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Title: Hospital Coding Quality Specialist

Responsible for completing hospital coding accuracy reviews to assist coding leadership in carrying out the department’s compliance plan to ensure that our coding team members are coding accurately according to the documentation within each record, validating accurate external reporting and appropriate reimbursement.

Reviews coded health information records to evaluate the quality of staff coding and abstracting, verifying accuracy and appropriateness of assigned diagnostic and procedure codes, as well as other abstracted data, such as discharge disposition. Ensure accurate coding for outpatient, day surgery and inpatient records. Verifies all codes and sequencing for claims according to American Hospital Association (AHA) coding guidelines, CPT Assistant, AHA Coding Clinic and national and local coverage decisions.

Works collaboratively with coding leadership per their direction in reviewing records with focused diagnosis and procedure codes, including specific APCs, DRGs and OIG work plan targets to assure compliance in all areas of coding, which may give visibility into documentation that is driving codes.

Works collaboratively with coding leadership to identify focused prospective records that need to be reviewed.

Identifies coder education opportunities, team trends, and consideration of topics to mandate for second level account review, before the account is final coded.

Reviews encounters flagged for second level review, including but not limited to; hospital acquired conditions (HACs), complications and other identified records such as core measures or trends as identified by coding leadership. Perform review of coded encounter for appropriate risk-adjustment, including accurate severity and risk of mortality assignment.

Responsible for coding participation in the Clinical Documentation Improvement and Hospital Coding alignment process. Review accounts with mismatched DRG assignment following notification from the Inpatient coder. Determine the appropriate DRG based on coding guidelines. Provide follow up to the clinical documentation nurse with rationale on final outcome. Recommends educational topics for coders and clinical documentation nurses based on their observations from reviewing mismatches.

Participate in hospital coding denial and appeal processes as directed. Ensure timely review and response to any third-party payer notification of claims where codes are denied. Determine if an appeal will be written based on application of coding guidelines and provider documentation.

Following review of overpayment or underpayment denials, provide appropriate follow-up to coding team member as appropriate, rebilling accounts to ensure appropriate reimbursement. All trends identified should be presented to coding leadership in a timely manner and logged for historical tracking purposes.

Investigates and resolves all edits or inquiries from the billing office or patient accounts, to prevent any delay in claim submission due to open questions related to coding. Identifies any coding issues as they relate to coding practices. Clarifies changes in coding guidance or coding educational materials.

Maintains continuing education credits and credentials by keeping abreast of current knowledge trends, legislative issues and/or technology in Health Information Management through internal and external seminars. Identify opportunities for continuing education for hospital coding team.

Scheduled Hours

Monday through Friday First Shift

This is a REMOTE Opportunity

Licenses & Certifications

• Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA), or
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or

Degrees

• Associate’s Degree in Health Information Management or related field.

Required Functional Experience

• Typically requires 5 years of experience in hospital coding for a large complex health care system, which includes hospital coding, denial review and/or coding quality review functions.

Knowledge, Skills & Abilities

• Demonstrated leadership skills and abilities.
• Demonstrates knowledge of National Council on Compensation Insurance, Inc. (NCCI) edits, and local and national coverage decisions.
• Expert knowledge and experience in ICD-10-CM/PCS and CPT coding systems, G-codes, HCPCS codes, Current Procedural Terminology (CPT), modifiers, and Ambulatory Patient Categories (APC), MS-DRGs (Diagnosis related groups).
• Advanced knowledge in Microsoft Applications, including but not limited to; Excel, Word, PowerPoint, Teams.
• Advanced knowledge and understanding of anatomy and physiology, medical terminology, pathophysiology (disease process, surgical terminology and pharmacology.)
• Advanced knowledge of pharmacology indications for drug usage and related adverse reactions.
• Expert knowledge of coding work flow and optimization of technology including how to navigate in the electronic health information record and in health information management and billing systems.
• Excellent communication and reading comprehension skills.
• Demonstrated analytical aptitude, with a high attention to detail and accuracy.
• Ability to take initiative and work collaboratively with others.
• Experience with remote work force operations required.
• Strong sense of ethics.

Coder I (Outpatient) HIMS Coding

Home/Job Search Results/Coder I (Outpatient) – HIMS Coding

Coder I (Outpatient)

Are you looking for a rewarding career with a top-notch healthcare company? We are looking for qualified Coders like you to join our Texas Health Family

Work location: Remote

Work hours: Monday through Friday, 8:00 am to 4:30 pm

HIMS Coding Department Highlights:

• 100% remote work
• Flexible hours/scheduling
• Terrific work/life balance

Here’s What You Need

Education

H.S. Diploma or Equivalent General Studies REQUIRED or

H.S. Diploma or Equivalent With completion of ICD 10 and CPT Coding courses/program from a nationally recognized organization i.e. AAPC, AHIMA Must provide proof of PPE/internship hours REQUIRED or

Associate’s Degree Health Information Technology Must provide proof of PPE/internship hours REQUIRED or

Bachelor’s Degree Health Information Administration Must provide proof of PPE/internship hours REQUIRED

Experience

1 Year if H.S. Diploma 1 yr experience in acute care hospital outpatient coding required REQUIRED

If completion of ICD 10 and CPT Coding courses/program, or Associate’s Degree in HIT, or Bachelor’s Degree in HIA no experience required REQUIRED

Licenses and Certifications

CCA Certified Coding Associate 12 Months REQUIRED or

COC Certified Outpatient Coder 12 Months REQUIRED or

RHIT Registered Health Information Technician 12 Months REQUIRED or

CPC Certified Professional Coder 12 Months REQUIRED or

RHIA Registered Health Information Administrator 12 Months REQUIRED

Skills

• Effective oral and written communication skills.
• Ability to apply definition of principal diagnosis to arrive at correct code assignment.
• Accurately distinguishes between symptoms and a true diagnosis.
• Applies knowledge of ICD 10-CM and CPT Procedure Guidelines for simple procedures.
• Able to read and interpret health record documentation relevant to coding, typically provided by a single provider.
• Keeps abreast of new developments in coding.
• Basic knowledge of automated encoding system and computer assisted coding methods.
• General knowledge of EHRs (electronic health record systems).
• Demonstrated ability to utilize decision tree logic to arrive at basic coding assignment preferred.
• Basic knowledge of Microsoft Office Suite i.e. Outlook, Excel, Word

What You Will Do

• Reviews and interprets health record documentation to identify pertinent diagnosis/procedures that require code assignment for outpatient ancillary, diagnostic, therapeutic and emergency department records.
• Demonstrates appropriate utilization of coding software and coding reference material.
• Assigns/sequences ICD10-CM and CPT codes to selected medical records per Coding Guidelines, THR Coding Compliance Policies, CMS and other third party payers.
• Queries physicians to ensure appropriate documentation for accurate coding.
• Maintains adequate production.
• Abstracts pertinent information from patient medical records.
• Correctly identifies and abstracts all physicians and disposition codes.
• Maintains coding proficiency by keeping up-to-date on coding guidelines as published in Coding Clinic and CPT Assistant.
• Completes all required training and education.
• Completes appropriate continuing education units as required for any credentials/certifications held and/or THR coding compliance requirements.

