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Operations Associate – Credentialing

Remote

About us:

We’re on a mission to fundamentally transform mental healthcare accessibility. Grow Therapy empowers therapists to launch and grow thriving insurance-accepting private practices. We’re creating game-changing technology to build America’s biggest behavioral healthcare group and ensure that anyone can afford quality mental healthcare. Following the mass increase in depression and anxiety, the need for accessibility is more important than ever.

To make our vision for mental healthcare a reality, we’re building a team of entrepreneurs and mission-driven go-getters. Our founders come from Harvard Medical School, Stripe, and Blackstone, and are champions of balancing bold ambitions with a culture that promotes holistic well-being. Since launching in 2020, Grow has raised over $90M from top VCs and angel investors, including TCV, Transformation Capital, SignalFire, Village Global, CoFound, and leaders of Oscar, Nurx, Quartet, Airbnb, and Blackstone.

What You’ll Be Doing:

We’re looking for an experienced Operations Associate for our Insurance Operations team who is passionate about improving the landscape for mental healthcare. You’ll play an essential role in ensuring that our credentialing and/or revenue cycle management teams have the appropriate technological infrastructure in place to grow our provider base, get our providers in-network with the insurance companies, and obtain reimbursement for services to enable continued engagement and growth. You’ll thrive in this role if you love learning new software to enhance productivity and figuring out how to automate processes that are tedious and manual. As you get to know our internal systems better, you’ll have the opportunity to expand your impact into different areas of the business, and you’ll eventually become the go-to person for a myriad of responsibilities.

In this role, you will primarily be responsible for building and maintaining systems for submitting our insurance applications and rosters. This will involve researching, planning, and scoping out the process, implementing the protocol for our Credentialing Assistants to follow, and building out metrics to help track the success of our operations. This will require great communication skills as well as an eye for detail and organization in order to manage the process from start to finish.

• Build and maintain automated workflows to keep our processes running smoothly. You may do this yourself through no-code automation tools, or you may work with our Engineering team to help them develop and implement high-value features for our platform. This work will directly impact our ability to expand access to care nationally!
• Design and execute complex analyses to support decision making within Insurance Operations and across departments at Grow.
• Own and monitor metrics that track the health of our Insurance Operations. You’ll be responsible for identifying problems that may arise in our processes then working towards a solution.
• Collaborate closely with our Growth, Customer Support, and Technology teams to ensure stellar operational performance and service while we scale.

Salary range: $62,250-$91,675

You’ll Be a Good Fit If:

• A Problem Solver. You’re able to identify business challenges based on metrics and analyses, and you’re ready to recommend solutions to improve business processes.
• Mission-Driven. You’re here to change the world, and you’re always connecting your work back to the importance of the Grow Therapy mission.
• Agile. You thrive in a fast-paced, unpredictable environment, and you’re able to pivot as new priorities emerge.
• A Team Player. You’re collaborative by nature, relish in camaraderie and group wins, and are looked to by your colleagues as a steadfast partner and source of encouragement.
• An Excel Guru. You know your way around spreadsheets, and you’re able to write complex formulas and pivot tables. Bonus if you have a command of SQL.
• Previous experience with HubSpot, Zapier, and/or other automation tools is a bonus, but we prioritize capability over experience and are excited to invest in your professional growth.

If you don’t meet every single requirement, but are still interested in the job, please apply. Nobody checks every box, and Grow believes the perfect candidate is more than just a resume.

Note: Please upload your resume in PDF format

Benefits

• The chance to drive impact within the mental healthcare landscape from day one
• Comprehensive health insurance plans, including dental and vision
• Our dedication to mental health guides our culture. Wellness benefits include (but are not limited to):
  • Flexible working hours and location (remote OR in-office, your choice!)
  • Generous PTO
  • Company-wide winter break
  • Mental health mornings (2 hours each week)
  • Team meditation
  • Wellness Stipend
  • In-office lunch and biweekly remote lunch on us!
• Continuous learning opportunities
• Competitive salary
• The opportunity to help build a rapidly scaling start-up organization by taking strong ownership of your work, mentorship, and our unbounded leadership opportunities

Title: Senior Director, Clinical Quality Assurance

Location: Hybrid, New Haven – Headquarters, Remote

Arvinas is a clinical-stage biotechnology company leading the way in targeted protein degradation therapeutics. Arvinas is the first company to focus solely on protein degradation and its platform technology is the most advanced in the field. Since its founding in 2013, Arvinas’ PROTAC Discovery Engine has been driving the most significant breakthroughs in the industry. Arvinas’ pipeline encompasses a range of validated and undruggable targets in oncology, immuno-oncology, and neuroscience. This includes three clinical-stage programs: bavdegalutamide (ARV-110) and ARV-766, which are being developed as potential treatments for men with late-line metastatic castrate-resistant prostate cancer, and ARV-471, which is being co-developed and commercialized by Arvinas and Pfizer as a potential treatment for patients with breast cancer.

#TeamArvinas is made up of more than 400 passionate and curious employees, whose erse thoughts and perspectives are highly valued. Arvinas employees embrace the freedom to pursue innovation, think creatively, and give back. They are driven by the company’s values and mission to improve the lives of patients with serious diseases by pioneering therapies created with our revolutionary PROTAC protein degradation platform. We’re really excited about the work we’re doing inside and outside of Arvinas, and think you will be, too. But don’t just take our word for it learn more about life at Arvinas and what employees have to say. For more information, please visit www.arvinas.com.

Position Summary

The Senior Director, Clinical Quality Assurance (CQA) is responsible for developing, maintaining and executing the requirements of the Arvinas Quality Systems as they pertain to clinical development of drug products by the company. The position provides direct Quality Assurance support for the Clinical Development and Clinical Operations functions, including the areas of clinical pharmacology, toxicology, pharmacovigilance, clinical trial conduct (Phase 1 – 4) and clinical data management. The position also contributes to the development, performance monitoring, and continuous improvement initiatives related to the company’s Quality Systems and their associated processes, policies, and procedures.

Under the direction from the Senior Vice President, Corporate Operations, the position provides quality assurance oversight and support for the various contract research organizations (CROs), clinical study sites and clinical service providers that perform GLP and GCP-related activities for the company.The incumbent works directly with the Arvinas Quality Team, Clinical Development, Clinical Operations, Regulatory Affairs, and the corresponding quality assurance staff of the various CROs, clinical study sites, and clinical service providers to ensure effective execution of the Arvinas Quality System requirements and compliance with the applicable GLP and GCP regulations / guidelines and industry standards. He/she also interfaces with representatives of similar responsibility from business partners working in collaboration with Arvinas to ensure effective delivery of joint projects/objectives.

This position reports to the Senior Vice President, Corporate Operations and can be located at our headquarters in New Haven, CT, or may be performed remotely from a location in the US.

Principal Responsibilities

Key responsibilities of this role include, but are not limited to:

• Quality Assurance oversight of activities performed at CROs and clinical service providers involved with the conduct of human clinical trials for Arvinas products. These activities may include, but are not limited to:
• On-site or remote / virtual auditing to support approval of new CROs; on-going qualification of existing CROs; or to investigate specific events involving GCP and GLP compliance ( for cause’ audits). Review and follow-up on audit responses from these clinical service providers to ensure appropriate corrective and preventive actions (CAPA) are assigned and executed.
• Provides Quality Assurance input / guidance regarding the handling of GLP/GCP compliance events that may occur to ensure these events are appropriately reported, investigated, and documented and that appropriate CAPA are identified and implemented, as appropriate.
• Provides inspection readiness support for key CROs and clinical study sites.
• Develops and approves Quality Agreements with key CROs and clinical service providers.
• Participates as a key member of internal and business partner project teams to ensure timely execution of responsibilities to meet the established project timelines.
• Serves as a standing member of the Arvinas Quality Board for the reporting of GLP and GCP compliance metrics, CRO audit performance, and recommendations to addresses areas of GLP and GCP compliance risk.
• Manages a team of Clinical QA professionals to ensure delivery of company and departmental objectives related to clinical development and GxP compliance. Manages contract support that may be required to support execution of CQA responsibilities.
• Provides support for regulatory inspection readiness initiatives, both internally and at Arvinas CROs and clinical sites, as appropriate.
• Performs verification reviews of clinical data and related information included with documents intended for subsequent regulatory submission or presentation at medical or investor conferences.
• Supports implementation of the Arvinas Quality Systems Plan, including the development, review and/or approval of Arvinas Quality System policies, procedures, and work practices associated with the GLP, GCP and GPvP requirements. Provides training to Arvinas colleagues and contractors on quality system requirements; conducts internal assessments and provides recommendations for improvements to existing quality system processes, policies, and procedures.
• Provides support for the implementation and qualification / validation of GCP/GLP-related computerized systems, as needed or requested.

Qualifications

• 15+ years of pharmaceutical clinical quality assurance experience in support of clinical development and clinical operations.
• Strong hands-on knowledge in the application and execution of GLP and GCP requirements.
• Experience with the application of phase-appropriate quality systems across the product development lifecycle (Phase 1 through commercial).
• Strong working knowledge in the application of the US and EU GCP guidelines, ICH Guidances, and industry standard requirements for Pharmaceutical Quality Systems. Experience in hosting regulatory inspections and in dealing with regulatory agencies throughout the drug product approval process.
• Strong communication skills (verbal / written).
• Ability to effectively communicate with business partners and third party clinical vendors and their quality assurance representatives to ensure Arvinas requirements are met and to resolve issues / discrepancies.
• Ability to prepare audit reports, quality agreements, standard operating procedures, and CAPA reports in accordance with Arvinas Quality System requirements.
• Oral and written presentation skills as needed to address colleagues at all levels of the organization, e.g., internal training presentations, presentation of CRO performance metrics, coordination of inspection readiness activities.
• Ability to work on multiple projects, manage competing priorities, and collaborate cross-functionally in a dynamic fast-paced environment.
• Hands-on experience with the use of electronic document management and QMS systems; Veeva Quality experience strongly preferred.

Education

• B.S. in a Healthcare-related scientific field. Advanced degree a plus.

#LI-Remote

Arvinas is proud to offer a competitive package of base and incentive compensation as well as a comprehensive benefits program designed to support the health, wellness and financial security of our employees and their families. Benefits include group medical, vision and dental coverage, group and supplemental life insurance, and much more. To learn more about Arvinas, please visit www.arvinas.com

Arvinas is an Equal Opportunity Employer

Title: Certified Medical Coder – Anesthesia

Location: US National

FULL-TIME/ REMOTE

At Zotec Partners, our People make it happen.

Transforming the healthcare industry isn’t easy. But when you build a team like the one we have, that goal can become a reality. Our accomplishments can’t happen without our extraordinary people those across the country who make up our erse Zotec family and help make this company a best place to work.

Over 20 years ago, we started Zotec with a clear vision, to partner with physicians to simplify the business of healthcare. Today we are more than 1,000 employees strong and we continue to use our incredible talent and energy to bring that vision to life. We are a team of Innovators, Collaborators and Doers.

We’re seeking a Certified Medical Coder to join us.

As a Certified Medical Coder, Anesthesia , you will be responsible for the full process of coding Anesthesia coding reports.

What you’ll do:

• Code Anesthesia coding reports
• Resolve coding issues
• Respond to coding related denials
• Take steps to correct claims
• Submit appeals
• Investigate and resolve reports submitted for coding investigations

What you’ll bring to Zotec:

• Current Certification AHIMA or AAPC
• Completed ICD10 Certification/Training, preferred
• 2+ years of experience coding Anesthesia coding reports
• Ability to work on internet based coding programs
• Thorough knowledge of medical office operations
• Proficiency in Microsoft Work, outlook and Excel
• Excellent communication and problem solving skills
• Capable of prioritizing work flow and able to ensure deadlines are met
• High school diploma or equivalent

Title: Registered Nurse

REMOTE Per Diem Bilingual RN – $38/hour (NY Licensed)

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

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

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

Vesta Healthcare partners with physician groups and home care agencies to help implement and deliver these services; providing administrative support, and helping to find committed and capable staff for the physician group.

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

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

The ideal teammate would be…

A Registered Nurse with availability to work a minimum of 24 DAYTIME hours a week either Monday through Friday or Friday through Sunday from the comfort of their own home. The RN must be experienced in triaging older adults and the elderly population and is conducted telephonically in a model with nurse practitioners for collaboration. You will play an integral role in reducing unnecessary utilization of the Emergency Room and maintain the patients’ independence and safety at home.

The ideal candidate would be able to:

• Speak with the member, family or caregiver
• Have confidence in the ability to recognize clinical scenarios that require escalation to the internal team nurse practitioner
• Have excellent customer service
• Have the ability to educate members, family or other caregivers on chronic conditions, diet changes, and medications.
• Utilize technology for documentation
• Have the confidence to work in a fast paced environment
• Have a quiet work environment in your home with high speed internet
• Coordinate care appropriately and timely with members of the care

Would you describe yourself as someone who has:

• Ability to fluently read, write, and speak Spanish or Cantonese or Mandarin or Russian AND English (required)
• Graduated from an accredited nursing program (required)
• Current RN License in the state of New York (required)
• The ability to work a minimum of 24 hours a week (required)
• A Registered Nurse with experience providing care to adult and geriatric patient populations (required)
• Confidence with clinical skills in performance of telephonic triage (required)
• The ability to work remotely and has a private area with a computer in their home/workspace (required)
• At least 2+ years of emergency department/care management, urgent care, and/or triage experience (preferred)
• At least 2+ years of chronic care management experience with the geriatric population (preferred)
• A genuine, compassionate desire to serve others and help those in need

Pay range is $38 per hour.

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

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

At Vesta, we are constantly searching for the most dynamic and best talent to join our team with a mission of empowering caregivers in the home!

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

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

Subrogation Investigation Specialist

Job Locations: US-Remote

ID2023-10486

Category

Audit – Healthcare

Position Type

Full-Time

Overview

We are seeking a talented inidual for an Investigation Specialist who is responsible for researching medical claim information from insurance companies, gathering third party information from attorneys and insurance adjusters, and verifying attorney representation and/or liability insurance involvement

The Subrogation Investigation Specialist position is a call center role where your primary responsibility is to support recovery of funds when one of our client’s members has been involved in an accident that was the cause of another party. You will be tasked with researching, documenting, and recording information based on phone calls, emails, and return files from 3rd party sources.

Responsibilities

You will work directly with our client’s membership, insurance adjusters, and attorney’s to:

• Recovery Function Responsible for performing a variety of tasks necessary to effectively recover incorrectly, erroneously paid, or unpaid policies and procedures
• Comply and be knowledgeable of all federal and state laws governing the collection of accounts
• Contact related parties (e.g., attorneys, adjustors, clients, and any other party involved on each account as necessary) by telephone, letter, or facsimile to obtain information related to account
• Negotiate payment arrangements within established guidelines
  Investigative Function – Research claims as investigative support for the company to maximize profits of each account worked
• Determine if a case has third party liability potential
• Work collaboratively with internal and external contacts to determine account liability
• Assign file to a Recovery Specialist after detailing investigation claims
• Coordinate benefits with no fault and first party auto carriers
• Contact consumers via telephone, mail, facsimile, or email, following recovery techniques to arrange payment in full or reasonable payment arrangements
• Execute the most feasible business decision based on accurate and thorough analysis of information obtained from the consumer responsible party and the client
• Handle inbound/outbound calls from members, attorneys, and adjusters to obtain accident details
• Investigative claims and accident details to identify recovery potential
• Update internal systems with information obtained and actions taken on account
• Ensure proper notification per client guidelines
• Effectively work, maintain, and manage a variety of cases with current and accurate notes
• Meet department objective standards for Customer Service.
• Follow account process to ensure proper investigative steps are taken on each account
• Follow client and state guidelines for determining potential for recovery on behalf clients
• Develop templates for system training materials based on the training strategy
• Deliver specific application training based on use needs analysis
• Create and document training materials based on key functionality across the application
• Coordinate with product teams to keep training materials current with updated functionality and features
• Develop additional system support materials such as user job aids

Qualifications

• High School diploma or GED required
• Minimum 6 months experience in health insurance industry, medical claims, data entry, or customer service required
• Basic knowledge of Microsoft Word and Excel required
• Basic computer proficiency required (typing, ability to navigate various websites)
• Ability to work independently to meet objectives
• Ability to perform well in a team environment
• Strong verbal and written communication skills
• Ability to be thorough and detailed when speaking over the phone or entering data
• Ability to interact with all levels of people both internally and externally in a professional manner
• Working knowledge of HIPAA privacy and security rules
• Ability to maintain a high level of confidentiality and ethics
• Basic knowledge of health insurance coverage and/or terminology preferred
• Ability to organize information to be shared to parties as required
• Ability to meet deadlines
• Bilingual (Spanish & English) a plus

Base compensation ranges from $15.20 to $18.40. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

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

#LI-KB1

#Remote

#associate

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

Clinical Operations Specialist

REMOTE

United States

Operations

Full time

Description

About Hone

Hone is a modern hormone therapy company that makes it easy for men to get back their energy, focus, and confidence. Our mission is to empower men to take back control of their health and feel like themselves again, all from the comfort of home. Our vision is to live in a world where age isn’t a limit.

Since launching in 2020, we have helped tens of thousands of men test their hormones and connect with leading hormone therapy specialists all over the country using telemedicine. We are expanding into additional therapeutic areas (like weight loss) and women’s care.

The Role

Are you passionate about helping people get back to feeling their best? Do you want to be part of the fastest-growing men’s healthcare company in the country? Are you excited about working with new technology, including an innovative new EMR built by our engineers? Are you a people person who loves to make new friends and collaborate with different teams? If so, we want to work with you.

