Land your dream remote job

Title: Clinical Research Coordinator 2

Location: Orland Park United States

Job Description:

Department

BSD CCC - Network Oncology Research Support

About the Department

About the Unit

The University of Chicago Comprehensive Cancer Center (UCCCC) is an integral component of the Biological Sciences Division (BSD). The BSD is the largest of four Divisions of the University and includes the Pritzker School of Medicine. UCCCC administers four established scientific programs, and the NCI-sponsored Cancer Center Support Grant funds ten Shared Resources. The Comprehensive Cancer Center comprises over 190 faculty members from twenty departments, with members currently being awarded over $47 million in total direct costs in peer-reviewed cancer research grants, and $28 million in non-peer-reviewed grants and contracts. The activities of the Center are broad and varied, including research, training and education, communications, fundraising, marketing, clinical trials management, and community outreach.

UCCCC has one of the largest cancer clinical trials programs in the country and in the Chicago area, with nearly 500 adult and pediatric therapeutic trials actively accruing patients. Many of these studies are investigator-initiated, including Phase I or I/II trials, demonstrating UCCCC's commitment to translating basic research findings to the clinic through proof-of-principle and early-phase studies. UCCCC opens over 250 new trials each year and accrues approximately 900 participants to therapeutic trials each year.

Job Summary

The Clinical Research Coordinator 2 (CRC2) is a specialized researcher partnering with the clinical Principal Investigator (PI) and under the direction of a departmental or lab research manager. While the Principal Investigator is primarily responsible for the overall design, conduct, and management of the clinical trial, the CRC2 supports, facilitates, and coordinates the daily clinical trial activities and plays a critical role in the conduct of the study.

By performing these duties with limited supervision and/or guidance, the CRC2 works with the PI, department, sponsor, and institution to support and provide advice on the administration of the compliance, financial, personnel, and other related aspects of the clinical study.

Responsibilities

• Manages all aspects of conducting clinical trials, including screening, enrollment, subject follow-up, completion of the case report form, and adverse event reports.

• Recruits and interviews potential study patients with guidance from PI and other clinical research staff.

• Collects, processes, ships, and stores specimens to the appropriate laboratory according to established aseptic techniques.

• Identifies and explains the responsibilities of principal investigators, research team members, sponsors, contract research organizations (CROs), and regulatory authorities related to the conduct of a clinical trial.

• Coordinates the conduct of the study from startup through closeout, including recruitment and screening of study subjects, obtaining informed consent, collecting research data, and ensuring protocol adherence.

• Plans and coordinates patient schedule for study procedures, return visits, and study treatment schedules.

• Educates patients about study procedures to be performed, visit schedule, what to report between and during visits, and the risks and benefits of the procedures.

• Performs assessments at visits and monitors for adverse events.

• Organizes and attends site visits from sponsors and other relevant study meetings.

• Protects patients and data confidentiality by ensuring security of research data and personal health information and compliance with federal regulations and sponsor protocols.

• Ensures Standard Operating Procedures (SOP) are implemented and documented in accordance to study sponsor, primary investigator, and regulatory agency specifications.

• Maintains accurate and complete records which may include, but are not limited to, signed informed consent, relevant IRB approvals, source documentation, Case Report Forms (CRFs), drug dispensing logs, and study-related communication.

• Understands the IRB submission and review process and when and how to apply for IRB review, including facilitation of study initiation through meticulous and timely preparation of IRB submissions independently.

• Ensures compliance with federal regulations and institutional policies.

• May prepare and maintain protocol submissions and revisions.

• May assist in the training of new or backup coordinators.

• Assists with various professional, organizational, and operational tasks under moderate supervision.

• Facilitates and participates in the daily activities of moderately complex clinical studies and performs various activities including patient data retrieval, documenting clinical research records, and participation in program audits.

• Uses knowledge of clinical studies to coordinate the collection of analyzable clinical research data and/or samples with a limited to moderate degree of independence. Contributes to the problem solving on assigned clinical research studies and tasks.

• Performs other related work as needed.

Minimum Qualifications

Education:

Minimum requirements include a college or university degree in related field.

Work Experience:

Minimum requirements include knowledge and skills developed through 2-5 years of work experience in a related job discipline.

Certifications:

• --

Preferred Qualifications

Education:

• Bachelor's degree.

Experience:

• Relevant clinical research experience.

• Working knowledge of coordinating multiple studies (e.g., investigator-initiated, industry-sponsored, multi-site trials).

Preferred Competencies

• Ability to interact and communicate with clarity, tact, and courtesy with patrons, patients, staff, faculty, students, and others.

• Strong organizational skills.

• Excellent interpersonal skills.

• Strong data management skills and attention to detail.

• Expert Knowledge of the Microsoft suite, including Outlook.

• Ability to understand complex documents (e.g., clinical trials).

• Ability to handle competing demands with diplomacy and enthusiasm.

• Ability to absorb large amounts of information quickly.

• Adaptability to changing working situations and work assignments.

Working Conditions

• Ability to navigate the assigned UChicago location as required by the Position.

• Hybrid work arrangements may be considered.

Application Documents

• Resume (required)

• Cover letter (preferred)

When applying, the document(s) MUST be uploaded via the My Experience page, in the section titled Application Documents of the application.

Job Family

Research

Role Impact

Inidual Contributor

Scheduled Weekly Hours

40

Drug Test Required

Yes

Health Screen Required

Yes

Motor Vehicle Record Inquiry Required

No

Pay Rate Type

Salary

FLSA Status

Exempt

Pay Range

$60,000.00 - $75,000.00

The included pay rate or range represents the University's good faith estimate of the possible compensation offer for this role at the time of posting.

Benefits Eligible

Yes

The University of Chicago offers a wide range of benefits programs and resources for eligible employees, including health, retirement, and paid time off. Information about the benefit offerings can be found in the Benefits Guidebook.

Posting Statement

The University of Chicago is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender, gender identity, or expression, national or ethnic origin, shared ancestry, age, status as an inidual with a disability, military or veteran status, genetic information, or other protected classes under the law. For additional information please see the University's Notice of Nondiscrimination.

Job seekers in need of a reasonable accommodation to complete the application process should call 773-702-5800 or submit a request via Applicant Inquiry Form.

All offers of employment are contingent upon a background check that includes a review of conviction history. A conviction does not automatically preclude University employment. Rather, the University considers conviction information on a case-by-case basis and assesses the nature of the offense, the circumstances surrounding it, the proximity in time of the conviction, and its relevance to the position.

The University of Chicago's Annual Security & Fire Safety Report (Report) provides information about University offices and programs that provide safety support, crime and fire statistics, emergency response and communications plans, and other policies and information.

Title: Director of Community Support Services

Location: Philadelphia United States

Job Description:

Division: Community Living & Home Supports (CLHS)

Location: Philadelphia, PA | Hybrid (4 days in-office, 1 day remote)

Summary

We are seeking a passionate and experienced leader to join our team as the Director of Community Support Services. In this role, you will oversee community residences for iniduals with mental health and intellectual disabilities, ensuring safe, supportive, and enriching environments. You will guide daily operations, supervise and develop staff, ensure compliance with all regulations, and foster a culture of care that promotes dignity, independence, and quality of life for residents. This is an exciting opportunity for someone who is dedicated to making a lasting impact in the lives of others while leading a committed team.

Key Responsibilities

• Provide leadership and oversight of community residences serving iniduals with mental health and intellectual disabilities.

• Supervise and mentor Associate Directors, therapists, and team leaders to ensure strong program delivery and adherence to agency standards.

• Ensure all residences are safe, well-maintained, and welcoming environments.

• Oversee program planning, implementation, and staff training to deliver high-quality, person-centered care.

• Collaborate with leadership, regulatory agencies, and community partners to maintain compliance and strong communication.

• Monitor staff performance, participate in hiring and evaluations, and ensure proper staffing levels to meet resident needs.

• Manage program resources, including household funds, petty cash, and vehicle safety.

• Support staff and programs during weekends, holidays, or emergencies as needed.

Required Qualifications

• Bachelor's degree in a human services field (psychiatry, social work, psychology, nursing, rehabilitation, special education, or activity therapies), Master's preferred.

• Certification in competencies as required by the Philadelphia Office of MH/MR (within three months of training).

• Significant experience working with iniduals with disabilities, preferably in a residential setting.

• Strong background in program development and implementation for iniduals with serious mental illness.

• Proven leadership, communication, and organizational skills.

Why Join Us?

At JEVS, we believe in creating supportive environments where both residents and staff can thrive. As the Director of Community Support Services, you'll have the chance to lead a dedicated team, shape impactful programs, and contribute to a mission-driven organization that values compassion, collaboration, and excellence.

What We Offer

• 401(k) with company match

• Health, Dental & Vision coverage

• Generous paid time off + 10-12 holidays

• Tuition assistance & professional development

• Wellness programs & Employee Assistance Program

• Commuter benefits & mileage reimbursement

• Fun culture perks: dress-down Fridays, office outings, holiday party, referral bonuses

The base pay for this position ranges from $58,000 to $73,000 and will vary based on factors such as skills and experience. Base pay is one part of the Total Compensation that JEVS Human Services provides to recognize employees for their work. JEVS provides competitive Benefits; we believe that benefits should support you at work and at home. Please visit the benefits page of our careers site for more details.

At JEVS, we are committed to ensuring all our employees feel included, valued, appreciated and free to be who they are at work. We cultivate a culture where differences are valued, and we are putting resources and attention towards improving employee engagement, retention, and promotion of our talented staff.

Diversity, inclusion, and equity are core principles that guide how we cultivate leaders, build our teams, and create an environment that is the right fit for JEVS Human Services' employees, our community partners, and the iniduals we serve.

For more information about what it's like to be a part of the JEVS team, visit our careers page at https://www.jevshumanservices.org/careers/

Qualified iniduals with disabilities are encouraged to apply; reasonable accommodations will be provided. Please contact your recruiter if you are in need of an accommodation during the interview process.

JEVS Human Services is committed to ensuring equal employment opportunities. The Agency will not engage in or tolerate unlawful discrimination (including any form of unlawful harassment) on account of a person's gender, gender identity, age, race, color, religion, creed, sexual preference or orientation, marital status, national origin, ancestry, citizenship, military status, veteran status, disability, or membership in any other protected group. Qualified iniduals with disabilities are encouraged to apply; reasonable accommodations will be provided.

Title: Senior Provider Enrollment Credentialing Coordinator

Location: NJ United States

ID: 552874

Full time

Job Description:

Salary Range: $64,800.00 - $80,000.00

The compensation range listed in this job posting reflects the market rate for the New York City Metropolitan area. Actual compensation may vary depending on the geographic location of the candidate, in accordance with local labor market conditions.

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to departmental budgets, qualifications, experience, education, licenses, specialty, and training. The above hiring range represents the University's good faith and reasonable estimate of the range of possible compensation at the time of posting.

The Senior Enrollment Coordinator leads enrollment functions for delegated, non-delegated, government, and third-party payers/vendors. This role supports enrollment, reenrollment, profile maintenance, updates, disenrollments, and resolution of payer-related issues. The coordinator ensures that provider records are accurate, compliant, and maintained in accordance with enrollment timelines, payer requirements, and internal standards. It also plays a key role in auditing payer rosters to ensure providers are enrolled correctly at the inidual (NPI), group (TIN), and location level, as well as verifying credentials align with payer records. While the core focus is enrollment, the role may support credentialing activities as needed to maintain workflow continuity and compliance.

Responsibilities

Technical & Analytical

• Manage full-cycle enrollment and credentialing tasks for delegated, non-delegated, government, and third-party payers/vendors.
• Independently prepare, maintain, submit, and track inidual and group provider enrollment submissions, including applications, delegated roster files, revalidations, group linkages, demographic changes, and terminations.
• Manage and coordinate complex enrollment scenarios, including large group changes, off-cycle submissions, delegated roster processing, provider transitions across payer networks and product types (e.g., OPRA to FFS), and out-of-state enrollment. Oversee all aspects from requirement identification to recredentialing follow-up, and lead high-priority or retroactive submissions, ensuring timely escalation and resolution as needed.
• Conduct thorough quality assurance (QA) reviews during application preparation to ensure file accuracy, completeness, and compliance with payer-specific requirements and documentation standards. Ensure documentation integrity and full adherence to established submission timelines and payer requirements.
• Maintain accurate and organized provider files in accordance with internal record-keeping standards.
• Oversee and update payer-specific forms, enrollment workflows, and documentation to ensure alignment with evolving payer requirements and internal SOPs.
• Manage payer portals (e.g., PECOS, Availity, eMedNY) to ensure real-time profile updates and enrollment tracking; serve as Delegated Official or PECOS Surrogate for government payers; determine appropriate application types (e.g., full enrollment, group link, revalidation); and submit secondary applications to resolve or supplement existing records as needed.
• Oversee the tracking and documentation of enrollment applications from initiation through confirmation. Conduct follow-up with payers via email, phone, and online systems to verify receipt, address issues, and confirm approvals. Ensure internal databases reflect accurate status and proactively identify and resolve delays. Provide leadership and stakeholders with regular updates on enrollment progress, outstanding items, and escalated concerns. Escalate incomplete submissions, delays, or errors according to escalation protocols.
• Manage and oversee provider profile maintenance activities, ensuring timely and accurate updates to licenses, DEA registrations, specialties, TINs, service addresses, hospital affiliations, board certifications, and more to maintain compliance and integrity of payer enrollment records.
• Follow up with departments to obtain missing documentation or signatures to support timely application submission.
• Log, troubleshoot, and track complex enrollment-related issues such as denials/underpayments, authorization issues, or other participation errors. Collaborate with internal departments and payer contacts to complete a comprehensive root-cause analysis, following through to resolution to minimize adverse impact to revenue and patient/provider abrasion. Escalate issues appropriately for review and resolution.
• Lead comprehensive roster audits across all major payers and product lines to ensure data integrity and compliance. (EX: PAR/NONPAR Status: Identify and coordinate resolution of participation discrepancies. Demographics: Verify NPI, TIN, and address accuracy across internal records and payer rosters. Credentialing: Reconcile licenses, board certifications, and specialties with payer records. Other: Conduct specialized audits related to fee schedules, Medicaid PAR status, ETIN connectivity, and upcoming recredentialing dates.)
• Coordinate across cross-functional teams to ensure alignment of enrollment records with onboarding timelines and downstream billing processes.
• Works collaboratively with fellow team members to regularly evaluate the effectiveness of department Standard Operating Procedures and workflows and identify gaps. Provides feedback and recommendations to the supervisor for improvements. Implements approved changes.
• Lead or contribute to strategic projects, including annual open enrollment, payer platform migrations, system transitions, and high-volume bulk submissions.
• Effectively communicate through informal and formal presentations for various audiences to ensure relevant communication is cascaded to the various interest and stakeholder groups as needed.
• Develop and maintain workflow tools, trackers, and templates to improve efficiency and accuracy.
• Partner with leadership to identify trends, gaps, or process improvement opportunities related to enrollment performance or payer feedback.
• Prepares and distributes status updates to stakeholders for accurate and timely updating of internal and external platforms (including but not limited to databases, credentialing grids, dictionaries, portals, and websites).
• Support credentialing activities as needed to maintain workflow continuity and compliance.

Compliance and Other

• Performs compliance checks and quality assurance activities to maintain the integrity of data and ensure adherence to standard operating procedures.
• Maintain subject matter expertise on payer requirements, state regulations, and industry best practices. Regularly update payer-specific workflows, documentation policies, and contact resources to ensure compliance with HIPAA, NCQA, payer requirements, and regulatory guidelines. Advise team on operational impacts of industry changes (e.g., CMS updates, Medicaid policy shifts).
• Lead process improvement initiatives by identifying systemic workflow inefficiencies and recommending strategic enhancements to leadership.
• Serves as the primary point of contact for providers, payers, and vendors. Lead regular meetings to discuss the status of open items and deliverables, preparing agendas in advance, and follow up with meeting minutes. Escalates to internal and external stakeholders as needed.
• Participate and serve as a key contributor in internal meetings, cross-functional workgroups, audit preparation, and department initiatives as assigned. Document key discussion points and follow up on assigned action items.
• Serve as the primary point of contact for internal inquiries, providing timely updates and guidance on enrollment status, payer requirements, and documentation needs.
• Manage and prioritize complex work queues to ensure the timely resolution of enrollment submissions in alignment with departmental goals and payer expectations.
• Establish and maintain positive relationships with payers, providers, practices, and administration, providing subject matter expertise and tailoring communications to adapt to each audience.
• Mentor, train, complete quality assurance activities, and provide escalation support to team members.

Please note: While this position is primarily remote, candidates must be in a Columbia University-approved telework state. There may be occasional requirements to visit the office for meetings or other business needs. Travel and accommodation costs associated with these visits will be the responsibility of the employee and will not be reimbursed by the company.

Minimum Qualifications

• Bachelor's degree or equivalent in education and experience.
• Minimum of 3 years of related experience in provider enrollment, credentialing, or healthcare operations.
• An equivalent combination of education and experience may be considered.
• Must demonstrate strong analytical and problem-solving skills with attention to detail and accuracy.
• Ability to work collaboratively with a culturally erse staff and patient/family population, strong customer service skills, demonstrating tact and sensitivity in stressful situations.
• Demonstrate proficiency in Microsoft Excel functions, including VLOOKUP and pivot tables
• Advanced time management skills, including planning, organization, multi-tasking, and the ability to prioritize, are required.
• Must demonstrate effective communication skills both verbally and in writing.
• Must successfully complete systems training requirements.

Preferred Qualifications

• Experience working in academic medical centers, health plans, or multi-specialty healthcare organizations
• Proficiency using credentialing platforms such as MD-Staff, IntelliCred, symplr, or Cactus
• Experience using government enrollment platforms such as PECOS, eMedNY, or Availity
• Experience managing group-level credentialing and enrollment for all payer types, including Out-of-State Medicaid
• Familiarity with payer-specific credentialing and enrollment requirements and workflows for government, delegated, and non-delegated plans
• Experience supporting NCQA-compliant delegated credentialing/enrollment programs or audits
• Experience performing complex enrollment activities, such as roster audits, directory maintenance, product line transitions, and issue resolution
• Strong understanding of NPI/TIN/location structures and their implications for payer enrollment
• Experience leading or coordinating provider enrollment activities during onboarding, offboarding, or large-scale practice transitions
• Prior involvement in vendor or payer relationship management (e.g., acting as primary liaison for delegated enrollment or credentialing partners)
• Experience auditing or reviewing delegated rosters or enrollment files for accuracy and compliance
• Demonstrated ability to provide mentorship or training to junior staff or cross-functional colleagues
• Familiarity with payer portals and internal processes used to verify participation and resolve escalations
• Understanding of the connection between enrollment delays and claims, authorizations, or billing issues
• Experience with enrollment performance tracking or metrics reporting for leadership review

Other Requirements

Accountability & Self-Management

Level 3 - Intermediate

Adaptability to Change & Learning Agility

Level 2 - Basic

Communication

Level 2 - Basic

Customer Service & Patient Centered

Level 3 - Intermediate

Emotional Intelligence

Level 2 - Basic

Problem Solving & Decision Making

Level 3 - Intermediate

Productivity & Time Management

Level 3 - Intermediate

Teamwork & Collaboration

Level 2 - Basic

Quality, Patient & Workplace Safety

Level 3 - Intermediate

Leadership Competencies

Minimum Proficiency Level

Performance Management

Level 2 - Basic

Equal Opportunity Employer / Disability / Veteran

Columbia University is committed to the hiring of qualified local residents.

Title: Associate Customer Service Representative (Remote-November)

Location: United States

Full-Time

Remote

Hourly Range: $14.74 USD to $22.84 USD

Job Category: Intermediate Level Cleric

Requisition Number: ASSOC005238

Job Description:

You likely know us as an insurance company, but that's just a portion of what we do! Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It's a mission we take seriously.

We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond!

Work environment

This opportunity is eligible for fully remote work in qualifying states, excluding Alabama, Alaska, California, Colorado, Connecticut, Delaware, District of Columbia (Washington D.C.), Hawaii, Illinois, Kentucky, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, Utah, Vermont, Washington, West Virginia, Wyoming.

Working Monday - Friday from 9:00 - 5:30 pm Central Time Zone. Training will take place Monday - Friday from 8:00 am - 4:30 pm Central Time Zone for approximately the first 10-12 weeks.

Pay information

• The estimated starting pay range for this role is $16.00 - $19.00/hour. Offers to top candidates are based on various factors such as previous experience, qualifications and internal equity.
• Opportunities for continued salary growth through performance-based incentive programs.
• Pay Level: 014
• FLSA Category: Nonexempt- Hourly
• BCBSND also offers a competitive benefits package to their employees and this role is eligible for benefits beginning December 1, 2025.

At BCBSND, we're committed to providing fair and equitable compensation. While the posted salary range reflects the full compensation range for this role, offers typically fall at or below the midpoint, and in alignment with internal equity and role expectations. Inidual offers are based upon candidates' unique experience, education, and skillsets. The top of the range reflects the ceiling for this role and is only used for offers in exceptionally rare cases. We do not extend offers above the posted maximum.

A day in the life

The Associate Customer Advocate is responsible for assisting and educating members, providers, or customers on products and plans. This position researches, analyzes, and resolves all inquiries, promoting a favorable image of the Company by demonstrating shared business values to all who contact. In addition, this position will foster and preserve reputable relationships with all members, providers, or customers by providing accurate and timely information in response to all inquiries.

Associate Customer Advocates work in a structured, fast-paced call center environment. They have a supportive team of trainers and leaders to guide them through a phased training and ensure they develop the skills to succeed in the health insurance industry.

• Provides assistance, service, and education to members, providers, or customers through various channels including telephone, internet, and written inquiries.
• Ensures accuracy and timeliness in responding to inquiries.
• Processes and resolves customer issues with varying complexities.
• Documents interactions and correspondence with members or providers in a clear and concise manner and ensures they are tracked appropriately so they are easily accessible.
• Applies intermediate computer-based skills to navigate multiple systems and internal resources to address inquiries and gather plan details for members or providers while maintaining timeliness standards and inventory levels.
• Maintains base knowledge of insurance terms and practices along with various company offered products.
• Address and resolve a range of issues, from routine to moderately complex, using established procedures and sound judgment.
• Demonstrate the ability to independently manage common problems while recognizing when to seek guidance more complex or unfamiliar situations.
• Maintain awareness of available resources and support channels to ensure timely and effective issue resolution.