Additional perks of being a Texas Heath Coder

• Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, Student Loan Repayment Program as well as several other benefits.
• A supportive, team environment with outstanding opportunities for growth.
• Explore our Texas Health careers site for info like Benefits, Job Listings by Category, recent Awards we’ve won and more.

Title: Patient Services Associate

About Us

Welcome to Alliance HealthCare Services, an Akumin company. As a leading provider of radiology and oncology services in the United States, we are dedicated to improving the diagnosis and treatment of patients through the use of advanced technology and expert clinical and operational knowledge. Our network of owned and operated imaging locations offers a range of outpatient diagnostic procedures, including MRI, CT, PET, and more. In addition, we provide a full suite of diagnostic imaging and cancer care services, including radiation therapy, to over 1,000 hospitals and health systems across 48 states. Our goal is to make healthcare more efficient and effective for both patients and providers. Thank you for considering a career with us!

Benefits Offered Depending on Eligibility:

• Medical, Prescription, Dental & Vision
• Savings and Spending Accounts: HSA & FSA
• Company Paid Life Insurance, AD&D and Disability
• Supplemental Life Insurance and AD&D
• Employee Assistant Program
• Retirement Plan and Company Match
• Paid Time Off: Vacation, Sick, & Holiday
• Additional Voluntary Benefits!

Job Responsibilities

PATIENT SERVICES ASSOCIATE – REMOTE WORK FROM HOME OPPORTUNITY

Must be available to work 9:00am -5:30 pm EST Monday -Friday

The Patient Services Associate I answers incoming calls and makes outgoing calls to remind patients of scheduled appointment and instructions, schedules appointments and pre-registers patients for medical scans. The majority of time will be spent handling reminder calls but will also include assisting with scheduling and pre-registration calls based on business needs. Follows standardized process to get and give information during scheduling/pre-registration calls according to documented work processes. Makes outbound reminder calls for medical scans. Enters all information into the applicable computer system. Determines the needs of other caller and transfers to appropriate personnel and ensures every customer receives the highest quality of customer service.

Specific duties include, but are not limited to:

• Makes outgoing calls and receives incoming calls to remind patients of scheduled appointment and instructions, schedule appointments and pre-register patients for medical scans; contacts patients and referring physician offices to schedule appointments.
• Follows prescribed list of questions/scripts and provides standardized responses to get and give information during scheduling/pre-registration/reminder calls.
• Ensures the gathering of accurate and complete patient data required to complete the scheduling process and any specific information required by customer facility.
• Enters all information into the applicable computer system in accordance with documented work processes.
• Determines customers’ needs based on incoming calls; transfers callers to appropriate staff; escalates calls as necessary to Patient Services Supervisor or Patient Services Lead as appropriate.
• Completes any additional job duties as assigned.

Position Requirements

• High School Diploma or equivalent experience required.
• 6 months to 1 year of medical or related training and/or experience required.
• Computer literacy and experience with general office equipment required.
• Strong multi-tasking abilities and communication skills.
• Ability to work well with physicians, patients, and coworkers; excellent interpersonal and customer service skills.

Title: Registered Nurse – Financial Clearance Specialist

Job Summary:

Responsible for obtaining authorizations for scheduled Oncology services, and other medical specialties as needed. Reviews medical records and prepares clinical reviews for medical necessity and authorization. Responsible for facilitating the denial and appeal process.

Key Position Details:

Work from home.

Work hours are 730a-4p with flexibility on work demands.

Job Description:

Job Requirements

• Bachelor’s degree in Nursing required
• 2 to 5 years experience in an acute hospital or medical clinic setting required
• 2 to 5 years health insurance authorization experience preferred and
• 2 to 5 years experience using InterQual, MCG, or other clinical criteria preferred
• Licensed Registered Nurse – MN Board of Nursing required upon hire

Principle Responsibilities

• Ensure services/procedures are appropriate and necessary per health benefit plans.
  • Assess clinical data from medical records to obtain authorization for scheduled services.
  • Abstract and submit clinical data from medical records to insurance payers.
  • Utilize clinical screening criteria and reviews insurance payer medical policies to ensure patients meet medical necessity for scheduled services.
  • Assure the medical record has the proper physician clinical documentation.
  • Monitor for continued authorization, communicates results and opportunities to nurses, physicians, finance, case managers, and payers.
• Facilitate denials and appeals process.
  • Evaluate potential denials or payment issues and initiates communication with physician or clinician regarding next steps.
  • Prepare and facilitates appeals for denied claims.
  • Facilitate peer to peer requests between the ordering physician, and the payer physician.
  • Other duties as assigned.

Intake Coordinator (WFH/Remote)

United States, Remote 

Marketing – Intake and Consultation

Full-time

Remote

Full-time Non-Exempt

Direct Hire

100% Remote

$18 – $22 per hour

About Expressable:

Expressable is a virtual speech therapy practice on a mission to transform care delivery and expand access to high-quality services, serving thousands of clients since our inception in late 2019. We are passionate advocates of parent-focused intervention. Our e-learning platform contains thousands of home-based learning modules authored by our clinical team, helping SLPs empower caregivers to integrate speech therapy techniques into their child’s daily life and improve outcomes. Our mission is to set a new standard in speech therapy by making every caregiver a champion of their loved one’s success. We envision a world where everyone can fulfill their communication potential.

About the Role:

We are looking for a highly organized Intake Coordinator who takes pride in attention to detail to join our growing team. You will be responsible for verifying and accurately documenting insurance benefits.

