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Senior Billing Specialist, Insurance

A/R

at Headspace Health

Location: Remote – United States

Headspace and Ginger have recently merged to become Headspace Health! While roles are still being recruited separately on our respective websites, new hires from this point forward will be joining Headspace Health. For more information, please speak with your recruiter!

About the Senior Billing Specialist, Insurance A/R at Headspace Health:

We’re looking for a Senior Billing Specialist who can combine their healthcare experience with a fast-paced and ever-changing environment. You will be working with the Billing team to ensure timely and accurate insurance A/R resolution, research and review exceptions and escalations from the billing team, perform productivity and quality reporting, and document and improve team processes to ensure insurance billing is handled correctly from start to finish.

How your skills and passion will come to life at Headspace Health:

• Serve as team lead for Insurance Follow-up Pod within the RCM team
• Work assigned worklists of complex and high risk accounts, and meet production productivity and quality targets
• Responsible for weekly cash reconciliation
• Review stuck claim issues, and provide day-to-day support and coaching for the Insurance Follow-up Pod
• Conduct A/R clean-up projects, and provide SWAT team support for high risk billing areas
• Identify trending claim issues related to rejections, denials and underpayment, and make recommendations to RCM and Finance leadership on A/R risk remediation strategies
• Produce and assign worklists for the team; monitor workload and make adjustments as needed
• Responsible for carrying out and improving quality assurance and productivity reporting processes
• Conduct ongoing quality audits, and perform staff training as needed
• Identify and implement improvement and automation opportunities
• Independently drive process improvement projects to accelerate insurance A/R resolution and reduce write-offs
• Work closely with Product and Engineering teams on designing and testing technology enhancement opportunities and RCM system requirements; conduct user acceptance testing for RCM related product changes
• Work cross-functionally with Support, Account Management, Channel Operations and Clinical Operations team on implementing and optimizing workflows for new and existing health plans and clients
• Work cross-functionally with clinicians when coding and billing questions / issues arise
• Monitor claims volume relative to staffing and work with RCM leadership on addressing any staffing capacity risks
• Work with RCM leadership on creating and maintaining a productive, collaborative, and rewarding work environment
• Uphold HIPAA compliance guidelines.

What you’ve accomplished:

• 7+ years Revenue Cycle Management experience and knowledge of medical claims and health plan / EAP rules
• Self-starter with strong billing, coding, and claims follow-up skills
• Behavioral health / mental health service line and telehealth billing experience preferred
• Experience in supervisory and managerial positions
• Experience working with payer provider relations teams on trending payer issues, as well as working cross functionally with other Ginger teams (including credentialing, support, contracting, account management) to improve internal workflows
• Proficient in Excel and data analysis
• Strong root cause and problem solving skills
• Ability to navigate occasionally complex workflows
• Strong attention to detail.
• Technically savvy with claims billing software and Microsoft Office, with a desire to learn new software as well
• Strong communication and interpersonal skills

Preferred Qualifications:

• Experience in behavioral health, telehealth, or digital health
• Experience in B2B2C healthcare.

How to get started:

If you’re excited by the idea of seeing yourself in this role at Headspace Health, please apply with your resume and a cover letter that best expresses your interest and unique qualifications.

Our Commitment to Diversity & Inclusion:

Diversity, Equity, Inclusion, and Belonging (DEIB) is at the heart of our mission to improve the health and happiness of the world. At Headspace Health, we are committed to bringing together humans from different backgrounds and perspectives while providing employees with a safe and welcoming work environment free of discrimination and harassment. We continuously strive to create a erse and inclusive environment where everyone can thrive, feel a sense of belonging, and do impactful work together. As an equal opportunity employer, we prohibit any unlawful discrimination against a job applicant on the basis of their race, color, religion, gender, gender identity, gender expression, sexual orientation, national origin, family or parental status, disability*, age, veteran status, or any other status protected by the laws or regulations in the locations where we operate. We respect the laws enforced by the EEOC and are dedicated to going above and beyond in fostering ersity across our workplace.

*Applicants with disabilities may be entitled to reasonable accommodation under the terms of the Americans with Disabilities Act and certain state or local laws. A reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing undue hardship on Headspace Health. Please inform our Talent team if you need any assistance completing any forms or to otherwise participate in the application process.

Headspace Health participates in the E-Verify Program.

Headspace Health is committed to protecting the privacy and security of your personal data. Please view our privacy notice here.

Virtual Care Nurse – US Remote

at League Inc.

US-Remote

Help Us Shape the Future of Healthcare

At League, we’re big on building connections – both through our product and with each other. Our platform is consumer centric, personalized and always on. We’re reimagining the health benefits experience to give people a more consumer-centric way to manage their health: immediate, seamless, and tailored to their unique needs. It’s a front door to healthcare that empowers people to live healthier, happier lives. Every day.

As a Virtual Care Nurse working for Virtual Concierge Services USA, P.C., you are responsible for delivering exceptional chat-based nursing care that people turn to and trust for health and wellness-related advice. You will provide service within the nursing scope of practice for members located across the United States, using our customer’s on-demand virtual care platforms. You will be servicing members’ chats within states your existing nursing license(s) enables you to practice, with the expectation that you will obtain additional nursing licenses where required within 6 months of hire.

We believe that erse teams perform better and that fostering an inclusive work environment is a key part of growing a successful team. We welcome people of erse backgrounds, experiences, and perspectives. We are an equal opportunity employer, and we are committed to working with applicants requesting accommodation at any stage of the hiring process.

In this role, you are expected to:

• Liaise with members and various health care providers to educate and help people to achieve their optimal health;
• Draw on your knowledge of the US healthcare system to empower and assist members to be able to navigate through the complexities of the differing levels of care;
• Help build & maintain efficient processes and protocols to address members’ priority health needs;
• Help deliver a best-in-class virtual care nursing experience;
• Proactively reach out to members regarding past visits, including those at high risk for chronic health issues;
• Provide expert health guidance via chat that remains within the scope of a Registered Nurse.

About you:

• Must hold an active multi-state RN license via the eNLC;
• Bachelor of Science in Nursing (BSN) or equivalent degree;
• Near-native bilingual (Spanish/English) candidates are preferred;
• Minimum of 3 years experience in post-graduate nursing practice, preferably in a primary care or emergency-based setting;
• Demonstrated experience working in a team environment;
• Experience working with triage processes is highly preferred to ensure members receive appropriate attention, in a suitable location, with the requisite degree of urgency;
• Tech-savvy with knowledge of how to use a Macbook is considered a huge plus.

At League, everyone is welcome. We believe iniduals should not be disadvantaged because of their background or identity, but instead should be considered based on their strengths and experience. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. If you are an inidual in need of assistance at any time during our recruitment process, please contact us at [email protected].

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Telephonic Nurse Case Manager

United States – Remote

Full time

82375

If you’re passionate about helping people protect what matters most to them, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you!

Territory: The location of this position is flexible and open to virtual and/or remote based applicants.

What you can expect: The Telephonic Nurse Case Manager is a member of the Worker’s Compensation team here at Nationwide. Your role is triaging your case load and determining our members needs in a timely manner to provide exceptional service and results. This is a three point contact position in which you will communicate with the members, injured Associate, claims specialist/adjuster, and the doctor or care provider. Your goal is ensuring the Associate returns to work safely and effectively.

You are expected to practice lean management principles on a daily basis.

The ideal candidate will have:

• Be a Registered Nurse (RN) with valid licensing.
• Bachelor’s of Nursing (BSN) is preferred.
• Certified Case Manager (CCM) preferred.
• Compact licensure required. Illinois and California licensure preferred,
• (For internal use only) Compensation Grade: F3

Nationwide pays based on a geographic-specific salary structure. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role as well as the cost of labor in the market; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range. The role may also be eligible for either short-term or long-term incentive plans based on business and/or position-specific results. Newly hired full-time associates receive a minimum of 18 days paid time off each full calendar year, pro-rated quarterly based on hire date. Newly hired full-time associates at higher job levels may receive additional paid time off. You will also receive 8 hours of Lifetime paid time off and 8 hours of Unity Day paid time off. The range for this role is listed below.

In Washington, the salary range for a Telephonic Nurse Case Manager is $66,500.00 to $131,500.00.

Job Description Summary

As a Telephonic Nurse Case Manager, you will be responsible for office based medical and disability case management with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment. You will also be responsible for helping to ensure injured workers receive appropriate treatment directly related to the compensable injury and for assisting claim handlers in managing medical treatment to an appropriate resolution and being an advocate to the injured employee/family, employer, provider(s), insurance company, and healthcare personnel.

Job Description

Key Responsibilities:

• Works telephonically with workers’ compensation patients, employers, providers, and claim handlers to coordinate and assure proper delivery and oversight of medical and disability services.
• Authorizes medical treatment and associated diagnostic testing on assigned claims as allowed by state or policy jurisdictions.
• Evaluates and coordinates quality, cost effective medical and rehabilitative services. Proactively manages the medical expenses by partnering with specialty resources (i.e. diagnostic and other ancillary services vendors) to achieve appropriate claim outcomes.
• Plans a proactive course of action to address issues presented to enhance the injured employee’s short and long-term outcomes.
• Assesses and identifies barriers to recovery; determines goals, objectives, and potential alternatives to care.
• Assists the injured worker by providing medical and disability education and coordinating on-site job analysis; work conditioning; functional capacities; and ergonomic evaluations.
• Negotiates and assists employers with the development of transitional sedentary or modified job duties based on the injured employee’s functional capacity to ensure the injured employee’s safe and timely return to work.
• Monitors, evaluates, and documents case management activities and outcomes including, but not limited to, case management approaches; over or underutilization; inappropriate care; effective treatment; permanent or temporary loss of function; failed or premature return to work; and non-compliance.
• Adheres to all appropriate privacy, security and confidentiality policies and procedures. Complies with established Best Practices.

May perform other responsibilities as assigned.

Reporting Relationships: Reports to Manager or Director. No direct reports but may lead others on projects and assignments.

Typical Skills and Experiences:

Education:

• Bachelor’s Degree required.

License/Certification/Designation:

• Registered Nurse (RN) with current state license(s) required. CDMS, CRC, CCM, or CRRN designation desirable.

Experience:

• Three or more years of clinical experience required, preferably in emergency room, orthopedics, neurological, critical care, and/or physical rehabilitation setting. Previous Workers’ compensation or disability case management experience preferred.

Knowledge, Abilities and Skills:

Knowledge of medical causation and relatedness as well as medical diagnostics, procedures and treatment standards is necessary. Understanding of Workers’ Compensation laws preferred. Excellent written and verbal communication, organizational and interpersonal, customer service, time management, and problem-solving skills required. Proficiency in Microsoft Office products, such as Word, Excel and Teams, as well as experience with internet searches and a comfort level with other software programs required. Ability to set priorities and work independently is essential.

Other criteria, including leadership skills, competencies and experiences may take precedence.

Staffing exceptions to the above must be approved by the hiring manager’s leader and HR Business Partner.

Values: Regularly and consistently demonstrates the Nationwide Values.

Job Conditions:

Overtime Eligibility: Exempt (Not Eligible)

Working Conditions: Normal office environment. Occasional travel may be required.

ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.

Benefits

• We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. To learn more about the benefits we offer, click here.

Nationwide is an equal opportunity employer. We celebrate ersity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. Nationwide prohibits discrimination and harassment and affords equal employment opportunities to employees and applicants without regard to any characteristic (or classification) protected by applicable law.

#claimsSmoke-Free Iowa Statement: Nationwide Mutual Insurance Company, its affiliates and subsidiaries comply with the Iowa Smokefree Air Act. Smoking is prohibited in all enclosed areas on or around company premises as well as company issued vehicles. The company offers designated smoking areas in which smoking is permitted at each inidual location. The Act prohibits retaliation for reporting complaints or violations. For more information on the Iowa Smokefree Air Act, iniduals may contact the Smokefree Air Act Helpline at 888-944-2247.

For NY residents please review the following state law information: Notice of Employee Rights, Protections, and Obligations LS740 (ny.gov) https://dol.ny.gov/system/files/documents/2022/02/ls740_1.pdf

Nationwide pays based on a geographic-specific salary structure. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role as well as the cost of labor in the market; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. The range for this role in California is listed below. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range.$66,500.00 – $115,500.00

Nationwide pays based on a geographic-specific salary structure. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role as well as the cost of labor in the market; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. The range for this role in Colorado is listed below. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range.$66,500.00 – $102,500.00

Nationwide pays based on a geographic-specific salary structure. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role as well as the cost of labor in the market; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. The range for this role in New York is listed below. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range.$66,500.00 – $139,000.00

RN Specialist

at Transcarent

US – Remote

Who we are

Healthcare is more confusing, more costly, and more complex than ever. Transcarent is a health and care experience company on a mission to empower Members to stay healthy by providing them with unbiased information, trusted guidance, and easy access to high value care where and when they need it. You will be part of a world-class team, supported by top tier investors like 7wireVentures and General Catalyst, and founded by amission-driven teamcommitted to transforming the health and care experience for all. We closed on our Series C funding in January 2022, raising our total funding to $298 million and enabling us to respond to the demand for rapid expansion of our offering.

Transcarent is committed to growing and empowering a erse and inclusive community within our company. We believe that a team with erse lived experiences, working together will strengthen our organization, and our ability to deliver “not just better but different” experiences for our members.

What we look for in our teammates

We are looking for teammates to join us in building our company, culture, and Member experience who:

• Put people first, and make decisions with the Member’s best interests in mind
• Are active learners, constantly looking to improve and grow
• Are driven by our mission to measurably improve health and care each day
• Bring the energy needed to transform health and care, and move and adapt rapidly
• Are laser focused on delivering results for Members, and proactively problem solving to get there

Summary:

The RN Specialist reports to the Senior Manager of Surgical Quality & Clinical Operations and is responsible for guiding members through their Transcarent experience in partnership with Transcarent’s Live Services Department. This role also supports quality assurance and improvement efforts and operations related to our Centers of Excellence (COE) program in accordance with the Transcarent Quality Tenets. The Nurse Clinical Specialist will reflect the mission, vision, and value statements of Transcarent to internal departments and external plan sponsors, providers, and partners.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Support the Live Services Department with clinical subject matter expertise and guidance relating to inidual cases and in broader strategy and processes. This includes direct support to Plan Members.
• Partner with the Live Services Department to manage a case load efficiently and effectively across a variety of clients and clinical categories.
• Supports members to introduce, coordinate, and guide members through their Transcarent experience.
• Work effectively with other supporting operational roles and internal departments, to coordinate the member’s case.
• Effectively address and resolve patient barriers to utilize the benefit including working with members to address program questions, including collecting medical records in a timely and accurate manner to ensure an expedited process
• Work with cross functional teams to develop new or update existing quality measures, protocols, processes and policies to minimize risk and ensure compliance.
• Work collaboratively with our COE facility and provider partners in support of achieving the highest quality experience for our Members.
• Support the Provider Relations team with guidance relating to COE facilities and providers for targeting and participation.
• Support the operational needs of the COE program from a clinical perspective including monitoring and support for member complications.

Qualifications:

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

• Registered Nurse and current licensure, BSN required.
• A minimum of 5 years clinical acute care experience as a practicing RN preferred

Competencies

• Flexibility – Openness and understanding that dynamic environments include change, and welcoming that change with a positive attitude
• Problem Solving – Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
• Customer Service – Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Oral Communication – Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
• Written Communication – Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
• Teamwork – Balances team and inidual responsibilities; Exhibits objectivity and openness to others’ views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone’s efforts to succeed.

Total Rewards

Inidual compensation packages are based on a few different factors unique to each candidate, including primary work location and an evaluation of a candidate’s skills, experience, market demands, and internal equity.

Salary is just one component of Transcarent’s total package. All regular employees are also eligible for the corporate bonus program or a sales incentive (target included in OTE) as well as stock options.

Our benefits and perks programs include, but are not limited to:

• Competitive medical, dental, and vision coverage
• Competitive 401(k) Plan with a generous company match
• Flexible Time Off/Paid Time Off, 12 paid holidays
• Protection Plans including Life Insurance, Disability Insurance, and Supplemental Insurance
• Mental Health and Wellness benefits

Location

You must be authorized to work in the United States. Depending on the position we may have a preference to a specific location, but are generally open to remote work anywhere in the US.

Transcarent is an equal opportunity employer. We celebrate ersity and are committed to creating an inclusive environment for all employees. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out!

Research shows that candidates from underrepresented backgrounds often don’t apply unless they meet 100% of the job criteria. While we have worked to consolidate the minimum qualifications for each role, we aren’t looking for someone who checks each box on a page; we’re looking for active learners and people who care about disrupting the current health and care with their unique experiences.

