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Utilization Review Nurse – Remote

Location: US National

Full-Time

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

Responsibilities

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

Qualifications

Required

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

Preferred

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

Expectations

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

Title: Director, Nursing Research

Location: Remote/Nationwide Remote/Nationwide USA

Full Time

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

Primary Responsibilities

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

Minimum Qualifications

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

Preferred Qualifications

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

We offer a competitive benefits package including:

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

#LI-Remote

This position is a Salary Grade B

Nurse Case Manager

Remote, USA

Full time

job requisition id REQ003554

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

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

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

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

JOB PURPOSE

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

PRINCIPAL ACCOUNTABILITIES / ESSENTIAL FUNCTIONS

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

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

ESSENTIAL FUNCTION REQUIREMENTS

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

QUALIFICATIONS

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

#LI-REMOTE

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

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

Salary Range:

$71,000.00 – $104,000.00

Billing Specialist

Remote

locations

Remote, United States

time type

Full time

job requisition id

REQ – 02223

Company: ABC Fitness Solutions

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

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

Job Description

At the very core…

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

WHAT’S IN IT FOR YOU:

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

What you’ll do…

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

What you will need to succeed…

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

Preferred Skills:

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

Payment Coordinator

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

About the role

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

What will you be doing?

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

What do you need to have?

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

Benefits of Working in ICON:

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

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

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

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

Same Day Surgery Coder HIMS Remote

locations

Remote Peoria AZ

Remote Flushing MI

Remote Albuquerque NM

Remote Lafayette LA

Remote Lincoln NE

Remote Hutchinson KS

Remote Mishawaka IN

Remote Midwest City OK

Remote Phoenix AZ

Remote Minneapolis MN

Remote Denver CO

Remote Ackley IA

Remote Mount Juliet TN

Remote Alpine UT

Remote Seattle WA

Remote Glendale CA

Remote Cheyenne WY

Remote Jamestown ND

Remote Chanhassen MN

Remote Carson City NV

Remote Covington LA

Remote Blue Springs MO

Remote Carriere MS

Remote Bella Vista AR

Remote Brooklyn NY

Remote Avon Lake OH

Remote Cleveland OH

Remote Boise ID

Remote Bismarck ND

Remote Elizabethtown KY

Remote Yukon OK

Remote Allentown PA

Remote Atlanta GA

Remote North Charleston SC

Remote Walker MN

Remote Anchorage AK

Remote Charlotte NC

Remote Arlington VA

Remote Ashland KY

Remote Salt Lake City UT

Remote Portland OR

Remote San Antonio TX

Remote Orlando FL

Remote Milwaukee WI

time type

Full time

job requisition id

R108120

Primary City/State:

Peoria, Arizona

Department Name:

Coding-Acute Care Hospital

Work Shift:

Day

Job Category:

Revenue Cycle

Primary Location Salary Range:

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

In accordance with State Pay Transparency Rules.

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

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

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

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

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

POSITION SUMMARY

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

CORE FUNCTIONS

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

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

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

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

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

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

MINIMUM QUALIFICATIONS

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

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

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

PREFERRED QUALIFICATIONS

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

Additional related education and/or experience preferred.

EOE/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

Staff Registered Nurse

Remote

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

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

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

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

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

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

Position Summary

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

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

Responsibilities

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

  RN Qualities:

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

  Qualifications

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

Utilization Review Registered Nurse

Remote

locations

US – Remote (Any location)

time type

Full time

job requisition id

7613

Job Family:

Clinical Appeals Nurse

Travel Required:

None

Clearance Required:

None

What You Will Do:

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

General Functions:

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

What You Will Need:

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

Nice To have:

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

The annual salary range for this position is $73,600.00-$110,500.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

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

Benefits include:

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

About Guidehouse

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

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

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

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

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

Location:

Ipswich, MA, US, remote

Onsite or Remote: Remote

Company Name: EBSCO HealthDecision

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

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

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

Responsibilities:

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

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

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

Maintain quality of content and participate in quality initiatives

Project manage editorial tasks/initiatives as required

Other duties as assigned by supervisor

Required Qualifications:

Bachelor’s degree in a healthcare field

Five years of direct patient care experience

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

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

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

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

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

Knowledge of PubMed, CINAHL searching strategies

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

Preferred Qualifications:

Advanced degree in a healthcare field

Specialty certification current and in good standing

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

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

Motivated self-learner with focus on team success

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

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

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

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

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

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

Director of Utilization Management

Job Locations: US-FL-Miami

Finance

Position Type

Full-Time

Monte Nido & Affiliates

Remote or Miami, FL

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

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

Responsibilities Include:

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

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

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

Qualifications:

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

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

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

Radiation Oncology Coder

Remote

Industry: Coder – Phy – Oncology Job Number: 2738

Job Description

Radiation Oncology Coder, Remote

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

Job Description:

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

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

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

Job Requirements:

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

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

A Little About Us:

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

Our Benefits:

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

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

Coding Consultant Inpatient 2

Location: US National

US-Remote

Position Type (Portal Searching): Employee Full-Time

Equal Pay Act Minimum Range: $22.00 – $30.00

Overview

Who we are…

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

What we offer…

At Ciox Health we offer all employees a place to grow and expand their current skills so that they can not only help build Ciox Health into the greatest health technology company but create a career that you can be proud of. We offer you complete training and long-term career goals. Our environment is what most of our employees are the proudest of and our Medical Coding Group is comprised of some of the brightest and most talented iniduals. Give us just a few moments to explain why we need you and hope you will help us change how the health Industry manages its’ medical records.

Details:

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

We Offer:

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

What we need…

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

Responsibilities

What You Will Do…

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

ADDITIONAL JOB COMPONENTS:

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

Qualifications

What Helps You Stand Out…

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

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

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

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

There is no COVID vaccine requirement for this role

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

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

Equal Pay Act Minimum Range $22.00 – $30.00

Medical Management Nurse II- RN

locations

Remote

time type

Full time

job requisition id

R5067

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

Duties and Responsibilities:

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

Skills:

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

Knowledge:

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

Experience:

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

Education and Certifications:

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

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

Senior Medical Coding Specialist

MultiPlan Work from Home/Remote Full-Time

Job Details

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

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

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

JOB ROLES AND RESPONSIBILITIES:

1. Review and analyze complex inpatient, outpatient, and practitioner billing for medical appropriateness of treatment; analyze charges of various revenue centers with consideration to patient diagnosis, procedures, age and facility type including any additional information perceived as potentially helpful in the payment integrity and/or negotiation process.
2. Assist management in the daily operations and processes within the department.
3. Design and participate in the clinical and coding education of coders, negotiators, and physicians. This includes orientation, training and mentoring of new and existing staff.
4. Facilitate daily claim completion meetings with coding operations team; discussing complex cases, providing feedback on prior day claim reviews, creating and initiating new coding protocols.
5. Drive successful coding operations through the application of learned, certified knowledge in addition to continuous professional development and ongoing coding research.
6. Provide general support to clinical team members, serving as a resource and subject matter expert (SME).
7. Monitors turnaround times for multiple applications and provides suggestions for process efficiencies.
8. Uses independent decision making skills to review claims after business hours to meet deadlines.
9. Apply national coding standards and regulations to claims billed.
10. Research and review inidual claims, claim trends or detailed itemized bills, operative notes and other documentation as needed.
11. Collaborate with physician and analytics teams to create, enhance or suggest new coding edits, claim factors, guidelines and other applicable reference materials.
12. Monitor, research, and summarize trends, coding practices, and regulatory changes.
13. Apply clinical judgment and high level of expertise along with analytic skills in review of the most challenging and difficult cases; including conducting additional research as needed.
14. Communicates clinical, coding and reimbursement findings to co-workers and management in a clear, organized manner.
15. Evaluate performance of both newly hired and existing staff.
16. Assist with education of staff as it relates to claims, suggest additional negotiation talking points or tools, develop instructional design, when applicable and communicate overall industry or regulatory changes which affect the department.
17. Partner with management to drive department goals and objectives.
18. Collaborate, coordinate, and communicate across disciplines and departments.
19. Ensure compliance with HIPAA regulations and requirements.
20. Demonstrate commitment to the Company’s core values.
21. Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
22. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE:

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

The salary range for this position is $70 – $80K. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

Job Requirements:

JOB REQUIREMENTS (Education, Experience, and Training):

• Completion of educational curriculum required of medical license or coding certification held with Bachelor’s Degree preferred; and at least 5 years of coding experience.
• Current nursing certification, coding credential (CCS, CCS-P or CPC), or Registered Health Information Technician credential(RHIA/RHIT) required and maintained as a condition of employment.
• Minimum 5 years experience in direct patient care, medical procedure billing, medical insurance auditing, line item review, audits, coding, and/or reimbursement.
• Extensive knowledge of inpatient/outpatient hospital billing including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD-10 diagnoses and procedure codes, DRG, APCs.
• Knowledge of payer reimbursement policies, state and federal regulations, medical necessity criteria and applicable industry standards.
• Knowledge of commonly used medical data resources such as MDR, Medical Fees in the US, etc.
• Auditing and health information management experience in a healthcare setting preferred.
• Required licensures, professional certifications, and/or Board certifications as applicable.
• Experience with professional and facility contract interpretation.
• Experience and proficiency using MS Office Suites: Excel, Outlook and PowerPoint. Visio helpful.
• Excellent communication (written, verbal and listening), interpersonal, organizational, time-management, analytical, problem-solving, trouble-shooting, customer service skills.
• Ability to develop educational materials and job aids pertaining to coding and claims.
• Ability to work evening or weekend hours as needed to meet deadlines.
• Ability to handle multiple tasks in a fast paced environment.
• Ability to meet inidual and team goals, deadlines and work standards.
• Ability to apply independent judgment and determine appropriate course of action.
• Ability to read and abstract medical records.
• Knowledge of medical terminology, anatomy, and physiology.
• Ability to interact and discuss results with providers.
• Ability to lead, teach, mentor others, and facilitate a learning environment.
• Inidual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone.

BENEFITS

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

Your benefits will include:

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

Medical Records Specialist I

Job LocationsUS-Remote

Requisition ID 2023-30565

# of Openings 1

Category (Portal Searching) Operations

Position Type (Portal Searching)

Employee Full-Time

Equal Pay Act Minimum Range

15.00 – 18.00

Overview

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

Who we are…

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

What we offer…

At Ciox Health we offer all employees a place to grow and expand their current skills so that they can not only help build Ciox Health into the greatest health technology company but create a career that you can be proud of. We offer you complete training and long-term career goals. Our environment is what most of our employees are the proudest of and our Architecture Group is comprised of some of the brightest and most talented iniduals. Give us just a few moments to explain why we need you and hope you will help us change how the health Industry manages its’ medical records.