We are interested in every qualified candidate who is eligible to work in the United States. However, we are not able to sponsor visas at this time.

What you would be doing at Expressable

• Complete insurance verification utilizing appropriate 3rd party portals, IVRs, and phone outreach to inidual payers.
• Check and document insurance requirements with accuracy and ensure contract compliance.
• Collaborate with the consultation team to ensure all prospective clients fully understand their insurance coverage, benefits, and payment options
• Correctly determine patient responsibility and benefit limits/utilization
• Create and update information in electronic health records and CRM.
• Properly escalate items needing attention.
• Participate, as needed, in collaboration with revenue cycle management partners in the research and appeal process of denied claims.
• Ensure work is performed in compliance with company policies including HIPAA and other regulatory, legal, and safety requirements.

What you bring to Expressable

• High school diploma or AA degree
• At least 2 years of experience working in client intake, patient/member services, insurance verification personnel, or medical front office representative
• Well versed in performing insurance verification, with in-depth knowledge of HMOs, PPOs, Commercial Payers, HSAs/FSAs, Medicaid, and Medicare
• Adept at interacting with a wide variety of insurance plans in multiple states each day.
• Competency in office productivity and collaboration tools such as MSOffice/Teams or Google Suite and Slack. Familiarity with Salesforce or other CRM platforms.
• Ability to collaborate with a fully remote team

Key competencies for success in this role

• Professionalism–Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
• Attention to Detail— Double-checks the accuracy of information and work product to provide accurate and consistent work. Provides information on a timely basis and in a usable form to others who need to act on it. Carefully monitors the details and quality of one’s own and others’ work.
• Planning/Organizing (Time Management)–Ability to work independently. Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Develops realistic action plans. Acts with a sense of urgency.
• 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. Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others’ ideas and tries new things.
• Adaptability–Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.

Benefits at Expressable

• Exceptional paid time off policies that encourage and support life balance
• 401k matching to ensure our staff have what they need to enjoy their retirement
• Health insurance options that ensure well being for the whole person and their family
• Company provided hardware and software for home office
• Remote work environment that strives for connectivity through professional collaboration and personal connections

Expressable values people. From the technology we develop, the services we provide, and the culture we maintain, Expressable cares about the experience of our employees, clients, and prospects. We intentionally create and sustain supportive environments in which everyone – clients, caregivers, speech-language pathologists, and team members – can achieve their highest potential.

We believe that building trusting and collaborative relationships is paramount to delivering quality care so we operate with the highest levels of honesty, transparency, and accountability as iniduals and a collaborative team. We believe that transforming therapy happens through the steady and iterative problem solving of an interdisciplinary team.

Expressable is an equal opportunity workplace. We celebrate and embrace ersity and are committed to building a team that represents a broad tapestry of backgrounds, perspectives, and skills.

Expressable is committed to the full inclusion of all qualified iniduals. In keeping with our commitment, Expressable will take the steps to ensure people with disabilities are provided reasonable accommodations. Accordingly, if reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact our HR Director at:

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.

SCOPE OF ROLE

The role of the UM Nurse is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, identifying member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure members receive the services and resources required to meet desired health and social outcomes. The UM Nurse is responsible for providing patient-centered care across the care continuum.

ROLE RESPONSIBILITIES

• Capacity to perform prospectively, retrospective, or concurrent medical necessity reviews for an assigned panel of members
• Capacity to review cases for medical necessity and apply the appropriate clinical criteria; to include, but not limited to Medicare criteria, Medicaid/Medi-cal criteria, Interqual, Milliman, or Health Plan specific guidelines
• Capacity to collaborate with the Medical Director to ensure the integrity of adverse determination notices based on the quality standards for adverse determinations
• Capacity to ensure discharge planning is timely and appropriately communicated to the transition of care teams, when applicable.
• Capacity to meet or exceed productivity targets set forth
• Capacity to serve as a resource to non-clinical team members when applicable
• Adheres to the Policies and Procedures set forth by the Quality Management Committee.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Associate’s degree in Nursing, preferred
• Minimum 2 years of experience in medical management clinical functions.
• Working knowledge of MCG, InterQual, and NCQA standards

LICENSURES AND CERTIFICATIONS

• Active and Unrestricted License as a Licensed Vocational Nurse (LVN)
• Certification Managed Care Nursing (CMCN) preferred

WORK ENVIRONMENT

• The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
• Some travel may be required.
• Ability to lift at least 50 pounds.

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.

As an Equal Opportunity 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.

Nurse Case Manager – Oncology

• Houston, TX
• Remote

Full time

REQ202212-011

About Accolade

Accolade (Nasdaq: ACCD) provides millions of people and their families with an exceptional healthcare experience that is personal, data driven and value based to help every person live their healthiest life. Accolade solutions combine virtual primary care, mental health support and expert medical opinion services with intelligent technology and best-in-class care navigation. Accolade’s Personalized Healthcare approach puts humanity back in healthcare by building relationships that connect people and their families to the right care at the right time to improve outcomes, lower costs and deliver consumer satisfaction. Accolade consistently receives consumer satisfaction ratings over 90%. For more information, visit

A Care Team Specialist (Oncology) is responsible for managing the member’s clinical experience from the point of request, through the desired outcome.

Responsibilities

• Activate new member account, draft member medical history and identify the goal of the consult
• Accurately enter necessary information into Case Management Software
• Identify appropriate medical records needed and follow 2nd.MD protocol for release of information forms
• Work closely with HIT (Health Information Technician) to organize medical records for specialist
• Identify the most appropriate 2nd.MD Specialist relative to the member’s condition and goal of the consult
• Coordinate video or phone consult with member and specialist
• Schedule 2nd.MD Monitor in advance of consult
• Troubleshoot and address issues prior to consult as needed
• Conduct ongoing follow-up, immediately after the consult and as needed to ensure member achieves the desired outcome
• Review specialist notes post-consult and make available to member
• Facilitate local recommendations as needed, and communicate with local primary care physician or specialist post-consult as needed
• Participate in weekly Care Team meetings
• Assist Account Management in enhancing vendor partner relationships
• Company Lead Case Manager assumes the liaison role, ensuring ongoing communication and reporting to the designated company
• Assist Nurse Manager and Chief Clinical Officer with special projects as needed
• Identify appropriate cases for testimonials

Qualifications

• RN with minimum of three years’ experience
• Communication skills, time management, organization, attention to detail, professionalism, critical thinking, interpersonal skills, experience navigating through multiple technology platforms
• Excellent communication and customer service skills

We strongly encourage you to be vaccinated against COVID-19.