Title: Account Supervisor

Location: Gladstone, New Jersey, United States

Work fully remote or from our New Jersey office

PRECISIONvalue is the top payer marketing agency in the country. We partner with global pharmaceutical and life sciences companies who are developing groundbreaking treatments to make medicines accessible and affordable. We excel at demonstrating the economic, clinical, and societal value of creative medical treatments to payers, providers, patients, and policymakers.

At Precision, we will recognize your achievements and contributions. You will have the opportunity to learn from external training, provide mentorship, and work with cross-functional project teams. Plus, our advancement opportunities will allow you to realize your full potential.

The Account Supervisor functions as a team leader and provides support through overseeing and coordination of projects. The Account Supervisor is responsible for assuring and maintaining client satisfaction as the primary client point of contact. The Account Supervisor serves as a liaison between client services leadership, strategy, and internal operations and is responsible for the success and profitability of all support projects.

Essential duties include but are not limited to:

Client Management:

• Assume primary lead for the client upon client acceptance of proposal
• Maintain and manage business opportunities with existing clients
• Development of client agendas and slide presentations
• Lead and/or support calls with client and LMR, faculty, and/or content experts regarding content and direction
• Review and forward status/contact reports to client after each client contact
• Develop project briefs and scope of work for clients and internal team members.

Project Management:

• Provide direction to support team on all aspects of project management to ensure client expectations are met or exceeded
• Manage projects by utilizing approved internal project briefs, proposal templates, and budget tools
• Collaborate with internal team on overall project plan, objectives, milestones, and deliverables

Leadership:

• Function as internal team leader ensuring all members of the team work together smoothly and effectively
• Mentor personnel at the Associate Account Executive, Account Executive, and/or Senior Account Executive levels. Depending on size of team, potential for management and supervision of colleagues.
• Conduct performance reviews, prepare development plan, and set goals for direct reports as applicable.
• Must be able to execute and teach junior level Account team employees the following: development of client agendas, project status, financial reports, and contact report

Business Development:

• Work with Client Services leadership and Strategy to help identify market opportunities that will further client business
• Identify opportunities for organic growth within assigned accounts Position Description

Finance:

• Develop proposals, budgets, and reconciliations
• Collaborate with all teams to ensure proposal development is accurate and all teams hours are captured (Traffic, Production, Creative, Clinical/Copy, Meeting Services, etc)
• Monitor budgets including direct costs, labor costs, fee, and out-of-pocket expenses to ensure team members/direct reports are managing assigned budgeted labor hours and direct costs
• Provide periodic budget status updates and communication with client

Qualifications:

Education:

• Bachelor’s degree in marketing, advertising, communications, or related subject
• 3-5 years in an Account role within a pharmaceutical/medical communications company.
• Daily client facing experience and Medical, legal, regulatory review experience is required.

Precision is required by law in some states or cities to include a reasonable estimate of the compensation range for this role. This compensation range takes into account the wide range of factors that are considered in making compensation decisions including but not limited to: skill sets, experience and training, licensure and certifications, and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Precision, it is not typical for an inidual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. This role is also eligible for a discretionary annual bonus, health insurance, retirement savings benefits, life insurance and disability benefits, parental leave, and paid time off for sick leave and vacation, among other benefits.

Reasonable estimate of the current range

$90,000$123,000 USD

Any data provided as a part of this application will be stored in accordance with our Privacy Policy.

Precision Medicine Group is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status or other characteristics protected by law. 2020 Precision Medicine Group, LLC

Title: Contractor Nursing Content Developer- FNP Prep

Location: Remote/Nationwide Remote/Nationwide USA

Part Time

Role

We are looking for a remote Contractor Nursing Content Developer- FNP Prep who will assist Kaplan’s nursing team in developing material to prepare students for the Family Nurse Practitioner (FNP) Certification examination. Kaplan s FNP Prep helps prepare students for the FNP examination while building a strong foundation of clinical knowledge. This is a remote opportunity with flexible hours (up to 20 per week).

Responsibilities

The responsibilities of the Contractor will include:

• Writing quiz questions in the style of American Nurse Credentialing Center (ANCC) or American Association of Nurse Practitioners (AANP) examinations.
• Writing or editing content related to pathophysiology, pharmacology, physical assessment, and evidence-informed practice.
• Contributing to suggested study plans or tips for preparing for the FNP certification examination.
• Quality assurance reviews of FNP simulation content.

Skill Requirements

The candidate must:

• Have excellent command of the English language – both verbal and written
• Possess a DNP or Master s degree from a nurse practitioner program accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN)
• One year of clinical experiences a nurse practitioner desired, FNP or Adult-Gerontology (A-GNP)
• Maintain an active RN license
• Have experience tutoring/mentoring/educating nursing students
• Have experience writing multiple-choice questions
• Have exceptional attention to detail, organization skills, and time management skills
• Be highly motivated and take initiative proactively
• Be receptive to feedback, meet deadlines, and take accountability for deliverables

Title: Scheduling Specialist

Location: United States

The Opportunity:

The Scheduling Specialist is responsible for performing scheduling duties for Diagnostic Services patients. Scheduling Specialists are to perform these functions while meeting the mission and of Ensemble Health Partners and all regulatory compliance requirements. They will work within the policies and processes as they are being performed across the entire organization.

Job Responsibilities:

• Scheduling and pre-registering patients for the appropriate procedures based on physician’s orders
• Selecting accurate medical records for patient safety
• Providing proper patient instructions, pre-registering patients, obtaining and validating demographic and insurance information, while providing excellent customer service
• Point of Service collections and financial counseling functions as appropriate

• Other job related duties as required by their supervisor, subject to reasonable accommodation

Required Education:

• High School Diploma, GED, or Equivalent Experience

Employment Qualifications:

• Certified Revenue Cycle Representative (CRCR) required within 6 months of hire

Experience we Love:

• 1-3 years’ work experience
• 2 years’ experience in a healthcare related position.
• Experience working with insurance companies and/or pre-authorizations required.
• Patient Access experience with managed care/insurance, formal typist with a minimum of 35 WPM, intermediate proficiency in MS applications (Word, Excel & PowerPoint), experience with multiple computer systems and use of dual screens. Able to multitask and work inidually while applying critical thinking skills.
• Customer Service experience highly preferred.

#LI-REMOTE

Outpatient Medical Coding Auditor (PPI Coding Disputes Team)– WORK AT HOME (ANYWHERE IN THE US)

Full time

Description

Responsibilities

Where you Come In

Humana is looking for an experienced medical coding auditor to handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Outpatient Coding Auditor (Surgical Specialty, Outpatient Surgery Coding, E&M and APC) – PPI Coding Disputes Team with Humana.

The Outpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate CPT/ HCPCS code 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.

What Humana Offers

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

This is a 40 hour per week role and the work hours will be 8 hours a day Monday to Friday

Required Qualifications – What it takes to Succeed

• CPC or CCS Certification
• CPT/ HCPCS auditing experience
• Minimum of 1 years’ work experience reading and interpreting claims
• Minimum of 3 years’ experience in performing outpatient coding audits in health insurance and/or hospital settings and working coding-related disputes and trending results
• Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
• Strong attention to detail
• Can work independently and determine appropriate course of action
• Ability to handle multiple priorities
• Capacity to maintain confidentiality
• Excellent communication skills both written and verbal
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

  WORK HOURS: Typical work hours fall between 6AM EST – 5PM EST, Monday-Friday. 8 hours per day, 5 days per week (Monday-Friday), depending on business needs.

Preferred Qualifications

• Associate’s Degree or higher in Health Information Management (HIM)
• Experience in Financial Recovery
• Experience in a fast paced, metric driven operational setting

Additional Information – How we Value You

• Benefits starting day 1 of employment
• Competitive 401k match
• Generous Paid Time Off accrual
• Tuition Reimbursement
• Parent Leave
• Go365 perks for well-being
• Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.

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

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 25m x 10m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves.

The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Scheduled Weekly Hours 40

Healthcare Billing Specialist- remote $15/hr

Full time

HEALTHCARE BILLING SPECIALIST (HBS)

LabCorp is seeking a HealthCare Billing Specialist to join our team! LabCorp’s Revenue Cycle Management Division is seeking iniduals whose work will improve health and improve lives. If you are interested in a career where learning and engagement are valued, and the lives you touch provide you with a higher sense of purpose, then LabCorp is the place for you!

Responsibilities:

• Research, translate, and analyze routine front end billing issues
• Research, translate, and update demographic data to ensure prompt payment from customers
• Resolve systems issues from daily reports to determine appropriate resolution action
• Fast paced; after extensive training- will have daily/weekly goals to be met

Requirements:

• High School Diploma or equivalent
• Associate’s Degree or Medical Coding and Billing Certification a plus
• REMOTE work; must have high level Internet speed (50 mbps) connectivity
• 1 year Billing experience a plus, but not required
• Ability to work and learn in a fast paced environment
• Strong attention to detail
• Ability to perform successfully in a team environment
• Excellent organizational and communication skills
• Strong verbal communication skills and excellent ability to listen and respond
• Basic knowledge of Microsoft office
• Alpha-Numeric Data Entry proficiency strongly preferred

Why should I become a Healthcare Billing Specialist at LabCorp?

• Generous Paid Time off!
• Medical, Vision and Dental Insurance Options!
• Flexible Spending Accounts!
• 401k and Employee Stock Purchase Plans!
• No Charge Lab Testing!
• Fitness Reimbursement Program!
• And many more incentives!

Labcorp is proud to be an Equal Opportunity Employer:

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

Claims Research and Resolution Representative

locations

• Remote Wisconsin
• Work at Home – Utah
• Work at Home – Washington
• Work at Home – Virginia
• Work at Home – Texas
• Work at Home – Tennessee
• Work at Home – South Carolina
• Work at Home – Pennsylvania
• Work at Home – Oregon
• Work at Home – West Virginia
• Work at Home – New York
• Work at Home – Ohio
• Work at Home – North Carolina
• Work at Home – New Mexico
• Work at Home – New Jersey
• Work at Home – New Hampshire
• Work at Home – Nevada
• Work at Home – Nebraska
• Work at Home – Missouri
• Work at Home – Massachusetts
• Work at Home – Montana
• Work at Home – Mississippi
• Work at Home – Minnesota
• Work at Home – Louisiana
• Work at Home – Michigan
• Work at Home – Kentucky
• Work at Home – Maryland
• Work at Home – Kansas
• Work at Home – Iowa
• Work at Home – Indiana
• Work at Home – Illinois
• Work at Home – Idaho
• Work at Home – Georgia
• Work at Home – Florida
• Work at Home – Colorado
• Work at Home – California
• Work at Home – Arizona
• Work at Home – Arkansas
• Work at Home – Alabama
• Work at Home – Oklahoma
• Work at Home – Wyoming
• Work at Home – Vermont
• Work at Home – Rhode Island
• Work at Home – North Dakota
• Work at Home – Maine
• Work at Home – Delaware
• Work at Home – Connecticut
• Work at Home – South Dakota

time type

Full time

job requisition id

R-297975

Description

Humana/iCare is seeking a Claims Research and Resolution Representative 4 to join our growing team. The Claims Research & Resolution Representative 4 is responsible for assisting the Supervisor of Claims Research & Resolution in providing general support and expertise to the claims and appeals team. Join this dedicated team and lead change in how health care for the underserved in Wisconsin is managed.

Responsibilities

Essential Duties and Responsibilities:

• Promptly and accurately address resolution of provider claims issues.
• Assist the Supervisor of Claims Research & Resolution in providing general support and expertise to the Operations team, including guidance and expertise in reviewing, researching, and responding to claims processing issues to providers in a timely manner.
• Coordinate work assignments for claims analysts to ensure that all work is completed in a timely fashion.
• Monitor the due dates for completion of all assignments made to the claims team to ensure the highest level of customer service to the provider community.
• Assume accountability for ensuring iniduals/team meet their performance metric goals.
• Monitor, track and direct day to day operations of claims staff.
• Monitor daily inventory reports in order to assess if assignment changes are needed; trend inventory levels and communicate with claims processing vendor to ensure levels remain at an acceptable level.
• Attend weekly and ad hoc meetings with iCare’s claims processing vendor to assign priorities, determine resolution, and develop processes affecting iCare Operations.
• Compile results of inquiry research to determine the root cause of provider issues.
• Assist staff in handling complicated or unusual claims and provider issues.
• Exercise proper judgment on questionable claims.
• Assist with the handling/resolution of provider appeals and operation related encounter errors according to iCare policy/procedures.
• Investigate trends, surface issues, identify root problems, and collaboratively work with various iCare teams/iniduals to resolve Operational related issues.
• Understand the enrollment process as it relates to claims processing.
• Monitor and work ICH Call Tracking queue.
• Respond to all Department Claims emails.
• Ensure high dollar claims are handled accurately and timely.
• Provide back up for approving Claims Payment Cycles and submitting Medical Reviews to 3rd party reviewer.

Required Qualifications

• Three (3) or more years of claims experience in HMO or insurance environment.
• Medicare and Medicaid experience.
• Experience analyzing all facets of complex claim situations and determining root cause of the issue.
• Proficiency with Microsoft Office applications such as Access, Excel, Word, and Outlook.
• Analytical skills and detail-oriented ability.
• Working knowledge of medical terminology, CPT procedure coding, ICD-9 and ICD-10 diagnosis codes, RUGS and DRG knowledge.
• Ability to multi-task and professionally interact with multiple departments.
• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
  • Satellite, cellular and microwave connection can be used only if approved by leadership.
  • Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Preferred Qualifications

• Strong technical background with advanced proficiency in Excel.
• Leadership or coaching/training experience.

Additional Information

• Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
• Typical Work Days/Hours: Monday – Friday, 8:30am – 5:00pm Central Standard Time (CST)
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes: 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more!
• COVID-19 Vaccine Information: Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Social Security Alert

Humana Values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from [email protected] with instructions to add the information into the application at Humana’s secure website.

Scheduled Weekly Hours

40

Remote Pro Fee Coder – Interventional Radiology, Part Time

US – Remote (Any location)

Part time

1160

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Do:

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

Responsibilities:

Demonstrates the ability to perform quality coding on ancillary charts, clinic charts, and emergency room records.

Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing. Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards. Achieves and maintains 95% accuracy in coding while maintaining a high level of productivity. Accuracy will be monitored during monthly reviews either within the facility. Ability to maintain average productivity standards as follows Works the review queue daily to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary. Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process. See re-bill policy in facility guidelines. Coder downtime must be reported immediately to the administrative staff to ensure turnaround is met. Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility. Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request. Responsible for coding or pending every chart placed in their queue within 24 hours. It is the responsibility of the coder to notify administrative staff in the event they cannot meet the twenty-four hour turn around standard. Coders are responsible for checking the Guidehouse email system at least every two hours during coding session. Coders must maintain their current professional credentials while working for Guidehouse. Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility. Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy) It is the responsibility of each coder to review and adhere to the coding ision policy and procedure manual content. Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services. Communicates problems or coding principle discrepancies to their supervisor immediately. Communication in emails should always be professional (reference e-mail policy).

What You Will Need:

Minimum 3-5 years outpatient professional coding experience in Interventional Radiology.

2-3 years coding both Cardio and Neuro Interventional Radiology procedures.

CPC certification from AAPC

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

What Would Be Nice To Have:

CIRCC credential from AAPC

EPIC experience

The annual salary range for this position is $42,900.00-$64,300.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

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

Benefits include:

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

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

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.

Billing Associate

Job Details

Level: Experienced

Remote Type: Fully Remote

Position Type: Full Time

Education Level: High School

Salary Range: $24.50 – $24.50 Hourly

Travel Percentage: None

Job Shift: Day

Job Category:Admin – Clerical

Description

Callen-Lorde is seeking a friendly and organized inidual with billing experience in medical settings to join our staff as a Billing Associate (BA). The BA is responsible for maintaining an efficient flow and accurate accounting of patients through the various medical, behavioral health and oral health services within Callen-Lorde. The BA must be courteous, patient, and professional at all times. Daily responsibilities will include patient accounts management, insurance verification, claims submission, re-billing/corrections, transaction adjustments, payment entry and reconciliation.

Work Schedule/Salary/Benefits

Callen-Lordes main site in Chelsea is open Monday through Saturday. This is a full-time position with normal business hours (Monday-Friday, 8:00-5:00pm). Occasional evenings may be required. Salary will be based on experience and accompanied by an excellent benefits package including an exceptional no cost medical plan option for you and your family, dental insurance, vision insurance, no cost life insurance, short- and long-term disability insurance, Flexible Spending Accounts, Tuition Assistance, TransitChek, a generous paid time off plan, and a 403B retirement savings plan.