What we need…

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

Responsibilities

What You Will Do…

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

Qualifications

What Helps You Stand Out…

Required

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

Preferred

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

Working conditions & physical demands

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

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

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

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

*Except for states where legally prohibited to enforce mandates.

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

Equal Pay Act Minimum Range

15.00 – 18.00

Senior Specialist Clinical Quality Assurance

Remote Eligible: Remote Global

Location: Diegem, BE

Additional Locations: Netherlands-Kerkrade; Germany-Dsseldorf

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

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

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

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

Your responsibilities will include:

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

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

Independent Auditing:

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

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

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

Acquisition integration:

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

What we’re looking for in you:

Minimum Qualifications:

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

Preferred Qualifications:

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

Requisition ID: 560425

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

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

NP/PA – Virtual Health Assessment (1099)

Remote

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

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

About the role

Hours Required:

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

Licenses Required:

• Texas, Georgia, and Florida

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

You will report to the Manager, Virtual Health Assessment.

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

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

Responsibilities

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

Qualifications

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

Bonus Points

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

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

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

Pay Transparency:

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

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

Reasonable Accommodation:

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

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

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

Nurse Practitioner (Contract) – Remote

SAN FRANCISCO, CA

CLINICAL

REMOTE

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

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

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

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

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

Responsibilities

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

Must-Haves

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

Nice to Haves

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

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

Coding, Team Lead

Remote, United States

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

Reports to: Manager, Coding

Responsibilities:

• · Supervise a team of production coders
• · Reviewing production coders’ work for quality
• · Provide clear, concise, and compliant written feedback to coders
• · Identify coder and/or documentation deficiencies and communicate them to the management team as needed
• · Participate in production coding daily as defined by management, based on department needs
• · Other responsibilities as assigned

Role Information:

• · Full-Time
• · Salaried
• · Exempt

· Eligible for Benefits

· Remote: The minimum bandwidth requirements are 10 Mbps upload and 50 Mbps download speeds. The recommended bandwidth requirements are 20 Mbps upload and 100 Mbps download speeds.

Job Requirements:

Required Knowledge, Skills, Abilities & Education:

• · Coding certification through AAPC or AHIMA (CPC, COC, RHIT, CCS, etc., no apprentice designation)High school diploma or equivalent
• · 5+ years outpatient surgical coding 1-2 years of supervisory, team lead experience or successful display of leadership qualities and completion of management training
• · Extensive knowledge of medical terminology, anatomy, and physiology
• · Ability to stay on task, working independently
• · Must have a dedicated home office with reliable high-speed internet
• · Ability to work independently and as part of a team
• · Strong attention to detail and speed while working within tight deadlines
• · Exceptional ability to follow oral and written instructions
• · A high degree of flexibility and professionalism
• · Excellent organizational skills
• · Outstanding communications skills; both verbal and written

Preferred Knowledge, Skills, Abilities & Education:

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

Physical Demands:

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

Key Competencies:

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

Compensation Information:

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

About Surgical Notes

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

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

Privacy Statement

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

Medical Coding Auditor

United States

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

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

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

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

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

The Role:

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

Quality Assurance Auditing Functions

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

Denial Management Auditing Functions

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

Skills & Requirements:

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

Modernizing Medicine Benefit Highlights:

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

Sr. Billing Representative, Remote

ATLANTA, GA 

NEW VENTURES NEW VENTURES 

FULL TIME

REMOTE

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

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

Responsibilities:

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

Performance Requirements, Skills, and Abilities:

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

Required Certifications, Education, and Experience

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

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

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

Who We Are:

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

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

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

What Does This Mean for You?

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

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

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

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

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

Medical Accounts Receivable Representative (Revenue Cycle Representative)

Remote, United States

Surgical Notes is hiring for a Medical Accounts Receivable Representative to assist with timely follow-up and collection on our clients’ third party payor accounts receivable. The ideal candidate has excellent organizational skills, communication skills, with the desire and ability to learn quickly. Working as a part of the team to meet deadlines, but also being able to work independently is crucial to the success in this position. Our organization prides itself on being built upon a set of strong core values. We are looking for candidate who will actively exhibit these core values: Service Excellence, Transparency, Teamwork, Accountability, Hardwork, and Positive Attitude.

Reports to: Revenue Cycle Manager

Responsibilities:

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

Role Information:

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

Required Knowledge, Skills, Abilities & Education:

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

Preferred Knowledge, Skills, Abilities & Education:

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

Physical Demands:

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

Key Competencies:

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

Compensation Information:

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

About Surgical Notes

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

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

Privacy Statement

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

Medical Billing Specialist

Fully Remote

Description

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

How you’ll help

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

What you’ll do

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

Experience and skills you’ll need

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

What We Provide (Benefits & Perks

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

Inpatient Coder

Up to $5000.00 Sign On Bonus

Job LocationsUS-Remote

Requisition ID 2023-30508

# of Openings

1

Category (Portal Searching)

HIM / Coding

Position Type (Portal Searching)

Employee Full-Time

Overview

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

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

Who we are…

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

What we offer…

At Ciox Health we offer all employees a place to grow and expand their current skills so that they can not only help build Ciox Health into the greatest health technology company but create a career that you can be proud of. We offer you complete training and long-term career goals. Our environment is what most of our employees are the proudest of and our Medical Coding Group is comprised of some of the brightest and most talented iniduals. Give us just a few moments to explain why we need you and hope you will help us change how the health Industry manages its’ medical records.

Details:

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

We Offer:

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

What we need…

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

Responsibilities

What You Will Do…

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

ADDITIONAL JOB COMPONENTS:

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

Qualifications

What Helps You Stand Out…

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

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

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

There is no COVID vaccine requirement for this role

Collections Specialist

Fully Remote • Remote

Full-time

Description

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

What We Have to Offer You:

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

The Position:

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

Responsibilities include:

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

Schedule:

• 8:30-5p Monday-Friday

Requirements

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

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

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

Soleo’s Core Values:

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

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

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

Nurse Care Manager (Newborn / Maternity)

Remote 

Clinical Strategy and Services – Clinical Team /

Full-time

Remote

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

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

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

Responsibilities:

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

Qualifications:

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

About Included Health

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

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

Remote Full- Time Inpatient Coder

Job Category: Coder

Requisition Number: REMOT001328

Posting Details

• Full-Time

• Locations

  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.

Schedule- Hours flexible, one weekend day per month is mandatory

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:

• Must possess CCS credential
• 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

Why Work for Aquity?

• Competitive salary
• 18 PTO days accrued during your first year!
• 7 paid holidays annually
• Job related education reimbursement, and CEU’s
• Full benefit package including Medical, Dental, Vision, short- and long-term disability and voluntary life insurance plan.
• 401(k) with company matching
• Opportunities for career advancement!

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.

#CB

Equal Opportunity Employer/Protected Veterans/Iniduals with Disabilities

The contractor will not discharge or in any other 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 a 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 60-1.35(c)

Remote Coders, Inpatient – Facility Coding (Part-Time) : Remote, Remote

Position Type

Part time

Requisition ID

27485

Level of Education

Years of Experience

About Exela

Exela is a business process automation (BPA) leader, leveraging a global footprint and proprietary technology to provide digital transformation solutions enhancing quality, productivity, and end-user experience. With decades of expertise operating mission-critical processes, Exela serves a growing roster of more than 4,000 customers throughout 50 countries, including over 60% of the Fortune® 100. With foundational technologies spanning information management, workflow automation, and integrated communications, Exela’s software and services include multi-industry department solution suites addressing finance & accounting, human capital management, and legal management, as well as industry-specific solutions for banking, healthcare, insurance, and public sectors. – Through cloud-enabled platforms, built on a configurable stack of automation modules, and 17,500+ employees operating in 23 countries, Exela rapidly deploys integrated technology and operations as an end-to-end digital journey partner.

Health & Wellness

We offer comprehensive health and wellness plans, including medical, dental and vision coverage for eligible employees and family members; paid time off; and commuter benefits. In addition, supplemental income protection including short term insurance coverage is available. We also offer a 401(k)-retirement savings plan to assist eligible employees in saving for their retirement. Participants are provided access to financial wellness resources and retirement planning services.

Military Hiring:

Exela seeks job applicants from all walks of life and backgrounds including, but not limited to, those who are transitioning military members, veterans, reservists, National Guard members, military spouses and their family members. Iniduals will be considered no matter their military rank or specialty.

Position – Remote Coding, Inpatient

Position Type – Non-Exempt

Location – Remote

Duration – Full-Time positions available

Inpatient coder positions are available for positive and self-motivated coding professionals on our growing remote coding services team. You can work from your home office for our clients.

LexiCode is the leading provider of HIM Coding and Consulting Services nationwide and our exceptional employees make this possible. For more than 35 years LexiCode has provided quality HIM coding and consulting services to healthcare providers nationwide. Our team works to enhance operations in every type and size of healthcare provider environment. Today LexiCode, an Exela brand, remains the industry leader in coding compliance solutions. The pay range for this position is $28.00-$38.00 per hour; however, base pay offered may vary depending on job-related knowledge, skills, and experience. Bonus opportunities may be provided as part of the compensation package, in addition to a full range of medical, financial, and/or other benefits, dependent on the position offered.

Job Description

Essential Functions and Responsibilities

· Provides remote medical records coding and abstracting services to our clients nationwide; and

· Work remotely from a home office.

LexiCode Offers

• Med, Dental, Vision, Rx, 401k, PTO and Holidays, STD, LTD

• Flexible Schedules

• Excellent hourly compensation

• Guarantee full time hours, not hired based on contract

• Computer with dual monitors and Encoder

• $3000.00 Referral bonuses

• Remote education platform, with training and brush up for many specialty skill sets

• CEU – free and reimbursement

• Reimbursement for certain additional certifications

Qualifications

Required:

· One of these credentials from AHIMA: RHIA, RHIT, CCS, CCS-P; or from AAPC: CPC, COC, or CIC

· At least 1 year coding experience in facility Inpatient coding

· Top coding facility Inpatient acute care skills

· Ability to work from home using high speed internet

Preferred:

· Experience with EMR, multiple encoders and abstracting systems

EEO Statement:

Exela is committed to creating a erse environment and is proud to be an equality opportunity employer. Qualified applicants will considered for employment without regard to their race, color, creed, religion, national origin, ancestry, citizenship status, age, disability, gender/sex, marital status, sexual orientation, gender identity, gender expression, veteran status, genetic information, or any other characteristic protected by applicable federal, state, or local laws.

Exela recruiters or representatives will only contact you from emails ending with @exelaonline.com, @exelatech.com, @lexicode.com, @rustconsulting.com or @ersgroup.com. We would never ask you for payment or ask you to deposit a check into your personal bank account during the recruitment process.