Hone is looking for a Clinical Operations Specialist to join our team. As someone with a clinical background, you are responsible for supporting doctors and their patients with their medical care. You will review, triage, and escalate physician and patient issues in collaboration with the customer service, clinical, and operations teams so that Hone patients have the best experience on our program. You must thrive in a fast-paced environment that requires excelling in an unstructured setting and thinking outside the box.

Requirements

• Own patient communications for clinical questions (e.g. side effects, prescriptions, labs) and know when to escalate the issue.
• Work with the clinical and operations team to make sure the patient receives fast resolution to any concerns.
• Support physicians to ensure any patient care issues are resolved in a timely manner.
• Follow established protocols and processes, with an eye towards improving operational processes to provide the best patient experience.
• Be willing to take on additional clinical projects or responsibilities when necessary.

Qualifications

• Medical background
  • RN or equivalent degree, preferred
• Very comfortable using common technology platforms (e.g. Gmail, Google Docs, Google Sheets, Google Meet).
• Can quickly learn new technology systems (e.g. Hone’s EMR) and communication tools (e.g. Slack, Zendesk).
• Demonstrated attention to detail and problem-solving skills.
• Organized multitasker.
• Effective and compassionate communicator (written and verbal).
• Ability to work autonomously and collaboratively.
• Must be a self-starter who looks for opportunities for improvement regularly.
• Preferred, but not required: Knowledge of testosterone deficiency in men.

Benefits

• Competitive salary, equity, and career development opportunities.
• Health, dental, and vision insurance plan coverage.
• Budget for the technology tools you need (laptop, monitor, and/or special software).
• Remote-first company.
• Company vacations and get togethers to build community.
• Generous vacation and sick days.

We are proud to be an equal-opportunity workplace committed to building a team culture that celebrates ersity and inclusion. We will ensure that iniduals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions. Please contact us to request an accommodation.

Registered Nurse (RN) – Remote Work from Home $ 34.00/hour!

Job Location US-TX-Austin

ID2023-3370

Category

Healthcare Support

Position Type

Regular Full-Time

Are you…?

Looking for a registered nurse position that is challenging, will keep your clinical skills sharp, but being doing so from the comfort of home.

Compassion-driven, self-motivated, high-performing registered nurse.

Your critical thinking and clinical skills are top-notch.

Ready for a fast-paced position where you interact with patients through innovative channels, while keeping your clinical abilities sharp.

Want to work for an organization poised for unprecedented growththat offers work-from-home options

Then we should talk.

Responsibilities

Carenet Healthcare Services is seeking RNs (Registered Nurses) to join our team of talented professionals who provide telehealth and virtual care clinical triage assessments, health education and other services to erse populations of patients and health plan members.

At Carenet Health, our nurses play an important role in helping healthcare consumers live their healthiest lives. You may not know our name, but odds are, our nurses or clinical staff have connected with you or someone you know as a trusted, behind-the-scenes partner for our clients250+ of the nation’s premier health plans, health systems and their partners.

About 50,000 times a day, our compassion-focused teams guide people via phone, video, chat and other channels to high-quality and cost-effective care, coach them to improved wellness, and educate them about their healthcare resources and costs.

Our nurses and clinical staff support patients across the U.S. and around the world. Our fast-paced positions offer innovative work-at-home capabilities, plus the opportunity to keep your clinical skills sharp and have meaningful interactions with patients in a less physically demanding setting than a traditional clinical environment.

We take great pride in our disciplined, evidence-based protocols and inidual care approach. Our most effective clinical team members combine clinical expertise, critical thinking and the ability to develop a virtual, meaningful rapport in an empathetic way By focusing on one patient at a time, you’ll leverage your clinical expertise, quick thinking and problem-solving skills to make a difference in thousands of lives every year.

Is this you?

Bring empathy and a passion for evidence-based care to all you do. Multitasking and attention to detail are your superpowers. You have a strong clinical background and believe part of your job as an RN is to advocate for your patients. You roll with the punches on any given day, with any given interaction, and never lose sight of the need to use your stellar interpersonal and quick assessment skills. You respect different cultures and know that rule-following is essential to your personal integrity and your employer’s quality compliance.

Atypical week in the life of this position:

Work independently to make clinical decisions on routine patient care matters (at your license level) Provide patient-focused care and guidance on the phone or online, including accurately assessing needs, delivering or directing to the appropriate level of care, identifying potential health problems and influencing people to make better health decisions Communicate with our organization’s clients as needed and other team members, verbally and digitally Monitor your own performance with dashboard metrics and look for ways to improve Participate in coaching sessions to improve performance Document all patient/member interactions via management software

For eight consecutive years,Inc. Magazinehas named Carenet as one of America’s fastest-growing private companies. You may not know our name, but odds are, we have connected with you or someone you know as a trusted, behind-the-scenes partner for our clients.

What’s important to us?

Being an integrity-driven organization that can truly change people’s lives Serving others joyfully and iniduallywe’re driven by the power of personal connection Pioneering next-generation healthcare consumer and clinical engagement experiences An entrepreneurial mindset A work/life balance

Qualifications

What’s required:

A min of 3 years as a Registered Nurse with recent direct patient care experience; Three (3) years preferred in a high acuity level i.e. ICU, CC, ER, med-surg, telemetry, and or Tele – Health, Telephonic Triage. Must currently reside and have a Multi-State (compact) unrestricted RN license in one of the following states: AL, AR, CO, FL, GA,IA, ID, IN, KS, KY, LA, ME, MS, MO, MT, NE, NM, NC, ND, NH, OK, SC, SD, TN, TX, VA, WI, WY Ability to become licensed in additional states as required

Minimum of an associate’s degree from a two-year technical college or technical school, or diploma nursing program; Bachelor’s degree preferred

More important information:

Full-time positions available (36-40 hours per week) Your schedule will include at least two weekend days every two weeks. Differential pay may be earned for certain shifts. Training is2-3 weeks, with the firsttwo weeks during daytime hours.100% Attendance is required. Training is done in a virtual, interactive classroom setting. For work-from-home positions, your home office must meet certain certification requirements that would be explained to you during the interview process.

Call Center Clinical Pharmacy Technician – Remote

locations

Home

time type

Full time

job requisition id

R-09739

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Call Center Clinical Pharmacy Technician – Remote

Job Description Summary

Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.

Job Description

• As a Call Center Clinical Pharmacy Technician working remotely, you will be responsible for high volume inbound call center serving calls from Members, Pharmacies and Prescribers for Medicaid/Medicare or commercial pharmacy benefits management business.
• You will be evaluating and authorizing approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
• Your performance measurements include quality, average handle time, productivity metrics, schedule adherence, and behavioral competencies.
• You must be available to work a set schedule during training and must be available and commit to work any assigned shift between the hours of 8AM and 10PM ET daily including weekends and holidays.
• You will determine appropriateness for medications and communicate decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
• You will research, resolve and document prior authorization outcomes in pharmacy system.
• You will communicate selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
• You will escalate requests to Pharmacist when request requires extensive clinical review or denial.
• You will research, resolve and document physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
• You will perform other duties as required.
• For CPTs assigned to work the fax queue, responsibilities will also include:
• Clinically reviews coverage determinations with attention to detail, for medications via Fax. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists within SLA (service level agreement) guidelines.
• Efficiently multi-tasks and monitors several queues and assignments. Adapts to team requirements as business needs change (e.g., fax work, pending queues, oral notifications, and failed faxes).

Responsibilities

• Must have an active pharmacy technician licensure or registration in accordance with state requirements.
• If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT).
• In states that do not require licensure or registration, or that restrict licensure to employees of dispensing pharmacies, must have an active national certification (e.g., PTCB or ExCPT).
• Active Pharmacist license supersedes requirement for CPT and/or PTCB.
• Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
• In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
• Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
• Excellent written and verbal communication skills.
• Ability to follow clinical criteria and instructions to approve prior authorization requests.
• Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.
• Ability to identify and trouble-shoot problematic issues.

Work Experience

Work Experience – Required:

Pharmacy

Work Experience – Preferred:

Education

Education – Required:

GED, High School

Education – Preferred:

Certifications

Certifications – Required:

CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements – Pharmacy – Pharmacy

Certifications – Preferred:

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the “Benefits at a glance” button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage erse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.

Scheduling Specialist

Remote

Full Time

Entry Level

About Us

Upperline Health launched in 2017 and is one of the nation’s leading comprehensive and coordinated lower extremity healthcare organizations. Upperline Health provides the highest quality integrated health services to more patients in need through a skilled and compassionate team. We specialize in targeting patients at risk of developing complications and intervening earlier with an innovative care management approach to prevent more serious consequences. Upperline Health is based out of Nashville, TN and currently has practices in Alabama, California, Florida, Indiana, Kentucky, Georgia and Tennessee.

Benefits

Comprehensive benefit options include medical, dental and vision, 401K and PTO.

About the Scheduling Specialist Role

Upperline Health Indiana is seeking a Scheduling Specialist to support our team of clinicians in delivering complex health services in the clinic setting. This person will be based REMOTELY but in Indianapolis, IN area and will be responsible for performing centralized appointment scheduling and a variety of clerical tasks. Candidates must possess excellent customer service skills and an engaging and professional phone presence. Responsibilities will be varied, and requires multitalented, flexible problem solvers who are eager to tackle complex problems and thrive in a fast-pace environment.

Scheduling Specialist Responsibilities

• Provide telephone scheduling support to our podiatric clinics
• Schedule patients via office scheduling policies and confirm appointment times
• Educate patients on the impactful services of Upperline Health Indiana clinics
• Answer and screen in-bound calls, take messages, and provide appropriate information to patients
• Proactively handle outgoing phone calls including, but not limited to appointment confirmations, referral calls, and pre-certifications
• May be requested to support and perform other duties based on business demand

Scheduling Specialist Experience Qualifications

• Minimum of one year of experience in a call center, managing a call queue or medical appointment scheduling
• Experience scheduling for multiple-doctors and locations and/or high-volume scheduling
• Bi-lingual (English and Spanish) is a plus
• Familiarity with health insurance plans is required
• Previous experience in a clinic or hospital setting handling patient interactions
• Previous working in a Practice Management and EHR system Athena system experience preferred
• Exceptional customer service orientation featuring an empathetic, compassionate and professional demeanor with each interaction
• Must be an effective communicator with excellent grammar and interpersonal skills
• Excellent data-entry skills and proven ability to navigate multiple computer systems, including uploading documents and faxing
• Demonstrated experience as a motivated and dedicated team member with a stable work history
• Thrives in a fast-paced environment that relies on the ability to multi-task, energy and drive balanced with sensitivity and compassion

Compensation

Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience.

Job Type: Full-time

Coding Specialist

Location: Remote

How will this role have an impact?

As a Coding Specialist you will review and evaluate health assessments/evaluations to assign, edit and/or validate the appropriate ICD-10 codes that are clinically identified and supported in the assessment/evaluation on a timely basis. A Coding Specialist performs coding and/or code validation across multiple entities by applying all appropriate coding guidelines and criteria for code selections.

This role will report to our Senior Coding Manager!

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.

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-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 ICD-10 coding and HCC (hierarchical condition category) coding.
• Utilizes advanced, specialized knowledge of medical codes and coding protocol by providing guidance to the Sr. Coding Manager 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 coding, compliance and reimbursement procedures related top Medicare Risk Adjustment.
• Make recommendations for coding policy/changes.
• Maintain coding certification after achieving certification status.
• Complete special projects as assigned by management, which require defining problems, and implementing required changes.
• Responsible for the security and privacy of any and all protected health information that may be accessed during normal work activities.

We are looking for someone with:

• Must hold an active CPC, CPC-A, COC, CCS, CCS-P or CCA
• Current coding certification in good standing.
• CRC preferred
• ICD-10 Coding Certification will be required
• Minimum of 0-5 years of ICD-10 coding experience.
• Prior work experience in the healthcare field specifically related to coding is preferred.
• Experience and knowledge of Medicare HCC coding.
• Experience with medical record documentation.
• Prior medical chart auditing/quality experience preferred.
• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology

About Us:

Signify Health is helping build the healthcare system we all want to experience by transforming the home into the healthcare hub. We coordinate care holistically across iniduals’ clinical, social, and behavioral needs so they can enjoy more healthy days at home. By building strong connections to primary care providers and community resources, we’re able to close critical care and social gaps, as well as manage risk for iniduals who need help the most. This leads to better outcomes and a better experience for everyone involved.

Our high-performance networks are powered by more than 9,000 mobile doctors and nurses covering every county in the U.S., 3,500 healthcare providers and facilities in value-based arrangements, and hundreds of community-based organizations. Signify’s intelligent technology and decision-support services enable these resources to radically simplify care coordination for more than 1.5 million iniduals each year while helping payers and providers more effectively implement value-based care programs.

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

To learn more about how we’re driving outcomes and making healthcare work better, please visit us at www.signifyhealth.com.

#LI-RD1

#REMOTE

Medical Insurance Verification Specialist

ORLANDO, FLORIDA

FINANCE

FULL-TIME

REMOTE

ABOUT US

Circle Medical is a venture-backed Y-Combinator healthcare startup on a mission to bring quality, delightful primary care to everyone on the planet. Built by top-tier physicians, engineers, and designers, our medical practice and underlying technology have pioneered how people find and receive care.

Our focus on building directly for our patients and providers to address serious care accessibility issues has enabled us to grow over 3X year-over-year. We’re now using our most recent round of funding from WELL Health, backed by Sir Li Ka-shing, to continue building out our hybrid in-clinic and telemedicine model across all fifty states.

As we enter the hypergrowth phase, we are looking for deeply motivated team players who are driven to solve some of the biggest challenges in healthcare so that people can live longer and healthier lives.

More about us can be found on our website.

DESCRIPTION

We are currently looking for a Medical Insurance Verification Specialist to join the Finance team at Circle Medical Technologies. As we continue to grow, we are constantly searching for exceptional talent to be a part of our team. This position will be remote in the U.S. for the right candidate.

WHAT YOU’LL DO

• • Accurately carries out the responsibility for verifying patient insurance coverage and ensures that necessary visits and procedures are covered by an inidual’s provider
  • Demonstrates proficiency in working with insurance companies (phone, chat, website) and has extensive knowledge of different types of coverage and policies
  • Forwards patients who have outstanding balances to a Billing Representative
  • Maintains and adheres to the company’s HIPAA and Compliance regulations

WHAT YOU’LL BRING

• • Proficient with Google Workspace, Microsoft Office Suite, or related software
  • Demonstrates excellent multitasking skills, with the ability to work on many projects at once. Is very detail-oriented, organized, and maintains accurate patient insurance records
  • Uses good judgment in contacting the patient for discovered unforeseen issues (i.e. anticipated procedure not covered, large co-pay or co-insurance, patient’s insurance premium was not paid)
  • Utilizes patient charts on an as needed basis, accessing only information related to treatment, payment, and health operations
  • High speed internet access required

EDUCATION & EXPERIENCE

• • High School diploma or College Degree (preferred)
  • At least two years prior insurance verification experience in a medical office, hospital facility, or call center (required)
  • Knowledge of customer service principles and practices

WHAT WILL GIVE YOU AN EDGE

• • Proven track record with other startups or VC funded companies
  • Is proficient in the use of Availity and insurance-specific portals to accurately verify insurance coverage and patient responsibility

COMPENSATION

In alignment with our values, Circle Medical has transparent salaries based on output levels, and options to trade cash for stock.

This is a full-time, hourly, non-exempt position with an hourly rate of $20.42 to $24.50 plus generous vacation, and full medical/dental benefits.

Telehealth Triage Nurse

Location: United States

Remote – Part Time to Full Time

Telehealth Triage Nurse (Remote)

Fonemed is recruiting remote Registered Nurses to join our team! We are looking for experienced and dependable Registered Nurse who are dedicated to providing quality nursing care to patients. If you are a Registered Nurse who is looking for a challenge and a company who values you, apply today!

With over 20 years in the telehealth industry servicing clients across North America, Fonemed prides itself on providing outstanding client experience and practicing a culture of care in everything we do. If you are looking for an opportunity to practice your nursing skills from home and work for company that values you, apply today!

Position Overview

Our nurses provide telephone triage and health advice to callers across the United States remotely from the comfort of their own home using world renowned Schmitt-Thompson protocols and provide nursing care advice virtually to patients. Calls received can vary greatly in subject matter and complexity. In addition to triage calls, we receive questions requesting information on medical conditions, medications, diagnostic tests, etc., and provide patient support through addressing their medical questions and concerns.

Registered Nurses must be attentive and engaged listeners who have strong critical thinking and clinical assessment abilities and are able to make decisions independently and document clear clinical data. All calls are documented electronically, and all telephone encounters are recorded.

Role Responsibilities

• Provide telephone triage and advice to callers to assist them in making timely medical decisions
• Exercise clinical judgment in combination with utilization of protocols to arrive at the appropriate disposition to provide timely and accurate level of care to patients
• Promptly complete confidential medical records as per company documentation standards
• Provide clear and concise information and direction during patient encounters

Shifts and Scheduling

• Fonemed is a 24/7 operation, meaning shifts can include days, evenings, overnights, weekends and holidays, with staggering starting times for operational needs
• Our highest operational need at this time is during weekend afternoons on both Saturday and Sunday
• Please note, there are no permanent overnights currently available as our overnight team is full. Permanent overnight requests will be considered based on seniority when space allows
• Part Time options available:
  • 0.5 FTE 20 hours/week working every weekend with 1-2 short evening shifts per week.
  • 0.5 FTE 20 hours/week working 3 weekends on/1 weekend off with 1-2 short evening shifts per week please note in this option, the week with your weekend off you would be scheduled more throughout the weekdays to account for the 20-hour work week.
  • 0.25 FTE 20 hours biweekly working every second weekend with 1-2 short evening shifts over a 2-week period.
  • Full time opportunities will be considered depending on factors such as licensure, availability, fluent languages, etc. and will be evaluated to determine eligibility.