Qualifications

• High school diploma or equivalent required, additional education preferred.
• 6+ months’ experience in a medical services environment, specifically with Medicaid billing preferred.
• 6+ months’ experience of performing extensive data entry preferred
• Knowledge of Federal & NY State patient privacy regulations/laws.
• Proficiency in Microsoft applications (i.e. Outlook, Word, Excel and PowerPoint)

Personal Characteristics, Skills, and Abilities

• Ability to remain calm, focused, and helpful under stress.
• Ability to handle multiple, simultaneous tasks.
• Strong work ethic and excellent attention to detail.
• Strong interpersonal skills and relationship-building skills
• Ability to work effectively with erse populations, including lesbian, gay, bisexual, and transgender communities.
• Commitment to the mission of Callen-Lorde.

Ambulatory Surgery Coder

Remote

Industry: Coder – OP Surgical

Job Number: 2782

Full Time & Part Time Available I Fully Remote

Are you a gifted Ambulatory Surgery Coder? Do you love to code? This role may be the opportunity you’ve been looking for! We’re actively seeking talented Ambulatory Surgery Coders with 3+ years of experience and AHIMA or AAPC certification (RHIT, CCS, CCS-P, CPC, CIC, COC, CIRCC, RCC, ROCC) to join our dedicated team.

Job Description:

This position plays an important role at CodingAID. The Ambulatory Surgery Coder is responsible for reviewing and abstracting patient medical records to assign diagnosis treatments, conditions, and procedures for hospital services.

Other responsibilities include accurately entering data into client software and/or Excel reports. Performing accurate coding using applicable guidelines (ICD-10-CM, CPT, and HCPCS) 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 Ambulatory Surgery 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 through AHIMA or AAPC (RHIT, CCS, CCS-P, CPC, CIC, COC, CIRCC, RCC, ROCC credential(s)).
• A minimum of the last 3+ years’ experience required coding for Ambulatory Surgery for all specialties.
• Requires strong proficiency in Microsoft Excel, Word, and EPIC.

• Requires advanced technical knowledge in ambulatory surgery specialties as assigned.
• 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.
• 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.

Our Benefits:

• Competitive Pay
• 401K
• Flexible Schedule
• Access to Monthly Webinars and CEU’s
• Fully remote work environment
• Full time benefits include medical, dental, vision, paid time off, paid holidays, etc.

RN, Nurse Navigator

• Remote
• Full time
• JR-09778

Cancer care is all we do

Hope in healing

Cancer Treatment Centers of America® (CTCA), part of City of Hope, takes a unique and integrative approach to cancer care. Our patient-centered care model is founded on a commitment to personalized medicine, tailoring a combination of treatments to the needs of each inidual patient. At the same time, we support patients’ quality of life by offering therapies designed to help them manage the side effects of treatment, addressing their physical, spiritual and emotional needs, so they are better able to stay on their treatment regimens and get back to life. At the core of our whole-person approach is what we call the Mother Standard® of care, so named because it requires that we treat our patients, and one another, like we would want our loved ones to be treated. This innovative approach has earned our hospitals a Best Place to Work distinction and numerous accreditations. Each of us has a stake in the successful outcomes of every patient we treat.

Job Description:

**This position is 100% Remote. The hours are Mon – Fri, 8a – 5p, PST.**

The Nurse Navigator RN functions as a member of the multidisciplinary team as an advocate and educator for patients from the initial intake phone assessment, through diagnostic studies, diagnosis, and treatment plan. The Nurse Navigation utilizes the nursing process, including assessment, diagnosis, planning, implementation, and evaluation to navigate new patients through the intake and evaluation process to treatment plan. The Nurse Navigator utilizes effective assessment skills and clinical knowledge to evaluate whether the patient’s condition makes them an appropriate candidate for travel and treatment. The Nurse Navigator serves as a liaison between the patient and family, primary care physician, internal and external care providers, specialists, and referring providers. The Nurse Navigator acts in compliance with hospital site (ATL, CHI, CAL, PHX) and enterprise policies/procedures as well as the state specific Nurse Practice Act.

JOB RESPONSIBILITIES

Uncovers and assesses cancer treatment history which includes diagnosis, type of treatment, names and addresses of treating physicians and or facilities. Works closely with OIS representatives and new patient schedulers when evaluating patient’s appropriateness for visiting CTCA. Upon initial visit, interviews patients and meets with them to ascertain clinical appropriateness to receive care at affiliated facilities, as well as clinical appropriateness for any clinical trials. Completes preadmission clinical evaluations and makes recommendations assessing the patient’s needs related to the medical diagnosis, treatment providers, treatment options and financial resources. Ensures proper and timely documentation in patient’s EMR and all outside records, imaging is received and current for evaluation. Follows patient through treatment decision to ensure there are no gaps in care to keep the patient moving timely through to treatment decision, resolving barriers as they arise.

Promotes inter and intra departmental collaboration, nurtures relationships with others and is viewed positively by co-workers. Responds appropriately to negativity, seeks to promote understanding and mutual achievement of goals. Strong orientation toward services excellence. Utilizes brand platform for consistent deployment of services. Seeks opportunities for organization improvement, consistently applies lean thinking to departmental operations to enhance or improve services. Demonstrates an orientation toward achievement and professional growth actively seeks and initiates self-improvement through continuing education and/or participation in work projects that offer developmental challenges.

Facilitates and/or assists with admissions via the intake process. Collaborates and develops plans of care (huddles) with teams from intake, medical oncology, specialty clinics and CAM ensuring the patient is educated on the proposed plan of care. Provides clarity and addresses concerns the patient and family may have. Facilitates multi-disciplinary patient education to ensure a thorough understanding of the proposed plan of care. Acts as liaison between Oncology Information Services (OIS) and the Medical Center care providers in all aspects of service recovery anticipating the needs of the patient. Facilitates a positive interaction between OIS and the Medical Center to ensure optimum attention to the Mother Standard of Care.

Carries own share of responsibility and willingly helps others. Supports the goals of the department and participates in department performance improvement. Attends required staff. Meets annual health screening requirements. Plans workflow to assure timely completion of relevant responsibilities. Ensures that encounters are documented, new chart is complete and contains necessary items for physician.

Applies problem solving techniques to the intake evaluation process. Plans workflow to assure timely completion of relevant responsibilities. Ensures that new chart is complete and contains necessary items for physician. Assesses special travel needs and works closely with support staff to ensure all details are coordinated for the upcoming patient visit.

Demonstrates knowledge of patient safety goals relevant to the work environment. Demonstrates knowledge of hospital variance reporting system and appropriate management procedures for unexpected occurrences. Demonstrates appropriate response to organizational disaster codes. Completes annual department Hazardous Communications Training. Completes required CE Direct. Consistently follows organizational guidelines for effective hand hygiene. As indicated, follows guidelines for standard and transmission-based precautions. Adheres to facility policies and procedures including assisting in maintaining the Joint Commission standards.

MINIMUM QUALIFICATIONS

Education: Graduate of an accredited School of Nursing, Bachelor of Science preferred

Licensure: State-issued Registered Nursing (RN) license

Certifications: Oncology Certified Nurse highly preferred, as well as appropriate certifications needed to fulfill job duties (BLS)

Pay Range

$64,411.78 – $106,120.56

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.

We win together

Each CTCA employee is a Stakeholder, driven to make a true difference and help win the fight against cancer. Each day is a challenge, but this unique experience comes with rewards that you may never have thought possible. To ensure each team member brings his or her best self, we offer exceptional support and immersive training to encourage your personal and professional growth. If you’re ready to be part of something bigger and work with a passionate, dynamic group of care professionals, we invite you to join us.

Managed Care Manager Nurses

Are you looking to join a team dedicated to providing high quality claims management and customer service to our customers? If so, the Managed Care Manager position may be of interest to you. The role manages and directs the delivery of department specific products and services within assigned branch office/unit considered medium in scope. Assumes responsibility for all operational and administrative activities as well as personnel issues.

Responsibilities:

• Develops. manages and directs staff to ensure the delivery of department specific products and services. Establishes work standards and monitors progress.
• Recruits, develops and manages human resources in order to create a high performing results oriented staff.
• Ensures personnel receive orientation, initial and on-going technical training.
• Manages performance management program including establishing and communicating objectives, providing on-going coaching, and conducting performance reviews. Identifies performance problems and initiates disciplinary actions.
• Manages salary (and non-salary) budgets, makes recommendations to Regional/HO Management concerning promotions, terminations and staffing authorizations.
• Acts as a technical expert and resource for staff which includes usually maintaining the highest level of authority within department specific office/unit. Refers problems and issues out of authority level to Regional/HO Management.
• Ensures appropriate compliance with all legislation, corporate policies, and programs. May periodically conduct desk audits.
• Assists Regional/HO Management and other departments with new business and/or renewal presentations and periodic service calls.
• Implements new and revised policies and procedures.
• Performs additional duties and/or is assigned special projects as requested.

Qualifications

• Ability to develop, manage and direct an office/unit operation and to effectively communicate operational procedures to field/unit staff.
• Demonstrated leadership and innovation in achieving results. Advanced knowledge of principles and methods pertaining to the specific department; knowledge of department management practices, company operations (i.e. other staff & line departments) and policies.
• Related degree or equivalent plus 6-8 years of relevant and progressively more responsible work experience required.
• Advanced insurance related designations preferred.
• Managed Care Licensure/registration and special certification as required by law.

Job Specifications:

Reference: 2023-54029

Category: Nursing Primary Location: Remote Schedule: Full-Time

Salary: USD-$91,300.00–$129,900.00-/-Year

Education Level: Travel: As Needed

Title: Remote Mental Health Therapist (GA)

Location: Atlanta, Georgia or Remote

At SonderMind, we’re changing how people access, receive, and participate in mental health care joining SonderMind means joining a community of mental health therapists and counselors who are committed to making a difference in people’s lives through personalized, evidence-based care.

Whether you’re looking to grow your mental health practice or develop your professional counselor skills, SonderMind can help you find the right caseload, participate in a community of dedicated licensed mental health professionals, and access professional development opportunities.

Being a Sondermind Mental Health Therapist means you can:

Facilitate treatment with comprehensive tools and community engagement:

• Personalized treatment plans leveraging data science, interactive applications, and psycho-educational tools

• One-on-one support with dedicated coaches, robust training, and onboarding

Enable your practice with a full suite of support and resources:

• Legal security and financial opportunity with the ability to offer affordable, accessible care

Provide high-quality, evidence-based care for improved outcomes:

• Clinical strategy rooted in feedback-informed care and measurement-based care

Mental Health Therapist Requirements:

• Licensed in the state of Georgia (required)
• Masters or doctorate-level licensed mental health therapists (required)
• Valid LPC, LCSW, LMFT, or LP (required)

Mental Health Therapist Benefits:

• Flexible schedule: You set your schedule
• $68-$80 per hour
• Flexibility to determine how you want to see clients, in-person or remotely, via telehealth
• Hassle-free credentialing and billing with guaranteed pay
• No fees or membership charges

Remote Medical Coders, Observations with I&I and PCS (Full Time & Part Time) ::

• Remote, Remote
• Position Type
• Full time
• Requisition ID
• 27030
• 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.

LexiCode

Position – Remote Coding, Observations with Injection and Infusion and PCS coding

Position Type – Non-Exempt

Location – Remote

Duration – Full-Time positions available

Job Summary

Observation Services coder openings are available now for positive and self-motivated coding professionals on our growing remote services team. You can work full-time coding 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 $26.00-$34.00 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

• Work remotely from the your home office providing coding services to our clients;
• Review medical records and assign pertinent diagnosis and procedure codes based on the patient’s medical record;
• Abstract appropriate information from the medical record based on the guidelines provided by the client;
• Meet coding productivity and accuracy expectations.

LexiCode Offers

• Excellent hourly compensation
• Generous productivity incentive plan
• Computer with dual monitors and Encoder
• Referral bonuses
• Continuing education

Qualifications

Required:

• RHIA, RHIT, CCS, or CCS-P credential from AHIMA; CPC, COC or CIC from AAPC
• 1 or more years of recent coding experience in U.S. acute care hospital Observation with I&I coding
• Demonstrated proficiency assigning CPT, ICD-10-CM, I&I and PCS
• Top coding skills
• Ability to work from home using high-speed internet

Preferred:

• Experience with EMR, multiple encoders and abstracting systems

Benefits That Matter

We offer comprehensive health and wellness plans, including medical, dental, and vision coverage for eligible employees and family members; paid time off; income protection plans such as short-term disability, long-term disability, and life insurance; financial and retirement planning services, and a robust learning and development (L&D) program with online courses and live training.

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.

Title: Medical Coder Lead

Location: United States

Work from Home/Remote Full-Time

Pride Health is hiring a Remote Medical Coder Lead to support our healthcare client based in Minneapolis, MN (The contractor needs to be authorized to work in the US.)

Duration 3-month contract position, with possible extension.

Shift/Schedule Monday through Friday with a flexible schedule after the training period. 40 hours per week

Responsibilities:

The Medical Coder Lead position is responsible for leading and overseeing the accurate and timely coding of intermediate to complex diagnostic, E& M, procedural, and surgery services in accordance with current billing, coding regulations, and policies. Coordinates coder’s daily workload, assists with scheduling coders, providing feedback, direction, and training to coding staff for a major medical area. Codes intermediate to complex diagnostic, Evaluation and Management, surgical and procedural services applying current billing and coding regulations and policies. May also include highly technical coding as well. Ensures accurate diagnoses, procedure codes and other specified data to ensure appropriate/optimal reimbursement for facility and/or professional charges utilizing information from medical records and following established methods and procedures Provides daily work direction and education to coding staff in specialty area as needed.

Qualifications:

HS grad with current CCS, CCS-P, CPC, CPC-A, RHIT, and/or RHIA coding certification. 5+ years of experience in coding and/or with previous experience in revenue cycle, healthcare/clinical operations.

Base pay range $40-48/hr.

*Base pay if hired will be determined on an inidualized basis and takes into consideration experience, expertise, education, and other qualifications.

Clinical Documentation and Coding Accuracy Educator

at VillageMD

Remote

Join VillageMD as a Clinical Documentation and Coding Accuracy Educator (Remote)

Join the frontlines of today’s healthcare transformation

*This is a Remote Opportunity with 20% travel required.

Why VillageMD?

At VillageMD, we’re looking for a Clinical Documentation and Coding Accuracy Educator to help us transform the way primary care is delivered and how patients are served. As a national leader on the forefront of healthcare, we’ve partnered with many of today’s best primary care physicians. We’re equipping them with the latest digital tools. Empowering them with proven strategies and support. Inspiring them with better practices and consistent results.

We’re creating care that’s more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. To accomplish this, we’re looking for iniduals who share our sense of excellence, are ready to embrace change, and never settle for the status quo. Iniduals who have the confidence to lead but the humility to never stop learning.

Could this be you?

As an integral member of the VillageMD Team, the Clinical Documentation and Coding Accuracy Educator is accountable for ensuring providers are documenting and coding conditions in accordance to the VMD standard. The goal of the role will be to oversee provider education and subsequently improve documentation accuracy across HCC coding.

The Clinical Documentation and Coding Accuracy Educator will review performance metrics and reports, as well as patient charts, to identify areas of opportunity to support coding accuracy and effective documentation practices. He/she will educate all primary care providers, physicians and advanced practice practitioners, and other clinical staff on a process for improving coding accuracy performance, proper documentation and general coding practices.

How you can make a difference

Education

• Conduct inidual training and group education sessions on proper coding and documentation practices for physicians and staff consistent with industry standards and in compliance with coding guidelines
• Effectively communicate and implement new coding education and initiatives with providers, including the appropriate change management support to ensure successful adoption
• Host market level coding office hours
• Collaborate with local market risk operations leader to complete provider education activities including 1:1 education, clinic education and all supporting provider education activities
• Provide new coder onboarding education and support

Operations

• Identify opportunities for improving coding accuracy through chart review and report review
• Review charts and query provider to address documentation reassessment opportunities and to prompt higher accuracy and/or specificity
• Conduct post-encounter review sessions with providers either in person or virtual
• Special review projects as assigned for analytics
• Focused efforts for other identified performance outliers
• Coach, facilitate, solve work problems and participate in the work of the team
• Collaborate with clinical stakeholders to continually develop new and maintain existing educational resources and internal guidelines.
• Participate as needed on process improvement, operational development and concept validation teams to share best practices and assist in the creation of best-in-class coding tools to support VillageMD risk adjustment accuracy

Compliance Support

• Demonstrate the ability to appropriately use coding principles that comply with CMS regulations and company goals and policies
• Ensure compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines
• Work with market to understand what payor audit/documentation requests require compliance review
• Direct and timely provider remediation response to compliance audit plan results

Skills for success

• Self-motivated: energetic, self-starter; can work autonomously with limited direction
• Results oriented: bias for action; demonstrated track record of achievement; drive for attainment of superior outcomes
• Flexible: ably navigates within ambiguity; solution-oriented
• Analytical: strong research, writing, analytical and critical reasoning skills
• Communication: conveys thoughts and expresses ideas effectively both verbally and in writing; strong presentation skills
• Collaboration: orientation to team-based work product and results, open to change and process enhancement
• Leadership: develop and nurture teams; successfully achieves results through others
• Humility: low ego; engenders trust; respectful

Experience to drive change

• Professional Coding Certification such as CRC, CCS, CPS required
• A minimum of 5 years of experience in advanced professional coding
• A minimum of 5 years of experience in coding training and/or education
• Experience in a large, independent clinic organization or the ambulatory environment of a hospital or integrated delivery system (Primary Care Practice highly preferred)
• Familiarity with Electronic Health Records documentation methodologies
• Demonstrated achievement with change management and quality improvement initiatives
• Proven success in building relationships and establishing credibility with doctors, nurses and other clinical staff
• Exceptional communication skills
• High level of emotional intelligence
• Ability to navigate resistance to change and solve problems effectively
• Ability to travel across assigned market(s) or region(s) 20%

How you will thrive

In addition to competitive salaries, a 401k program with company match, bonus and a valuable health benefits package, VillageMD offers paid parental leave, pre-tax savings on commuter expenses, and generous paid time off. You work in a highly-collaborative, conscientious, forward-thinking environment that welcomes your experience and enables you to make a significant impact from Day 1.