DRG Validation Coding Auditor

Remote

Full time

Description

The DRG Validation Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM and PCS) to patient records. The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The DRG Validation Auditor confirms appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

The Auditor position is a virtual opportunity within the United States. Provides expert coding auditing, coding and documentation improvement education.

Performs DRG validation reviews

Utilizes encoders and various coding resources Conducts peer reviews to ensure compliance with coding guidelines and provides reports as needed Maintains strict patient and physician confidentiality and follows all federal, state and hospital guidelines for release of information Maintains current working knowledge of ICD-10 coding principles, government regulation, protocols

WORK STYLE: 100% Remote, Work At Home (anywhere in the US)

SCHEDULE: Monday-Friday, 8 hours per day, 5 days per week. Typical work hours are between 6AM-5:30PM in the employee’s time zone.

Overtime might be available and is typically voluntary, depending on business needs.

Required Qualifications

• RHIA, RHIT, CCS Certification(s)
• Experience with MS-DRG auditing or APR auditing experience
• Acute in-patient coding experience
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

ADDITIONAL INFORMATION:

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required Satellite and Wireless Internet service is NOT allowed for this role A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

• Bachelor’s degree

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability.

Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Modern Hire interview.

In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses or text to each question.

You should anticipate this interview to take about 15 to 30 minutes. Your recorded/text interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Medical Biller and Coder

REMOTE 

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 seeking an eager, detail-oriented Medical Biller and Coder to join our Finance team at Circle Medical Technologies. As we continue to grow, we are constantly searching for exceptional talent to be a part of our adventure. This position will be remote in the U.S. for the right candidate.

WHAT YOU’LL DO

• Review patient claims for accuracy and completeness and proactively obtain any missing payer information for inclusion
• Appeal medical insurance claim denials in a timely manner
• Ensure compliance with procedures and coding guidelines
• Answer patient inquiries related to coverage denials and coding reviews for resubmissions as necessary.
• Communicate with clinical leadership and third-party billing company on issues regarding CPT & ICD-10 coding selections

WHAT YOU’LL BRING

• Excellent verbal and written communication skills
• Excellent organizational skills and attention to detail
• Excellent time management skills with a proven ability to meet deadlines
• Knowledge of CPT and ICD-10 codes
• Ability to identify coding trends and areas of risk
• Proficient with Google Workspace, Microsoft Office Suite, or related software

EDUCATION & EXPERIENCE

• Associate degree in business, finance, health administration or a related field preferred
• Required – Certified Professional Coder (CPC)
• 2+ years of experience in a primary care clinic setting (preferred)
• Mental/behavioral health experience is a plus

WHAT WILL GIVE YOU AN EDGE

• Proven track record with other startups or VC funded companies
• At least two years related experience required working in accounts receivable billing, or insurance, or as a customer service representative in a medical office, hospital, or call center environment

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 $21.00 to $25.00 plus, generous vacation, and full medical/dental benefits.

Circle Medical is an equal opportunity employer and affirmatively seeks ersity in its workforce. Circle Medical recruits qualified applicants and advances in the employment of its employees without regard to race, color, religion, gender, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, ethnic or national origin, marital status, veteran status, or any other status protected by law.

Care Coordinator

REMOTE

United States

Non-Clinical

Full time

Description

About Us

Resilience Lab is the largest community of clinicians working collaboratively to produce better outcomes and improve quality mental health access. In the last 3 years we have delivered more than 100,000 therapy sessions, working with more than 4,000 clients.

Our erse team of best-in-class therapists is committed to delivering the best care experience:

• Clients who match with Resilience Lab therapists benefit from holistic, evidenced-based, high-quality, and affordable care that meets them where they’re at, wherever they are.
• Clinicians are trained in the Resilience Institute, an online platform for the modern mental health clinician, offering continued learning to guarantee clients the highest quality of service and contemporary care.
• Technology powers Resilience Lab care delivery, automating all non-clinical work to foster therapeutic alliance and team-based care.

Opportunity

Our Care Team plays a key role in our clients’ therapy journeys. As a Care Coordinator, you’re the first point of contact for new clients seeking therapy. You’ll work to understand each client’s therapist preferences and therapy goals. You’ll then make a personalized recommendation, matching each client with the right therapist for them, creating highly effective therapist-client dyads to facilitate successful treatment outcomes. In addition to directly helping clients, you’ll work cross-functionally with other members of our management and clinical teams. Overall, you’ll play an integral role in helping us grow and advance towards our mission of providing high quality, affordable mental healthcare to all.

Responsibilities

• Handle incoming referrals on a daily basis from different channels:
  • Phone
  • Email
  • Our website
  • Referral websites
  • Referral partners
• Respond to prospective clients within 24 business hours.
• Speak with prospective clients to gather necessary clinical information, answer questions about the matching process, and ultimately schedule them with the therapist best suited for them.
• Track progress related to each prospective client by updating data in various tools, including our CRM, our proprietary clinical platform, etc.
• Learn about our therapists by reviewing their profiles and other sources of information, and/or by meeting with them, to inform the client matching process.
• Interact with our therapist team, typically to confirm information related to prospective clients.
• Work cross functionally to report on weekly outcomes, report website issues, optimize the process, and stay updated on new company initiatives.

Requirements

We are excited about you because

• You thrive within a startup environment.
• We’re building and refining our approach and this excites you!
• You’re comfortable iterating on manual processes as we automate.
• You care about outcomes – both business and clinical outcomes are at the heart of our practice and we want to reflect that at every level of the organization.
• You’re flexible and collaborative – open-minded about changing your approach as many times as needed as parameters change.
• You’re an empathetic listener.
• You’re a clear communicator.
• You’re technologically adept, especially with CRM and other tools.
• You have strong organizational skills.
• You’re detail-oriented.
• You’re curious.
• You’re passionate about improving access to care & supporting clinician growth.
• You have behavioral health care experience with either LMSW or equivalent credentials and are well-versed in clinical specialties and modalities. This is not a requirement, but a big plus!

Benefits

• $65k annual salary
• 401k
• Health/Dental/Vision insurance
• PTO
• Stock options
• Remote in the U.S.

MEDICAL CODER 2

Boston, MA

Full time

R31245

Opportunities at Change Healthcare, part of the Optum family of businesses. We are transforming the health care system through innovative technology and analytics. Find opportunities to make a difference in a variety of career areas as we all play a role in accelerating health care transformation. Help us deliver cutting-edge solutions for patients, hospitals and insurance companies, resulting in healthier communities. Use your talents to improve the health outcomes of millions of people and discover the meaning behind: Caring. Connecting. Growing together.

Please review the full template and ensure that you have removed all instructional sections prior to posting.

Work Location: Fully Remote -U.S

Position:

Abstracts clinical information from a variety of medical records and assigns appropriate ICD 10CM and/or CPT codes to patients records according to established procedures. Analyzes, enters and manipulates database, confirms appropriate DRG assignments. Knowledge in ICD-10 and CPT-4 coding required.

KEY JOB RESPONSIBILITIES

• Meet productivity standards as outlined in client metrics
• Identify any issues or trends and bring them to the attention of management team
• Work on special projects as assigned
• Other duties as assigned

Competencies:

• Knowledge of the medical coding process (ambulance coding preferred)
• Ability to meet position metrics goals (KPI’s)
• Strong written and verbal communication skillls

MINIMUM JOB QUALIFICATIONS

Education / Training:

• Required: High school diploma or equivalent work experience

Business Experience:

• 3+ years’ general work experience
• 6 months minimum of coding work experience

SPECIALIZED KNOWLEDGE / SKILLS

• Knowledge of medical coding
• Organized
• Detail Oriented
• 10,000 alpha / numeric keying speed
• Computer literate
• General office demands

Unique Benefits*:

• Flexible work environments
• Ready, Set, Grow Career Development Center & access to Change Healthcare University for continuous professional learning & development with more than 5,000 training assets
• Volunteer days, employee giving and matching gifts programs, community awards and dollars for doers, community partnerships
• Employee wellbeing programs and generous health plans
• Educational assistance programs
• US 401(k) or Group RRSP (Canada) savings plans with matching employer contributions
• Be sure to ask our Talent Advisors for more information on location specific benefits and paid time off policies

*Eligibility for some benefits may be limited or not available for part-time employees, be sure to speak with your Talent Advisor.

California / Colorado / New Jersey / New York / Rhode Island / Washington Residents Only:

The applicable base pay for your state is listed below. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, Change Healthcare offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with Change Healthcare, you’ll find a far-reaching choice of benefits and incentives.

The base pay range for this position is $19.90 – $44.19

Diversity, Equity & Inclusion:

At Change Healthcare, we include all. We celebrate ersity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.

Business Resource Groups (BRGs) play a central role in advancing ersity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at https://careers.changehealthcare.com/ersity

COVID Vaccination Requirements

We remain committed to doing our part to ensure the health, safety and well-being of our team members and our communities. As such, some iniduals may be required to disclose COVID-19 vaccination status prior to or during employment. Certain roles may require COVID-19 vaccination and/or testing as a condition of employment. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.

Bilingual Health Coach Manager

at Virta Health

Remote

Virta Health is on a mission to transform diabetes care and reverse the type 2 diabetes epidemic. Current treatment approaches aren’t working—over half of US adults have either type 2 diabetes or prediabetes. Virta is changing this by helping people reverse type 2 diabetes through innovations in technology, personalized nutrition, and virtual care delivery reinvented from the ground up. We have raised over $350 million from top-tier investors, and partner with the largest health plans, employers, and government organizations to help their employees and members restore their health and live diabetes-free. Join us on our mission to reverse diabetes in 100M people by 2025.

As Health Coach Manager, you are responsible for managing a team of coaches that are providing direct care for our patients. Health coaches at Virta work directly with patients to help reverse metabolic disease by providing high quality remote care through personalized nutrition and lifestyle recommendations. You’ll lead, develop, and inspire your team to achieve exceptional patient outcomes and ensure delightful patient experiences as our teams continue to grow and scale.

This role is open to remote applicants, so please apply regardless of your location.

Responsibilities

• Lead a erse team of health coaches and own team metrics and outcomes, while ensuring safe and high quality delivery of the Virta Treatment, managing coach capacity and team coaches, and supporting inidual coach development
• Create and maintain a collaborative environment of trust, problem solving, and growth.
• Encourage opportunities for teammates to collaborate, mentor each other and share learnings and best practices to elevate patient care and achieve patient success.
• Monitor and own coach (and team) performance through key metrics to Identify high performers and actively manage underperformers through coaching and performance management. Providing guidance, coaching, and consistent feedback to all teammates.
• Assist and support coaches as an expert in our coaching methods, internal systems, processes, and technology
• Encourage a solution-oriented culture and work to iterate and improve on our processes
• Lead teammates through transitions and times of change with clear communication, empathy, and understanding while helping teammates understand what success looks like.
• Demonstrate and serve as a champion of the Virta culture and team values.