Expectations of Nurse

• Private HIPAA compliant home office with high-speed internet connectivity (wired/ethernet highly recommended)
• Must be able to provide own computer equipment (computer or laptop, second monitor, keyboard, mouse, wired headset and high-speed internet)
• Participation (via telephone or video) in staff meetings
• Full compliance with FONEMED policies and procedures, including HIPAA privacy requirements
• Provide patients your dedicated, unided attention during your calls

Qualifications and Experience

• Completion of a recognized Nursing program
• Minimum 3 years of recent clinical experience as a Registered Nurse, preferably in areas such as ER/Urgent Care, Adult, Pediatric, OB/GYN, Orthopedic, Ambulatory Care, Home Health, or ICU
• An active license in CA is required, along with active license in your home state.
• Active RN license in the following states would be considered an asset: AK, PA, NY, OR and WA
• Active licensure in all 50 states would be an asset or the willingness to obtain licenses at the company’s request
• Previous telephone triage experience using electronic triage software and computerized medical protocols will be considered an asset
• Experience using the Barton Schmitt/David Thompson guidelines will be considered an asset
• Strong communication skills
• Strong clinical assessment skills
• Strong computer skills within a Windows environment and keyboarding ability
• Bilingual English/Spanish or another language will be considered an asset

Why Work With US:

• Competitive hourly pay, with shift differentials for overnight and weekend hours
• Company reimbursement for licensure costs
• A comprehensive training and orientation program with a supportive team of co-workers and managers
• A friendly and collaborative work environment from a company who values our employees
• Recognition of employee achievements and milestones

Telehealth Triage Nurse

Remote

Part Time

Mid Level

SHARE

Since 2004, Sequence Health has offered a wide breadth of innovative patient engagement and patient management solutions to help optimize operational efficiency, elevate brand awareness, and grow physician practices and healthcare businesses.

We are seeking a Registered Nurse who will provide nursing and administrative support to a range of practices across the country. Candidates should have strong computer skills and excellent phone skills to work with providers, patients, and administrators. This position will be for overnight and weekend work, potential day shifts available.

Essential functions include:

• Receive inbound calls from patients and place outbound calls to patients.
• Provide clinical assessment based on established protocols and triage patients by phone or through patient portal.
• Respond to patients’ messages in patient portal, create orders and route to appropriate parties.
• Provide administrative support for patients’ and providers’ needs in terms of FMLA, ADA, and LTD/STD
• Communicate with Health Care Provider through approved methods as needed.

Qualifications:

• Registered Nurse
• Current demonstration of clinical proficiency
• Excellent written and oral communication skills
• Excellent critical thinking and problem-solving skills
• Ability to work within approved procedure and clinical guidelines
• Electronic Medical Record Experience, i.e EPIC, Cerner, Greenway
• Ability to use windows-based computer software including ADOBE, MS Word, MS Excel, Fax and others

Minimum Requirements

• Registered Nurse with Unencumbered e-NCL Licensure. Licensure in Nebraska, California licensure required.
• Minimum of 5 years’ experience in working in a variety of direct patient care settings including Emergency Department, Labor and Delivery, Critical Care. Women’s Health or Labor and Delivery experience preferred.
• Able to work remote at home in a private HIPAA compliant workspace
• Able to house company equipment needed to perform job
• Broadband Internet Access
• Immigration or work visa sponsorship will not be provided
• Physical Demands:
• Ability to hear in normal range and wear a headset / earpiece
• Good visual acuity to read computer screens, scripts, forms etc.
• May sit 100% of the time when taking calls

Title: Provider Solutions Associate

Location: Remote – USA

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

The Provider Solutions team ensures that Clover is successfully managing our contracted providers’ most complex operational needs. The Provider Solutions team will serve as a conduit between Clover and our providers to diffuse and resolve critical payor-provider escalations. The Provider Solutions team will work with operational leaders across Clover, including, but not limited to Provider Data, Claims, Configuration, Payment Integrity, Customer Experience, Network, and Finance to optimize Clover’s provider relationships.

As a Provider Solutions Associate, you will play a vital role in strengthening provider relationships through resolution and education of complex provider issues. We are looking for a candidate with experience in health plan operations and a thorough understanding of the provider/payer dynamic and claims processing. Additionally, the ideal candidate will be comfortable interacting with administrators and executives within provider organizations as well as within Clover. The candidate should have a strong ability to synthesize issues, create a plan for resolution, and effectively communicate to all parties.

Come be at the heart of the action!

As a Provider Solutions Associate, you will:

• Be the subject matter specialist on all the Clover Health Operational area processes including: Contracting, Payment Integrity Audits, Member Grievances, Claims Configuration, and Processing.
• Lead projects to improve the overall provider experience.
• Become the designated representative for high priority providers and lead external calls on a monthly cadence and/or as needed.
• Research, resolve, and respond to provider-related escalations received internally and externally.
• Work cross-functionally with internal teams to research and resolve standard provider escalation issues including but not limited to claims, contract, provider data/directory, configuration, payment integrity and payment issues.
• Outreach to provider groups as needed to educate providers on network status and new Clover policies, initiatives, and best practices.
• Assist in identifying opportunities for process and technology improvements to drive down provider abrasion.
• Escalate issues to The Provider Solutions Management team when appropriate.
• Manage and/or support other projects and activities as assigned.

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 providers’ lives, while also advocating for their needs.
• You are a team player. You know how to communicate effectively to build trust and lasting partnerships with many different types of people, teams, and stakeholders.
• You are a strategic prioritizer. You are able to identify where and when to focus your energy.
• You enjoy technology. You like learning about new programs and leveraging them to solve large issues.
• You have a critical and analytical mindset. You are able to break down complex information and/or comprehensive data into basic principles in order to make a thoughtful decision.

You should get in touch if:

• You have 3+ years experience in the health and medical insurance industry.
• You are proficient in Data Analytics and a multitude of programs including but not limited to: Microsoft Excel, Salesforce, JIRA, Mode, and Google Suites.
• You are a certified professional coder, preferred but not required.
• Understanding of healthcare topics such as: claims processing, prior authorizations, medical billing and coding, payment integrity and reimbursement practices for physician and facility services.
• Understanding of compliance and payer requirements, including but not limited to CMS Medicare regulations and guidelines.
• Understanding of interpreting medical records, CPT and ICD-CM coding guidelines.

#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.

Account Representative III

Remote Location

Full time

219669

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

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

Job Title: Account Representative III

Location: Cleveland

Facility: Remote Location

Department: RCM Special Billing-Finance

Job Code: U18025

Shift: Days

Schedule: 8:00am-4:30pm

Job Summary

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as the No. 4 hospital in the nation, according to the U.S. News & World Report. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

As an Account Representative III, you will perform a specific operational responsibility within a revenue cycle management functional unit including customer service, insurance billing and follow-up processes for commercial and government payers, insurance verification, cash application, credit balance resolution, and/or account reconciliation. The ideal future caregiver is someone who:

• Is engaged with their job responsibilities.
• Thrives working both independently and as part of a team.
• Acts in a professional, caring, and helpful manner.
• Is an effective communicator.

By taking this opportunity, you’ll have the opportunity to learn and develop within the team as well as advance your career into positions such as CSR I, II, III, Work Leader, and more.

At Cleveland Clinic, we know what matters most. That’s why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you’ll find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future. When you join Cleveland Clinic, you’ll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare.

Job Details

Responsibilities:

• Recommends and provides input to execute customers service programs in accordance with changes in insurance reimbursement regulations and data obtained from various groups.
• Provides supervisor/manager with information to assist department liaison with various departments in regards to various issues including but not limited to contract and reimbursement rules. Complies, recommends and assists with the implementation of various management reporting systems to insure accurate and timely reporting of department goals and results.
• Assists with department audits as required. Participates in meetings with various payors, internal billing groups and other CCF departments to address discrepancies in payment and provides summary data and trend analysis to Managed Care Business Development for use in contract negotiations.
• In conjunction with supervisor, recommends changes in billing practices intended to reduce payor mis-adjudication of claims and identifies contract language or specific payment methodology contributing to errors in payment.
• Maintains data and develops enhancements to database and other various management reporting systems to insure accurate presentation of trends in payor reimbursement, error rates, and maximize recovery of underpayments.
• Validates new and existing contracts and reimbursements rules/logic.
• Other duties as assigned.

Education:

• High School Diploma or GED required.
• An Associate’s Degree may offset one year of required experience.
• A Bachelor’s Degree may offset two years of the required experience.

Certifications:

• None required.

Complexity of Work:

• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.

Work Experience:

• Minimum of three years patient accounting experience.
• An Associate’s Degree may offset one year of required experience.
• A Bachelor’s Degree may offset two years of the required experience.
• Knowledge of patient accounts which includes customer service, insurance processing, insurance verification and cash application.
• Knowledge of additional specialized function may be required such as third party payors, Medicare processing, hospital and physician billing and pricing, CPT4/ICD code application.
• Must have excellent verbal and written skills.

Physical Requirements:

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

Personal Protective Equipment:

• Follows standard precautions using personal protective equipment as required.

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinic Health System’s Smoking Policy will be permitted to reapply for open positions after 90 days.

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

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.

Title: Primary Care Telehealth Nurse Practitioner (Part Time)

Location: United States

Hello! We’re Babylon, a leading digital healthcare company.

Our mission is to make high-quality healthcare accessible and affordable for everyone on Earth. Building on the success of Babylon in the United Kingdom, Rwanda and Canada, we are building a 50-state provider network in the United States. We want to provide health services to the Medicaid population, who are often underserved and overlooked. Today, we cover over 3.5 million members in the US.

By shifting the focus from sick care to preventative care, we’re creating a better model of healthcare. One that combines AI-powered technology with the highest quality clinical expertise so we can help people live healthier, longer lives. With over 2,000 global employees, we’ve brought together one of the largest teams of healthcare professionals, scientists, mathematicians and engineers.

Our talented team is looking to hire the best clinicians and operations talent to build and scale in the US. We’re driven by people whose ideas and energy align with our mission and our values: to dream big, build fast and be brilliant.

The Opportunity

Babylon is hiring part-time Family Medicine or Medicine-Pediatrics Nurse Practitioners to help us redefine the healthcare landscape in America. As a Babylon Provider, you’ll get the opportunity to work with a global digital healthcare and AI company that is truly making an impact across the globe. To support our mission to provide affordable and accessible healthcare, this position is 100% remote and supports a national primary care service.

WHAT YOUR WORK WILL ENTAIL:

• Provide the full scope of primary care and urgent care services which fall under his/her field of training, including but not limited to diagnosis, treatment, coordination of care, preventive care and health maintenance to patients.
• Orders or executes various tests and diagnostic images to provide information on a patient’s condition.
• Reviews incoming reports (e.g. lab, x-ray, EKG) signs, dates and follows-up with results in the timeframe outlined in Babylon policies
• Educate patients regarding health and illness prevention. Recommend community resources to meet patient and family needs.
• Administers or prescribes treatments and medications, and instructs patients on proper utilization.
• Supervises and collaborates with advanced practice nurses, physician assistants, and clinical pharmacists
• Close collaboration with scheduling and nursing support teams
• Close collaboration with other care team members, including but not limited to behavioral health providers
• Provide coordinated care services and lead care teams as necessary to provide appropriate care based on evidence-based guidelines
• Flexibility in scheduling to facilitate us staffing our primary care service 365 days a year

Qualifications (NP):

• 3+ years of experience post licensure as a Family Nurse Practitioner
• FNP (Telemedicine experience preferred)
• Active state license (Medicare and Medicaid enrolled preferred)
• Proficiency with Electronic Medical Records and other technologies (Athena preferred)

WHAT WE OFFER:

• Competitive compensation
• Medical Malpractice Coverage
• Medical, Dental and Vision Insurance (full-time only)
• License renewal and/or reimbursement as well as opportunity to obtain additional licenses based on business needs and growth.
• We provide a full training program and a supportive environment to help improve your video consultation and clinical skills, including ongoing appraisals and peer reviews
• CME 5 days and $1000 a year for full-time providers, prorated for part-time.
• 4 weeks’ accrued paid vacation
• 401k with employer matching contribution
• Incredible growth opportunities with a global health tech startup with a meaningful mission

#LI-remote

Salary Range Disclosure (US ONLY)

At Babylon the US base compensation for this part-time position is $67.31/hr – $70.67/hr. The range displayed reflects the minimum and maximum target for new hire salaries across all locations in the US. Within the range, inidual pay is determined by work location and additional factors, included job related skills, experience, and relevant education or training.

Compliance Disclosure (US ONLY)

If you are a Babylon employee who is also a California resident, under the California Consumer Protection Act of (2018) as amended, you have a right to:

• know about the personal information Babylon collects about you and how it is used and shared;
• correct inaccurate information;
• delete personal information collected from you (with some exceptions such as if it is still needed for the purpose for which it was provided or if we are required by law to maintain it);
• limit the use and disclosure of your sensitive personal information;
• opt-out of automated decision-making technology;
• opt-out of the sale of your personal information; and
• non-discrimination for exercising your CCPA rights (including employment decisions or retaliation).

WORKING AT BABYLON

Whether you work in one of our amazing offices or a distributed team, Babylon is highly collaborative and fun! You’ll have a chance to work in a fast-paced environment with experienced industry leaders. We have a learning environment where you can make an impact.

WHO WE ARE

We are a team on a mission, to put accessible and affordable healthcare in the hands of every person on earth. Our mission is bold and ambitious, and it’s one that’s shared by our team who shares our values, to dream big, build fast and be brilliant. To achieve this, we’ve brought together one of the largest teams of scientists, clinicians, mathematicians and engineers to focus on combining the ever-growing computing power of machines, with the best medical expertise of humans, to create a comprehensive, immediate and personalized health service and make it universally available.

At Babylon our people aren’t just part of a team, they’re part of something bigger. We’re a vibrant community of creative thinkers and doers, forging the way for a new generation of healthcare. We’re only as good as our people. So, finding the best people is everything to us. We serve millions, but we choose our people one at a time

DIVERSITY AT BABYLON

We believe that difference inspires a better, healthier world. That’s why it’s at the heart of everything we do. From our people to our products, difference enriches every part of our business and creates a culture based on equality of opportunity, and in which all Babylonians can progress their careers. We’re committed to creating an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, colour, religion, sex, pregnancy status, national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information, and any other characteristic protected by applicable law.

Nurse Case Manager

locations

• Portland, OR
• Remote, USA

time type Full time

job requisition id REQ003818

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

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

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

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

JOB PURPOSE

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

PRINCIPAL ACCOUNTABILITIES / ESSENTIAL FUNCTIONS

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

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

ESSENTIAL FUNCTION REQUIREMENTS

Demonstrated skills: Effective case management. Effective identification and resolution of problems. Clear and persuasive expression of ideas in both written and oral communications. Effective collaboration with peers and team members.

Ability to: Utilize computer software and hardware applications. Talk by telephone. Shift priorities to meet demands from various customer groups. Make decisions in the absence of specific direction. Facilitate group discussions. Achieve professional designation.

Working knowledge of: Assistive devices needed by people with disabilities. The Americans with Disabilities Act, family leave laws, Fair Claims Settlement Practices Act, and laws governing client confidentiality.

QUALIFICATIONS

Education: BS or MS in a related field.

Experience: A minimum of 4 years hospital or clinical experience in relevant medical fields (e.g. cardiology, orthopedics, mental health) or utilization review or quality management, or the equivalent combination of education and/or relevant experience.

Professional certification required: Current Registered Nursing license, with a CCM or CPDM designation or ability to obtain such a designation within 2 years of hire. Is a job requirement

#LI-REMOTE

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

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

Salary Range: $71,000.00 – $104,000.00

Standard Insurance Company, The Standard Life Insurance Company of New York, Standard Retirement Services, Inc., StanCorp Equities, Inc. and StanCorp Investment Advisers, Inc., marketed as The Standard, are Affirmative Action/Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, religion, color, sex, national origin, gender identity, sexual orientation, age, disability, or veteran status or any other condition protected by federal, state or local law. The Standard offers a drug and alcohol free work environment where possession, manufacture, transfer, offer, use of or being impaired by an illegal substance while on Standard property, or in other cases which the company believes might affect operations, safety or reputation of the company is prohibited. The Standard requires a criminal background investigation, employment, education and licensing verification as a condition of employment. All employees of The Standard must be bondable.

Senior Investigator (Healthcare Fraud)

Job Locations US-Remote

ID 2023-9775

Category Fraud, Waste, & Abuse

Position Type Full-Time

Overview

As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis (a high level of proficiency with Excel is required). This is not a physical investigator role. This position may be worked remotely from home anywhere in the US.

Responsibilities

• Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse.
• Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial or review.
• Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation.
• Conducts investigation-related training.
• Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions.
• Negotiates settlement agreements to resolve disputes.
• Maintain current knowledge of relevant laws, regulations and standards.
• Participates in special projects as required.

Qualifications

• Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience.
• 5-8 years of related investigative experience.
• Advanced level skills in Excel.
• Excellent verbal and written communication skills.
• Strong listening and observation skills.
• Attention to detail and high level of accuracy.
• Effective organizational and prioritization skills with multi-tasking ability
• Preferred certifications:
  • Accredited Healthcare Fraud Investigator (AHFI),
  • Certified Fraud Specialist (CFS),
  • Certified Fraud Examiner (CFE),
  • Certified Forensic Interviewer (CFI), or
  • Certified in Healthcare Compliance (CHC).