What you need to succeed

• A High School Diploma or GED with 1 year of experience in customer service or related experience is required. Experience in hospitality, healthcare, or an office-based setting is highly preferred.
• A private work-space and fast-paced internet with a hard-wired internet connection.
• Strong communication skills both verbally and written.
• Technology savvy with the ability to navigate multiple computer programs and application systems.
• Willingness to learn new skills.

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

Benefits

• Affordable medical, dental and vision coverage accepted throughout the United States
• Employer funded Lifestyle Spending Accounts, Health Savings Accounts and Health Reimbursement Arrangements
• Employer-paid life and disability insurance
• 401(k) retirement plan with company match and immediate vesting
• Paid holidays, paid time off (PTO), PTO donation program, and paid parental leave
• Voluntary benefits including Accident, Hospital Indemnity, Critical Illness, Term/Whole Life, Cancer Care Insurance, and more.

Additional company perks

• Robust mental health offerings including an Employee Assistance Program, Learn to Live, meQ.
• Comprehensive learning and development opportunities and an Educational Assistance Program.
• 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
• Employee recognition, community initiative events and yearly company outings.
• Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
• Opportunities to connect through employee committees.

Equal opportunity employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Inidual with Disabilities, as well as Sexual Orientation or Gender Identity.

Coding & OASIS Reviewer

locations

Remote – Other

time type

Full time

job requisition id

R013548

Responsible for reviewing OASIS and/or coding for home health and hospice agencies

Responsibilities

• Review OASIS and document recommended changes in approved system
• Review ICD-10 coding and sequencing from documentation in the patient chart
• Complete documentation of results review; ensure workflow processes are timely and accurate
• Document reason for change and recommended reimbursement impact
• Consistently meet chart equivalent targets and quality metrics of 50 CEs per week

Qualifications

Required

• At least 1 year of experience in coding and OASIS reviews
• HCS-D certification
• HCS-O OR COS-C certification
• Proven ability to consistently meet deadlines
• High attention to detail with excellent organization skills
• Demonstrates learning agility; seeks out opportunities for teaching, support, and professional growth

Preferred

• Quality assurance work experience in a post-acute setting

Expectations

• Comfortable with remote work arrangements and virtual collaboration tools
• Physical demands include extended periods of sitting, computer use, and telephone communication

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.

If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please use this form to request details which you may be legally entitled.

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

Title: Medical Coding Quality Assurance Specialist (CPC)

Location: Remote United States

Job Description:

The Coder+ Quality Assurance Specialist will be accountable for executing the quality assurance program related to CODER+ services provided by Privia Health. The QA Specialist will serve as an integral member of the CODER+ program team, responsible for partnering with vendor partners and internal coders to ensure high quality coding is being performed and that proper feedback is being given. This position will spend the majority of the time reviewing coders, educating coders, and working on various projects that involve coding and education. The ideal candidate will draw on existing expertise in primary care and specialty medical coding, billing and compliance with government and commercial payers and act as a coding resource within the team. The Quality Assurance Specialist will perform Evaluation and Management coding, procedure, ICD-10 and HCPC quality reviews as well as other projects related to physician coding. The ideal candidate demonstrates a thorough understanding of complex coding and reimbursement as they relate to physician practices and clinic settings.

Job Requirements:

• Apply appropriate coding classification standards and guidelines to medical record documentation for accurate coding
• Perform quality assessments of records, including verification of medical record documentation (electronic and handwritten)
• Perform quality assessments of coders completed work to validate standards are met
• Research and answer coding and coding workflow related questions for providers and clinic staff
• Meet with providers and clinic staff as needed
• Educate coders and other staff on appropriate coding guidelines
• Assist in development and ongoing maintenance of processes and procedures for each assigned client
• Collaborate with internal Privia+ and Privia teams
• Collaborate with vendor partners
• Follow coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
• Assist in the Privia+ day-to-day coding/educational needs as needed
• Other duties as assigned
• 5+ years of provider medical coding experience across medical and surgical specialties
• 3+ years experience in coding audit or quality review work
• AAPC Certified Professional Coder (CPC) certification required
• CPMA preferred
• Athena EMR experience preferred
• Experience working in a physician practice setting strongly preferred
• Ability to work effectively with physicians, advanced practice providers (APP), practice staff, health plan/other external parties and Privia multidisciplinary team
• Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
• Must comply with HIPAA rules and regulations
• Passion for efficiency and a drive to reduce redundancy
• Professional, clear, and concise oral and written communication
• Knack for prioritizing efficiently and multi-tasking
• Self-directed with the ability to take initiative
• Competent in maintaining confidential information
• Strong team player with ability to manage up members of team to encourage partnership and cooperation with clinic staff

The salary range for this role is $65,000.00 to $75,000.00 in base pay. This role is also eligible for an annual bonus targeted at 10% based on the performance for the role. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

All your information will be kept confidential according to EEO guidelines.

Technical Requirements (for remote workers only, not applicable for onsite/in office work):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.

Title: Medical CPC Coding Specialist

Location: Mount Laurel United States

Job Description:

Overview

The Medical CPC Coding Specialist position with ExamWorks is a great opportunity for talented candidates who are enthusiastic about using their skills to make a difference in the world of health care!

We are looking to bring to our team a CPC, CPC-A, or CPMA who will perform the impressive task of creating and writing reports based on medical records and appropriate guideline criteria. This position utilizes the system database to determine usual and customary and/or state fee schedule allowances and this position is responsible for analyzing provider billing for proper coding and billing guidelines across all provider types and ensures reviews are completed with highest quality and integrity and that all work is in full compliance with client contractual agreements, regulatory agency standards and/or federal and state mandates.

This position is 100% remote, however, in order to work remote you must have access to your own ISP with a router (both the phone and virtual desktop must be plugged in) and a dedicated “office space” where you can set up your work station with desk and chair.

The hours are Monday through Friday; 8:00am-5:00pm EST.

It can’t be just mere coincidence that you’ve come across this job posting. You may be who we’re looking for!

Responsibilities

• Receives client submissions and inputs client and examinee data in the system database.
• Sorts and verifies each claim contains all information required to conduct the review.
• Processes claims by correctly identifying the billing type (physician, surgery center, hospital, etc) and entering medical bills into the reviewing system, allowing automated adjudication to process.
• Reviews each claim and addresses all necessary modifications manually. Including reviewing and applying any applicable coding and/or billing guidelines per industry standards and/or specific client requests.
• Contacts client to resolve questions, inconsistencies, or missing data needed for review.
• Performs quality assurance on every case prior to completion.
• Ensures all medical records and reports are properly documented and saved in the appropriate location and available for audit at all times.
• Processes client invoicing in accordance with the client’s fee schedule.
• Handles and responds promptly to incoming calls, emails or faxes from clients requesting report status and/or information.
• Provide notification to the Supervisor of any provider appeals and follow directions as given to resolve the claim.
• Responsible to inform management of any issues, concerns, updates or changes needed to a client’s profile, report of sale and/or client identification numbers.
• Communicates any issues, errors, or questions concerning the medical review bill system with management and/or with the IT helpdesk.
• Provides testimony in court as to the content of prepared reports, as required.
• Ensures all practices are carried out in accordance with HIPAA compliance practices, state and federal safety standards and legal regulations.
• Promotes effective and efficient utilization of clinical resources and supplies.
• Performing quality assurance on various coding related reviews.
• Perform other duties as assigned.

Qualifications

• Must have current, active coding certification in CPC through AAPC.
• CPMA certification is preferred but not required.
• High school diploma or equivalent required.
• Minimum one year medical billing experience; or equivalent combination of education and experience required.
• Must be able to cross reference different types of billings to ensure consistency in the review process.
• Knowledge of standard fee schedule review, UC&R review, drug and supply charges, rarity, utilization review, CPT guidelines, ICD 10, bundling/unbundling, duplicate billing and CMS reimbursement guidelines preferred but not required.
• Must possess complete knowledge of general computer, fax, copier, scanner, and telephone.
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Must have a full understanding of HIPAA regulations and compliance.
• Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.

As part of our consideration process you will be asked to complete online assignments. These assignments are designed to gauge your skills and give us an idea of how you approach tasks relevant to the Coding Specialist role.

ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured iniduals under automotive, disability, liability and workers’ compensation insurance coverages.

ExamWorks, LLC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified iniduals with disabilities and all iniduals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

Equal Opportunity Employer – Minorities/Females/Disabled/Veterans

ExamWorks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.

RN Clinical Consultant, Claims Shared Services

Fully Remote

Remote – United States

Full time

R000105501

Position Summary

The RN Clinical Consultant serves as a clinical resource for the investigation and assessment of medical information regarding disability by providing comprehensive medical reviews and analysis of long-term disability claims. The RN Clinical Consultant identifies restrictions, limitations and duration impacting functional capacity based on medical data, to assist the Claim Managers in determining claim liability. The RN Clinical Consultant collaborates with treating providers to assist iniduals to obtain appropriate care and ensure optimal treatment outcomes and acts with urgency and ownership to resolve customer issues and prioritize the customer experience.

Candidate Responsibilities

The RN Clinical Consultant reviews long-term disability claims to determine the impact of claimants’ medical condition on their function as well as the impact of their medical treatment in achieving improved functional outcomes. They must possess a strong clinical background to understand and apply rationale of how injury or illness may impact the claimant’s function; possess excellent verbal and written communication skills to gather and report information accurately, ask appropriate questions to facilitate partnership with treating providers, claimants, and internal partners to encourage participation of claimant in appropriate treatment goals. The RN Clinical Consultant works collaboratively with internal vocational rehab specialists in identifying opportunities for return to work. They work to proactively identify and resolve customer issues, when possible, to enhance the customer experience.

Activity

Review and assess claimant subjective reports and objective medical evidence to determine the impact of medical conditions on function. Clarify medical information, interpret medical reports, and evaluate restrictions and limitations to assess current and ongoing level of impairment. Apply current medical knowledge regarding diagnosis, treatment, prognosis, and impairment. Participate proactively through early assessment of medical issues, work capacity and RTW opportunities.

Conduct analysis of claimant’s current treatment plan and collaborate with health care providers and claimants to promote accountability for the appropriateness and status of treatment plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move claimants toward appropriate care.

Proactively contact claimants to obtain information about their condition and impact on work and daily living as part of ongoing assessment of medical condition. Proactively contact treating providers to discuss treatment plans and clarify treatment and RTW goals. Educate providers and claimants on the positive impact of return to work to ensure improved functional status and medical outcomes.

Serve as a technical resource on the medical aspect of the claim. Identify opportunities to educate claim staff and peers on medical aspect of disability. Provide ongoing training and mentoring to claims staff and peers regarding issues impacted by the nature of injury or illness and its impact on function in work or daily activities.

Provide consultation with peers. Work collaboratively with vocational rehab specialists to identify opportunities for return-to-work services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals.

Utilization of independent vendors to perform independent medical assessments. Specifically define issues to be addressed or clarified by outside physician or provider and oversee quality of review. Follow best practices for developing reviews and sharing feedback with treating providers.

Demonstrate diplomacy and professional competency through interactions with medical providers, claim staff, and peers and display empathy and a focus on customer service in all interactions.

Manage case load efficiently, organize priorities, provide timely intervention, and implement continuous quality process improvement.

Reporting Relationships

As our RN Clinical Consultant, the incumbent will report to our Team Leader of LTD Clinical Services, who reports to our Head of LTD Claims

Candidate Qualifications

Functional Skills

Competencies/Skills:

• Excellent written and verbal communication skills.
• Ability to exercise independent and sound judgement in decision-making.
• Excellent organizational and time management skills.
• Must have ability to multi-task with the ability to manage work based on continually changing priorities.
• Display self-motivation and be able to work independently.
• Ability to work collaboratively with multiple professional disciplines and erse populations.
• Detail oriented.
• Excellent information research skills.

Leadership Behaviors

In addition to the above requirements, a candidate for this position must lead by example and demonstrate the following behaviors (including but not limited to):

• Uphold Guardian’s commitment to ethical business practices.
• Continuously strive to provide superior products and customer service.
• Establish and maintain collaborative relationships that are mutually respectful.

Position Qualifications

• RN from an accredited school of Nursing with a valid nursing license in good standing.
• Proficiency in multiple computer systems required.
• CCM preferred.

Experience:

• Minimum of 5 years of clinical nursing experience, with at least 2 of those years within an acute care setting.
• Disability experience strongly preferred.

Location

• Remote

Travel

• Less than 10% of travel required for this role.

Salary Range

$0.00 – $0.00

The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.

Our Promise

At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by erse colleagues with high ethical standards.

Inspire Well-Being

As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues.

Health Care

• Choice of [high deductible/copay] medical plans* with prescription drugs, including coverage for fertility and transgender inclusive benefits
• Dental plan
• Vision plan
• Health care accounts – flexible spending, health reimbursement, and health savings accounts
• Critical illness insurance

Life and Disability Insurance

• Company-paid Life and Disability insurance plus voluntary supplemental coverage
• Accident insurance

Retirement and Financial

• 401(k) retirement plan with a company match, plus an annual age/service-based Company contribution and an annual profit-sharing contribution, if applicable
• Complimentary 1:1 financial guidance with a licensed Fidelity representative

Time Off and Remote Work

• Flexible work arrangements (part in-person/part remote)
• Unlimited paid time off for most roles plus time off for volunteering, jury duty, voting, and bereavement
• Personal holidays for colleagues to use in recognition of religious, cultural, or civic days
• Paid parental leave and paid family and medical leave policies

Emotional Well-being and Work-Life

• Emotional well-being, mental health, and work/life resources powered by Spring Health
• Wellness programs, including fitness program and equipment reimbursement
• Child, adult, and elder back-up care support through Bright Horizons
• Adoption assistance
• College planning
• Tuition reimbursement
• Student loan assistance
• Commuter benefits in select metropolitan areas

Equity & Inclusion

Opportunities to build inclusive and meaningful connections through involvement in colleague-led affinity groups:

• Employee Resource Groups:
• Colleague Connection Committees
• Community Involvement Committees

A culture that encourages colleagues to bring their authentic selves to work

• Voluntary self-ID
• Pronunciation and phonetic spelling of names

Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.

Equal Employment Opportunity

Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.

Accommodations

Guardian is committed to providing access, equal opportunity and reasonable accommodation for iniduals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the inidual’s known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact [email protected].

Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.

Title: Risk Adjustment Medical Coder (CRC, CPC, CCS, CCS-P Certification Required) – Fully Remote!

Location: United States

Job Description:

Centauri Health Solutions provides technology and technology-enabled services to payors and providers across all healthcare programs, including Medicare, Medicaid, Commercial and Exchange. In partnership with our clients, we improve the lives and health outcomes of the members and patients we touch through compassionate outreach, sophisticated analytics, clinical data exchange capabilities, and data-driven solutions. Our solutions directly address complex problems such as uncompensated care within health systems; appropriate, risk-adjusted revenue for specialized sub-populations; and improve access to and quality of care measurement. Headquartered in Scottsdale, Ariz., Centauri Health Solutions employs 1700 dedicated associates across the country. Centauri has made the prestigious Inc. 5000 list since 2019, as well as the 2020 Deloitte Technology Fast 500 list of the fastest-growing companies in the U.S. For more information, visit www.centaurihs.com.

Role Overview

The Risk Adjustment Coder with AHIMA or AAPC certification performs medical record diagnosis code abstraction based upon clinical documentation, ICD-10-CM Official Guidelines for Coding and Reporting, AHA Coding Clinic Guidance, CMS program guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The Risk Adjustment Coder will apply guidance provided for the medical record code abstraction primarily for Medicaid lines of business (Complete Code Capture), but may also include Medicare Advantage Risk Adjustment or Commercial Risk Adjustment. Certified through AHIMA or AAPC required.

Role Responsibilities

• Perform code abstraction of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation
• Identify diagnosis and chart level impairments and documentation improvement opportunities for provider education
• Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations
• Ability to pass coding quiz with 80% accuracy
• Consistently maintain a minimum 95% accuracy on coding quality audits
• Meet minimum productivity requirements as outlined by the project terms
• Ability to adhere to client guidelines when superseding other guidelines
• Assist coding leadership by making recommendations for process improvements to further enhance coding goals and outcomes
• Handle other related duties as required or assigned

Role Requirements:

• Minimum of 3 years certified with a core coding credential from AHIMA or AAPC
• Must be one of the following (CRC, CPC, CCS, CCS-P)
• Experience and proficiency working with Medicaid plans 1+ years
• Strong organizational skills
• Technical savvy with high level of competence in basic computers, Microsoft Outlook, Word, and Excel
• Strong written and verbal communication skills
• Ability to work independently in a remote environment
• Minimum of 1 recent year of production coding experience in Retrospective Risk Adjustment coding (must be within last 6 months)
• Required code set knowledge and coding experience in Medicaid (primary), Medicare, and Commercial benefit plans
• Minimum of 1 year coding experience with Complete Code Capture

We believe strongly in providing employees a rewarding work environment in which to grow, excel and achieve personal as well as professional goals. We offer our employees competitive compensation and a comprehensive benefits package that includes generous paid time off, a matching 401(k) program, tuition reimbursement, annual salary reviews, a comprehensive health plan, the opportunity to participate in volunteer activities on company time, and development opportunities. This position is bonus eligible in accordance with the terms of the Company’s plan.

Centauri currently maintains a policy that requires several in-person and hybrid office workers to be fully vaccinated. New employees in the mentioned categories may require proof of vaccination by their start date. The Company is an equal opportunity employer and will provide reasonable accommodation to those unable to be vaccinated where it is not an undue hardship to the company to do so as provided under federal, state, and local law.

Factors which may affect starting pay within this range may include geography/market, skills, education, experience and other qualifications of the successful candidate.

This position is bonus eligible in accordance with the terms of the Company’s plan.

Other details

• Pay Type Hourly
• Min Hiring Rate $25.00
• Max Hiring Rate $29.00

Professional Coder II

US-Remote

Remote: Yes

Position Type: Regular Full-Time

Company Overview

Shriners Children’s is a family that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience defines us as leaders in pediatric specialty care for our children and their families.

Job Overview

The Professional Coder II performs at an advanced level medical coding position and serves as an expert utilizing International Statistical Classification of Diseases (ICD-10) and Current Procedural Terminology (CPT 4) classification system coding to all diagnoses and procedures on a variety of encounter types including but not limited to Evaluation and Management (E/M) and surgery at stated minimum performance levels.

Responsibilities

• Interpret health record documentation using knowledge of anatomy, physiology, clinical disease processes, pharmacology and medical terminology to identify diagnoses and procedures
• Assign and sequence all ICD-10; CPT 4; Healthcare Common Procedure Coding (HCPC) and modifier codes for services rendered accurately and completely
• Reconcile correct coding edits and discrepancies prior to final coding
• Maintain coding quality of 95% or higher while meeting established productivity requirements based on encounter type
• Follow coding guidelines and legal requirements to ensure compliance with federal and state regulations
• Identify trends in documentation deficiencies and communicates areas of improvement opportunities to leadership and/or providers
• Act as a key liaison for the physicians and clinical staff as it relates to coding and compliance
• Interact with physicians and other professional staff of documentation issues relating to coding data
• Must be able to work independently with minimal supervision

Qualifications

Minimum:

• 4 yrs of profee coding in medical, surgical and physician professional specialties
• Advanced knowledge of Medical Terminology and Anatomy & Physiology
• Advanced knowledge of professional coding practice standards
• Experience with 3M system or other encoder programs
• Experience with CPT 4 coding assignment and ICD-10 diagnosis code assignment
• Experience with HCPC and modifier codes
• Current CCS (AHIMA), CCS-P (AHIMA) or CPC (AAPC) certification
• High School Diploma/GED

Preferred:

• Pediatric, orthopedic and/or injury coding experience

Title: Psychiatric Mental Health Nurse Practitioner

Location: Remote (United States)

Job Description:

Our Company:

At Cerebral, we’re on a mission to democratize access to high-quality mental health care for all. We believe that everyone everywhere deserves to get the care they need, and are striving to make care convenient and accessible, while tackling the stigmas that surround mental illness.

Since launching in January of 2020, Cerebral has scaled to provide mental health services to more than 700,000 people in all fifty US states. With support from investors like SoftBank, Silver Lake, Access Industries, Bill Ackman, WestCap, and others, and impactful leaders like you, we’ll continue to democratize mental health care and double down on clinical quality and deliver exceptional client outcomes for years to come. With a heavy focus on clinical quality and safety in all that we do, we’ve accomplished excellent outcomes for hundreds of thousands of clients:

• • 82% of clients report an improvement in their anxiety symptoms after using Cerebral.

• • 75% of clients who report improvement in their depression see improvement within 60 days.

• • 50% of clients who initially report suicidal ideation no longer harbor suicidal thoughts after treatment with Cerebral.

This is just the beginning for Cerebral, and we won’t stop building, growing, and iterating until everyone, everywhere can access high-quality, evidence-based mental health care without high costs and/or long wait times. We’re looking for mission-driven leaders who share these values, and we need your help as we transform access to high-quality mental health care in the United States and beyond.

The Role:

We are hiring contract Psychiatric Mental Health Nurse Practitioners! Cerebral provides evidence-based treatment for adults seeking mental health care. Our telemedicine prescribers collaborate with Therapists and Psychiatrists to support clients during their mental health journey. This PMHNP role provides direct patient care for a panel of clients and allows for flexibility when client sessions can be scheduled. You can see clients during traditional business hours, evenings, or on weekends.

This position is a 1099 independent contract role working a minimum of 15-20 hours per week. Current state license requirements include California, Colorado, Illinois, Pennsylvania, and Texas.