What is important to us…

Creating an enduring company that is hyper-focused on our culture and making a meaningful impact in the lives of our employees, members and customers. The secret to our success is:

We find joy and purpose in serving others

Making a difference in our members’ and customers’ lives is what we do. Even when it’s hard, we do the right thing for the right reasons.

We are strong inidually and together, we’re powerful

Trusting in our colleagues and embracing their different backgrounds and experiences enable us to solve tough problems in creative ways, having fun along the way.

We roll up our sleeves and get stuff done

Results motivate us. And we aren’t afraid of the hard work or tough decisions needed to get us there.

We’re boldly and relentlessly reinventing healthcare

We’re curious and act big — not afraid to knock down barriers or take calculated risks to change the world, one person at a time.

Accolade is committed to being a company that embraces a hybrid work environment where employees can enjoy the best of both worlds – the flexibility to work from home and the opportunity to have a common place to connect, collaborate, and innovate with others in-person. Our hybrid work model requires that employees who live within 40 miles of an Accolade office are required to be in the office for at least two days during the work week. Accolade will provide reasonable accommodation to qualified employees with disabilities or for a sincerely held religious belief.

Accolade is an Equal Opportunity and Affirmative Action Employer committed to advancing an inclusive environment for all qualified applicants and employees. We provide employment opportunities, without regard, to any legally protected status in accordance with applicable laws in the US. We are committed to help ensure you have a comfortable and positive interview experience.

Accolade, Inc., PlushCare, Inc., and Accolade 2ndMD LLC will never ask you to pay to get a job. Anyone who does this is a scammer. Further, we will never send you a check and ask you to send on part of the money or buy gift cards with it. These are also scams. If you see or lose money to a job scam, report it to the Federal Trade Commission at ReportFraud.ftc.gov. You can also report it to your state attorney general.

To review our policy around data use, visit our Accolade Privacy Policy Page. All your information will be kept confidential according to EEO guidelines.

2nd.MD

Ambulance Coder

locations

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

time type

Full time

job requisition id

R30447

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.

Ambulance Coder

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:

A combined role of ambulance coding, data entry and insurance follow-up. Coder is responsible for daily coding, denial management, charge hold, RAI resolution and abstraction for EMS- Ambulance Coding (Emergency). Participate in internal QA audits. Abstracts clinical information from the ambulance report and assigns appropriate ICD 10 and/or CPT codes to patient records according to established procedures. Analyzes, enters, and manipulates database. Knowledge in ICD-10 coding is required. Flexible to do insurance follow-up and take patient phone calls as needed.

Requirements:

• High School diploma or equivalent
• Professional Coding Certification (CPC, CCS or CCA)
• 1-3 years Production Coding experience with both quality and productivity requirements
• Data Entry experience

Preferred Qualifications:

• Ambulance coding experience preferred
• Strong attention to detail
• 10,000 alpha / numeric keying speed
• Knowledge of medical coding

Working Conditions/Physical Requirements:

General office demands

Unique Benefits*:

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

Diversity and Inclusion:

• At Change Healthcare, we include all. We celebrate ersity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.
• Business Resource Groups (BRGs) play a central role in advancing ersity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at https://careers.changehealthcare.com/ersity

#LI-remote

Feeling Inspired? Ready to #MakeAChange? Apply today!

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

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

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

Diversity, Equity & Inclusion:

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

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

Feeling Inspired? Ready to #MakeAChange? Apply today!

COVID Vaccination Requirements

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

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare’s Privacy Notice to California Job Applicants Regarding the Collection of Personal Information.

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Auditor, Coding & Clinical Validation (Episode of Care)

Job Locations: US-Remote

ID2022-9473

Category

Audit – Healthcare

Position Type

Regular

Overview

This is an at home-based position and you must have a work location within the continental US.

The Auditor, Coding & Clinical Validation position has an extensive background in either facility-based nursing and/or inpatient coding and has a high level of understanding in reimbursement guidelines specifically an understanding of the MS-DRG, AP-DRG and APR-DRG payment systems. This position is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of Cotiviti and our clients. Responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding and DRG assignment accuracy. More specifically, this position will align to EOC (Episode of Care) reviews, performed without a medical record.

Responsibilities

• Analyzes and Audits Claims. Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. Performs work independently.
• **May Analyze and Audit EOC claims – Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities. Draws on advanced ICD-10 coding expertise, clinical guidelines, and industry knowledge to substantiate conclusions. Review and analyze the billing associated to the entire episode of care including the professional bill as well the inpatient bill. Performs work independently.
• Effectively Utilizes Audit Tools. Utilizes Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters.
• Meets or Exceeds Standards/Guidelines for Productivity. Maintains production goals set by the audit operations management team.
• Meets or Exceed Standards/Guidelines for Accuracy and Quality. Achieves the expected level of accuracy and quality set by the audit for the auditing concept, for valid claim identification and documentation (letter writing).
• Identifies New Claim Types. Identifies potential claims outside of the concept where additional recoveries may be available. Suggests and develops high quality, high value concept and or process improvement, tools, etc.

Qualifications

• Education (at least one of the following is required)-
  • Associates or Bachelor’s degree in Nursing (active/unrestricted license)
  • Associate or Bachelor’s degree in Health Information Management (RHIA or RHIT)
  • Equivalent experience of 5+ years experience in claims auditing, quality assurance, or recovery auditing…ideally in a DRG / Clinical Validation Audit setting or a hospital environment.
• Coding Certification (at least one of the following are required and are to be maintained as a condition of employment)
  • RHIA or RHIT
  • Inpatient Coding Credential – CCS or CIC preferred
  • Candidates who hold a CCDS or CPC will be given consideration but will need to obtain an inpatient coding certification within 1 year of their hire date with the company.
• Experience (required)
  • 5 to 7+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology.
  • Experience with EOC (Episode of Care) reviews preferred
  • Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge – DRG, ICD-10, CPT, HCPCS codes.
  • Requires working knowledge of and applicable industry based standards.
  • Proficiency in Word, Access, Excel and other applications.
  • Excellent written and verbal communication skills.