Job Demands:

• This is a work-at-home position. Access to high-speed internet is required (all other equipment will be provided).
• Must be able to sit and use a computer keyboard for extended periods of time
• Travel up to 15%
• Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
• After hours and/or weekend work required where necessary for major deliverables/deadlines (not consistent)

Base compensation ranges from $64,500 to $85,000. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

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

#senior

#LI-JB1

#LI-Remote

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

Pay Transparency Nondiscrimination Provision

Cotiviti will not discharge or in any manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as part of their essential job functions cannot disclose the pay of other employees or applicants to iniduals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)

Virtual Psychiatric Nurse Practitioner (Full-Time) (California Licensed)

Remote

Role Summary: As a Psychiatric Mental Health Nurse Practitioner at Tia, your role in this transformative healthtech company will be foundational in setting the tone for the mental health care delivered at Tia. You will work closely and collaboratively with a growing multidisciplinary team of Therapists, MDs, NPs, and Acupuncturists in a virtual primary care setting ensuring optimal patient care. You will conduct responsible and compassionate psychiatric assessments, diagnosis, treatment planning, medication management, and referrals. You will also work cross-functionally to weave the mental health perspective into our educational offerings, supporting the clinical team in case consultation, health education / guidance, quality and policy development through collaboration and staying abreast of current trends and best care practices.

A bit about you:

Values and abilities you’ll bring to Tia:

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

Skills and assets you’ll bring to Tia:

• You’re a board certified Psychiatric Mental Health Nurse Practitioner with an active and unrestricted license in the state of California, able to provide patient centered mental health and psychiatric care with compassion and empathy. While experience providing virtual care in the past is not a must – it is highly desired!
• At least 2 years post graduate clinical experience.
• Confidence prescribing, titrating, refilling, and monitoring psychotropic medications in all 5 major classes (anti-anxiety agents, antidepressants, antipsychotics, mood stabilizers, and stimulants)
• Experience with the following: Adjustment disorders, anxiety, depression, trauma, personality disorders, substance use and dependence, cognitive impairment, bipolar spectrum, attention-related disorders, postpartum depression, schizoaffective disorders, sleep disorders, and acute psychosis
• Knowledge and expertise in facilitating extended mental healthcare interventions in the greater NYC-area, greater LA-area, greater SF Bay Area or greater Phoenix area (ie. referrals and social service resources)
• Documentation skills requirements for an accurate and complete medical record
• Collaborate closely with MH and NP Leads to identify and support high-risk patients
• Exceptional written and verbal communication skills.
• Demonstrated excellence in Interpreting and act on clinical labs + ultrasound results
• Willingness to work evenings + weekends as needed by schedule
• Authorized to work in the US

Other nice to have skills:

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

Tia requires that Nurse Practitioners complete credentialing with specified payors and that you authorize Tia to complete this credentialing through our preferred vendors.

Benefits

• Talented and collaborative team who will both support and challenge you.
• Remote role with flexibility to work from home
• Market competitive salary
• Annual CME stipend
• Medical and dental benefits
• Paid holidays, vacation, and sick leave

Per California Pay Transparency Laws (as of Jan 1, 2022), please see below for the compensation range for this role:

Salary range: 140k-160K depending on experience for a 40 hour a week (FT role) plus performance-based bonuses.

Internal Auditor II – Hospital Coding

Apply

locations

Sacramento

Remote – Utah

Remote – Texas

Remote – Tennessee

Remote – South Carolina

View All 17 Locations

time type

Full time

posted on

Posted 7 Days Ago

job requisition id

R-39401

We are so glad you are interested in joining Sutter Health!

Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

This Compliance Auditor role will have primary responsibility for leading a variety of independent assurance and consulting projects covering the operational, regulatory, and reporting processes of Sutter Health and its Affiliates’ functions related to Hospital Coding.

Responsible for assisting in advancing the departmental mission in a manner consistent with the values and standards of Sutter Health, the Department and the internal audit profession. Responsible for familiarizing themselves with the annual work plan, researching relevant topics to carry out assigned project areas and fostering important strategic relationships with other functions and affiliates. Participates in improving the efficient and effective delivery of the Department’s assurance and consulting services including promoting the departmental brand.

Job Description:

• This role is in the Ethics & Compliance Team and involves hospital coding.
• Candidate must be a certified coder (CPC or CCS) to be considered for this role.
• Canidate must live in the Northern California Sutter footprint and come on site as needed for meetings, etc.

EDUCATION:

Bachelor’s: Degree in Accounting, Auditing, Finance or other Business Administration area. or equivalent education/experience

TYPICAL EXPERIENCE:

• 2 years recent relevant experience

DEPARTMENT REQUIRED CERTIFICATION & LICENSURE:

• Department: Coding Audit, CPC-Certified Professional Coder
• OR Department: Coding Audit, CCS-Certified Coding Specialist

SKILLS AND KNOWLEDGE:

• Knowledge of internal audit leading practices and computerized auditing techniques.
• General knowledge of Institute of Internal Auditors (IIA) Standards for the Professional Practice of Internal Auditing.
• Advanced analytical and project management skills, including the ability to analyze data and information, reach practical conclusions, recommend corrective actions, resolve conflicts, and institute effective changes.
• Able to display a high degree of professionalism and leadership.
• Excellent verbal and written communication, interpersonal, and presentation skills with the ability to explain complex technical or sensitive information related to audit activities clearly and professionally to erse audiences.
• Proficient computer skills, including a working knowledge of Microsoft Office Suite (Word, Excel, Outlook, Access), Microsoft Visio or other flowcharting tool, audit software applications.

Ability to:

• work independently, as well as part of a multidisciplinary team, while demonstrating excellent organization skills.
• managing multiple priorities/projects simultaneously, sometimes with rapidly changing priorities
• maintaining audit schedule
• meeting tight and often conflicting deadlines
• analyze possible solutions using precedents, existing departmental guidelines and policies, experience and good judgment to identify and solve standard problems.
• maintain strict confidentiality and ensure the privacy of each patient’s protected health information (PHI).
• build collaborative relationships with peers, other departments, stakeholders, and external agencies.

Nurse Practitioner

(New York Licensed)

Remote

About Us:

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

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

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

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

About the role:

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

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

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

A bit about you:

Values and abilities you’ll bring to Tia:

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

Skills and assets you’ll bring to Tia:

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

Other “nice to have” skills:

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

Benefits

• Remote role with flexibility to work from home
• Market competitive salary ( 110-137K depending on experience for 40 hour work week)
• Annual CME stipend
• Medical and dental benefits
• Paid holidays, vacation, and sick leave
• 6% of yearly salary bonus paid quarterly thats based on personal and company production

Triage Registered Nurse

Remote 

Clinical Strategy and Services – Clinical Team

Part-time

Remote

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

Essential Job Duties:

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

Requirements:

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

Other Skills/Abilities:

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

#LI-Remote

#LI-LC1

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.

Credentialing Coordinator

locations

US-Remote

time type

Full time

job requisition id

R0017443

At GenesisCare we want to hear from people who are as passionate as we are about innovation and working together to drive better life outcomes for patients around the world.

The Credentialing Coordinator is responsible for completing the Managed Care Credentialing/Recredentialing applications in a timely and accurate fashion. The Coordinator is responsible for follow-up to ensure that the physician is enrolled on the contracted managed care plans.

Your Key Responsibilities:

• Responsible for creating Physician Reference Guides (PRG) in the department’s Access Credentialing Database for new physicians.
• Responsible for CAQH on-line credentialing set up and maintenance efforts.
• Accurate and timely submission of Managed Care Credentialing & Recredentialing applications for physicians and paraprofessionals.
• Timely follow-up phone calls & documentation on a monthly basis to verify that credentialing applications have been received, until effective date is obtained.
• Composing email notifications regarding participation effective dates for providers to appropriate market contacts, office & billing staff members.
• Responsible for developing and updating Contract Summary Sheets with physician effective dates.
• Responsible for requesting expired information for providers on a monthly basis to keep credentialing up to date.
• Responsible for updating the Recredentialing portion of the database and auditing plans quarterly to ensure all recredentialing efforts are current.
• Updating Managed Care Monthly (MCM) Updates with provider’s effective dates.
• Notifying Managed Care plans regarding practice changes such as add/term locations & add/term providers and completing monthly follow up phone calls & documentation on open requests, until process is complete.
• Assist other departments with credentialing and contracting issues as it pertains to claims.
• Other duties as assigned.

Minimum Qualifications:

• Must have a High School Diploma or equivalent.
• Applicant must have credentialing experience in a physician office or health plan environment.
• Advanced Excel Skills and proficient in MS Office.

Preferred Qualifications:

• Experience working with Access.

About GenesisCare:

Across the world, we have more than 440 centers offering the latest treatments and technologies that have been proven to help patients achieve the best possible outcomes. For radiation therapy, that includes over 130 centers in the U.S. as well as 14 centers in the U.K., 21 in Spain and 36 in Australia. We also offer urology and pulmonology care in the U.S. in over 170 integrated medical offices. Every year our team sees more than 400,000 people globally.

Our purpose is to design care experiences that get the best possible life outcomes. Our goal is to deliver exceptional treatment and care in a way that enhances every aspect of a person’s cancer journey.

Joining the GenesisCare team means a commitment to seeing and doing things differently. People centricity is at the heart of what we dowhether that person is a patient, a referring doctor, a partner, or someone in our team. We aim to build a culture of care’ that is patient focused and performance driven.

GenesisCare is an Equal Opportunity Employer that is committed to ersity and inclusion.

#LI-BR1

#LI-Remote

GenesisCare is an Equal Opportunity Employer.

Customer Contract Analyst

Updated: Yesterday

Location: United States-North America – US Home-Based Job ID: 23003190

Description

Customer Contract Analyst

Syneos Health is the only fully integrated biopharmaceutical solutions organization purpose-built to accelerate customer success. We lead with a product development mindset, seamlessly connecting our capabilities to add high-value insights to speed therapies to patients and provide practical value to help our customers achieve their objectives.

Every day we perform better because of how we work together, as one team, each the best at what we do. We bring a wide range of talented experts together across a wide range of business-critical services that support our business. Every role within Corporate is vital to furthering our vision of Shortening the Distance from Lab to Life®.

Discover what our 29,000 employees, across 110 countries already know:

WORK HERE MATTERS EVERYWHERE

Why Syneos Health

• We are passionate about developing our people, through career development and progression; supportive and engaged line management; technical and therapeutic area training; peer recognition and total rewards program.
• We are committed to our Total Self culture – where you can authentically be yourself. Our Total Self culture is what unites us globally, and we are dedicated to taking care of our people.
• We are continuously building the company we all want to work for and our customers want to work with. Why? Because when we bring together ersity of thoughts, backgrounds, cultures, and perspectives – we’re able to create a place where everyone feels like they belong.

Job responsibilities

• Maintains ownership of and manages contract process to ensure timely delivery and execution consistent with standard cycle times, including but not limited to, the coordination and finalization of the contractual instrument and budget to align with defined scope of work.
• Negotiates and prepares contracts, budgets and related documents for participation in clinical trials. Analyzes and validates contract and budgetary changes and provides appropriate commentary to Project Managers and Customer to support the overall budget value. Proactively communicates budgetary issues to internal parties, escalates deviations to department leadership and stays engaged in communications until issues are resolved.
• Drives quarterly revenue targets through active workload management and prioritization and setting of plans for delivery and execution. Contributes to team effort and takes self-initiative to accomplish inidual targets that align with quarterly departmental goals.
• Develops Customer relationships and works independently with Project Managers and Customer on assigned projects. Attends face-to-face meetings or calls with Project Managers and Customers as needed to ensure timely execution of contract.
• Updates and maintains timely records in Customer Relationship Management (CRM) system and Contract Management System based on Global Deal and Contracts Management (GDCM) processes throughout the day on a daily basis.
• Works consistently within the department’s metrics/timelines for completion of documents.
• Follows all GDCM review processes and strives to consistently deliver a quality product to both internal and external Customers. Evaluates contracts for completeness and accuracy by comparing to department guidelines to determine adherence and ensures that corrections are appropriately made and documented to ensure the highest quality document is always delivered.
• Maintains a high level of flexibility. Creates and resets priorities as the need arises. Identifies and raises issues before they become critical and adjusts quickly to the changes of a dynamic organization.
• Perform all other duties as assigned. Minimal travel may be required (up to 25%).

Qualifications

What we’re looking for

• BA/BS degree in a Business Administration or Finance with a minimum of 1-3 years’ experience, preferably in budgeting, finance, proposal development and/or contracts management within a clinical research/pharmaceutical environment; or equivalent combination of education, training and experience.
• Must be customer-centric, self-motivated and proactive. Flexibility in responding to job demands.
• Have excellent problem-solving skills and above average attention to detail.
• Ability to perform several tasks simultaneously, to meet critical deadlines and possess strong analytical skills.
• Knowledge of Microsoft Excel, Word and an understanding of costing models.
• Ability to prepare and interpret budgets.
• Ability to work successfully in a team environment and maintain effective working relationships with colleagues and manager.
• Demonstrates effective time management skills.
• Ability to prioritize multiple tasks with management guidance and oversight.
• Excellent interpersonal, verbal and written communication skills.
• Demonstrates a positive and flexible attitude toward new and/or unconventional work assignments.
• Ability to consistently perform and deliver a high-quality work product. Excellent organizational skills. Ability to work well under pressure and adapt to changing priorities.
• Knowledge of clinical trial proposal process and budget management.
• Professional ability to interact with iniduals at all levels and different personalities.
• Proficiency in mathematics and ability to work with budgets.
• Good interpersonal skills and ability to work well with others.

Department Chair – Nursing (Online/Remote)

Job Category: Academics

Requisition Number: DEPAR004695

Posting Details

• Full-Time
• Locations: Online / Remote

Job Details

Description

* When Applying: Upload a CV and a copy of unofficial transcripts, master’s degree and above. Student issued/unofficial copies are acceptable. Please do not send us official copies, unless specifically asked.

The Department Chair is a key leadership position within the University. The Department Chair provides the leadership for a quality learning experience for students by ensuring coherence in the discipline and relevance to the practice in support of the University Mission. This leadership position contributes to a range of activities that supports student learning outcomes, program quality, discipline integrity, and faculty growth, success, and belonging, all of which focus on student learning, teaching excellence, and faculty and student retention. The Department Chair collaborates with other departments including the Office of the Provost, Faculty Human Resources, Curriculum and Assessment, Instructional Design, Trefry Library, Electronic Course Materials, and the Center for Teaching and Learning, as well as operational departments such as Advising, Registrar, Marketing, Enterprise Data Office, Workforce Learning Solutions, and Military and Corporate Outreach. The Department Chair oversees the daily operations of one or more programs and faculty.

Responsibilities:

Essential operations responsibilities include the ability to:

• Articulate the department’s goals and needs to advance the department’s programs within the School, as well as outside the institution
• Confer with internal and external stakeholders and advisory groups to obtain knowledge of student, curricular, occupational, discipline, or University needs
• Collaborate with cross-functional departments and program stakeholders to develop, measure, and evaluate student learning outcomes, instructional efficacy, and student persistence and retention for continuous improvement
• Contribute to and participate in the annual strategic planning and budgeting processes
• Manage student conduct, appeals, and grievance processes

Essential teaching and learning culture activities include the ability to:

• Hire, develop, support, and evaluate faculty
• Document faculty successes and improvements in teaching, research, curriculum management, and service
• Recognize faculty and colleagues for outstanding performance and accomplishments
• Assign courses / credential faculty to teach
• Assign appropriate amount of curriculum development to FTF
• Regularly communicates with faculty
• Convene regular faculty meetings

Essential leadership activities include the ability to:

• Develop and support faculty to ensure discipline and program continuity, currency, and relevancy
• Collaborate with faculty to ensure the program’s evolution reflects external changes in the discipline, external market, and internal changes within the University
• Empower and support faculty to create student-centric, inclusive, welcoming learning environments in which all students can succeed
• Model good engagement in the discipline
• Demonstrate excellence in teaching and share effective practices within the University community
• Uphold academic quality design by leading curriculum innovation, academic rigor, and teaching excellence

Effective leaders will possess these critical skills and professional characteristics:

• Contribute and model professionalism as a thought-leader within the discipline, the School, and the University
• Remain current on trends and developments within academic disciplines and leadership
• Take initiative to address current challenges and opportunities with forward-thinking solutions
• Show attention to detail and accountability for deliverables while managing competing priorities
• Collaborate effectively, respectfully, and constructively with faculty and staff following the APEI employee handbook, APUS employee handbook and faculty handbook
• Coach and develop others to improve performance and achieve professional goals
• Practice emotional intelligence and coaching techniques, especially when managing stressful situations and difficult conversations
• Value the ersity, equity, inclusion, belonging, strengths, and perspectives of others
• Adapt quickly to changing priorities, strategic initiatives, and industry trends
• Communicate effectively via written, oral, and visual media
• Flexibility when need arises

Required Education and Experience:

• Doctoral degree in nursing or a closely related field from a regionally accredited institution is required.
• Five or more years of nursing experience is required
• Five or more years of teaching experience is required.
• Academic management and leadership experience is required.
• Online teaching experience is required.
• Proficient in Microsoft Office Suite programs required.
• Experience with nursing specialty accreditation is strongly preferred.

Compensation and Benefits:

• Full-time faculty are salaried employees. The starting salary for this position is $90,000 annually.
• Information regarding our faculty benefits may be found here: https://www.apus.edu/about/careers/faculty.

*Please Note: Full-time faculty members and department chairs are to consider APUS their primary employer. Full-time salaried faculty and department chairs may not be full-time employees of any university, school, college, or institution of higher education outside of APUS; this includes administrative, staff, and teaching positions.