Who you are:

• • You are PMHNP licensed and in good standing in at least one of the states outlined above

• • Board certification (AANP or ANCC)

• • Minimum of a Master’s degree in nursing, specializing in psychiatric mental health

• • Comfortable assessing and formulating evidence-based treatment plans for clients with mental illness

• • Maintain a strong evidence-based clinical skill set while practicing & implementing outcome-focused care within the clinical coverage team

• • Empathetic and intuitive listening

• • Strong verbal and written communication

• • Knowledgeable in crisis response

• • Comfortable working autonomously in a telemedicine environment

• • Tech-savvy with the ability to navigate various systems & tools with ease (this includes, but is not limited to Google Workspace, proprietary EMR, etc.)

• • Passionate about our mission of improving access to high-quality mental health care

• • An entrepreneurial spirit or previous experience within a startup or fast-paced environment is preferred

How your skills and passion will come to life at Cerebral:

• • Hold thoughtful and engaged sessions with clients; 30 minute initial sessions and 15 minute follow up sessions

• • Maintain and provide direct care to a panel of clients

• • You will work collaboratively with other mental health care partners at Cerebral to ensure the most beneficial level of evidence-based treatment plans for our clients

• • Work alongside other like-minded clinicians that have a common goal to positively impact the lives of others, and create an environment that leads to favorable outcomes for clients

What we offer:

• • Mission-driven impact:
    • • Unlike traditional mental healthcare, Cerebral’s telehealth service is accessible, convenient, and affordable. Build a platform that is improving the lives and well-being of hundreds of thousands of people.
    • • Join a community of high achievers who have a passion for promoting mental health.

• • Path to develop & grow:
    • • Robust training and onboarding program to ensure you feel set up for success prior to seeing clients!
    • • Case consultations offered multiple times a week, led by readily available clinical leaders, covering a variety of topics and modalities, ensuring you always receive the support you need.
    • • Access to Relias for continued education (free CEU offering).

• • Remote-first model:
    • • Flexibility to choose the hours and schedule that work best for you.
    • • Work virtually from anywhere in the United States as long as you have a HIPAA compliant location with a strong internet connection.

• • Culture & connectivity:
    • • Highly-responsive and supportive team of clinical and operational management committed to helping you provide exceptional care.
    • • Compensated opportunities to engage with peers and leaders throughout the organization through live Q&As, office hours, fireside chats and more!
    • • Additional support offered for complex clients through our Complex Case Management Program.
    • • Decreased administrative time for clinicians through ongoing technology improvements and automations. Cerebral also handles all marketing, client referrals, billing, insurance claims processing, and payment needs allowing clinicians to fully focus on their clients.
    • • Fully integrated, data-enabled EMR with embedded clinical decision support, monthly clinical metric reports, and task management system.
    • • Opportunity to participate in strategic development initiatives to improve our clinical quality and safety and/or clinical processes across the organization.
    • • Internal credentialing team to handle enrollment to payers that Cerebral is contracted with while continuing to expand our network of payers.

Who we are (our company values):

• • Client-first Focus – relentless focus on advancing the quality of care, clinical experience, and patient safety

• • Ethics & Integrity – do what is right and demonstrate ethical principles, even when no one is watching

• • Commitment – accountable for fully delivering on commitments to our clients and each other

• • Impact & Quality – make a positive impact and deliver high quality outcomes, based on data and evidence

• • Empathy – act compassionately, listen to seek understanding, and cultivate psychological safety with clients and colleagues

• • Collaboration – achieve our goals together as a united team, strengthened by mutual openness, trust, and ersity of thought

• • Thoughtful Innovation – continuously evolve our ability to deliver on our mission, prioritizing long-term, strategic bets over short-term gains

Cerebral is committed to bringing together humans from different backgrounds and perspectives, providing employees with a safe and welcoming work environment free of discrimination and harassment. As an equal opportunity employer, we prohibit any unlawful discrimination against a job applicant on the basis of their race, color, religion, gender, gender identity, gender expression, sexual orientation, national origin, family or parental status, disability, age, veteran status, or any other status protected by the laws or regulations in the locations where we operate. We respect the laws enforced by the EEOC and are dedicated to going above and beyond in fostering ersity across our workplace.

___________________

Cerebral, Inc. is a management services organization that provides health information technology, information management system, and non-clinical administrative support services for various medical practices, including Cerebral Medical Group, PA and its affiliated practices (CMG), who are solely responsible for providing and overseeing all clinical matters. Cerebral, Inc. does not provide healthcare services, employ any healthcare provider, own any medical practice (including CMG), or control or attempt to control any provider or the provision of any healthcare service. “Cerebral” is the brand name commonly used by Cerebral, Inc. and CMG.

Title: Office Assistant – Remote – Nationwide

Location: Sacramento, California

Medical Billing

Type: Full-Time

Categories: Operations Support

Job Description:

Remote, Nationwide – Seeking Office Assistant

At Vituity you are part of a larger team that is driven by our purpose to improve lives. We are dedicated to transforming healthcare through our culture by working together to tackle healthcare’s most pressing challenges from the inside.

Join the Vituity Team. At Vituity we’ve cultivated an environment where passion thrives, and success comes through shared purpose. We were founded in a culture that values team accomplishments more than inidual achievements, an approach we call “culture of brilliance.” Together, we leverage our strengths and experiences to make a positive impact in our local communities. We foster this through shared goals and helping our colleagues succeed, and we also understand the importance of recognition, taking the time to show appreciation and gratitude for a job well done.

Vituity Locations: Vituity has opportunities at 475 sites across the country, serving 9 million patients a year. With Vituity, if you ever need to move, you can take your job with you.

The Opportunity

• Verifies and ensures documents for accuracy (i.e., refund checks, compares account notes/documentation, letters, addresses, etc.).
• Identifies any documents/files/accounts that may have an error/oversight/printing issues during processing.
• Notes in patient accounts all action; mailing or faxing and if fax confirmation received.
• Completes data entry and documentation in patient accounts and/or billing system(s).
• Provides documentation for accounts when requested or required.
• Processes, sorts, and routes incoming data.
• Performs other office support tasks, including but not limited to: data entry, correspondence, filing, printing, and faxing.
• Maintains a high level of customer service for our external and internal customers.

Required Experience and Competencies

• High School Diploma or GED equivalent required.
• One (1) year of on the job working experience required.
• Must be able to type a minimum speed of 40 words per minute or 7,000 data entry keystrokes per hour required.
• Experience in an office setting, preferably in an administrative or clerical role preferred.
• Experience with billing insurance claims preferred.
• Ability to perform detail-oriented tasks with attention to accuracy.
• Skilled in effective and appropriate verbal and written communication, including spelling, grammar, and punctuation.
• Ability to read and comprehend simple instructions, short correspondence, and memos.
• Ability to write simple correspondence.
• Ability to provide excellent customer service and demonstrate strong interpersonal skills.
• Organizational skills, ability to prioritize, and comfortable working independently.
• Skilled in basic computer programs and ability to operate general office equipment.
• Knowledge of billing systems.
• Ability to navigate multiple computer applications/systems.
• Ability to use 10-key by touch.
• Ability to establish and maintain effective working relationships and work in a team environment.
• Ability to correctly add, subtract, multiply, and ide in all units of measure, using whole numbers, common fractions, and decimals.
• Ability to apply common sense understanding to carry out instructions furnished in written, verbal, or diagram form.
• Ability to deal with problems involving several concrete variables in standardized situations.
• Ability to prioritize workflow and meet performance and/or volume expectations.
• Ability to take accountability and responsibility with all assigned daily tasks.
• Ability to comply with Vituity – RCM policies and procedures.
• Ability to identify and problem solve challenges that may not be outlined in a manual or know when to seek assistance.
• Ability to perform tasks as directed by supervisor or manager.

The Community

Even when you are working remotely, you are an important part of the Vituity Community. We offer plenty of opportunities to engage with other Vitans through a variety of virtual meet-and-greets, events and seminars.

• Monthly wellness events and programs such as yoga, HIIT classes, and more
• Trainings to help support and advance your professional growth
• Team building activities such as virtual scavenger hunts and holiday celebrations
• Flexible work hours
• Opportunities to attend Vituity community events including LGBTQ+ History, Día de los Muertos Celebration, Money Management/Money Relationship, and more

Benefits & Beyond*

Vituity cares about the whole you. With our comprehensive compensation and benefits package, we are mindful of what matters most, and support your needs of today and your plans for the future.

• Superior health plan options
• Dental, Vision, HSA/FSA, Life and AD&D coverage, and more
• Top Tier 401(k) retirement savings plans that offers a $1.20 match for every dollar up to 6%
• Outstanding Paid Time Off: 3-4 weeks’ vacation, Paid holidays, Sabbatical
• Student Loan Refinancing Discounts
• Professional and Career Development Program
• EAP, travel assistance, and identify theft included
• Wellness program
• Vituity community initiatives including LGBTQ+ History, Día de los Muertos Celebration, Money Management/Money Relationship, and more
• Purpose-driven culture focused on improving the lives of our patients, communities, and employees

Title: Coding Manager – Remote

Location: Livonia United States

Job Description:

Employment Type:

Full time

Shift:

Day Shift

Description:

Certified Medical Coding Manager – Remote

Location: Trinity Health PACE Corp Michigan, Livonia, MI

Status: Full time Exempt

Shift: 7 am to 330 pm Eastern

Position Purpose:

The Certified Medical Coding Manager oversees the Coding Regional Team’s daily operations, ensuring quality, accuracy, and compliance. Working with the Director of Coding, the manager provides direction, enforces standards, and audits practices to align with regulations. This role also ensures that team practices follow best industry standards and efficiently manages team operations. The manager directly supervises Certified Medical Coders.

Position Details:

This is a fully remote exempt position. Schedule is typically 7 to 330 Eastern.

Training will take place in person in Livonia, MI for two weeks (expenses paid). Onsite training is required for position.

What you will do:

• Provides tactical direction to the regional coding team, emphasizing quality, accuracy, and accountability. Partners with the Director of Coding, Clinical Documentation & HIM, and PACE leadership to develop and implement process improvement plans, technology, and procedures to achieve desired outcomes.
• Ensure the completion of reports, special projects, and EHR upgrade testing. Collaborate with the Director of Coding, Clinical Documentation & HIM in designing and implementing educational programs, evaluating regional coding team performance, and maintaining communication with coding staff and providers.
• Facilitate external auditing efforts, working closely with auditors and PACE Organizations to monitor, respond, and support during audits.
• Lead auditing efforts, coordinate communications with PACE Organizations on audit outcomes, and work with coders/providers to develop and implement corrective actions.
• Collaborate with the Director of Coding, Clinical Documentation & HIM to analyze the quarterly Semi-Annual Risk Adjustment Reporting Suite and develop strategies to reduce dropped HCCs.
• Assist in onboarding new coders by providing education, training, and orientation, in partnership with the Director of Coding, Clinical Documentation & HIM.
• Work with the Director of Coding, Clinical Documentation & HIM and PACE Organizations to provide onboarding education and training for new providers.
• Develop ongoing education programs for coders and providers in collaboration with the Director of Coding, Clinical Documentation & HIM.
• Ensure monthly revenue reports are validated and submitted to CMS in partnership with the Director of Coding, Clinical Documentation & HIM.
• Collaborate with Information Systems and other stakeholders to develop data standards, quality controls, and procedures related to the Electronic Health Record (EHR) and associated systems.
• Work closely with the Director of Coding, Clinical Documentation & HIM, providers, and medical records teams to coordinate record processing, physician notifications, medical record management, and coding practices. Contribute to the development of coding department policies and procedures.
• Plan, direct, and implement procedures to ensure coding aligns with established policies and guidelines.
• Provide coverage for the coding team as needed.
• Ensure accurate and complete client care documentation is timely and ready for billing.
• Meet or exceed productivity and quality standards for coding and abstracting.
• Continuously seek opportunities to reduce waste and improve processes.

Minimum Qualifications:

• Bachelor’s degree in healthcare related field required.
• CPC and CRC certifications required.
• RHIT certification strongly preferred.
• 8 years of coding using ICD-9-CM/ICD-10-CM or equivalent.
• 4 years of documentation excellence experience.
• Previous supervisory experience required.
• Strong knowledge of medical terminology, human anatomy, physiology, and disease processes.
• Extensive knowledge of medical codes involving selection of most accurate and descriptive code using CPT codes.
• Proficient in using Electronic Health Records to analyze encounters and notify providers of necessary data corrections.
• Action-oriented with strong business acumen, effective conflict management, and customer-focused decision-making. Adaptable to change with strong organizational agility and the ability to work independently.
• Excellent interpersonal skills for driving collaboration, commitment, and productivity in cross-functional teams, with comfort working in a virtual, shared leadership environment.
• Superior written and verbal communication skills
• Expert proficiency with Microsoft Office (Word, Excel, PowerPoint) and basic knowledge of electronic mail and calendaring systems.
• Occasional travel to Livonia, MI or other supported PACE locations may be required.
• Excellent organizational skills, capable of managing multiple tasks while maintaining high customer service standards. Adaptable to changing work priorities and skilled in problem-solving.
• Ability to research, analyze, and synthesize information from various sources, demonstrating critical thinking and effective workload prioritization.

Position Highlights and Benefits:

• Comprehensive benefit including 1st Day medical coverage, dental, vision, paid time off, 403B and educational assistance.
• Access to daily pay and employee referral incentives.
• Supportive environment with a patient-centered focus.
• Opportunities for professional development.

Ministry/Facility Information

Trinity Health PACE provides high-quality care to seniors in the communities we serve. Our interdisciplinary team offers comprehensive services, allowing seniors to remain independent at home.

We are guided by core values of reverence, commitment, safety, justice, stewardship, and integrity.

Apply now!

Min Pay Rate: $33.98

Max Pay Rate: $50.97

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate ersity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A erse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Apply Now

Explore Location

Coding Auditor

Remote, United States San Francisco, California Portland, Oregon St. Louis, Missouri New York, New York Charlotte, North Carolina Newark, Delaware | Administration

Description

Position at GoHealth Urgent Care

Job Description:

The Coding Auditor is responsible for conducting medical coding audits to evaluate compliance with regulatory guidelines. The work will include performing and documenting audit test work, communicating audit issues to management, writing audit reports, and identifying and evaluating emerging areas of organizational risk. These iniduals may coordinate with external third-party consultants as needed and report directly to the Coding Audit Manager.

Responsibilities:

1. Conducts coding, billing, and documentation compliance audits within established timeframe and in accordance with the standards defined by GoHealth

Qualifications:

Education

Associate level degree in business administration or health care related field, Certified Professional Coder (CPC) required.

Work Experience

• 3+ years of relevant experience in a professional audit capacity required
• Strong technical knowledge of Institute of Internal Auditing (IIA) standards and Centers for Medicare & Medicaid Services (CMS) regulatory guidelines, including ICD-10 CM, CPT, and HCPCS Procedure Coding
• Proficiency in MS Office products – intermediate to advanced knowledge of MS Excel.
• Excellent communication skills, both written and verbal to interact with varying levels of management and professional staff.
• Strong analytical, problem-solving, and strategic thinking skills.

Title: Coding Manager, Pro Fee & FQHC

locations

Remote, USA

time type

Full time

job requisition id

R240000009540

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.

As our Coding Manager, Pro Fee & FQHC, you will supervise remote-based, pro fee coding associates. Every day you are responsible for managing your team’s performance, productivity, and quality. In addition to the managerial responsibilities, the Site Coding Manager works directly with R1’s clients to communicate coding performance, collaboratively identify and solve problems, assist in managing projects, and help to deliver on coding-related financial and operational commitments. To thrive in this role, you must have demonstrated experience managing a team of coders and multiple client accounts as well as proficiency in professional fee coding.

Here’s what you will experience working as a Coding Site Manager:

• Ensure managed coders meet or exceed productivity and quality standards.
• Supervises and directs daily coder work schedules and work assignments.
• Assists with assessment, training and onboarding of new-hires; creates 30/60/90-day ramp-up plans for new associates.
• Creates and manages inidual growth and development plans for coders related to quality, productivity and employee development.
• Provides ongoing training and coaching to domestic and international teams.
• Assists various process improvement projects associated with coding and other reimbursement activity workflows.
• Identifies and solves moderate to complex problems related to coding and other reimbursement activity workflows.
• Optimizes staffing efficiency by minimizing production downtime to meet specific targets.
• Implements findings from Regional Coding Manager to meet or exceed team coding quality standards.
• Identifies, tracks and reports key barriers and process defects to the client and leadership teams on weekly basis.

Required Skills:

• AAPC or AHIMA Certified coding professional: CPC, CCS
• Demonstrated leadership experience including managing direct reports
• Client management experience including preparing and presenting various reports and presentation slide decks in PowerPoint
• Ability to manipulate and analyze data in Excel using pivot tables
• Strong communication skills including the ability to vocalize and document complex coding scenarios and prepare slide decks for internal and external stakeholders

For this US-based position, the base pay range is $64,657.00 – $80,821.00 per year . Inidual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.

R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent

Coding Supervisor

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:

CAREER OPPORTUNITY OFFERING:

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement
• This position pays between $51,700 – $99,000 based on experience

Responsible for the day to day coding activities for the respective physician facilities within the company. This includes assisting the Manager and/or Director, and/or Coding Sr. Leader, with duties assigned to assure Accounts Receivable goals are met.

Job Responsibilities:

• The supervisor is responsible for the staffing, organizing and directing of coding activities within a given facility under the direction of the market Coding Manager. They will coach (SMART Responsibilities where applicable), develop, complete timely performance evaluations and discipline those staff members under their responsibility as needed.
• Assists with the creation and delivery of educational presentations/material related to coding.
• Monitors progress and achievement of coding goals and objectives and reports such information in a timely manner as requested by leadership.
• Monitors workflow, productivity and quality of coding and abstracting functions per system guidelines. Performs routine audits of work performed by all staff members.
• Maintains knowledge of all federal and state rules and associated coding guidelines.
• Assists in the development of policies and procedures and monitors staff compliance with policy and procedures.
• Acts as site resource person for coding related questions, to include assisting members of the medical staff and members of the management team.
• Completes staff schedules and timecards according to Company policy. Holds staff accountable for compliance with paid time off, (PTO) policies.
• Acts as a technical resource and assists with resolution of technical issues and/or works with appropriate staff/department to rectify technical issues impeding the functions of the coding team.
• If workload demands, accurately assigns codes to any medical record in conformance with American Hospital Association, (AHA) coding guidelines and/or financial payer requirements. Assigns appropriate modifiers and present on admission, (POA) indicators as necessary. Assigns appropriate Diagnosis Related Group, (DRG) to reflect the documentation within the medical record.

Experience We Love:

• 3+ years of cardiology coding experience
• 3+ years of leadership experience
• Ability to function independently with minimal supervision, as well as part of a team
• Knowledge of medical record content to include electronic medical records, (EMRs.)
• Ability to function under continual deadlines. Ability to maintain accuracy during frequent interruptions
• Proficiency in keyboarding skills and working knowledge of computers
• Excellent communication skills

Minimum Education:

• Bachelors Degree or Equivalent Experience

Licensure/Certification Required:

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

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

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: Wellness Nurse Care Manager

Location: Remote – USA

Job Description:

Clover is reinventing health insurance by working to keep people healthier.

• • Our complex care programs are designed to improve care and outcomes for our most medically complex members. Clover wants to take accountability for these members’ healthcare journeys and provide high-quality personalized care that is consistent with members’ values and preferences.

• • The Wellness Nurse Care Manager collaborates closely with members, their health providers, and Clover clinical teams to improve member health outcomes. To do so, the WNCM facilitates member assessments, evaluations, care planning, care coordination, and advocacy related to a member’s comprehensive health needs. This process includes medical, social, developmental, behavioral, financial, and educational intervention with focus on high quality and cost effective outcomes. The Wellness Nurse Care Manager will report directly to the program lead.

    As a Wellness Nurse Care Manager, you will:

• • Engage and provide telephonic care coordination and management to identified patient populations.

• • Effectively collaborate with members of Clover clinical teams (e.g. In Home Care team, Readmission Prevention Program team, Supportive Care team, Behavioral Health team, field Nurse Practitioners, Medical Assistants).

• • Initiate referrals to specialty services, follow up on open referrals, and foster continuity of care.

• • Create a personalized care plan for each member to resolve barriers to care and engage with social support systems as appropriate.

• • Follow NCQA Care management accreditation standards.

• • Document all member care activities and escalate findings in accordance with Clover Policies.

• • Coordinate with the interdisciplinary team as needed, including members’ outpatient providers.

• • Provide telephonic teaching and counseling in the areas of health promotion, disease prevention, maintenance, and management of acute/chronic diseases.

• • Attend and participate in regular ongoing meetings.

• • Demonstrate flexibility in assignments within Clover’s Clinical Programs based on member and company needs.

• • Advocate for members to ensure their needs and choices are fully represented and supported.

• • Participate in ongoing professional development and self-improvement.
    You will love this job if:

• • You genuinely enjoy interacting with erse iniduals on a daily basis

• • You want to make a positive difference; you’re passionate about helping members live healthier lives

• • Your mode of operation is being meticulous in your work and motivational to others.

• • Technology is your friend; you embrace learning about new software and working alongside a tech team.

You should get in touch if you have:

• • 3-5 years of post-licensure care management experience

• • Bachelor’s degree (BSN) from an accredited school of nursing

• • Current unencumbered NJ Licensure as a Registered Nurse

• • Case management certification or completion of CCM certification within 1 year of employment preferred

• • Experience in completion of assessment, care plans, care coordination, and issue resolution

• • Knowledge of healthcare reimbursement, utilization management, discharge planning, disease management

• • Knowledge of geriatrics and chronic illness

• • Basic knowledge of Medicare, Medicare Advantage Plans, preferred

• • Comfortable with documenting in electronic medical record and utilizing electronic data and reports

• Intermediate level of proficiency with Mac/PC computer skills

#LI-Remote

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we’ve created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven iniduals with erse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people’s lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone’s responsibility.

