs, which will include obtaining an influenza vaccination on an annual basis, and being fully vaccinated against COVID-19, or obtaining an approved exemption.

Senior IRF Coder

locations

Remote – Other

time type

Full time

job requisition id

R011430

Responsible for daily coding, auditing and DRG validation of assigned encounters is accurate and compliant.

Do you perform coding audits of medical records for Inpatient Medical Rehabilitation ?

We are seeking a candidate who has a proven record for accuracy in IRF coding and thorough understanding of ICD-10 codes and related IRF coding PPS regulations. Responsibilities include conducting IRF PPS Coding audits inclusive of IRF-PAI and UB-04 review, maintaining expertise in ICD-10 coding and credentials and meeting daily accuracy and productivity standards. in accordance with established department policies. The ideal candidate has a highly developed ability to review medical records to identify the etiologic diagnosis , current comorbid conditions, tiers, and complications recorded on the IRF-PAI relative to the patient’s inpatient rehabilitation stay. The candidate must have ability to review the coding on the UB-04 claim form and determine the accuracy of the principal diagnosis and secondary diagnoses as determined by physician documentation. Essential is the ability to identify incomplete or missing diagnosis codes on the IRF-PAI and UB-04 claim form and also identify codes that impact CMG tier and compliance.

Come join this amazing team of experts that provides inpatient rehab healthcare facilities the clinical and technical expertise that enables them to adhere to the complex regulations for care and payment. Collaborate with our IRF clinicians who in conjunction with coders perform full coding only and coding /clinical audits in adherence with up-to-date ICD-10 coding guidelines. Also perform coding only audits in adherence with up to date ICD-10 coding guidelines.

Knowledge and skills:

• Associate’s degree in medical coding or equivalent training acquired through at least five years of progressive on-the-job experience; health related BS degree a plus.
• Experience in IRF coding is required
• A minimum of 3-5 years of ICD-10-CM coding experience directly applying codes for inpatient rehabilitation prospective payment systems is required. CCS Certified AHIMA Coding Specialist, CIC, Certified Inpatient Coder, CPC credential from AAPC a plus. * CCS, Certified Coding Specialist, AHIMA; CPC, Certified Professional Coder, AAPC a plus.

• Experience answering complex IRF coding questions
• Experience conducting IRF coding chart audits
• Experience writing and reviewing IRF coding reports
• Experience with coding productivity standards
• Experience coding for 20+ bed-sized IRF facilities

Our erse team of highly motivated leaders, innovators, and healthcare experts are the secret to our 30 plus years of success. If you are a professional who collaborates with their team to deliver the best and most reliable network system then apply today!

Expectations

• Normal office environment including but not limited to long periods of sitting, typing, analyzing data, telephone communication, use of standard office equipment and daily personal interaction. Normal office environment including but not limited to long periods of sitting, typing, analyzing data, telephone communication, use of standard office equipment and daily personal interaction.

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all iniduals. We celebrate ersity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the inidual can provide proof of valid prescription to Netsmart’s third party screening provider. Additionally, a positive result for marijuana will not automatically disqualify a candidate from employment if the inidual can provide a valid prescription for medicinal use issued in his or her state of residence. A prescription is required even in states where recreational use has been legalized.

All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.

Senior Hospital Coder – Remote

• Full Time
• Finance

Why Mayo Clinic

Mayo Clinic has been ranked the #1 hospital in the nation by U.S. News & World Report, as well as #1 in more specialties than any other care provider. 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

The Quality Senior Coder is responsible for working collaboratively with various team members such as Coding Operations, Revenue Integrity, Provider Education, Billing and Accounts Receivable and Denials. This position coordinates with others as needed to ensure comprehensive and inclusive education, training and auditing as it relates to all professional and hospital coding processes. This position will mentor, instruct and/or train other Professional and Hospital Coders in compliant coding standards (ICD-10 coding conventions, Official ICD-10 Reporting Guidelines, Coding Clinic, etc.). The Quality Senior Coder educates, trains and audits Coders based on their review, interpretation, and translation of provider medical diagnostic and procedural information documentation into appropriate codes following professional and hospital inpatient and/or outpatient claims and reporting requirements.

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

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

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 7 years hospital inpatient coding and/or hospital outpatient coding experience OR Associate’s Degree and 5 years hospital inpatient coding and/or hospital outpatient coding experience required; Bachelor’s Degree preferred.

Additional Qualifications:

• Experience with inpatient or outpatient coding guidelines and facility claim rules along with appropriate coding skills: ICD-10-CM diagnosis assignment, ICD-10-PCS procedure assignment, DRG assignment (e.g., MS-DRG and APR-DRG) for SOI and ROM.
• Experience with hospital outpatient coding guidelines and claims reporting rules with appropriate coding skill set of CPT/HCPCS.
• Experience with applications or applying National Correct Coding Initiative (CCI) edits, National Coverage Determinations (NCD), Local Coverage Determinations (LCD), Coding Clinic, Coding Clinics for HCPCS, Current Procedural Terminology (CPT) Assistant coding guidelines, and official ICD-10 guidelines for Coding and Reporting.
• In-depth knowledge of medical terminology, anatomy and physiology, simple to complex disease processes, pathophysiology, and pharmacology.
• Knowledge of principles, methods, and techniques related to compliant healthcare hospital billing.
• Knowledge of coding and billing requirements for provider based (PBB) facilities and critical access hospital (CAH).
• 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.

License or Certification:

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

Exemption Status

Nonexempt

Compensation Detail

$27.95 – $37.74 / 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, normal business hours.

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: Customer Service Representative

Location: United States

JOB DESCRIPTION

Responsibilities

• Responsible for coordinating testing services for patients by:
• Reviewing test request forms and additional documentation submitted with a patient specimen to ensure accurate and timely testing.
• Working with healthcare providers to complete the required documentation and sample submission.
• Working with insurance companies to secure the highest possible coverage for patients.
• Communicating with patients to explain insurance coverage benefits and test information including process and turnaround time.
• Employee will be on the phone approximately 60-80% of the time.
• Participate in the Quality Assurance plan.
• Comply with applicable CLIA and HIPAA regulations.

Pay: $18.46/hr

Qualifications

• High School Diploma or GED
• Bachelor’s degree and more than one year of customer service and reimbursement experience preferred
• Excellent interpersonal and communication skills
• Accurate typing skills of at least 65 words per minute
• Excellent listening, transcribing, and self-review skills PC experience, including familiarity with Excel, Word, Internet, and e-mail
• Able to manage several tasks simultaneously, often under pressure.

Physical and Mental Job Requirements

• 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.
• While performing the duties of this job, the employee is frequently required to sit; talk; or hear.
• The employee is occasionally required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; and stoop; kneel; or crouch
• The employee must occasionally lift and/or move up to 25 pounds.
• Specific vision abilities required by this job include close vision, distance vision and depth perception.

#LI-REMOTE

Biostatistician

We are seeking a trained Biostatistician to assist with data management and monitoring for UNITAID-funded project. The goal of the grant is to conduct studies aimed at reducing TB incidence and deaths among people living with HIV(PLHIV) (15-49) and child contacts through sustainable implementation of affordable TB preventive therapies, as well as assess risks associated with these therapies among pregnant women living with HIV. The incumbent will have a primary appointment in the Johns Hopkins School of Medicine and will work in a multidisciplinary environment collaborating with investigators based at the Bloomberg School of Public Health, as well as our international partners based in Sub-Saharan Africa. The types of studies conducted under this grant include inidual- and cluster-randomized clinical trials, as well as observational studies.

Primary responsibility will be implementing best practices of data management, providing study design and analytic support for various studies and secondary analyses for publications, presentations and grant submissions. This position will routinely interact with a multidisciplinary team. Must have ability to manage multi-project workload, both development and maintenance. Depending on the task and project involved the position may be expected to lead, work as part of a team, or work inidually to complete the work as necessary.

Specific Duties & Responsibilities

• Across ongoing studies, as well as the two newly initiating studies, the successful candidate will be required to work with the project Lead Statistician to provide the following support.
• For ongoing studies, the databases will be developed and access to these will be provided. For new studies, responsibilities may include developing the study databases on a platform described in the protocol, and this may include using the Research Electronic Data Capture (REDcap) system, for which training will be available.
• Conduct data monitoring and regular summaries of the data as described in the protocols.
• Assist the study statistician will interim data analyses if specified in the protocols this may entail assembling the analytic data sets, conducting analyses and generating associated figures and tables.
• Assemble analytic datasets with input from the study statistician for the primary outcomes analysis and any sub-analyses deemed necessary for the study.
• Attend study-related meetings and provide data updates as needed. The frequency of these will be determined by the investigative teams.
• Contribute to manuscript drafting and other results dissemination activities.

Minimum Qualifications

• Master’s Degree in biostatistics, epidemiology, or related quantitative field.
• Minimum of one-year related experience.

Preferred Qualifications

Classified Title: Biostatistician

Role/Level/Range: ACRP/04/MD Starting Salary Range: $54,080-$74,390-$94,710 Annually (Commensurate with experience) Employee group: Full Time Schedule: Monday-Friday, 8:30am-5:00pm Exempt Status: Exempt Location: Remote Department name: SOM DOM Infectious Disease Personnel area: School of Medicine

Total Rewards

The referenced salary range is based on Johns Hopkins University’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. Johns Hopkins offers a total rewards package that supports our employees’ health, life, career and retirement. More information can be found here: https://hr.jhu.edu/benefits-worklife/

Claims Support Coordinator (Remote)

REMOTE 

MEMBER CARE – MEMBER CARE

FULL-TIME

REMOTE

The Role:

As a Claims Support Coordinator, you will be part of a vibrant team of high performing and highly engaged professionals that work to ensure a quality patient experience within our service level agreements. The Claims Support Coordinator role serves as a liaison between plan members, providers and health insurance companies to get claims issues resolved. The Claims Support handles all communication, paperwork, and negotiations with a health insurance carrier or provider on the behalf of the plan member.

Responsibilities:

• Your primary objective is to provide effective and timely customer service for members, providers, insurer and clients regarding health care claims
• Ensure timely follow-up on requests for accounts to be reviewed
• Organize health insurance paperwork and medical record documentation
• Demonstrate knowledge of proprietary software and other required technology (Google apps, etc)
• Negotiate with providers on plan member balances
• Challenge denials of claims by the insurance company
• Communicate with medical offices, hospitals, laboratories, etc… in an effort to obtain relevant records for the patient’s case
• Contact providers and insurance companies to resolve claim concerns
• Assist with understanding of explanation of benefits (EOBs)
• Enabling members to get the errors fixed and recoup or lower their expenses by resolving their: medical bills, denied medical claims, medical letters of appeal
• Analyze and identify trends and patterns related to member billing complaints
• Collaborate with peers and management across functions
• Understand the evolving business requirements and adapt the operational processes to meet those requirements
• Speak clearly, confidently and have a friendly phone demeanor while demonstrating persuasion in overcoming objections
• Be able to handle a fast-paced dynamic environment with competing priorities
• Model a culture reflective of our Core Company Values; gain and maintain a thorough understanding of the Patient Care Team policies, processes, software, etc.

Qualifications:

• Minimum 3 years Claims experience strongly preferred
• Hospital Claims experience strongly preferred
• Highly effective communication, problem resolution and organizational skills
• Demonstrated ability to meet goals in a rapidly changing environment
• Excellent data and overall analytical skills
• Proven track record of driving measurable efficiency results
• Knowledge of medical terminology, ICD-9/ICD-10, CPT and DRG coding a plus.
• College degree preferred (additional experience in lieu of college degree will be considered)

#LI-CH1

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.

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.

Insurance Follow Up Specialist

Location Tampa, Florida, USA

22 USD – 22 USD/Hour

REMOTE Hospital Biller

A top healthcare revenue cycle management company is excited to welcome applicants for an

opportunity as an Insurance Representative that will join their team Coralville, IA. Within this role, you will follow up with payers, file appeals, when necessary, perform insurance billing, and adjust identification to ensure proper account resolution.

Further explore this exclusive opportunity below

What’s in it for you:

• Flexibility Ability to work remotely from anywhere in the U.S.
• Training Extensive training program based on the employee’s needs
• Growth Openings due to increase in business needs
• Strong Culture Inclusive workplace focused on professional and personal development

In this role you will

• Effectively handling each form of insurance follow-up
• Handle insurance billing and adjustment identification to ensure proper account resolution
• Make 40-60 outbound calls per day with insurance companies and customers
• Research if/why claims were denied and file and work to file an appeal when necessary

Required Experience:

• High School Diploma or Equivalent
• 3+ Years Insurance Follow-Up (for hospital claims) or 2 Years of Hospital Billing experience
• Past Work with 1500 and UB04 Forms
• Understanding of HIPPA, PCI protocols, and insurance follow-up processes
• Knowledge of inpatient/outpatient denials follow up
• Ability to make 40-60 outbound calls per day

Title: Clinical Enablement Specialist

Location: Remote

Virta is the first company with a clinically-proven treatment to safely and sustainably reverse type-2 diabetes without the use of medications or surgery. Our innovations in nutritional biochemistry, data science and digital tools combined with our clinical expertise are shifting the diabetes treatment paradigm from management to reversal.

Our mission: reverse type 2 diabetes in 100 million people.

Virta is available to 100% of the U.S population, and we are expanding our capabilities to bring our groundbreaking online type 2 diabetes reversal treatment to even more patients.

We’re looking for a motivated inidual to join our Clinical Enablement team at Virta. As a Clinical Enablement Specialist, you will support the clinical operations of our provider team as we guide patients through diabetes reversal. Your primary responsibilities in this role will include working with internal and external teams to improve provider efficiency by executing on clinical support tasks in order to achieve positive patient health outcomes.

The Clinical Enablement Specialist will be part of a team who is accountable for metrics such as patients under management per provider and overall provider satisfaction. We’re looking for someone who is passionate about clinical operations and who is willing to jump in and make an impact. This role will work cross-functionally with our coaches, providers, CS, enrollment, and engineering teams to ensure our providers and patients are receiving resolutions for clinical issues which will help Virta transform more and more patients’ lives!

Responsibilities

• Execute on tier 1 and 2 provider and coach requests via the ZenDesk ticketing system. This includes cueing up prescriptions in our electronic prescribing software, handling prior-authorization requests, and ordering patient labs.
• Communicating with outside healthcare facilities (i.e. Insurance companies, pharmacies, labs, clinics) to fulfill clinical requests from Virta’s providers
• Utilize our EHR Spark in order to review and transcribe incoming patient labs, and appropriately cue them up for our providers to review
• Continually find ways to improve our processes and support our clinical teams, while maintaining high patient safety and quality standards

90 Day Plan

Within your first 90 days at Virta, we expect you will do the following:

• Become familiar with the Virta treatment and be able to answer all different types of provider tickets autonomously
• Become familiar with our provider databases and how to appropriately pull information from them to answer both internal and external questions
• Develop a consistent and efficient daily workflow with the team to ensure all tickets and requests are resolved in a timely manner (usually within 24 hours)

Must-Haves

• Experience working in a healthcare clinical setting
• Passion for clinical operations and working closely with healthcare providers
• Ability to think critically and be data-driven in solving patient problems
• Operational experience- especially in a fast-growing, rapidly changing environment
• Knowledge of technology tools and ability to quickly pick up new technologies
• Strong and effective communication skills, with the ability to listen to understand an issue and problem solve
• Keen attention to detail in order to effectively solve tickets the first time around
• Strong time management skills and the ability to work efficiently while multitasking

Nice-to-haves

• Clinical Experience working alongside doctors and nurses to deliver patient care
• Customer facing experience
• Prior experience using technology tools including GSuite, ZenDesk, SalesForce, and JIRA
• Healthcare and diabetes knowledge

Values-driven culture

Virta’s company values drive our culture, so you’ll do well if:

• You put people first and take care of yourself, your peers, and our patients equally
• You have a strong sense of ownership and take initiative while empowering others to do the same
• You prioritize positive impact over busy work
• You have no ego and understand that everyone has something to bring to the table regardless of experience
• You appreciate transparency and promote trust and empowerment through open access of information
• You are evidence-based and prioritize data and science over seniority or dogma
• You take risks and rapidly iterate

As part of your duties at Virta, you may come in contact with sensitive patient information that is governed by HIPAA. Throughout your career at Virta, you will be expected to follow Virta’s security and privacy procedures to ensure our patients’ information remains strictly confidential. Security and privacy training will be provided.