About Us:

American Public University System (APUS) is an Online University based in Charles Town, WV. Our company has over 100,000 students. Our emphasis is educating our nation’s military and public services communities with quality and affordable education. APUS provides partnership and commitment in helping students realize the dream of a higher education and the opportunities that brings. It is the policy of American Public University System (APUS) to afford equal opportunity to all qualified persons. We treat all qualified iniduals equally as to their recruitment, hiring, assignments, advancements, compensation, and all other terms and conditions of employment. of American Public University System (APUS) does not discriminate on the basis of race, color, religion, creed, sex, age, national origin, sexual orientation, or physical, mental, or sensory disability, or any other characteristic protected by law.

Sales Excellence Support Associate

locations

USA Remote

job requisition id

R3346

Get your career started at eHealth

eHealthInsurance has many exciting career opportunities in a number of locations, across various functions. Come join us today!

We are seeking a Sales Excellence Support Associates Full time and Seasonal to join the Sales Excellence team. The Sales Excellence Support Associate works directly with both sales supervisors and agents providing timely feedback with notes that will ensure inside sales agents adhere to pre-defined processes and company policies.

Attributes we are seeking:

We are seeking highly motivated self-starters comfortable being an inidual contributor as well as functioning within a group dynamic. As a Support associate at eHealth, you will be responsible for reviewing sales interactions for adherence to Sales Mastery University quality standards, while identifying areas in which to improve sales performance and increase reliability of the agent’s sales process.

• Strong listener with exceptional attention to detail, able to perform daily call monitoring and evaluate call transcripts to ensure that processes are being followed.
• Analytical thinker with the ability to analyze data and trends, and proactive in recommending opportunities to enhance the customer experience and sales performance.
• Attend weekly calibration meetings with Sales leadership team, giving feedback and running meetings
• An eye for efficiency, constantly looking for ways to streamline and improve quality assurance processes and procedures.
• Effective collaborator, capable of working with different audiences such as sales leadership, analysts, and other quality assurance specialists.
• Ability to execute in a fast-paced environment in which priorities may frequently change.
• Self-starter that is results-oriented, able to get things done without constant direct supervision.
• Team player, willing to share best practices and coach peers as necessary.
• Willingness to participate in special projects as required.

Salary: $58,000 annually

Basic Qualifications:

• Bachelor’s Degree, or the equivalent combination of education, professional training, and/or work experience
• 3+ years of relevant work experience
• Excellent written and verbal communication skills
• Good understanding of customer service industry standards

Preferred Qualifications:

• 2+ years of experience working in the Medicare industry
• 1+ year of Quality Assurance in a call center or related experience, preferably in the Medicare industry
• Basic knowledge of quality assurance and continuous improvement concepts, procedures, and processes
• Familiarity with NICE inContact or similar telephony tools
• Outstanding time management skills, with a track record of making deadlines in a fast-paced environment
• Exceptional organizational skills, with the ability to multitask and manage competing priorities

#LI-Remote

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The base pay range reflects the anticipated pay range for this position. The actual base pay offered will depend on various factors including inidual skills, experience, performance, qualifications, the department budget, and the location where work is performed. Base pay is one component of eHealth’s total rewards package, which also includes an annual performance bonus, plus an array of benefits designed to support employees’ personal and professional wellness. For more information on our total rewards offerings, please visit our career site.

–

Base Pay Range -$47,500 – $59,400

–

eHealth is an Equal Employment Opportunity employer. It is our policy to provide equal opportunity to all employees and applicants and to prohibit any discrimination because of race, color, religion, sex, national origin, age, marital status, sexual orientation, genetic information, disability, protected veteran status, or any other consideration made unlawful by applicable federal, state or local laws. The foundation of these policies is our commitment to treat everyone fairly and equally and to have a bias-free work environment.

Title: Ethics and Compliance Specialist

Location: Remote US

About iRhythm

iRhythm is a leading digital healthcare company focused on the way cardiac arrhythmias are clinically diagnosed by combining our wearable bio sensing technology with powerful cloud-based data analytics and Artificial Intelligence capabilities. Our goal is to be the leading provider of ambulatory ECG monitoring for patients at risk for arrhythmias. iRhythm’s continuous ambulatory monitoring has already put over 4 million patients and their doctors on a shorter path to what they both need answers.

About this role:

We are seeking an ethics and compliance professional with an aptitude for enabling compliant high-performing cultures. Our ideal teammate has a desire to grow professionally and a commitment to being a compliance business partner. This role will be a part of a fast-paced, results-driven environment that fosters employee growth and career development.

Responsibilities Include:

• Deliver employee training, evaluate ethics and compliance activities, and act as a liaison between the Global Risk and Integrity (GRI) team and the organization
• Conduct compliance research and develop presentations for leadership and the organization
• Develop and provide employee training on compliance policies, practices, and reporting systems
• Track compliance projects and ensure timely/effective follow up, as appropriate
• Support policies and procedures development and associated communication, education, and follow up
• Coordinate and conduct periodic monitoring and internal investigations and assessments
• Develop and track compliance dashboard(s)
• Serve as an internal and initial point of contact for compliance and privacy-related questions and concerns
• Maintain compliance program documentation
• Provide timely and effective communication with and data/reporting to the GRI team, Chief Compliance Officer, and the Chief Risk Officer
• Develop engaging compliance communications and educational materials to reinforce awareness
• Conduct work with integrity and compassion
• Engage with all teammates in support of our positive and inclusive environment

Qualifications:

• Bachelor’s degree required
• 3+ years professional experience, with 1-2 years of compliance experience required
• Experience in health care compliance field including Federal Healthcare Regulations and International Healthcare Regulations
• Experience utilizing project management methodologies
• Ability to work in a fast-paced environment while maintaining a positive attitude
• Self-motivated and self-disciplined with the willingness to exceed expectations, learn and grow
• Demonstrated learning agility and growth mindedness; adaptable to new ideas and proactively applies new learnings
• Exceptional written and verbal communication skills
• Exceptional time management and ability to multi-task and prioritize
• Ability to coordinate and work effectively across a geographically dispersed organization
• Candidate should be very experienced in Microsoft Excel and PowerPoint

Preferred Qualifications

• Life Sciences/Medical Device background is preferred, but not required
• Ability to occasionally travel is preferred
• Deep understanding of laws, regulations, standards, and risks relevant to medical device compliance is preferred

What’s in it for you:

This is a full-time position with a competitive compensation package and excellent benefits including medical, dental and vision insurance, paid holidays and paid time off.

iRhythm also provides additional benefits including 401K (w/ company match), employee stock purchase plan, annual organizational and cultural committee events and more!

FLSA Status: Exempt

As a part of our core values, we ensure a erse and inclusive workforce. We welcome and celebrate people of all backgrounds, experiences, skills and perspectives. iRhythm Technologies, Inc. is an Equal Opportunity Employer (M/F/V/D). Pursuant to San Francisco Fair Chance Ordinance, we will consider for employment all qualified applicants with arrest and conviction records.

Make iRhythm your path forward.

#LI-MC1

#LI-Remote

Outpatient Complex Coder Remote

locations

Remote US

time type

Full time

job requisition id

R4339032

Primary City/State:

Phoenix, Arizona

Department Name:

Coding-Acute Care Hospital

Work Shift:

8 hours

Job Category:

Revenue Cycle

Primary Location Salary Range:

$23.84 – $35.77 / hour, based on education & experience

In accordance with State Pay Transparency Rules.

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

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

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

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

POSITION SUMMARY

This position provides coding and abstracting for a full range of outpatient complex surgical and observation acute care services at all Banner hospitals. This includes highest level of complexity of accounts encountered in Banner’s Academic, Trauma and high acuity facilities. Reviews health record documentation and assigns diagnoses and/or surgical procedure codes on all outpatient complex records using ICD CM/PCS and CPT4 coding classification systems. Completes APC assignment on outpatient complex records as appropriate. Ensures ethical and accurate coding in accordance with all regulatory requirements and nationally recognized coding guidelines.

CORE FUNCTIONS

1. Analyzes medical information from medical records. Accurately codes diagnostic and procedural information, including modifiers, in accordance with national coding guidelines and appropriate reimbursement requirements. Consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes. Provides thorough, timely and accurate coding in accordance to department specific productivity and quality standards. Codes ICD CM/PCS and CPT4 for accurate APC assignment. Addresses National Correct Coding Initiative (NCCI) edits as appropriate. Reconciliation of charges as required.

2. Abstracts clinical diagnoses, procedure codes and other pertinent information obtained from the patient encounter. Place account in the appropriate status for required missing documentation to complete assignment of disease and procedure codes, and any pertinent abstract elements.

3. Provides quality coding by ensuring 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 Banner specific policy and procedures and applicable professional standards for a full range of outpatient complex surgical and observation acute care services at all Banner hospitals. This includes highest level of complexity of accounts encountered in Banner’s Academic, Trauma and high acuity facilities.

4. May provide mentoring for less experienced staff members. May act as a subject matter expert for complex coding.

5. Works under general supervision using specialized expertise in the subject matter. Works within a set of defined rules. Ability to address complex coding matters independently with regard to interpretation of coding guidelines, NCCI edits, and LCDs (Local Coverage Determinations) prior to referral to coding analyst, coding educator, or coding manager/supervisor.

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 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) in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).

Requires two or more years of outpatient complex experience in an acute care inpatient facility or healthcare system.

Must demonstrate a level of knowledge and understanding of ICD CM/PCS, CPT4 coding principles and coding competencies as demonstrated by certification through the American Health Information Management Association or by the American Academy of Professional Coders.

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.

Title: Full Time New York (NY) Licensed Nurse Practitioner (NP)

Remote

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

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

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

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

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

The ideal teammate would be…

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

The ideal teammate would be able to:

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

Would you describe yourself as someone who has:

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

Pay range is $120K – $125K annually based on experience.

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

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

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

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

Coordinator Appeals

Job Locations: USRemote

Requisition ID: 202389528

# of Openings: 1

Job Function: Clinical

Job Schedule: Regular FullTime

Job Summary

Essential Duties and Responsibilities:

• Function as a Subject Matter Expert in one or more process areas.
• Analyze data submitted for Independent Medical Review.
• Conduct fact finding and analyses on those cases deemed complex in nature or requiring adjudication; apply established procedures where the nature of the system, feasibility, computer equipment and reporting tools have not already been decided.
• Track and meet required deadlines for complex cases or other assigned tasks.
• Assist leadership through research of data and/or authoring reports.
• Analyze data using all applicable state law, state regulations, process documents, and other sources as defined by the client contract.
• Work independently on specific situations or on a team to resolve problems and deviations according to current established practices; and obtains advice where precedents are unclear or not available from the client.
• Answer and respond to phone calls/emails from participants in the Independent Medical Review process.
• This position may assist others or provide onthejob training or act as a mentor to production staff.

Minimum Requirements:

• High School diploma or equivalent with 0-2 years of experience.

MAXIMUS Introduction

Since 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of governmentsponsored programs. With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.

EEO Statement

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 longterm incentives as well as programspecific 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.

Posted Max

USD $24.04/Hr.

Posted Min

USD $9.62/Hr.

Professional Coder – Remote

Job ID 306596

Rochester, MN

Full Time

Finance

Why Mayo Clinic

Mayo Clinic has been ranked the #1 hospital in the nation by U.S. News & World Report, as well as #1 in more specialties than any other care provider. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans – to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic. You’ll thrive in an environment that supports innovation, is committed to ending racism and supporting ersity, equity and inclusion, and provides the resources you need to succeed.

Responsibilities

The Professional Coder reviews, analyzes, and codes professional/physician medical record documentation to include, but not limited to, medical diagnostic, lab, pathology and E/M coding information for various practices in the hospital outpatient, hospital inpatient and clinic settings.

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

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

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

Qualifications

–Associate’s Degree required; Bachelor’s Degree preferred.

-Minimum of 2 years of physician/professional coding experience with E/M services.

License of Certification:

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

Exemption Status

Nonexempt

Compensation Detail

$24.85 – $33.57 / hour. Education, experience and tenure may be considered along with internal equity when job offers are extended.

Benefits Eligible

Yes

Schedule Full Time

Hours/Pay Period 80

Schedule Details Monday – Friday with typical business hours between 8:00 am – 4:30 pm CST.

Weekend Schedule Based on business needs.

International Assignment No

Site Description

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

Affirmative Action and Equal Opportunity Employer

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

Pro Fee Coder – Radiology

• Remote – USA
• Full time

R2508

Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).

The Pro Fee Coder will review clinical documentation to assign and sequence diagnostic and procedural codes for specific patient types to meet the requirements of hospital data or physician data retrieval for billing and reimbursement. Coder I may validate APC calculations to accurately capture the diagnoses/procedures documented in the clinical record for hospitals. The Coder I performs documentation review and assessment for accurate abstracting of clinical data to meet regulatory and compliance requirements. Coder I may interact with client staff and providers.

DUTIES AND RESPONSIBILITIES:

• Select and sequence ICD-10, and/or CPT/HCPCS codes for designated patient types which may include but not limited to: Ancillary (Diagnostic)/ Recurring; Hospital, Clinic; Physician Pro Fee; Technical Fee or Evaluation and Management, any associated chart capturing with any patient type.
• Review and analyze facility records to ensure that APC assignments and/or Evaluation and Management codes accurately reflect the diagnoses/procedures documented in the clinical record.
• Abstract clinical data from the record after documentation review to ensure that it is adequate and appropriate to support diagnoses, procedures and discharge disposition is selected.
• Complete assigned work functions utilizing appropriate resources. May act as a resource with client staff for data integrity, clarification and assistance in understanding and determining appropriate and compliant coding practices including provider queries.
• Maintain strict patient and provider confidentiality in compliance with all HIPPA Guidelines.
• Participate in client and Savista staff meetings, trainings, and conference calls as requested and/or required.
• Maintain current working knowledge of ICD-10 and/or CPT/HCPCS and coding guidelines, government regulations, protocols and third-party requirements regarding coding and/or billing.
• Participate in continuing education activities to enhance knowledge, skills, and maintain current credentials.

SKILLS AND QUALIFICATIONS:

• Candidates must successfully pass pre-employment skills assessment.
• Required: An active AHIMA (American Health Information Association) credential including but not limited to RHIA, RHIT, CCS, CCA, or an active AAPC (American Academy of Professional Coders) credentials COC (formerly CPC-H), CCS-P, or CPC or related specialty credential.
• Two years of recent and relevant hands-on coding experience
• Knowledge of medical terminology, anatomy and physiology, pharmacology, pathophysiology, as well as ICD-10 and CPT/HCPCS code sets
• Ability to consistently code at 95% threshold for quality while maintaining client-specific and/or Savista production and/or quality standards
• Proficient computer knowledge including MS Office including the ability to enter data, sort and filter excel files, (Outlook, Word, Excel)
• Must display excellent interpersonal and problem-solving skills with all levels of internal and external customers

PREFERRED SKILLS:

• Recent and relevant experience in an active production coding environment strongly preferred
• Associates degree in HIM or healthcare-related field, or combination of equivalent education and experience
• Experience using Rcx, Cerner, Optum (a plus)

Note: Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $22.08 – $34.69 an hour. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.

SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.

Clinical Content Specialist – Nursing

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locations

USA-MN-Remote

USA-AZ-Work from Home

USA-IL-Work from Home

USA-IN-Work from Home

USA-GA-Work from Home

View All 7 Locations

time type

Full time

posted on

Posted 2 Days Ago

job requisition id

R0035833

R0035833

Clinical Content Specialist Nursing

MN – Remote, U.S.

We are looking for a Clinical Content Specialist – Nursing to facilitate our mission to provide both faculty and students with best-in-class educational tools. We are known as innovators in the Nursing Education market and are constantly looking for new and inventive ways to prepare students for entry-level practice. If you’re an analytical thinker passionate about enabling the next generation of nurses, we want to hear from you!

The Clinical Content Specialist – Nursing will work closely with the Content Management Consultant to integrate our products within an institution through their curriculum. Together they will also plan and deliver high quality NCLEX Review and Consultation services by identifying and assessing client needs and developing evidence-based, best practice, content for faculty and students to assist in preparation for the NCLEX.

The Clinical Content Specialist – Nursing will work cross-functionally with internal and external stakeholders to provide updates to assessment products and coordinate efforts with the nursing education team. The ideal candidate will be passionate about Nursing Education, pedagogy, analysis, and student success as well versed on the New Generation NCLEX. The person will be able to work collaboratively in a team-based approach to achieve goals and have a bias toward action. This candidate should be ready to e in and understand the current market of Nursing Education and the importance of student success to prepare future nurses for the innovative and dynamic world of nursing.

ESSENTIAL DUTIES & RESPONSIBILITIES

The Senior Content Management Analyst’s primary responsibilities include:

• Develop and maintain data analysis procedures to help provide clients with the best information possible when promoting student retention and success.
• Teach faculty how to maximize the use of their adopted resources using evidence-based practice in nursing education.
• Develop program and product-centered communications via multiple media platforms for Wolters Kluwer.
• Provide information about other Wolters Kluwer products and services that may be relevant based on conversation with the client.
• Follow up with clients responding to questions/concerns from decision makers.
• Assist in effectively integrating our products throughout a client’s curriculum.
• The ability to fully understand strengths and weaknesses as a whole or inidually per program within an institution.
• Provide top quality customer service to current and future customers.
• Facilitate PreView, ReViews, Mentoring and Consultations to current and future long-standing customers.
• Assist on creating learning tools to be used by faculty from our product line.
• Provide faculty education through conferences, webinars, recorded sessions, and in-person training.
• Utilize multiple modalities in teaching faculty and students.
• Ability to stay up to date on Nursing practice and Nursing Education fields of studies.