Certified Medical Coder

Location: Phoenix United States

Salary Range : (27) $24.00 – $35.40

Job Description:

As an Outpatient Medical Coder for Valleywise Health, you will collaborate with peers and offer suggestions and solutions to improve workflow for our Primary Care and Specialty Clinics. Using your certification skills, you will assist the hospital coding team with meeting our HIMs and organizational goals. We need your experience and knowledge in assigning ICD-10-CM/CPT codes based on the provider’s documentation in our primary care and specialty clinics.

Our HIMs team is a family; we like to make work fun. We embrace ersity and different learning styles. Not only do we have a dedicated Coding Educator to provide you guidance during your onboarding, we also offer easy-to-find and follow coding guidelines and workflow resources in one location within our OP Coding One Note tool to assist you to be successful in your role here.

Hourly Pay Range: $24.00 – $35.40

• Requires an associate degree in a Health Information Technology related field or an equivalent combination of training and progressively responsible experience that results in the required specialized knowledge and ability to perform the assigned work in lieu of degree.
• A Bachelor’s degree is preferred.

Experience: 

• Requires prior healthcare coding experience that demonstrates an understanding of the required knowledge, skills, and abilities.

Specialized Training:

• Requires the ability to pass a coding exam prior to hire.

Certification/Licensure:

• Must have certification as either RHIA, RHIT, CCS, or CPC.

Knowledge, Skills, and Abilities:

• Must have knowledge of and be able to code patient medical records.
• Must be able to demonstrate an understanding of ICD-10, CPT, and HCPCS codes.
• Must be able to achieve and maintain appropriate coding quality and productivity established in the Coding Department Policy and Procedure.
• Must have a good understanding of computer applications and automated encoder systems.
• Must have knowledge of anatomy and physiology, medical terminology, surgical terminology, pharmacological terminology, patient care documentation terminology, ICD-10, CPT, HCPCS codes, Severity of Illness, Risk of Mortality, and HCC codes for PQRS RAF scores, as appropriate for outpatient.
• Must have the analytical ability necessary to interpret data contained in records and to assign appropriate codes.
• Must also have knowledge of, ICD10, APC coding systems, and MS Diagnostic-Related Groups and APC’s.
• Must be able to abide by the Standards of Ethical Coding as set forth by the American Health Information Management Association and Certified Professional Coders Association.
• Must be able to communicate effectively and have excellent customer service skills.
• Requires the ability to work well independently and demonstrate independent decision-making abilities.
• Requires the ability to read, write, and speak effectively in English.

Title: Nurse Manager

Location: United States

Job Description:

OUR MISSION

Calibrate is on a mission to change the way the world treats weight. We’re defining a new category in metabolic health that mirrors what the research shows-that weight reflects our biology, not our willpower. Our program was designed by world leaders in obesity and nutrition science to improve metabolic health and drive long-term weight loss that’s impactful, realistic, and sustainable.

Obesity is America’s underlying pandemic and largest category of chronic disease, and Calibrate is closing the gap in care for 175mm adults in a $600bn market where we spend millions of dollars each year and do not lose millions of pounds.

To bring Calibrate to everyone who needs it, we’re building the first value-based model in obesity treatment, aligning incentives for patients, providers, payors, and pharmaceutical companies. We’ve built a suite of products that combine medication with our proprietary intensive lifestyle intervention to deliver results that last.Calibrate launched in 2020 direct-to-consumer and has since expanded into enterprise channels to increase access to effective obesity treatment.

Calibrate’s programs bring decades of clinical research directly to consumers, immersing members in a biweekly 1:1 coaching program and curriculum that educates and encourages them to build enduring healthy habits across the four areas essential to lasting metabolic health: food, sleep, exercise, and emotional health. A purpose-built app enables daily tracking of food, energy levels, weight, and bi-weekly goals and helps members interact with their Coaching and Medical teams, while a members’ group and events calendar create additional opportunities to engage with the Calibrate community.

KEY RESPONSIBILITIES

• • Develop and manage Calibrate nursing team to support member outcomes, high-touch clinical program communications, and completion of appropriate nursing-scope tasks (eg. lab review, Rx renewals, message triaging)

• • Manage a team of direct reports and deliver continuous support through routine touchpoints that address iniduals’ career development, successes, and growth opportunities, approximately 40% of weekly hours will be dedicated to people management; address and/or advocate for general nursing team needs

• • Consistently provide a world-class level of patient experience and clinical care through direct clinical care, allotting up to 20% of weekly hours on direct patient contact

• • Approximately 40% of allotted hours will be devoted to specifically-assigned projects and ownerships working directly in conjunction with leadership, scope of which may include weekly staffing, queue management, workflow writing, cross-functional collaboration, data management, quality control, and more.

• • Conduct QA for Calibrate nursing team; work with clinical leadership to support QA of Calibrate medical team

• • Create care management workflows for patients throughout the program lifespan in coordination with cross-functional teams

• • Develop clinical program liaison training to address clinical and programmatic questions for patients at all stages of their Calibrate journey

• • Work with clinical leadership on cross-functional care coordination between clinical, coaching, pharmacy, and member experience teams

• • Drive product solutions and optimizations to help propel our transition to a product-lead company

• • Own, drive progress, and report on finite or continuous projects approved by and in conjunction with leadership

BACKGROUND & EXPERIENCE

• • Bachelor of Science Degree in Nursing (BSN) graduate or higher of an accredited school of nursing

• • Current state license(s) in the state(s) practicing

• • At least five years of direct clinical experience, digital health experience preferred

• • A minimum of 3 years people management experience

• • Leadership in startup or innovative health practice preferred

• • Primary/preventative care, acute care, or emergency medicine experience

• • Demonstrated excellence in leadership and clinical operations roles. Exceptional written/verbal communication skills and virtual “bedside” manner

• Multiple active, unrestricted licenses preferred, but license in any current Calibrate state acceptable. Must be willing and able to become broadly licensed

Ideal Qualities:

• • Experience leading and developing clinical teams

• • Experience with project management and strong organizational skills; preferably involving cross-functional teams

• • Organized, solutions-oriented, self-starter

• • Excellent communicator with a customer service mentality

• • Creative problem-solving skills that can be leveraged to empower others and drive member outcomes

• • Excited to build and deliver a new model for achieving lasting weight health

• • Adaptable and flexible, but always puts the patient first

• • Excellent at forging successful and respectful relationships within a team and across the organization

• • Quick learner, comfortable using a variety of applications and software

• Natural driver of team culture

The salary range for this role is $115,000-125,000.

BENEFITS

At Calibrate, we’re committed to our vision of putting our members and our teammates in control of their health. Some of our benefits for 2024 include:

• • Competitive salary with opportunity for equity in an early stage, high growth business

• • Generous paid time off, including an all-company holiday over Thanksgiving week

• • Calibrate-funded health benefits (medical, dental, vision) – starting at zero cost to you

• • Calibrate-paid disability and basic life insurance to give you peace of mind during unforeseen events

• • Therapy on your time with free access to Headspace and HeadspaceCare

• • An employee assistance program through Guardian to provide counseling across a range of personal topics

• • Remote-first team

• • Competitive Paid Parental Leave for parents

OUR VALUES

We’re in it together: We have an audacious mission, and we’re building a lot of things for the first time – from the first DTC pharma business within the healthcare ecosystem to the data infrastructure for providing real-world evidence in the largest category of chronic disease. It takes superpowers to build something simple and intuitive within the complex healthcare market, so we identify and work as a team from our inidual points of strength. Not everyone has to be good at everything, but we know that when we harness what we’re each great at, we’re unstoppable.

Small wins create big wins: We ground every experience in optimism, recognizing and celebrating successes along the way. We break projects down into smaller components. And we focus on where we have momentum. We always plan for larger goals with the knowledge that our plans will evolve as we achieve smaller milestones.

You’re in control: We don’t let location stand in the way of the best talent – and from coaches to engineers, we are a remote-first team. Our business is multi-faceted, so each Calibrater is hired to be an expert in their piece of it – in control of their own initiatives, in control of their own impact, and in control of driving their own (real) results.

Real results matter: We’re obsessed with outcomes because when our members win, we win, and the data proves that we’ve built the best metabolic health program on the market. We’re purposeful, optimistic, and relentlessly confident that we can solve the biggest medical issue of the 21st century.

Calibrate is proud to be an equal opportunity workplace, providing equal employment and advancement opportunities to all team members. To achieve our mission of changing the way the world treats weight, we are building an environment where every Calibrater can thrive, feel a sense of belonging, and do the best work of their careers. We value ersity and recruit, hire, and promote iniduals solely based on talent, qualifications, competence, and merit. We evaluate candidates without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics as required by law and as a matter of our company values.

#LI-REMOTE

Registered Nurse – Transitions of Care

Remote

*Scheduling includes 4 10-hour shifts, every weekend required*

The Transitions of Care Registered Nurse for CareBridge is a key member of the clinical team and is responsible for providing patient outreach, triage and disease education through telehealth modalities to patients who receive Home and Community-Based Services (HCBS) services through state Medicaid programs and who have recently experienced an acute transition of care.  The Registered Nurse works closely with the family and natural supports, paid caregivers, specialty, CareBridge providers and primary care physicians to ensure the patient receives the necessary care to keep them home.

Responsibilities:

• Provide compassionate care to erse patients and their families.
• Educate and triage the care of iniduals experiencing an acute transition of care with a multitude of health problems ranging from primary care to urgent care issues.
• Thrive as a member of the interdisciplinary team and facilitate the continuum of care.
• Reinforce cost-effective, high-quality care to patients.
• Perform follow up and check in with patients to monitor post-discharge course.
• Communicates with hospital, skilled nursing and other acute setting staff as needed to monitor acute admission course and complete discharge planning
• Active participation in quality improvement processes and initiatives as well as customer service programs.
• Reviews and reconciles medications
• Escalates complex cases to the advanced practice provider or clinical pharmacist as needed to get the best outcomes for the patient
• Recognizes and responds promptly and appropriately to emergency situations
• Provides effective patient education using the Teach-Back technique.
• Documents all patient encounters per documentation standards.
• Participates in clinical case conferences.
• Able to organize and track multiple tasks throughout the day.
• Maintains excellent punctuality and attendance during work hours.
• This role will provide cross coverage on the inbound acute nurse line.
• Other duties as assigned.

Qualifications:

• Holds active, unencumbered, compact RN license
• Experience in care of adult, chronically ill patients, chronically ill pediatric patients, and patients with IDD
• Utilization Management or Case Management experience strongly preferred
• Previous Transitions of Care experience a plus
• Working knowledge of computers and ability to document effectively and efficiently in an electronic system
• Expert communicator over the telephone, providing timely, appropriate advice and/or guidance with health care issues

Those who thrive at CareBridge tend to possess these qualities:

• An entrepreneurial spirit. Must be a tenacious self-starter.
• Flexible and adaptable to a constantly changing workload.
• Must enjoy working in a fast-paced environment.
• A sense of humor and down-to-earth nature.

Employment Type: Full-Time 

Location: Remote

About CareBridge

CareBridge is a provider of technology and services that assist payers and states in caring for patients receiving long-term support services. CareBridge’s services include electronic visit verification (EVV), data aggregation, 24/7-member support, and benefit management. CareBridge is led by a team of healthcare service and technology veterans and is headquartered in East Nashville.

Inpatient Coding Coordinator

Location: Remote United States

Job Description:

Under general supervision and with aid of Official Coding Guidelines, the Inpatient Corporate Coding Coordinator codes diagnoses, and procedures of inpatient accounts according to ICD-10-CM/PCS. The Inpatient Corporate Coding Coordinator is responsible for assisting the Corporate Coding Manager with second level coding reviews and educates coders on correct coding. Assists the coding department with coding questions, reviews, or inquiries. A pre-employment coding proficiency assessment will be administered.

Essential Duties and Responsibilities

• Performs second level coder reviews on accounts that are sent back from Revint, Iodine, coding audits, and coding/billing editor.
• Provides coders with education and guidance on correct coding based on second level reviews.
• Assists coding manager and coding department with coder questions, coding reviews, and coding inquiries. Codes outpatient accounts when coverage is needed.
• Monitors and assists coding manager with DNFC management to goals.
• Attends Tenet coding educations and maintains coding credentials.

Required

• 3-5 years acute hospital coding experience.
• Skilled and working knowledge of MS Office suite.
• Ability to analyze coding related reports and take action.
• Associate degree in health information management.
• RHIT or CCS certification.

Preferred

• 5 plus years’ experience in a large, complex, multi-system acute care hospital organization.
• Bachelor’s Degree in Health Information Management.
• RHIA and CCS certification.

Compensation

• Pay: $27.70-$44.00 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Observed holidays receive time and a half.

Benefits

• The following benefits are available, subject to employment status:
• Medical, dental, vision, disability, life, AD&D and business travel insurance
• Paid time off (vacation & sick leave)
• Discretionary 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance.
• For Colorado employees, paid leave in accordance with Colorado’s Healthy Families and Workplaces Act is available

Responsibilities for Internal candidates

• Performs second level coder reviews on accounts that are sent back from Revint, Iodine, coding audits, and coding/billing editor.
• Provides coders with education and guidance on correct coding based on second level reviews.
• Assists coding manager and coding department with coder questions, coding reviews, and coding inquiries. Codes inpatient accounts when coverage is needed.
• Monitors and assists coding manager with DNFC management to goals.
• Attends Tenet coding educations and maintains coding credentials

Qualifications for Internal candidates

Required:

• Associates Degree in Health Information Management
• RHIT or CCS
• 3-5 years acute hospital coding experience
• Skilled and working knowledge of MS Office suite
• Ability to analyze coding related reports and take action

Preferred:

• Bachelor’s Degree in Health Information Management
• RHIA and CCS
• 5 plus years’ experience in a large, complex, multi-system acute care hospital organization

Position will support Tenet corporate located in Texas. Tenet Healthcare complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

2403036913

Title: Inpatient Coding Specialist

Location: United States

Job ID: 2800477

Full-time • Work From Home

Job Description:

Introduction

Sign-On Bonus Eligible*

Are you looking for a work environment where ersity and inclusion thrive? Submit your application for our Inpatient Coding Specialist opening with Work from Home today and find out what it truly means to be a part of the HCA Healthcare team.

Benefits

Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

We are seeking an Inpatient Coding Specialist for our team to ensure that we continue to provide all patients with high quality, efficient care. Did you get into our industry for these reasons? We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply!

Job Summary and Qualifications

As an Inpatient Coding Specialist, you will review and evaluate hospital inpatient medical record documentation to assign, sequence, edit, and/or validate the appropriate ICD-10-CM and ICD-10- PCS codes. You will perform coding and/or code/DRG validation across multiple entities.

What you will do in this role:

• Assigns, sequences, validates, and/or edits codes/DRGs and abstracted data (e.g., physician, discharge disposition, query tracking) for inpatient records for multiple facilities using ICD-10CM and ICD-10-PCS to include:
• Diagnosis description with appropriate 3-7 digit code assignment with corresponding Present On Admission (POA)
• Procedure description with appropriate 7 digit ICD-10-PCS code, date and surgeon
• Admitting Diagnosis
• Discharge disposition
• Where applicable, completes the coding portion of the IRF-PAI
• Maintains or exceeds established accuracy standards • Maintains or exceeds established productivity standards
• Utilizes the complete patient medical record documentation in code/DRG assignment, validation, and/or editing of codes/DRGs
• Initiates, reviews, and/or edits physician queries in compliance with Company and HSC policy where appropriate
• As needed, may periodically be asked to perform Coding Account Resolution Specialist III (CARS III) duties

Qualification you will need:

• High School graduate or GED equivalent required
• Undergraduate (Associates or Bachelors) degree in HIM/HIT preferred
• Minimum 1 year of acute care hospital inpatient coding required, 3 years preferred
• RHIA, RHIT or CCS preferred

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

“Across HCA Healthcare’s more than 2,000 sites of care, our nurses and colleagues have a positive impact on patients, communities and healthcare.

Together, we uplift and elevate our purpose to give people a healthier tomorrow.”- Jane Englebright, PhD, RN CENP, FAAN

Senior Vice President and Chief Nursing Executive

If you find this opportunity compelling, we encourage you to apply for our Inpatient Coding Specialist opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing apply today!

We are an equal opportunity employer and value ersity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Title: Coding Associate III

Location:

Remote, USA

time type

Full time

job requisition id

R240000008810

Job Description:

R1 RCM Inc. is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals, and physician practices. Headquartered in Chicago, R1® is a publicly traded organization with employees throughout the US and international locations. Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patients, and each other. With our proven and scalable operating model, we complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.

The Coding Assoc III will be responsible for reviewing clinical documentation and diagnostic results as appropriate (i.e., to extract data and apply appropriate ICD-10-CM, HCPCS and CPT-4 codes for billing, review and correct billing edits, internal and external reporting, research, and regulatory compliance).

Under the direction of the Coding Leadership Team, the successful candidate must be able to accurately code conditions and procedures as documented in the ICD-10-CM Official Guidelines for Coding and Reporting.

Schedule is primarily Monday – Friday in EST 8am – 4pm

Responsibilities:

• Assigns codes for diagnoses, treatments, and procedures according to the
• appropriate classification system for professional service encounters to determine the highest level of specificity ICD-10 codes, CPT codes, HCPCS codes, and modifiers.
• Reviews physician assigned diagnosis code after thorough review of the medical record and, if necessary, queries physician for additional clarity in a professional manner.
• Able to accurately abstract information from the medial records into the abstract system, according to established guidelines
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC) adheres to official coding guidelines
• Enters and validates codes, charges and other edits flagged in Athena or EPIC for review
• Review documentation (and returned accounts) to verify and correct place of service, billing and service providers, or other missing data elements (i.e.: NDC #, or number of units)
• Uses CCI edit software to check bundling issues, modifier appropriateness, and LCD’s/NCD’s for medical necessity
• Communication with other departments, including offshore team, to recommend coding guidance for charge corrections, appeals processes, and patient billing concerns
• Meet and/or exceeds the established coding productivity standards

Required Qualifications:

• High School Diploma or GED required
• CCS-P, CPC
• Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA) (i.e.: Documentation Guidelines ’95 & ’97)
• Basic knowledge of government, and commercial payer guidelines.
• Must be able to use standard office equipment and Microsoft Office.
• Ability to interact with other employees through effective communication.
• Ability to prioritize and shift workloads to ensure departmental goals align with revenue cycle goals
• Meet and/or exceeds the established quality standard of 95% accuracy while meeting and/or exceeding productivity standards

Preferred Qualifications

• 3 years professional coding experience
• Working in OBGYN, surgical or radiology
• Experience running reports

R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company provides a workplace free from harassment based on any of the foregoing protected categories.

For this US-based position, the base pay range is $18.58 – $29.49 per hour . Inidual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Title: Coding Specialist III – St. Peter’s Hospital – FT – Remote

Location: US

00552841

Job Description:

Employment Type: Full time

Shift: Day Shift

If you are looking for a career as a health care professional, where you are nurtured by collaboration and teamwork, open communication, and learning. We invite you to become part of an award winning health care system.

Position Highlights:

Quality of Life: Where career opportunities and quality of life converge

Advancement: Strong orientation program, generous tuition allowance and career development

Work/Life: Positions and shifts to accommodate all schedules

Position Summary:

Inpatient coding position

Analyzes physician/provider documentation contained in assigned health records (electronic, paper or hybrid) to determine the principal diagnosis, secondary diagnoses, principal procedure and secondary procedures.

Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of

Internal Classification of Diseases,

Clinical Modification diagnosis and procedure codes, and

Current Procedural Terminology / Healthcare Common Procedure Coding System (HCPCS) procedure codes and all required modifiers.

Utilizes coding guidelines established by the Centers for Medicare/Medicaid Services (CMS), American Hospital Association (AHA) Coding Clinic, American Medical Association (AMA) for CPT codes and CPT Assistant, American Health Information Management Association (AHIMA) Standards of Ethical Coding, Revenue Excellence/Regional Health Ministry (RHM) coding policies and CHE Trinity Health Coding Manual (TBA).

Minimum Qualifications:

1. Completion of an AHIMA-approved coding program or an AAPC-approved coding program, or Associate’s degree in Health Information Management or a related field or an equivalent combination of years of education and experience is required. Bachelor’s degree in Health Information Management (HIM) or related healthcare field is preferred.

2. Certified Coding Specialist (CCS), Certified Procedural Coder (CPC), Registered Health Information Technologist (RHIT), or Registered Health Information Administrator (RHIA) is required.

3. Two years of current acute care coding emergency department and observation or physician coding experience is required.

4. Current experience utilizing encoding/grouping software or CAC is preferred. Ability to utilize both manual and automated versions of the ICD and CPT coding classification systems is preferred.

5. Ability to use a standard desktop and windows based computer system, including a basic understanding of e-mail, internet, and computer navigation. Ability to use other software as required to perform the essential functions on the job. Familiarity with distance learning or using web-based training tools desirable.

All new employees are required to undergo and pass all applicable state and federally mandated pre-employment screening requirements.

Pay Range:$22.25 – $34.79

Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.

If you are looking for a career as a health care professional, where you are nurtured by collaboration and teamwork, open communication, and learning. We invite you to become part of an award winning health care system.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate ersity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A erse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Title: Senior Coder – Inpatient (Remote)

time type

Full time

job requisition id

JR69231

Job Details

Do you want to work at one of the Top 100 Hospitals in the nation? We are guided by our values of Love and Excellence and are passionate about delivering health, not just health care. Come join us at ChristianaCare!

ChristianaCare, with Hospitals in Wilmington and Newark, DE, as well as Elkton, MD, is one of the largest health care providers in the Mid-Atlantic Region. Named one of “America’s Best Hospitals” by U.S. News & World Report, we have an excess of 1,100 beds between our hospitals and are committed to providing the best patient care in the region. We are proud to that Christiana Hospital, Wilmington Hospital, our Ambulatory Services, and HomeHealth have all received ANCC Magnet Recognition®.