Virta has a location based compensation structure. Starting pay will be based on a number of factors and commensurate with qualifications & experience. For this role, the compensation range is $47,954 – $62,286. Information about Virta’s benefits is on our Careers page at: https://www.virtahealth.com/careers.

Title: Implementation Manager-Enterprise Healthcare

Location: US, Remote

WE’RE LUMA HEALTH.

Needing healthcare can be hard getting care shouldn’t be.

We built Luma Health because we are all patients. We believe it should be easy to see and connect with our doctor. To get the care we need, when we need it.

So, we’ve created solutions to fix this problem. Our technology makes messaging easier, scheduling appointments more efficient, and it modernizes care delivery from beginning to end.

The Role:

We are looking for a highly driven and empathetic Implementation Manager to be responsible for all customer implementations and training from go-live through fully implemented and expansion.

The Implementation Manager will be responsible for ensuring our customer implementations stay on track and are delivered on time and with high quality. This role will work closely with our Customer Success Managers and our Engineering team to customize and configure the product, solve issues, keep the project on track, report on progress, and address obstacles to ensure successful on-time launches. The Implementation Manager will also be responsible for developing new processes to reduce the time and effort involved in customer implementations.

You will provide expert guidance to clients that enable them to adopt and use the product, and make informed decisions about future product selection based on client inquiries during implementation. You will proactively engage with and train users at each account to help them get the most out of Luma.

The successful candidate will be a self-starter, experienced IM who has a track record of successfully implementing complex, multi-stakeholder, or small, contained deployments. This person is passionate about tackling difficult problems in healthcare and is excited by the ambiguity and opportunity that comes with working in a dynamic, fast-growing technology company.

What you’ll do:

• Become an expert on the Luma Health platform and products
• Manage implementation of customers from contract through launch
• Work with the CSM to understand client pain points and success metrics
• Document data requirements and process workflows
• Develop product customization based on client requests
• Develop project plans, track progress and monitor roadblocks during implementation phases
• Partner internally with our technical team to optimize client implementations and resolve technical challenges, and with the product team to design ideal offering/features. Ensure on-time delivery of Luma implementations
• Keep clients and internal tech teams on track and communicate and nudge (politely!) as necessary to meet deadlines
• Regularly report on status of implementations and potential issues
• Help our clients learn and navigate our product and the process change it can bring; proactively ensure new clients are getting value from Luma Health
• Identify weaknesses and failure points in current project implementation plans and spearhead process improvements
• Contribute to the development of scalable content resources for Luma clients (e.g., user guides, presentations, best practice recommendations, and other tools for the client)
• Be creative; be willing to build out new approaches that help define a playbook for ongoing customer engagement and success

Qualifications:

• Minimum 3 years of software implementation experience. SaaS experience is preferred. Direct healthcare experience is strongly preferred
• Excellent project management skills and ability to collaborate across multiple internal and external stakeholders
• Excellent written and verbal communication skills
• Detail oriented
• Strong analytical and critical thinking skills; strong problem solving skills
• You have proven success in building trust and driving results for a broad range of stakeholders: C-Suite, senior executives, developers, and day-to-day users of the software.
• Ability to quickly identify underlying drivers of problems, quickly develop hypotheses, and execute on a path to solve
• Proven record of unblocking relationships, turning detractors into advocates, and driving issues to resolution with great client satisfaction
• A natural tendency to be customer first and a willingness to go the extra mile
• Team-oriented, doer mentality (i.e. no task is too small)
• Growth company DNA — ability to thrive in a dynamic, fast-paced startup environment
• Degree from a nationally-recognized and well-regarded four-year institution
• Ability to travel to client sites as necessary

We Take Care of You!

• Competitive Health Benefits: Luma Health covers 99% of the employee and 85% of the dependent premium costs.
• Work Life Balance
• Flexible Time Off
• Wellness Programs
• Discounted Perks
• 401(k) and Company Equity

Don’t meet every single requirement? At Luma Health we are dedicated to building an inclusive workplace so if you’re excited about this role but your past experience doesn’t align with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.

Luma Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We believe in order to thrive, businesses need a erse team and leadership. We welcome every race, religion, color, national origin, sex, sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an inidual with a disability, genetic information, or other applicable legally protected characteristics. Everyone is welcome here.

Come join us if you want to make a difference in health care.

Note: we have been made aware of iniduals fraudulently claiming to represent Luma Health recruiting. Please note that you will never be asked to submit payment or share financial information to participate in our interview process. All emails from Luma Health will come from “@lumahealth.io” email addresses. Any emails from other email addresses are scams. If you suspect that you’ve been contacted by a scammer, we recommend you cease all communication with the scammer and contact the FBI Internet Crime Complaint Center. If you’d like to verify the legitimacy of an email you’ve received from Luma Health recruiting, forward it to [email protected].

ProFee/Facility Medical Coder

Job LocationsUS

Job ID 2023-5235

Category Other

Remote Yes

The way you think makes you different. At Wipfli, we embrace that.

Our inclusive culture provides a space for everyone to have a voice. Our growing number of DEI resource groups celebrate ersity and champion awareness throughout Wipfli.

We’re also focused on helping you achieve success with balance. From hybrid schedules and flexible time off to training programs and mental wellness initiatives, we take care of our team.

If you want to be in an environment where you can grow, feed your curiosity and make a difference, Wipfli is the place for you.

Responsibilities

• Reviews patient charts, documents for verification and review code assignment in accordance with official coding guidelines.
• Ensures codes are sequenced according to government and insurance regulations.
• Assigns or validates discharge disposition and POA indicators.
• Abstracts and enters the coded data for hospital statistical and reporting requirements.
• Researches and analyzes data needs for reimbursement.
• Researches, analyzes and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
• Maintains 95% coding accuracy rate and maintains site designated productivity standards.

Qualifications

• Recognized coding credential from AHIMA or AAPC; and RHIA or RHIT may also be considered.
• Coding Certifications; preferred (CPC and/or CCS).
• 3-5+ years of work experience as a Medical Coder in both facility and professional coding setting required.
• Preferred setting experience in coding for Acute Care Hospitals, Critical Access Hospitals, Clinics, Rural Health Clinics, Federally Qualified Healthcare Centers.
• Excels at organizing and prioritizing workload and deadlines with high quality and accuracy.
• Proficient computer skills and working with coding software.
• Excellent written and verbal communication skills.

Title: Quality RN

Location: Remote

Company Description

Amwell is a leading telehealth platform in the United States and globally, connecting and enabling providers, insurers, patients, and innovators to deliver greater access to more affordable, higher quality care. Amwell believes that digital care delivery will transform healthcare. We offer a single, comprehensive platform to support all telehealth needs from urgent to acute and post-acute care, as well as chronic care management and healthy living. With over a decade of experience, Amwell powers telehealth solutions for over 150 health systems comprised of 2,000 hospitals and 55 health plan partners with over 36,000 employers, covering over 80 million lives.

Brief Overview:

This position provides quality review and support to the Amwell Medical Group (AMG). The RN candidate will be employed by Amwell providing review and support to the Amwell Medical Group Practice. The Amwell Medical Group is comprised of board-certified, credentialed, qualified physicians and other allied providers and is built to provide online healthcare services for Amwell’s Online Care clients.

The Amwell Medical Group currently provides acute care services in approximately 44 states, with the expectation of expanding to providing other medical services (e.g., chronic care management, specialty care, behavioral health) in all 50 states in the future. Care is delivered utilizing Amwell’s Online Care system. Online Care allows patients and consumers to connect with physicians immediately, whenever they have a health need, from their homes or offices. The innovation uses advanced Web-based technologies and telephony to remove traditional barriers to healthcare access, including insurance coverage, geography, mobility and time constraints.

Core Responsibilities:

• Participate in monthly Ongoing Professional Provider Evaluation (OPPE)- in-depth provider case reviews.
• Identify provider trends and deficits in clinical and documentation standards.
• Participation in Provider coaching/training
• Participate in monthly client meetings to understand and support client expectations.
• Initiation and management of Prior Authorizations.
• Participation in workflow design and QA improvements.
• Participation in risk management planning.
• Participation in ongoing policy and procedure design and editing- including, but not limited to clinical matters, intake, emergency preparation, referral planning, and documentation.
• Participation in regulatory assessment and compliance planning.
• Interface with providers as needed.
• Provide clinical support to other departments as needed to support organizational initiatives.
• Participation in department and committee meetings.
• Participation in the development of a process that measures outcomes.
• Participation in the quality management program, including investigation of red flag cases and adverse events.
• Participate in root cause analysis.

Qualifications:

• Registered nurse with a broad range of clinical experience; minimum of 10 years in practice
• Experience managing clinical outcomes based on a variety of acute and chronic illnesses.
• Strong communication skills: the ability to build professional relationships with providers to provide ongoing feedback/coaching.
• Strong analytical skills, review, and analysis of metrics to identify provider issues.
• Strong technical and application skills to support providers/patients.
• Interpretation and manipulation of clinical data via excel spreadsheets.
• Experience providing remote care/support is a plus.
• Desire to be a part of the telehealth innovation.

Additional information

Working at Amwell:

Amwell is changing how care is delivered through online and mobile technology. We strive to make the hard work of healthcare look easy. In order to make this a reality, we look for people with a fast-paced, mission-driven mentality. We’re a culture that prides itself on quality, efficiency, smarts, initiative, creative thinking, and a strong work ethic.

Our Core Values include One Team, Customer First, and Deliver Awesome. Customer First and Deliver Awesome are all about our product and services and how we strive to serve. As part of One Team, we operate the Amwell Cares program, which brings needed assistance to our communities, whether that be free healthcare for the underserved or for people affected by natural disasters, support for equality, honoring doctors and nurses, or annual Amwell-matched donations to food banks. Amwell aims to be a force for good for our employees, our clients, and our communities.

Amwell cares deeply about and supports Diversity, Equity and Inclusion. These initiatives are highlighted and reflected within our Three DE&I Pillars – our Workplace, our Workforce and our Community.

Amwell is a “virtual first” workplace, which means you can work from anywhere, coming together physically for ideation, collaboration and client meetings. We enable our employees with the tools, resources and opportunities to do their jobs effectively wherever they are!

The typical base salary range for this position is $91,200-$125,400. The actual salary offer will ultimately depend on multiple factors including, but not limited to, knowledge, skills, relevant education, experience, complexity or specialization of talent, and other objective factors. In addition to base salary, this role may be eligible for an annual bonus based on a combination of company performance and employee performance. Long-term incentive and short-term variable compensation may be offered as part of the compensation package dependent on the role. Some roles may be commission based, in which case the total compensation will be based on a commission and the above range may not be an accurate representation of total compensation.

Further, the above range is subject to change based on market demands and operational needs and does not constitute a promise of a particular wage or a guarantee of employment. Your recruiter can share more during the hiring process about the specific salary range based on the above factors listed.

Additional Benefits

• Unlimited Personal Time Off (Vacation time)
• 401K match
• Competitive healthcare, dental and vision insurance plans
• Paid Parental Leave (Maternity and Paternity leave)
• Employee Stock Purchase Program
• Free access to Amwell’s Telehealth Services, SilverCloud and The Clinic by Cleveland Clinic’s second opinion program
• Free Subscription to the Calm App
• Tuition Assistance Program
• Pet Insurance

Community Wellness Advocate

locations Remote

time type Full time

job requisition id 28661

POSITION SUMMARY:

A Community Wellness Advocate (CWA) is a trusted member of the community who helps high risk patients maintain stable health and wellness along a continuum, through integrating and connecting hospital, home-based, and community-based services. CWAs are responsible for providing advocacy and case management services; developing an interdisciplinary care plan based on identified patient needs; facilitating access to social service resources and other internal and external resources; monitoring the patient’s progress; and problem-solving with patients to both accelerate and enhance access to concrete supports.

CWAs provide in-home or community-based one-on-one, family, and/or interdisciplinary group support to high risk care patients and collaborates with the Patient Care Manager, PCP, and other members of the care team to conduct needs assessments to identify and respond to barriers to the patient’s health and wellness.

Position: Community Wellness Advocate

Department: Pop Health – Care Management

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Initiates face to face contact with eligible patients to describe role, explain participation benefits and begin screening process.
• Schedules and completes initial hospital, clinic, or community-based (homes, shelters, housing agencies, substance use treatment programs, etc.) visit screening, care plan, and follow up visits and phone calls for enrolled patients within specified timeframes.
• Teaches key educational messages using a variety of culturally, linguistically and educationally appropriate strategies, in a variety of settings.
• Clearly documents all activities in the patient’s record and care management system.
• Participates with other staff in activities that include community outreach, presentations to community organizations, development of materials, and phone calls.
• Works with patients and providers to set goals for patient’s care and provides guidance for patient to achieve those goals.
• Reinforces educational messages regarding disease self-management by linking clients with supportive community services and programs.
• Presents patients at case review meetings succinctly and logically.
• Consults with Patient Care Manager, primary clinical staff, behavioral health teams and / or PCP regarding complex patient situations, demonstrating an understanding of how to solicit and incorporate provider feedback in order to continuously develop the most optimal plan for care.
• Demonstrates the ability to function within an inter-disciplinary team (nurse care coordinators, social workers, behavioral health clinicians, physicians, resource specialists, clinical support staff, etc.), connecting the patient with resources as needed.
• Records and monitors the participants’ progress toward goals within specific timeframes.
• Documents assessments and key patient updates in Epic system; documents relevant day-to-day activities and patient data.
• Prepares reports and documents as needed or requested.
• Assists patients with organizing their records, making follow-up appointments, attending follow-up appointments, and filling their prescriptions.
• Helps patients fill out applications, for example for Medical Assistance, Housing, and SNAP (Supplemental Nutrition Assistance Program).
• Provides advocacy, patient education and successful warm hand offs in accessing community-based and hospital-based programs.
• Assists patient in addressing and overcoming barriers with a range of concrete supports, including but not limited to: healthcare support services, behavioral health, financial assistance, child-care and caregiver support, housing, support with utility bills, food, financial entitlements, clothing, transportation, food pantries, violence prevention, social isolation and any other appropriate community resources.
• Coordinates with community-based long-term services and supports.
• Provide intensive home and community-based outreach, motivational interviewing and goal setting, resource connection and accompaniment to medical appointments as needed to help patients appropriately utilize healthcare.
• CWAs may visit patients in hospital and ER settings to facilitate with transitions of care.
• Establishes culturally appropriate and trusting relationships with patients and their families.
• Participates in all training activities as designated by Community Wellness Manager (CWM) and the Nurse Practitioner.
• Attends regularly scheduled supervision and other program assigned meetings.
• Develops and maintains strong relationships with the community and community resources to ensure patient access.

NOTE: The CWA will not provide hands on care or other services noted as home health services, including but not limited to: performance assessments, provision of care, treatment, or counseling; and/or monitoring of patient’s health status.

JOB REQUIREMENTS

EDUCATION:

• HS Diploma with community experiences or Bachelor’s degree

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

• Driver’s license required

EXPERIENCE:

• Minimum of 2 years prior healthcare, public health, or community-based experience in community setting.

KNOWLEDGE AND SKILLS:

• Basic knowledge of healthcare system.
• Outstanding interpersonal skills of foremost importance to interact with families and patients.
• Interest in community health and outreach.
• Exceptional organizational skills; ability to multi-task and work independently and as part of a team.
• Demonstrated oral and written English communication skills.
• Fluency in Haitian Creole or Spanish preferable.
• Understanding of how language, culture and socioeconomic circumstances affect health.
• Desire to work with erse, multi-cultural and multi-lingual populations.
• Proficiency with Microsoft Office applications (i.e. MS Word, Excel, Access, Outlook) and web browsers. Proficiency with data entry and data tracking.

Nurse Clinical Lead

at Signify Health

Remote

Position Overview:

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

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.