Most importantly, you make a difference. You see a clear connection between your daily work on VillageMD products and services and the advancement of innovative solutions and improved quality of healthcare for providers and patients.

Our unique VillageMD culture how inclusion and ersity make the difference

At VillageMD, we see ersity and inclusion as a source of strength in transforming healthcare.We believe building trust and innovation are best achieved through erse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system.Iniduals seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Those seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.

For Colorado Residents only: The base compensation range for this role is $62,000 to $73,000. At VillageMD, compensation is based on several factors including but not limited to education, work experience, certifications, location, etc. This role may be eligible for annual/quarterly bonus incentives (if applicable), and the selected candidate will be eligible for a valuable company benefits plan, including health insurance, dental insurance, life insurance, and access to a 401k plan with company match.

Explore your future with VillageMD today.

Patient Navigator (Nurse, Remote)

Works With: Director of Community Relations

FLSA Status: Exempt, Full Time

Background:

National Brain Tumor Society (NBTS) unrelentingly invests in, mobilizes and unites our community to discover a cure, deliver effective treatments, and advocate for patients and their care partners. NBTS is a leading policy advocacy and research organization as well as a convener of brain tumor research leaders including industry, regulators, funders, clinician researchers and patient advocates. The organization also delivers timely information and support to patients and families. Through collaborative leadership with partners, our results include paradigm shifting research discoveries, increased federal funding for brain tumor research, innovative new clinical trials, opportunities for entrepreneurship and venture philanthropy to benefit brain tumor research, and empowering collaborative advocacy that results in reforms and advances to health care and the development of treatments.

While we have seen significant progress in terms of scientific understanding of brain tumor biology, we are unsatisfied with the status quo of today’s treatment options. NBTS is committed to investment in new ideas and research poised to incent the development and realization of treatments that dramatically increase survival and quality of life for patients.

Position Summary:

The Patient Navigator, as part of the NBTS Personalized Support and Navigation team, will respond to outreach from brain tumor patients and caregivers through approaches agreed upon with NBTS to raise awareness about information resources, support programs and services, and assist in meeting other brain tumor-related needs of patients and caregivers. The Patient Navigator will also lend their expertise to inform key NBTS initiatives.

Essential Duties and Responsibilities:

• Empower patients as they navigate the complexities of the healthcare system by providing key tools, information, and opportunities to make more informed decisions about their care.
• Work collaboratively with other NBTS team members to identify barriers to quality care that contribute to disparities, and identify information, resources and emotional support needs of newly diagnosed and medically underserved patients, survivors, and caregivers.
• Establish and leverage relationships and alliances with healthcare and other support providers to enhance service and referral networks.
• Foster and maintain relationships with other members of the NBTS team in order to build patient referral mechanisms and promote patient navigation.
• Facilitate community access to available NBTS and non-NBTS services and programs.
• Implement a revisit plan to ensure that NBTS navigation services have met the needs of community members.
• Identify gaps in resources offered and work with NBTS team members to find solutions for those gaps.
• Maintain accurate, confidential records documenting services provided and unmet needs using Salesforce.
• Invite patients and their caregivers to become part of NBTS programs, network of volunteers and advocates as appropriate.
• Participate in the strategy and planning of NBTS initiatives that relate to overall education, assistance and treatment of patients with brain tumors and their care partners
• Provide support in facilitating monthly virtual caregivers support group
• Other duties as assigned

Education & Experience:

• Bachelor’s or Master’s degree in a healthcare field or equivalent experience required
• 3 5 years of related professional experience required. Experience in neuro-oncology nursing or a related field strongly preferred.

Required Skills, Knowledge, & Abilities:

• Provide high-quality engagement, both internally and externally
• Strong communication, interpersonal and organizational skills
• Thorough knowledge of healthcare systems, and medical terminology
• Experience working with neuro oncology patients and families preferred
• Experience facilitating patient and caregiver support groups preferred
• Thorough knowledge of resources available to assist brain tumor patients
• Complete work in a timely, accurate, and efficient manner
• Respond to changing circumstances and priorities in a focused, efficient manner
• Able to work independently with minimal direction or oversight
• Use available technology to perform position responsibilities

Work Environment:

The physical demands and 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.

• Location: Remote. Work will be performed by employee in their home office or other previously established workspace. Primary work location must be within the United States.
• This is a full-time, exempt position. Normal hours are 9:00am to 5:00pm ET, Monday through Friday. Infrequent meeting/event attendance outside of normal working hours and on weekends may be required.
• Travel throughout the US may be required approximately 5% of the time for conferences, meetings, events, etc. Employee may occasionally be required to meet with the Community & Government Relations team or other NBTS staff members in person at NBTS headquarters in Newton, MA.
• Role is largely sedentary and requires sitting or standing in a stationary position for extended periods of time.
• This role frequently involves communicating on the phone and operating a computer for at least 70% of the work day.

NBTS strives to ensure we have a workplace that embraces erse viewpoints, backgrounds, cultures, and experiences. NBTS provides equal employment opportunities to all employees and applicants for employment, and prohibits discrimination and harassment of any type without regard to race, religion, color, national origin, gender, sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an inidual with a disability, or other applicable legally protected characteristics.

Coding Specialist

at Signify Health (View all jobs)

Remote

How will this role have an impact?

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

This role will report to our Senior Coding Manager!

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

What will you do?

Reviews health risk assessments/evaluations to determine completion and compliance with CMS guidelines on a timely basis. Reviews and assesses the accuracy, completeness, specificity and appropriateness of diagnosis codes identified in the health risk assessments/evaluations. Reviews health risk assessments/evaluations to accurately and completely assign all ICD-10 codes that are clinically identified and supported in the assessment/evaluation on a timely basis. Communicates timely and effectively with supervisor regarding issues with the health risk assessments/evaluations and/or corrections required to the health risk assessments/evaluations. Understanding the relationship between ICD-10 coding and HCC (hierarchical condition category) coding. Utilizes advanced, specialized knowledge of medical codes and coding protocol by providing guidance to the Sr. Coding Manager to ensure the organization is following Medicare coding protocol for payment of claims. Demonstrate a commitment to integrating coding compliance standard into coding practices. Identify, correct and report coding problems

Maintain adequate knowledge of coding, compliance and reimbursement procedures related top Medicare Risk Adjustment.

Make recommendations for coding policy/changes. Maintain coding certification after achieving certification status Complete special projects as assigned by management, which require defining problems, and implementing required changes. Responsible for the security and privacy of any and all protected health information that may be accessed during normal work activities

We are looking for someone with:

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

About Us:

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

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

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

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

Title: Spanish / English Bilingual Per Diem Registered Nurse RN – $35/hour (Remote)

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

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

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

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

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

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

The ideal teammate would be…

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

The ideal candidate would be able to:

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

Would you describe yourself as someone who has:

• Graduated from an accredited nursing program (required)
• Current RN License (required)
• Ability to read, write and speak both English and Spanish (required)
• A Registered Nurse license with at least 1 years of emergency department, urgent care, and/or triage experience (required)
• The ability to work a minimum of 24 hours a week (required)
• A Registered Nurse with experience providing care to adult and geriatric patient populations (required)
• Confidence with clinical skills in performance of telephonic triage (required)
• The ability to work remotely and has a private area with a computer in their home/workspace (required)
• A genuine, compassionate desire to serve others and help those in need

Pay range is $35 per hour.

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

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

Risk Adjustment Medical Coder

Remote – US

Part time

R29850

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:

Change Healthcare is offering flexible opportunities in the medical field as a Risk Adjustment Medical Coder. In this role, you will identify members’ health conditions and assign and map codes to risk adjustment models, so health plans have appropriate payments to cover care.

Whether you’re looking for a side gig and supplemental income, or simply want to gain more training and experience in your field, this is a chance to boost your earnings potential on a flexible schedule and help transform the healthcare industry, from provider to patient.

This position reports to a Risk Adjustment Manager at the top level and with Clinical Advocacy team as point of contact.

Core Responsibilities:

• Assign appropriate ICD10-CM codes and mapping to risk adjustment models
• Assign Change Healthcare Flagged Event codes when documentation in the record is inadequate, ambiguous, or otherwise unclear for medical coding purposes
• Comply with the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adhere to official coding guidelines
• Comply with HIPAA laws and regulations
• Maintain quality and production standards required by company – all medical coders must maintain minimum QA passing requirements based on HCC scoring model (HCCx < or equal to 5 and HCCm < or equal to 5)
• Remain current on diagnosis coding guidelines and risk adjustment reimbursement reporting requirements

Requirements:

• Active certified coder certification (CRC, CPC, CCS-P) through AHIMA or AAPC (CCA, CPC-A not accepted)
• At least two years of risk adjustment coding experience
• Ability to code using an ICD-10-CM code book (without using an encoder)
• Knowledge of HIPAA, recognizing a commitment to privacy, security and confidentiality of all medical chart documentation
• Strong clinical knowledge related to chronic illness diagnosis, treatment and management
• Computer proficiency (including MS Windows, MS Office, and the Internet
• High-speed Internet access, a home computer with a current Windows operating system, an internet application, and Adobe Acrobat 6.0 or better

Preferred Qualifications:

• Extensive knowledge of ICD-10-CM outpatient diagnosis coding guidelines (knowledge and demonstrated understanding of Risk Adjustment coding and data validation requirements is highly preferred)
• Reliability and a commitment to meeting tight deadlines (24-hour turnaround time on all assigned charts)
• Personal discipline to work remotely without direct supervision
• Analytical skills

Working Conditions/Physical Requirements:

• General office demands

Unique Benefits*:

• 100% work from home
• Flexible work schedule (20 to 40 hours per week)
• Per chart compensation and paid training
• W2 tax classification
• Assigned advocate to help with admin topics

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 $0.00 – $0.00

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.

Title: Payment Posting Specialist

Location: US National

Full-Time

Description

Who We Are Looking For

As the Payment Posting Specialist, you’ll be responsible for the full scope of cash posting. The ideal candidate has strong attention to detail and works with a sense of urgency when it comes to posting in high volume batches.

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

• Post large payment batches for customer clinics
• Manage high-volume patient and insurance account receivables
• Review patient accounts for accuracy, making corrections when necessary
• Follow all insurance payment posting procedures for electronic and manual processing, including researching and posting take backs, refunds, and forward balances.
• Review and interpret insurance carrier explanation of benefits (EOB) to post appropriate payment and denial codes.
• Reliable and punctual in reporting for work and taking designated breaks.

What You Should Have to Qualify

• Understand the ins and outs of medical billing, payment and cash posting, and medical reimbursements.
• Ability to read an EOB with denial code review.
• Be organized, ahead of schedule, communicative, and accountable.
• Work well in difficult situations.
• Impeccable communication skills.
• Two years of experience posting large batches of payments.
• Two years of experience supporting small-to mid-sized practices.

Ideally, You Would Also Have These

• Knowledge of ICD-10 and CPT codes.
• Knowledge of insurance guidelines especially Medicare and Medicaid.
• Experience posting for physical therapy clinics.
• Knowledge with EOB (Explanation of benefits) and posting experience.

Culture is at our Core

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

About Us

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

Company Perks

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

#LI-Remote

Qualifications

Skills

Preferred

Medical Billing

Intermediate

Experience

Required

2 years: Experience supporting small-to mid- sized practices.

2 years: Experience posting large batches of payments.

Nurse Navigator

Remote

US – Remote

Pager delivers a “doctor in your family” healthcare experience by making it simple for consumers to connect with the trusted experts they need to make the right healthcare decisions. Through AI-enabled technology, Pager brings consumers, nurses, doctors and other members of the care team together through secure chat, voice and video chat, all in one place. We partner with healthcare organizations to deliver seamless, tech-enabled services and solutions for a consumer experience that leads to better decisions, outcomes and healthier lives. Started in 2014 and based in New York City, Pager is led by seasoned technology and healthcare entrepreneurs to redefine the way that consumers interact with their healthcare.

This position is for a full-time, remote Registered Nurse who is willing to think creatively and utilize their clinical skills in the field of Telehealth! We are seeking motivated Registered Nurses with 2+ years of experience to work in Pager’s Command Center.

An active compact unencumbered RN license is required for this position. This position entails working three, 12-hour days (8am-8pm/11am-11pm EST) a week, including alternating weekends.

The core objective of the Triage RN, Nurse Navigator is to use technology to build trust and triage patients to the right care at the right time while providing an exceptional virtual care experience through empathic communication.

Responsibilities for the Triage RN, Nurse Navigator:

• Provide exceptional customer service and virtual care by communicating with patients via live messaging, video, phone, and email
• Document within EMR
• Follow and apply clinically validated triage protocols
• Ensure the highest quality customer service for patients and providers
• Complete basic nursing responsibilities, outpatient testing, medications, etc…
• Troubleshoot technology with patients
• Work to ensure a seamless patient call center experience
• Coordinate lab orders, prescription orders, radiology tests, and any aspect of patient care
• Work on projects that will optimize operational efficiency and improve the patient’s telemedicine experience
• Assist in identifying technology needs that improve patient experience
• Additional projects as assigned

Candidate Profile for the Triage RN, Nurse Navigator:

• 2+ years clinical (hospital) experience
• An active compact unencumbered RN license
• Minimum of Associates in Nursing
• Ability to give and receive actionable feedback
• Must be bilingual and fluent in both Spanish and English
• Passionate about patient care and triage
• Enjoy helping others
• Ability to use critical thinking when presented with new and challenging situations
• Relish solving problems, seeking out answers, and trying new things
• Kind, empathetic and possess a strong social perceptiveness
• Positive, energetic, and fun!
• Outstanding multitasking skills
• Enthusiasm and savviness for new technology
• Mastery of oral and written language along with strong typing skills
• Ability to assess and communicate with patients via a text-based platform
• Flexible and fast learner, comfortable in a fast-paced and changing environment
• Eager to challenge the status quo of traditional healthcare
• Detail oriented and an organized self-starter with outstanding interpersonal skills

For Colorado, Nevada, and New York-based employment: In accordance with the Pay Transparency laws the pay range for this position is $32.00 – $36.00 plus shift differentials and quarterly bonuses. The compensation package includes a range of medical, dental, vision, financial, generous PTO, stipends for professional development, and wellness benefits. Final compensation for this role will be determined by various factors such as a candidate’s relevant work experience, skills, certifications, and geographic location. The range listed only applies to Colorado, Nevada, and New York.

At Pager, we value ersity and always treat all employees and job applicants based on merit, qualifications, competence, and talent. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status

Billing Support Specialist

Remote

Full Time

Corporate

Entry Level

About Us

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

Benefits

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

About the Billing Support Specialist Role

Upperline Health is seeking a Billing Support Specialist to support a team of clinicians in delivering complex health services by providing telephone billing support and assistance to patients and team members across all our podiatric clinics. Ideal candidates will have prior experience working with medical billing, familiarity with medical terminology and insurance as well as customer service experience. This person must be an outstanding communicator, and a team player who demonstrates strong attention to detail and thrives in a collaborative environment. As Upperline expands, this inidual will be able to explore a wide range of career opportunities within the company.