Scheduling Flexibility and Perks

• The schedule and hours for this position are very flexible and we will work with you on work/life balance to build a schedule that works for you
• This position is 100% remote and we encourage national candidates to apply
• We provide equipment, coding books, continuing education credits as well as professional organization memberships to AHIMA or APC

Primary Function:

ChristianaCare is currently seeking a full-time Senior Coder to be responsible for accurate and timely assignment of ICD 10 CM/PCS and HCPCS/CPT codes, payment group classification assignment and data abstraction for reimbursement purposes and statistical information reporting on all Inpatient, Outpatient, Emergency Medicine, Ancillary and Diagnostics records, and/or any other patient records for which HIMS Department performs coding services. Meets or exceeds productivity and accuracy standards outlined in the HIMS Coding Policies and Procedures.

Principal Duties and Responsibilities:

• Reviews and interprets Inpatient, Outpatient, Ancillary, Diagnostics and Emergency Medicine or other patient type records in order to assign appropriate ICD 10 CM/PCS diagnosis and procedure codes and/or HCPCS/CPT procedure codes as required based on record type and CCHS reporting practices.
• Performs coding and abstracting tasks to support accurate and timely billing, data quality and statistics, and calculation of severity of illness and risk of mortality reporting.
• Follows UHDDS definitions, CMS regulations, and Official and Internal Coding Guidelines.
• Utilizes information on diagnostic reports (i.e., radiology, pathology, EKG reports, laboratory values, doctors’ orders, and administrative medication forms) to accurately code patient charts in accordance with the Official Coding Guidelines.
• Completes daily work assignment as directed by Coding Support.
• Works within service line structure where applicable based on patient type.
• Serves as a mentor to newer coders in the Coder Position or coders who are being trained in a new coding discipline.
• Abstracts pertinent data, determines, and sequences codes for diagnoses and procedures, and enters all information into the coding and abstracting system.
• Utilizes coding and abstracting system as a communication tool, as outlined in the HIMS Coding DNFB Tagging procedures, including but not limited to placing accounts on hold in order to ask questions to management and initiate queries.
• Receives feedback and reviews charts with a member of the Coding Management Team for accurate code assignment.
• Provides all necessary coded and abstracted information required for final coding and billing of accounts within productivity expectations by work type in order to support department and organization goals for DNFB dollar amounts and bill hold days.
• Reviews prepopulated patient demographic information fed via HL7 from source system into coding system and makes necessary abstracted data changes in coding system as required for accurate posting to CCHS billing system.
• Utilizes coding system to calculate all inpatient encounters in both MS DRG and APR DRG groupers to support the accurate reporting of coded data for severity of illness and risk of mortality.
• Utilizes coding system to sequence CPT codes invoking the APC grouper methodology to arrive at the proper CPT code hierarchy.
• Submits timely, accurate, and concise daily productivity reports in accordance with department policy and practice.
• Attends and participates in coding section and department meetings, inservice training sessions, seminars and workshops.
• Reports errors as identified in patient identification, account or encounter information, documentation or other medical record discrepancies as they are noted during daily work performance.
• Supports the Coding Management team by working on special coding projects as assigned.
• Works with the HIMS Coding Systems Analyst under the direction of HIMS management to achieve the IT initiatives of the HIMS department. This may include systems testing and report reconciliation as needed in our coding and billing systems as well as other IT project support as deemed necessary by the coding management team.
• Works with the HIMS Coding Support Team under the direction of HIMS management to achieve the revenue cycle goals of the HIMS department. This may include working through aged coding accounts, accessing our billing system, and coding system reports and queues as deemed necessary by the coding management team.

Education and Experience Requirements:

• CCS credential required
• College Degree in Health Information Management, Completion of AHIMA Approved Certificate Program, or one-year coding experience in the acute care setting coding Inpatient, Observation, Emergency Medicine or Same Day Surgery is required.
• Associate or Bachelor Science degree in Health Information Technology preferred.
• An equivalent combination of education and experience may be substituted.

Christianacare Offers:

• Full Medical, Dental, Vision, Life Insurance, etc.
• 403(b) with company match.
• Generous paid time off.
• Incredible Work/Life benefits including annual membership to care.com, access to backup care services for dependents through Care@Work, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors for hotels, rental cars, theme parks, shows, sporting events, movie tickets and much more!

EEO Posting Statement

Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.

Location: Irving United States

Job Description:

Job Applicant Privacy Notice

Professional Fee E/M Coder

Publication Date: Nov 13, 2024

Ref. No: 522606

Location:

Irving, TX, US, 75063

Who we are.

We are a team of passionate experts with a clear ambition: applying digital technology to advance what matters for our clients and society.

Together we create reliable and responsive digital foundations for the world’s businesses, institutions, and communities.

Learn more on Advancing what matters

The future is our choice

At Atos, as the global leader in secure and decarbonized digital, our purpose is to help design the future of the information space. Together we bring the ersity of our people’s skills and backgrounds to make the right choices with our clients, for our company and for our own futures.

Professional Fee E/M Coder

Location: Remote (US Wide)

Experience Required

• Minimum of 1 Coding Certification from AHIMA or AAPC; RHIA, RHIT, CPC, CCS, COC
• 3+ years Coder work experience
• 2+ years of Oncology coding experience. EPIC/3M 360 CAC

1. Ability to level/audit/abstract documentation for E/M level for:

• Outpatient E/M
• Inpatient E/M
• Observation
• Telehealth
• Critical Care
• Emergency Medicine
• Prolonged services

1. In-office procedure coding
2. Neoplasm coding experience
3. Knowledge of global periods
4. Knowledge and use of modifiers
5. LCD/NCCI
6. Teaching Physician rules and regulations Production Standard of 13-20 charts per hour.

Rewards and benefits:

• Law and Superior Benefits
• Wellbeing programs & work-life balance – integration and passion sharing events.
• Opportunities for professional growth and career advancement.
• Benefits platform -culture, shopping, sport, etc.
• Continuous learning programs and online courses.
• Possibility to participate to charity and eco initiatives.

Future career path:

• After your 1st year in Atos you can apply to any position to keep growing as a professional.

If you’re ready to embark on this exciting adventure with us, sign in on jobs.atos.net.

For any questions, please contact our recruiter Juan Estrada / [email protected]

Join our phenomenal team to grow together!

#LI-US #LI-REMOTE

Learn more about us

At Atos, we embrace ersity as the ultimate engine of ingenuity for our clients, and we constantly strive to create a culture where people feel supported and encouraged. Read more about our commitment here.

Whether it is fighting climate change, promoting digital inclusion, or ensuring trust in data management – tech for good sits at the core of our identity. With numerous global recognitions for our ESG practices, we are committed to building a better future for all by harnessing the power of technology. Learn more here

Coder II – OP Physician Coding (Ortho Specialty)

Remote, United States

Full Time

JOB SUMMARY

• The Coder 2 is proficient in three or more types of outpatient, Profee, or low acuity inpatient coding.
• The Coder 2 may code low acuity inpatients, one time ancillary/series, emergency department, observation, day surgery, and/or professional fee to include evaluation and management (E/M) coding or profee surgery.
  • For professional fee coding, team members in this job code will be proficient for inpatient and outpatient, for multi-specialties.
• Coder 2 utilizes the International Classification of Disease (ICD-10-CM. ICD-10-PCS), Healthcare Common Procedure Coding System (HCPCS) including Current Procedural Terminology (CPT) and other coding references to ensure accurate coding.
  • Coding references will be used to ensure accurate coding and grouping of classification assignment (e.g., MS-DRG, APR-DRG, APC etc.)
• The Coder 2 will abstract and enter required data.

WORK MODEL

100% Remote

SALARY

The pay range for this position is $26.27 (entry-level qualifications) – $39.41 (more experienced) The specific rate will depend upon the successful candidate’s specific qualifications and prior coding experience.

ESSENTIAL FUNCTIONS OF THE ROLE

• Examines and interprets documentation from medical records and completes accurate coding of diagnosis, procedures and professional fees.
• Reviews diagnostic and procedure codes and charges in the applicable documentation system to generate appropriate coding and billing.
• Communicates with providers for missing documentation elements and offers guidance and education when needed.
• Reconciles billing issues by formulating the rationale for rejecting and correcting inaccurate charges.
• Works collaboratively with revenue cycle departments to ensure coding and edits are processed timely and accurately.
• Reviews and edits charges.

KEY SUCCESS FACTORS

• Sound knowledge of applicable rules, regulations, policies, laws and guidelines that impact the coding area.
• Sound knowledge of transaction code sets, HIPAA requirements and other issues impacting the coding and abstracting function.
• Sound knowledge of anatomy, physiology, and medical terminology.
• Demonstrated proficiency of the use of computer applications, group software and Correct Coding Initiatives (CCI) edits.
• Sound knowledge of ICD-10 diagnosis and procedural coding and Current Procedural Terminology (CPT) procedural coding.
• Ability to interpret health record documentation to identify procedures and services for accurate code assignment.
• Flexibility and adaptability while also balancing requirements and regulatory and accreditation guidelines that are non-negotiables.

Must have one of the following Certifications:

• Registered Health Information Administrator (RHIA)
• Registered Health Information Technologist (RHIT)
• Certified Coding Specialist (CCS)
• Certified Coding Specialist Physician-based (CCS-P)
• Certified Professional Coder (CPC)
• Certified Outpatient Coder (COC)
• Certified Inpatient Coder (CIC)
• Certified Interventional Radiology Cardiovascular Coder (CIRCC)

BENEFITS

Our competitive benefits package includes the following:

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

• EDUCATION – H.S. Diploma/GED Equivalent
• EXPERIENCE – 2 Years of Experience
• CERTIFICATION/LICENSE/REGISTRATION – : Must have ONE of the coding certifications as listed:
  • Cert Coding Specialist (CCS)
  • Cert Coding Specialist-Physician (CCS-P)
  • Cert Inpatient Coder (CIC)
  • Cert Interv Rad CV Coder (CIRCC) – Cert Outpatient Coder (COC)
  • Cert Professional Coder (CPC)
  • Reg Health Info Administrator (RHIA)
  • Reg Health Information Technician (RHIT).

Multispecialty Outpatient Medical Coder

US – Remote (Any location)

Full time

Travel Required:

None

Clearance Required:

Ability to Obtain NACI

The Multispecialty Surgery Coder III will Code for Multispecialty Surgery physicians primarily Single Path Coding. Multi-specialty surgical coding experience, any Trauma, Urology, ENT, Plastics, GenSurg, OB/GYN, Cardiovascular, Interventional Radiology, etc. Ability to extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting, research as required, and regulatory compliance. Under the direction of the coding manager—the coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. The coder scope may involve reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines.

This position is full time as and 100% remote.

Responsibilities:

• Demonstrates the ability to perform quality surgical coding and multispecialty chart types as assigned
• Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing.
• Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards
• Achieves and maintains 97% accuracy in coding while maintaining a high level of productivity. Accuracy will be monitored during monthly reviews either within the facility
• Ability to maintain average productivity standards as follows
• Works the review queue daily to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary
• Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process. See re-bill policy in facility guidelines
• Coder downtime must be reported immediately to the administrative staff to ensure turnaround is met
• Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility
• Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request
• Responsible for coding or pending every chart placed in their queue within 24 hours
• It is the responsibility of the coder to notify administrative staff in the event they cannot meet the twenty-four hour turn around standard
• Coders are responsible for checking the Guidehouse email system at least every two hours during coding session
• Coders must maintain their current professional credentials while working for Guidehouse
• Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility
• Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy)
• It is the responsibility of each coder to review and adhere to the coding ision policy and procedure manual content
• Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services
• Communicates problems or coding principle discrepancies to their supervisor immediately
• Communication in emails should always be professional

What You Will Do:

Demonstrates the ability to perform quality E/M coding and surgical as appropriate on assigned Hospitalist encounters.

• Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing
• Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards
• Achieves and maintains 97% accuracy in coding while maintaining a high level of productivity. Accuracy will be monitored during monthly reviews either within the facility
• Ability to maintain average productivity standards as follows
• Works the review queue daily to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary
• Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process. See re-bill policy in facility guidelines
• Coder downtime must be reported immediately to the administrative staff to ensure turnaround is met
• Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility
• Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request
• Responsible for coding or pending every chart placed in their queue within 24 hours
• It is the responsibility of the coder to notify administrative staff in the event they cannot meet the twenty-four hour turn around standard
• Coders are responsible for checking the Guidehouse email system at least every two hours during coding session
• Coders must maintain their current professional credentials while working for Guidehouse
• Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility
• Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy)
• It is the responsibility of each coder to review and adhere to the coding ision policy and procedure manual content
• Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services
• Communicates problems or coding principle discrepancies to their supervisor immediately
• Communication in emails should always be professional (reference e-mail policy)

What You Will Need:

• High School Diploma/GED or 3 years of relevant equivalent experience in lieu of diploma/GED, or post-high school education through a university or technical school program resulting in completion of ONE of the following:
• Successful completion of an American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) coding certification preparation course for professional services or facility coding that includes medical terminology, anatomy and physiology, health information management concepts, and pharmacology
• Successful completion of a training course beyond apprentice level for medical technicians, hospital corpsmen, medical service specialists, or hospital training, obtained in a training program given by the Armed Forces or the U.S. Maritime Service under close medical and professional supervision
• One of the following recognized professional coding certifications: Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist – Physician (CCS-P)
• 3 years Multi-Specialty Surgery Coding experience, both IP and OP coding for physician claims
• EMR experience
• Must maintain credential throughout employment

What Would Be Nice To Have:

• Certified Inpatient Coder (CIC)
• Registered Health Information Technician (RHIT)
• Registered Health Information Administrator (RHIA)
• Certified Coding Specialist (CCS)
• Recognized E&M coding certifications: Certified Evaluation and Management Coder (CEMC), or National Alliance of Medical Auditing Specialists’ (NAMAS) Certified Evaluation and Management Auditor (CEMA)
• Must be able to work independently, multi-task well and interface with all levels of personnel as well as clients
• Knowledge & experience with Federal & State Coding regulations and Guidelines to include DHA or Military Health Coding experience
• Multiple EMR and/or Practice Management systems experience
• Single path coding experience

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

Remote Part-Time Outpatient Medical Coder

HIM | Remote Home Office | Part Time

Job Description

Remote VA Experienced Outpatient Medical Part Time Coders

Summary

Cooper Thomas, LLC, a leading provider of medical coding services to the Department of Veterans Affairs (VA), has immediate openings for experienced Outpatient Coders. Applicants must have at least 2 years of experience for part-time remote coding positions, with the opportunity for a flexible schedule. Previous experience with VA is required, whether as a 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, PIV Card, eToken, and Contractor/Moonlighter Account.

Ask about our productivity and quality incentives to maximize your pay.

We are looking for coders who can commit to a minimum of 20 hours per week, scheduled at your discretion from Monday through Sunday weekly.

Qualifications

· Must be able to perform the full scope of multi-specialty OP clinic, ED, minor procedures, radiology, rehabilitation, and lab encounters utilizing ICD-10, CPT, and HCPCS codes.

· At least 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 10.0x 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)

· Certified Professional Medical Auditor (CPMA)

Minimum Education

· High School Diploma or equivalent

Cooper Thomas, LLC is a leading provider of health information management services. Established in Washington, DC in 2003, Cooper Thomas offers a competitive salary, opportunities for quality bonuses, and the opportunity for growth. The selected candidate will be required to undergo a background investigation. Veterans encouraged to apply. Equal opportunity employer.

IMPORTANT NOTE: To apply, please go to the “Careers” section of our website at www.cooperthomas.com, and follow the instructions to register and apply.

Coding Specialist

Remote

How will this role have an impact?

Under the supervision of the Manager of Coding, this position is responsible for ICD-10 coding of Health Risk Evaluations of Medicare and Medicaid members that are performed by the Signify Health physicians and reviewing the Health Risk Assessments/Evaluations to insure completeness, accuracy and compliance with CMS guidelines.

What will you do?

• Reviews health risk assessments/evaluations to determine completion and compliance with CMS guidelines on a timely basis.
• Reviews and assesses the accuracy, completeness, specificity and appropriateness of diagnosis codes identified in the health risk assessments/evaluations.
• Reviews health risk assessments/evaluations to accurately and completely assign all ICD-9/10 codes that are clinically identified and supported in the assessment/evaluation on a timely basis.
• Communicates timely and effectively with supervisor regarding issues with the health risk assessments/evaluations and/or corrections required to the health risk assessments/evaluations.
• Understanding the relationship between IC-9/10 coding and HCC (hierarchical condition category) coding.
• Utilizes advanced, specialized knowledge of medical codes and coding protocol by providing guidance to the Director of Coding to ensure the organization is following Medicare coding protocol for payment of claims.
• Demonstrate a commitment to integrating coding compliance standard into coding practices. Identify, correct and report coding problems.
• Maintain adequate knowledge of compliant coding procedures related top Medicare Risk Adjustment.
• Maintain coding credentials
• Complete special projects as assigned by management, which require defining problems, and implementing required changes.
• Follows all legal and policy requirements for HIPAA protected data.
• Actively demonstrates teamwork at all times.
• Ability to work overtime.
• Is able to meet and maintain required accuracy and efficiency standards.

We are looking for someone with:

The base salary hiring range for this position is $16.44 to $28.08. Compensation offered will be determined by factors such as location, level, job-related knowledge, skills, and experience. Certain roles may be eligible for incentive compensation, equity, and benefits.

About Us:

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.

#SignifyHealth

#LI-RD1

Nurse Practitioner

Remote, USA

Working here

Our team is passionate, talented, and driven by our purpose to improve the health and happiness of our members. Our culture empowers each Twin to do what’s needed to create impact for our members, partners, and our company, and enjoy their experience at work. Twin Health was awarded Innovator of the Year by Employer Health Innovation Roundtable (EHIR) (out of 358 companies), named to the 2021 CB Insights Digital Health 150, and recognized by Built In’s 2022 Best Places To Work Awards. Twin Health has the backing of leading venture capital funds including ICONIQ Growth, Sequoia, and Sofina, enabling us to scale services in the U.S. and globally and help solve the global chronic metabolic disease health crisis. We have recently announced broad and growing partnerships with premier employers, such as Blackstone and Berkshire Hathaway. We are building the company you always wished you worked for. Join us in revolutionizing healthcare and building the most impactful digital health company in the world!

Excited to join us and do your part in improving people’s health and happiness?

Opportunity

As a Twin Advanced Practice Provider, you make a difference in people’s lives by providing treatment, management, and guidance to empower your members seeking to achieve complete diabetic reversal and overall health improvement across multiple conditions, using artificial intelligence, machine learning, and a health coach, RN, and provider care management model. This role is to support members in multiple states through remote care management.

Responsibilities

• Engage with collaborative team of healthcare professionals including health coaches, physicians, chief medical officer, and other colleagues
• Conduct health assessments including review of laboratory results, medical history, and psychosocial history
• Assess symptoms and treat as appropriate, collaborating with Twin Health member’s primary care provider
• Willingness to deliver care using telemedicine and to document in Twin’s clinical platform
• Manage a high risk population and work collaboratively between the care team and member to understand social determinants of health and population specific needs
• Willingness to learn and understand the Twin Model of Care to support reversal of diabetes and other chronic conditions
• Basic understanding of business objectives and service level agreements that support both financial, clinical, and quality success and outcomes
• Collaborate with Twin medical team to provide excellent customer service and experience, focusing member care around multiple chronic conditions
• Provide patient education to promote habits that will prevent diseases and maintain good health as outlined by Twin Health Program
• Discussing and reviewing patients’ medical history, symptoms, allergies, and current medications.
• Asking patients situation-specific questions to assess symptoms
• Prescribing suitable medications to patients and providing proper dosage and administration instructions per Twin Health Policy
• Maintaining accurate records of patients’ contact details, medical history, prescribed medications, allergies, diagnoses, and progress
• Additional duties as assigned

Qualifications

• Advanced Practice Registered Nurse license, licensed in multiple states.
• 3-5 years of experience as an advanced practice provider.
• Clinical experience and passion in working with multiple different populations including underserved groups
• Experience managing patients remotely across different geographic areas and states
• Eager to collaborate with a wonderful team of internal medicine and family medicine physicians and health coaches
• Board-certified in family or internal medicine or a related field
• Proven experience working as an advanced practice provider
• Sound medical knowledge
• The ability to consult with patients through virtual communication channels
• Excellent analytical and problem-solving skills
• Exceptional communication skills
• A patient and compassionate disposition
• Detail-oriented
• Interest in working with underserved groups
• Experience using technology and data to guide care decisions
• Fluent in English and Spanish preferred

Compensation and Benefits

The compensation for this position is $120,000 annually.

Twin has an ambitious vision to empower people to live healthier and happier lives, and to achieve this purpose, we need the very best people to enhance our cutting-edge technology and medical science, deliver the best possible care, and turn our passion into value for our members, partners and investors. We are committed to delivering an outstanding culture and experience for every Twin employee through a company based on the values of passion, talent, and trust. We offer comprehensive benefits and perks in line with these principles, as well as a high level of flexibility for every Twin.

• A competitive compensation package in line with leading technology companies
• As a remote friendly company we are committed to providing opportunities for all who join to further build relationships, increase cross-functional collaboration, and celebrate our accomplishments.
• Opportunity for equity participation
• Unlimited vacation with manager approval
• 16 weeks of 100% paid parental leave for delivering parents; 8 weeks of 100% paid parental leave for non-delivering parents
• 100% Employer sponsored healthcare, dental, and vision for you, and 80% coverage for your family; Health Savings Account and Flexible Spending Account options
• 401k retirement savings plan

Title: Nurse Care Manager

Location: United States

Job Description:

Targeted Care Navigation Local Nurse Care Managers provide comprehensive, in-home care management services to high-risk patients. This role focuses on preventing hospital readmissions, improving health outcomes, and ensuring patients receive the support and resources they need to manage their conditions effectively. The Nurse Care Manager will work closely with patients, their families, and other healthcare providers to develop and implement personalized care plans that address each patient’s unique needs.