In this role, the Spirometry Nurse Clinical Lead serves as a lead within Network Oversight and is responsible for the oversight of ensuring the provider network is meeting quality standards for Spirometry testing. The Nurse Clinical Lead will serve as the clinical resource for the Diagnostic and Preventive Services department, including spirometry testing, pilot projects, and escalations related to the quality of testing and completions. The Nurse Clinical Lead will be responsible for answering clinical questions regarding spirometry testing, device, workflow, and troubleshooting errors for spirometry testing. The Nurse Clinical Lead will also be responsible for the completion management of spirometry testing. The Nurse Clinical Lead will be required to follow all Signify Health policy and protocols related to spirometry testing and diagnostic and preventive services and escalate to other departments as appropriate if additional leadership is needed.

Spirometry 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 Spirometry testing provider escalations, recommendations and will be required to follow all Signify Health policy and protocols and escalate to a Regional Clinical Lead if additional leadership is needed
• Point of contact for spirometry clinical leadership to the provider network as needed
• Provide diagnostic preventative service training to clinicians
• Provides general support to the senior nurse clinical manager and departmental leaders

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 30-40% 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 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

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.

Title: Clinical Coding Specialist

Location: US National

Remote

Position Summary:

The Clinical Coding Specialist supports clients transitioning to value-based programs and troubleshoots lagging performance assisting in removing barriers. The Clinical Coding Specialist is a nurse and certified coder. They serve as an advisor and consultant on coding initiatives for internal and external stakeholders. This inidual will create and review clinical content related to coding, perform coding audits for select clients, and train clients on accurate and complete coding. The role requires translating clinical, regulatory, and contractual language into actionable tactics that can be implemented in a physician’s practice.

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.

Essential Duties and Responsibilities: To perform this job successfully, an inidual must be able to perform the following satisfactorily; other duties may be assigned. Reasonable accommodations may be made to enable iniduals with disabilities to perform essential functions.

• Audit accuracy, quality, and consistency of coded data by conducting audits of medical records, practice management systems, billing systems, and computer databases related to Medicare reimbursement
• Serve as a subject matter expert on topics such as CMS risk adjustment coding, Hierarchical Condition Category coding, best practices, and medical record review criteria.
• Train and facilitate educational events related to best practices in coding for audiences, including primary care physicians, nursing staff, administrators, coders, and billers.
• Coordinate with Delivery Team, Content Team & Product Team to develop, integrate, and maintain clinical coding content into our Approved Content library and Platform product functionality.
• Verify compliance with federal, state, and local laws, especially regarding Medicare coding and documentation guidelines. Synthesize complex information from multiple, sometimes conflicting, sources to form a conclusion.
• Research and resolve education content inquiries and provide training for internal and external stakeholders

Competencies: To perform the job successfully, an inidual should demonstrate the following:

• Proficient and knowledgeable in ICD-10, ICD-9, CPT, HCPCS, and HCC Coding
• Demonstrates ability to provide training on documentation & coding in a way that engages multiple learners (physicians, nurses, medical assistants, practice administrators, office staff)
• The ability to evaluate medical records with attention to detail and to summarize findings
• Excels in public speaking and client engagement
• Ability to collaborate and meet demands of multiple stakeholders across departments
• Proficient planning and organizational skills.
• Calm and effective in a high-pressure, fast-paced, client-driven environment.
• Self-motivated and able to work independently and collaborate in a virtual environment while managing multiple deliverables with competing priorities.

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

Education/Experience:

• Current licensure as a Registered Nurse with a BSN (Bachelor of Science in Nursing) or equivalent degree
• Certified Coder credentials from a nationally recognized organization required (Ex: CMC, CPC, CCS). CRC certification is preferred.
• Minimum of five years of experience in billing, coding, and HCC in an ambulatory care setting
• Experience working with Accountable Care Organizations preferred
• RHC and/or FQHC coding experience a plus.

Telehealth RN

REMOTE

United States

AM&CS

Full time

Description

At Current Health, we’re building technology and services to identify disease onset and bring treatment straight to the patient. When you join our team, you embark on solving some of the toughest problems our society faces, delivering a platform that directly saves lives.

If you want to solve really hard problems, if you want to work in an exciting, collaborative environment where you get to touch and change real-lives on a daily basis, if you are driven to do things better, then we want to know you.

We are looking for a responsible, well-respected registered nurse to work closely with our platform partners to conduct virtual/remote visits with patients. Our clients – large US health systems and global pharma organizations – rely on Current Health to provide video and telephone triage when their patients are experiencing a clinical problem. We are looking for knowledgeable, flexible, friendly nurses who can assess patients by telephone or video and then make decisions that are clinically appropriate, escalating if necessary, or deferring to routine care if appropriate.

We seek to build a team of nurses who serve as clinical partners to our clients’ healthcare providers. We want nurses who get to know our clients’ patients and follow their care, collaborating with the clinicians who are advancing their care in person and virtually.

As we expand this clinical service at Current Health, members of this team will also be responsible for developing educational content for patients and our commercial partners, serving as clinical reviewers of content created by other non-clinicians on the Current Health team, and helping our organization innovate as we expand and grow.

Responsibilities:

• Providing prompt, professional, friendly triage for clinical issues escalated by our frontline non-clinical team
• Reliably assess clinical issues using Schmitt-Thompson triage protocols
• Work collaboratively and flexibly with the Current Health team, both our clinical team and our broader organization.
• Constantly strive to provide a high-quality clinical experience for our partners and their patients
• Help us get better by working to improve our services and our technology, providing constructive feedback as appropriate.
• Get to know Current Health technology and services and stay up to date on new product releases so you can serve as a product expert for patients.
• Help the customer success team periodically, as patient-facing tasks arise within key accounts, and as patients transition in and out of our program.
• Create evidence-based written and digital content for our clinical and commercial programs.
• Review content created by non-clinical teams for accuracy and clinical appropriateness.

Requirements

We value people who are passionate about improving health, who are hard-working and smart! In addition, we would like to see:

Skills and Competencies

• A supportive and empathetic manner that patients will trust and enjoy.
• Finely tuned clinical skills based on experience communicating with patients by phone or video
• Positive attitude and willingness to take on multiple projects, roll up your sleeves and e in in a lean, start-up environment.
• Highly organized.
• Excellent communication, presentation and interpersonal skills.
• Skillful with technology, including video platforms and medical devices

Required Qualifications/Experience:

• ADN (associates degree in nursing) required from an accredited nursing school, BSN (bachelor’s) preferred, and 2-3 years of clinical nursing experience in a med/surg, ICU, or ED inpatient setting.
• Active multi-state RN license in a Nurse Licensure Compact state, with ability to license in all U.S. states and territories.
• Prime Source Verification of nursing license is required prior to the first day of employment (covered by Current Health).
• Ability to work at least three shifts per week (36 hours) and the equivalent of 40 hours a week in a 6-week schedule.
• A team player who thrives in collaborative environments while being very results driven.
• Strong written and communication skills.
• Strong documentation skills and experience working with Epic or Cerner.
• All team members will have on-call requirements in order to have backup’ staffing
• All team members will be asked for flexibility to work other shifts in order to cover vacation and holiday times

Nice-to-have experience:

• Experience working for a medical device, health IT, or digital health company.
• Telephone triage experience
• Telehealth experience
• Spanish fluency

Current Health has offices in Boston and Edinburgh however many of our team choose to work remotely. We anticipate that this role will be remote, however there will be occasional in-person meetings.

We actively seek to reflect the community that we serve, and so iniduals of all genders, race, sexual orientation, nationality, ability, veteran status, and educational background are strongly encouraged to apply.

Benefits

• Health Care Plan (Medical, Dental & Vision)
• Retirement Plan (401k, IRA)
• Life Insurance (Basic, Voluntary & AD&D)
• Paid Time Off (Vacation, Sick & Public Holidays)
• Family Leave (Maternity, Paternity)
• Short Term & Long Term Disability
• Training & Development
• Work From Home
• Wellness Resources
• Bonus Scheme

Medical Review RN – Medicare A&B/Medicaid

Remote

Full-Time/Regular

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving iniduals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.

Qlarant has an exciting opportunity for an experienced Medical Review RN (Claims Analyst II) to join our Unified Program Integrity Contractors (UPIC) West team. Our UPIC team identifies and investigates fraud, waste and abuse in the Medicare Parts A & B and Medicaid programs covering 16 Western states and territories. The selected candidate can be home based in most states in the U.S.

Please Note: Current, active and non-restricted RN license required. An LVN will not meet requirements.

This mid-level professional performs medical record and claims review for Medicare Parts A&B, Medicaid, and/or other claims data in order to ensure that proper guidelines have been followed. As a member of an investigative team, may act as a facilitator as well as a case manager regarding assessment for potential overpayment, fraud, waste, and abuse with regards to Medicare, Medicaid, and/or other claims.

Essential Duties and Responsibilities include some or all of the following. Other duties may be assigned.

• Completes desk review or field audits to meet applicable contract requirements and to identify evidence of potential overpayment or fraud.
• Effectively identifies and resolves claims issues and determines root cause.
• Interacts with beneficiaries and health plans to obtain additional case specific information, as needed.
• Consults with Benefit Integrity investigation experts for advice and clarification.
• Completes inquiry letters, investigation finding letters, and case summaries.
• Investigates and refers all potential fraud leads to the Investigators/Auditors.
• Has basic understanding of the use of the computer for entry and research.
• Responsible for case specific or plan specific data entry and reporting.
• Participates in internal and external focus groups and other projects, as required.
• Identifies opportunities to improve processes and procedures.
• Has the responsibility and authority to perform their job and provide customer satisfaction.
• May participate as an audit/investigation team member for both desk and field audits/investigations
• Has developed expertise with standard concepts, practice and procedures in field. Relies on limited experience and judgment to plan and accomplish goals.
• Understands and complies with the company’s policies and procedures pertaining to compliance with HIPAA.
• Testifies at various legal proceedings as necessary.
• May mentor and provide guidance to junior and level one analysts.
• Performs a variety of tasks some requiring independent thought and research. A degree of creativity and latitude is required.

Required Skills

To perform the job successfully, an inidual should demonstrate the following competencies:

• Analytical – Synthesizes complex or erse information; Collects and researches data; Uses intuition and experience to complement data.
• Problem Solving – Gathers and analyses information skillfully; Identifies and resolves problems.
• Judgment – Supports and explains reasoning for decisions.
• Written Communication – Writes clearly and informatively; Able to read and interpret written information.
• Quality Management – Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
• Interpersonal Skills – Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others’ ideas and tries new things.
• Teamwork – Balances team and inidual responsibilities; Exhibits objectivity and openness to others’ views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; able to build morale and group commitments to goals and objectives; Supports everyone’s efforts to succeed.
• Professionalism – Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
• Other Skills and Abilities
  • To perform this job successfully, an inidual should have intermediate level knowledge of Microsoft Office and the internet to meet contract deliverables.
  • Utilizes required data entry and reporting systems, including advanced features.
  • Must have the ability to work independently with minimal supervision.
  • Must be able to communicate effectively with all members of the team to which he/she is assigned.

Required Experience

Education and/or Experience

• BSN OR an RN with additional current and active degree/license/certification/s in a relevant healthcare discipline (i.e., CPC, CPHM, CFE, CCM, HCAFA).
• Must possess at least five years clinical experience.
• At least one year healthcare experience that demonstrates expertise in conducting medical records and claims reviews and/or utilization reviews.
• ICD-9 coding, CPT coding, and knowledge of Medicare and/or Medicaid regulations strongly preferred.
• Prior successful experience with CMS, State Medicaid, and OIG/FBI or similar agencies preferred.

Certificates, Licenses, Registrations: Current, active and non-restricted RN licensure required. An LVN will not be accepted.

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Iniduals with Disabilities.

Title: Outpatient Medical Coder

Location: United States

Remote Home Office | Full Time

JOB DESCRIPTION

Hiring Remote VA Experienced Outpatient Full Time Medical Coders

Summary

Cooper Thomas, LLC, a leading provider of medical coding services to the Department of Veterans Affairs (VA), has immediate openings for full-time VA experienced Outpatient Medical Coders. We want to hire you as either a Full-Time Hourly W2 Employee with No Benefits, which will allow you to maximize your hourly cash earnings or as a traditional Full-Time W2 Employee with Benefits at a slightly lower hourly rate. Applicants must have 2 years of experience with the opportunity for a flexible weekly work schedule.

Previous experience with VA is required, whether as a former VA employee or with another VA contractor. You must be able to pass an initial entrance exam and code at a minimum of 95% accuracy. This work will be performed remotely in your home office. Preference will be given to those candidates who meet the qualifications below and have an active Background Investigation, COI, PIV Card, eToken, and an active Moonlighter and/or Contractor Citrix Network Account.

The company is looking to hire a minimum of 15 full-time Outpatient Coders. The medical coding volumes for our projects are predictable, consistent, and sustainable into the future.

These projects require experience utilizing ICD-10, CPT, and HCPCS codes

Qualifications

• Two (2) years of VA or other relevant coding experience, either as a VA employee or with another Government contractor supporting VA
• Ability to code a minimum average of 10 Outpatient encounters per hour with 95% accuracy
• Must produce copies of and maintain active credentials as a certified coder or auditor
• Ability to follow site-specific coding guidelines
• Familiar with E/M leveling for OP and ED visits using 95′, 97′ and 2022 guidelines
• Familiar with E/M calculator and ability to use this tool proficiently
• Familiar with 3M Encoder for ICD10 and CPT coding
• Knowledge in anatomy and physiology, medical terminology, pathology and disease processes, pharmacology, health record format and content, reimbursement methodologies and conventions, rules and guidelines for current classification systems (ICD, CPT, HCPCS).
• Must be able to complete work within the required TAT of 5 days from the date of assignment.

Accepted Coding Credentials

American Health Information Management Association (AHIMA):

• Registered Health Information Administrator (RHIA) / Registered Health Information Technician (RHIT)
• Certified Coding Specialist (CCS) / Certified Coding Specialist-Physician (CCS-P)

American Academy of Professional Coders (AAPC):

• Certified Professional Coder (CPC)
• Certified Outpatient Coder (COC)

Minimum Education

• High School Diploma or equivalent

Cooper Thomas, LLC is a leading provider of health information management services to Federal health clients. Established in Washington, DC in 2003, Cooper Thomas offers a competitive compensation and benefits as well as steady and predictable weekly work volumes, potential overtime, and the opportunity for growth. The selected candidate will be required to undergo a background investigation. Veterans encouraged to apply. Equal opportunity employer.

Utilization Review Nurse – Remote

Location: US National

Full-Time

Responsible for utilization review work for emergency admissions and continued stay reviews.

Responsibilities

• Review electronic medical records of emergency department admissions and screen for medical necessity, using InterQual or MCG criteria.
• Participate in telephonic discussions with emergency department physicians relative to documentation and admission status.
• Enter clinical review information into system for transmission to insurance companies for authorization.

Qualifications

Required

• Current RN licensure
• At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
• At least 3 years case management, concurrent review or utilization management experience
• Experience with InterQual and/or MCG criteria
• Proficiency in medical record review

Preferred

• Case management/concurrent review/utilization management experience within the ED setting
• Bachelors of Science in Nursing

Expectations

• This job operates in a remote environment that must be private. This role routinely uses standard office equipment such as computers, phones, and printers.
• Hours will vary, including two weekends a month.
• Must be able to remain in a stationary position 50% of the time and constantly operate a computer.
• Frequently communicates with internal, external and executive personnel and must be able to listen and exchange accurate information.

Title: Director, Nursing Research

Location: Remote/Nationwide Remote/Nationwide USA

Full Time

The Director of Nursing Research partners with leadership to design, plan and implement Kaplan Nursing s strategic research initiatives including defining research priorities, identifying and facilitating research partnerships, designing and implementing research studies, analyzing data, synthesizing findings into scientific articles and white papers, and publishing in peer-reviewed journals and industry publications.