What You’ll Do

• Effectively triage inbound medical billing related calls by asking appropriate fact-finding questions
• Assist in resolving billing related questions and issues with patients in a timely and appropriate manner over the phone
• Adhere to all company policies and procedures regarding payment arrangements, account documentation, proper disclosures, and update of patient information
• Answer internal medical billing related questions from team members working in the clinics in addition to the questions from patients directly
• May be requested to support and perform other duties based on business demand

Qualifications of the Billing Support Specialist

• Exceptional customer service orientation featuring an empathetic, compassionate and professional demeanor with each interaction
• Significant familiarity and experience with medical billing (HCPCS, ICD-10), medical insurance, and medical terminology
• Tenacious problem solver, with demonstrated capacity to embrace complex problems and arrive at effective solutions in a timely manner
• Experience with Athenahealth EMR is ideal but not required
• Enjoys working in a team-based environment with active collaboration
• Must be an effective communicator, able to explain billing resolutions in an informational, influential, concise, and personable manner with outstanding etiquette
• Strong written communication skills with success in providing notes, updates, and written communications via computer systems
• Thrives in a fast-paced environment that relies on the ability to multi-task and balance multiple, competing priorities, yet is still able to balance that energy and drive with sensitivity and compassion

Job Type: Full Time

Remote Experienced Medical Writer

Job Locations: United States

Category: Medical Writing

Job Summary

Our corporate activities are growing rapidly, and we are currently seeking a full-time,home-based experienced Medical Writer to join our team. This position will work on a team to accomplish tasks and projects that are instrumental to the company’s success. If you want an exciting career where you use your previous expertise and can develop and grow your career even further, then this is the opportunity for you.

Responsibilities

• Write IND modules, NDA modules and other related regulatory documents
• Write clinical study reports, protocols, and protocol amendments
• Coordinate quality control reviews of those documents and maintain audit trails of changes
• Interact closely with the sponsor, and other Medpace subject matter experts

Qualifications

• Advanced degree in a life science (PhD or PharmD preferred);
• At least 4 years of prior medical writing experience in the clinical research or pharmaceutical industry;
• Strong computer skills, project management skills, and a high attention to detail; and
• Strong communication skills (both written and oral)

Medpace Overview

Medpace is a full-service clinical contract research organization (CRO). We provide Phase I-IV clinical development services to the biotechnology, pharmaceutical and medical device industries. Our mission is to accelerate the global development of safe and effective medical therapeutics through its scientific and disciplined approach. We leverage local regulatory and therapeutic expertise across all major areas including oncology, cardiology, metabolic disease, endocrinology, central nervous system, anti-viral and anti-infective. Headquartered in Cincinnati, Ohio, employing more than 5,000 people across 40+ countries.

Why Medpace?

People. Purpose. Passion. Make a Difference Tomorrow. Join Today

The work we’ve done over the past 30 years has positively impacted the lives of countless patients and families who face hundreds of diseases across all key therapeutic areas. The work we do today will improve the lives of people living with illness and disease in the future.

Medpace Celebrates 30 Years

As we celebrate 3 decades of industry expertise and organic growth, we recognize the global team responsible for driving clinical development at Medpace. Click here to learn more about Medpace Celebrating 30 Years.

Medpace Perks

• Hybrid work-from-home options (dependent upon position and level)
• Competitive PTO packages – starting at 20+ days
• Company-sponsored employee appreciation events
• Employee health and wellness initiatives
• Wellness rooms and huddle rooms
• Flexible work schedule
• Competitive compensation and benefits package
• Structured career paths with opportunities for professional growth
• Discounts for local businesses

Awards:

• Recognized by Forbes as one of America’s Best Mid-size Companies in 2021 and 2022
• Continually recognized with CRO Leadership Awards from Life Science Leader magazine based on expertise, quality, capabilities, reliability, and compatibility

Patient Record Specialist – Remote

Hamilton Township, New Jersey, United States

Remote

Description

Forefront Telecare Inc. provides better behavioral health for all seniors. We Follow the Patient.

At this time, we are looking for a PRS (Patient Record Specialist) who will be primarily responsible for supporting the documentation of provider activity for billing and clinical quality Successful candidates will possess a sense of urgency, accuracy, and a commitment to daily tracking and reporting. The PRS will report to one of Forefront’s Director of Care Delivery for inpatient services or emergency services.

Duties and Responsibilities include:

1. Confirm that daily encounters are properly input into Sales Force tracker platform
2. Collect face sheets for all patients seen and store in FFT EMR
3. Complete Patient Registration in FFT EMR capturing demographic data efficiently, and accurately from Hospital EMR for all patients seen
4. Insurance verification and documentation.
5. Retrieve Discharge Summaries from hospital EMR and Upload into FFT EMR
6. Responsible for all Facility Requested Providers signatures through Docu-Sign
7. Support Data Entry for Monthly Facility Schedules
8. Support Unique workflows for facilities as needed
9. Communicates verbally and electronically with providers, facilities, and others
10. Maintain confidentiality of patient information
11. Other duties as business needs dictate

Requirements

1. Excellent prioritization, decision-making and multi-tasking skills are essential
2. Resourceful to secure necessary documentation
3. Superior attention to detail and accuracy
4. Experience with EMR systems; ability to quickly learn new software systems
5. Excellent verbal and written communication with providers and facilities
6. Ability to follow processes from initiation through resolution
7. Prior experience in healthcare registration
8. Must have high-speed broadband internet connectivity, as the role is remote (United States based)

Benefits

The role is a full time, hourly position and benefits eligible. Benefits include:

1. Medical
2. Dental
3. Vision
4. FSA/HSA/DCA
5. 401k with employer match
6. Paid Time Off and Holidays
7. Short Term and Long Term Disability
8. Life Insurance

Forefront Telecare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.Forefront Telecare is an E-Verify company.

Provider Data Analyst

Remote

Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives apply to join our team.

SCOPE OF ROLE

Our Provider Data team is responsible for partnering with our Care Partners to turn their provider networks into market leading integrated delivery systems. We are reimagining how the network development, network management, and provider relations functions can advance affordable, simple, and personal care for our members. As the Provider Data Analyst, you will have the opportunity to work closely with our Care Partners and other participating providers to build and strengthen the foundation of provider data exchanges between our organizations. You will serve as a key contributor to the strong data connection between Bright and our network participants.

ROLE RESPONSIBILITIES

The Provider Data Analyst job description is intended to point out major responsibilities within the role, but it is not limited to these items.

• Manage all current and future provider data analysis and reporting needs
• Continuously streamline and improve our provider data structure
• Work with a delegated employee inside of our Care Partner to obtain mandatory data elements, updates, and any data improvements
• Assist in keeping the Provider Data group organized between contracting, fee schedule creation, and provider database
• Assist in creating business rules, understanding specific requirements, and working with our team to create needed provider data extracts
• Acts as the subject matter expert on provider data, provider database, provider data ecosystem
• Creates specialty mapping for new care partners and new vendors
• Supports team in provider audits and filings that happen through the year to include providing ad hoc provider data reports and participating in calls as appropriate
• Handles escalated provider data issues that have a verified root cause of a provider data error
• Monitor CMS and other regulatory or industry requirements that should be applied to the department
• Participates in cross-department teams to analyze business opportunities and address critical issues
• Other duties and responsibilities as assigned.

SUPERVISORY RESPONSIBILITIES

This position does not have supervisory responsibilities.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• High school diploma or GED required; Bachelor’s degree in related field preferred
• Three (3) or more years of data analytics required
• Provider/customer relations, data entry, and/or project management experience preferred
• High proficiency in Microsoft Excel and, preferably, experience in Access, and Database management. Experience with Quest Analytic tools helpful.
• Previously worked in a data management/analyst role

EEO/AFFIRMATIVE ACTION STATEMENT

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a erse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law

We’re Making Healthcare Right. Together.

We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:

Focusing on Consumers

We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.

Building on Alignment

We integrate and align inidual incentives at all levels, from financing to optimization to delivery of care.

Powered by Technology

We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.

Scheduling Assistant Manager

at Incredible Health

Remote

Do you love leading teams? Are you a lover of people development and helping your team members do their best work? Do you want to be in a working environment surrounded by amazing team members who are just as passionate and excited as you are?

Well, this is your lucky day because Incredible Health is hiring an assistant manager like yourself!

Responsibilities:

We’re looking for an amazing assistant manager for our Scheduling teams. These teams are made up of dedicated Registered Nurses whose job it is to connect with nurses who sign up for our platform and assist in scheduling their interviews with recruiters. As an assistant manager, you will empower these teams to be as successful as possible and work alongside the team lead to be a resource and mentor.

• Improve team performance through leadership and process improvement
• Manage and support the team to ensure daily metrics are met
• Recruit and hire the best team members aligned with our culture to keep pace with our rapid growth
• Collaborate with assistant managers on other teams to improve work efficiency
• Drive the culture of the team and the company
• Become an expert on people management and team development
• Help our the nurses on our platform find their best work

Requirements:

• Exceptional problem-solving skills, with an ability to think strategically while also maintaining strong attention to detail
• Collaborative, team-oriented working style with the ability to work independently and make decisions when needed
• Excellent ability to focus and call candidates with an optimistic attitude
• Empathetic and energetic leadership
• Willingness and deep desire to learn
• 1+ years of people management experience preferred
• 3+ years in healthcare or in a fast-growth tech startup preferred

Location:  US Locations Only; 100% Remote

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Clinical

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Compassion. It’s the starting point for health care providers like you and it’s what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you’re also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life’s best work.^SM

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  $5,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by ersity and inclusion, career growth opportunities and your life’s best work.(sm) 

We’re focused on improving the health of our members, enhancing our operational effectiveness and reinforcing our reputation for high – quality health services. As Senior Inpatient Facility Medical Coder you will provide coding and coding auditing services directly to providers. You’ll play a key part in healing the health system by making sure our high standards for documentation processes are being met.  The Senior Inpatient Facility Medical Coder functions as the first line management for the Coding Department and provides oversight for the coding staff and operations. This includes education to the Coders, Providers and Staff on coding and proper documentation for Ambulatory services. Responsibilities within the department include: coding, audits, project management, staff development, quality management and training.  This is a virtual, remote, position that requires candidates to be highly organized, self – starters, well – versed in technical applications. Previous success in a remote environment is preferred.

Work Schedule: Full – time (40 hours / week and a minimum of at least 1 weekend day). Employees are required to work the weekly schedule and will have the opportunity to choose between Tuesday – Saturday OR Sunday – Thursday OR work both weekend days including the flexibility to work occasional overtime.

We offer 4 weeks of training. The hours during training will be 8:00 AM – 5:00 PM Monday-Friday. Training will be conducted virtually from your home.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Identify appropriate assignment of ICD – 10 – CM and ICD – 10 – PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC / MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
• Abstract additional data elements during the Chart Review process when coding, as needed
• Adhere to the ethical standards of coding as established by AAPC and / or AHIMA
• Adhere to and maintain required levels of performance in both coding quality and productivity as established by Optum360
• Provide documentation feedback to providers and query physicians when appropriate
• Maintain up – to – date Coding knowledge by reviewing materials disseminated / recommended by the QM Manager, Coding Operations Managers, and Director of Coding / Quality Management, etc
• Participate in coding department meetings and educational events
• Review and maintain a record of charts coded, held, and / or missing

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

Required Qualifications:

• High School Diploma/GED (or higher)
• Professional coder certification with credentialing from AHIMA and / OR AAPC (ROCC, CPC, COC, CPC – P, CCS) to be maintained annually
• 3+ years of Acute Care Inpatient medical coding experience (hospital, facility, etc.)
• Experience with working in a Level I trauma center and/or teaching hospital with a mastery of complex procedures, major trauma ER encounters, cardiac catheterization, interventional radiology, orthopedic and neurology cases, and observation coding
• ICD – 10 (CM & PCS) experience and DRG coding experience
• Ability to pass all pre – employment requirements including, but not limited to, drug screening, background check, and coding
• Ability to work the weekly schedule (40 hours / week) and will have the opportunity to choose between Tuesday – Saturday OR Sunday – Thursday including the flexibility to work occasional overtime and 1 weekend day based on business need

Preferred Qualifications:

• 2+ years of outpatient facility coding experience
• Experience with OSHPD reporting
• Experience with various encoder systems (eCAC, 3M, EPIC)
• Ability to use a personal computer in a Windows environment, including Microsoft Excel (create, edit, save, and send spreadsheets) and EMR systems

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state, and local 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. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with erse, engaged and high-performing teams to help solve important challenges.  

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

**PLEASE NOTE** The sign-on bonus is only available to external candidates.  Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time or per diem basis (“Internal Candidates”) are not eligible to receive a sign on bonus.

Colorado, Connecticut, Nevada or New York City Residents Only: The salary range for Colorado residents is $21.68 to $38.56. The salary range for Connecticut / Nevada / New York City residents is $23.94 to $42.40. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.   

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

Location:  US Locations Only; 100% Remote

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Clinical

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Compassion. It’s the starting point for health care providers like you and it’s what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you’re also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life’s best work.^SM

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$3,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by ersity and inclusion, career growth opportunities and your life’s best work.^SM

Healthcare isn’t just changing. It’s growing more complex every day. ICD – 10 Coding replaces ICD – 9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and Healthcare organizations continue to adapt, and we are vital part of their evolution. And that’s what fueled these exciting new opportunities.

Who are we? Optum360. We’re a dynamic new partnership formed by Dignity Health and Optum to combine our unique expertise. As part of the growing family of UnitedHealth Group, we’ll leverage our compassion, our talent, our resources and experience to bring financial clarity and a full suite of Revenue Management services to Healthcare Providers, nationwide.

This position is full-time (40 hours/week). Employees will have the opportunity to choose between Tuesday – Saturday or Sunday – Thursday (1 weekend day is required). It may be necessary, given the business need, to work occasional overtime.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Identify appropriate assignment of CPT and ICD-10 Codes for outpatient Emergency Department services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
• Apply coding knowledge to analyze/correct CCI Edits and Medical Necessity Edits
• Understand the Medicare Ambulatory Payment Classification (APC) codes
• Abstract additional data elements during the chart review process when coding, as needed
• Adhere to the ethical standards of coding as established by AAPC and/or AHIMA
• Adhere to and maintain required levels of performance in both coding quality and productivity as established by Optum360
• Provide documentation feedback to providers, as needed, and query physicians when appropriate
• Maintain up-to-date coding knowledge by reviewing materials disseminated / recommended by the QM Manager, Coding Operations Managers, and Director of Coding / Quality Management, among others
• Participate in coding department meetings and educational events
• Review and maintain a record of charts coded, held, and / or missing
• Additional responsibilities as identified by manager

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

Required Qualifications:

• High School Diploma / GED (or higher)
• 2+ years of Outpatient Facility coding experience
• Professional coder certification with credentialing from AHIMA and/or AAPC (ROCC, CPC, COC, CPC-P, CCS) to be maintained annually
• Experience with ICD-10
• Ability to use a PC in a Windows environment, including MS Excel and EMR systems
• Ability to work 40 hours/week. Hours are flexible; will have the opportunity to choose between Tuesday – Saturday or Sunday – Thursday (1 weekend day is required)

Preferred Qualifications:

• Experience with various encoder systems (eCAC,3M, EPIC)
• Intermediate skills of experience with Microsoft Excel (create, data entry, save)
• Experience with OSHPD reporting

To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state, and local 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. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with erse, engaged, and high-performing teams to help solve important challenges.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

**PLEASE NOTE** The sign-on bonus is only available to external candidates.  Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time or per diem basis (“Internal Candidates”) are not eligible to receive a sign on bonus. 

Colorado, Connecticut, Nevada or New York City Residents Only: The salary range for Colorado residents is $18.17 to $32.26. The salary range for Connecticut / Nevada / New York City residents is $20.00 to $35.53. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

Director of Operations

Job Location(s) US-TX-Irving

ID

2023-3939

Category

Corporate Departments

Role Overview

NorthStar Anesthesia is seeking a Director of Operations to join our team.

This role offers the flexibility to be remote or hybrid. We are open to candidates outside of the Dallas, TX area.

A Smarter Career Investment

NorthStar is the fastest growing anesthesia management company in the U.S. We run successful anesthesia programs with more than 2,500 clinicians across 20+ states. Whether you’re a physician, CRNA or office professional, NorthStar is a great place to invest your career.

Benefits

• Health
• Dental
• Vision
• Short term disability
• Company paid long term disability
• Company paid life insurance and AD&D insurance
• 401K plan with company match
• Pet Insurance
• generous PTO
• 10 paid company holidays
• And much more!

Job Summary

The Director of Operations is responsible for partnering with staffed CRNAs, Physicians, and clinical leadership to administer direction, evaluation, and coordination of regional functions that ensure operational objectives fall in line with the overall needs of NorthStar. This person will provide exceptional leadership by establishing operational goals, plans, and policies, while developing scalable business processes to support NorthStar’s rapid growth.