Work Environment:

• This is an at home-based position and you must have a work location within the continental US
• This position requires that you provide a high-speed internet connection and a work environment free from distractions (all other equipment will be provided by the company).
• This role is aligned to certain productivity and quality requirements
• Must be able to sit and use a computer keyboard for extended periods of time
• Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.

#LI-JJ1

#LI-Remote

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

Title: Full Time Bilingual Day/weekend Shift Triage Registered Nurse (English/Spanish) 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 English/Spanish speaking Registered Nurse to work weekdays (8am-5pm ET) and weekends (8am-5pm ET), with rotating holiday shifts from the comfort of their own home. This position is flexible and requires RNs who are comfortable performing triage for the elderly population using a virtual visit technology (Telehealth). You will play an integral role in reducing unnecessary utilization of the Emergency Room and maintain the patients’ independence and safety at home with the correct interventions.

The ideal candidate would be able to:

• Receive clinical calls and triage
• Utilize telehealth system and perform virtual visits
• Coordinate care appropriately and timely with members of care team both internal and external
• Have the ability to educate members, family or other caregivers on chronic conditions, diet changes, and pieces of their care plan
• Have confidence in ability to triage appropriately in a setting where other healthcare professionals are not available for collaboration
• Utilize technology for documentation

Would you describe yourself as someone who has:

• Fluency in English and Spanish, in writing, reading and speaking (required)
• Graduated from an accredited nursing program (required)
• Current RN License in good standing in the states of NY and/or Compact License (required)
• A Registered Nurse license with at least 2 years of emergency department, urgent care, triage and/or inpatient/acute experience (required)
• A Registered Nurse with experience providing care to adult and geriatric patient populations (required)
• The availability for days, evenings, rotational weekends and holiday shifts (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
• High speed home WiFi/data connection to support company provided IT equipment

In addition to amazing teammates, we also offer:

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

Pay range is $80k-90K per year based on experience.

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

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

Fertility Billing Analyst

at Carrot Fertility

Remote

About Carrot:

Carrot Fertility is the leading global fertility healthcare and family-forming benefits provider for employers and health plans. Companies use Carrot to customize an inclusive fertility benefit that provides employees financial, medical, and emotional support as they pursue parenthood and fertility care, reducing healthcare costs and resulting in better clinical outcomes.

The Role:

Carrot Fertility is looking for a Fertility Billing Analyst to support our review of member expense submissions and our data reporting services to customers across our book of business. You’ll report to our Senior Director of Analytics and Business Intelligence, and will collaborate closely with our Medical Outcomes and Member Success, Payments teams. You will support the Senior Director of Analytics and Business Intelligence to build out our database of member fertility billing data and help to shape how we communicate about that data to our customers. You will be trusted to provide feedback to help streamline data entry workflows and ensure all necessary data is captured and structured appropriately during the review and storage process. We are looking for a self-motivated inidual with deep expertise in fertility billing / coding and a knack for breaking down tasks and setting up new, organized workflows.

The Team: This role is the first of its kind at Carrot. The right candidate is excited to build out new workflows and processes to support internal and external stakeholders. The role reports to the Senior Director of Analytics and Business Intelligence.

Minimum Qualifications:

• 2-3 years of experience as a fertility claims billing coder, ideally for a high-quality and high-volume fertility clinic
• Process-oriented with an automation/efficiency mindset
• Highly detail-oriented
• Self-motivated and excited to jump into a new challenge, building workflows from a blank slate
• Enthusiasm for Carrot Fertility’s mission and eagerness to become part of our collaborative, friendly, and dynamic team

Compensation:

Carrot offers a holistic Total Rewards package designed to support our employees in all aspects of their life inside and outside of work, including health and wellness benefits, retirement savings plans, short- and long-term incentives, parental leave, family-forming assistance, and a competitive compensation package. The expected base salary for this position will range from $70,000 – $80,000. Actual compensation may vary from posted base salary depending on your confirmed job-related skills and experience.

Why Carrot?

Founded in 2016, Carrot now supports 450+ companies and is available in more than 120 countries across North America, Asia, Europe, South America, and the Middle East. Carrot has been honored by Fast Company as one of the Most Innovative Companies, recognized for its commitment to ersity, equity, and inclusion as a gold winner in the inaugural Anthem Awards, named one of Quartz’s Best Companies for Remote Workers, and celebrated as one of LinkedIn’s Top Startups. Additionally, Carrot is certified as a Great Place to Work and an Age-Friendly Employer.

Utilization Review Nurse- PRN- Weekends

locations

Remote – Other

time type

Part time

job requisition id

R011197

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

Responsibilities

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

Qualifications

Required

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

Preferred

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

Expectations

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

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

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

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

Psychiatric Nurse Practioner

Location: Remote – United States

About the Psych Nurse Practitioner at Headspace Health:

In 2021, Headspace and Ginger joined forces to form Headspace Health, the world’s most comprehensive and accessible mental healthcare platform. In the midst of a growing mental health crisis, Headspace Health set out to democratize mental healthcare so people everywhere could get the care they need, when they need it. Today, Headspace Health touches nearly 100 million lives worldwide through its brands Headspace, Ginger, and Headspace for Work. Headspace Health is changing the way the world thinks about mental healthcare, delivering beloved meditation and mindfulness exercises and one-on-one care anytime, anywhere.

On the Ginger platform, members receive a personalized care plan and the right level of care based on their needs – from self-management tools and coaching to therapy and psychiatry. The Ginger proprietary app delivers clinically validated self-care content, along with chat access to coaches and video access to therapists, psychiatrists for our members. At the moment of need, we provide our members with stigma-free access to high-quality coaches, clinicians and content.

About the Role

Ginger is experiencing high-growth and is seeking full-time, licensed psychiatric nurse practitioners to provide direct, virtual care as part of a multidisciplinary team. Psychiatrists will provide care only to members who reside in states in which the clinician is licensed. You will be part of the professional corporation affiliated with Ginger.