Primary Responsibilities

• Plans, implements, and evaluates nursing research and evidence-based practice activities in nursing education
• Promotes, supports, and facilitates iniduals engaging in research activities to advance research in education/practice, evidence-based practice, the conduct of research, research utilization, and dissemination of research results.
• Conducts annual research needs assessment and uses results to construct a strategic nursing research plan.
• Collaborates and develops innovative programs to educate, mentor, and enhance the knowledge of institutional partners and the Kaplan nursing team.
• In collaboration with the Executive Director, Nursing Innovation & Graduate Programs, organizes and conducts workshops, conferences, symposia, advisory boards, and other similar activities.
• Promotes the development and testing of more efficient educational processes, identifies new ways to incorporate technology to enhance learning and discovers more effective approaches to promote lifelong learning.
• Seeks research funding through grant applications as applicable.

Minimum Qualifications

• Doctoral degree (Ph.D., EdD, DNP) in nursing education or related field from an accredited college or university
• 5 years as a nurse in a teaching/leadership/research role
• 2 years experience facilitating research activities preferred (may be as principal investigator of a grant or active involvement in designing and delivering research projects).
• Must have an active RN license
• Current CITI training
• Proficient in using SPSS and NVivo software
• Comfort with business suite technologies such as GoogleSuite and ability to adapt to new technologies

Preferred Qualifications

• Institutional review board (oversight and submission of applications) experience
• Proven track record of publishing evidence-based research and/or peer-reviewed articles.

We offer a competitive benefits package including:

Remote work providing flexible work/life balance Comprehensive Retirement Package including 401K company match and two pension programs Our Gift of Knowledge Program provides tuition assistance and substantial discounts for our employees and close family members Competitive health benefits and new hire eligibility starts day-1 of employment Generous Paid Time Off includes paid holidays, vacation, personal, sick paid time-off, plus one (1) volunteer day and one (1) ersity and inclusion day to participate and give back to our local communities And so much more! #LI-JB1

#LI-Remote

This position is a Salary Grade B

Nurse Case Manager

Remote, USA

Full time

job requisition id REQ003554

At The Standard, you’ll join a team focused on putting our customers first.

Our continued success is driven by a high-performance culture. We’re looking for people who are collaborative, accountable, creative, agile and are driven by a passion for doing what’s right across the company and in our local communities.

We offer a caring culture where you can make a real difference, every day.

Ready to reach your highest potential? Let’s work together.

JOB PURPOSE

Assess claimants’ medical conditions, diagnostics, procedures performed and ongoing treatment to determine functional capacity levels as well as the appropriateness of care. Collaborate with treating physicians to promote suitable care plans directed toward return to work by communicating with claimants, treating and consulting physicians, employers and benefits personnel. Assess medical record documentation for completeness. Coordinate claim prevention, intervention and return to work programs for employers.

PRINCIPAL ACCOUNTABILITIES / ESSENTIAL FUNCTIONS

Contribute to the company’s success through excellent customer service and meeting or exceeding performance objectives for the following major job functions:

• Evaluate medical history and treatment and test results during file reviews and consultations with ision benefits staff. Provide assessments of claimants’ functional capacity and their levels and expected durations of impairment. Identify and resolve stated limitations inconsistent with medical documentation. Assess medical records to determine if claim for disability is caused or contributed to by a limited or excluded medical condition.
• Assess adequacy and appropriateness of treatment. Advocate on behalf of the claimant for appropriate services and treatment to attain maximum medical improvement and successful return to work. Work in conjunction with vocational and benefits staff to assess claimants’ psychosocial, environmental and financial status. Communicate with claimants, their families, employers, medical treatment providers, rehabilitation counselors and other carriers such as workers’ compensation providers or HMO’s, to ensure understanding of and cooperation with the recommended treatment plans and the goal of returning to work.
• Provide claim prevention services by working with employers to evaluate their organizations’ trends in disabilities. Coordinate site visits and assessments; advise on educational programs for employee groups; work in conjunction with vocational staff to recommend job site modifications and safety or procedural changes. Collaborate with sales, underwriting, and vocational and benefits staff to recommend, develop and implement intervention and return to work programs and practices for employers.
• Develop and conduct medical education and training for ision claims personnel.

ESSENTIAL FUNCTION REQUIREMENTS

• Demonstrated skills: Effective case management. Effective identification and resolution of problems. Clear and persuasive expression of ideas in both written and oral communications. Effective collaboration with peers and team members.
• Ability to: Utilize computer software and hardware applications. Talk by telephone. Shift priorities to meet demands from various customer groups. Make decisions in the absence of specific direction. Facilitate group discussions. Achieve professional designation.
• Working knowledge of: Assistive devices needed by people with disabilities. The Americans with Disabilities Act, family leave laws, Fair Claims Settlement Practices Act, and laws governing client confidentiality.

QUALIFICATIONS

• Education: BS or MS in a related field.
• Experience: A minimum of 4 years hospital or clinical experience in relevant medical fields (e.g. cardiology, orthopedics, mental health) or utilization review or quality management, or the equivalent combination of education and/or relevant experience.
• Professional certification required: Current Registered Nursing license, with a CCM or CPDM designation or ability to obtain such a designation within 2 years of hire. Is a job requirement

#LI-REMOTE

Please note – the salary range for this role is listed below. In addition to salary, our package includes incentive plan participation and comprehensive benefits including medical, dental, vision and retirement benefits, as well as an initial PTO accrual of 164 hours per year. Employees also receive 11 paid holidays and 2 wellness days per year.

• Eligibility to participate in an incentive program is subject to the rules governing the program and plan. Any award depends on various factors, including inidual and organizational performance.

Salary Range:

$71,000.00 – $104,000.00

Billing Specialist

Remote

locations

Remote, United States

time type

Full time

job requisition id

REQ – 02223

Company: ABC Fitness Solutions

It’s fun to work in a company where people truly BELIEVE in what they’re doing!

We’re committed to bringing passion and customer focus to the business.

Job Description

At the very core…

The ideal Billing Specialist is an administrator and accounting liaison to internal and external customers, providing support, and acts as a backup to multiple roles in the Finance group. Coordinates, maintains, and develops processes, tools, communications, training, and methodologies to ensure the success of client’s account.

WHAT’S IN IT FOR YOU:

• Highly collaborative and global remote-first environment
• Fitness, Healthcare, and Wellness benefits
• Learning and Development
• Start-up vibe
• 401K/RRSP (geo specific)
• Accrued PTO

What you’ll do…

• Coordinate with Professional Services, Revenue Operations, IT, Sales, Accounting, and Finance teams to optimize processes and ensure accurate and timely billing using multiple software programs (including Workday, Recurly, Salesforce Billing, Chargebee, and proprietary systems) to generate invoices for services, hardware, and software subscriptions
• Administrator and accounting liaison for internal and external customers; including deductions, reimbursements, fees, various research request, and applicable analysis
• Provide support and input for various accounting reconciliations (EON, iSeries, Commerce)
• Works directly with the “Closing Sales and Discontinue” team to facilitate changes
• Creates custom reports to facilitate financial operations and associated analysis needed
• Other duties as assigned by management
• Regular and reliable attendance required

What you will need to succeed…

• 2+ years’ experience in billing in a high-volume and multi-platform environment
• Proficiency with Microsoft Office suite, including at least intermediate Microsoft Excel (pivot tables & V Lookup)
• Professional communication skills and a collaborative mindset
• Ability to multi-task in a fast-paced environment
• Ability to make sound decisions and take calculated risks
• Excellent written and verbal communication skills
• Ability to problem solve using deductive reasoning skills in a timely manner
• Basic skills including but not limited to addition, multiplication and ision of whole numbers, decimals and fractions
• Flexibility and adaptability to frequent change

Preferred Skills:

• Workday ERP experience
• Experience understanding accounting system functionality
• Experience with payment processing and/or software-as-a-service industries
• 1+ years of Accounting experience
• Strong customer orientation and teamwork skills
• Detail-oriented and able to make sound decisions
• Excellent interpersonal and communication skills
• Commitment to company values

Payment Coordinator

• UNITED STATES
• 2023-100581
• CONTRACTS ADMINISTRATION
• REMOTE

About the role

ICON plc is a world-leading healthcare intelligence and clinical research organisation. From molecule to medicine, we advance clinical research providing outsourced services to pharmaceutical, biotechnology, medical device and government and public health organisations. With our patients at the centre of all that we do, we help to accelerate the development of drugs and devices that save lives and improve quality of life. Our people are our greatest strength, are at the core of our culture, and the driving force behind our success. ICON people have a mission to succeed and a passion that ensures what we do, we do well.

What will you be doing?

The Grants Specialist is able to perform in a fast paced environment, able to create and reset priorities as the need arises, identify and raise issues before they become critical, and adjust quickly to the changes of a dynamic organization.

What do you need to have?

• Demonstrates sound judgment in daily decision making.
• Process and review vendor payments
• Sufficient working knowledge of system to train new starters.
• Employee effectively utilizes his/her technical skills.
• Contributes to the CD&F process.
• Excels in priority management.
• Experience with SAP is a plus
• Proven ability to use all MS Office suite or applications including Word, Excel, Access & PowerPoint.
• Read, write and speak fluent English; fluent in host country language required.
• Bachelor’s Degree or international equivalent preferred.
• 1 plus year of CRO pr Phrama experience with clinical payments

Benefits of Working in ICON:

Our success depends on the knowledge, capabilities and quality of our people. That’s why we are committed to developing our employees in a continuous learning culture – one where we challenge you with engaging work and where every experience adds to your professional development.

At ICON, our focus is to provide you with a comprehensive and competitive total reward package that comprises, not only an excellent level of base pay, but also a wide range of variable pay and recognition programs. In addition, our best in class employee benefits, supportive policies and wellbeing initiatives are tailored to support you and your family at all stages of your career – both now, and into the future.

ICON, including subsidiaries, is an equal opportunity and inclusive employer and is committed to providing a workplace free of discrimination and harassment. All qualified applicants will receive equal consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

If, because of a medical condition or disability, you need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please let us know.

Same Day Surgery Coder HIMS Remote

locations

Remote Peoria AZ

Remote Flushing MI

Remote Albuquerque NM

Remote Lafayette LA

Remote Lincoln NE

Remote Hutchinson KS

Remote Mishawaka IN

Remote Midwest City OK

Remote Phoenix AZ

Remote Minneapolis MN

Remote Denver CO

Remote Ackley IA

Remote Mount Juliet TN

Remote Alpine UT

Remote Seattle WA

Remote Glendale CA

Remote Cheyenne WY

Remote Jamestown ND

Remote Chanhassen MN

Remote Carson City NV

Remote Covington LA

Remote Blue Springs MO

Remote Carriere MS

Remote Bella Vista AR

Remote Brooklyn NY

Remote Avon Lake OH

Remote Cleveland OH

Remote Boise ID

Remote Bismarck ND

Remote Elizabethtown KY

Remote Yukon OK

Remote Allentown PA

Remote Atlanta GA

Remote North Charleston SC

Remote Walker MN

Remote Anchorage AK

Remote Charlotte NC

Remote Arlington VA

Remote Ashland KY

Remote Salt Lake City UT

Remote Portland OR

Remote San Antonio TX

Remote Orlando FL

Remote Milwaukee WI

time type

Full time

job requisition id

R108120

Primary City/State:

Peoria, Arizona

Department Name:

Coding-Acute Care Hospital

Work Shift:

Day

Job Category:

Revenue Cycle

Primary Location Salary Range:

$21.63/hr – $32.45/hr, based on education & experience

In accordance with State Pay Transparency Rules.

A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you’re looking to leverage your abilities you belong at Banner Health.

Ideal Acute Care/Facility Same Day Surgery HIMS Coder | Medical Coder will have experience coding Acute Care Same Day Surgeries (multiple specialties – and have wide variety), Observation visits, solid CPT skills in a variety of encounters/surgery types, working knowledge of PCS coding fundamentals, and experience addressing NCCI edits and applying appropriate modifiers. They would be able to work effectively with common office software and coding software and abstracting systems. In most of our Coding roles, there is a Coding Assessment given after each successful interview. Banner Health provides your equipment when hired.

*This is a fully remote position and available if you live in the following states only: AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, MD, MI, MN, MO, MS, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI & WY.*

The hours are flexible as we have remote Coders across the Nation. Generally, any 8-hour period between 7am 7pm can work, with production being the greatest emphasis. Apply today!

Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you’ll find many options for contributing to our award-winning patient care.

POSITION SUMMARY

This position evaluates medical records, provides clinical abstracts and assigns appropriate clinical diagnosis and procedure codes in accordance with nationally recognized coding guidelines.

CORE FUNCTIONS

1. Analyzes medical information from medical records. Accurately codes diagnostic and procedural information in accordance with national coding guidelines and appropriate reimbursement requirements. Consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes. Provides thorough, timely and accurate assignments of ICD and/or CPT4 codes, MS-DRGs, APCs, POAs and reconciliation of charges.

2. Abstracts clinical diagnoses, procedure codes and documents other pertinent information obtained from the medical record into the electronic medical records. Seeks out missing information and creates complete records, including items such as disease and procedure codes, point of origin code, discharge disposition, date of surgery, attending physician, consulting physicians, surgeons and anesthesiologists, and appropriate signatures/authorizations. Refers inconsistent patient treatment information/documentation to coding quality analysis, supervisor or inidual department for clarification/additional information for accurate code assignment.

3. Provides quality assurance for medical records. For all assigned records and/or areas assures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards.

4. As assigned, compiles daily and monthly reports; tabulates data from medical records for research or analysis purposes.

5. Works independently under regular supervision. Uses specialized knowledge for accurate assignment of ICD/CPT and MS-DRG codes according to national guidelines. May seek guidance for correct interpretation of coding guidelines and LCDs (Local Coverage Determinations).

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

MINIMUM QUALIFICATIONS

High school diploma/GED or equivalent working knowledge and specialized formal training equivalent to the two year certification course in medical record keeping principles and practices, anatomy, physiology, pathology, medical terminology, standard nomenclature, and classification of diagnoses and operations, or an Associate’s degree in a related health care field.

Must demonstrate a level of knowledge and understanding of ICD and CPT coding principles as recommended by the American Health Information Management Association coding competencies, and as normally demonstrated by certification by the American Academy of Professional Coders. Six months providing coding services within a broad range of health care facilities. Must be able to achieve an acceptable accuracy rate on the coding test administered by the hiring facility according to pre-established company standards.

Must be able to work effectively with common office software and coding software and abstracting systems.

PREFERRED QUALIFICATIONS

Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC) in an active status or Certified Coding Specialist-Physician (CCS-P) with American Health Information Management Association or American Academy of Professional Coders is preferred. Will consider experience in lieu of certification/degree.

Additional related education and/or experience preferred.

EOE/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

Staff Registered Nurse

Remote

Wheel is the health tech company powering the next generation of healthcare. The entire healthcare industry is racing to serve patients online, but outdated business models, technologies, and mindsets are continuing to get in the way. We pioneered a new way for companies to build and scale virtual care.

Instead of starting from scratch, companies can leverage Wheel’s virtual care platform and nationwide clinician network to develop a virtual care service — bypassing the 15 months and $15 million it can take to build from the ground up. Today, Wheel powers the most innovative companies in healthcare today, including digital health companies, clinical lab networks, retailers, traditional healthcare providers, and tech companies.

We’re a team of experts and innovators working together to solve some of healthcare’s most challenging problems in order to put great care within everyone’s reach. We’ve raised $216 million in funding and backed by top investors including Lightspeed Venture Partners, Tiger Global, Coatue, CRV, Tusk Ventures, Salesforce Ventures, and Silverton Partners.

In the last year we’re proud to have been named:

• Forbes Next Billion Dollar Startups
• Built In’s Best Remote-First Places to Work
• CB Insights Digital Health 150
• Business Insider 30 Leaders under 40 Changing Healthcare

We’re looking for people to join our team who share a passion for making a positive difference in healthcare and feel connected to our core values.

Position Summary

As a Staff RN and part of Wheel’s clinical operations team, you will play a key role in supporting our clinicians, clients, and patients through a variety of different ways. Your primary function is to provide clinical support to patients on multiple telehealth platforms. You will work closely with the clinical operations team to assist in the execution of quality improvement initiatives based on performance data and organizational goals. You will be supported by a cross-functional team, including clinicians, product managers, implementation managers, and engineers to ensure the highest quality of care is met across the entire Wheel team. You will serve as a leader for the Clinical Support RN team, orienting and mentoring the RN team, developing, implementing, and improving processes and workflows, and advocating for the work of the Clinical Support RN team across the organization.