90 Day Plan

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

• Master the basics of the Virta Treatment and understand the full patient experience.
• Become an expert on our coaching methods, internal systems, processes, and technology.
• Get to know your fellow coach managers and direct reports.
• Partner with other Coach Managers to build relationships, share learnings and provide consistency for all of our patients.
• Understand key performance indicators that are used to track health coach and pod (team) performance and what behaviors influence those metrics.
• Complete audits and chart reviews to provide developmental feedback to teammates.
• Review patient feedback and follow up with patients to identify opportunities to improve the patient experience through coaching.

Must-Haves

• 3+ years people management experience (required)
• Bilingual, (English/Spanish preferred)
• Experience in a digital health organization or customer service support role (strongly preferred)
• Prior experience (1+ year) coaching or counseling patients in a clinical and/or behavioral setting (strongly preferred)
• Outstanding verbal and written communication skills
• Strong organizational skills with attentiveness to detail

Who You Are:

• Outcomes-driven and passionate about improving metabolic health for our patients and ensuring positive patient experiences. You put the patient at the center of every decision and rally your team around that.
• Comfortable with ambiguity and to lead through times of change. You are an ally for change success and support your team through change management.
• Supportive and able to drive alignment. You build a strong team culture and create an environment of trust, problem solving and growth.
• You embrace a growth mindset, approaching challenges with curiosity and openness to change
• You have unquestionable integrity and authenticity in daily interactions.
• Resourceful, creative and solution-oriented when it comes to solving problems and addressing challenges.
• Lead through influence as much as through management. You are grounded and realistic, yet bring optimism in every situation.
• Hold a high standard for performance. You coach and manage your team to deliver on exceptional outcomes.

Values-driven culture

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

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

Is this role not quite what you’re looking for? Join our Talent Community and follow us on Linkedin to stay connected!

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

Virta has a location based compensation structure. Starting pay will be based on a number of factors and commensurate with qualifications & experience. For this role, the compensation range is $69,600 – $96,000. Information about Virta’s benefits is on our Careers page at: https://www.virtahealth.com/careers.

Professional/Physician Coder

Remote

Full time

JR-10023

Professional/Physician Coder

About City of Hope

City of Hope is an independent biomedical research and treatment organization for cancer, diabetes and other life-threatening diseases.

Founded in 1913, City of Hope is a leader in bone marrow transplantation and immunotherapy such as CAR T cell therapy. City of Hope’s translational research and personalized treatment protocols advance care throughout the world. Human synthetic insulin, monoclonal antibodies and numerous breakthrough cancer drugs are based on technology developed at the institution. AccessHope™, a subsidiary launched in 2019 serves employers and their health care partners by providing access to City of Hope’s specialized cancer expertise.

A National Cancer Institute-designated comprehensive cancer center and a founding member of the National Comprehensive Cancer Network, City of Hope is ranked among the nation’s “Best Hospitals” in cancer by U.S. News & World Report and received Magnet Recognition from the American Nurses Credentialing Center. Its main campus is located near Los Angeles, with additional locations throughout Southern California, Arizona, Illinois and Georgia.

Job Description:

Physician Coder:

The Physician Coder is responsible for reviewing physician documentation and assigning appropriate Evaluation and Management (E/M) code, ICD-10 diagnosis, and CPT codes. Works with physicians to obtain documentation that complies with coding guidelines and compliance standards.

Minimum Job Qualifications:

Education: HS Diploma, Associates Degree preferred

Certification(s):

• CPC (Certified Professional Coder) from the American Association of Professional Coders, OR,
• CCS-P by the American Health Information Management Association, OR,
• Associate Degree from an approved school for Health Information Technology as outlined with successful completion of the accreditation exam (RHIT), RHIA combined with an AAPC certification (CPC)

Experience:

• Minimum 3 years’ experience in ICD-10 and CPT Physician coding, preferred
• Experience and familiarity in working with erse facets of medical staff activities

Knowledge, Skills, Abilities:

• Self-starter and well organized
• Demonstrated knowledge of current ICD10 diagnosis and CPT procedural coding.
• Knowledge of the revenue cycle, charge master, manual coding assignment, encoding software revenue codes, and workflow management. Knowledge of medical terminology, anatomy, and physiology
• Strong written and verbal communication skills
• Must be willing to travel, as needed
• Customer-service oriented, timely in responses to requests for service/information, able to manage multiple tasks and priorities and possess leadership skills

Preferred Attributes:

• Additional AAPC Certifications
• Oncology coding experience
• Previous experience developing and conducting physician and coding educational sessions
• Knowledge of cancer specialty medicine coding and reimbursement
• Strong written and verbal communication skills
• Must be willing to travel, as needed.
• Customer-service oriented, timely in responses to requests for service/information, able to manage multiple tasks and priorities and possess leadership skills.

Pay Range

$23.39 – $38.56

Placement within the identified pay range is based on inidual and market factors including, but not limited to, experience, education, credentials (including licenses and certifications), geographic location, market competition, skill set (including market availability of required skills), assigned/anticipated job tasks, and level of responsibility. These factors are considered without regard to an inidual’s status as a member of any protect group pursuant to federal, state, and/or local law.

City of Hope’s commitment to Diversity, Equity, and Inclusion

We believe ersity, equity and inclusion is key in serving our mission to provide compassionate patient care, drive innovative discovery, and advance vital education focused on eliminating cancer and diabetes in all of our communities. Our commitment to Diversity, Equity and Inclusion ensures we bring the full range of skills, perspectives, cultural backgrounds, and experiences to our work — and that our teams align with the people we serve in order to build trust and understanding. We are dedicated to fostering a community that embraces ersity – in ideas, backgrounds, and perspectives; this is reflected in our work and represented in our people.

Visit: Jobs.cancercenter.com to begin your journey.

Coder II

• Remote – USA
• Full time
• R2286

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).

• Coders are responsible for review and submission of 64 encounters per day or 8 per hour related to evaluation & management, procedures, testing, monitoring and hospital services daily. Must be comfortable with discussing coding and guidelines with providers in a collaborative and professional manner.
• Ability to elaborate on findings and guidelines with providers on issues identified within daily work-flow.
• Review assigned CPT, HCPCS and ICD-10 diagnosis codes for accuracy prior to submission.
• Understanding of hierarchy coding as well as column 1 and 2 positioning
• Ability to navigate electronic medical records as it relates to billing and coding.
• Understanding of clinical documentation as it relates to ICD-10, CPT and HCPCS coding.
• Must be able to map and link diagnosis for evaluation and management and procedures.
• Inidual must be able to communicate clearly with precise with providers during querying process.
• Knowledge of Medicare, Managed Care and Commercial Insurance guidelines for coding E&M and procedures.
• Outstanding organization skills and time management required.
• 3 plus years of experience is required.

Justification

Position replacement for coder who terminated a few months ago and a recent colleague who transitioned to PRN. This position supports 17 providers for medical coding of Cardiology evaluation and management, Non-Invasive procedures, Remote and Pacer Monitoring, Cardiac Cath billing and Electrophysiology. Responsibility for support of denials insurance follow-up and response.

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.

Physician Coding Educator – Remote

Job ID 193422BR

• Rochester, Minnesota
• Full Time
• Finance

Why Mayo Clinic

Mayo Clinic is the nation’s best hospital (U.S. News & World Report, 2022-2023) and ranked #1 in more specialties than any other care provider. We have a vast array of opportunities ranging from Nursing, Clinical, to Finance, IT, Administrative, Research and Support Services to name a few. Across all locations, you’ll find career opportunities that support ersity, equity and inclusion. At Mayo Clinic, we invest in you with opportunities for growth and development and our benefits and compensation package are highly competitive. We invite you to be a part of our team where you’ll discover a culture of teamwork, professionalism, mutual respect, and most importantly, a life-changing career!

Mayo Clinic offers a variety of employee benefits. For additional information please visit Mayo Clinic Benefits. Eligibility may vary.

Position description

The Coding & Documentation Educator is an internal resource to clinicians by providing training, consultation, audit and coordinated feedback on their medical service documentation and coding to ensure that Mayo Clinic receives appropriate reimbursement and conforms to applicable guidelines and regulations. This position performs medical record audits to ensure compliance with all applicable coding regulations as well as with organizational standards, practices, policies, and procedures. It is intended to provide elbow-to-elbow coding and documentation support through ad hoc phone calls, site visits, the creation of specialty or inidual provider tip sheets, virtual and on-site presentations. Serves as subject matter expert with specialty-specific knowledge of surgical, E&M, diagnosis coding & documentation. Analyzes data, communicates findings, and facilitates improvement efforts. Independently develops and maintains educational materials and training programs. Works in conjunction with the clinical practice managers and production coding leadership teams. This position may require on-site work to interact with physicians with potential for remote work as directed by manager.

*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.

Qualifications

-Associate’s Degree required; Bachelor’s Degree preferred in a health care related field. -Minimum of 6 years of professional coding experience and demonstrated knowledge of complex service lines. -Additional 2 years progressive and in-depth multispecialty professional services coding and/or auditing experience in assignment of diagnostic and procedural/surgical coding.

Additional qualifications

-5 years extensive auditing experience with demonstrated ability to provide effective analytical problem solving. -2 + years of multispecialty professional services coding experience assigning evaluation & management codes. -2 years experience with project management functions and presenting education and training feedback to small and large groups, especially to physicians or other clinical providers.

Advanced proficiency in use of Microsoft Office Suite of products and other software programs to document and manage audit data.

License or 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), Certified Professional Medical Auditor (CPMA) or Certified Professional Coder (CPC) required.

Certified Professional Medical Auditor (CPMA) or other specialty-specific certifications must be obtained within 2 years of position start date:

Ambulatory Surgical Center – CASCC

Anesthesia and Pain Management – CANPC Cardiology – CCC Cardiovascular and Thoracic Surgery – CCVTC Dermatology – CPCD Emergency Department – CEDC Evaluation and Management – CEMC Family Practice – CFPC Gastroenterology – CGIC General Surgery – CGSC Hematology and Oncology – CHONC Interventional Radiology and Cardiovascular – CIRCC® Obstetrics Gynecology – COBGC Ophthalmology – COPC Orthopaedic Surgery – COSC Pediatrics – CPEDC Rheumatology – CRHC Urology – CUC

Exemption status Exempt

Compensation Detail $65,894.40 – $92,248.00 / year

Benefits eligible Yes

Schedule Full Time

Hours / Pay period 80

Schedule details Monday – Friday

*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.