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

Direct Care

• Provide high quality, innovative, tele-psychiatry to Ginger patients over a HIPAA compliant video conferencing platform
• Complete, sign and lock clinical case notes within 24 hours of session
• Maintain your personalized database to record proof of licensure, license updates, expiration dates, personal information, etc.
• Stay up to date with clinical leadership communication (checking and responding to emails in a timely fashion)
• Work with a collaborative care team including health coaches, other therapists, psychiatrists, and external care providers, which includes participating in weekly all-team meetings and weekly consultation groups

What you’ve accomplished:

• PMHNP-BC with completion of accredited nurse practitioner program
• Licensure in multiple states is highly valued, specifically MUST be in full scope of practice states (GREEN)
  Must be cross licensed and/or willing to cross license in multiple full scope of practice states (WA, NY likely)
• 3+ years experience providing clinical psychiatry services
• Experience with tele-psychiatry highly valued
• Willingness and confidence to integrate cutting-edge technology into all aspects of your care
• Clinical competence in psychopharmacology and in evidence based practices (CBT, DBT, ACT, Mindfulness, etc.)
• Knowledge of current research to integrate into your practice
• Familiarity, comfort and confidence with technology – various applications, tech tools, Google web-apps, video conferencing, EMR, etc.
• **Tech-savviness is a must**

Preferred but not required:

• Bilingual
• Experience with triage and working within a team-based care model
• Have worked with a text-based platform providing care in the past

About the Company:

Headspace Health is the world’s most accessible and comprehensive digital mental health and wellbeing platform. Headspace and Ginger have come together at a critical moment of global need. Headspace Health will democratize mental health and wellbeing so people around the world are supported by a full spectrum of affordable care. In addition to its vast library of mindfulness and meditation content, our behavioral health system offers emotional support, guidance, therapy, and medication from professional coaches, licensed therapists, and psychiatrists, respectively.

Our mission is to create a world where mental health is never an obstacle. By harnessing the power and convenience of a smartphone, Headspace Health is able to provide access to high-quality care to anyone, anywhere, in order to reduce symptoms of stress, anxiety, and depression.

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.

How we feel about Diversity & Inclusion:

Headspace Health is committed to bringing together humans from different backgrounds and perspectives, providing employees with a safe and welcoming work environment free of discrimination and harassment. We strive to create a erse & 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.

Title: Billing, Coding Specialist

Location: United States

• Remote, US, United States
• Employees can work remotely
• Full-time

Company Description

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

Job Description

Title/Position: CODER/BILLER+ Specialist

Department or Business Unit: RCM Reporting Structure: CODER/BILLER+ Program Manager Employment Type: FTE Exemption Status: EXEMPT Min. Experience: Mid-Level Travel Required: Yes ~5%

Overview of the Role:

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

Primary Job Duties:

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

Qualifications

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

Pediatric Nurse Care Manager

REMOTE

CLINICAL STRATEGY AND SERVICES CLINICAL TEAM

FULL-TIME

Hiring/Start Date Timeframe: Jan 2022 – Feb 2023

We’re looking for telephonic Pediatric Nurse Care Manager who are passionate about caring for members holistically through their healthcare journey and ensuring needs are met with industry-leading interventions.

Telephonic Pediatric Nurse Care Manager will guide members through complex medical situations, partnering with a multidisciplinary clinical team that includes a variety of healthcare professionals, care coordinators, and records specialists, to deliver integrated remote care in an innovative way. The Telehealth Nurse Care Manager should enjoy spending time on the phone, listening to members’ needs, answering questions, and serving as an advocate. They should also excel at creating cohesive care plans, and should possess the clinical acumen to guide members clinically and navigate available benefits and resources. Nurse Care Managers will support members through complex care management, disease management, and acute case management, ensuring they receive longitudinal care that results in excellent health outcomes.

Responsibilities:

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

Qualifications:

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

About Included Health

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

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

Risk Mitigation Coding Specialist

United States

This key role will provide coding support in the evaluation, and performance that supports the mandated CMS RADV audits as required for both ACA and MA segments, targeted risk mitigation audits and federal mandated audits. This position will require the candidate possess analytical and strategic thinking skills typically attained from experience with interpreting CMS and HHS regulations and participation in the audit process.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards.

Responsibilities

• Performs medical record reviews to ensure documentation supports submitted CMS and HHS Hierarchical Condition Categories (HCC) conditions for Commercial and Medicare Risk Adjustment Payment system.
• Ensure diagnosis codes are supported by the documentation and ensure adherence with ICD-10CM, AHA Guidelines for Coding and Reporting.
• Maintains up-to-date coding knowledge by reviewing materials disseminated and/or recommended by clients and managers.
• Participates in coding department meetings and educational events.
• Contributes to the quality improvement activities of the department and the organization including participating in internal department and client audits.
• Communicates audit findings effectively and professionally by preparing summary reports
• Reports trends and opportunities to improve coding and clinical documentation opportunities.
• Makes corrections (additions and deletions) as needed to ensure accurate submission of HCC codes to CMS
• Possess and maintain a comprehensive understanding and knowledge of company business, products, programs, organizational structure, and basic research principles/methodologies.
• Assists management in implementing programs that provide solutions.
• Assists leadership by investigating, reviewing, and recommending innovative solutions which identify problems/root cause of issues.
• Assists with and documents feedback between corporate business areas and participates in group or committee discussions.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

Requirements

EDUCATION:

• High School diploma or GED equivalent required.
• Bachelor’s degree in a related field preferred.
• Certificate/License (CPC, CPC-H, CRC, CCS-P, CCS) required.
• Relevant combination of education and experience may be considered in lieu of degree.
• Continuous learning, as defined by the Company’s learning philosophy, is required.

EXPERIENCE:

• Minimum of five (5) years HCC specific coding experience required.
• Experience and understanding of CMS HCC Risk Adjustment coding and data validation requirements.
• 3 years RADV audit experience in health plan operations.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Extensive knowledge of RADV audits and Risk Adjustment.
• Strong analytical, planning, problem-solving, verbal, and written skills to communicate complex ideas.
• Ability to develop project management, meeting process, and presentation skills.
• Strong ability to work independently and direct the efforts of others.
• Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).
• Ability to work independently, within a team environment, and communicate effectively with employees and clients at all levels.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an “at will” basis. Nothing herein is intended to create a contract.

Legal Disclaimer: Advantasure is an Equal Opportunity Employer. view full text

Remote Pro Fee Coder – ENT, Part Time

US – Remote (Any location)

Part time

Job Family: General Coding

Travel Required: None

Clearance Required: None

What You Will Do:

The Remote Pro Fee Medical Coder – ENT must be proficient in ENT coding for all places of services. 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 manager—the coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. The coder scope may involve reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines. This position is part time and is 100% remote.