The ideal candidate will have the unique combination of a strong clinical background as a Registered Nurse mixed with telehealth experience in clinical quality improvement and patient care support. We are looking for someone who exhibits strong communication skills, a growth mindset, equitable judgment, attention to detail, and a highly collaborative work style. This role requires a Registered Nurse who is tech savvy and can balance multiple applications simultaneously. Most importantly, this candidate must have the willingness to embrace change amongst a fast paced startup environment.

Responsibilities

• • Support clinicians by completing prior authorizations, reporting communicable diseases to the public health department, monitoring and addressing labs, performing chart audits, and providing post-visit patient support.
  • Help deliver feedback to clinicians and clients in regards to clinical quality with recommended process improvements.
  • Contribute to the development of a clinical quality platform including but not limited to collaborating on the innovation of quality objectives, metrics, and principles.
  • Collaborate with the Product, Operations, and Medical Teams to help provide clinicians with the best in class care on industry-leading clinical guidelines, Webside Manner™, and telemedicine best practices.
  • Assist clinicians who reach out to our Support team by answering questions, solving technical issues, and working with clients to solve clinician problems. In addition, you will identify trends and common issues affecting clinicians and propose long term solutions to mitigate problems.

  RN Qualities:

  • Relationship-oriented: foster trust while balancing the best interests of our clinicians, our clients and their patients, and the entire Wheel team.
  • Quick learner: proactive self-starter that is excited to become an expert on both Wheel and the client, navigating rapidly evolving platforms and policies
  • Passionate about continuous quality improvement: comfortable with implementing the minimum viable clinical product, then iterating based on analysis of qualitative and quantitative data
  • Excellent communication skills: clear, respectful, and solution-focused communication
  • Leader: Consistently speaks up and provides useful input in group conversations + starts to help enable others to speak up

  Qualifications

  • Active RN license (must have 35+ active state licensure)
  • 5+ years of RN experience
  • 2+ years telemedicine experience
  • 1+ years of quality/performance improvement experience
  • Experience developing and implementing processes
  • 1+ years Experience in a leadership role
  • Proficiency with common software applications and experience with multiple different EMR systems.
  • Strong interpersonal skills and the ability to effectively communicate across the organization
  • Must have advanced computer skills including typing speed, email, internet research, downloading and uploading files, and working in multiple browser windows

Utilization Review Registered Nurse

Remote

locations

US – Remote (Any location)

time type

Full time

job requisition id

7613

Job Family:

Clinical Appeals Nurse

Travel Required:

None

Clearance Required:

None

What You Will Do:

The Remote Utilization Management Nurse – is accountable for performing initial, concurrent, and/or post-service review activities; discharge care coordination; and assisting with efficiency and quality assurance of medical necessity reviews in alignment with federal, state, plan, and accreditation standards. Serves as a liaison between providers/facilities. This position is 100% remote. Some evening/weekends/holidays required.

General Functions:

• Experience and knowledge of clinical guidelines/criteria and the accurate application during a clinical review. Maintains objectivity in decision making by utilizing facts to support decisions.
• Supports the care management model as a working partner with providers, facilities, care managers, social workers, pharmacists, and other professional staff.
• Able to adhere to communicated utilization management productivity metrics, including call volume and reviews.
• Able to adhere to quality standards for utilization management per policy, including appropriate documentation in alignment with guidelines, strict adherence to turn around time, identification of deviations from the progression of care, initiation of a discharge plan, and communication of barriers to other team members.
• Demonstrates a solid understanding of managed care trends, payer regulations, reimbursement, and the effect on utilization and outcomes of the different methods of reimbursement.
• Demonstrates participation in multi-disciplinary team rounds if designated to cover a facility designed to address utilization/resource and progression of care issues. Assists in developing and implementing an improvement plan to address issues.
• Implements a discharge plan to prevent avoidable days or delays in discharge.
• Transition iniduals to next level of care in coordination with facility Discharge Planner.
• Identify and refer complex risk members to care management.
• Completes documentation in a timely, complete, and accurate manner in accordance with client benefits, guidelines, and regulatory requirements.
• Identify documents and refer cases to the Physician Advisor for medical review when services do not meet medical necessity criteria, the appropriate level of care, and/or potential quality issues.
• Utilizes resources efficiently and effectively.
• Must be proficient in various word processing, spreadsheet, graphics, and database programs, including Microsoft Word, Excel, PowerPoint, Outlook, etc.
• Other duties as assigned.

What You Will Need:

• Graduate of an accredited school of nursing, RN.
• Current Registered Nurse license in the state of hire.
• Minimum of 3 years clinical experience.
  Minimum of 2 years Utilization Management experience.
• Clinical Denials Experience required
• Attention to detail, strong organizational skills and self-motivated.
• Ability to independently & accurately make decisions and assimilate multiple data sources or issues related to problem solving.
• Ability to work under a timeline/deadline & provide clear & accurate updates to project leader of assignment progress, hours worked & expected outcomes daily.
• Familiarity with medical records assembly & clinical terminology, coding terminology additionally beneficial.
• Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and excellence in customer service.

Nice To have:

• Bachelor’s or master’s degree in Nursing.
• Health plan based utilization review.
• California Nursing License

The annual salary range for this position is $73,600.00-$110,500.00. 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.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Clinical Editor, Medical Surgical and Critical Care, Nursing & Health Professions

Location:

Ipswich, MA, US, remote

Onsite or Remote: Remote

Company Name: EBSCO HealthDecision

EBSCO Information Services (EIS) provides a complete and optimized research solution comprised of e-journals, e-books, and research databases – all combined with the most powerful discovery service to support the information needs and maximize the research experience of our end-users. Headquartered in Ipswich, MA, EIS employs more than 2,700 people worldwide, most now working hybrid or remotely. We are the leader in our field due to our cutting-edge technology, forward-thinking philosophy, and outstanding team. EIS is a company that will motivate you, inspire you, and allow you to grow. Our mission is to transform lives by providing relevant and reliable information when, where, and how people need it. We are looking for bright and creative iniduals whose unique differences will allow us to achieve this inclusive mission around the world.

The Clinical Editor will be responsible for supporting the Section Editor(s) in overseeing the development of high-quality content within specific content domain(s), applying both clinical knowledge/experience and the principles of evidence-based practice. The candidate must have the ability to analyze and critically appraise medical, nursing and allied health research and literature, write clinical topics and edit work produced by clinical editorial team.

Healthcare experience, particularly in direct patient care, is required. Nurses with at least 5 years of experience working in medical surgical and critical care will be considered.

Responsibilities:

Write new clinical content topics in several formats for clinical practice tools.

Serve as content specialist within specific content domain(s), and facilitate topic enhancement and development, systematic literature surveillance, and regular review of content collection

Support culture of teamwork and writer development through effective editing and feedback

Maintain quality of content and participate in quality initiatives

Project manage editorial tasks/initiatives as required

Other duties as assigned by supervisor

Required Qualifications:

Bachelor’s degree in a healthcare field

Five years of direct patient care experience

> 2 years of writing experience related to medical or scientific content

Demonstrated understanding/use of principles of evidence-based practice and use of health information technology to support clinical decision making

Demonstrated ability to extract relevant clinical information from research and write clinical content concisely, exercising judgment to produce content with minimal errors

Experience assessing evidence and performing critical appraisal of research. Statistical skills sufficient to analyze clinical relevance of all study types

Ability to self-manage multiple priorities within deadlines and report on work produced

Knowledge of PubMed, CINAHL searching strategies

> 2 years’ experience with MS Office Suite including Word (with use of track changes) and Excel

Preferred Qualifications:

Advanced degree in a healthcare field

Specialty certification current and in good standing

Demonstrated leadership qualities, such as initiative and a strong work ethic

Demonstrated interpersonal skills such that feedback is effectively and constructively given and received

Motivated self-learner with focus on team success

Proficiency with specific Dynamic Health processes may serve in lieu of minimum required qualifications

Experience with content management systems and project tracking programs (e.g., SDL/Oxygen, Rally, Distiller)

We are accepting candidates who can work fully remote with occasional travel (conditions permitting) to our headquarters in Ipswich, MA or Glendale, CA.

Target Annual Salary Range: $64,160.00 – $91,660.00. The actual salary offer will carefully consider a wide range of factors including your skills, qualifications, education, training, and experience, as well as the position’s work location. EBSCO provides a generous benefits program including medical, dental, vision, life and disability insurance, flexible spending accounts, a retirement savings plan, paid parental leave, holidays and paid time off (PTO), as well as tuition reimbursement. View more about EBSCO’s benefits here: https://www.ebsco.com/about/benefits

We are an equal opportunity employer and comply with all applicable federal, state, and local fair employment practices laws. We strictly prohibit and do not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, sex, pregnancy status, age, national origin or ancestry, ethnicity, religion, creed, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

We comply with the Americans with Disabilities Act (ADA), as amended by the ADA Amendments Act, and all applicable state or local law.

Director of Utilization Management

Job Locations: US-FL-Miami

Finance

Position Type

Full-Time

Monte Nido & Affiliates

Remote or Miami, FL

Monte Nido & Affiliates has been delivering treatment for eating disorders for over two decades.Our programs offer a model of treatment that blends medically sophisticated care with a personalized treatment approach. Our work is grounded in evidence-based strategies for adults and adolescents suffering from eating disorders. We work from a multi-disciplinary treatment team approach while integrating state-of-the-art medical, psychiatric, nutritional, and clinical strategies to provide comprehensive care within an intimate home setting.

We are looking for a Director of Utilization Management to oversee the Utilization Management/Review team and function. This role with report to the Chief Medical Officer.

Responsibilities Include:

The Director of Utilization Management (UM) will work in partnership with the Chief Medical Officer to ensure the utilization review activities at Monte Nido & Affiliates’ facilities are completed accurately, timely and in compliance with regulations.

This includes the precertification and recertification, peer to peer process, and appeals. The UM Director will manage and analyze the status of authorizations, clinical documentation, current denial rates and appeals and report outcomes to the Chief Medical Officer. The UM Director will collaborate with the managed care contract team, revenue cycle, legal and compliance, and oversee and scale the UR team.

• Will develop and maintain appropriate facility/corporate reports to track relevant indicators related to UM.
• Assists with training, writing, tracking, and following up on appeals.
• Ensures peer reviews/doctor-to-doctors reviews are occurring as needed and/or as scheduled.
• Works with the clinical staff to ensure documentation requirements are met.
• Works to ensure appeals are completed thoroughly and in a timely manner.
• Interfaces with managed care contract team, revenue cycle, legal and compliance and managed care organizations, external reviewers, and other payers as needed to resolve denials.
• Works with facilities to ensure accurate reporting of denials and outcomes on a regular basis.
• Is proficient in data gathering, Excel spreadsheets, reporting and data analysis.

Qualifications:

Education: Master’s degree and current clinical license strongly preferred

Experience: Previous utilization management experience in a behavioral healthcare facility preferred, knowledge of Joint Commission compliance strongly preferred

License: Current unencumbered clinical license and valid driver’s license

Radiation Oncology Coder

Remote

Industry: Coder – Phy – Oncology Job Number: 2738

Job Description

Radiation Oncology Coder, Remote

Are you a gifted medical coder? Do you love to code? This role may be the opportunity you’ve been looking for! We’re actively seeking talented radiation oncology Coders with 5+ years of experience and AAPC or AHIMA coder Certification to join our dedicated team.

Job Description:

This position plays an important role at CodingAID. The radiation oncology Coder is responsible for abstracting all E/M, CPT, HCPCS, ICD-10-CM, modifiers, units from the medical record documentation.

Other responsibilities include accurately entering data into client software and/or Excel reports. Performing accurate coding using applicable guidelines and client protocols and communicating with clients and/or providers as needed. Provide written feedback of coding results as needed in the form of comments, summary findings and recommendations. Ensure compliance with federal and state laws, regulations, and standards related to health information and coding principles. Communicate with Project Manager as needed (i.e. schedule changes, daily assignments/work volume, coding questions, etc.).

The contributions of the radiation oncology Coder are invaluable to our organization, and each team member is made to feel welcome and appreciated for their unique talents and efforts.

Job Requirements:

To meet the needs of this role, we request candidates with the following qualifications apply:

• Must be a certified coder Must be a certified coder through AAPC or AHIMA.
• A minimum of 5+ years’ experience required abstract coding CPT, E&M, HCPCS and ICD-10-CM codes from medical records.
• Requires advanced technical knowledge in specific specialties including radiation oncology.
• Extensive knowledge of medical terminology.
• Experience in researching and applying coding rules and regulations.
• Must have experience with data entry of codes into a database and/or software tool.
• Proficiency in Microsoft Excel, Word, and EMR (Electronic Medical Record) systems.
• Excellent oral and written communication skills.
• Have a positive, respectful attitude.

A Little About Us:

CodingAID, a ision of Managed Resources Inc. is a nationwide leading provider of medical coding support, coding and compliance reviews, educational programs, recruitment, revenue cycle management, and many other managed healthcare solutions. We’re proud to have served healthcare organizations and medical groups for over 25 years with proven success in meeting their operational challenges. Learn more about our mission and vision here.

Our Benefits:

• Competitive Pay
• 401K
• Flexible Schedule
• Fully Remote Work Environment
• Access to Monthly Webinars and CEU’s

CodingAID, a ision of Managed Resources Inc., is an Equal Opportunity Employer (EOE) M/F/D/V/SO

Coding Consultant Inpatient 2

Location: US National

US-Remote

Position Type (Portal Searching): Employee Full-Time

Equal Pay Act Minimum Range: $22.00 – $30.00

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 so that they can not only help build Ciox Health into the greatest health technology company but 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 and our Medical Coding Group is comprised of some of the brightest and most talented iniduals. 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.

Details:

• Full time, Flexible Schedule
• Location: Remote/Work from home, NO VACCINATION REQUIREMENT
• Required: A minimum of 3 years of IP coding or auditing experience.
• Preferred: CCS, RHIT, or RHIA credentials.

We Offer:

• Full Benefits: 401k Savings Plan
• 20-24 free CEUs per year, provided by Ciox
• AAPC/AHIMA dues compensation
• Company equipment will be provided to you (including computer, monitor, etc.)
• Comprehensive training led by a credentialed profesional coding manager

What we need…

Our business is growing and we are looking for experienced, credentialed Inpatient Coders to join the team. Assigns diagnostic and procedural codes to patient records using ICD-9-CM, ICD-10-CM, and ICD-10-PCS codes.

Responsibilities

What You Will Do…

• Reviews medical records and assigns accurate codes for diagnoses and procedures.
• Assigns and sequences codes accurately based on medical record documentation.
• Assigns the appropriate discharge disposition to medical records.
• Abstracts and enters the coded data for hospital statistical and reporting requirements.
• Audits the work of Level 1 & 2 Coders, if applicable.
• Communicates documentation improvement opportunities and coding issues to appropriate personnel for follow up and resolution.
• Maintains 95% coding accuracy rate and 95% accuracy rate for MS-DRG assignment and maintains site designated productivity standards.
• Maintains minimum production of 1 charts per hour or site specific productivity standards.
• Demonstrates excellent written and verbal communications skills.
• Communicates professionally with co-workers, management, and hospital staff regarding clinical and reimbursement issues.

ADDITIONAL JOB COMPONENTS:

• Typically works remotely, accessing work related tasks via VPN access.
• Reports to work as scheduled.
• Willing and able to travel when necessary, if applicable.
• Complies with all Company and HIM Division policies and procedures.
• Responsible for tracking continuing education credits to maintain professional credentials.
• Attends mandatory sponsored in-service and/or education meetings as required.
• Adheres to the American Health Information Management Association’s code of ethics.
• Performs other duties as assigned.