Weekend schedule N/A

Remote No

International Assignment No

Site description

Mayo Clinic is located in the heart of downtown Rochester, Minnesota, a vibrant, friendly city that provides a highly livable environment for more than 34,000 Mayo staff and students. The city is consistently ranked among the best places to live in the United States because of its affordable cost of living, healthy lifestyle, excellent school systems and exceptionally high quality of life.

Recruiter Oo Her

EOE

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.

Nurse Practitioner – Prescribing

UNITED STATES

MEDICAL AFFAIRS – PRESCRIBER TEAM

PART TIME – NON-EXEMPT/HOURLY

REMOTE

ABOUT US

At Vida, we help people get better — and we’re helping the healthcare system get better, too.

Vida provides expert, personalized, on-demand health coaching and programs through a network of experienced health care providers — like dietitians, therapists, and health coaches and leading medical institutions — coupled with an easy-to-use app with award-winning content.

We focus on chronic conditions — like diabetes, depression, and hypertension — which account for 80% of the $3 trillion spent on healthcare in the US.

By combining advanced technology with the top-notch healthcare providers, Vida is breaking down the barriers that have historically kept people from getting the best care. Vida’s cloud-based platform captures real-time data from 100+ devices and apps and delivers AI-driven insights back to employers, health plans, and providers to improve care. We are trusted by Fortune 1000 companies, major national payers, and large providers to enable their employees to live their healthiest lives.

**Vida is authorized to do business in many, but not all, states. If you are not located in or able to work from a state where Vida is registered, you will not be eligible for employment. Please speak with your recruiter to learn more about where Vida is registered.

The Prescribing Nurse Practitioner plays a key role in providing accessible and convenient care for our members. The Nurse Practitioner works in partnership with psychiatric specialists and physicians to diagnose, manage, and provide medication management and outpatient treatment via Telehealth.

Responsibilities:

• • Provides patient support by prescribing, monitoring, and supporting treatment plans in accordance with statutes, regulations and protocols.
  • Refers higher acuity patients to specialized care based off of a stringent screening guideline to ensure quality of care and the best outcome for patients.
  • Maintains medical records and high quality of clinical documentation.
  • Provides psychiatric and cardiometabolic (HTN, HLD, diabetes, obesity) health services, education, and medication management in an empathetic and judgment-free manner.
  • Issues medication prescriptions in accordance with treatment guidelines.
  • Orders laboratory tests, interprets and explains the test results to patients.
  • Provides patient education regarding medications, risks, benefits and reasonable outcome expectations.
  • Communicates with patients and engages in follow-up as necessary.

Requirements:

• • Masters of Science in Nursing from an accredited college or university required.
  • Two (2) years of experience practicing outside of post-training required.
  • Active license as a Nurse Practitioner (NP) by the State in which performing services are required.
  • Active license in multiple states (at least 20). A current DEA Number or ability to obtain upon employment required.
  • Ability to deliver care via telehealth.
  • Must maintain professional demeanor and uphold values of patient care.
  • Proficiency with EMR (electronic medical record) systems.

Vida is proud to be an Equal Employment Opportunity and Affirmative Action employer.

Diversity is more than a commitment at Vida—it is the foundation of what we do. All qualified applicants will receive consideration for employment without regard to race, color, ancestry, religion, gender, gender identity or expression, sexual orientation, marital status, national origin, genetics, disability, age, or Veteran status. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law.

We seek to recruit, develop and retain the most talented people from a erse candidate pool. We don’t just accept differences — we celebrate them, we support them, and we thrive on them for the benefit of our employees, our platform and those we serve. Vida is committed to providing reasonable accommodations for qualified iniduals with disabilities and disabled veterans in our job application procedures.

We do not accept unsolicited assistance from any headhunters or recruitment firms for any of our job openings. All resumes or profiles submitted by search firms to any employee at Vida in any form without a valid, signed search agreement in place for the specific position will be deemed the sole property of Vida. No fee will be paid in the event the candidate is hired by Vida as a result of the unsolicited referral.

Patient Scheduling Representative

REMOTE

United States

Contact Center

Full time

Description

Are you interested in stepping into the healthcare industry? Do you have a passion for helping others and providing the highest level of customer service? Want to join a great company and work from home?

If so, we want you on our team at T2 Flex Force! We are looking for full-time Patient Scheduling Representative. The Patient Scheduling Representative provide call center-based scheduling, registration and patient access services to hospitals, healthcare networks and physician practice groups. Our goal is to increase patient access and revenue, decrease abandonment rates, and improve patient and customer satisfaction.

Prerequisites for employment will be a clear Background Check and Medicare Fraud Check.

THE RESPONSIBILITIES:

• Collecting all required patient information, including scheduling, pre-registration, and insurance verification
• Answering, screening, and processing requests and telephone inquiries with adherence to HIPAA and HITECH confidentiality policies and procedures
• Obtaining and accurately entering necessary demographic, clinical, and billing information
• Explaining processes, forms and procedures to callers, ensuring that patients understand required documentation requirements and subsequent measures
• Collecting copays and payment information when necessary
• Processing required information according to client policies and procedures
• Providing professional, compassionate and concierge-like service to patients
• Available to work full time
• Available between the hours of 7am-7pm EST

Requirements

• Medical assistant experience
• Minimum 1 year patient scheduling experience preferred
• High school diploma or GED
• Ability to maintain the highest level of confidentiality
• Excellent attention to detail and a commitment to accuracy
• Exceptional interpersonal, written and oral communication skills
• Knowledge of medical terminology is a plus
• Must be flexible and adaptive to a fast pace call center environment
• Strong computing and software skills (PC, MS Word, Excel, Outlook)
• Strong work ethic, reliability, and dependability
• Team player, self-motivated, compassionate and patient care centered
• EPIC EMR experience
• Must have computer and additional monitor (2 screens)

Benefits

• Career development advancement
• Competitive benefit package including medical/dental/vision insurance
• Extensive training and learning opportunities
• Knowing that you make a difference everyday
• After 90 days you will receive paid time off, medical, dental, vision, and sick time
• Positive work culture and great team of people

More about this position:

This is a full-time employment W2 position with eligibility for benefits

This is a remote / Work From Home position

Employees must have internet to support the IT systems

Sr. Financial Implementation Consultant (Healthcare)

locations

• USA, TX, Austin
• USA, WY, Remote
• USA, RI, Remote
• USA, AZ, Remote
• USA, AR, Remote
• USA, VT, Remote
• USA, UT, Remote
• USA, WI, Remote
• USA, TN, Remote
• USA, OH, Remote
• USA, CO, Remote
• USA, OR, Remote
• USA, NJ, Remote
• USA, WV, Remote
• USA, WA, Remote
• USA, PA, Remote
• USA, NV, Remote
• USA, MT, Remote
• USA, MD, Remote
• USA, MA, Remote
• USA, VA, Remote
• USA, OK, Remote
• USA, NM, Remote
• USA, NC, Remote
• USA, MS, Remote
• USA, LA, Remote
• USA, IN, Remote
• USA, NE, Remote
• USA, MO, Remote
• USA, ID, Remote
• USA, AK, Remote
• USA, CO, Denver
• USA, NC, Raleigh
• USA, NH, Remote
• USA, CT, Remote
• USA, CA, Remote
• USA, UT, Salt Lake City
• USA, IA, Remote
• USA, FL, Remote
• USA, DE, Remote
• USA, AL, Remote
• USA, SC, Remote
• USA, ND, Remote
• USA, MI, Remote
• USA, KS, Remote
• USA, TX, Remote
• USA, NY, Remote
• USA, ME, Remote
• USA, TX, Frisco
• USA, IL, Remote
• USA, DC, Remote
• USA, GA, Atlanta
• USA, MN, Minneapolis
• USA, SD, Remote
• USA, IL, Chicago
• USA, MN, Remote
• USA, KY, Remote
• USA, GA, Remote
• USA, CA Bay Area, Remote
• USA, CA, Pleasanton

time type Full Time

job requisition id JR-74608

Your work days are brighter here.

At Workday, it all began with a conversation over breakfast. When our founders met at a sunny California diner, they came up with an idea to revolutionize the enterprise software market. And when we began to rise, one thing that really set us apart was our culture. A culture which was driven by our value of putting our people first. And ever since, the happiness, development, and contribution of every Workmate is central to who we are. Our Workmates believe a healthy employee-centric, collaborative culture is the essential mix of ingredients for success in business. That’s why we look after our people, communities and the planet while still being profitable. Feel encouraged to shine, however that manifests: you don’t need to hide who you are. You can feel the energy and the passion, it’s what makes us unique. Inspired to make a brighter work day for all and transform with us to the next stage of our growth journey? Bring your brightest version of you and have a brighter work day here.

About the Team

The Professional Services Sr. Financial Implementation Consultant will be responsible for ensuring the successful implementation of the Workday solution for our Healthcare customers. Providing Workday product and implementation expertise to their engagements. Understanding their clients business requirements and help configure and test the Workday solution. The Sr. Financial Consultant will take direction and provide status to the Engagement Manager assigned to their project.

About the Role

The Sr. Financial Implementation Consultant will be responsible for ensuring the successful implementation of Workday’s Finance solution for our healthcare customers while adhering to best practices. The Sr. Financial Implementation Consultant will provide Workday product and implementation expertise to their engagements by primarily serving as an architect on the Workday project team. This role is also responsible for ensuring Financials solution alignment with other functional areas.

Locations: Preference will be given to candidates located near Workday offices. Hybrid role position. We will consider remote candidates.

Key Areas of Responsibility:

• Contribute and help maintain healthcare best practices to reflect new industry requirements and trends.
• Understand client business requirements and consult to provide and configure the Workday solution. Demonstrate the configurations through the development of prototype systems and assist the client in testing.
• Work with Delivery Assurance to ensure compliance with agreed to checkpoints.
• Participate in update training and other events that help share one’s product skills with other consultants.
• Provide the Engagement Manager with status reports and keep them informed of overall project status.
• Mentor junior consultants.

About You

Basic Qualifications:

• 6+ years of financial consulting experience
• Experience with Workday, Lawson, SAP, Oracle, PeopleSoft, or similar applications.
• Experience with General Ledger along with one or more of the following: Accounts Payable, Accounts Receivable, Asset Management, Expense Management and Banking & Settlement

Other Qualifications:

• Bachelor’s degree or equivalent experience – preferably in Finance or Accounting
• 6+ years of financial consulting experience with at least 2 full-cycle healthcare industry implementations OR 6+ years of financial or accounting operational experience in healthcare organizations.
• Implementation or operational experience with Workday, Lawson, SAP, Oracle, PeopleSoft, or similar applications.
• Passion for customer service and project management experience
• Experience architecting Workday Foundation Data Model (FDM)
• Ability to communicate with all levels of customer/prospect leadership
• Ability to learn technology quickly through instruction and self-training.
• Experience with multiple financial applications and/or Grants Management.
• Ability to handle multiple project engagements at a time

As a federal contractor, Workday is requiring all new hires to verify that they are fully-vaccinated against COVID-19 within 72 hours of beginning employment with Workday, consistent with applicable law. Workday is an equal opportunity employer. Candidates who are not vaccinated due to a sincerely held religious belief, medical reasons, or other legally-protected reason should contact [email protected] to explore what, if any, reasonable accommodations or exemptions Workday is able to offer.