Primary duties:

• Demonstrates the ability to perform quality coding on ancillary charts and clinic charts.
• 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
• 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 coding ENT outpatient professional services.
• Advanced knowledge of E&M coding, CMS/MAC guidance, coding skills, and CPT.
• Must hold one of the following credential: CPC
• Ability to analyze Provider documentation and assign codes accurately
• Strong knowledge and application of government and other payer guidelines as they relate to compliant coding
• High level of accuracy and productivity and will meet or exceed standards consistently
• Must maintain credential throughout employment
• Experience with Cerner, Epic, Optum and 3M
• Experience with CDI and querying physicians
• 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
• Strong working knowledge and experience with federal and state coding regulations and guidelines

What Would Be Nice To Have:

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.

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

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

Location:  US Locations Only; 100% Remote

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Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you’ll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life’s best work.^SM

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

Combine two of the fastest – growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making Healthcare data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.^SM

This position is full-time (40 hours/week). Training will be conducted virtually from your home between 8am – 5pm in local time zone, training can last up to 3 months. After training, work schedules/shifts can flex.

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

Primary Responsibilities:

• Investigate, review, and provide clinical and / or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review. This could include Medical Director / physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
• Perform clinical coverage review of claims, which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
• Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing
• Knowledge of and the ability to: identify the ICD-10-CM/PCS code assignment, code sequencing, and discharge disposition, in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance
• Must be fluent in application of current Official Coding Guidelines and Coding Clinic citations, in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments
• Solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment
• Writes clear, accurate and concise rationales in support of findings
• Identify aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommend providers to be flagged for review
• Maintain and manages daily case review assignments, with a high emphasis on quality
• Provide clinical support and expertise to the other investigative and analytical areas
• Will be working in a high-volume production environment that is matrix drive

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)
• 3+ years of performing inpatient acute care hospital coding (may substitute equivalent years of DRG validation experience) OR 3+ years of Clinical Documentation Improvement experience (coding OR auditing)
• Unrestricted RN (registered nurse)
• CCS or CIC OR the ability to obtain certification within 6 months of hire
• Experience with ICD – 10 CM and PCS coding
• Ability to use a Windows PC with the ability to utilize multiple applications at the same time
• Ability to do virtual training for approximately 3 months from 8:00am – 5:00pm local time
• Ability to work any 8 hour shift including the flexibility to work occasional overtime per business need

Preferred Qualifications:

• RHIT (registered health information technician), RHIA (registered health information administrator), CDIP (certified documentation improvement practitioner) OR current certified facility in – patient coder
• Experience using Microsoft Excel with the ability to create / edit spreadsheets, use sort / filter function, and perform data entry
• Healthcare claims experience
• Managed care experience
• Investigation and / or auditing experience
• Knowledge of health insurance business, industry terminology, and regulatory guidelines

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Physical and Work Environment:

• Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people’s lives. This is where it’s happening. This is where you’ll help solve the problems that have never been solved. We’re freeing information so it can be used safely and securely wherever it’s needed. We’re creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.^SM

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $26.15 – $46.63. The salary range for Connecticut / Nevada residents is $28.85 – $51.30. 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

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.

Billing/Coding Specialist (CPC)

• Remote, US, United States
• Employees can work remotely
• Full-time
• Department: 250 – Revenue Cycle

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

Title/Position: CODER/BILLER+ Specialist

Department or Business Unit: RCM Reporting Structure: CODER/BILLER+ Program Manager Employment Type: FTE

Exemption Status: EXEMPT

Min. Experience: Mid-Level

Travel Required: Yes ~5%

Overview of the Role:

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

Primary Job Duties:

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

Qualifications

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

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

Technical Requirements (for remote workers):

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

Title: Emergency Department Coder

Location: United States – Remote – USA

Time Type: Full time

University Experienced ED Coder

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

• Code emergency room records for a large university health system. Also able to code SDS & OBSV chart types.
• A minimum of 3 years of recent and relevant hands-on coding experience.
• Requires active CCS, CCA, CCS-P, COC, CPC, CPC-A, RHIT or RHIA credential.
• Ability to consistently maintain 95% or better overall coding accuracy while maintaining client-specific and/or Savista production standards

(Contract) Medical Billing & Collections Specialist

Remote, US 

Operations

Contract

Remote

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

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

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

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

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

(Contract) Medical Billing & Collections Specialist

The (Contract) Medical Billing & Collections Specialist role at pMD is to help our team reach our customers and our business goals through the reconciliation of outstanding accounts. This role primarily focuses on aggressively pursuing payment on accounts receivables from insurance carriers and effectively appealing denials to exceed industry standard benchmarks.

Responsibilities include:

• collect on delinquent accounts and aggressively work the aging receivables for both patient and insurance balances
• resubmit charges for reprocessing, i.e. provide supporting documentation for medical necessity and/or take corrective action for resubmission
• appeal outstanding denials issued by the insurance carrier
• retrieve explanation of benefits from payer portals to reconcile deposits and post both payer and patient payments expeditiously
• proactively communicate denial trends identified to manager for prevention
• ability to manage time effectively

Requirements include:

• associates degree in business, health care administration, accounting, or related field and/or a certified coder
• at least 2 years of experience as a medical biller
• ability to work at least 25 hours per week during ET business hours for a 6 month period with the option to extend
• availability to start immediately
• must be familiar with CPT/ICD-10 and the latest coding guidelines
• EMR experience
• reside in the U.S.

This is a 1099 contractor position. Hourly rate: $30.69 / hour

Candidates must be authorized to work in the U.S. as a precondition of employment.

Registered Dietitian, Diabetes Specialist (Remote)

REMOTE

CLINICAL

About Season

Season is a remote first, hybrid startup (with hubs in Austin, NYC and SF) setting out to rethink nutrition-based healthcare. Our platform allows doctors, registered dietitians and other healthcare experts to prescribe Food as Medicine. This prescription, in the form of a consumer app, allows patients to conveniently choose, procure and enjoy the foods that are right for their clinical nutritional needs and which fit their lifestyle, household preferences and tastes – and finally realize the promised benefits of Food as Medicine.