Qualifications

What Helps You Stand Out…

• Associate or Bachelor’ degree from AHIMA certified HIM Program or Nursing Program or completion of certificate program with CCS preferred.
• Ability to communicate effectively in the English language.
• A minimum of 2-5 years of coding experience in a hospital and/or coding consulting role.
• Experience in computerized encoding and abstracting software.
• Required to take and pass annual Introductory HIPAA examination and other assigned testing to be given

Pay ranges for this job title may differ based on location, responsibilities, skills, experience, and other requirements of the role. The estimated pay range for this role is $22 – $30 hour.

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.

There is no COVID vaccine requirement for this role

Pay ranges for this job title may differ based on location, responsibilities, skills, experience, and other requirements of the role.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Equal Pay Act Minimum Range $22.00 – $30.00

Medical Management Nurse II- RN

locations

Remote

time type

Full time

job requisition id

R5067

This position resides in the Medical Management Department. Included in this position are four aspects of medical necessity review; Pre-Authorization, Concurrent Review, Medical Claims Review and Appeals. This position includes 2 tiers to this position that allow for career progression and ability to recognize those that not only have demonstrated continued exceptional performance but have expanded their work experience, education and has demonstrated leadership qualities such as mentoring their peers.This position is responsible for managing requests for medical necessity review, applying Milliman criteria to requests, researching new and experimental procedures, interpreting Capital’s Medical Policies and current Medicare Guidelines and doing so within the framework of established policy and procedures of Capital’s Clinical Management Department.

Duties and Responsibilities:

• Responsible for maintaining unit service level goals.
• Determines medical necessity and appropriateness of the service requested or incurred by reviewing the member’s Clinical information, utilizing established criteria to determine appropriate course of action.
• Determines when collaboration with the Medical Director/Associate Medical Director is necessary to decide appropriate course of action.
• Determines when it is necessary to communicate with the provider staff any determinations related to the requested service.
• Communicates any concerns to the Senior Team Lead for follow up and resolution.
• Educates providers on the medical management process for Capital. Identifies knowledge deficits in the Provider Network and refers targeted providers to Provider Relations and Network Management for education, as appropriate.
• Identifies and refers Members with complex needs to the appropriate Clinical Management programs.
• Identifies and refers Members with Potential Quality of Care issues to Quality Management through the PQI Referral Form and any Quality of Service issues to Customer Service for follow up.
• Complies with both internal policies and external regulatory requirements regarding member confidentiality.
• Complies with documentation standards.
• Complies with CMS, NCQA, ERISA and PA. Act 68, and other state and federal regulations and timeliness standards.
• Offers suggestions for improvement in departmental processes and identifies opportunities for new knowledge and approaches.
• Attends and participates in company and departmental meetings and training sessions as required.
• Assists in the orientation and mentoring of their peers.
• Practices within the scope of his or her license and/or certification.

Skills:

• Ability to critically think through processes so as to problem solve and make clinically appropriate decisions daily.
• Successfully work independently and as part of a team.
• Actively and proactively interact with other departments, as needed, to advise, educate and/or direct Members to appropriate internal services.
• Demonstrates openness, flexibility, problem solving, patience, and tact when dealing with Members, family, providers and their peers.
• Demonstrated ability to communicate in a concise and clear manner in both written and oral communications.

Knowledge:

• Working knowledge and operation of a personal computer (PC), including proficiency in Microsoft Word and Access.
• Knowledge of ICD-9-CM, CPT and HCPCS coding.
• Knowledge of Act 68, NCQA, ERISA and CMS regulations.
• Knowledge of managed care principles and emerging health treatment modalities.

Experience:

• A minimum of 5 years clinical experience working in an acute care hospital setting, and preferably 2 years of managed care/preauthorization experience.

Education and Certifications:

• Must be currently licensed as an RN in the Commonwealth of Pennsylvania.

Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.

Senior Medical Coding Specialist

MultiPlan Work from Home/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!

The Senior Medical Coding Specialist provides analysis of the highest dollar and most complex claims by applying research, coding standards, industry knowledge and federal regulations to ensure correct billing practices. In this role, incumbent will perform reviews to identify variations from quality of billing as well as to monitor bills for accuracy and compliance.

JOB ROLES AND RESPONSIBILITIES:

1. Review and analyze complex inpatient, outpatient, and practitioner billing for medical appropriateness of treatment; analyze charges of various revenue centers with consideration to patient diagnosis, procedures, age and facility type including any additional information perceived as potentially helpful in the payment integrity and/or negotiation process.
2. Assist management in the daily operations and processes within the department.
3. Design and participate in the clinical and coding education of coders, negotiators, and physicians. This includes orientation, training and mentoring of new and existing staff.
4. Facilitate daily claim completion meetings with coding operations team; discussing complex cases, providing feedback on prior day claim reviews, creating and initiating new coding protocols.
5. Drive successful coding operations through the application of learned, certified knowledge in addition to continuous professional development and ongoing coding research.
6. Provide general support to clinical team members, serving as a resource and subject matter expert (SME).
7. Monitors turnaround times for multiple applications and provides suggestions for process efficiencies.
8. Uses independent decision making skills to review claims after business hours to meet deadlines.
9. Apply national coding standards and regulations to claims billed.
10. Research and review inidual claims, claim trends or detailed itemized bills, operative notes and other documentation as needed.
11. Collaborate with physician and analytics teams to create, enhance or suggest new coding edits, claim factors, guidelines and other applicable reference materials.
12. Monitor, research, and summarize trends, coding practices, and regulatory changes.
13. Apply clinical judgment and high level of expertise along with analytic skills in review of the most challenging and difficult cases; including conducting additional research as needed.
14. Communicates clinical, coding and reimbursement findings to co-workers and management in a clear, organized manner.
15. Evaluate performance of both newly hired and existing staff.
16. Assist with education of staff as it relates to claims, suggest additional negotiation talking points or tools, develop instructional design, when applicable and communicate overall industry or regulatory changes which affect the department.
17. Partner with management to drive department goals and objectives.
18. Collaborate, coordinate, and communicate across disciplines and departments.
19. Ensure compliance with HIPAA regulations and requirements.
20. Demonstrate commitment to the Company’s core values.
21. Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
22. 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 minimal supervision in order to complete the outlined responsibilities. The incumbent balances several projects at a time and work is varied and complex. More complex issues are referred to higher levels. The incumbent follows 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 $70 – $80K. 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):

• Completion of educational curriculum required of medical license or coding certification held with Bachelor’s Degree preferred; and at least 5 years of coding experience.
• Current nursing certification, coding credential (CCS, CCS-P or CPC), or Registered Health Information Technician credential(RHIA/RHIT) required and maintained as a condition of employment.
• Minimum 5 years experience in direct patient care, medical procedure billing, medical insurance auditing, line item review, audits, coding, and/or reimbursement.
• Extensive knowledge of inpatient/outpatient hospital billing including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD-10 diagnoses and procedure codes, DRG, APCs.
• 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.
• Required licensures, professional certifications, and/or Board certifications as applicable.
• Experience with professional and facility contract interpretation.
• Experience and proficiency using MS Office Suites: Excel, Outlook and PowerPoint. Visio helpful.
• Excellent communication (written, verbal and listening), interpersonal, organizational, time-management, analytical, problem-solving, trouble-shooting, customer service skills.
• Ability to develop educational materials and job aids pertaining to coding and claims.
• Ability to work evening or weekend hours as needed to meet deadlines.
• Ability to handle multiple tasks in a fast paced environment.
• Ability to meet inidual and team goals, deadlines and work standards.
• Ability to apply independent judgment and determine appropriate course of action.
• Ability to read and abstract medical records.
• Knowledge of medical terminology, anatomy, and physiology.
• Ability to interact and discuss results with providers.
• Ability to lead, teach, mentor others, and facilitate a learning environment.
• 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 (low copay & deductible)
• 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

Medical Records Specialist I

Job LocationsUS-Remote

Requisition ID 2023-30565

# of Openings 1

Category (Portal Searching) Operations

Position Type (Portal Searching)

Employee Full-Time

Equal Pay Act Minimum Range

15.00 – 18.00

Overview

• Full-Time: Monday-Friday, 1st shift
• Comfortable working in a high-volume production environment.
• Processing medical record requests by taking calls from patients, insurance companies and attorneys to provide medical record status
• Documenting information in multiple platforms using two computer monitors.
• Proficient in Microsoft office (including Word and Excel)

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 so that they can not only help build Ciox Health into the greatest health technology company but 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 and our Architecture Group is comprised of some of the brightest and most talented iniduals. 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…

This is an entry level position responsible for processing all release of information (ROI), specifically medical record requests, in a timely and efficient manner ensuring accuracy and providing customers with the highest quality product and customer service. Associate must at all times safeguard and protect the patient’s right to privacy by ensuring that only authorized iniduals have access to the patient’s medical information and that all releases of information are in compliance with the request, authorization, company policy and HIPAA regulations.

Responsibilities

What You Will Do…

• Receive and process requests for patient health information in accordance with Company and Facility policies and procedures.
• Maintain confidentiality and security with all privileged information.
• Maintain working knowledge of Company and facility software.
• Adhere to the Company’s and Customer facilities Code of Conduct and policies.
• Inform manager of work, site difficulties, and/or fluctuating volumes.
• Assist with additional work duties or responsibilities as evident or required.
• Consistent application of medical privacy regulations to guard against unauthorized disclosure.
• Responsible for managing patient health records.
• Responsible for safeguarding patient records and ensuring compliance with HIPAA standards.
• Prepares new patient charts, gathering documents and information from paper sources and/or electronic health record.
• Ensures medical records are assembled in standard order and are accurate and complete.
• Creates digital images of paperwork to be stored in the electronic medical record.
• Responds to requests for patient records, both within the facility and by external sources, retrieving them and transmitting them appropriately.
• Answering of inbound/outbound calls.
• May assist with patient walk-ins.
• May assist with administrative duties such as handling faxes, opening mail, and data entry.
• Must meet productivity expectations as outlined at specific site.
• May schedules pick-ups.
• Other duties as assigned.

Qualifications

What Helps You Stand Out…

Required

• Ability to commute between locations as needed.
• Able to work overtime during peak seasons when required.
• Basic computer proficiency.
• Comfortable utilizing phones, fax machine, printers, and other general office equipment on a regular basis.
• Professional verbal and written communication skills in the English language.
• Detail and quality oriented as it relates to accurate and compliant information for medical records.
• Strong data entry skills.
• Must be able to work with minimum supervision responding to changing priorities and role needs.
• Ability to organize and manage multiple tasks.
• Able to respond to requests in a fast-paced environment.

Preferred

• Experience in a healthcare environment.
• Previous production/metric-based work experience.
• In-person customer service experience.
• Ability to build relationships with on-site clients and customers.
• Comfortable bringing new ideas, process improvement suggestions, and feedback to internal stakeholders.

Working conditions & physical demands

Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to stand and sit frequently throughout an eight-hour period, reach horizontally and vertically for overhead use. Must be able to use a telephone or headset equipment. Incumbent must be able to lift 20 lbs., perform work at a computer terminal for 6-8 hours a day, and function in an environment with constant interruptions. Reasonable accommodations are available to qualified iniduals with disabilities. Low to no travel required.

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.

With very limited exceptions (medical conditions or sincerely held religious beliefs that prohibit you from getting the vaccine), one of the requirements for this job is that you be fully vaccinated against COVID-19.

*Except for states where legally prohibited to enforce mandates.

Pay ranges for this job title may differ based on location, responsibilities, skills, experience, and other requirements of the role.

Equal Pay Act Minimum Range

15.00 – 18.00

Senior Specialist Clinical Quality Assurance

Remote Eligible: Remote Global

Location: Diegem, BE

Additional Locations: Netherlands-Kerkrade; Germany-Dsseldorf

Diversity – Innovation – Caring – Global Collaboration – Winning Spirit – High Performance

At Boston Scientific, we’ll give you the opportunity to harness all that’s within you by working in teams of erse and high-performing employees, tackling some of the most important health industry challenges. With access to the latest tools, information and training, we’ll help you in advancing your skills and career. Here, you’ll be supported in progressing whatever your ambitions.

We are seeking an engaging and qualified Senior Clinical Quality Assurance Specialist who is aligned with our core values that define Boston Scientific culture and empower our employees: Caring – Meaningful innovation – High performance – Global collaboration – Diversity – Winning spirit. Because a career with Boston Scientific is more than just a job. It’s personal. We’re committed to solving some of healthcare’s toughest problems united by a deep caring for human life. If you’re a natural problem-solver with the imagination, courage, and spirit to make a meaningful difference in clinical quality, there’s no better place to build your career.

This is a remote position supporting a global Clinical team conducting investigational device trials at global sites. Qualified US and OUS candidates are encouraged to apply.

Your responsibilities will include:

Clinical Compliance – Hands-on partnership with Clinical for clinical quality consultation and inspection readiness:

• Provides clinical quality representation on clinical trial project teams to always foster and inspire clinical teams towards a state of inspection readiness
• Provides support and response to compliance and regulation questions including quality review of clinical study documents and related functional study plans
• Supports Inspection Readiness program to include inspection readiness training and coordination/participation in Mock BIMO inspections as well as external inspections
• Communicates with global clinical teams and Strategic Sourcing regarding clinical vendors, new clinical vendor requests, current clinical vendor needs, and future needs

Independent Auditing:

• Creates risk-based study audit plans; plans, schedules, and conducts internal clinical quality audits, clinical process audits, investigator site audits, and clinical vendor audits to assure BSC clinical investigational trials and post market studies comply with applicable regulatory requirements, quality and GCP standards, and BSC policies and procedures
• Documents and communicates audit observations; evaluates impact and makes recommendations for corrections and/or corrective actions. Evaluates responses to audit findings and ensures that appropriate corrections and corrective actions are timely initiated and completed
• Keeps abreast of and interprets current worldwide regulatory requirements; advises various stakeholders regarding possible ramifications of regulatory changes

Clinical Quality System: Support to the Clinical organization in meeting BSC Quality system requirements

• Supports Clinical and QS team during External Regulatory/Notified Body audits
• Supports the CAPA program, providing quality input for assessing internal noncompliance and recommending initiation of corrections/CAPAs, working closely with Clinical CAPA team and CAPA owners through to successful closure
• Participates on clinical process improvement projects and initiatives
• Provides review and comment to relevant BSC procedure revisions
• Supports departmental, isional, and corporate quality goals and priorities
• Initiates and/or collaborates on continuous improvement projects related to the BSC Clinical Quality Management System.

Acquisition integration:

• Represents Clinical Quality on clinical acquisition/integration teams for identification, assessment, and mitigation of risks associated with the transfer of sponsorship of clinical studies from acquired entities, supporting development and execution of a clinical integration plan, transfer of quality systems, and compliance to GCP and applicable regulations with aim to ensure subject safety and integrity of study data.

What we’re looking for in you:

Minimum Qualifications:

• Minimum of a bachelor’s degree with minimum of 8 years’ experience in the medical device, pharmaceutical, or other industry in an area regulated by GCP regulations and guidelines; OR in the alternative, a life science or Nursing Associate Degree with active Registered Nurse licensure and at least 12 years of relevant experience
• Demonstrated clinical research audit experience or suitability to quickly train into clinical study/investigator site auditing role, with one or more of the following proficiencies: clinical research associate/site monitor, clinical trial primary research coordinator, GCP lead auditor, CAPA leader, research compliance, and clinical research SOP author
• Demonstrated experience in Clinical Quality Assurance and/or healthcare research compliance
• Working knowledge of regulations, standards, paper and electronic Good Documentation Practices, and privacy/security obligations relevant to conducting IDE Trials, including 21 CFR (50, 54, 56, 812, Part 11), GCP (ISO14155:2020 and/or ICH E6 R2), HIPAA and GDPR
• Independent, reliable, professional, collaborative, team player aligned with BSC mission, vision, and culture goals
• Demonstrated experience with complex verbal and written communication to a variety of stakeholders, as well as successful conflict resolution skills
• Strong electronic system adopter/user with understanding of system user access controls and workflow validations process
• Ability to travel domestically and internationally up to 30%

Preferred Qualifications:

• RAQP-GCP/ SoCRA or ACRP certification or equivalent
• Experience with maintaining compliance to medical device manufacturer quality system or other clinical quality system requirements
• EU CA, Health Canada, PMDA, CFDA, BfArM experience
• 5 or more years of direct clinical quality (GCP) auditing experience
• Knowledge of EU MDR
• Non-English language(s) proficiency for reliable verbal and written audit related reviews and communication with EU investigational sites (Germany, Italy, Spain)
• Demonstrated experience communicating with all levels of the organization

Requisition ID: 560425

As a leader in medical science for more than 40 years, we are committed to solving the challenges that matter most united by a deep caring for human life. Our mission to advance science for life is about transforming lives through innovative medical solutions that improve patient lives, create value for our customers, and support our employees and the communities in which we operate. Now more than ever, we have a responsibility to apply those values to everything we do as a global business and as a global corporate citizen.