What you will do in this role

• Partner with corporate and local leadership to drive financial and operational performance improvements and help NorthStar meet its goals and objectives.
• Complete advanced analytics to assess hospital efficiency and productivity via Excel models, scheduled reporting, and ad hoc requests by executive leaders.
• Conduct regular reviews of staffing/productivity across all anesthesia departments and continuously strive to identify new and innovative approaches to labor-related opportunities.
• Demonstrate ability to develop long-term professional relationships with a variety of stakeholders including corporate and clinical colleagues.
• Partner with department leads to define and implement operations strategy, structure and processes.
• Collaborate with executive leadership to develop and meet NorthStar’s goal and guidance on operations projects and systems.
• Act as a liaison between NorthStar and hospital staff/personnel to support the establishment of new facilities, startups, and acquisitions.
• Monitor performance and proactively identify efficiency issues and propose solutions.
• Support recruitment, hiring and onboarding of clinicians.
• Review CRNAs and Physician schedules to ensure adequate staffing for specific locations.
• Partner with HR to handle discipline and termination of clinicians in accordance with company and hospital polices.
• Identify, recommend, and implement new processes and systems to improve and streamline organizational processes.
• Identify areas in need of process improvement and develop and manage implementation plans around practice management, clinical quality improvement and operations.

Key Deliverables

• Foster a success-oriented environment in Operations by establishing long range operational goals, plans and policies.
• Coordinate support to operations throughout NorthStar by overseeing the day-to-day operations and maintain a working knowledge of all phases of operations.
• Manage a variety and complex assortment of projects simultaneously and work with internal and external managers, directors, and executives at all levels.

What qualifications you will need

• Bachelor’s degree in Finance, Business Administration or a related field is required; Master’s degree preferred.
• 3+ years’ experience in operational leadership is required. Healthcare experience preferred.
• Anesthesiology experience is a plus.
• Equivalent combination of education and/or experience may be considered

Competencies

• Client Focus
• Analytical mindset
• Thorough knowledge of hospital operations and patient flow
• Creative problem-solving skills
• Communications (Verbal and written)
• Inidual Leadership/Influencing
• Teamwork
• Work Management

Fast growing. Dynamic team culture. Your chance to shine.

As a corporate employee in the healthcare field, you understand that our industry is changing rapidly, and you want to be a part of those positive changes. Founded in 2004 by an anesthesiologist and a CRNA, NorthStar Anesthesia is the fastest growing anesthesia management company in the country, and we have built a foundation of anesthesia expertise unparalleled in the market. Our corporate culture emphasizes collaboration, appreciation, mutual respect, and accountability. We put patients at the center of everything we do; and our corporate team works to support our clinicians so that they can provide world class anesthesia care.

“The best part about working at NorthStar is the people. In my opinion, we have some of the most knowledgeable, innovative, and hard-working professionals in healthcare. Across all departments, clinical and non-clinical, I have always been impressed with the talent within our organization. “

Landon Owens, Sr. Director of Talent Acquisition and Strategy

Join NorthStar as a Director of Operations and invest in your career! Apply today and a member of our Talent Acquisition team will follow up with you.

NorthStar is an Equal Opportunity Employer. We do not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law.We are committed to having a workforce that celebrates ersity, equity, and inclusion. We are an Affirmative Action Employer.

Title: Code Edit Support Team Medical Coding Coordinator 3

Location: United States – Remote

Description

The Medical Coding Coordinator 3 extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding Coordinator 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.

Responsibilities

Where you Come In

The Medical Coding Coordinator 3 researches/reviews and educates providers when there is a dispute on adjudicated claims that contain a code editing related denial or recovery. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Decisions are typically focused on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.

This is a remote position from anywhere in the US

What Humana Offers

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

Required Qualifications What it takes to Succeed

• AAPC or AHIMA Coding Certification (no apprentice)
• Minimum of 2 Years Coding Experience
• Prior healthcare experience
• Problem solve complex issues
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• If progressed to offer, you will be required to:
• Provide proof of full vaccination OR commit to weekly testing, following all CDC protocols, OR Provide documentation for a medical or religious exemption consideration.

Preferred Qualifications

• Medicare/Medicaid experience

Additional Information – How we Value You

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

Work-At-Home Requirements

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

Satellite, cellular and microwave connection can be used only if approved by leadership

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

Remote Nurse Practitioner-Endocrinology

at Perry Health Inc (View all jobs)

Fully Remote

THE HIGHLIGHTS

• Anticipated Start Date: Jan 1, 2023
• Shift: M-F 9a-6p ET
• Hourly Rate: $60/hr
• 100% Remote: must have consistent access to clean, quiet workspace; solid internet connection; proficient technical experience (basic computer skills)

OUR MISSION

Perry Health is on a mission to rethink chronic care delivery through a purely-remote, continuous care model. This remote-first approach allows us to extend high-quality specialist care to all patients, regardless of geography or other care disparities. Although we plan on making Perry available to every patient with a chronic illness, we’re starting with a focus on Medicare patients living with diabetes. Perry’s remote care fills the necessary gap between physician appointments for our patients.

We equip our patients with cellular-connected devices (glucometers, blood pressure cuffs, etc.) that transmit data passively upon use, allowing even the most tech naive patient to participate. This real-time data flows to Perry’s team of clinicians (physicians, nurses, dietitians), who monitor trends in the data and deliver proactive care over the phone. We’ve built a proprietary continuous-care Electronic Health Record (EHR), which can ingest these data pipelines and build elegant workflows on top of them for our clinical staff. Facing a chronic disease alone is overwhelming and isolating, and we aim to alleviate that emotional burden by providing care to our members 24/7.

Our high-touch approach to chronic care management creates tangible outcomes for our members and thousands of dollars in savings to the system by preventing hospitalizations, and we’re just getting started.

ABOUT THE ROLE

We’re looking for an experienced Nurse Practitioner who has ample experience helping people with diabetes and is passionate about changing health. You will be responsible for conducting video visits with our members for their initial consultation for our program.

You’ll evaluate their diagnosis, medications and lab results to assess the member’s acuity and validate their candidacy for our program. You’ll support the full clinical organization with clinical escalations and quality assurance measures.

KEY RESPONSIBILITIES

• Provide video-based care to patients in Perry Health’s RPM program
• Deliver swift, empathic care to our members and assess their competencies
• Determine members’ eligibility for our clinical program
• Support quality improvement calibrations
• Serve as a point of contact for our practice for clinical escalations

QUALIFICATIONS

• Education: Bachelor of Science degree in Nursing (BSN) & Master of Science in Nursing (MSN)
• License: hold an unencumbered, active state license; multi-state licenses preferred, specifically Alabama, Arizona, Colorado, Florida, Georgia, Mississippi, New Jersey, Texas, Utah, Virginia, Wisconsin
• Minimum 3+ years experience managing patients with diabetes
• Spanish-speaking preferred, certification required

ABOUT OUR TEAM

Perry Health launched in August of 2021 and has been supported by investors such as Primary Ventures, General Catalyst and Box Group. Our team has helped build businesses at the intersection of technology, consumer, healthcare and retail including Vroom, K Health, Gilt, ShopKeep, SoulCycle, and more. Our team is committed to bringing together people from different backgrounds and perspectives to deliver real outcomes to our members.

OUR VALUES

Our patients are our purpose: We understand that the decisions we make have an impact on our patients’ health. We are a healthcare company above all else. The choices we make are always in the best interest of our patients.

Bring your best self: The authenticity of our team drives our innovation. We show up for each other and our patients every day. Your teammates will count on you for motivation and support, and you should expect the same in return. Conversely, recognize when you are not at your best so you can seek support and take time to recharge.

Own your ideas and your results: Each member of the team contributes to the growth of Perry. Identify problems, seek solutions that maximize impact. Ownership is key; seek out support from team members, and take accountability for the results of your efforts.

Move fast, but with purpose: Consistent, rapid growth is expected. Set goals, work with purpose, assess, reassess, and pivot when necessary. Perfection should not impede progress. Ego should not prevent reevaluation. Each day will provide opportunities for learning and growth and will move us closer to our goals.

Good ideas come from anywhere: Ideas, good and bad, come from every level of the organization. Employees at all levels are empowered to share their ideas and feedback. The whole of Perry is greater than the sum of its parts. All ideas are considered, and when a decision is made we will move forward together.

Clinical Coder – Nurse Auditor (Remote)

REMOTE

United States

Quality

Full time

Description

Vatica is one of the most innovative and fastest growing healthcare technology companies. We are always looking for great people to join our erse team.

The Clinical Coder/Nurse Auditor will independently review cases, ensuring accurate ICD-10-CM risk adjusted coding and clinical documentation. They will stay abreast of current changes to the Risk Adjustment field and continue education to maintain high level proficiency.

• Independently reviews cases, ensuring accurate ICD-10-CM risk-adjusted coding and clinical documentation.
• Responsible for performing second reviews of QI work as assigned.

• Stays abreast of current changes to the Risk Adjustment field.
• Continues education to maintain high level of proficiency in Risk Adjustment field.
• Maintains RN and CRC certifications.
• Performs research as needed to determine whether codes are appropriate.
• Maintains inidual 95% IRR score.
• Maintains required productivity.
• Executes other responsibilities per business needs.

Requirements

• Must have minimum of 3 years of clinical experience
• Bachelor’s Degree or equivalent combination of education and experience
• Must have Certified Risk Adjustment Coder (CRC) Certification
• At least 1 year of Risk Adjustment coding experience
• Working knowledge of ICD-10 CM guidelines and appropriate clinical documentation.
• Experience reviewing clinical cases.
• High level of expertise in navigating EMRs.
• Proficient in Microsoft Office.

Benefits

WORKING AT VATICA HEALTH ADVANTAGES

Prosperity

• Competitive salary based on your experience and skills we believe the top talent deserves the top dollar
• Bonus Potential (based on role and is discretionary) if you go above and beyond, you should be rewarded
• 401k plans we want to empower you to prepare for your future
• Room for growth and advancement- we love our employees and want to develop within

Good Health

• Comprehensive Medical, Dental, and Vision insurance plans
• Tax-free Dependent Care Account
• Life insurance, short-term, and long-term disability

Happiness

• Excellent PTO policy (everyone deserves a vacation now and then)
• Great work-life balance environment- We believe family comes first!
• Strong supportive teams- There is always a helping hand when you need it

Are you up to the challenge? What are you waiting for? Apply today!

Title: Care Coordinator – Clinical Operations – Remote

Location: United States

Join us in helping people live healthier, happier & longer lives

About Us:

PlushCare, an Accolade company (NASDQ: ACCD), is a Silicon Valley-based virtual primary care platform that is transforming the healthcare industry by making exceptional healthcare more accessible, convenient, and affordable. Since 2015, we have connected hundreds of thousands of patients throughout the United States with world-class physicians from a phone or laptop.

As we continue to grow and expand our services, we are looking for passionate and empathetic iniduals to be part of our journey. Experience in the startup ecosystem is helpful, but a growth mindset and passion for helping people live healthier, happier & longer lives is essential.

PlushCare Care Coordinator – Remote

As the Care Coordinator, you will serve as the face of the company. You will be interfacing with our patients over the phone and through email, while also providing internal coordination with our team and doctors to ensure all our patient’s needs are addressed.

This role sits virtually in your home office and requires an ability to maintain consistent schedule and work independently.

Candidates must have all of the following qualifications:

• We are considering full time candidates (at least 30 hrs/wk) and part time candidates (at least 24 hrs/wk)
• Care Coordinators must be able to work at least one consistent weekend day per week
• We are looking for iniduals to work between the hours of 5AM – 6PM PST with 1 Saturday/Sunday a week.
• We have the following shifts available: early morning (shift would start around 3 to 4 am PST), evening (shift would start around 2 to 3 pm PST), overnight (9 pm – 5 am PST)
• Empathy and a passion to provide every American with more convenient and more affordable access to healthcare
• Exceptional interpersonal and communication skills: you are able to communicate clearly and respond effectively via phone, email and face-to-face
• Demonstrated commitment to exceptional service
• Able to thrive in a fast-paced environment with minimal guidance
• At least one year of experience working in the healthcare industry

Skills that’ll help:

• Receptionist/call center experience
• Ability to manage customer de-escalations
• Familiarity working with EHRs or EMRs
• CRM experience (i.e Salesforce, Zendesk)
• Reasonable understanding of apps and how to navigate the Android and iPhone systems

Full-time employees receive the following benefits:

• Salary Range: $14-$18 per hour for day/evening shift; $16 – $22 per hour for over night shift
• Free medical appointments with PlushCare
• 15 days of paid vacation (based on 40hr/work week)
• 1 week paid sick leave
• 401(k) Plan through the company
• Additional Well-being programs available
• Healthcare coverage for you and your family, based upon your inidual elections (~85% employer paid premiums)
  BlueCard PPO and Kaiser HMO options for medical, Aetna dental and EyeMed Network vision

We believe ersity drives innovation. We are committed to inclusion across race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. We celebrate multiple approaches and erse points of view that drives us forward every day. #LI-JB1 #LI-Remote

Accolade, Inc., PlushCare, Inc., and Accolade 2ndMD LLC will never ask you to pay to get a job (this includes but is not limited to sending you a check, asking to send money or buy gift cards). These are phishing attempts. If you are asked to send money or if you or have lost money to a job scam, report it immediately to the Federal Trade Commission at ReportFraud.ftc.gov. You can also report it to your state attorney general.

Utilization Management Nurse

Remote

Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.

General Purpose

The Utilization Management Nurse is responsible for reviewing requests for pre and post-service authorization(s) and/or payment for both inpatient and or outpatient services for all plan members. The Utilization Management Nurse works in collaboration with the Claims Department and as a liaison with the Utilization and Case Management teams, the Medical Directors, and leadership to assure the timely processing of preauthorizations, medical claims review, provider dispute resolutions, and grievance and appeal requests, to ensure the organizational compliance with CMS and all other rulings, governing and regulatory bodies. Which enables the organization to deliver the highest qualities/standards. The objective of this position is to ensure positive outcomes data and treatment are provided in the most cost-efficient manner without affecting our “Quality of Services”.

Duties and Responsibilities:

• Review pre and post-service payment requests for medical necessity, contract, and regulatory compliance. Referring all determinations to a Medical Director.
• Utilize CMS guidelines (LCD, NCD), Milliman-Roberts, or InterQual guidelines to assist in the determination of referrals.
• Knowledge of CMS Chapter 13
• Maintain goals for established turn-around time (TAT) for referral processing.
• Maintain a professional rapport with providers, physicians, support staff, and patients to review and resolve medical clinical issues as they arise;
• Monitor work queues and Email for incoming requests.
• Verify eligibility and/or benefit coverage for requested services.
• Verify the accuracy of ICD 10 and CPT coding in processing pre-certification requests.
• Contact requesting provider and request medical records, orders, or necessary documentation to process related pre-service requests/authorizations;
• Accurately documents any pertinent determination factors within the referral system.
• Review referral denials for appropriate guidelines and language.
• Assist Medical Directors in reviewing and responding to Appeals and Grievances
• Identify gaps in HCC capture based on clinical review.
• Report gaps to the data team daily.
• Recognize work-related problems and contributes to solutions.
• Meet specific deadlines (responds to various workloads by assigning task priorities according to department policies, standards, and needs).
• Maintain confidentiality of information between and among healthcare professionals.

Experience:

• At least 2 years experience with Medicaid and/or Medicare. 1-2 years experience in a medical setting working with IPAs, entering referrals/prior authorizations.
• Must know ICD-10, CPT codes, Managed Care Plans, medical terminology (certificate preferred), and referral system (Access Express/Portal/N-coder)

Licensures and Certifications:

• An active, unrestricted Registered Nurse (RN) license to practice as a health professional in a state or territory of the United States is required for this role.

We’re Making Healthcare Right. Together.

We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:

Focusing on Consumers

• We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.

Building on Alignment

• We integrate and align inidual incentives at all levels, from financing to optimization to delivery of care.

Powered by Technology

• We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.

Title: Senior Account Manager, Recoveries (Remote Friendly)

Location: United States

Mission Lane is revolutionizing access to financial tools to pave a clear way forward for millions of Americans on the path to financial success. We strive to create solutions no one ever has before, to redefine the financial industry for the better. Sound like a mission you could get behind?

We’re looking for a solutions-oriented self-starter with customer service leadership experience to to join our Recoveries Department as a Senior Account Manager.

Senior Account Managers can choose to work from our beautiful headquarters office in Richmond, VA, or from their homes, or a little bit of both! We are currently hiring for this position in AR, AZ, FL, MO, NV, PA, TX, UT and VA.

This is a unique opportunity to contribute at a company that’s on the verge of becoming the household name in financial products for the 50% of Americans who aren’t served by traditional financial institutions.

About you:

You’ve developed your problem-solving and leadership skills with 2+ years experience in any professional environment where exceeding customer expectations is the number one priority. We’ve found that customer service leaders from the retail, restaurant and hospitality industries are particularly well prepared for success in this key role.