The Targeted Care Navigation Local Nurse Care Manager will work directly with members in their local communities to bring better health and quality of life to these iniduals and families. They will be a part of an integral team including a Community Health Worker and an Included Health Virtual PCP

Responsibilities:

• Conduct in person visits to assess patient health status, educational, and psychosocial needs of the patient and their family. This will be at patient’s homes, hospitals, or accompanying to medical appointments.
• Together with patients and our multidisciplinary care team, generate a comprehensive inidualized plan of care and targeted interventions to help patients achieve desired goals
• Provide education and support to patients and families on managing chronic conditions, medications, and lifestyle changes
• Identify and address barriers to care, including social determinants of health, and connect patients with community resources and support services with the support of a remote Licensed Social Worker and Local Community Health Worker.
• Collaborate with patients, the remote Included Heath team, community physicians, family members, and other members of the health care team in order to ensure coordinated care.
• Continually monitor patient response to the plan of care, and revise the care plan as indicated.
• Implement systems of care that facilitate close monitoring of high-risk patients to prevent and/or intervene early during acute exacerbations.
• Maintain required documentation for all care management activities.
• Participate in case conferences and care coordination meetings to ensure a holistic approach to patient care.
• Participate in member engagement initiatives, including outreach to local provider and hospital groups.
• Stay current with best practices and evidence-based guidelines in chronic disease management and care coordination.
• 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.

As a condition of employment, the successful applicant for this position must be fully vaccinated against the flu (including annual booster) and provide acceptable proof of vaccination against Hepatitis B, Varicella, and MMR. Although not required, Included Health highly encourages the successful applicant to be fully vaccinated against COVID-19 (including annual booster).

In accordance with its policies, Included Health provides reasonable accommodations, absent undue hardship, to those who are unable to be vaccinated, either because of a sincerely held religious belief or a disability. If granted a reasonable accommodation from a vaccination requirement, the successful applicant will be required to be masked when providing services within patients’ homes.

Required Qualifications:

• Current Bachelor of Science in Nursing (BSN)
• Must reside in and have an active RN license in good standing with your state (AZ, TX, or IL) medical board
• BLS certification
• Current driver’s license, reliable transportation, car insurance, and an acceptable driving record with willingness to travel within approximately 50 miles to meet in person with patients in their homes or other medical facilities including hospitals, and local physician offices.
• 2+ years of experience with adult medicine and pediatric patients in primary care/ambulatory care, home health agency, skilled nursing facility, or hospital medical-surgical setting, within the past five years
• Strong clinical assessment, physical exam, and critical thinking skills. Comfortable discussing a wide variety of medical conditions.
• Broad knowledge of chronic conditions, evidence based guidelines, prevention, wellness, health risk assessment, and patient education
• Demonstrate excellent communication–both verbal and written. Proficient at writing medical information in easy-to-understand, patient-centric language.
• Able to work independently with strong internal drive, yet able to actively communicate challenges and/or concerns to leadership.
• Excellent interpersonal and facilitation skills
• Excellent time-management skills and an ability to adapt to changing needs/priorities
• Be highly empathetic with the ability to understand cultural and socioeconomic issues affecting patients and excellent at building rapport with patients and families from erse backgrounds.

Valued Qualifications:

• Current CCM Certification (in states where not required)
• 5+ years of experience in nursing
• Comfortable with technology and experience working remotely or with innovative care teams
• Experience working with patients in their homes
• Bilingual: Spanish and English
• Ability to have flexible schedule, position may require weekend work

Physical/Cognitive Requirements:

• Driving to member’s homes up to 5 days per week over wide geographical area
• Prompt and regular attendance at assigned work location.
• Ability to remain seated in a stationary position for prolonged periods.
• Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment.
• No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required.
• Ability to interact with leadership, employees, and members in an appropriate manner.

$66,850 – $86,910 a year

The United States new hire base salary target ranges for this full-time position are:

Zone A: $66,850 – $86,910 + equity + benefits

This range reflects the minimum and maximum target for new hire salaries for candidates based on their respective Zone. Below is additional information on Included Health’s commitment to maintaining transparent and equitable compensation practices across our distinct geographic zones.

Starting base salary for the successful candidate will depend on several job-related factors, unique to each candidate, which may include, but not limited to, education; training; skill set; years and depth of experience; certifications and licensure; business needs; internal peer equity; organizational considerations; and alignment with geographic and market data. Compensation structures and ranges are tailored to each zone’s unique market conditions to ensure that all employees receive fair and competitive compensation based on their roles and locations. Your Recruiter can share details of your geographic alignment upon inquiry.

In addition to receiving a competitive base salary, the compensation package may include, depending on the role, the following:

Remote-first culture

401(k) savings plan through Fidelity

Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)

Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents

Generous Paid Time Off (“PTO”) and Discretionary Time Off (“DTO”)

12 weeks of 100% Paid Parental leave

Family Building Benefit with fertility coverage and up to $25,000 for Surrogacy & Adoption financial assistance

Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment)

11 Holidays Paid with one Floating Paid Holiday

Work-From-Home reimbursement to support team collaboration and effective home office work

24 hours of Paid Volunteer Time Off (“VTO”) Per Year to Volunteer with Charitable Organizations

About Included Health

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community – no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com. Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.

Title: RN Daytime Triage

Location: United States

R-0059875

Job Description:

Number of Job Openings Available: 1

Department: 62000635 Allina Health Group Daytime RN Triage

Shift: Day (United States of America)

Shift Length: 8 hour shift

Hours Per Week: 32

Union Contract: Non-Union

Weekend Rotation: Every 3rd

Job Summary:

Allina Health is a not-for-profit health system that cares for iniduals, families and communities throughout Minnesota and western Wisconsin. If you value putting patients first, consider a career at Allina Health. Our mission is to provide exceptional care as we prevent illness, restore health and provide comfort to all who entrust us with their care. This includes you and your loved ones. We are committed to providing whole person care, investing in your well-being, and enriching your career.

Key Position Details:

Employee is required to live within one hour of Apple Valley, MN.

• Fully remote position, including orientation, occasional onsite requirements
• 0.8 FTE, 8-hr day shifts, every third weekend and holiday rotation required
• Cross trained to process medication refills
• Benefit eligible position

Job Description:

Nursing is the diagnosis and treatment of human response to actual or potential health problems. This includes establishing an intentional therapeutic relationship between a registered nurse and a patient and family. As a leader and the integrator of care, the professional nurse has the responsibility, authority, and accountability for planning, coordinating and evaluating the patient’s care needs.

Provides patient care support for centralized nursing program, outpatient and home care services. This includes Triage services, Anti-coagulation, and refill. Iniduals in this role will work in an outpatient clinic setting.

Principle Responsibilities

• Assessment.
• Collects, prioritizes and synthesizes comprehensive data pertinent to the patient’s health or situation.
• Collects and prioritizes data in a systematic and ongoing process that involves the patient, family, other health care providers and environment as appropriate.
• Integrates data relevant to the situation to identify needs, patterns and variances.
• Uses appropriate evidence based assessment techniques and instruments in data collection.
• Diagnosis.
• Analyzes assessment data to determine nursing diagnoses.
• Interprets assessment information to identify each patient’s needs relative to age, developmental stage and culture.
• Formulates, revises and resolves nursing diagnoses that reflect the current patient status.
• Validates and communicates nursing diagnoses with the patient, family and other health care team members.
• Documents nursing diagnoses in compliance with the patient care guidelines.
• Outcomes Identification.
• Identifies expected outcomes inidualized to the patient.
• Establishes, in the collaboration with the family, patient, realistic and measurable patient expected outcomes based on nursing diagnoses, patients present and potential capabilities, goals, available resources and plan for continuity of care.
• Planning.
• Develops a plan that prescribes interventions to attain expected outcomes.
• Develops an inidualized plan considering patient characteristics or the situation as appropriate in conjunction with the patient, family and others.
• Establishes a plan that provides for continuity of care.
• Incorporates evidence based nursing practice takes into consideration current statutes, rules and regulations when developing the plan of care.
• Implementation.
• Implements the identified plan.
• Implements interventions in a safe, timely, appropriate manner.
• Utilizes evidence-based interventions and treatments specific to the diagnoses as appropriate.
• Coordinates implementation of the plan of care if appropriate
• Documents interventions according to documentation guidelines.
• Evaluation.
• Evaluates the patient’s progress towards attainment of the outcome.
• Evaluates the patient’s/family’s understanding of and response to the plan of care.
• Utilizes systematic and ongoing assessment data to revise diagnoses, outcomes and the plan of care.
• Involves the patient, family, and health care team members in the evaluation process when appropriate.
• Documents revisions in diagnoses, outcomes and the plan of care according to documentation guidelines.
• Quality of Practice.
• Systematically enhances the quality and effectiveness of nursing practice.
• Participates in quality improvement activities related to nursing practice.
• Incorporates available QI data to improve nursing practice and outcome.
• Education.
• Attains knowledge and competency that reflects current nursing practice.
• Participates in educational activities related to nursing practice.
• Acquires and applies the knowledge gained from educational experiences to current nursing practice.
• Professional Practice Evaluation.
• Evaluates one’s own nursing practice in relation to professional practice standards and regulatory guidelines.
• Engages in self-evaluation of practice on a regular basis, identifying strengths and goals for professional development.
• Obtains informal feedback regarding one’s own practice from patients, peers, professional colleagues, and others.
• Collegiality.
• Contributes to the professional development of peers, colleagues, and others.
• Shares knowledge and skills in practice settings.
• Provides immediate and ongoing positive and constructive feedback to colleagues regarding their performance.
• Contributes to a supportive and healthy work environment.
• Collaboration.
• Collaborates with patient, family, and others in the conduct of nursing practice.
• Partners with others to effect change and generate positive outcomes through knowledge of the patient or situation.
• Ethics.
• Acts in an ethical manner.
• Maintains a therapeutic and professional patient-nurse relationship with appropriate professional role boundaries.
• Serves as a patient advocate assisting patients in developing skills for self-advocacy
• Uses available resources to help formulate ethical decisions.
• Research.
• Integrates research findings in practice.
• Utilizes the best evidence, including research findings, to guide practice decisions.
• Resource Utilization.
• Incorporates factors related to safety, effectiveness, cost, and impact on practice in planning and delivering patient care.
• Utilizes resources related to standards of care in a safe, effective and ethical manner.
• Manages resources to assure they will be accessible to other in the future.
• Leadership.
• Provides leadership in the professional practice setting and the profession.
• Functions as a professional role model.
• Promotes a positive work environment.
• Participates in shared decision-making.
• Environmental Health.
• Practices in an environmentally safe and healthy manner.
• Attains knowledge of environmental health concepts, such as implementation of environmental health strategies.
• Promotes a practice environment that reduces environmental health risks for workers and healthcare consumers.
• Communicates environmental health risks and exposure reduction strategies to healthcare consumers, families, colleagues and communities.
• Charge Nurse (only when acting in this role).
• Demonstrates ability to coordinate and direct unit operation so the patient and family needs are met and resources are efficiently utilized in a safe manner.
• Promotes an environment that encourages inidual growth, nurtures professional practice and fosters teamwork.
• Collaborates effectively with unit staff, leadership and other disciplines.
• Preceptor (only when acting in this role).
• Demonstrates ability to identify the orientee’s learning needs and plans appropriate learning experiences.
• Demonstrates ability to implement an inidualized orientation plan for the orientee.
• Demonstrates ability to validate clinical competence of orientee.
• Facilitates development of organizational and prioritization skills of orientee.
• Demonstrates ability to evaluate interpersonal sills of orientee.
• Serves as a professional role model.
• Facilitated socialization of orientee into the organization and work group.
• Other duties as assigned.

Required Qualifications

• Associate’s or Vocational degree in nursing
• Minimum 3 years RN experience

Preferred Qualifications

• Experience in triage, anticoagulation, or remote nursing support

Licenses/Certifications

• Licensed Registered Nurse-MN Board of Nursing required
• Licensed Registered Nurse-WI Dept of Safety & Professional Services required by completion of orientation

Physical Demands

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

Title: Manager, Government Corporate Accounts (Remote)

Req ID: 46773

Job Category: Sales

Location: Mentor, OH, US, 44060

Workplace Type: Remote

Job Description:

At STERIS, we help our Customers create a healthier and safer world by providing innovative healthcare and life science product and service solutions around the globe.

How You Will Make a Difference:

Do you have a proven track record for navigating key decision makers and building rapport? The Manager, Government Corporate Accounts will play a pivotal role in developing and nurturing strategic relationships within the healthcare sector, leveraging key decision-makers and influencers to drive growth and enhance customer experiences.

As an Manager, Government Corporate Accounts expands the STERIS enterprise footprint and presence in the assigned market. Leverages corporate key decision makers and influencers in supply chain, clinical and administration by providing a comprehensive sales strategy and team approach to the STERIS total portfolio solution.

This is a remote based customer facing position. To support and service our customers in this assigned territory candidates must be based out of one of the following state/city: Candidate must be able to travel 50% and can live anywhere in the US.

What You Will Do:

• Identify opportunities to increase existing business and secure new Customer agreements, managing a range of 15 to 20 accounts, with responsibility for a minimum of $15 million in annualized business.
• Achieves all revenue, gross margin and business targets representing the assigned STERIS enterprise footprint.
• Ensures customer needs are communicated through proper internal channels
• Assures integration into customer’s business via membership and attendance to Customer group associations and functions
• Conducts regular check-ins and businesses reviews with AVP to review objectives, progress, successes and development opportunities
• Develop and implement strategies and tactics necessary to expand the STERIS “enterprise” through successful account penetration at levels of the assigned Customer groups.
• Facilitates the development and expansion of the business by developing and nurturing strategic relationships, industry associations within healthcare.
• Monitors and reports external business trends back to their team
• Develops and maintains cooperative relationships with field sales, marketing and internal support functions of the organization by consistently sharing information, responsibilities, decision-making and recognition with others to maximize sales growth.
• Develops, implements and monitors activities with key Customers with direct focus on improving the Customer Experience.
• Engages, collaborates and supports internal teams focused on project business.
• Identifies and expands partnership opportunities with 3rd party Customers supporting and influencing key Customers.
• Develops and supports distribution opportunities aligned with Business Unit objectives.
• Helps identify the key business implications or changes in existing processes, programs, and priorities to drive growth in the assigned Customer group.
• Networks with key industry leaders, corporate partners, and key influencers within area of responsibility
• Interacts regularly with marketing, sales and internal support leaders to ensure process improvements are implemented effectively.
• Ensure the success of existing and new products and services through focused programs at key corporate accounts and as a field sales support mechanism.
• Identify and develop alternative market opportunities through corporate contacts that are not a part of field sales normal call patterns
• Attends and promotes STERIS at strategic trade shows, conventions, and industry affairs.

We Take Care of You:

• Base salary plus commission
• Car stipend and mileage reimbursement
• Business travel and related expenses paid via company credit card
• Cell phone stipend
• Excellent healthcare/ dental/ vision benefits
• 401(k) with a company match
• A robust sales training program
• Excellent opportunities for advancement

What You Need to be Successful:

• Four-year Degree; MBA preferred
• 10+ years of demonstrated success in medical sales; Five (5) years STERIS sales preferred. Competitive or related experience considered; plus 3+ years of management experience (marketing, corporate accounts, system project management)
• High level of business and financial acumen based on strategies to drive business unit revenue and goals.
• Possess extensive knowledge of STERIS products and services (technical and clinical).
• Demonstrated sales management and negotiation experience in medical device, capital products, and services
• Demonstrated ability to lead and/or influence a cross functional team and operate successfully in a highly complex medical device environment.

Must be able to be compliant with hospital/customer credentialing requirements

#LI-BS1

Skills

Pay range for this opportunity is $98,750.00 – $130,000.This position is eligible for commission.

Minimum pay rates offered will comply with county/city minimums, if higher than range listed. Pay rates are based on a number of factors, including but not limited to local labor market costs, years of relevant experience, education, professional certifications, foreign language fluency, etc.

Employees (and their families) may enroll in our company-sponsored medical, dental, vision, flexible spending, health savings account, voluntary benefits, supplemental life/AD&D plans and the company’s 401k plan. Employees are covered by an employee assistance program (also available to household members) and long-term disability. Full-Time Employees are also eligible for short-term disability. Full-time Employees will also receive Paid Time Off (PTO) based on years of service and paid Holidays. Part-time employees working 20 or more hours receive a pro-ration of the full-time PTO allocation and paid Holidays based on their standard hourly work week. Full-Time employees are eligible for four weeks of paid parental leave. Part-time employees also receive paid parental leave, pro-rated based on their standard hourly work week.

STERIS is an Equal Opportunity Employer. We are committed to equal employment opportunity and the use of affirmative action programs to ensure that persons are recruited, hired, trained, transferred and promoted in all job groups regardless of race, color, religion, age, disability, national origin, citizenship status, military or veteran status, sex (including pregnancy, childbirth and related medical conditions), sexual orientation, gender identity, genetic information, and any other category protected by federal, state or local law. We are not only committed to this policy by our status as a federal government contractor, but also we are strongly bound by the principle of equal employment opportunity.

Req ID: 46773

Job Category: Sales

Location:

Mentor, OH, US, 44060

Workplace Type: Remote

STERIS Sustainability

Life at STERIS

Title: Payer Operations Specialist (Remote)

Location: US

Type: Contract

Job Description:

About Carda

Rehab is a pain. So much so that only 10% of qualifying Cardiac and Pulmonary patients attend. At Carda Health, we’ve reimagined rehab. Our program allows patients to complete inspiring, convenient, life-saving therapy remotely.

Who are we?

We are a team of clinicians, data scientists, mathematicians and repeat entrepreneurs. And a few recovering financiers. Our belief is that technology and data, when applied to the right problem, transforms people’s lives and changes even the most entrenched industries. Carda was founded by Harry and Andrew, two friends from Wharton who share a family history of heart disease and experience with poor access to care. We now work with some of America’s largest and top-ranked hospitals and most innovative insurers. We are fortunate to be backed by some of the best investors in the business who have also backed the likes of Livongo, Hinge, Calm, MDLive, and others.

Who are you?

You are motivated by the prospect of working at a fast-growing start-up. You are excited about the details but able to connect them back to bigger company goals. You are passionate about enabling others to do their jobs better and more efficiently – in this case expanding access to life-changing therapies. If you exhibit one characteristic above all others it is that of ownership. It personally bothers you when processes don’t work and you do everything in your power to prevent this from happening. You are a great collaborator and communicator who has experience both managing teams and working across teams to implement key initiatives. You are able to complete tasks and implement processes in ? of the time of a peer.

What will you do?

The Business Operations Analyst will have executional and strategic responsibilities. You will have the opportunity to gain exposure to a myriad of experiences working at a venture backed startup from an early stage. Your primary focus or driving goal will be ensuring that revenue (insurance claims and patient collections) is maintained as well as handling any compliance concerns related to revenue and business operations. The key driver of our revenue is insurance claims so experience in Revenue Cycle Management (RCM) and a willingness to learn are critical to succeeding in this role. This role requires collaboration across the Carda team including everyone from our C-suite executives to our clinicians.

In a little more detail:

• Communicate with patients daily to clarify insurance coverage and answer billing related questions
• Work with our billing company to complete tasks on claims that fail validation
• Work with Excel to manage reporting on claims and claims operations
• Work within our EMR and homegrown practice management system to correct patient data found to be inaccurate during the claim routing or adjudication process
• Assist with insurance verification/ eligibility determination questions
• Maintain updates in our billing system(s)
• Other duties as assigned

What we look for:

• A year of experience in an administrative medical setting working with patients
• Strong interpersonal skills
• Attention to detail
• Highly organized
• Knowledge of Medicare and Medicare Advantage Plans

Sr Admin – Medical Records (Remote)

General information

Job Posting Title

Sr Admin – Medical Records (Remote)

City

Remote

Country

United States

Working time

Full-time

Description & Requirements

Maximus is currently hiring a Sr. Admin – Medical Records to support the Independent Medical Review (IMR) program.

At Maximus, we are committed to cultivating a positive and inclusive work environment, and we are pleased to offer the following:

• Comprehensive Insurance Coverage – Medical, Dental, Vision, Life insurance, and enjoy discounts on Auto, Home, Renter’s, and Pet insurance.
• Future Planning – Prepare for retirement with our 401K Retirement Savings plan and Company Matching.
• Paid Time Off Package – Enjoy PTO, Holidays, and extended sick leave, along with Short and Long Term Disability coverage.
• Holistic Wellness Support – Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP).
• Recognition Platform – Acknowledge and appreciate outstanding employee contributions.
• Diversity, Equity, and Inclusion Initiatives – Join a workplace committed to fostering ersity and inclusion.
• Tuition Reimbursement – Invest in your ongoing education and development.
• Employee Perks and Discounts – Additional benefits and discounts exclusively for employees.
• Maximus Wellness Program and Resources – Access a range of wellness programs and resources tailored to your needs.
• Professional Development Opportunities: Participate in training programs, workshops, and conferences.

Essential Duties and Responsibilities:

– Correctly identify the party from which the medical records were submitted.

– Ensure correct documents are provided to the physician reviewer and submit assigned reports accurately and timely.

– Examine case file to ensure all relevant information has been submitted.

– Review documents to determine completeness and eligibility and report identified errors appropriately and timely.

– Correctly identify non-medical records and make appropriate decision on the need for further review of these documents.

– Index hundreds of pages of medical records completely, accurately, and efficiently.

– Perform other duties as may be assigned by management.

– Perform data entry tasks with accuracy.

Minimum Requirements

– High School Diploma or Equivalent required; Associate degree preferred.

– 4 to 6 years of related experience required.

– Medical-related experience preferred.

– 2- 4 years of relevant experience in healthcare administrative customer service experience.

– Strong analytical skills

– Detail and solution oriented

– Ability to work independently

– Excellent written and oral communication skills

– Proficiency in Microsoft Office suite

Preferred Requirements

-Experience in data entry and conducting reviews for data accuracy.

Home Office Requirements

– Maximus provides company-issued computer equipment

– Reliable high-speed internet service

– Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity

– Minimum 5 Mpbs upload speeds

#NYMC #LI-Remote

EEO Statement

Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and erse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate’s education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus’s total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant’s salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.