Other Duties:

• Travel up to 40 – 50% as needed for NCLEX reviews, conferences, consultations, and training.
• Trend information discussed with clients that may be the platform for new products.
• Collaborate with the nurse educator team to evaluate practices and processes in place.
• Flexible to work on other product development as needed.

QUALIFICATIONS

Education: Education: Master’s Degree in Nursing required. Doctoral degree in nursing (PhD or DNS (DNP) preferred)

Required Experience:

• 5+ years teaching in academic nursing programs.
• 5+ years’ experience as a RN.
• Experience in NCLEX Review for nursing students.
• Experience leveraging data to meet customer needs.
• Experience interfacing with customers
• Teaching experience in an academic nursing program.
• Active RN licensure (unencumbered).
• Proficient in Microsoft Office.

Other Knowledge, Skills, Abilities or Certifications:

• Strong oral and written communication skills, including presentation skills.
• Ability to manage and handle difficult scenarios.
• Ability to prioritize and manage complex tasks simultaneously.
• Organization, analytical, and planning skills.
• Strong cross-functional collaboration skills.
• Attention to detail; ability to meet deadlines.
• Persistence.
• Ability and willingness to travel to meet business goals and objectives.
• Professionalism and integrity.
• Flexible and Agile to changing environment.

Travel: up to 40 – 50%

Veterinary Nurse

REMOTE

DIGITAL HEALTH

FULL-TIME

The Company

Fuzzy is your pet health partner. On a mission to make pet care more accessible, Fuzzy is a subscription-based service offering members 24/7 Live Vet Chat support, virtual vet consultations, and on-demand answers from a team of licensed, on-staff pet health experts. Fuzzy also offers pet parents vet-tested and recommended products and personalized programs for nutrition, training, and obedience.

Through technology, we’re creating a different type of relationship between pet parents and their veterinary caregivers one that’s personal, empowering, and focused on improving the lives of animals.

The Role

We are looking for full time Veterinary Nurses to provide Fuzzy Pet Health customers with a compassionate, thorough, and a medically excellent tele-health experience. Our customers subscribe to the Fuzzy Pet Health digital health experience to get professional, point of need advice about all manner of issues they are having with their pets. You’ll be responsible for using an evolving diagnostic framework to evaluate, consult, and advise pet owners, and following up with customers to ensure successful outcomes.

You’ll use your expertise and training to triage inbound emails and chats, ranging from counseling customers who are experiencing urgent and emergency issues, needing to stabilize their pet and get them to an urgent care facility, to talking owners through minor issues and providing general advice on issues like food allergies, nutrition, dermatology, and parasites.

What We’re Looking For

• • At least 5 years of clinical experience
  • You love pets and are passionate about helping owners be awesome pet parents
  • Excited about the potential for digital transformation in veterinary medicine and you want to make a BIG impact on pet health
  • Enthusiasm, collegiality, and integrity are at the core of who you are and how you work
  • Reliable, accountable, and find joy in your chosen profession.
  • Flexible to work one weekend day per week and some holidays.
  • Actively enrolled DVM students are also welcome to apply

Responsibilities

• • Provide Fuzzy’s pet parents with a compassionate, thorough, and a medically excellent telehealth experience
  • Use your expertise and training to triage inbound emails and chats to mitigate a variety of situations
  • Provide counsel to customers experiencing urgent, emergency issues and needing to stabilize their pet in order to get them to a proper care facility
  • Talk owners through minor issues and provide general advice on matters related to mild food allergies, nutrition, dermatology, and parasites

We know that great work comes from great, and inclusive teams. At Fuzzy, we specifically look for iniduals of varying strengths, skills, backgrounds, and ideas. We believe this gives us a competitive advantage to better serve our members and helps us all grow as Fuzzyrs and iniduals.

We hire candidates of any race, color, ancestry, religion, sex, national origin, sexual orientation, gender identity, age, marital or family status, disability, veteran status, and any other status. Fuzzy is proud to be an Equal Opportunity Employer and will consider qualified applicants with criminal histories in a manner consistent with the San Francisco Fair Chance Ordinance. If you have a disability or special need that requires accommodation, please let us know.

Nurse Specialist

Remote_United States

Full time

The Nurse Specialist is responsible for supporting the operations of Labcorp Peri-approval and Commercialization patient support and access programs. This inidual interacts primarily with patients and care partners who are receiving clinical support services from a program. Examples of this type of support may include contact center based-services, such as advising patients on dosing, guiding patients through product administration, providing approved recommendations to patients on managing side effects, discussing medication adherence with patients, or field-based services, such as on-site patient injection training

Additionally, this inidual may be responsie for preparing monthly and ad hoc project-specific reports. The Nurse Specialist also serves as a subject matter expert on programs and is first point of contact for clinical care program calls.

The Nurse Specialist may be either contact-center based or field-based.

Essential Duties

• Makes scheduled outbound calls and responds to inbound calls from patients and other customers regarding clinical aspects of a product, product administration, and adherence to medical therapies or treatments or for other related issues. Conducts follow up calls or sends follow up correspondence as necessary according to the program’s guidelines.
• Reviews approved therapy or treatment-related information with callers and identifies potential barriers to treatment. Within guidelines approved by the program’s sponsor, helps identify solutions to improve access and to help patients remain on prescribed treatment. Provides approved information to patients and their caregivers in a clear, caring way so that they may make informed choices.
• Keep case notes and tracks cases effectively using proprietary computer system. Establishes appropriate activity plans to trigger next call, correspondence, or intervention.
• May provide pre-approved medical information or literature to customers based on the guidelines of the specific program.
• May conduct /behavioral interviewing and motivational coaching calls with patients to encourage them to be adherent to their medication as prescribed.
• Documents adverse events and provides reporting per Labcorp and client policies and procedures
• Other duties, as assigned

Experience

Minimum Required:

• Minimum of two years customer service and contact center experience strongly desired. Experience with field-based work is also desired.
• 2 years clinical experience

Education/Qualifications/Certifications and Licenses

Minimum Required:

The Nurse Specialist will have a current RN license in good standing in the state of practice. In addition, will ideally hold a Bachelor’s degree or evidence of continual work toward a degree is strongly preferred. The Nurse Specialist without a Bachelor’s Degree must have an Associate’s Degree and ideally should have four or more years of healthcare or customer service work experience.

Additional required skills include:

• Strong written and oral communication skills.
• Customer service focus.
• Ability to work effectively through influence and collaboration.
• Good judgment in managing and escalating client or project issues. Must be able to manage multiple projects and understand contact center processes.
• Excellent interpersonal skills.
• Ability to identify problems, take initiative, and be solution oriented.

As a leading global contract research organization (CRO) with a passion for scientific rigor and decades of clinical development experience, Fortrea provides pharmaceutical, biotechnology, and medical device customers a wide range of clinical development, patient access and technology solutions across more than 20 therapeutic areas. With over 19,000 staff conducting operations in more than 90 countries, Fortrea is transforming drug and device development for partners and patients across the globe.

Pay Range: $32.00 – $46.00 an hour

Benefits: All job offers will bebased on a candidate’s skills and prior relevant experience, applicabledegrees/certifications,as well as internal equity and market data.Regular, full-time or part-time employees working 20 or more hours per week are eligible for comprehensive benefits including: Medical, Dental, Vision, Life, STD/LTD, 401(K), ESPP, Paid time off (PTO) or Flexible time off (FTO), Company bonus where applicable. For more detailed information, please click here.

Did you know?

Labcorp’s Clinical Development and Commercialization Services business is now Fortrea in connection with its planned spin-off from Labcorp, which is expected in mid-2023. Fortrea’s spin-off from Labcorp is subject to satisfaction of certain customary conditions. This spin-off will position both organizations for accelerated growth and allow each to focus resources on distinct strategic priorities, customer and employee needs and value creation opportunities.As a provider of phase I-IV clinical trial management, regulatory guidance, patient access solutions and market access consulting, Fortrea will partner with both emerging and large pharmaceutical, biotechnology, device and diagnostic companies to drive healthcare innovation and improve the lives of patients worldwide.

Fortrea is looking for problem-solvers and creative thinkers who are passionate about breaking down barriers faced by sponsors of clinical trials, and who are committed to helping transform the development process to get promising life-changing ideas and therapies to patients faster. Join us as we cultivate a workspace where all employees have the opportunity to grow and make impacts on a global scale. For more information and questions related to Fortrea, please visit www.fortrea.com.

Labcorp is proud to be an Equal Opportunity Employer:

As an EOE/AA employer, Labcorp strives for ersity and inclusion in the workforce and does not tolerate harassment or discrimination of any kind. We make employment decisions based on the needs of our business and the qualifications of the inidual and do not discriminate based upon race, religion, color, national origin, gender (including pregnancy or other medical conditions/needs), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic. We encourage all to apply.

Remote Behavioral Health Inpatient Medical Coder

Job Category: Coder

Requisition Number: REMOT001376

Part-Time

Locations

Showing 1 location

Virtual, USA

Job Details

Description

About Aquity: Headquartered in Cary, NC, a suburb of Raleigh, Aquity Solutions employs more than 7,000 clinical documentation production staff throughout the U.S., India, Canada, and Australia. With over 40 years of experience and recognized by both KLAS and Black Book as the top outsourced transcription service vendor, Aquity Solutions is focused on delivering superior business results. Aquity Solutions provides healthcare professionals with key services including: Medical Scribing, Interim HIM Services, Medical Coding and Medical Transcription.

Position Summary: As an experienced inpatient coder, you will be responsible for providing coding and abstracting for Inpatient services using ICD-10 CM/PCS coding systems. You will use established coding principles, software and your knowledge and experience to assign diagnostic and procedural codes after a thorough review of the medical record to obtain the appropriate DRG. As a coding professional, we may ask you to mentor new hires by providing education and training. We may need for you to perform other responsibilities when production requirements allow.

Essential Functions:

• Reviews Medical Records to identify pertinent diagnoses and procedures relative to the patients’ healthcare encounter
• Selects the principal diagnosis and principal procedure, along with other diagnoses and procedures using UHDDS definition. Ensures appropriate DRG assignment.
• Abstracts appropriate information from the medical record based on the guidelines provided by the client and after a thorough review of the medical record.
• Solicits clarification from the physician regarding ambiguous or conflicting documentation in the medical record using guidelines provided by the client.
• May act as a mentor to training coders and/or new hires by providing education and training.
• Maintains current knowledge of the information contained in the Coding Clinic and the Official Inpatient Guidelines for Coding and Reporting.
• Ability to meet productivity standards while maintaining a 95% accuracy rate.
• Assists with other responsibilities when requested.
• Maintains effective and professional communication skills.
• Contributes to a positive company image by exhibiting professionalism, adaptability and mutual respect.

Requirements:

• Licenses/Certifications; CCS, RHIT, RHIA preferred.
• Must have a minimum of 1-year Inpatient coding experience.
• Extensive knowledge of ICD-10 CM/PCS coding principles and guidelines, DRG Assignment, MCC/CC capture, federal, state and payor-specific regulations and policies pertaining to documentation, coding and billing
• Understands medical terminology, anatomy, physiology, surgical technology, pharmacology and disease processes
• A high-level of coding accuracy, critical thinking skills and attention to detail
• Excellent oral and written communication skills, must be detailed and articulate
• Strong knowledge of Microsoft Word, Excel, PowerPoint and Outlook

We have a wide array of customers providing our coders the opportunity to work with different environments and specialty areas- so every day is something new and exciting. The best thing- you can do this from the comfort of your own home. Our coders have an opportunity to work remotely and can work flexible hours contingent on client’s needs.

Sr Manager of Community and Wellness (Remote)

Remote 

Member Success

Remote / Full Time Employee

Remote

At Plume, we’re on a mission to radically transform healthcare access for the transgender and gender-nonconforming communities. As a trans-founded company, we’re proud to be building a virtual care home that makes a difference in countless lives. This work is deeply personal and heart-driven, and we want teammates who, above all else, care. We offer an affirming, trans/queer-friendly, culturally inclusive work environment filled with purpose and camaraderie. Are you ready to be part of our growing team in the healthtech industry?

Available to over 1 million transgender iniduals across 45 states, we’re growing fast and need passionate, talented iniduals like you to join our journey and help us to increase access to life-saving Gender Affirming Hormone Therapy and improve the lives of trans folks. If you have a heart-forward approach and resonate with our values, we’d love to hear from you!

Our Core Values:

We Are Authentic: We opt for honest and direct conversations. We strive to be vulnerable and connect authentically.

We Are Accountable: We follow up and commit to each other within the community and to ourselves.

We Are Growth-Oriented: We take the initiative, we’re proactive learners, and we tackle new challenges.

We Are Inclusive: We’re considerate of working across erse experiences. Every voice is valuable in serving our vision. We have an unusual bias for seeking input.

We Are Collaborative: We put we before I, we stay engaged and communicative when we disagree, and we can commit even if we’re not in complete agreement.

We Are Trans-Informed: We ask why? and distrust the status quo. We honor awkwardness & experimentation over polish and how things have always been done.

If our mission and values speak to you, you’re an experienced Community & Wellness Manager in healthcare, you have a passion for serving marginalized and underrepresented communities, and you have a deep understanding of the trans experience, we can’t wait to meet you!

About the Role:

At Plume, we envision a member experience that provides thoughtful, expert, timely, and gender-affirming care that celebrates and enhances the quality of life for every trans person. Reporting directly to our Sr Director of Member Services, our next Sr Manager of Community and Wellness will oversee our Community and Wellness team as well as the strategic development and implementation of new wellness initiatives, and promote and ensure quality community engagement through a robust engagement platform, including the creation and monitoring of community events, peer support groups, bulletin boards, etc. Your duties will span team leadership & management, program development & evaluation, community engagement, the design/delivery of persuasive presentations, and more! You’ll work cross-functionally with our Director of Strategic Partnerships to evaluate member retention and satisfaction metrics, and build/nurture relationships with external mission-aligned organizations to enhance our offerings and promote our members’ wellness.

Responsibilities:

• Provide leadership, guidance, and mentorship to our Community and Wellness team, supporting professional development, assessing performance, and conducting regular stand-up meetings and 1:1s to discuss progress, challenges, and future plans
• Represent Community Wellness needs and priorities on the Member Services management team, and manage communications and relationships with partners to ensure effective collaboration and alignment with Plume’s mission, values, and goals
• Design, manage, evaluate, and ensure the effectiveness of our overall Community Wellness program, including creating new programs to address the wellness needs of our members and incorporating input from the community and external partners
• Establish partnerships with mission-aligned organizations to enhance our member wellness initiatives, and evaluate these programs/initiatives to ensure their success and impact, adjusting to ensure effectiveness when appropriate
• Prepare reports on community engagement and program evaluation to assess the effectiveness of initiatives
• Contribute quarterly to strategic planning and goal-setting for the Community Wellness program and Member Services team, helping to identify, measure, and KPIs and OKRs
• Accountable for the success of relevant cross-functional projects
• Supervise community engagement activities, which encompass guiding Plume support groups and community events, managing resources for members, and both leading and taking part in public speaking opportunities
• Collaborate cross-functionally to launch and manage a care navigation and peer coaching program that supports members in their wellness journey
• Provide escalation support, effectively addressing community issues and safety concerns
• Due to the nature of startups, this role is expected to be dynamic and may evolve to encompass additional duties and ad hoc projects as needed

About you:

• A strong appreciation for the trans experience and a desire to increase access to gender-affirming care
• Adept at multitasking, prioritizing, and working quickly. Even in a remote, fast-paced startup setting, you hold yourself and others accountable to meet deadlines and complete tasks
• Excellent in cultivating and maintaining relationships, working collaboratively with both internal and external stakeholders, and ensuring alignment with Plume’s mission, values, and goals
• Excellent at planning, organizing, and focusing on the important tasks
• Innovative problem-solver with a knack for generating unique and effective solutions
• Proficient in fostering professional growth and development in others
• Strategic thinker with the ability to visualize the big picture and anticipate future trends
• An exceptional communicator who excels in clear and concise speaking, writing, listening, and presenting
• Analytically minded, adept at preparing reports and evaluating the effectiveness of initiatives

Qualifications:

• 7+ years of experience in healthcare (10+ years preferred)
• 6+ years of experience directly managing people & teams, ideally within healthcare
• Strong experience or demonstrated focus on working with marginalized or underrepresented communities
• Prior experience in telehealth, digital-health, or health-tech startups is a plus!
• Extensive experience in program management, design, and evaluation, particularly related to wellness initiatives and community engagement
• Proven ability in strategic planning, establishing KPIs and OKRs, and preparing reports to assess program effectiveness
• Proven ability to establish and nurture partnerships with organizations that align with our mission & values
• Direct experience in managing crisis situations, effectively addressing community issues and safety concerns preferred
• Familiarity with or experience in care navigation and peer coaching programs preferred

Compensation & Perks:

• Competitive Annual Salary DOE
• Ground-Floor Equity
• Medical, Dental, Vision, 401(k)
• Free Plume and Mental Health Subscriptions

Plume is an equal-opportunity employer. Trans and gender-nonconforming iniduals are strongly encouraged to apply, particularly those who identify as people of color, and we also encourage applications from suitably qualified and eligible candidates regardless of age, color, disability, national origin, ancestry, race, religion, gender, sexual orientation, gender identity and/or expression, veteran status, genetic information, or any other status protected by applicable law. We will provide reasonable accommodations to iniduals with disabilities upon request. Please let us know if you require any accommodations to apply or interview for this position.

Discover more about Plume at www.getplume.co and become part of our award-winning journey towards transforming healthcare for every trans life. Join us today in shaping the future of healthtech and LGBTQ+ care!