So, choosing a career with Boston Scientific (NYSE: BSX) isn’t just business, it’s personal. And if you’re a natural problem-solver with the imagination, determination, and spirit to make a meaningful difference to people worldwide, we encourage you to apply and look forward to connecting with you!

NP/PA – Virtual Health Assessment (1099)

Remote

Hi, we’re Oscar Medical Group. We’re hiring an Advanced Practice Clinician to join our Virtual Health Assessment team.

Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

Hours Required:

• Available during 8a-12p ET and/or 4p-8p ET (4 hour minimum shifts)

Licenses Required:

• Texas, Georgia, and Florida

You will perform virtual health assessment appointments where we help to identify areas in the patient’s medical journey that can be improved. The health assessment is a virtual appointment where you will review the patient’s current medical diagnosis, medications and overall health history. The provider will use this appointment to confirm or deny suspected conditions that can be used for Risk Adjustment for Oscar Health Insurance.The health assessment will also be an opportunity to identify and close HEDIS gaps, this will help the patient stay up to date on appropriate preventative care. The provider should feel comfortable working with patients virtually, including virtual assessment, diagnosis and treatment. You will also help to support teams across Oscar Medical Group, including Virtual Primary Care and Virtual Urgent Care when needed.

You will report to the Manager, Virtual Health Assessment.

This is a remote / work-from-home role. You must reside in one of the following states: You must reside in one of the following states: Arizona, California, Colorado, Florida, Georgia, Nevada, New York, Ohio, Pennsylvania, Texas, or Virginia. Note, this list of states is subject to change #LI-Remote

The base pay for this role is: $55 – $72 per hour. This is a 1099 Independent Contractor role.

Responsibilities

• Conduct virtual health assessment where the provider reviews the member’s current medical diagnosis, medications and overall health history.
• Review suspected conditions that can be used for Risk Adjustment for Oscar Health Insurance.
• Identify and close HEDIS gaps, this will help the member stay up to date on appropriate preventative care.
• Cross-train into urgent care and virtual primary care service lines
• Work with members virtually, including virtual assessment, diagnosis and treatment.

Qualifications

• DNP, FNP, ENP, or PA from accredited program
• Board Certification (NCCPA or AANP or ANCC)
• Licensed in Florida, Texas and Georgia
• 3+ years experience in Family Medicine, Internal Medicine or Primary Care

Bonus Points

• Experience with Risk Adjustment and managing HEDIS quality measures
• Fluent in Spanish
• 1+ year Telemedicine experience
• Also Licensed in: California, New York, Oklahoma, Connecticut, North Carolina, Iowa, Pennsylvania, Virginia, New Jersey, Ohio, Nebraska, Arizona, and Illinois

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We’re on a mission to change health care — an experience made whole by our unique backgrounds and perspectives..

Pay Transparency:

Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience.

Full-time employees are eligible for benefits including: medical, dental, and vision benefits, paid holidays, paid vacation and sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Reasonable Accommodation:

Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([email protected]) to make the need for an accommodation known.

To protect the health and safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against COVID-19 by their start date. If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our Benefits team at [email protected] to submit an accommodations request.

*Note: In-person work includes: employees required to work from our offices, employees conducting sales work in the field and employees conducting at-home or in-person visits with members.

Nurse Practitioner (Contract) – Remote

SAN FRANCISCO, CA

CLINICAL

REMOTE

Revero is on a mission to reverse the autoimmune diseases epidemic. Revero integrates machine learning, personalized nutrition, and virtual care to address the root causes of disease. We have helped thousands of paying customers restore their health and live disease-free, and raised over $5 million from top-tier investors such as A16Z Scout and Goodwater Capital.

Revero has a unique virtual care model that delivers treatment exclusively through a telemedicine platform, with no physical clinics. We have helped thousands of people heal from arthritis, psoriasis, Crohn’s disease, Type II diabetes, and more, and find improvements in obesity, hypertension, and inflammation.

To achieve our mission of reversing the chronic disease epidemic, Revero is hiring contract (1099) licensed nurse practitioners to join our team. This is a 100% remote work opportunity.

As an exceptional clinician, you have many options. You want to work here because you:

• • Believe in Revero’s vision of reversing diseaseWant to help us revolutionize healthcare
  • Want to work with an exceptional team who values patient outcomes
  • Have a growth mindset with openness to learn and set aside the ego

Responsibilities

• • Evaluate prospective new patients in a telemedicine visit
  • Do an in depth overview of medical history and medications and document it in the EHR
  • Support the patients on their path toward disease reversal and improved health
  • Monitor the patient’s daily biomarkers, adjust medications, and schedule follow up visits as needed with proper documentation in the EHR
  • Commit to providing the highest quality care and patient experience while communicating with the coach

Must-Haves

• • Board certified in a relevant specialty
  • Unrestricted state medical licenseDeep interest in the science behind Revero
  • Strong technological literacy to use various digital and virtual care platforms

Nice to Haves

• • Flexible hours Monday through Sunday
  • Ability to commit at least 10+ hours per week
  • Bilingual (Spanish) written and verbal communication

For this role the compensation for candidates is $60 /hr.

Coding, Team Lead

Remote, United States

Surgical Notes is hiring for a Team Lead, Coding to assist with supervising the coding team as well as participating in product daily coding. 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: Manager, Coding

Responsibilities:

• · Supervise a team of production coders
• · Reviewing production coders’ work for quality
• · Provide clear, concise, and compliant written feedback to coders
• · Identify coder and/or documentation deficiencies and communicate them to the management team as needed
• · Participate in production coding daily as defined by management, based on department needs
• · 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 outpatient surgical coding 1-2 years of supervisory, team lead experience or successful display of leadership qualities and completion of management training
• · Extensive knowledge of medical terminology, anatomy, and physiology
• · Ability to stay on task, working independently
• · Must have a dedicated home office with reliable high-speed internet
• · 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:

• · Associate Degree or higher in a healthcare related field
• · 3+ years Ambulatory Surgical Center coding experience
• · CASCC (Certified Ambulatory Surgery Center Coder certification through AAPC)2+ years supervisory/team lead experience
• · Experience working in an Ambulatory Surgery Center (ASC)
• · Strong Microsoft Office skills in Excel, Outlook, and Teams

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:

• · Job Knowledge/Technical Knowledge
• · Communication
• · Initiative/Execution
• · Productivity
• · Quality Control

Compensation Information:

• $52,900.00-$66,125.00 based upon qualifications and experience

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].

Medical Coding Auditor

United States

At Modernizing Medicine, we look for passionate, innovative, creative Rock Stars!

• South Florida Business Journal, Business of the Year 2022
• BIG Awards for Business, Company of the Year 2021
• Best in Biz Award (Silver), Fastest-Growing Company of the Year 2021
• South Florida Business Journal, Best Places to Work 2021
• Inc. Magazine Best Workplaces of 2020

Modernizing Medicine delivers truly disruptive and transformative products and services that will impact the healthcare industry. The work we do makes a difference.

Our web and mobile applications are transforming healthcare information technology to increase practice efficiency and improve patient outcomes. We offer end-to-end specialty-specific solutions from practice management, through EMR to Revenue Cycle Management (RCM) that help our clients maximize their efficiencies.

Modernizing Medicine is hiring a Medical Coding Auditor. The Medical Coding Auditor is responsible for ensuring that coding performed on behalf of Modernizing Medicine’s RCM clients is in compliance with all published federal, state and payer specific coding guidelines. The RCM Coding Auditor, HCPCS, modifier usage and procedure coding are being followed by the RCM Coding Team. The RCM Coding Auditor also performs as a denial management coder which reviews and analyzes assigned coding denials and/or correction of these claims when applicable. The RCM Coding Auditor maintains continuous contact with both the onshore and offshore RCM teams to provide statistical and qualitative feedback on the quality of coding and provides education and guidance consistent with established coding and compliance guidelines. The RCM Coding Auditor performs duties under the supervision of the RCM Medical Coding and Auditing Supervisor and related to the product(s) to which they are assigned.

The Role:

• Research, analyze and respond to inquiries regarding inappropriate coding, denials, rejections or billable services
• Ensure accurate coding for diagnosis, procedural coding and modifier usage – dependent on federal, state and payer guidelines
• Assist team to accurately resolve coding issues and rejections
• Supports in the review, appeal and follow up of third party (RAC, CERT, etc.) audits if needed
• Advise RCM staff and department leadership on issues related to client’s coding or documentation compliance
• Report all coding trends and issues to department lead as they are identified
• Verify medical necessity for proper payment of claims
• Audit new clients, when necessary, to assess potential coding or documentation issues and/or trends
• Serve as point of contact and coding compliance SME for coding questions and issues
• Provides guidance and training to RCM onshore & global teams on proper coding of ICD’s, CPT’s, HCPCS’s and modifier usage as necessary
• Assist with continuous quality improvement by helping with the process of implementation and carry through of coding protocols and procedures
• Constructive collaboration with fellow coding/auditing team members to maintain department compliance and effectiveness
• Responsible for obtaining continuing education units (CEU) for maintaining coding certification(s)
• Perform other job duties and projects as assigned

Quality Assurance Auditing Functions

• When working on Quality Assurance activities the Revenue Cycle Coding Auditor is responsible for analyzing, reviewing and providing feedback on QA audits performed
• Ensuring all federal and state coding guidelines and regulations are met as well as payer guidelines
• Provide effective feedback to the Global Services Team to aid in their successful coding of RCM contracted coding clients
• Maintaining a communication log to show successful training of the Global Services Team when coding trends or issues are found
• Review target cases per month based on the ModMed Quality Assurance SOP
• Accurately document their daily audit results in the Daily Audit Log and communicate coding resolutions to the RCM or Global Services Team
• This would include monthly assistance in maintaining QA audit logs summary pages which details Global Services Teams (coders/auditors) monthly coding accuracy levels
• Working alongside coding leadership in regards to Global Services Team training of coding processes as well as attending remote coding sessions with Global Services Team
• Help with other daily communications between RCM team and Auditing team in regards to other coding inquires or issues
  • This would include any sync calls pertaining to assigned clients or ModMed committee calls pertaining to assigned specialities
• Perform RCM or Compliance audits when requested by RCM or other ModMed staff which help to determine coding compliance or client documentation issues

Denial Management Auditing Functions

• Work as an effective denial management coder and assist with resolving reimbursement and denial issues related to coding inaccuracies or insufficiencies
• Review target cases per month based on the ModMed Denial Management SOP
• Review medical charts, electronic ERAs, claims, billing notes, etc. and provide detailed notes for denials and task to the appropriate ModMed assignment to be resolved accordingly
• Accurately document review results and resolutions in the Daily Review Log and communicate coding resolutions to RCM team
  • Aid in the RCM communication processes which includes advising RCM staff of any coding issues or trends pertaining to client denials or documentation issues
• Help with other needed daily communications between RCM team and Auditing team in regards to other types of coding inquires or issues
  • This would include any sync calls pertaining to assigned clients or ModMed committee calls pertaining to assigned specialities
• Perform RCM or Compliance audits when requested by RCM or other ModMed staff which help to determine coding compliance or client documentation issues

Skills & Requirements:

• Certified Professional Medical Auditor (CPMA) required
• Certification in one or more of the following:
  • Certified Professional Coder (CPC)
  • Certified Outpatient Coder (COC)
  • Certified Coding Specialist-Physician (CCS-P)
• Minimum 2 years experience as a certified medical coder – physician based and/or ASC based
• Minimum 1 year experience as a certified medical auditor is preferred
• Must be knowledge in E/M coding – Office/Outpatient and Inpatient and Incident to guidelines
• Knowledge of CPT and ICD-10 coding, federal and state coding compliance regulations
• Knowledge of medical terminology and anatomy
• Understanding of NCCI and CCI bundling edits
• Understanding of EOBs and ERA’s and denial remarks
• Detailed knowledge of medical billing is preferred
• Proficient with Microsoft programs (Excel, Word) as well as use of overall computer functions
• Experience in gMed/gGastro or EMA/PM is preferred but not required
• Strong analytical skills such as the ability to identify, research and resolve issues

Modernizing Medicine Benefit Highlights:

• Health Insurance, 401(k), Vacation, Employee Assistance Program, Flexible Spending Accounts
• Employee Resource Groups
• Professional development opportunities including tuition reimbursement programs and unlimited access to LinkedIn Learning
• Weekly catered breakfast and lunch, treadmill workstations, quarterly onsite massages, onsite dry cleaning, onsite car wash and many more!

Sr. Billing Representative, Remote

ATLANTA, GA 

NEW VENTURES NEW VENTURES 

FULL TIME

REMOTE

Aledade is a leader in population health that is using innovative, value based solutions to transform the way physicians interact with their patients. We are on a mission to change healthcare for the better and solve complex problems within the healthcare system.

The Sr. Billing Representative is integral to the revenue cycle management team. This role supports several revenue cycle functions, including insurance verification and eligibility, timely claims submission, and denial management. The Billing Representative is the subject matter expert for compliant claims submission, payer policies, and governmental regulations.

Responsibilities:

• Electronic claims submission according to payer contracts, governmental and/or third-party guidelines
• Timely follow-up on claim denials, submission of corrected claims and written appeals, ongoing follow-up of appeal submissions
• Utilize the accounts receivable aging report to resolve outstanding AR
• Adhere to productivity standards using key performance indicators (KPIs) and established healthcare billing metrics
• Collaborate with the coding team to overturn coding-related denials
• Collaborate with the RCM teams to ensure effective resubmission of special projects
• Identify and alert leadership of denial trends and make recommendations for front-end edits to minimize reimbursement delays
• Provide education and accurate answers to billing-related questions in a timely manner
• Serve as a super-user for multiple practice management systems
• Assists in process mapping and the development of workflows for best practices in medical billing
• Report data inconsistencies to leadership
• Participate in regular team meetings, peer review activities, and departmental and organizational work groups as applicable
• Performs all job functions in compliance with applicable federal, state, and local laws and organizational policies and procedures
• Other duties as assigned

Performance Requirements, Skills, and Abilities:

• Understanding of various types of insurance plans
• Adaptability to perform in various electronic health records (EHRs) and practice management systems
• Expert knowledge of risk coding in an Accountable Care Organization
• Expertise in applying payer policy, Local Coverage Determinations, National Coverage determinations, and National Correct Coding Initiatives
• Knowledge of CPT, ICD-10, and HCPC Level II coding guidelines
• Ability to navigate healthcare industry rules and regulations, including HIPAA, False Claims Act, Fair Debt Collections Act, and Stark Law
• Excellent interpersonal and organizational skills
• Effective oral and written communication skills with audience adaptability
• Ability to work independently
• Establish and maintain effective working relationships with partner practices, insurance payers, EHR vendors, internal Aledade stakeholders, and co-workers
• Ability to use good judgment and critical thinking skills; ability to identify and resolve problems promptly
• Ability to work with erse populations

Required Certifications, Education, and Experience

• High School Diploma or GED
• Bachelor’s degree in health-related services preferred
• Certified Professional Coder (CPC), Certified Professional Biller (CPB), or related certification preferred
• Minimum of 10 years of billing experience in an outpatient physician practice, ambulatory care setting, or other health-related enterprise, with solid understanding of coding guidelines

All prospective hires will be required to demonstrate that they have been fully vaccinated, including booster shots, against COVID-19 with a COVID-19 vaccine for which the U.S. Food and Drug Administration has issued a license or an Emergency Use Authorization prior to mutually-agreed upon start date at Aledade, unless they qualify for a medical or religious accommodation to this vaccination requirement.