Pursuant to applicable Fair Chance law, Workday will consider for employment qualified applicants with arrest and conviction records.

Workday is an Equal Opportunity Employer including iniduals with disabilities and protected veterans.

Are you being referred to one of our roles? If so, ask your connection at Workday about our Employee Referral process!

Hospital Outpatient Coder – Remote

Job ID 199686BR

• Rochester, Minnesota
• Full Time
• Finance

Why Mayo Clinic

Mayo Clinic is the nation’s best hospital (U.S. News & World Report, 2022-2023) and ranked #1 in more specialties than any other care provider. We have a vast array of opportunities ranging from Nursing, Clinical, to Finance, IT, Administrative, Research and Support Services to name a few. Across all locations, you’ll find career opportunities that support ersity, equity and inclusion. At Mayo Clinic, we invest in you with opportunities for growth and development and our benefits and compensation package are highly competitive. We invite you to be a part of our team where you’ll discover a culture of teamwork, professionalism, mutual respect, and most importantly, a life-changing career!

Mayo Clinic offers a variety of employee benefits. For additional information please visit Mayo Clinic Benefits. Eligibility may vary.

Position description

The Hospital Outpatient Coder reviews, analyzes, and assigns codes from medical record documentation to include, but not limited to, medical diagnostic and procedural information for outpatient medical and surgical encounters on the facility claim.

*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.

Qualifications

• Associate degree required; Bachelor’s Degree preferred.
• Applicant must have a minimum of 2 years of hospital outpatient coding experience.

Additional qualifications

• Experience using the technical coding rules and regulations for hospital outpatient including injection and infusion hierarchical coding. Experience with Ambulatory Payment Classification (APC) logic, National Correct Coding Initiative edits (NCCI), National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and hospital outpatient coding guidelines for official coding and reporting.
• In-depth knowledge of medical terminology, disease processes, patient health record content and the medical record coding process.
• Experience of principles, methods, and techniques related to compliant healthcare billing/collections.

License or certification

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

Exemption status

Non-exempt

Compensation Detail

$24.85 – $33.57 / hour

Benefits eligible

Yes

Schedule

Full Time

Hours / Pay period

80

Schedule details

Monday – Friday, typical business hours from 8:00 am – 5:00 pm.

*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.

Weekend schedule

N/A

Remote

No

International Assignment

No

Site description

Mayo Clinic is located in the heart of downtown Rochester, Minnesota, a vibrant, friendly city that provides a highly livable environment for more than 34,000 Mayo staff and students. The city is consistently ranked among the best places to live in the United States because of its affordable cost of living, healthy lifestyle, excellent school systems and exceptionally high quality of life.

Recruiter

Oo Her

EOE

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.

Emergency Department Medical Coder

• Job Category: Coder
• Requisition Number: REMOT001214
• Full-Time
• Virtual, USA

Company Description:

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. AAity Solutions provides healthcare professionals with key services including: Medical Scribing, Interim HIM Services, Medical Coding and Medical Transcription.

Position Summary:

As an experienced Aquity coder you will be responsible for providing coding and abstracting services for clients on emergency room facility accounts. You will use established coding principles and your knowledge and experience to assign diagnostic and procedural codes after a thorough review of the medical record to obtain the appropriate emergency room codes for procedures and injections and infusions. You will be located on a remote basis at a home office.

Essential Functions:

• Reviews medical records to identify pertinent diagnoses and procedures relative to the patient’s health care encounter.
• Assigns Evaluation & Management (E/M) level for emergency room encounters- facility and professional
• Assigns principal and secondary CPT codes and associated charges for procedures and injections/infusions performed in the emergency room
• Assign appropriate modifiers to CPT codes based on hospital, payer, or state guidelines
• 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.
• Participates in Coding Roundtables through presentation of materials, articles and current issues related to coding and Health Information Management.
• Maintains current knowledge of the information contained in the Coding Clinic, CPT Assistant, and the Official Guidelines for Coding and Reporting.
• Maintains effective and professional communication skills.
• Contributes to a positive company image by exhibiting professionalism, adaptability and mutual respect.

Requirements:

• CCS, CPC, RHIA or RHIT
• Excellent verbal and written communication skills.
• University Hospital Coding preferred, not required
• Must have a minimum 1 year of related acute care coding experience
• Understands medical terminology, anatomy, physiology, surgical technology, pharmacology and disease processes.
• Extensive knowledge CPT/HCPCS coding principles and guidelines, reimbursement systems, federal, state and payer-specific regulations and policies pertaining to documentation, coding and billing.
• Passing score on ED test and injection/infusion coding proficiency test required.

Why Work for Aquity:

We offer competitive benefits such as:

• Competitive salary
• Three weeks of paid time off (120 hours) annually
• Seven paid holidays annually
• Job related education reimbursement, CEU and credentials
• Opportunities to move into mentoring/QA positions

Compensation and Benefits: The pay range for this position is $26.00 – $27.00 per hour. Pay is based on several factors including but not limited to current market conditions, location, education, work experience, certifications, etc. Aquity Solutions offers a competitive benefits package including healthcare, 401k, and paid time off (all benefits are subject to eligibility requirements for full-time employees). Aquity Solutions is an equal opportunity employer and does not discriminate based on race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status.

Qualifications

Required

1 year: Experience coding injections/infusions and hospital leveling

1 year: Experience assigning a diagnosis and facility evaluation and management level?

1 year: Assign CPT codes to procedures ·

1 year: Able to assign ICD 10 CM diagnosis codes

1 year: ED Coding Experience

Equal Opportunity Employer/Protected Veterans/Iniduals with Disabilities

The contractor will not discharge or in any other 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 a 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 60-1.35(c)

Medical Coding Specialist

Fully Remote United States Revenue Cycle Management

Description

OpenLoop is looking for a Medical Coding Specialist to join our team remotely or at our HQ in Des Moines, IA. This role will be a member of the Revenue Cycle Management team reporting to the RCM Director.

About the Role

Responsibilities include, but are not limited to:

• Support Revenue Cycle Management Team by auditing physician coding and clinical documentation for correct code assignment and medical necessity support.
• Timely resolution of insurance claims including appeals and other similar items
• Act as a resource for documentation, coding, claim review/submission process, billing questions, and accounts receivable by staying up-to-date with local, state, federal laws, regulations, and guidelines
• Queries and follows up with providers when charts need updating in order to apply the most appropriate coding for the procedures performed
• Prepares and submits clean claims to various insurance payers both electronic and paper.
• Works with patients to review billing issues and process outstanding balances.
• Contact insurance carriers to verify eligibility and authorizations.
• Answering patient or insurance coding inquiries via telephone.

About OpenLoop

OpenLoop was co-founded by CEO, Dr. Jon Lensing, and COO, Christian Williams, with the vision to bring healing anywhere. Our telehealth support solutions are thoughtfully designed to streamline and simplify go-to-market care delivery for companies offering meaningful virtual support to patients across an expansive array of specialties, in all 50 states.

Our Company Culture

We have a relatively flat organizational structure here at OpenLoop. Everyone is encouraged to bring ideas to the table and make things happen. This fits in well with our core values of Autonomy, Competence and Belonging, as we want everyone to feel empowered and supported to do their best work.

Our Benefits

In addition to competitive salaries, this role includes:

• Unlimited PTO
• Medical, Dental and Vision
• 401K Program
• Flexible Schedule

Sound like a good fit? We’d love to meet you.

Requirements

• Understanding of EOB and remittance advises
• Must have a clear understanding of medical necessity
• Good communication, organizational and time management skills
• Familiarity with Evaluation and Management coding
• 3+ years of Revenue Cycle Experience
• CPC preferred
• Telemedicine coding experience preferred

Social Care Supervisor (Remote)

• Full time
• 898805BR
• Brand
• Best Buy Health
• Job Category
• Best Buy Health Group
• Job Level
• Supervisor
• Minimum Pay ($)
• 58,200.00
• Store Number or Department
• 100029 Remote – Nevada
• Maximum Pay ($)
• 103,700.00
• 9390 Gateway Dr. Suite 100
• Reno, NV, 89521
• Corporate, Health, Remote Work from Home

Job Description

This position is remote eligible.

Schedule: Monday – Friday, 9:00am – 5:30pm PST

About the team

The Social Care Counselor Team plays a critical role in our mission of enriching people’s lives through technology. The Social Care Counselor Team remotely engages customers, while completing assessments and Care Plans with them. They are empathetic and compassionate while assisting those in need. Team members maintain the highest degree of professionalism and are emotionally committed to the company’s mission. This role is important to Best Buy Health because it supports the technology which helps our customers manage their health and wellbeing needs while providing social support, health education, and community resources. They focus on the factors that impact a customer’s health including wellness, health and clinical needs, legal and financial needs, personal care, and technology assistance. The Social Care Counselor Team helps customers overcome challenges and improve their health and wellbeing in times of stress or difficulty.

About the job

The primary purpose of the Social Care Supervisor-Care Counselor Team is to provide administrative, clinical, and supportive supervision to the Social Care Counselor team members. This includes organizing and directing the daily activities, ensuring quality levels, and guiding Social Care Counselors as they provide social support, health education, and community resources. This inidual will also provide new offering feedback by reviewing outcome metrics and program successes while reporting to management any recommendations for program updates.