The impact you’ll make:

You’ll drive forward our mission of financial inclusion by supporting our fast-growing front line team (aka Front-Laners) as we deliver the brand defining experiences that help our customers thrive. Along the way, you’ll play a key role in identifying ways to continually improve and refine our processes and procedures as we continue to grow.

As a Senior Account Manager on the Recoveries team, you will:

• Research and resolve complex customer escalations
• Provide real time policy/procedure coaching for front line agents as needed
• Monitor production queues and partner with workforce management routinely to optimize queue performance
• Identify, track, and communicate any trends for continued front line agent improvement
• Be the primary point of contact for the front line team as it relates to production support issues
• Collaborate effectively across Customer Insights and horizontal business teams as needed
• Routinely deliver policy/procedure updates and refreshers to the frontline team
• Maintain a high level of awareness of the call center activities, processes, and procedures as well as call center best practice

You’ll thrive in this role if:

• You have 2+ years customer service experience, which includes 1+ years of leadership experience and a history of going above and beyond for customers!
• You’re an excellent communicator with proven de-escalation skills.
• You’re a self-stater who is resourceful, resilient, and thrives in a fast-paced environment.
• You have great interpersonal skills and the ability to adapt to the situation at hand.
• You think critically and analytically – reviewing issues, evaluating conditions, and using your good judgment and discretion to determine the best way forward.
• You’re savvy with the use of technology & software.
• You have strong attention to detail.
• You have a private, quiet, distraction free area to work (if working remotely)
• You have a High School diploma or GED

At Mission Lane, we’re looking for people who have the courage to take on new challenges. If you need accommodations to perform at your highest potential throughout the application and/or interview process, don’t hesitate to reach out.

We’re committed to ensuring our team members have balance in their lives. Our comprehensive benefits package* provides the support you need to thrive at work and at home.

• Work: An engaging culture with access to training programs and advancement opportunities
• Life: Full health, dental, and vision benefits, Flexible Spending Account (for medical and childcare expenses), paid parental leave, and a 401k Company Match
• Balance: Generous PTO, flexible schedules, a Calm App subscription, and more.

*Benefits may vary by location

More about Mission Lane:

Mission Lane is based in the U.S., with offices in Richmond, Virginia & San Francisco, California. Founded in December 2018, we’ve rapidly grown to almost 2 million customers.

It all started with a realization: nearly fifty percent of the adult population in the U.S. doesn’t have access to a clear line of credit. And by clear we mean credit without crazy fees that only increase debt. Most traditional credit card companies either overlook or overcharge this group because they have less-than-prime credit scores or no score at all. We decided this just wouldn’t do.

We understand that everyone doesn’t have the same opportunities. We also know that everyone joins us at different stages of their financial journeys. Providing access to clear credit was a critical first step, but our work isn’t done. We are actively developing new products designed to meet our customers where they are, according to their needs.

We get it – life happens. That’s why Mission Lane is hard at work paving a better way forward.

Just like for our customers, Mission Lane creates opportunities for our employees to learn, grow, and prosper. We strive to create an environment that brings out the best in everyone, everyday.

Mission Lane is an Equal Opportunity Employer committed to ersity and inclusion in the workplace. All qualified applicants will receive consideration for employment without regard to sex, race, color, age, national origin, religion, physical and mental disability, genetic information, marital status, sexual orientation, gender identity/assignment, citizenship, pregnancy or maternity, protected veteran status, or any other status prohibited by applicable national, federal, state or local law.

Mission Lane is not currently accepting applications from Colorado, California, Washington State, or New York City. Additionally, we’re not sponsoring new applicant employment authorization and please, no third-party recruiters.

ProFee Coding Lead

Job Locations: US-Remote

Requisition ID: 2022-29340

# of Openings: 1

Category: HIM / Coding

Position Type: Employee Full-Time

Overview

Who we are…

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

What we offer…

At Ciox Health we offer all employees a place to grow and expand their current skills 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…

Responsibilities

Role and Responsibilities

· Reviews medical record documentation to identify pertinent diagnosis/procedures that require code assignment for profee charts and accurately code the diagnoses and procedures for the purpose of reimbursement, research, and compliance with federal regulations.

· Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes.

· Keeps abreast of coding guidelines and reimbursement reporting guidelines and brings identified concerns to manager for resolution

· Mentors and trains newly hired Coders and providers and provides ongoing training of Coding staff

· Assists Coding Manager with special coding assignments or coding tasks to resolve unbilled issues.

· Serves as a resource for all coding related questions, responding in a timely manner to requests and questions from Coding staff.

· Promotes inidual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

· Identify and implement improvement measures that will enhance department operations and customer service.

· Monitor and report all required performance measures to include the development of department goals and assist in the assessment of goal attainment.

· Conduct and recommend trainings to improve team performance.

· Ensure management is informed of any employee personnel issues.

· Function as a resource to employees for questions and additional training.

· Assist management in monitoring staff’s KPIs, time keeping and schedules.

· Other duties as assigned.

Qualifications and Education Requirements

Education preferred: High School Diploma or GED required; Associates Degree in Health Information Managemendt or any Healthcare Related Field preferred

Certifications: Coding Certification from the American Association of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) required

· Three to Five (3-5) years of profee coding experience

· Previous supervisory/team lead experience

Preferred Skills

· Effective oral and written communication skills

· Strong knowledge of ICD 10 and Profee coding guidelines

· Strong analytical skills to interpret data

· Strong knowledge of human anatomy, medical terminology, and surgical terminology

· Strong critical thinking skills and decision-making skills

· Strong knowledge of coding compliance policies, coding guidelines for multiple specialties, and insurance payor policies

· Billing/denial experience

Additional notes

· Auditing experience is a plus

· Education/Training experience is a plus

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.

Remote Sr. Coding Specialist

• locations
• Remote Location
• time type
• Full time
• job requisition id
• 196363

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
  • Remote Sr. Coding Specialist
• Location
  • Cleveland
• Facility
  • Remote Location
• Department
  • Coding Reimbursement-Chief Of Staff Division
• Job Code
  • U99901
• Shift
  • Days
• Schedule
  • 7:00am-3:30am

Job Summary

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 the 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

Title: Coding, Auditing Training Lead

Location: United States – Remote Full time

TruBridge is actively seeking an experienced Observation and Outpatient Surgery Auditor with infusion and injection experience. Our auditing/training positions provide you with the flexibility of training and working from home. The Auditor/Trainer position is a Full Time, Monday through Friday opportunity.

Qualifications:

• Must be credentialed through AHIMA or AAPC
• Must have 7 or more years experience Coding in a Clinic Setting
• Must have experience assigning Professional Fee Levels using 95 Guidelines
• Must have experience assigning Facility Levels
• Must have experience assigning injection and infusion charges

Technical Specifications:

• Base download/upload internet speed of at least 5Mbps SATELLITE/HOT SPOT INTERNET IS NOT ACCEPTABLE.

Schedule:

• Monday to Friday

Experience:

• ICD-10: 1 year (Preferred)

Patient Account Representative (Remote)

Job Details

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

The Patient Account Representative is responsible for working accounts to ensure they are resolved in a timely manner. This candidate should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. Representative will need to effectively follow-up on claim submission, remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities. Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance is preferable. An effective revenue cycle process is achieved with working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving accounts with minimal assistance.

Representative must be able to work independently as well as work closely with management and team to take appropriate steps to resolve an account. Team member should possess the following:

• Perform duties as assigned in a professional demeanor, which includes interacting with insurance plans, patients, physicians, attorneys and team members as needed.
• Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions
• Access payer websites and discern pertinent data to resolve accounts
• Utilize all available job aids provided for appropriateness in Patient Accounting processes
• Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account
• Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership
• Identify and communicate any issues including system access, payor behavior, account work-flow inconsistencies or any other insurance collection opportunities
• Provide support for team members that may be absent or backlogged

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Researches each account using company patient accounting applications and internet resources that are made available. Conducts appropriate account activity on uncollected account balances with contacting third party payors and/or patients via phone, e-mail, or online. Problem solves issues and creates resolution that will bring in revenue eliminating re-work. Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, identifies payor issues and trends and solves re-coup issues. Requests additional information from patients, medical records, and other needed documentation upon request from payors. Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed. Takes appropriate action to bring about account resolution timely or opens a dispute record to have the account further researched and substantiated for continued collection. Maintains desk inventory to remain current without backlog while achieving productivity and quality standards.
• Perform special projects and other duties as needed. Assists with special projects as assigned, documents, findings, and communicates results.
• Recognizes potential delays and trends with payors such as corrective actions and responds to avoid A/R aging. Escalates payment delays/ problem aged account timely to Supervisor.
• Participate and attend meetings, training seminars and in-services to develop job knowledge.
• Respond timely to emails and telephone messages as appropriate.
• Ensures compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors.

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.

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.

• Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies
• Intermediate skill in Microsoft Office (Word, Excel)
• Ability to learn hospital systems ACE, VI Web, IMaCS, OnDemand quickly and fluently
• Ability to communicate in a clear and professional manner
• Must have good oral and written skills
• Strong interpersonal skills
• Above average analytical and critical thinking skills
• Ability to make sound decisions
• Has a full understanding of the Commercial, Managed Care, Medicare and Medicaid collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements for government payors
• Familiar with terms such as HMO, PPO, IPA and Capitation and how these payors process claims.
• Intermediate understanding of EOB.
• Intermediate understanding of Hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
• Ability to problem solve, prioritize duties and follow-through completely with assigned tasks.

EDUCATION / EXPERIENCE

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

• High School diploma or equivalent. Some college coursework in business administration or accounting preferred
• 1-4 years medical claims and/or hospital collections experience
• Minimum typing requirement of 45 wpm

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.

• Office/Team Work Environment
• Ability to sit and work at a computer terminal for extended periods of time

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.

• Call Center environment with multiple workstations in close proximity

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified iniduals with disabilities unless doing so would result in an undue hardship.

Principal Medical Writer (Remote)

Primary United States Secondary Remote Req ID 2213008 Category Medical Division AbbVie

The remote Principal Medical Writer is responsible for providing clinical regulatory document support to the clinical teams, ensuring successful preparation of high-quality submission-ready documents and effective implementation of the writing process. Provides medical writing expertise for multiple compounds/devices and/or projects within various therapeautic areas (oncology and aesthetics highly preferred, immunology preferred). Interfaces with external groups (e.g. PK, Toxicology, eSubmissions, Regulatory, Statistical Support, Data Management, Clinical, Publishing) to ensure accurate and timely completion/delivery of information and review of clinical regulatory submissions. Serves as the scientific writing content expert for the department.

• Serves as medical writing lead on more complex clinical regulatory documents, such as those associated with filings and dossiers. Works closely with the Regulatory team(s) on document strategies. Implements all activities related to the preparation and compilation of data and information into a single comprehensive package for new and updated clinical regulatory documents (US and ex-US).
• Serves as a subject matter expert within department for the Aesthetics area. As assigned, provides direction and guidance to medical writers regarding assigned projects, including review of work product. Provides input and feedback to management regarding internal medical writers’ work product/quality. Recognizes potential scheduling and resource conflicts for projects across therapeutic area/product assignments and provides recommendations to resolve.
• Converts relevant data and information into a form that meets clinical regulatory document requirements. Explains data in manner consistent with clinical regulatory requirements. Coordinates the review, approval, and other appropriate functions involved in the production of clinical regulatory projects. Arranges and conducts review meetings with the team. Ensures required documentation is obtained.
• Responsible for effective communication among team members. Communicates deliverables needed, writing process, and timelines to team members. Holds team members accountable to agreed-upon project dates. Negotiates with functional areas on project outcomes and deliverables to meet conflicting demands (time, deliverables, etc.). Must identify and resolve conflicts (including document content issues), remove barriers, generate innovative ways to ensure teams achieve project goals.
• Understands, assimilates, and interprets sources of info with appropriate guidance/direction from product teams and/or authors. Interprets and explains data generated from a variety of sources, including internal/external studies, research documentation, charts, graphs, and tables. Verifies that results are consistent with protocols. Confirms completeness of info to be presented. Challenges conclusions when necessary. Independently resolves document content issues and questions.
• Understands/complies with appropriate conventions, proper grammar usage, and correct format requirements per ICH and other governing bodies following applicable isional guidelines, templates, and SOPs.
• Performs literature searches as needed for drafting document content. Interprets literature information and makes recommendations for application to clinical regulatory documents.
• Works with Regulatory Quality Assurance throughout clinical regulatory document audit process, answers questions during the audit process (as appropriate) and works with team to draft responses as necessary.
• Maintains expert knowledge of US and international regulations, requirements, and guidance associated with clinical regulatory document preparation and submissions. Advises teams regarding compliance with clinical regulatory document content as defined in regulations. Must continually train/be compliant.
• Serves as a department representative on project teams. Acts as Subject Matter Expert for assigned clinical teams regarding computer-based technologies utilized by the respective departments (e.g. eDocs, ARCH, and eCTD databases). Coaches, mentors, and assists medical writers. Provides guidance to non-AbbVie medical writers and external vendors/agencies. Recommends, leads, and implements tactical process improvements, both within the department and ision-wide.

• Bachelor of Science required, with significant relevant writing experience, or Bachelor’s degree in English or communications, with significant relevant science experience. Masters or PhD in science discipline preferred with relevant writing experience.
• American Medical Writing Association (AMWA) certification or other is preferred, with a specialty in Editing/Writing or Pharmaceutical.
• 4 years relevant industry experience in medical writing in the healthcare industry or academia required or in a related area such as quality, regulatory, clinical research, or product support/R&D. Clinical regulatory device writing experience preferred.
• 2 years relevant industry experience preferred.
• 4 years experience in experimental design and clinical/preclinical data interpretation preferred.
• High-level content writing experience and experience with all types of clinical regulatory documents required. Expert in assimilation and interpretation of scientific content with adeptness in ability to translate for appropriate audience. Working knowledge of statistical concepts and techniques.
• Expert knowledge of US and international regulations, requirements, and guidance associated with clinical regulatory document preparation and submissions and ability to advise teams regarding compliance with regulations. Knowledge and expertise with Common Technical Document content templates. Expert knowledge of current electronic document management systems and information technology. Knowledge of Medical Device Regulation (MDR) preferred.
• Excellent written and oral communication skills. Superior attention to detail. Ability to find and correct errors in spelling, punctuation, grammar, consistency, clarity and accuracy.
• Expert in word processing, flow diagrams, and spreadsheets. Excellent working knowledge of software programs in Windows environment.
• Extensive experience in working with collaborative, cross-functional teams, including project management experience.

At AbbVie, we value bringing together iniduals from erse backgrounds to develop new and innovative solutions for patients. As an equal opportunity and affirmative action employer, we do not discriminate on the basis of race, color, religion, national origin, age, sex (including pregnancy), physical or mental disability, medical condition, genetic information, gender identity or expression, sexual orientation, marital status, protected veteran status, or any other legally protected characteristic. If you would like to view a copy of the company’s affirmative action plan or policy statement, please email [email protected].

Significant Work Activities: Continuous sitting for prolonged periods (more than 2 consecutive hours in an 8 hour day)Keyboard use (greater or equal to 50% of the workday)

Travel: Yes, 10 % of the Time

Job Type: Experienced

Schedule: Full-time

Senior Group Director, Healthcare Communications (Remote USA)

Remote – USA

Full time

Working at Real Chemistry and in the healthcare industry isn’t just a job for us. We got into this field for different reasons, but we all stay for the same reason – to uncover insights, make meaningful connections, infuse creativity, and improve the patient experience by transforming healthcare through AI and ideas.

Real Chemistry creates the world around modern therapies with over 2,000 talented professionals, and for the last 20+ years has, carved out its space at the intersection between healthcare, marketing and communications, data & AI, and the people at the heart of it all. We work with the top 30 pharma and biotech companies and are built for uncommon collaboration—we believe we are best together, bring together experts from a wide range of disciplines collaborate without barriers under a single, unified mission: to transform what healthcare is to what it should be. This one-of-a-kind model allows us to work in a way that better reflects how people experience healthcare—all with the intent to transform healthcare from what it is to what it should be. But we can’t do it alone – you in?

Job Scope & Responsibility:

The Senior Group Director is a leadership role on the Scientific and Medical Affairs team within the Integrated Marketing Communications (IMC) pillar of Real Chemistry. In this role, they are responsible for leading large medical affairs accounts and helping to drive new business and organic business, including driving innovation within accounts.