Minimum Salary

$22.00

Maximum Salary

$22.00

Centralized Coding Specialist – Remote-7410-7798

Pacific Medical Data Solutions

Description

The Physician Services Revenue Integrity team at Lifepoint Health is a nationwide revenue cycle management services provider that has been offering high quality medical billing services since 2004. We offer a rewarding work environment with career advancement opportunities while maintaining a small company, employee-focused atmosphere.

This is a fully remote position!You must live in the United States.

We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.

We are always looking for people inspired to help us in our mission. If you are someone who wants to change the lives of patients, drive success for our partners and be part of a team driven to improve care, we may have your next opportunity.

We are currently seeking a Centralized Coding Specialist. This remote-based position willspend the bulk of their time making sure that their clients are fully supported from a charge entry, coding, and billing perspective.

The Centralized Coding Specialist will spend the bulk of their time making sure that their clients are fully supported from a charge entry, coding, and billing perspective. You will be responsible for reviewing a patients medical record after a visit and translating the information into codes that insurers use to process claims.

You will make sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations, complying with medical coding guidelines and policies. Following up and clarifying any information that is not clear.

Clearinghouse knowledge and working experience is also a plus You would be working in a team environment with guidance from the Manager Coding and Integrity. This position also works closely with the AR department for coding related issues.

Perform Evaluation and Management coding, procedure, ICD-10 and HCPC quality reviews as well as other projects related to physician coding compliance. Demonstrates a thorough understanding of complex coding, and reimbursement, as they relate to physician practices and clinic settings.

Keeps informed regarding current coding regulations, professional standards and company/department policies and procedures and effectively applies this knowledge.

This Position is 100% Remote; can work from anywhere within the US.

Qualifications

ESSENTIAL FUNCTIONS

• Seeking Certified Pro-Fee with a minimum of 3-5 years’ coding experience.
• Cardiology Experience preferred
• Experience with Provider Based and Rural Health preferred.
• Apply appropriate coding classification standards and guidelines to medical record documentation for accurate coding.
• Resolve medical record documentation deficiencies through healthcare provider query and provide routine feedback to correct deficiencies.
• Perform quality assessment of records, including verification of medical record documentation (both electronic and handwritten).
• Responsible for researching errors or missing documentation from medical record in order to provide accurate coding processes.
• Abstract and assign the appropriate ICD-10, HCPCS/CPT codes; including Level I & Level II modifiers as appropriate for all diagnosis and procedures performed in outpatient and inpatient settings.
• Assist in the development and ongoing maintenance of processes and procedures for each assigned client revolving around system use, billing/coding rules, and client specific guidelines.
• Manage time effectively to meet all required deadlines and timeframes for client and department needs.
• Collaborate in a team environment with the Department Manager and other staff on a regular basis.
• Ensure compliance with all relevant regulations, standards, and laws.

Other Functions

1. Maintains regular and predictable attendance.

2. Performs other essential duties as assigned.

KNOWLEDGE, SKILLS & ABILITIES:The requirements listed below are representative of the knowledge, skills and/or abilities required.

Education:High school diploma or equivalent required.Bachelors Degree preferred or equivalent experience

Experience:3-5 years of medical coding experience

License or Certification:

This position requires credentialing through AHIMA, and/or AAPC

The following certifications are accepted:

• CPC
• CEMC
• CPMA
• CRC
• CPB
• Specialty certification
• CCS-P
• RHIT

Skills and Abilities:

• This position requires an understanding and knowledge of physician documentation requirements in a clinic setting to capture patients acute and chronic conditions
• Ability to create and follow written procedure.
• Ability to provide professional written communication and excellent customer service.
• Technical proficiency with computers, basic Microsoft software, and medical software systems (PM/EHR)
• Strong organizational skills
• Excellent communication skills and ability to work in a team environment.
• Strong technical and computer skills (PM/EHR Software, Excel, Outlook, MS Office, Web)
• Ability to learn new systems, software, and client specialties quickly.
• Self-starter with little to no supervision

Benefits

At Lifepoint, our Mission of Making Communities Healthier extends to our employees. We offer an excellent total compensation package, including a competitive salary and benefits. Some of our benefits include 401k, flexible PTO, generous Employee illness benefit (EIB), medical, dental, vision, tuition reimbursement, and an Employee Assistance Program.

We believe that happy, healthy people have a passionate engagement with life and work and have designed our package to enhance your wellbeing.

We also offer a flexible, remote work environment.

Pay range:$23-25/hour DOE Thefinal agreed upon compensation is based on inidual education, qualifications, experience, and work location. This position is bonus eligible.

Primary LocationColorado-Denver

ScheduleFull-time

Work ScheduleDay shift, 7-10 hr/shift, weekdays only

Clinical Nursing Coordinator

Fully Remote • Remote Worker – N/A

Description

From Intake to Outcomes, CareMetx is dedicated to supporting the patient journey by providing hub services, innovative technology, and decision-making data to pharmaceutical, biotechnology, and medical device innovators.

Clinical Nursing Coordinator: Job Description

POSITION SUMMARY:

The RN in this role is responsible for providing and documenting call center services for patients with rare or chronic disorders, on behalf of manufacturer clients. These clients, secured by CareMetx, provide specific guidelines for required nursing services. Nurse Educators do not provide medical advice or work clinically within this role, and do not interact directly with healthcare providers or offices. The nurse reports to the Sr. Director Operations.

PRIMARY DUTIES AND RESPONSIBILITIES:

1. Ability to work in call center environment, utilizing computer equipment, hardware and software, to successfully execute all job responsibilities
2. Executes assigned responsibilities as agreed upon by the manufacturer client and company leadership
3. Educates patients, physicians and families on prescribed, FDA approved therapies, according to manufacturer client needs and requirements
4. Utilizes reviewed and approved call scripts for communicating key messaging to patients?
5. Provides HIPAA compliant feedback and analysis to the manufacturer client as contractually required
6. Adheres to and is compliant with mandatory HIPAA requirements
7. Adheres to all company policies and procedures
8. Effectively communicates with patient, family, provider, manufacturer and team members
9. Responsible for maintaining required nursing licenses and relevant certifications?
10. Ability to manage time efficiently and prioritize job responsibilities?
11. Conveys a strong professional image and positive attitude at all times
12. Performs related duties as assigned.

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

1. Active RN licenses must be free of disciplinary actions and/or restrictions?
2. Minimum of 2 + years nursing experience
3. Consideration will be given to RN’s living in Nursing Licensure Compact ‘home states’
4. Bachelor’s degree preferred; Associate’s degree commensurate with experience
5. Prior call center or telehealth nursing experience preferred

MINIUMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

1. Knowledge and familiarity with call center and telehealth processes

Knowledge of biologic therapies, specialty pharmacy, and managed care processes

Proficient in Technology: Microsoft Office – particularly Word and Excel, Zoom, MS Teams, WebEx, Salesforce, Telephone systems)

1. Excellent interpersonal skills – demonstrates initiative, problem solving skills, acts as a team player
2. Excellent oral and written communication skills
3. Excellent organizational skills – ability to prioritize and adjust to shifting priorities
4. Excellent judgment/ decision Making skills
5. Compassionate and patient-focused
6. Ability to sit for extended periods of time
7. Ability to connect to the internet from remote location, as needed
8. Ability to perform all work duties from remote location, as needed
9. Ability to perform administrative responsibilities accurately and on time
10. Willingness to work multiple US time zones as needed
11. Ability to travel for national training meetings approximately 15%
12. Ability to work independently as well as with a team
    Ability to work flexible hours, as needed?
13. Ability to perform other program and company priorities, as needed

Physical Demands

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

• While performing the duties of this job, the employee is regularly required to sit.
• The employee must occasionally lift and/or move up to 10 pounds.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable iniduals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Schedule

• Must be flexible on schedule and hours
• Some travel may be required

CareMetx considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply.

At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.

CareMetx is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.

Content and Curriculum Manager, Nursing

Job Description

For more than 80 years, Kaplan has been a trailblazer in education and professional advancement. We are a global company at the intersection of education and technology, focused on collaboration, innovation, and creativity to deliver a best-in-class educational experience and make Kaplan a great place to work.

The future of education is here and we are eager to work alongside those who want to make a positive impact and inspire change in the world around them.

The Nursing Content Manager leads key content and curriculum development projects in order to revise or develop new nursing products. She or he determines the appropriate team to recruit and manage for the execution of the project and works with implementation specialists to manage projects to ensure completion is timely, obstacles are removed, and any new processes are created and documented in order to achieve success. As a subject matter expert in nursing education, the content manager also ensures the quality of the product, alignment with customer expectations, and adherence to learning science principles.

Primary Responsibilities

• Content creation and development using multiple platforms on a project-by-project basis. This includes tracking, training, and metric reporting/presenting.
• Use of situational leadership and G.R.O.W. coaching to manage and develop content developers and content specialists.
• Collaborate with Kaplan teams to keep student success the focus of our delivery efforts. This includes customer service teams (NC, AM, Contact Center, Sales), academics, learning science, marketing, publishing, and technology.
• Actively pursue opportunities to continue to learn best practices in product development through research, professional development, and alternate learning opportunities. Sharing your learning with the team and broader KNA through thought leadership activities.

Education & Experience

• MSN in Nursing (required)
• 5+ years in nursing education and content development
• Considerable knowledge of current literature, trends, and developments in the design and development of nursing education/products.
• Excellent computer (Microsoft Office & Google Suites) and presentation skills.
• Open-minded team player with a positive attitude, sense of humor, energy, and dedication to collaborate and learn new systems/platforms/processes for authoring/reporting.
• Understanding and ability to provide training and assistance to internal team members with content development, platform/software usage, and navigation of Kaplan sites.
• Strong communication, public relations, and interpersonal skills for effective oral and written communication. Including the ability to develop/implement policy and procedures.
• Ability to provide leadership and supervise the planning, development, and establishment of new, modified, and/or improved projects. Including goal setting, research, data analysis, promotion, scoping, and independently prioritizing toward a deadline.

Preferred Qualifications

• DNP or PhD in Nursing or Education (preferred), Specialty/Certification (in nursing, instructional design, leadership, project management, and/or education).

We offer a competitive benefits package including:

Remote work provides a flexible work/life balance

Comprehensive Retirement Package automatically enrolled in The Company Contribution Plan (8-10% annual company contribution based on tenure)

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 start on day 1 of employment

Generous Paid Time Off includes paid holidays, vacation, personal, and 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!

For full-time positions, Kaplan has two Salary Grades, this position is a Salary Grade B: $64,000 – $202,600. Actual compensation for this role is determined by several factors including but not limited to job level, candidate’s skills, experience, and education, among other factors determined by the business.

#LI-DK1

#LI-Remote

Location

Remote/Nationwide, USA

Additional Locations

Employee Type

Employee

Job Functional Area

Content/Material Creation

Business Unit

00092 Kaplan Health

At Kaplan, we recognize the importance of attracting and retaining top talent to drive our success in a competitive market. Our salary structure and compensation philosophy reflect the value we place on the experience, education, and skills that our employees bring to the organization, taking into consideration labor market trends and total rewards. All positions with Kaplan are paid at least $15 per hour or $31,200 per year for full-time positions. Additionally, certain positions are bonus or commission-eligible. And we have a comprehensive benefits package, learn more about our benefits here.

Diversity & Inclusion Statement:

Kaplan is committed to cultivating an inclusive workplace that values ersity, promotes equity, and integrates inclusivity into all aspects of our operations. We are an equal opportunity employer and all qualified applicants will receive consideration for employment regardless of age, race, creed, color, national origin, ancestry, marital status, sexual orientation, gender identity or expression, disability, veteran status, nationality, or sex. We believe that ersity strengthens our organization, fuels innovation, and improves our ability to serve our students, customers, and communities. Learn more about our culture here.

Kaplan considers qualified applicants for employment even if applicants have an arrest or conviction in their background check records. Kaplan complies with related background check regulations, including but not limited to, the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. There are various positions where certain convictions may disqualify applicants, such as those positions requiring interaction with minors, financial records, or other sensitive and/or confidential information.

Kaplan is a drug-free workplace and complies with applicable laws.

Title: Medicare Nurse Reviewer

Location: United States

Job Description:

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and inidual plans.

Under limited supervision, the Medicare Nurse Reviewer applies medical necessity guidelines in making authorization determinations for inpatient admissions, concurrent, and retrospective reviews in collaboration with physician reviewers. Applies evidence-based discharge planning so that patients have a safe and timely transition to next appropriate level of care.

Note: This position allows you the flexibility to work at home. We are looking for applicants that have a strong clinical utilization management background. Medicare experience is a plus.

Responsibilities

• Evaluates clinical information using established national decision support criteria, company policies, and inidual patient considerations to ensure the provisions of safe, timely, and appropriate covered healthcare services.
• Independently conducts basic to complex post-acute care admissions, concurrent, and retrospective reviews, including skilled nursing facility, acute physical rehabilitation, and long-term acute care hospitals, to ensure compliance with criteria guidelines, member eligibility, benefits and contracts.
• Plans, implements, and documents, discharge planning activities based on the members’ specific clinical condition, health plan benefits, and optimal care delivery. Acts as a resource to the provider community, explaining processes for accessing the Company’s website to identify network providers for next level of care and post-discharge follow-up care
• Promotes effective resource management by directing member care to accessible cost-effective post-acute network providers and services at appropriate level of care. Coordinates with other Pharmacy and Care Management departments to facilitate the timely provision of covered health care services.
• Participates with designated external vendors and Assistant Medical Directors, social workers and case managers to determine potential high dollar member costs, discharge planning interventions that ensure delivery of consistent and quality health care services.
• Keeps up to date on utilization management regulations, policies and practices.
• If assigned to Preceptor/Trainer task: Orients, trains and provides guidance to more junior or less experienced staff. Supports implementation of new procedures, processes or clinical systems.
• Performs other duties as assigned.

Qualifications

• Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor’s degree preferred.
• 3 years as a Registered Nurse with a combination of clinical and or utilization/case management experience, preferably in the health insurance industry.
• Acute inpatient level of care in Medical/Surgical/Critical Care/ ambulatory care experience preferred.
• Registered Nurse with current State of Ohio unrestricted license.
• Intermediate Microsoft Office skills and proficiency navigating windows and web-based systems.
• Knowledge of, and the ability to apply fundamental concepts related to HIPAA compliance and related regulations.
• Knowledge of clinical practices and efficient care delivery processes.
• Ability to occasionally travel offsite for on-going training.
• Ability to occasionally work weekends and extended hours as needed.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That’s why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance – insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay idends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and inidual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

#LI-REMOTE

Healthcare Revenue Cycle SNF Billing Consultant II

Job Locations: US

Job ID

2024-6404

Category

Consulting

Remote

Yes

At Wipfli, people count.

At Wipfli, our people are core to everything we do—the catalyst behind our ability to create exceptional impact and extraordinary results.

We believe in flexibility. We focus on relationships. We encourage each inidual to follow their own path.

People truly matter and they feel it. For those looking to make a difference and find a professional home, Wipfli offers a career-defining opportunity.

Join Wipfli as a Healthcare Revenue Cycle SNF Billing Consultant II, guiding clients through the complexities of optimizing financial performance. By collaborating with cross-functional teams, this role supports Skilled Nursing and Senior Living clients in streamlining their revenue processes and enhancing operational efficiencies, making an impact on financial strategies and solutions.

Responsibilities:

• Conduct revenue cycle assessments and provide actionable insights for enhancement.
• Research, analyze, and resolve complex cases and problem accounts.
• Develop good working relationships with clients to maintain and provide ongoing service to them.
• Lead a small group of associates on day to day outsourced billing engagements.
• Assists in developing strategies to improve overall revenue performance.
• Ability to balance projects simultaneously.
• Ability to work under pressure and time deadlines.
• Ability to analyze data and recommend solutions.
• Ability to travel to client sites as needed.

Qualifications:

• Bachelor’s Degree
• Two to three years of years’ work experience in a professional services firm or three+ years of private industry experience focused on healthcare.
• Healthcare revenue cycle and denial management experience required.
• Experience with SNFs and senior living facilities required.
• Experience with home health and hospice preferred.
• Working knowledge of UB-04 and HCFA-1500 required.
• Experience with multiple EHR systems; PCC, Matrix, and/or ECS preferred.
• Proficient in Word, Excel, and Outlook.

Cheyenne Lee, from our recruiting team, will be guiding you through this process. Visit her LinkedIn page to connect!

Wipfli is an equal opportunity/affirmative action employer. All candidates will receive consideration for employment without regards to race, creed, color, religion, national origin, sex, age, marital status, sexual orientation, gender identify, citizenship status, veteran status, disability, or any other characteristics protected by federal, state, or local laws.

Wipfli is committed to providing reasonable accommodations for people with disabilities. If you require a reasonable accommodation to complete an application, interview, or participate in our recruiting process, please send us an email at [email protected].

Wipfli supports equal pay for equal work and values each candidate’s unique experiences and skill sets. The estimated pay range for this position is: $54,000.00 to $90,000.00. Compensation within the range is determined by a variety of factors including, but not limited to, location, iniduals’ skills, experience, training, licensure and certifications, business needs and applicable employment laws.

#LI-CL2 #LI-remote

Part Time Case Manager RN

Job Locations: US-Remote

Job ID

2024-3583

Category

Care Management

Type

Regular Part-Time

Overview

Now is the time to join us!

We’re Personify Health. We’re the first and only personalized health platform company to bring health, wellbeing, and navigation solutions together. Helping businesses optimize investments in their members while empowering people to meaningfully engage with their health. At Personify Health, we believe in offering total rewards, flexible opportunities, and a erse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

Responsibilities

Who are you?

We are seeking Case Manager RN to join our team on a part-time basis, working up to 29 hours per week. In this role, you will provide telephonic case management between providers, patients and caregivers to help ensure cost-effective, high-quality healthcare for health insurance plan participants. This position offers flexibility and is ideal for candidates looking for reduced hours while making an impact within the team.

In this role you will wear many hats, but your knowledge will be essential in the following:

• Telephonically manage cases on a long- or short-term basis per established Company guidelines, policies and procedures, as well as other standardized criteria in the healthcare industry.
• Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
• Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs.
• Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals.
• Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions.
• Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care.
• Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
• Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis.
• Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.
• Establish and maintain working relationships with healthcare providers, client/group, and patients to provide emotional support, guidance and information.
• Evaluate and make referrals for wellness programs.
• Maintain complete and detailed documentation of case managed patients in Eldorado and UM Web; maintain site specific files ensuring confidentiality; prepare reports and updates at 30-day intervals for high-risk cases and 90 days interval for low risk cases ensuring confidentiality according to Company policy and HIPAA
• Perform Utilization Review for assigned members.
• Serve as mentors to LVNs and provide guidance on complicated cases as it relates to clinical issues.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Qualifications

What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

• Graduation from an accredited RN program and possession of a current California RN license.
• Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience.
• Prefer case management experience, emergency room, critical care background or some other area of clinical care that is pertinent to case management.

You also take pride in offering the following Core Skills, Competencies, and Characteristics:

• Knowledge of medical claims and ICD-10, CPT, HCPCS coding.
• Ability to critically evaluate claims data and determine treatment plan; discharge planning experience.
• Ability to work independently making decisions and problem solving
• Knowledge of community resources and alternate funding programs.
• Computer proficiency or working knowledge of Microsoft Office Suite.
• Excellent interpersonal, communication and negotiation skills.
• Strong customer orientation.
• Good time management skills and highly organized.

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

Personify Health is an equal opportunity organization and is committed to ersity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $32.00 to $38.00. Note that compensation may vary based on location, skills, and experience.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.

#LIRemote

#WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded

Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to [email protected]. All of our legitimate openings can be found on the Personify Health Career Site.

Application Deadline: Open until position is filled.

Remote Multispecialty Surgery Coder III

locations

US – Remote (Any location)

Full time

Job Family:

Health

Travel Required:

None

Clearance Required:

Ability to Obtain NACI

The Multispecialty Surgery Coder III will Code for Multispecialty Surgery physicians primarily Single Path Coding. Multi-specialty surgical coding experience, any Trauma, Urology, ENT, Plastics, GenSurg, OB/GYN, Cardiovascular, Interventional Radiology, etc. Ability to extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting, research as required, and regulatory compliance. Under the direction of the coding manager—the coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. The coder scope may involve reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines. This position is full time as and 100% remote.

Responsibilities:

• Demonstrates the ability to perform quality surgical coding and multispecialty chart types as assigned.

What You Will Do:

Demonstrates the ability to perform quality E/M coding and surgical as appropriate on assigned Hospitalist encounters.

What You Will Need:

• High School Diploma/GED or 3 years of relevant equivalent experience in lieu of diploma/GED, or post-high school education through a university or technical school program resulting in completion of ONE of the following:
  • Successful completion of an American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) coding certification preparation course for professional services or facility coding that includes medical terminology, anatomy and physiology, health information management concepts, and pharmacology
  • Successful completion of a training course beyond apprentice level for medical technicians, hospital corpsmen, medical service specialists, or hospital training, obtained in a training program given by the Armed Forces or the U.S. Maritime Service under close medical and professional supervision.
• One of the following recognized professional coding certifications: Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist – Physician (CCS-P)
• 3 years Multi-Specialty Surgery Coding experience, both IP and OP coding for physician claims.
• EMR experience
• Must maintain credential throughout employment.

ONE of the following recognized professional coding certifications:

• Certified Professional Coder (CPC)
• Registered Health Information Technician (RHIT)
• Registered Health Information Administrator (RHIA)
• Certified Coding Specialist – Physician (CCS-P)
• 3 years Multi-Specialty Surgery Coding experience, both IP and OP coding for physician claims.
• EMR experience
• Must maintain credential throughout employment.

What Would Be Nice To Have:

• Certified Inpatient Coder (CIC)
• Registered Health Information Technician (RHIT)
• Registered Health Information Administrator (RHIA)
• Certified Coding Specialist (CCS)
• Recognized E&M coding certifications: Certified Evaluation and Management Coder (CEMC), or National Alliance of Medical Auditing Specialists’ (NAMAS) Certified Evaluation and Management Auditor (CEMA)
• Must be able to work independently, multi-task well and interface with all levels of personnel as well as clients
• Knowledge & experience with Federal & State Coding regulations and Guidelines to include DHA or Military Health Coding experience
• Multiple EMR and/or Practice Management systems experience
• Single path coding experience

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

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.