Responsibilities

• Continuously evaluate work process and design; ensure quality/performance improvement, productivity, and service delivery for the team.
• Manage and direct daily activities of the Social Care Counselor team.
• Provide supervision, call review, coaching, training, disciplining, and performance reviews for all assigned Social Care Counselor team members.
• Work collaboratively with all other Caring Center leaders to ensure customer social care needs are met.
• Serve as a resource by answering questions; assign tasks, follow up and provide instructions as needed.
• Follow up and resolve customer complaints, escalating to Senior Leadership when appropriate.
• Communicate solutions, successes, and opportunities to Senior Leadership and other leaders.
• Create and maintain an environment that encourages input from all team members and supports the company culture and quality expectations.
• Provide training, supervision, and overall support, including completing required paperwork, to the Social Care interns and universities.
• Ensure availability for on-the-spot questions and direction for all employees.
• Maintain high ethical standards in all decisions that are made.
• Acts as human services resource to other groups in Care.
• Adhere to all Company procedures, protocols, processes as well as, Federal and State regulations as they pertain to the assigned program – such as information security & privacy (i.e., CPNI, HIPAA, and FDA’s 501K Clearance issues).
• Other duties as assigned

Knowledge/skills/abilities

• Communication: written, oral, public speaking/presenting
• Flexibility in work duties and work schedule
• Strong customer service skills with prior experience in social work and healthcare
• Excellent analytical and problem-solving skills
• Adept in all MS Office applications
• Ability to adapt to changing business needs and competing priorities
• Ability to work independently and as part of a cross-functional team
• Strong organizational skills with a high level of attention to detail
• Ability to multi-task with a high level of organization.
• Respect and use of an evidence-based approach

Basic qualifications

• Masters’ Degree in Social Work
• LMSW, Licensed Masters Social Work or LCSW, Licensed Clinical Social Worker
• 5 years of social work leadership experience

Preferred qualifications

• 3 years providing social work supervision
• Experience with new program development and evaluation

Benefits

• Best Buy offers a range of benefits to support your overall well-being, as outlined in the Benefits Guide. Eligibility may vary.

Patient Account Associate, Full Time, Remote

• Adventist Health System/West, Roseville, California
• Support Services
• Corporate
• 91529

Adventist Health is more than an award-winning health system. We provide whole-person care to our communities and champion the greater good – from the operating room to the boardroom, we are driven by our unique passion to live God’s love through health, wholeness and hope. From Oregon to Oahu, we have a calling to always do more. Now is your chance to apply your passion to our mission.

We’re looking for someone to join our team as a Patient Account Associate who:

Performs medical billing and collection activities for assigned patient accounts.

Essential Functions:

• Reviews, corrects and submits claims to payers through application of basic or developing knowledge and experience. Communicates with patients, government agencies and third party payers to gather, process and record information needed for appropriate reimbursement.
• Reviews unpaid accounts, initiates corrective actions to collect the accounts, and follows up to ensure expected result is achieved. Initiates collection action for past due and denied claims. Calculates write-off and debit or credit adjustments.
• Posts insurance and personal payments to the correct account and calculates, verifies and posts contractual adjustments to the correct patient account.
• Meets or exceeds productivity and quality performance expectations.
• Performs other job-related duties as assigned.

You’ll be successful with the following qualifications:

Education:

• High School Education/GED or equivalent: Preferred
• Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred

Work Experience:

• Healthcare billing experience: Preferred

Required Licenses/Certifications:

• Certified Professional Coder (CPC) – AAPC: Preferred

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.

The estimated base pay for this position is $15.40 – $23.07. Additional inidual compensation may be available for this role through years of experience, differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package and a comprehensive benefits program is available for qualifying positions. Please contact our Talent Acquisition team for more information.

Registered Nurse

United States

OUR MISSION

Calibrate’s mission is to change the way the world treats weight. We’re defining a new category in metabolic health that mirrors what the research showsthat weight reflects our biology, not our willpower. Our program was designed by world leaders in obesity and nutrition science to improve metabolic health and drive long-term weight loss that’s impactful, realistic, and sustainable. Obesity is America’s underlying pandemic and largest category of chronic disease, and Calibrate is closing the gap in care for 175mm adults in a $600bn market where we spend millions of dollars each year and do not lose millions of pounds.

To bring Calibrate to everyone who needs it, we’re building the first telemedicine business within the healthcare ecosystem, aligning incentives for consumers, doctors, insurers, and pharmaceutical companies. We’ve built a proprietary Vertical Pharmacy Engine to connect our members to the most efficient path to insurance coverage, paving the way for a new model of chronic disease care. Calibrate’s first product, the One-Year Metabolic Reset, brings decades of clinical research directly to consumers through a virtual program combining FDA-approved prescription medication with intensive lifestyle intervention. The 52-week structured program includes biweekly 1:1 video coaching and curriculum that spans classes, recipes, workouts, and more. A purpose-built app enables daily tracking of food, energy level, weight, and bi-weekly goals and helps members interact with their Coaching and Medical teams, while a members’ group and events calendar create additional opportunities to tap into the Calibrate community.

Calibrate’s recently launched Masters Program keeps members engaged and supported in their metabolic health beyond their first year with the same evidence-based approach that defines Calibrate’s One-Year Metabolic Reset, at a lower cost. The result is a program that sustains and builds on members’ results with improved whole-body health that enables them to embrace a new day-to-day.

ABOUT THE ROLE

A modern approach to weight requires modern practices, and that means radically remodeling how intensive lifestyle intervention programs operate and scale. As part of our clinical program team, you’ll deliver several critical components of the Calibrate program: outreach and support for members to enhance their program progress, clinical program coordination, and confirmation of clinical appropriateness for clinical care pathways, introduction to our method, and setting program plans with members.

In addition to providing exceptional patient care, your feedback on how we can continue to improve our program to help patients achieveand maintaintheir metabolic health and weightloss goals will help shape and improve the program.

KEY RESPONSIBILITIES

• Consistently provide a world-class level of patient experience and clinical care
• Utilize and support a detailed clinical treatment paradigm, developed and updated by the Calibrate team and specialized to support obese patients achieve weight-loss goals
• Provide care management for a panel of patients who need additional clinical support throughout the program
• Serve as a program ambassador to address clinical and programmatic questions for patients at all stages of their Calibrate journey
• Engage with physicians and coaches to coordinate care for patients
• Review and manage daily tasks, patient messaging and callbacks

QUALIFICATIONS

• Bachelor of Science Degree in Nursing (BSN) graduate of an accredited school of nursing
• Current state license(s) in the state(s) practicing
• At least three years of direct clinical experience required, leadership experience preferred
• At least one year of health tech experience required
• Primary/preventative care, acute care, or emergency medicine experience
• Demonstrated excellent written/verbal communication skills and virtual bedside manner
• At least two licenses required, one of which must be from the following list: PA, NY, Compact, WA, CA, MI

Ideal Qualities:

• Excellent communicator with a customer service mentality
• Experience with project management and strong organizational skills
• Creative problem-solving skills that can be leveraged to empower others and drive member outcomes
• Self starter, solutions-oriented mentality
• Excited to build and deliver a new model for achieving lasting weight health
• Adaptable and flexible, but always puts the patient first
• Excellent at forging successful and respectful relationships with the entire team
• Quick learner, comfortable using a variety of applications and software

Additional Details:

• Malpractice coverage provided by employer

ABOUT OUR TEAM

Calibrate launched Summer 2020, and in 18 months has raised $127.6mm in funding from leading healthcare and consumer investors, including Founders Fund, Tiger Global, Forerunner Ventures, Threshold Ventures, Optum Ventures, and Redesign Health. Our team helped build businesses at the intersection of technology, consumer, and healthcare, including Athenahealth, Capsule, Flatiron Health, Harry’s, One Medical, Galileo, PillPack, Rent the Runway, and more. Our Clinical Advisors include Donna Ryan, the past President of the World Obesity Federation, and Darriush Mozafarrian, cardiologist and Dean at the Tufts Friedman School of Nutrition Science and Policy.

Since launch, Calibrate has been recognized by the following publications and organizations for our mission to change the way the world treats weight:

• TIME’s 2022 Best Inventions
• Fast Company’s 2022 World Changing Ideas Awards
• The World Economic Forum’s 2021 TechPioneers
• NYC Health Business Leaders on the NYC Digital Health 100

Calibrate is committed to bringing together people from different backgrounds and perspectives to deliver real results for our members.

BENEFITS

At Calibrate, we’re committed to our vision of putting our members and our teammates in control of their health. Some of our benefits for 2023 include:

• Competitive salary with opportunity for equity in an early stage, high growth business
• Generous paid time off, including an all-company holiday over Thanksgiving week
• Calibrate-funded health benefits (medical, dental, vision) – starting at zero cost to you
• Calibrate-paid disability and basic life insurance to give you peace of mind during unforeseen events
• Fertility, gynecology, and wellness support through Carrot Fertility
• Therapy on your time with free access to Headspace and Ginger
• An employee assistance program through Guardian to provide counseling across a range of personal topics
• Remote team with a headquarters in NYC
• Competitive Paid Parental Leave for parents

OUR VALUES

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

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

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

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

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

Home Health RN Triage (Remote)

remote type Fully Remote

locations Allina Commons

time type Part time

job requisition id R-0039401

Number of Job Openings Available: 1

Department: 78008776 Care Navigation

Shift: Day/Evening (United States of America)

Hours Per Week: 24

Union Contract: Non-Union

Weekend Rotation: Every Other

Job Summary:

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

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

Key Position Details:

This is a remote position, working 100% of the time from home.

Day/Evening shifts, every other weekend.

Job Description:

Job Requirements

• Associate’s or Vocational degree in nursing required
• Bachelors preferred
• Minimum 1 year nursing experience required
• Licensed Registered Nurse – MN Board of Nursing required if working in the state of MN upon hire
• BLS Tier 1 – Basic Life Support – Multisource required by completion of orientation

Principle Responsibilities

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

Physical Demands

Medium Work*: Lifting weight Up to 32 lbs. occasionally (*Allina Safe Patient Moving Policy), Up to 25 lbs. frequently

Coding/Billing Specialist (CPC)

• Employees can work remotely
• Full-time
• Department: 953 – Virtual Products – Scribe and Coder

Company Description

Privia Health is a national physician platform transforming the healthcare delivery experience. We provide tailored solutions for physicians and providers, creating value and securing their future. Through high-performance physician groups, accountable care organizations, and population health management programs, Privia works in partnership with health plans, health systems, and employers to better align reimbursements to quality and outcomes.

Job Description

Under the supervision of the Director, Privia + the CODER/BILLER+ Specialist is responsible for complete, accurate, and timely processing of all designated claims, reviewing and responding to daily correspondence from physician practices, answering incoming telephone calls, and providing information as requested or properly authorized. This person will assist in Coder/Biller+ go-live training as well as communicate closely with providers and practice staff. The ideal candidate possesses strong follow up skills, attention to detail, and takes pride in successfully resolving issues. This position works collaboratively with the staff in our physician practices as well as team members at Privia.