Title: Full-Time Bilingual Registered Nurse (Remote)

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

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

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

Vesta Healthcare partners with physician groups and home care agencies to help implement and deliver these services; providing administrative support, and helping to find committed and capable staff for the physician group.

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

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

The ideal teammate would be

As a Registered Nurse, you will be a valued member of the team. We are looking for an RN who recommends resources and creates Personalized Home Intervention Plans for high-risk, high-utilizer iniduals to facilitate quality inidualized treatment interventions and outcomes. This position will collaborate with the clinical team in maintaining a successful program which may include helping develop workflows, reporting, staff recruitment and training. They will be responsible for the day-to-day work with patients related to in-home insights & interventions needed for quality outcomes to reduce avoidable admissions, readmissions, and ED utilization. This is a remote/work from home position.

The ideal teammate would be able to:

• Plan and conduct intervention opportunity evaluations, respond to urgent alerts and remote patient monitoring alerts as needed to help drive high quality care at a lower cost
• Work directly with the member, via various forms of communication, texting, virtual visits, and telephone, to develop and achieve patient centered chronic care management goals
• Develop and update care plans for members while keeping a close eye on caregiver support
• Apply clinical experience and judgment to the utilization management/care management activities
• Collaborate with engagement and product teams to promote quality outcomes, optimize service experience, and promote effective use of resources for complex or elevated medical issues
• Participate in quality management/performance improvement activities

Would you describe yourself as someone who has:

• Graduated from an accredited nursing program (required)
• Current NY RN License in good standing? (required)
• 2+ years of experience in a fast-paced health services organization providing community care services ideally including care management, home care, remote telephonic triage, palliative care, and/or other related services (required)
• Bilingual in English and Spanish, Russian, Mandarin and/or Cantonese (required)
• Experience providing care to adult and geriatric patient populations (required)
• Experience with Chronic Care Management and Advanced Care Planning workflow (preferred)
• Ability to identify social determinants of health and develop goals associated with overcoming barriers (preferred)
• Strong analytical, written and verbal communication skills; demonstrated ability to think critically and make decisions based on data
• Very strong computer skills with ability to toggle between multiple systems simultaneously
• Metrics and process-driven, passionate about numbers as well as people
• Motivated self-starter and creative problem-solver who is comfortable working in a fast-paced, dynamic environment
• A genuine, compassionate desire to serve others and help those in need

In addition to amazing teammates, we also offer:

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

Pay range is $82K – $87K based on experience. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

We look forward to speaking with you!

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

(Contract) Medical Coding Specialist

REMOTE, US

OPERATIONS

CONTRACT

REMOTE

We hold ourselves to exceptionally high standards in order to provide unparalleled service to healthcare professionals, their staff and patients. We strive to end each workday knowing that we’ve made someone’s life better.

Our team is comprised of courageous and caring healthcare warriors. We’re here to solve the impossible problems, such as reducing medical errors, saving patient lives, and empowering physicians to stay financially independent. We care deeply about making a big impact and we are relentless.

Inspired to grow the company and our careers, we remain committed to daily discipline, self improvement, and a ceaseless search for solutions.

We equally value our work and our life apart from work. We’re compelled to work with urgency, decisiveness, and efficiency in everything we do. This affords us freedom and time for things that matter most.

Leaders at pMD are developed through our mentorship program. Investing in the success of each inidual strengthens our team and builds loyalty. We believe in leading by example. Everything one does ripples outward. Therefore, we need each inidual at pMD to embody our leadership principles to thrive as an enduring great company.

(Contract) Medical Coding Specialist

(Contract) The Medical Coder role at pMD helps our team and our customers reach our business goals through thoroughly scrubbing claims for coding and billing accuracy. This is an important role that focuses on the front-end revenue cycle. This includes identifying and preventing claim errors that would result in a denial to support timely payment and exceed industry standard benchmarks.

Responsibilities include:

• perform claim scrubbing review to support coding and billing accuracy and clean claim submission
• apply accurate modifiers and ensure that the correct provider, place of service, insurance, filing type, and referrals/auths are included
• verify claims against NCCI edits to facilitate compliance and prevent coding denials
• review National Coverage Determinations (if necessary) when scrubbing the charge to adhere to payer policies
• maintain confidentiality of all patient records

Requirements include:

• Post-Secondary Certificate in Medical Billing and Coding
• must be proficient with CPT/ICD-10, NCCI edits, and abreast of the latest coding guidelines issued by the AMA and CMS
• must be able to work independently in a fast-paced environment
• exceptional attention to detail
• must be willing to comply with independent contractor guidelines
• reside in the U.S.

We are only accepting applications through our online job portal, Lever. We aren’t able to consider and respond to other types of applications, including those sent via email to pMD support, at this time. Please direct application status questions to [email protected].

Oncology Pathology Assistant

Remote

PRIMARY RESPONSIBILITIES:

• Assist the medical and customer service teams with the interpretation of oncology pathology reports to identify optimal samples to request when initial FFPE blocks or slides are inadequate for testing.
• Read and ensure accurate curation of clinical history, diagnosis, progress notes, and specimen information is entered into the Signatera sample database.
• Assist with devising strategies to stratify data for retrieval from the Signatera sample database and other databases as necessary.
• Maintain proficiency with and help organize diagnostic data according to pertinent WHO guidelines.
• Serve as subject matter expert to the Laboratory Director, Genetic Counseling, Customer Experience, Sales, and Clinical Trial teams for pathology reports.
• Assist in the identification and alert the Laboratory Director when samples may have been collected at suboptimal timepoints and/or fixative conditions.
• Assist Genetic Counseling and Customer Experience teams in identification and procurement of optimal additional samples, as necessary.
• Provide professional support for the Clinical Trial team through accurate and organized data transfer.
• Performs other duties as assigned.

QUALIFICATIONS:

• Bachelor’s degree, or higher, with certification as a Histology Technologist by the American Society of Clinical Pathology (ASCP), or equivalent board, is required.
• Minimum of 5 years of experience in anatomic pathology including extensive knowledge of solid tumor pathology.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Ability to accurately understand and convey information found in anatomic pathology reports to team members for a wide variety of solid tumors, including but not limited to lung, colon, and breast cancer.
• Ability to identify potential diagnostic sample(s) that will ensure successful testing.
• Ability to communicate effectively with team members and referring pathology laboratories.
• Ability to build relationships with referring pathology laboratories.
• Detail oriented. Ability to think broadly about the importance of clinical information and to work independently.

#LI-REMOTE

The pay range is listed and actual compensation packages are based on a wide array of factors unique to each candidate, including but not limited to skill set, years & depth of experience, certifications and specific office location. This may differ in other locations due to cost of labor considerations.

Colorado

$75,700—$113,500 USD

OUR OPPORTUNITY

Natera™ is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. Our aim is to make personalized genetic testing and diagnostics part of the standard of care to protect health and enable earlier and more targeted interventions that lead to longer, healthier lives.

The Natera team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions, who care deeply for our work and each other. When you join Natera, you’ll work hard and grow quickly. Working alongside the elite of the industry, you’ll be stretched and challenged, and take pride in being part of a company that is changing the landscape of genetic disease management.

WHAT WE OFFER

Competitive Benefits – Employee benefits include comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents. Additionally, Natera employees and their immediate families receive free testing in addition to fertility care benefits. Other benefits include pregnancy and baby bonding leave, 401k benefits, commuter benefits and much more. We also offer a generous employee referral program!

For more information, visit www.natera.com.

Specialist II, Customer Education

Remote Eligible: Remote in Country

Location: Maple Grove, MN, US, 55311

Additional Location(s): Remote

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

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

About the role:

Initiates, develops, administers and executes meetings and SHV events that are aligned with the SHV Clinical Education objectives. Supports departmental budgeting, planning and report outs.

Your responsibilities will include:

• Participates in the planning, execution and finalization of projects according to strict deadlines, within budget and by following organized and repeatable procedures
• Coordinates the efforts of team members in order to deliver projects according to objectives
• Acts as a liaison with stakeholders and effectively communicates expectations to team members and stakeholders in a timely and clear fashion.
• Serves as an ambassador for Boston Scientific by providing thorough and professional communication, visit oversight and management, across stakeholders within the organization
• Build and maintain relationships with marketing, engineering, sales reps, and executives to ensure the execution of successful and customized customer interactions
• Works with various teams and stakeholders to support business objectives
• Metrics & Continuous Improvement: Evaluates the effectiveness of programs by soliciting participant feedback, summarizing results, and formulating recommendations to determine successes and areas of improvement, which will be used to improve subsequent program effectiveness
• Process & System Activation & Improvement: Represents function as an expert, initiating, guiding and/or participating in various process and system activation and improvement efforts (e.g. Cvent, salesforce.com, etc.)
• In all actions, demonstrates a primary commitment to patient safety and product quality by maintaining compliance to the Quality Policy and all other documented quality processes and procedures
• Manage digital content and access portals in collaboration with technical experts
• Work collaboratively within the team and with other business functions

Required qualifications:

• 5+ years of Structural Heart or Interventional Catheter Based therapy experience
• Ability to execute on multiple projects simultaneously and meet deadlines in a fast-paced environment
• Ability to prioritize projects based on business need
• Fully remote based, but travel to Maple Grove HQ and training sites required
• Approximately 20% overnight travel required, with multiple consecutive days
• Basic competency on Microsoft Office 365 products (Word, Excel, PowerPoint, Teams)

Preferred qualifications:

• Good time management skills
• Great interpersonal and communication skills
• Self-starter with clear focus
• Continuous improvement mindset; ability to identify existing gaps/needs
• Comfortable learning new/unfamiliar process’

Requisition ID: 563863

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

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

At Boston Scientific, we recognize that nurturing a erse and inclusive workplace helps us be more innovative and it is important in our work of advancing science for life and improving patient health. That is why we stand for inclusion, equality, and opportunity for all. By embracing the richness of our unique backgrounds and perspectives, we create a better, more rewarding place for our employees to work and reflect the patients, customers, and communities we serve. Boston Scientific is proud to be an equal opportunity and affirmative action employer.

Boston Scientific maintains a drug-free workplace. Pursuant to Va. Code § 2.2-4312 (2000), Boston Scientific is providing notification that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the workplace and that violations will result in disciplinary action up to and including termination.

Please be advised that certain US based positions, including without limitation field sales and service positions that call on hospitals and/or health care centers, require acceptable proof of COVID-19 vaccination status. Candidates will be notified during the interview and selection process if the role(s) for which they have applied require proof of vaccination as a condition of employment. Boston Scientific continues to evaluate its policies and protocols regarding the COVID-19 vaccine and will comply with all applicable state and federal law and healthcare credentialing requirements. As employees of the Company, you will be expected to meet the ongoing requirements for your roles, including any new requirements, should the Company’s policies or protocols change with regard to COVID-19 vaccination.

Title: Client Coordinator

(US)

Location: Remote

What you’ll do

In a few words

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

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

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

The fundamentals for the job

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

What we expect of you:

The bold requirements

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

Nice to haves

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

Physical requirements

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

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

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

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

#LI-JD1 #LI-REMOTE

Patient Billing Support Specialist

Job Category: Billing

Requisition Number: PATIE004138

Posting Details

• Full-Time

• Locations

  United States

Job Details

Description

Who We Are Looking For

As a WebPT Patient Billing Support Specialist, you will be a part of our patient billing customer service team, delivering exceptional customer service to our members’ patients. You will be responsible to perform both inbound and outbound self pay collections efforts to resolve a patient balance.

What You’ll Be Doing As A Part of Our Team

• Manage high volume inbound and outbound calls in a timely manner while providing exceptional customer service.
• Follow call center scripts and member requirements when handling patient calls.
• Identify patient needs, clarify information, research every issue and provide solutions.
• Complete assigned work as directed in a timely manner.
• Meet personal and team production and performance targets.
• Work closely with management team in reporting any patient complaints and provide thoughtful feedback on areas needing improvement.
• Interact with others in a positive, respectful and considerate manner.
• Maintain a positive attitude and be a team player.
• Other duties as assigned
• Reliable and punctual in reporting for work and taking designated breaks.

What You Should Have to Qualify

• Demonstrate core customer service competencies, such as active listening, empathy and other de-escalation tactics.
• Ability to multitask in a fast paced call center environment.
• Adapt to an ever changing environment.
• Be organized, ahead of schedule, communicative, and accountable.
• 1 year of customer service call center experience.

Ideally, You Would Also Have These

• 1 year of experience in hospital or physician billing.
• Prior experience in a fast paced call center environment.
• Knowledge of the Fair Credit Report Act (FCRA) and Fair Debt Collections Practices Act (FDCPA).
• Bilingual

Culture is at our Core

• Service: Create Raving Fans
• Accountability: F Up; Own Up
• Attitude: Possess True Grit
• Personality: Be Minty
• Work Ethic: Be Rock Solid
• Community Outreach: Give Back
• Health and Wellness: Live Better
• Resource Efficiency: Do Ms With Menos

About Us

Here, we work hardbut we have lots of fun doing it. We believe in equal opportunity for all, autonomy, trailblazing, and always doing right by our Members. Most importantly, though, we believe in empowering rehab therapy professionals to achieve greatness in practice. So, if you’re a can-do kinda person who loves to help Members win and enjoys working from just about anywherethen you’ll fit right in. We’ve got big plans, but we can’t achieve them without you. Join us, and let’s achieve greatness.

Company Perks

• Ample Time Off for fun and rest
• Work from nearly anywhere in the US
• WFH supply budget
• Time Off to make an impact through volunteering
• Multiple Employee Resource Groups (ERGs)
• Health, Dental, Vision, 401k, HSA, any many other benefits
• Authenticity and Acceptance

#LI-CB1

#LI-Remote

Qualifications

Skills

Required

Customer Service

Intermediate

Preferred

Medical Billing

Intermediate

Experience

Required

1 year: Customer service call center experience

Technical Assistance Specialist

Remote

Part Time

Mid Level

ABOUT ZERO TO THREE

Founded in 1977, ZERO TO THREE works to ensure that babies and toddlers benefit from the early connections that are critical to their well-being and development. Our mission is to ensure that all babies and toddlers have a strong start in life. At ZERO TO THREE, we envision a society with the knowledge and will to support all infants and toddlers in reaching their full potential. Our Core Values Statement: We believe that how we do our work is as important as what we do. To learn more about ZERO TO THREE, please visit our website at zerotothree.org.

OUR COMMITMENT TO DIVERSITY

ZERO TO THREE is proud to be an equal opportunity employer committed to inclusive hiring, advancement, and professional development. It is dedicated to ersity in its work, its staff, and with community partners. This is an exceptional opportunity for a professional who shares our commitment to ersity, equity, and inclusion and supports our mission to enhance outcomes for all children.

SUMMARY

The Technical Assistance (TA) Specialist provides support to Tribal Maternal, Infant, and Early Childhood Home Visiting (TMIECHV) grantees in implementing the goals of the Tribal MIECHV program, including the following:

• Supporting the development of happy, healthy, and successful American Indian and Alaska Native (AIAN) children and families through a coordinated home visiting strategy that addresses critical maternal and child health, development, early learning, family support, and child abuse and neglect prevention needs
• Implementing high-quality, culturally relevant, evidence-based home visiting programs in AIAN communities
• Expanding the evidence base around home visiting interventions with Native populations
• Supporting and strengthening cooperation and coordination and promoting linkages among various early childhood programs, resulting in coordinated, comprehensive early childhood systems

ESSENTIAL RESPONSIBILITIES

• Assist Project Director, other TA staff, ACF staff, and consultants to plan and deliver all levels of technical assistance activities to grantees
• Maintain an ongoing and responsive relationship with a portfolio of 4 – 6 assigned grantees, including development of inidualized TA plans and provision of intensive, relationship-based technical assistance
• Implement grantee communication strategies as directed by ACF including participating and notetaking on grantee monthly calls
• Actively participate in the development and implementation of an annual, national grantee meeting, and regional grantee meetings as assigned.
• Participate in the implementation of targeted TA activities including Communities of Learning and webinars.
• Identify best practices and disseminate lessons learned to promote the adoption of tribal home visiting core strategies to a broad audience through written products, presentations and other dissemination mechanisms
• Utilize electronic media, virtual communication technology and other technology resources to plan, deliver and track all technical assistance activities within time frame defined
• Contribute to the evaluation of Tribal Home Visiting Programmatic TA, including tracking TA performance data, sharing observations of lessons learned in the planning and delivery of TA, and participating in quality improvement efforts
• Coordinate with the MIECHV Tribal Evaluation TA provider, the MIECHV Technical Assistance Resource Center and other TA providers, as appropriate
• Make in-person TA visits to grantees as assigned
• Performs other duties as assigned to ensure the efficient and effective functioning of the project

ESSENTIAL SKILLS & EXPERIENCE

• A minimum of six years of experience in home visiting, early childhood, mental health, public health or related field
• Expertise in effectively communicating with, training, and providing technical assistance in the above domains to professionals and paraprofessionals in American Indian-Native Alaskan communities
• Strong knowledge of home visiting, child development, early learning, family support, and the prevention of child abuse and neglect
• Experience planning, coordinating and providing inidualized technical assistance to states, communities and/or programs
• Ability to work collaboratively with iniduals representing a range of backgrounds, ersities and skill levels
• Experience in facilitating groups, including decision-making and managing conflict
• Ability to be flexible and adaptable to dynamic changes in the work environment
• Excellent writing and verbal skills with a proven ability to publish articles, develop materials, and communicate issues around home visiting, child development, early learning, family support, and the prevention of child abuse and neglect
• Ability to work with a team as well as independently
• Strong interpersonal skills
• Ability to read, analyze and interpret complex documents
• Ability to manage multiple tasks
• Travel, including overnight stays, required

ESSENTIAL QUALITIES

• Encourages and practices critical thinking
• Is self-reflective and empathic
• Recognizes the influence of workplace relationships on outcomes and results
• Maintains a respectful and accepting approach to others
• Awareness of the influence of the larger context on inidual behavior
• Collaboratively and creatively supports the work efforts of colleagues at all levels and in all areas of the organization

EDUCATION

Master’s degree in early childhood, mental health, public health or related field recommended.