What You Will Do:

• Be the senior scientific lead on multiple medical affairs accounts. Drive the strategic direction for medical communications, including workshop design, planning, and content frameworks for key medical affairs activities.
• Work across teams, including with creative, account, strategy, and analytics and be regarded as a scientific authority.
• Work on significant and unique issues where analysis of situations or data requires an evaluation of intangibles. Exercises independent judgment in methods, techniques and evaluates criteria for obtaining results. Take accountability for decisions. Increasingly lead groups and teams in strategy and execution. Also participate in thought leadership efforts.
• Distill complex scientific information into clear, compelling stories. Lead discussions/presentations with clients and internally. Consistently translate science into the development of compelling strategies and tactics.
• Mentor and manage junior staff, including interns, junior-level scientific strategists, and junior medical writers. Be seen as a leader across the firm. Establish prominent visibility within the firm and externally as a capable, inspiring organizational leader.
• Work with junior staff in the creation of medical content, including scientific platforms, publications, disease state decks, data presentation decks, medical science liaison materials, MOA/MOD messaging, and other key medical tactics.
• Manage the billability and utilization of direct reports in conjunction with specified organizational targets
• Think strategically about business impact, effective team management, innovative and creative thinking. Exemplifies the agency model of servicing clients with high degree of trust and spirit of partnership. Anticipates needs (of clients, accounts, employees) and proactively partners cross-functional teams/leaders (social, analytics, etc.). Be a knowledge master, motivated to grow (self and team) and innovate.
• Function as a strategic leader to help drive brands forward, regardless of their stage in the product lifecycle. Consistently design and lead workshops, then remain integral for outputs and implementation.
• Be a scientific and strategic leader in new business efforts, helping to drive revenue growth within the group.
• Participate consistently to drive internal education efforts with support from junior staff to develop materials.
• Be a key client relationship lead in conjunction with account leadership, consistently leading scientific and strategic discussions with clients in support of their business goals.
• Independently support IR and PR teams as needed in workshop participation and development of scientific narratives. Design and drive workshops, then remain integral for outputs and implementation.

This position is a Perfect Fit for You If

• Our Company values – Best Together, Impact-Obsessed, Excellence Expected, Evolve Always and Accountability with an “I” – really speak to you.
• You have a ton of energy and enjoy operating in a fast-paced and growing environment.
• You are adaptable, resilient, and OK with adjusting your scope, responsibilities, and focus as we grow. When things change, so do we. We’re always evolving.
• You enjoy being empowered to decide where you do your best work. We currently operate with a flexible, hybrid approach that gives you the ability to work in the setting that’s best for you – at home, in the office or a mix.
• You are proactive, driven and resourceful with strong prioritization skills and a desire to e into the data.
• You want to be a critical part of a visible, cross-functional team and will help drive strategic decision making.
• You are highly organized self-starter, able to work independently and under tight deadlines.

What You Should Have:

• 6+ years of experience in large company with Healthcare/Life Sciences industry, agency experience preferred.
• Strong Medical Communications background.
• PhD, PharmD or MD degree required.

Pay Range: $175,000 – $219,000

This is the pay range the Company believes it will pay for this position at the time of this posting. Consistent with applicable law, compensation will be determined based on job-related, non-discriminatory factors including but not limited to work experience, skills, certifications and geographical location. The Company reserves the right to modify this pay range at any time.

Real Chemistry is proud to be Great Place to Work® certified; check out what our people shared about our culture and workplace on our Great Places to Work Profile here.

Real Chemistry is currently operating with a flexible, hybrid approach and giving our teams the ability to operate in the way that works best for them – at home, in office or a mix.* We trust our people to decide what works best for them, working together with their teams and leaders to support our customers and make the world a healthier place. This policy will continue to be evaluated and may change in the future as we seek to ensure our people stay inspired, engaged, and motivated to do their best work.

Real Chemistry offers a comprehensive benefit program and perks, including options for medical, dental, and vision plans, a generous 401k match, flexible PTO, and entitlement to a five-week sabbatical program after 5 years of service. Other perks include an annual wellness reimbursement, student loan debt contributions, mental wellness coaching and support, and access to more than 13,000 online classes with LinkedIn Learning. Additional benefits for those just starting or continuing with their family building journey include access to enhanced fertility support, Bright Horizons family support programs, as well as expanded paid leave for new parents including personalized coaching support through Your 4th Trimester ®. Learn more about our great benefits and perks at: https://www.realchemistry.com/

Lead Medical Assistant

REMOTE, USA

OPERATIONS – CENTRAL OPERATIONS

FULL TIME

REMOTE

At Truepill, we power the future of consumer healthcare. We started in 2016 with a vision to modernize healthcare, but we didn’t stop there. We connect telehealth, diagnostic, and pharmacy infrastructure to create innovative solutions for leading companies, enabling our partners to deliver convenient and accessible care. We provide the building blocks needed to launch and scale world-class healthcare experiences.

With over 10 million prescriptions shipped and millions of patients served, we work with many of the world’s largest healthcare organizations – including payers, providers, life sciences companies, consumer health brands, and government agencies. And with new partners continually joining our mission, we aim to further shape the future of healthcare – one patient at a time.

Come join us. Let’s build something great together.

About the Role

We’re looking for an experienced Medical Assistant Lead to support our Telehealth Operations department. You’ll work alongside collaborative partners and dedicated achievers in the field. You’ll utilize your medical assistant skills, customer service, phone and messaging etiquette skills to provide solutions to all patient and customer inquiries.

Why You’ll Love Working at Truepill…

• We are collaborators – The backbone of Truepill is our people. We support each other by listening and evolving together to make our goals attainable.
• We are curious – We never settle for how it’s done today. We invent how it will be done tomorrow. Because we don’t just ask “why?”, we ask “why not?”.
• We are innovators – We’re the spark that ignites positive change in healthcare. We create impact because we don’t anticipate; we innovate.
• We are honest – Leading with integrity is the foundation of trust. We always do what’s best for our people, our customers, and above all, our patients.
• We are committed to supporting employees’ happiness, health, and overall well-being – We offer a variety of PTO plans and comprehensive benefits for both our remote and onsite employees.

You’re Excited About This Opportunity Because…

• You will perform typical front office and back office responsibilities, including patient education, medication requests, handling patient questions, supporting provider needs, and conduct training/onboarding as necessary
• Assist with patient support such as answering patient emails, patient phone calls, take on escalated calls, processing medical records, and provide patient care coordination
• Work collaboratively with team members and our provider network to maintain an excellent model focused on patient care and high quality service
• Become an expert with our software solutions, including but not limited to Truepill EMR, Zendesk, and Five9.
• Primary work will come from inbound calls, outbound calls, and email support requests
• With our internal tools, you’ll be providing the most adequate resolution for our team and patients
• You’re able to maintain a positive, empathetic and professional attitude towards your team, patients, and providers at all times
• You’ll be responding to telephone calls from customers/insurance/patients etc, routing them, if needed, to the appropriate department or resolving the escalation as appropriate
• You’ll work collaboratively with other leaders and team members to ensure smooth workflow in all departments to provide support when needed

We’re excited about you because…

• You possess phone etiquette skills in order to provide excellent customer service
• You have 2+ years of Medical Assisting experience (preferably in a remote/start up environment)
• You’re able to communicate effectively with coworkers, patients, and providers
• You’re detail oriented: accuracy is essential to our operations!
• You’re collaborative and enjoy working with your team to develop professional relationships
• You are self driven and have experience working with complex systems in a remote work environment!
• You’re able to work a flexible schedule that may include holidays/weekends
• You’re adaptable to change in a high paced environment
• Preferred: Experienced with Five 9, has prior leadership experience
• Knowledge of and ability to use and apply medical terminology
• Strong computer skills and knowledge of electronic medical records
• Ability to speak and write effectively at a high school graduate level
• Ability to solve problems and identify solutions
• Ability to demonstrate customer service skills in interactions with all patients, families, and staff including in high volume and stressful situations
• Ability to work independently as well as an integral part of the patient care team
• Ability to follow instructions and standard operating procedures
• High School Diploma or GED equivalent
• Medical Assistant Certificate/Diploma from an approved school/institution or equivalent documented training (i.e. military medic, EMT, etc.).
• Preferred: Experience with healthcare related customer support

Pay Range – $24 to $26 per hour

Diversity, Equity & Inclusion

Truepill is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an inidual with a disability, or other applicable legally protected characteristics.

PACE Risk Adjustment Coder

Remote

Contracted to Full Time

Audit Services

Mid Level

SHARE

This is a remote contract position.

We are seeking a highly motivated and dedicated auditing professional to join our team as a contractor. The ideal candidate must have at least 2 years of PACE Risk Adjustment coding experience. The position requires one to be resourceful, organized, and extremely driven. This seasonal contractor position that would starts in January and go through March with a possible extension through May of 2023. Work location is remote.

What You’ll Do:

• Code medical records to validate ICD-10-CM codes for PACE Risk Adjustment
• Meet department production and quality standards
• Research regulatory guidelines for supporting documentation
• Prepare coding reports using excel
• Prepare oral and/or written reports of work activity to Supervisor
• Be responsible and accountable for maintaining the confidentiality, integrity, and availability of protected health information. Follow HIPAA security policies and procedures affecting your job, and report any suspected or actual violation or breach
• Other duties as assigned

Experience You’ll Need:

• Minimum 2 years of risk adjustment coding experience
• Extensive ICD-10-CM coding experience, with Risk Adjustment models for PACE
• Excellent written and verbal communication skills
• Ability to own project and complete charts assigned in work queue daily
• Detail oriented and deadline driven attitude
• Ability to think critically and determine the best method for completing tasks
• Strong computer skills (Excel, Word, EMR systems, and internet)
• Ability to multitask and keep a sense of urgency
• Strong time management, organization skills, and work ethic

Certification Requirements:

• CRC or 5 years’ experience coding risk adjustment

Billing and Follow Up Rep – Remote

Job ID 195932BR

• Rochester, Minnesota
• Full Time
• Finance

Apply Now

Not ready to apply? Join our talent community

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 Billing and Follow Up Representative II is an experienced level position that enables the accurate and timely submission of claims. This position will be responsible for the correction of billing errors that will enable timely claim submission to payers, following up on non-adjudicated claims, and review of claims with contractual underpayments. This position will be responsible for working billing and follow up tasks of higher complexity, and will require knowledge of payer billing requirements. This role will require adherence to quality assurance metrics, as well productivity standards that will enable billing and follow-up key performance indicators to be met.

Qualifications

• High School Diploma or GED and 2 years of experience in medical billing (hospital and/or professional)
• OR
• Bachelor’s Degree Required
• Ability to read and communicate effectively in English
• Basic computer/keyboarding skills, intermediate mathematic competency
• Good written and verbal communication skills
• Knowledge of proper phone etiquette and phone handling skills
• Must maintain regular and acceptable attendance; may be required to work weekend, holiday or OT hours

Additional qualifications

• Associates degree or higher preferred
• Four years of relevant experience preferred
• Knowledge of and experience with Epic is preferred
• General knowledge of medical billing and collections processes preferred
• General knowledge of healthcare terminology preferred
• Knowledge of contracted payers preferred

License or certification NA

Exemption status Non-exempt

Compensation Detail $22.99 – $31.05 / hour

Benefits eligible Yes

Schedule Full Time

Hours / Pay period 80

Schedule details 100% Remote, can be seated at any site.

Monday – Friday, five 8 hour shifts between 7am-5pm

Weekend schedule n/a

Remote Yes

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.

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.

Title: Credentialing Coordinator (Contract)

Location: Remote

Hims & Hers Health, Inc. (better known as Hims & Hers) is a multi-specialty telehealth platform building a virtual front door to the healthcare system. Hims & Hers connects consumers to licensed healthcare professionals, enabling people to access high-quality medical care from wherever is most convenient for numerous conditions related to primary care, mental health, sexual health, skincare, and more. Launched in November 2017, the platform also offers thoughtfully created and curated health and wellness products. With products and services available across all 50 states and Washington, D.C., Hims & Hers’ mission is to make it easier for all Americans to access affordable care and treatment for conditions that impact their daily lives. In January 2021, the company was listed on the NYSE at an initial valuation of $1.6 billion and is traded under the ticker symbol HIMS . To learn more about our brand and offerings, you can visit forhims.com and forhers.com.

JOB DESCRIPTION

About the job:

The Credentialing Contractor will be engaged in all aspects of credentialing of health care professionals. This includes maintaining current information on file and making sure all providers have current certification and licensure. This position is also engaged in verifying compliance of NCQA and state requirements. The Credentialing Contractor primarily works independently, but frequently coordinates with the Credentialing Coordinator, and reports to the Director of Supply Operations.

Responsibilities:

• Assist with organizing, maintaining, and verifying all aspects of the credentialing process while updating current files on practitioners.
• Audit and verify compliance with NCQA and state level requirements for providers to practice.
• Data entry of new applications/licenses in the credentialing database.
• Update and process various agreements.
• Perform employment verifications and send out certificates of insurance for current providers.
• Document and audit receipts for licensure reimbursement.Requirements:
• Bachelor’s Degree preferred and a minimum of three (3) years credentialing experience with working knowledge of credentialing accreditation regulations, policies and procedures, and NCQA standards.
• Must demonstrate exceptional communication skills, listening effectively and asking questions when clarification is needed.
• Must be a self-starter with a strong attention to detail
• Must be able to plan and prioritize to meet deadlines; with the ability to re-prioritize as needed.
• Excellent computer skills including Excel, Word, Google Suite, and Internet use.

DIVERSITY STATEMENT

We are focused on building a erse and inclusive workforce. If you’re excited about this role, but do not meet 100% of the qualifications listed above, we encourage you to apply.

Hims 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. Hims considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance

Title: Nurse Triage Position

Major Responsibilities:

• Remotely Performs nursing telephone triage of acute illness by evaluation of symptoms utilizing established triage algorithms, policies and procedures. Provides telephone consultation/triage to patients, family members and significant others, prioritized by level of urgency, essential needs and available resources.
• Collects and analyzes patient and family data for the purpose of assessment, diagnosis and management. Formulates and articulates succinct and comprehensive assessments of real or potential patient problems. Integrates and translates research-based knowledge and experience into well-defined actions to facilitate achievement of quality outcomes. Ask questions to assess patient’s knowledge and skill level in order to mutually plan the experience.
• Educates and counsels consumers on the options available to them in meeting their health care needs. Increases health awareness, plans and provides necessary teaching, evaluates response to teaching and documents in medical record. Provides referrals to the appropriate level of health care and/or social services resources within the community, ensuring the highest quality care for patient/family. Modifies teaching strategy based on patient/family response, readiness to learn and level of comprehension.
• Performs outbound follow-up calls to patients who received triage services to determine illness improvement and/or additional health care needs and referrals. Schedules appointments with emphasis on making the appointment in correlation to the recommended end point of the protocol used. Collaborates with other health care team members to coordinate medical and nursing management of patient care, including procedures and medication refills.
• Maintains and updates accurate clinical and patient records according to agency, State and Federal guidelines. Documents all call encounters utilizing online information systems at the time of the call. Communicates information relating to the patient’s physical and psychological status to the physician and/or additional members of the interdisciplinary team as appropriate. Provides pertinent and concise reports describing patient’s response to medical and nursing plans of care.
• Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirements relative to his/her age-specific needs, and to provide the care needed as described in the department’s policies and procedures. Age-specific information is developed further in the departmental job standards.

Licensure, Registration, and/or Certification Required:

• Registered Nurse license in WI, MI and IL. **Can obtain these upon hire, license outside of home state are not required prior to hire

Education Required:

• Associate’s Degree (or equivalent knowledge) in Nursing.

Experience Required:

MUST have 2+ years of acute care experience within the last 4 years (ED, Urgent Care and some Med Surg will be considered)

Knowledge, Skills & Abilities Required:

• Critical thinking skills necessary to independently determine and prioritize the needs of patients using sound judgment and strong problem-solving skills.
• Knowledge of a variety of healthcare specialties, including levels of care, symptom identification and proven treatment recommendations. Ability to incorporate past experience with established protocols.
• Excellent verbal communication skills demonstrating empathy, respect, restatement, open-ended questions, active listening and diplomacy with a erse customer population.
• Ability to develop rapport and maintain positive, professional relationships with a variety of patients, staff and physicians.
• Proven ability to independently organize and prioritize work, managing multiple priorities and maintaining a flexible schedule in a fast paced, dynamic customer service environment.
• Excellent customer service and follow-up skills including the ability to stay calm during stressful situations.
• Demonstrated proficiency as a technology user with computers, internet, desktop software packages and multiple-line telephone systems.
• Ability to converse with customers/patients while researching and documenting calls on multiple systems. Knowledge of documentation techniques for communication, including experience with the SBAR technique.

Physical Requirements and Working Conditions:

• ability to sit for the extended periods of time
• Must have functional vision, touch, speech, and hearing.
• Required stable and secure internet connection
• must have quiet space to make and receive phone calls
• able to lift 15 lbs