Title: Inpatient Coder

Location: Phoenix United States

time type: Full time

job requisition id: R4392719

Job Description:

Department Name:

Work Shift: Day

Job Category: Revenue Cycle

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.

As part of the Banner Health Revenue Cycle Team, there are opportunities within that team. We specialize in Inpatient coding on the facility side. We do not do pro-fee coding. We are a team of 4 Inpatient Coding Managers who cover for each other and report to the Director of Acute Care Coding. These positions offer opportunities for growth both within the coding department, including roles such as Coding Educator, Coding Quality Analyst and supervisory/management opportunities. Additionally, as part of the Revenue Cycle team, there are opportunities within that team as well.

Looking for a motivated, experienced Inpatient Facility | Acute Care | HIMS Coder -Remote | Medical Coder, with CPC or CCS and/or RHIT or RHIA Certifications, to join our talented Acute Care HIMS Coding Team. Candidate should have experience coding all service lines including, but not limited to; Trauma, ICU, Cardiac, Transplant, Orthopedics, High-Risk OB, NICU, and more. Must have ICD-10-PCS coding experience. Ideally 1 or more years of experience coding in a facility coding setting (physician or pro-fee coding for IP is not considered part of the required experience coding facility inpatient accounts). We use the number of accounts for specific patient types and specialties in combination with the Case Mix Index and case financial information to formulate Banner productivity standards, which are currently more stringent than most national standards identified. Quality standards are set at a DRG accuracy rate of 95% or higher among other quality measures. Meeting Accounts Receivable goals supports Banner Financial goals. In all of our Inpatient Coding roles, there is a Coding Assessment given after each successful interview. Banner Health provides your equipment when hired. You will be fully supported in during initial training by both the Banner Coding Education team and your hiring manager, with continued support throughout your career here!

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, WV, 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.

Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefit

POSITION SUMMARY

This position provides coding and abstracting for lower tiered complexity range of acute care services at all Banner hospitals. Reviews diagnosis and diagnostic information and codes and abstracts diagnoses and/or procedures on inpatient records using ICD CM and PCS coding classification systems. Completes MS-DRG and APR-DRG assignments on inpatient records as appropriate. Ensures ethical and accurate coding in accordance with all regulatory requirements and AHIMA Standards of Ethical Coding.

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 timely and accurate coding in accordance to department specific productivity and quality standards thorough assignment of ICD CM and PCS codes, MS-DRGs, APR-DRGs and POAs for lower tiered complexity range of acute care services at all Banner hospitals.
2. Abstracts clinical diagnoses, procedure codes and documents other pertinent information obtained from the patient encounter. Seeks out missing information and creates complete records, including items such as disease and procedure codes, discharge disposition, date of surgery, attending physician, consulting physicians, surgeons and anesthesiologists. Refers inconsistent patient treatment information or documentation to coding support tech, coding quality analyst or coding manager 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. Works under general supervision. Uses specialized knowledge for accurate assignment of ICD-CM and PCS and MS-DRG or APR-DRG codes according to national guidelines.

MINIMUM QUALIFICATIONS

High school diploma/GED or equivalent working knowledge and specialized formal training 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.

Requires Certified Coding Specialist (CCS) or Certified Outpatient Coder (COC) or Certified Professional Coder (CPC) or Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) or other appropriate coding certification in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).

Requires one year of coding experience in Acute Care inpatient facility or healthcare system.

Must demonstrate a level of knowledge and understanding of ICD-CM and PCS coding principles as recommended by the American Health Information Management Association coding competencies.

Must be able to work effectively and efficiently in a remote setting, utilizing common office programs, coding software and abstracting systems.

PREFERRED QUALIFICATIONS

Associates degree in a job-related field or experience equivalent to same.

Previous experience in large, multi-system healthcare organization.

Additional related education and/or experience preferred.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

PRN Corporate Coder

Location: Dallas United States

Job ID: 2403035697-0

Facility: Other Staff

Job Description:

Tenet Healthcare has immediate needs for remote, home-based Corporate Coders to support the hospital business. Corporate Coders can be based anywhere in the country with home internet access.

The Corporate Coder (“CC”) functions under the direction of the Health Information Corporate Coding Manager. The CC is responsible for accurate coding and abstracting of clinical information from the medical record. The CC is responsible for maintaining standards for coding data quality and integrity, as well as productivity within established guidelines. The CC is responsible for coding of Tenet facilities as assigned, assisting with productive coding to maintain DNFC, assisting with quality chart reviews, assisting with the training of new CC’s and/or other projects where indicated.

• Accurately and productively code/abstract patient health documentation for Tenet facilities.
• Utilize coding abilities to review flagged cases, in CARDS and RevInt for coding accuracy.
• Assisting in coding quality reviews/audits and second level reviews as needed.
• Attends Tenet coding educations and maintains coding credentials.

Required:

• Associates or higher-level degree in a Health Information Management discipline.
• 1-3 years inpatient coding experience.
• Skilled and working knowledge of MS Office suite.
• Strong technical background and electronic medical record experience.
• Successful completion of at least one AHIMA (American Health Information Management Association) certified program with achievement of the correlating professional credential preferred (RHIA, RHIT, and / or CCS, etc.).

Preferred:

• Bachelor’s or higher-level degree in a Health Information Management discipline.
• 3+ years of inpatient coding experience.
• Coding experience in a large, complex health system.

A pre-employment coding proficiency assessment will be administered.

Compensation

• Pay: $26.40 to $39.00 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Observed holidays receive time and a half.

Benefits

The following benefits are available, subject to employment status:

• Medical, dental, vision, disability, life, AD&D and business travel insurance
• Paid time off (vacation & sick leave)
• Discretionary 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance.
• For Colorado employees, paid leave in accordance with Colorado’s Healthy Families and Workplaces Act is available.

Tenet Healthcare complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

#LI-DM4

2403035697

Registered Nurse Care Manager

Remote, United States

Interwell Health is a kidney care management company that partners with physicians on its mission to reimagine healthcare—with the expertise, scale, compassion, and vision to set the standard for the industry and help patients live their best lives. We are on a mission to help people and we know the work we do changes their lives. If there is a better way, we will create it. So, if our mission speaks to you, join us!

Are you passionate about making a real difference in the lives of patients with chronic kidney disease? As an RN Care Manager, you’ll empower members to manage their health, offering personalized support that helps slow disease progression and minimize the need for costly interventions. In this role, you’ll collaborate with healthcare providers, dialysis teams, and other professionals to create inidualized care plans, educate patients, and coordinate their transitions to dialysis. Your work will primarily be telephonic, using motivational interviewing to engage patients in their care and reduce hospitalization risks. We’re looking for empathetic, proactive problem-solvers with strong communication skills and the ability to adapt in a fast-paced environment. Join us in delivering high-quality care while contributing to program improvements and impactful initiatives.

Note: This position is 100% remote, with multiple openings available! Candidates outside the Eastern Time zone must be willing to work Eastern Time hours.

What you will do: 

• Collaborate with clinical and non-clinical staff and other members of the patient’s health care team to develop inidualized interventions to meet the member’s current needs.
• Communicate and coordinate with the member and appropriate members of the patient’s health care team in developing, executing, and reviewing results of care coordination efforts.
• Utilize motivational interviewing techniques to influence members to engage in their own care.
• Collaborate with providers and members to ensure an optimal and successful transition from chronic kidney disease to dialysis.
• Partner closely with providers and dialysis clinics to identify and mitigate hospitalization and mortality risk for members.
• Participate in quality improvement activities and project-based work including practice, clinic, and community-based education initiatives.
• Evaluate program processes and make recommendations to management that will improve the effectiveness and efficiency of the program.

What you will need: 

• Registered Nurse (RN) required with active unrestricted licensure in practicing state, with a willingness to obtain additional state licensures as needed; a clear and active Nurse Licensure Compact (NLC) is also required
• Associate Degree in Nursing (ADN) required; Bachelor of Science in Nursing (BSN) preferred.
• 2 to 5+ years of Nephrology Nursing and/or Case Management experience, with experience in a role related to patient education and/or case management preferred.
• Must have knowledge of teaching-learning process, principles, and methods of adult education.
• Proven understanding of renal and diabetes disease process and current management practices.
• Familiarity with telehealth platforms and electronic health records (EHRs).
• Demonstrated knowledge of healthcare regulations, including HIPAA, with a strong commitment to patient confidentiality and ethical care.
• Excellent communication and interpersonal skills, with the ability to establish rapport and convey empathy over the phone, as well as proficiency with explaining complex medical information in simple terms
• Empathetic and culturally competent, able to quickly build trust and maintain a patient-centered approach with erse populations.
• Ability to prioritize tasks, manage workload, and adapt to rapidly changing situations and patient needs.

Our mission is to reinvent healthcare to help patients live their best lives, and we proudly live our mission-driven values:

– We care deeply about the people we serve.

We are committed to ersity, equity, and inclusion throughout our recruiting practices. Everyone is welcome and included. We value our differences and learn from each other. Our team members come in all shapes, colors, and sizes. No matter how you identify your lifestyle, creed, or fandom, we value everyone’s unique journey.

Oh, and one more thing … a recent study shows that men apply for a job or promotion when they meet only 60% of the qualifications, but women and other marginalized groups apply only if they meet 100% of them. So, if you think you’d be a great fit, but don’t necessarily meet every single requirement on one of our job openings, please still apply. We’d love to consider your application!

It has come to our attention that some iniduals or organizations are reaching out to job seekers and posing as potential employers presenting enticing employment offers. We want to emphasize that these offers are not associated with our company and may be fraudulent in nature. Please note that our organization will not extend a job offer without prior communication with our recruiting team, hiring managers and a formal interview process.

Title: Inpatient Coder Senior Associate

Location: Remote – USA

Job Description:

Clover is reinventing health insurance by working to keep people healthier.

The Payment Integrity team is a group of innovative thinkers sitting at the intersection of Clover’s provider Network, Claims, and Tech teams. The Payment Integrity team ensures that Clover pays claims in an accurate manner, with a particular focus on reducing inappropriate medical spend.

As a Senior Associate – Inpatient Coder for Payment Integrity at Clover Health, you will play a key role ensuring that Clover is able to continue to build and scale a compliant, efficient and profitable program. You will work to ensure quality assurance standards and regulatory policy are reflected in claims processing practices. You will help drive value for every member by ensuring that Clover’s medical claims are paid accurately and recovering overpayments when they are identified. The Senior Associate – Inpatient Coder monitors and coordinates the identification of provider DRG denials and upcoding.

As an Inpatient Coder Senior Associate, you will:

• • Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues on a prospective and retrospective basis that drive inaccurate payments to providers.

• • Proactively identify overpayments to ensure accurate claims payments on all inpatient services.

• • Prepare response letters to deliver our decisions to members and/or providers within the regulatory timeframes set forth by the Centers for Medicare & Medicaid Services (CMS).

• • Act as a subject-matter expert for cross-functional clinical reviews: digest complex concepts and regulations and communicate them effectively to different stakeholders, including senior-level leadership.

• • Research and respond to external auditor concerns/questions regarding the completeness and accuracy of data creation and integration.

• • Work closely with data scientists, engineers and operational teams to create sustainable and scalable solutions.

• • Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams.

• • Identify and review potential program efficiencies and opportunities.

• • Continue to analyze existing policies to ensure accuracy and proper execution.

• • Communicate effectively both internally and externally to ensure accurate claims adjudication and proper provider notification.

You will love this job if:

• • You want to make an impact. You thrive off of helping others, and want your work to make a difference in our members’ lives.

• • You are a team player. You enjoy partnering with others, and want to work collaboratively to find new solutions.

• • You are a strong communicator. You have strong verbal and written communication skills that foster trust, knowledge sharing, and progress.

• • You are detail-oriented. You pay attention to the small things, while understanding how they fit into the bigger picture.

• • You are motivated to learn. There is no shortage of technical, clinical, and operational skills to learn at Clover.

You should get in touch if:

• • You hold a CCS certification or similar inpatient coding certification; required

• • You have a deep knowledge and understanding of DRG pricing methodology; required.

• • You have current or previous nursing or firsthand clinical experience; preferred.

• • You have 5+ years of experience in clinical coding; preferred

• • You have Medicare or Medicare Advantage payment integrity or claims operations experience; preferred

• • You are technologically savvy with strong computer skills in Excel and PowerPoint.

• • You have knowledge of statistical methods used in the evaluation of healthcare claims data and SQL a plus.

Benefits Overview:

• • Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.

• • Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.

• • Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, company holidays, access to mental health resources, and a generous flexible time-off policy.

• • Professional Development: We are committed to developing our internal talent. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.

Additional Perks:

• • Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities

• • Reimbursement for office setup expenses

• • Monthly cell phone & internet stipend

• • Remote-first culture, enabling collaboration with global teams

• • Paid parental leave for all new parents

• • And much more!

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we’ve created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven iniduals with erse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people’s lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone’s responsibility.

#LI-Remote

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

For California, Colorado, New Jersey, New York, or Washington residents, a reasonable estimate of the base salary range for this role can be found below. For candidates residing in other geographic areas, the range will be adjusted based on location. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc.

Colorado/Washington Pay Range

$64,000 – $89,000 USD

California/New Jersey/New York Pay Range

$64,000 – $99,000 USD

Title: CODING SPECIALIST II – Remote – FT Days

Location: United States

Category: Health Information Management

Job Id: 00548737

Job Description:

Employment Type: Full time

Shift: Day Shift

If you are looking for a remote Coding Speicalist position, this could be your opportunity. Here at St. Peter’s Health Partner’s, we care for more people in more places.

Position Highlights:

Quality of Life: Where career opportunities and quality of life converge

Advancement: Strong orientation program, generous tuition allowance and career development

Work/Life: M-F 8am – 4:30pm with the option to flex time.

What you will do:

The Coding Specialist II analyzes physician/provider documentation contained in health records (electronic, paper or hybrid) to determine the principal diagnosis, secondary diagnoses, principal procedure and secondary procedures.

Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of Internal Classification of Diseases, Clinical Modification diagnosis and procedure codes, and Current Procedural Terminology / Healthcare Common Procedure Coding System (HCPCS) procedure codes and all required modifiers

What you will need:

Two years of current E&M Coding Experience

Completion of an AHIMA-approved coding program or an AAPC-approved coding program, or

Associate’s degree in Health Information Management or a related field or an equivalent combination of years of education and experience is required.

Certified Coding Specialist (CCS), Certified Procedural Coder (CPC), Registered Health Information

Technologist (RHIT), or Registered Health Information Administrator (RHIA) is required.

Current experience utilizing encoding/grouping software is preferred. Ability to utilize both manual and automated versions of the ICD and CPT coding classification systems is preferred.

Ability to use a standard desktop and windows based computer system, including a basic understanding of e-mail, internet, and computer navigation. Ability to use other software as required to perform the essential functions on the job. Familiarity with distance learning or using web-based training tools desirable.

Well-developed written and oral communication skills that may be used either on-site or in virtual working environments. Ability to communicate effectively with iniduals and groups representing erse perspectives.

Ability to work with minimal supervision and exercise independent judgment.

Ability to research, analyze and assimilate information from various on-site or virtual sources based on technical and experience-based knowledge. Must exhibit critical thinking skills and possess the ability to prioritize workload.

Excellent organizational skills. Ability to perform multiple duties and functions related to daily operations and maintain excellent customer service skills. Ability to perform frequent detailed tasks and provide immediate service with frequent interruptions. Ability to change and be flexible with work priorities. Strong problem-solving skills.

Must be comfortable functioning in a virtual, collaborative, shared leadership environment.

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

Pay Range:$21.20 – $29.15

Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate ersity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A erse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Title: Remote Psychiatric Mental Health Nurse Practitioner (W2, Full-Time)

Location: Orlando United States

Job Description:

Job description

Brave Health is on a mission to expand access to high-quality, affordable care for behavioral health conditions. We utilize the power of technology to eliminate barriers and expand access to high quality mental health and substance use disorder treatment. Through telehealth services we are able to reach those in need, when and where they need it. As a community based start-up, our goal is to make quality mental health services accessible for all.

We are looking for full-time Psychiatric Mental Health Nurse Practitioners to join our team and provide outpatient services through our telehealth program!

Benefits: Our team works 100% remotely from their own homes!

Compensation range – $125,000 to $130,000 plus quarterly bonuses ($1,000 to $10,000)

• W2 full-time positions
• Compensation package includes a base plus bonus!
• Monday – Friday schedule; No weekends!
• Liability insurance coverage and annual stipend for growth and education opportunities
• We not only partner with commercial health plans, but are also a licensed Medicaid and Medicare provider and see patients across the lifespan

Requirements: Brave PMHNP’s may be based anywhere in the US, but must have an active Florida license to get started.

• 2 years experience practicing as a Nurse Practitioner
• Experience in Addiction and Mental Health
• Currently holds a Psychiatric Mental Health certification (PMHNP) in Florida
• Eligibility to work in the United States. We are not able to provide or assist with visas or attaining work eligibility
• Open to obtaining additional state licesnure
• Fluency in English; Spanish preferred, proficiency in other languages a plus

Skills:

• Willingness to work in partnership with the client to achieve goals
• Experience working with adults in need of mental health and/or substance abuse treatment.
• Knowledge of mental health and/or substance abuse diagnosis. Diagnostic skills.
• Treatment planning
• Ability to utilize comprehensive assessments.
• Timely and quality documentation; experience with EHRs.
• Adaptable to technology, including telehealth software or comfortable with video communication. Experience utilizing telehealth platforms preferred.
• Awareness of and compliance with HIPAA and 42 CFR Part 2

Brave Health is very proud of the erse team we have that cares for our erse population of patients. We are an equal opportunity employer and encourage all applicants from every background and life experience without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Location: Remote, US

Type: Full Time – Regular

Workplace: remote

Category: Clinical Delivery

Job Description:

Registered Nurse

Department: Global Delivery

Level: Inidual Contributor

Work Location: Remote

______________________________________________________________________________________

What We Do

Care Access is a unique, multi-specialty network of research sites which operates as one connected team of physician investigators, nurse coordinators, and operations managers. Our goal is to engage every healthcare professional in clinical research and to make clinical trials a care option for every patient. By removing this bottleneck, Care Access is helping accelerate the approval and delivery of critical and life-saving therapies.

Who We Are

We care. Our people are the engines behind our mission: to revolutionize access to clinical trials for the benefit of patients everywhere. We care for one another, find new ideas to accelerate medicine, and seed a long-term impact for generations.

Position Overview

The Registered Nurse (RN) in this role will manage the communication of abnormal lab results to patients, ensuring compliance with state licensure requirements. This includes contacting patients, documenting communications, following up on lab escalations, and collaborating with providers to ensure all patient interactions are appropriately managed and documented. This role is critical in ensuring timely patient communication and maintaining compliance with clinical and legal standards.

What You’ll Be Working On

Duties include but not limited to:

Lab Results Management:

Receive and Review Results: Receive flagged abnormal, urgent, or critical lab results and ensure they are ready for patient communication.

Patient Communication: Contact patients to communicate abnormal lab results, ensuring focused, uninterrupted time for calls due to potential challenges in reaching patients. Follow protocols and scripts to ensure compliance. RNs must provide only legally permissible information, avoiding diagnosis or prescribing advice, as per scope of practice.

Documentation: Accurately document all communications in patient progress notes, including abnormal results, patient concerns, and follow-up actions. Ensure compliance with part-11 signature requirements and submit completed notes to the Clinical Conduct Team.

Escalation to Providers: For questions beyond the RN’s scope, escalate to a licensed, on call provider (NP/PA/MD/DO) and ensure they review and sign off on progress notes.

Retention Team Escalations: Address lab-related escalations from the Retention Team, such as result clarifications, data discrepancies, or additional test requests, and communicate resolutions back to the patient, documenting the outcome.

Physical and Travel Requirements

This is a remote position with less than 10% travel requirements. Occasional planned travel may be required as part of the role.

? PTO and On-Call Coordination: Work within a structured on-call system to ensure coverage when team members are on leave.

What You Bring

Knowledge, Skills, and Abilities:

Skills:

Excellent communication and patient interaction skills.

Strong attention to detail and ability to manage multiple patients efficiently.

Ability to work independently while collaborating with a larger clinical team.

Certifications/Licenses, Education, and Experience:

Education:

Active RN license in an NLC or non-compact state.

BSN or equivalent degree preferred.

Experience:

Minimum of 2 years of experience in clinical research, patient communication, or related field.

Proficiency in Salesforce or other EMR systems for documenting patient interactions.

Licensure Requirement: Compact licensure required, non-compact state license preferred. Willingness to maintain and obtain additional state licenses as needed. Must hold all licenses in good standing.

Compact States [42]: RNs with compact licenses can practice in all 42 states in the compact, including Alabama, Arizona, Arkansas, Colorado, Florida, Texas, and more.

Non-Compact States [8]: California, Nevada, Illinois, Hawaii, Alaska, Oregon, Minnesota, New York.

Benefits (US Full-Time Employees Only)

PTO/vacation days, sick days, holidays.

100% paid medical, dental, and vision Insurance. 75% for dependents.

HSA plan

Short-term disability, long-term disability, and life Insurance.

Culture of growth and equality

401k retirement plan

Diversity & Inclusion

We serve patients and researchers from erse cultures and communities around the world. We are stronger and better when we build a team representing the people we aim to support. We maintain an inclusive culture where people from a broad range of backgrounds feel valued and respected as they contribute to our mission. We value ersity and believe that unique contributions drive our success.

At Care Access, every day, we are advancing medical breakthroughs. We’re uniting standard patient care with cutting-edge treatments and research. Our work brings life-changing therapies to those in need and paves the way for newer and greater treatments to reach the world. We’re proud to advance these breakthroughs and work with the big players while engaging with the physicians and caring for patients.

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

Care Access is unable to sponsor work visas at this time.