PHYSICAL REQUIREMENTS

While performing the responsibilities of the job, the employee is frequently required to use finger dexterity and sufficient hand dexterity to use a computer keyboard and be capable of reading a computer screen. Also, they may need to remain seated for extended periods, can perform repetitive motions, and reach for objects. An employee is frequently required to hold a writing instrument, communicate verbally, and hear well enough to detect nuances and receive detailed information. They may be required to grasp objects, push, and pull objects, bend, stand, walk, squat, or kneel. Vision abilities required by this job include close vision for data preparation or analysis, and expansive reading. May need to lift up to 30 pounds.

WORKING CONDITIONS

The work conditions described here are representative of those an employee encounter while performing this job. Depending on work location, the incumbent will typically work indoors in a heated and air-conditioned office, with a mixture of natural, incandescent, and fluorescent light with low to moderate noise levels or be subject to working conditions conducive to a home environment. When travel is expected, the incumbent will be exposed to outside environmental conditions during those times

Credentialing Associate

Location: Denver, CO or Remote

At SonderMind, we know that therapy works. SonderMind provides accessible, personalized mental health care that produces high-quality outcomes for iniduals. SonderMind’s inidualized approach to care starts with using innovative technology to help people not just find a therapist, but find the right, in-network therapist for them.

How you’ll make an impact

The Credentialing Associate is responsible for managing the credentialing activities for providers that join our network, and ensuring that providers submit proper documentation and adhere to our outlined processes and deadlines. You will be focused on shortening the amount of time it takes to get providers credentialed with SonderMind and our contracted payor partners.

Success looks like

• Within one week, fully understand each step of the credentialing process.
• Within one month, reach a level of efficiency across your duties, including serving as the point of contact for onboarding providers.
• Within two months, ramp up to the prescribed service level agreements while maintaining accuracy
• Within three months, generate and implement at least one process improvement across all Credentialing activities.

What you’ll do

• Serve as the Credentialing point of contact for providers as they move through the onboarding process. This communication will take place via text, email, and sometimes video conferencing.
• Continuous outreach and follow-ups to providers to ensure they complete their application (judged by completion of CAQH)
• Proactively obtain the necessary documents, updates and actions from providers during the onboarding process
• Reduce the time it takes to get a signed provider to a maximally credentialed’ provider
• Be able to quickly manage multiple priorities within established deadlines and metrics

What you’ll bring with you

Required Experience

• Previous experience and knowledge of credentialing activities
• Attention to detail and the ability to organize workflow effectively to meet deadlines and metrics
• Ability to work collaboratively with internal and external stakeholders.
• Excellent written and verbal communication skills
• Comfortable corresponding live with clinicians

Preferred Experience

• Experience using CAQH
• Experience with a CRM software (Salesforce preferred)
• Experience working as a liaison between customers and partners
• Experience working with healthcare insurance companies in some capacity

What we value

• Curious: Seek to understand and pull the thread
• Courageous: Takes action, even when uncomfortable
• Lightful: Assume positive intent in others
• Authentic: Say what you mean, mean what you say, act accordingly
• Bucketworthy: Don’t let your bucket leak

Our Benefits

The anticipated salary range for this role is $21.64/ hour. Actual compensation is based commensurate with qualifications and experience.

As a leader in redesigning behavioral health we are walking the walk with our employee benefits package. We focus on meeting SonderMinders wherever they are and supporting them in all facets of their life with both mental and physical aspects in mind.

Our benefits include:

• Medical, Dental, and Vision coverage effective on your first day with plans to meet your needs including HSA and FSA options.
• Therapy coverage benefits to enable our employees to get the care they need
• Generous PTO increasing based on years of service, company paid holidays
• Employer-paid disability & AD&D to cover life’s unexpected – not only that, we cover the difference in salary for up to eight weeks of short-term disability leave
• Eight weeks of paid parental leave
• Competitive market salary, up-to 4% salary company match on 401K
• Pet insurance through ASPCA

Mental wellness impacts people of every community. At SonderMind, building and supporting a erse workforce is foundational to our goal to redesign behavioral healthcare to be more approachable and accessible. SonderMind is a committed equal opportunity employer and provides a workplace that will not tolerate discrimination or harassment on the basis of race, religion, national origin, gender identity or expression, sexual orientation, age, or marital, veteran, or disability status.

Title: Medication Coordinator (1099 Contract)

Location: Remote (United States)

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:

As a Medication Coordinator at Cerebral, you will support the successful administration of our Medication Management program. The right inidual for the role should feel comfortable operating independently and remotely, and working alongside medical providers to ensure timely and accurate medication delivery. As the bridge between the medical teams, support teams, and counseling teams, this inidual should feel empowered to request updates from key stakeholders or elevate any concerns. We are looking for a sharp inidual with a keen eye for detail. If you can spot a different size font while copyediting, or get agitated when people do not capitalize their names on forms – This is the role for you!

Who you are:

• MA or Pharmacy Technician Certification or licensure is not required, but is preferred
• Experience working in a fast-paced or startup environment a plus
• Former professional experience in an administrative or clinical function
• Preferable to working weekends on a rotating schedule, but is not required
• Always acts first in consideration of client safety and wellbeing
• Detail-oriented and likes to follow a process
• Clear written communicator
• Advanced proficiency using a computer and ability to learn how to use new computer programs quickly (e.g. Slack, Dosespot)
• Feels comfortable making judgment calls or seeking support from others
• Basic knowledge or understanding of common medications for mental health management

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

• Triage incoming client request for refills of medication; escalating to RN’s or Prescribers as needed
• Utilize problem-solving skills to troubleshoot medication related issues at client’s preferred local pharmacy, or through in-house delivery pharmacy to ensure no medication gaps.
• Complete insurance related task; i.e. Prior Authorizations

What we offer:

• Mission-driven impact:
  • Shape the future of the #1 largest and fastest growing online mental health care company in the world
  • Build a platform that is improving the lives and well-being of hundreds of thousands of people (and counting)
  • Join a community of high achievers who have a passion for promoting mental health
• Path to develop & grow:
  • Bi-annual performance reviews & opportunities for promotions – as Cerebral grows, so should you. We build your goals together and forge a career path that is right for you
• Remote-first model: Work virtually from anywhere in the US
• Competitive compensation & benefits:
  • Total compensation includes equity/stock options
  • Medical, Dental, Vision, Life Insurance, and 401k with employer match to all employees
  • Unlimited PTO – we encourage taking the time you need to relax and recharge
  • Top-tier wellness benefits and perks, including bi-quarterly mental health days (8 per year), No-Meeting-Wednesdays, holistic monthly wellness stipend, and access to on-demand health & wellness content
    • $200 WFH reimbursement
• Culture & connectivity:
  • Virtual social events (e.g., happy hours) enable us to build a sense of community and connect on a more personal level
  • Monthly peer-to-peer recognition allowance via Bonusly allows team members to reward one another for values-aligned contributions
  • Optional in-person company retreats provide an opportunity to augment team-building and celebrate our successes together

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

Utilization Review Nurse- Full-Time (Days, Evenings & Nights)

locations

Remote – Other

time type

Full time

job requisition id

R011499

Do you perform admission and/or continued stay reviews in a hospital setting? Do you have five years of hospital acute care nursing experience? Are you looking for a remote opportunity?

We are seeking a candidate who has a proven record of conducting UR reviews in an acute hospital setting using InterQual. The ideal candidate must have at least 5 years of acute care experience in a hospital setting (OR, ER, ICU, MedSurg, Tele, NICU, Peds, Ortho) and at least 3 years of UR doing admission reviews and/or continued stay reviews in an acute hospital setting.

The Utilization Review RN requires a quick onboarding process to consult for our clients at the assigned facilities.

Responsibilities

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

Qualifications

Required

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

Preferred

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

Expectations

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

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.

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

Clinical Policy Coding Administrator

Locations: Telecommuter

Time Type: Full time

Job Requisition Id: R26325

Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership.

Forbes ranked Premera among America’s 2023 Best Midsize Employers because we are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!

This is a Work from Home Opportunity!!

As a Clinical Policy Coding Administrator for the Medical Policy and Clinical Coding team, you will work with a dynamic team of experts that pull together medical policy operations and clinical expertise to inform decisions that ensure members receive safe services and accurate payment for those services. The Clinical Policy Coding Administrator will focus on identifying and applying appropriate codes to support claim system edits that direct payment of medical services. You will be a liaison between the clinical and operations teams, working to bring the two aspects of the business together and making sure prior authorization applies to the appropriate services on the front end and that members claims are paid as expected once the service is performed.

Using your knowledge and expertise as a certified clinical coder, you will be the key contact for analyzing medical policies and identifying the appropriates codes to represent services, then collaborating with system configuration to ensure payment systems accurately process the member’s claims. Other work involves collaborating with benefits, preventive services, partnering with vendors on their coding requirements, reviewing provider appeals, assessing pricing determinations at claims level, managing the auto authorization process, supporting implementation of mandates, and many other special projects.

What you will do:

• Collect and analyze data to evaluate the effectiveness of medical policy implementation, identify and update appropriate procedure and diagnosis codes, and support business decisions regarding utilization management activities and guidelines.
• Support medical policy development and implementation by identifying and updating appropriate procedure and diagnosis codes for company medical policies and UM guidelines that reflect medical necessity, experimental/investigational or other code categories.
• Provide subject matter expertise for the Medical Policy Implementation Workgroup to ensure cross-functional collaboration within Healthcare Services, and other areas on coding edit decision-making related to medical policies and mitigate downstream impact.
• Perform analysis, research, and assessment in response to cross-functional requests to inform accuracy and consistency for claims processing, reimbursement, benefit, and product configuration issues.
• Develop and use data gathering tools to document and analyze patterns of code payments and denials, medical policy changes, and coding changes.
• Research and interpret medical claims utilization and program participation. Present findings to internal customers to assist them in managing healthcare costs and improved member satisfaction.
• Identify potential patterns and/or trends to confirm alignment of code payments, changes and denials, and medical policy changes.
• Provider appeal review determinations including assessment of appropriate coding, medical record review, and Correct Coding Initiative (CCI) bundling edits.
• Recommend pricing guidance for by report procedures at the claims level.
• Recommend action steps regarding code configuration issues, annual utilization, and review analysis to aid clinical review teams.
• Maintain current knowledge of coding application for current medical coding and other applicable coding systems that apply to medical documentation and claims.
• Provides subject matter expertise to a variety of internal committees as assigned.
• Completes special projects and other duties as assigned.

What you will bring:

• Bachelor’s degree or four (4) years’ relevant work experience. (Required)
• Current certification as a professional coder (RHIA, RHIT or CPC). (Required)
• Four (4) years of experience applying clinical coding expertise with two (2) of those years spent in a health plan or healthcare setting. (Required)
• Claims processing systems and product configuration experience including familiarity with supplemental tables and product configuration.
• Experience/knowledge of claims processing with a working knowledge of different claim types is desired.
• Current Washington State License: Registered Nurse (RN), Advanced Registered Nurse Practitioner (ARNP), or Physician’s Assistant (PA) (Bonus not required)

What we offer

• Medical, vision and dental coverage
• Life and disability insurance
• Retirement programs (401K employer match and pension plan)
• Wellness incentives, onsite services, a discount program and more
• Tuition assistance for undergraduate and graduate degrees
• Generous Paid Time Off to reenergize
• Free parking

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified iniduals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

National Salary Range: $68,400.00 – $116,300.00

National Plus Salary Range: $77,300.00 – $131,400.00 *National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

About Us

At Premera, we make healthcare work better. By focusing on improving our customers’ experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives.

As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from iniduals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services.

Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.

Remote Triage Nurse – Call Center

Nursing

United States

Company: Oak Street Health

Location: Various

Company Description

Oak Street Health is a rapidly growing company of primary care centers for adults on Medicare in medically-underserved communities where there is little to no quality healthcare. Oak Street’s care is based on an entirely new model that is based on value for its patients, not on volume of services. The company is accountable for its patients’ health, spending more than twice as long with its patients and taking on the risks and costs of their care. For more information, visit http://www.oakstreethealth.com.

Role Description:

At Oak Street Health, Nurses are an integral member of our Care Teams. The Clinical Call Center Triage RN effectively extends our care team outside of regular clinic hours, addressing patient’s medical, social, and psychological needs, via the phone and other future technologies such as telemedicine.

Together our teams are responsible for providing and coordinating care for an intimate panel of patients in our neighborhoods. While the typical primary care panel in the U.S. is around 2,500 patients for a single physician, our panels at Oak Street Health are around 500-750 for a team. This creates an opportunity to spend more time with patients, build deeper relationships, and to better execute/coordinate care plans.

We partner with a network of elite specialists and hospitals for specialty and acute care. As such, our Nurses, with our doctors, focus exclusively on care within the clinic: primary care, care coordination, and population health.

Core Responsibilities:

• Determine what kind of care and services the patient needs, direct them to the correct specialist, clinic, hospital, or other acute care setting, while providing clinical input up to the level of the role’s competency.
• Be on call with a licensed provider at all times, should consult that provider for input, and refer the patient to that provider in real time whenever appropriate
• Offer patient education when appropriate
• Coordinate care with other providers, specialists, testing facilities, agencies
• Population health approach, in coordination with the Care Team
• Participate in phone triage and outreach
• Participate in Oak Street Health promotional activities
• Other duties as assigned

What are we looking for?

We’re looking for motivated, nurses with:

• Excellent skills and care in giving advice, ensuring that they respond with the appropriate standard of care for a specific case and a warm, friendly approach
• Ability to accurately and succinctly document advice given and the patient’s response
• Active, non-probationary state Registered Nurse license
• Genuine passion for primary care
• Intrinsically motivated
• Embrace teamwork and the opportunity to collaborate with colleagues
• Want to be a part of an innovative model focused on empirically-guided population health
• Bilingual Spanish preferred
• Comfort with an evolving environment
• Some travel may be required
• US work authorization
• Someone who embodies being “Oaky”

What does being “Oaky” look like?

• Radiating positive energy
• Assuming good intentions
• Creating an unmatched patient experience
• Driving clinical excellence
• Taking ownership and delivering results
• Being scrappy

Why Oak Street?

Oak Street Health offers our coworkers the opportunity to be at the forefront of a revolution in healthcare, as well as:

• Collaborative and energetic culture
• Fast-paced and innovative environment
• Competitive benefits including paid vacation and sick time, generous 401K match with immediate vesting, and health benefits

Oak Street Health is an equal opportunity employer. We embrace ersity and encourage all interested readers to apply to oakstreethealth.com/careers.

Inpatient Coder II

Job ID: 975353

REMOTE

PERMANENT

HEALTHCARE

$60,000.00 USD ANNUALLY – $72,000.00 USD ANNUALLY

The Judge Group is looking for a full-time, 100% remote inpatient coder II!

The Inpatient Coder II is the coding and reimbursement expert for ICD-10-CM diagnosis coding and ICD-10-PCS procedure coding for complex inpatient acute care discharges. This person possesses a strong foundation in coding conventions, instructions, Official Guidelines for Coding and Reporting and Coding Clinics. The Inpatient Coder II has a deep understanding of disease process, anatomy/physiology, pharmacology, and medical terminology.

Responsibilities & Duties

• Utilizes technical coding expertise to assign appropriate ICD-10-CM and ICD-10-PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II’s typically see average CMI’s of 2.2609. This index score demonstrates higher patient complexity and acuity.
• Utilizes expertise in clinical disease process and documentation, to assign Present on Admission (POA) values to all secondary diagnoses for quality metrics and reporting.
• Thoroughly reviews the provider notes within the health record and the Findings from the Clinical Documentation Nurse in the Clinical Documentation Improvement (CDI) Department who concurrently reviewed the record and provide their clinical insight on the diagnoses.
• Utilizes resources within 3M 360 CAC (Computerized Assisted Coding) software to efficiently review documentation and select or assign ICD-10-CM/PCS codes using autosuggestion or annotation features.
• Reviews Discharge Planning and nursing documentation to validate and correct, when necessary, the Discharge Disposition which impacts reimbursement under Medicare’s Post-Acute Transfer Policy.
• Utilizes knowledge of MS-DRG’s, APR-DRG’s, AHRQ Elixhauser risk adjustment to sequence the appropriate ICD-10-CM codes within the top 24 fields to ensure correct reimbursement.
• Collaborate with CDI on approximately 45% of discharges regarding the final MS or APR DRG and comorbidity diagnoses.
• Educates CDI on regulatory guidelines, Coding Clinics and conventions to report appropriate ICD-10-CM diagnoses.
• Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, medical terminology to determine the Principal Diagnosis, secondary diagnoses and procedures.
• Follows the ICD-10-CM Official Guidelines for Coding and Reporting, ICD-10-PCS Official Guidelines for Coding and Reporting, Coding Clinic for ICD-10-CM and ICD-10-PCS, coding conventions and instructional notes to assign the appropriate diagnoses

Education & Experience

• A minimum of three years’ experience is required in an Academic Medical Center with Inpatient Coding experience.
• Current CCS, CIC, RHIA, or RHIT certification
• Position requires excellent computer/communication skills for provider and staff interactions.
• Candidate must have ability to handle multiple projects and appropriately prioritize tasks to meet deadlines.
• Candidate must have excellent organizational skills, able to understand and follow inidual client Standard Operating Procedures