If you are passionate about transforming the healthcare system into one that best serves the needs of patients, doctors, and society, we’d love for you to join us!

Who We Are:

Aledade is a leader in population health that is using innovative, value based solutions to transform the way physicians interact with their patients. We are on a mission to change healthcare for the better and solve complex problems within the healthcare system.

We follow the simple but radical idea that Aledade only succeeds when our partner practices succeed. From our cutting-edge technology platform to practice transformation services, we provide physicians with everything they need to create and run an accountable care organization (ACO), revamping the way they practice and getting them back to where they should be: quarterbacking their patients’ health care!

Our customized solutions help clinicians in communities across America preserve their autonomy, deliver better care to their patients, reduce overall costs, and keep independent physician practices flourishing.

What Does This Mean for You?

At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness, and a desire to learn. You will work with team members that bring a wide range of experiences, interests, backgrounds, beliefs, and achievements to their work, united by a shared passion for public health and a commitment to the Aledade mission.

We’ve recently been recognized as a Top Workplace by The Washington Post, Best Workplace in HealthCare & Biopharma, Top 100 Best Small & Medium Workplaces, Glassdoor Best Places to Work, a Best and Brightest Companies to Work for in the Nation, a Tech Tribune 10 Best Tech Startups in Maryland and Bethesda, Best Tech for Good, Best Workplaces for Millennials, Best Workplaces for Women, Best Workplaces for Parents, Top Workplaces USA, and a Healthcare Industry Top Workplace.

That’s because the things that matter to you also matter to us!

• In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the needs of our full-time team-members:
• Flexible work schedules and ability to work remotely available for many roles
• Educational Assistant Program
• Robust time off plan (21 days of PTO in your first year!)
• Paid Volunteer Days
• 11 paid holidays
• 12 weeks paid Parental Leave for all new parents
• 6 weeks paid sabbatical
• Health, dental and vision insurance paid up to 80% for employees, dependents, and domestic partners
• 401(k) with up to 4% match
• Stock options
• Monthly cell phone stipend
• Jeans everyday workplace
• Gender neutral bathrooms
• And more!

At Aledade, we don’t just accept differences, we celebrate them! We strive to attract, develop, and retain highly qualified iniduals representing the erse communities where we live and work. Aledade is committed to creating a erse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance, and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.

Medical Accounts Receivable Representative (Revenue Cycle Representative)

Remote, United States

Surgical Notes is hiring for a Medical Accounts Receivable Representative to assist with timely follow-up and collection on our clients’ third party payor accounts receivable. 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: Revenue Cycle Manager

Responsibilities:

• Work through book of AR and develop plan for maintaining proper coverage on all accounts.
• Review aged accounts, trace and appeal unpaid and/or erroneously paid or denied accounts
• Work all denials and underpayments received within 24 hours by researching steps previously taken and take additional action, as needed to resolve the claim.
• Work tickler accounts daily to ensure overall health of client accounts receivable.
• Review and address correspondence daily, including emails from clients
• Identify trends and inform client lead/manager, as appropriate
• Escalate issues to client lead/manager, as appropriate
• Other responsibilities as assigned.

Role Information:

• Full-Time
• Hourly
• Non-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.

Required Knowledge, Skills, Abilities & Education:

• Minimum of one year’s experience working with a healthcare provider or an Associate’s Degree in Healthcare Management, Business Management or a related field
• Experience with healthcare billing and collections
• Experience with various practice management systems (Advantx, HST, Vision, Amkai, SIS, Cerner, CPSI, Meditech, CEntricity, Allscripts, AdvancedMD)
• Experience with revenue cycle management and follow-up
• Experience with facility and/or professional revenue cycle experience
• Minimum tenure of 1-2 years in each previous position held
• Proficient with MS Outlook, Word, and Excel
• 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
• Strong interpersonal and persuasive abilities in order to secure accurate and timely payment from patients
• Ability to work in a fast-paced environment
• Outstanding communications skills; both verbal and written
• Positive role model for other staff and patients by working with them to promote teamwork and cooperation
• Ability to apply commonsense understanding and logic in day to day activities.

Preferred Knowledge, Skills, Abilities & Education:

• Experience working in an Ancillary/Ambulatory Surgery Center (ASC)
• Strong Microsoft Office skills in Teams
• Comfortable with electronic and manual payor follow-up
• Able to quickly identify trends and escalate, as appropriate
• Ability to read, analyze and interpret insurance plans, financial reports, and legal documents
• Tenure of greater than two years at all previous employers with no gaps in employment

Physical Demands:

• Sitting and typing for an extended period of time
• Reading from a computer screen for an extended period of time
• Work environment of a traditional fast-paced and deadline-oriented office
• Working closely with others
• Frequent verbal communication, primarily over the phone, and face-to-face interaction
• Working independently
• Frequent use of a computer and other office equipment

Key Competencies:

1. Communication
2. Attention to detail
3. Responsiveness
4. Customer Service
5. Execution

Compensation Information:

• $20.00-$23.00 per hour based upon qualifications and experience

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

Medical Billing Specialist

Fully Remote

Description

At UpStream we believe good health is a state of independence where each person has the capacity to live a long, happy, and active life. We aim to deliver the type of care our members need to regain and maintain their independence by delivering effective, efficient, and sustainable care. UpStream is a trusted partner to primary care physicians, helping them focus on what is most important, the patient. We support the delivery of value-based care for seniors and people living with chronic conditions. By working in partnership with healthcare practices and clinics we offer a comprehensive solution for physicians that delivers and sustains better outcomes.

How you’ll help

As a member of the Billing Team, you will work as an extension to our clinical care teams and billing departments within the physician practice. Billing Specialists work directly with our partner practices to initiate, manage, and reconcile patient claims and address insurance-related questions. They also collaborate internally to support our clinical care teams embedded in these practices. The Billing Specialist will review the work for each clinician to ensure billing documentation is accurate. To this end, the billing specialist will support the research and resolution of outstanding, overdue, or denied insurance claims to help maximize profitability for each practice.

What you’ll do

• Generating monthly billing summaries and financial transparency reports.
• Serving as a main point of contact for insurance related questions.
• Work within a medical office’s Electronic Medical Records (EMR) system to submit claims.
• Submit, track, and resolve claims and billing questions.
• Verify and correct rejected insurance claims.
• Work with management and cross-functional teams to establish and improve billing processes.
• Review charts to ensure appropriate information is documented as it relates to the services we are billing for.

Experience and skills you’ll need

• 1+ years medical billing experience with knowledge of ICD-10 and CPT codes
• 1+ years of experience working directly with an Electronic Medical Records (EMR)
• 1+ years of experience resolving insurance discrepancies and disputes.
• 1+ years direct experience using excel. Solid excel skills preferred.
• Proficient experience with Microsoft Office products with an emphasis in Excel.
• Team-oriented inidual who is also self-motivated and able to work well independently.
• Strong communication, critical-thinking and problem-solving skills.
• Demonstrated adaptability, handles day to day work challenges confidently, is willing and able to adjust to multiple demands, shifting priorities; shows resilience in the face of challenges, demonstrates flexibility.

What We Provide (Benefits & Perks

• Health insurance plans through United Health Care including FSA and HSA plans.
• Dental, Vision, Life, Accident through Guardian.
• 401k plan with match (Roth and Traditional).
• Financial perks and rewards through BenefitHub.
• Free EAP access through WorkLifeMatters.
• Generous PTO plus 9 paid holidays.

Inpatient Coder

Up to $5000.00 Sign On Bonus

Job LocationsUS-Remote

Requisition ID 2023-30508

# of Openings

1

Category (Portal Searching)

HIM / Coding

Position Type (Portal Searching)

Employee Full-Time

Overview

$$ Offering up to 5,000K Sign On Bonus for Full Time Candidates $$

We are offering Full Time and PRN positions ! Come join our Team !

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 so that they can not only help build Ciox Health into the greatest health technology company but 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 and our Medical Coding Group is comprised of some of the brightest and most talented iniduals. 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.

Details:

• Full time, Flexible Schedule
• Location: Remote/Work from home, NO VACCINATION REQUIREMENT
• Required: A minimum of 2 years of IP coding or auditing experience.
• Preferred: CCS, RHIT, or RHIA credentials.

We Offer:

• Full Benefits: 401k Savings Plan
• 20-24 free CEUs per year, provided by Ciox
• AAPC/AHIMA dues compensation
• Company equipment will be provided to you (including computer, monitor, etc.)
• Comprehensive training led by a credentialed professional coding manager

What we need…

Our business is growing and we are looking for experienced, credentialed Inpatient Coders to join the team. Assigns diagnostic and procedural codes to patient records using ICD-9-CM, ICD-10-CM, and ICD-10-PCS codes.

Responsibilities

What You Will Do…

• Reviews medical records and assigns accurate codes for diagnoses and procedures.
• Assigns and sequences codes accurately based on medical record documentation.
• Assigns the appropriate discharge disposition to medical records.
• Abstracts and enters the coded data for hospital statistical and reporting requirements.
• Communicates documentation improvement opportunities and coding issues to appropriate personnel for follow up and resolution.
• Maintains 95% coding accuracy rate and 95% accuracy rate for MS-DRG assignment and maintains site designated productivity standards.
• Maintains minimum production of 1 charts per hour or site specific productivity standards.
• Demonstrates excellent written and verbal communications skills.
• Communicates professionally with co-workers, management, and hospital staff regarding clinical and reimbursement issues.

ADDITIONAL JOB COMPONENTS:

• 100% Remote
• Reports to work as scheduled.
• Complies with all Company and HIM Division policies and procedures.
• Responsible for tracking continuing education credits to maintain professional credentials.
• Attends mandatory sponsored in-service and/or education meetings as required.
• Adheres to the American Health Information Management Association’s code of ethics.
• Performs other duties as assigned.

Qualifications

What Helps You Stand Out…

• Associate or Bachelor’ degree from AHIMA certified HIM Program or Nursing Program or completion of certificate program with CCS preferred.
• Ability to communicate effectively
• A minimum of 2-5 years of coding experience in a hospital and/or coding consulting role.
• Experience in computerized encoding and abstracting software.
• Required to take and pass annual Introductory HIPAA examination and other assigned testing to be given

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.

There is no COVID vaccine requirement for this role

Collections Specialist

Fully Remote • Remote

Full-time

Description

Soleo Health is seeking a Remote Collections Specialist. Join us in Simplifying Complex Care!

What We Have to Offer You:

• Competitive Wages
• Flexible schedules
• 401(k) with a match
• Referral Bonus
• Annual Merit Based Increases
• No Weekends or Holidays!
• Affordable Medical, Dental, & Vision Insurance Plans
• Company Paid Disability & Basic Life Insurance
• HSA & FSA (including dependent care) options
• Paid Time Off
• Education Assistance Program

The Position:

The Collections Specialist is responsible for a broad range of collection processes related to medical accounts receivable in support of multiple site locations. The Collections Specialist will proactively work assigned accounts to maximize accurate and timely payment.

Responsibilities include:

• Researches all balances on the A/R and takes necessary collection actions to resolve in a timely manner
• Researches assigned correspondence; takes necessary action to resolve requests
• Routinely reviews and works correspondence folder requests in a timely manner
• Makes routine collection calls on outstanding claims
• Identifies billing errors, short payments, unpaid claims, cash application issues and resolves accordingly
• Ability to identify potential risk, write offs and status appropriately and report and escalate to management on as identified.
• Researches refund requests received by payers and statuses refund according to findings
• Documents detailed notes in a clear and concise fashion in Company software system
• Identifies issues/trends and escalates to Manager when assistance is needed
• Provides exceptional Customer Service to internal and external customers
• Ensures compliance with federal, state, and local governments, third party contracts, and company policies
• Must be able to communicate well with branch, management, patients and insurance carriers
• Ability to perform account analysis when needed
• Answering phones/taking patient calls regarding balance questions
• Using portals and other electronic tools
• Ensure claims are on file after initial submission
• Identifies, escalates, and prepares potential payor projects to management and company Liaisons
• Write detailed appeals with supporting documentation
• Keep abreast of payor follow up/appeal deadlines
• Submits secondary claims

Schedule:

• 8:30-5p Monday-Friday

Requirements

• 3-5 years of home infusion collection experience is preferred
• CPR+ system experience is desired
• Excellent math and writing skills
• Excellent interpersonal, communication and organizational skills
• Ability to prioritize, problem solve and multitask
• Word, Excel and Outlook experience
• High School Diploma or GED

As a condition of hire, full dosage of the COVID-19 vaccination is a requirement for this position. Soleo Health will consider accommodation for disability/medical and/or sincerely held religious beliefs.

About Us: Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the Soleo Health Difference!

Soleo’s Core Values:

• Improve patients’ lives every day
• Be passionate in everything you do
• Encourage unlimited ideas and creative thinking
• Make decisions as if you own the company
• Do the right thing
• Have fun!

Soleo Health is committed to ersity, equity, and inclusion. We recognize that establishing and maintaining a erse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring erse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive. Our commitment to these values is evidenced by our erse executive team, policies, and workplace culture.

Soleo Health is an Equal Opportunity Employer, celebrating ersity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor.

Nurse Care Manager (Newborn / Maternity)

Remote 

Clinical Strategy and Services – Clinical Team /

Full-time

Remote

We’re looking for telephonic Nurse Care Managers with Newborn / Maternity experience, who are passionate about caring for members holistically through their healthcare journey and ensuring needs are met with industry-leading interventions.

Nurse Care Managers will guide members through complex medical situations, partnering with a multidisciplinary clinical team that includes a variety of healthcare professionals, care coordinators, and records specialists, to deliver integrated remote care in an innovative way.

The Telehealth Nurse Care Manager should enjoy spending time on the phone, listening to members’ needs, answering questions, and serving as an advocate. They should also excel at creating cohesive care plans, and should possess the clinical acumen to guide members clinically and navigate available benefits and resources. Nurse Care Managers will support members through complex care management, disease management, and acute case management, ensuring they receive longitudinal care that results in excellent health outcomes.

Responsibilities:

• Deliver coordinated, patient-centered virtual Care Management by telephone and/or video that improves members’ health outcomes.
• Generate impactful care plans together with members and our multidisciplinary care team, and help members achieve the desired goals.
• Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.
• Partner with the members’ local providers to ensure coordinated care.
• Provide compassionate, longitudinal follow-up care, building supportive relationships.
• Assist throughout acute healthcare episodes, such as hospitalizations and rehabilitation stays, providing coordinated Case Management to support the member and their family.
• Coordinate necessary resources that holistically address members’ problems, whether clinical or social

Qualifications:

• Bachelor of Science in Nursing.
• Must reside in a compact state.
• Registered Nurse, Compact licensed and in good standing with the nursing board of their state.
• Willingness to become licensed in multiple states.
• 5+ years of experience in nursing preferred.
• 2+ years experience working in Complex Care and Acute Case Management or Hospice Case Management preferred.
• Case Management Certification / CCM Certification
• Be comfortable discussing a wide variety of medical conditions;Spanish speaking desirable.
• Experience working remotely preferred;Be comfortable with technology.
• Be highly empathetic. We work with patients and their families who are going through challenging times. Ideal candidates practice empathy and reassure patients that we are available to help them.
• Must be able to work efficiently. We are a fast growing company and we are busy. Our team is expected to meet volume goals without sacrificing quality. Good judgment for balancing priorities is a must.
• Be flexible and comfortable with working in a rapidly-changing environment.
• Be able and willing to work until 6pm local time, with occasional weekend commitments as well.
• Strictly follow security and HIPAA regulations to protect our patients’ medical information.
• Be pleasant, responsive, and willing to work with and learn from our team.
• Strong verbal and written communication skills. A lot of time is spent on the phone with patients and families, as well as a lot of time communicating with colleagues. Therefore, 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.
• Collaborate well across multidisciplinary teams with clinical and non-clinical members to deliver a seamless, top-quality care experience to patients.
• Ability to understand cultural and socioeconomic issues affecting members and to coordinate all available resources to serve members.
• Excellent grammar, attention to detail, and efficient at writing medical information in easy-to-understand, patient-centric language.

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

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.