Primary Job Duties:

• HOLD and Denial Management:
  • Investigate denial sources; resolve and appeal HOLDs / Denials, which may include contacting payer representatives.
  • Independently decide how to adjust claims, including resubmission, appeals, and other claim resolution techniques.
• Assist in performing CODER/BILLER+ go-live training in collaboration with market RCM teams.
• Research and answer BILLER+ claim HOLD questions; deliver instructions to the providers and practice staff.
• Perform E&M, Procedural, and Surgical coding of professional claims as assigned
• Manage Salesforce cases
  • Route claims to the appropriate owner
  • Manage all Biller+ cases
  • Manage all Coder+ cases
    • Serves as the primary escalation point by working with the vendor to resolve coding issues and relaying resolutions to the care center
• Monitor and respond to email timely
• Follow guidelines and legal requirements to ensure compliance with federal and state regulatory bodies.
• Collaborate with Success Management on Check-in meetings for overall program success and client satisfaction
  • Provide HOLDs breakdown and aging report
  • Identify trends and solicit feedback from the Care Center to improve program success
  • Review current HOLDs in the practice worklist and set expectations
• Provide additional training sessions with the Care Center as requested
• Clean-up projects for escalated care centers

Qualifications

• High School diploma, Medical Office training certificate or relevant experience preferred
• Claim and denials management experience required
• 3+ years of experience in medical billing office preferred
• Must be a Certified Professional Coder
• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims
• Strong preference for experience working with athenaHealth’s suite of tools
• Must provide accessibility to private, quiet work space with high-speed internet to effectively work remotely
• Must comply with HIPAA rules and regulations
• Ability to work effectively with physicians, Non-physician practitioners (NPP), practice staff, health plan/other external parties and Privia multidisciplinary team

Colorado, New York, New Jersey, California and Washington Residents Only: The salary range for this role is $$48,000.00-72,000.00 in base pay and exclusive of any bonuses or benefits. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

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

Technical Requirements (for remote workers):

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

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

Prior Authorization Specialist

locations

Alpharetta – Windward Pkwy

Remote – Alaska

Remote – Alabama

Remote – Maryland

Remote – Maine

View All 51 Locations

time type Full time

job requisition id R31219

Change Healthcare is a leading healthcare technology company with a mission to inspire a better healthcare system. We deliver innovative solutions to patients, hospitals, and insurance companies to improve clinical decision making, simplify financial processes, and enable better patient experiences to improve lives and support healthier communities.

Work Location

• Fully Remote – U.S.

Position

• The Prior Authorization Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures, medications, surgery and outpatient radiology testing.

Core Responsibilities

• Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements
• Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services
• Manage correspondence with insurance companies, physicians, specialist, and patients as needed, including documenting in the EHR as appropriate
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
• Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial
• Prioritize the incoming authorizations by level of urgency
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations
• Communicate any insurance changes or trends among team
• Maintains a level of productivity according to established internal metrics
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
• Other duties as assigned.

Requirements

• High school diploma or equivalent
• Knowledge of CPT and ICD coding highly desired
• Knowledge of Medicare, Medicaid and third-party payer guidelines highly desired
• Good judgment, tact, diplomacy, and ability to problem solve
• Effective customer relation skills, ability to organize and interpret data
• Knowledge of EMR systems (Cerner/Powerchart, Meditech, EPIC, etc.).

Preferred Qualifications

• Previous experience in a clinic setting preferred
• Knowledge of insurance process and medical terminology highly desired
• PACS certification desired.

Working Conditions/Physical Requirements

• General office demands
• Must have a high speed internet connection and a quiet place to work remotely (equipment needed to work from home is provided by Change Healthcare).

Unique Benefits*

• Flexible work environments
• Ready, Set, Grow Career Development Center & access to Change Healthcare University for continuous professional learning & development with more than 5,000 training assets
• Volunteer days, employee giving and matching gifts programs, community awards and dollars for doers, community partnerships
• Employee wellbeing programs and generous health plans
• Educational assistance programs
• US 401(k) or Group RRSP (Canada) savings plans with matching employer contributions
• Be sure to ask our Talent Advisors for more information on location specific benefits and paid time off policies
• *Eligibility for some benefits may be limited or not available for part-time employees, be sure to speak with your Talent Advisor.

California / Colorado / New Jersey / New York / Rhode Island / Washington Residents Only:

The applicable base pay for your state is listed below. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, Change Healthcare offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with Change Healthcare, you’ll find a far-reaching choice of benefits and incentives.

The base pay range for this position is $13.07 – $29.02

Senior Edit Coder – Remote

Frisco, TX, United States

Job Identification

2305009468

Job Category

Administrative Functions

Conifer – Virtual Office

Degree Level

High School Diploma/GED (±11 years)

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

JOB SUMMARY

This position will be functioning under minimal supervision while utilizing independent decision making. This position will assist the manager and supervisor in training new team members, coordinate inquiries from ancillary departments regarding DNFB and edit tasks. The Sr. Edit Coder will investigate and solve edit issues and communicate root cause data to management in order mitigate potential upstream and downstream impacts.

Responsible for modifying and completing moderate to high complexity reviewing and resolving coding and charge edits using ICD-10-CM, CPT and HCPCS or any other designated coding classification system in accordance with coding rules and regulations. Abides by the Standards of Ethical Coding as set forth by AHIMA. Abstracting required clinical information from the medical record. Working in billing editor systems as required.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Performs claim edit reviews on outpatient encounters to validate appropriateness of the CPT codes, HCPCS Level II codes, and modifier assignments, APC group appropriateness, review for missed secondary diagnoses and/or procedures, and ensure compliance with all APC mandates and outpatient reporting requirements. Monitors medical visit code selection by departments against facility specific criteria for appropriateness. Assists in the development of such criteria as needed. Addresses CCI and LCD edits within the various billing editors while abiding by the Standards of Ethical Coding as set forth by the American Health Information Management Association. Meets and/or exceeds Conifer’s Edit Coder productivity standards.
• Runs and submits coding operational reports to leadership as requested, reviews data and identifies opportunities or trends. Demonstrates working knowledge of DNFB and uses data to drive performance excellence. Ability to analyze, display, and communicate data in meaningful manner. Ability to maneuver thru various electronic systems effectively.
• Ability to deal with customer/partner issues and resolve conflict. Ability to multi-task and meet deadlines. Will act as a resource for Edit Coders.
• Reviews claim denials and utilizes the medical record in determining accurate code assignment of all documented diagnoses and procedures adhering to the standards of ethical coding.
• Monitors DNFB report for outstanding and/or uncoded encounters to ensure timeliness of coding completion. Brings identified issues to department managers for resolution.

KNOWLEDGE, SKILLS, ABILITIES

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

• Three years minimum hospital outpatient coding/edit experience
• Advanced personal computing skills including MS Outlook, MS Word, MS Excel
• Advanced technical skills required to learn and navigate a variety of software systems, trouble-shoot computer problems, and work efficiently in a virtual environment
• Strong written and verbal communication skills
• Ability to think/work independently, yet interact positively with team
• Advanced problem-solving skills and ability to quickly analyze a situation.
• Comprehensive knowledge of ICD-10 and CPT coding systems.
• Strong knowledge base of changes in LCDs and NCDs.
• Strong knowledge base of current NCCI and OCE guidelines
• Attention to detail is critical to this position
• Other functions as deemed necessary to complete and final bill claims accurately

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience required to perform the job.

• Previous auditing experience or strong training background in coding and reimbursement
• Outstanding interpersonal communication skills as well as excellent oral and written communication skills
• Comprehensive knowledge of the APC structure and regulatory requirements.
• Knowledge of medical terminology, anatomy and physiology, disease process, and surgical procedures

CERTIFICATES, LICENSES, REGISTRATIONS

Required: AHIMA RHIT or RHIA or AAPC CCS, CPC approved credential

PHYSICAL DEMANDS

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

• Ability to lift 15-20lbs
• Ability to sit and work at a computer for a prolonged period of time
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

WORK ENVIRONMENT

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

• Office/Hospital Work Environment
• Works in a private office space in the coder’s home per Conifer Telecommuter Policy as defined in the Telecommuting Program Guide

OTHER

Must be able to travel nationally as needed, not to exceed 10%

Responsibilities

Is responsible for coding OP Ancillary, Clinic, ED, OPS, and Observation outpatient accounts.

Qualifications

Education:

Required: Associate degree

Preferred: Bachelor’s degree

Experience:

Required: 2 to 5 years of coding experience

Certifications:

Preferred: RHIA, RHIT, CCS, CPC or COC

Sr. Coding Specialist (Fully Remote)

• Remote Location
• Full time
• 198457

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
• Sr. Coding Specialist (Fully Remote)
• Location
• Cleveland
• Facility
• Remote Location
• Department
• Coding Reimbursement-Chief Of Staff Division
• Job Code
• U99901
• Shift
• Days
• Schedule
• 8:00am-4:30pm

Job Summary

This position will be supporting our Anesthesia Coding Team.

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.

Responsible for timely and accurate coding of clinical data through the assignment of CPT, ICD 10, and HCPCS codes while complying with the regulations and requirements of the Federal Government, State licensing agencies and corporate policies and procedures while maintaining an accuracy rate at or above 95%. Responsible for covering multiple specialties and special projects as assigned.

Job Details

Job Responsibilities:

• The Senior Coding Specialist is responsible for correct coding of professional services and upholding compliance standards.
• Perform coding and related duties using established Professional Coding policies in an accurate and timely manner. Review medical documentation and assign CPT, ICD-10, HCPCS II and modifiers based on documentation and payor requirements on all patient encounters and all medical and surgical specialties.
• Frequent assignment changes to support the enterprise.
• Special projects as assigned to support the enterprise.
• Provides necessary mentoring and training for the professional coding staff.
• Assists with resolution of coding edits in a timely manner. Identify opportunities to reduce claim edits and enhance first pass payment rate.
• Interacts with Providers, and coding staff to resolve documentation or coding issues
• Maintains current knowledge of coding principles and guidelines as coding conventions are updated; monitors and analyzes current industry trends and issues for potential organizational impact.
• Assists in the development of programs and procedures to ensure a 95% or greater coding accuracy rate.
• Demonstrate a commitment to integrating coding compliance standards into daily coding practices. Identify, correct and report coding problems.
• Advise and participate in coding policy changes.
• Maintain required coding certification/credentials.
• Required to meet cross coverage and training competencies.
• Other duties as assigned.

Education:

• High School Diploma / GED or equivalent required.
• Associate’s degree preferred.
• Specific training related to CPT procedural coding and ICD-10 diagnostic coding through continuing education programs/seminars and/or community college.
• Working knowledge of human anatomy and physiology, disease processes and demonstrated knowledge of medical terminology.

Certifications:

• At least one of the following preferred certifications are required: Certified Professional Coder (CPC), Certified Coding Specialist Physician (CCS, CCS-P), Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA) from American Academy of Professional Coders (AAPC).

Complexity of Work:

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

Work Experience:

• Minimum of 4 years of progressive on-the-job coding experience with ICD-10-CM and CPT coding in a health care environment and/or medical office setting.

Physical Requirements:

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

Personal Protective Equipment:

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

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.

Please review the Equal Employment Opportunity poster.

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Iniduals with Disabilities