Season is a series-A stage business backed by Andreessen-Horowitz, LRV Health, 8VC, Bain Capital, Healthy.VC and Grand Central Tech among others. Season recruits, employs, compensates, and promotes regardless of race, religion, color, national origin, gender identity, disability, age, veteran status and other protected status as required by applicable law and as a matter of our company ethics.

About the Role

The Registered Dietitian Nutritionist/Diabetes Specialist will deliver comprehensive and seamless services that bridge the gap and integrate clinical and self-management aspects of diabetes and chronic disease care. In this role, you will provide collaborative, comprehensive and person-centered care and education to support behavior change and improved quality of life across the lifespan. From providing Medical Nutrition Therapy (MNT) to overseeing Season’s innovative diabetes self management education (DSME) programming and content, you will advocate for people affected by diabetes to optimize quality care. You will also be responsible for writing nutrition prescriptions appropriate for a variety of conditions including prediabetes, obesity, cardiovascular disease, kidney disease, cancer and gastrointestinal disorders as well as assisting our team in creating innovative educational content and programming. Must be able to work during normal Mountain Time business hours as well as one evening each week.

What You Will Do

• Complets comprehensive assessments for each patient including emotional and behavioral health, interprets personal health data, develops an inidualized care plan based on the patient’s assessed needs and goals and promotes successful self-management.
• Identify and provide age-specific nutrition counseling to meet the cultural needs of the patients.
• Document all inidual contacts/visits in the electronic health record and outcomes database according to guidelines and in a timely manner.
• Work with external providers to communicate medication adjustment recommendations, when appropriate.
• Provide quality diabetes self-management education and medical nutrition therapy via telehealth in inidual and group settings based on assessed needs. Utilizes appropriate teaching techniques that are sensitive to the learning preferences of the person with diabetes or other chronic medical conditions.
• Collaborate, advocate, and confer other members of the diabetes care team in developing person-centered diabetes plans.
• Advocate for and supports technology-enabled diabetes education and care.
• Actively participate in the quality improvement processes.
• Partner with iniduals to deliver care and education conducive to behavior change and improved quality of life for self-management of diabetes and other chronic conditions across the lifespan.
• Contribute to research and applies current research and evidence-based care to practice.
• Apply self-care behaviors to educate on and initiate behavior change.
• Contribute to the achievement of established clinical goals and objectives and adheres to department policies, procedures, quality standards and safety standards.
• Participate in meetings and serve on cross-functional teams as appropriate.
• Develop, review, update, and implement educational content as needed.

Scope of Practice: Pharmacotherapy

• Medication adjustment recommendations will be a shared responsibility and collaborative approach between Providers and RDNs for diabetes care and self-management.
• Season does not have a provider approved medication protocol.
• Season has not been granted ordering privileges or received a delegated order from a referring physician to initiate, implement, and adjust protocol- or physician-order-driven nutrition related medication orders and pharmacotherapy plans in accordance with an established policy or protocol.
• Providers must be notified if a change in medication is being recommended. It is the responsibility of the Provider to initiate and communicate the change with the patient.

About You

• Maintain RD credentialing with the Commission on Dietetic Registration (must be in good standing and maintained), additional specialty certifications preferred
• Master’s Degree in nutrition or a related field, preferred.
• Valid License based on practice locations (must be in good standing and maintained)
• Certified Diabetes Care and Education Specialist or BC-ADM credential must be in good standing and maintained
• Knowledge of food and current nutrition trends as well as best practices in nutrition care
• Eagerness to learn and discover new ideas, solve problems
• A track record of flexibility in deploying new evidence-based tools, and moving quickly
• A demonstrated ability to think strategically about clinical solutions as well as the hands on skills to solve customer issues
• Passion for working in an early-stage company and building from the ground up
• Comfort with ambiguity
• Excellent written and oral communications skills
• Excellent nutrition science fundamentals
• Ability to inspire and collaborate with colleagues from a wide array of backgrounds
• An overdeveloped sense of ownership
• Has working knowledge of diabetes technology
• Highly organized and strong attention to detail
• Strong problem solving and critical thinking skills
• Must be able to work with a erse patient population and have exceptional customer service skills

What You Get

• To be part of an awesome team that developing innovative ways to positively impact lives
• A full-time role at a competitive wage
• Medical, dental, and vision benefits provided to you and your dependents at no cost
• Option to participate in 401k plan
• Flexible work arrangements, including unlimited PTO
• An opportunity to use your skills to help improve nutrition and population health at a mission-driven company
• A stipend to customize the tools you need to do your best work (get a special monitor, noise canceling headphones, a sick mechanical keyboard, etc)
• Fun coworkers
• A fully remote environment with paid expenses to an in-person meeting about every 8 weeks

Title: Senior Study Manager

About the role

This vacancy has now expired. Please see similar roles below…

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

Accountable for the development of realistic detailed study startup and monitoring plans. Accountable for conducting country level feasibility in collaboration with Global Clinical Trial Execution and CROs, reviewing Pre-trial Assessment outputs , approving sites, and assessing site activation plans. Leads study risk planning process in context of site and subject. Coordinates study/protocol training & investigator meetings. Develops and provides key inputs to Clinical Trial Budget (e.g., Per Subject Costs). Accountable for the delivery of the study against approved plans

leads and manages the tactical execution of one or more clinical studies from study startup through database release.

provides quality oversight to the Contract Research Organisation (CRO) and of the CRO deliverables related to study execution. leads and coordinates the execution of a clinical trial from Study start-up through Database release and inspection readiness to ensure timely delivery of quality study data. Study Managers may also input to and support compilation of sections to Clinical Study Reports will provide leadership to the teams in the setting of realistic recruitment targets and delivery milestones as the single point of accountability for detailed study start-up and monitoring plans and for delivery to the agreed plans. core member of the Study Team and will represent the CRO on matters of study execution. works with functional lines and directly with CRO line functions to resolve or triage site level issues. will drive decision making and work closely with the Clinical Project Manager to provide input to operational strategy.

Responsible for Study Management and oversight of all Study Management functions internally and at the CROs

Operational Study Management for 1 or more studies of moderate complexity generally with responsibility for all study management aspects of assigned studies Accountable for the development of realistic detailed study startup and monitoring plans Accountable for conducting country level feasibility in collaboration with Global Clinical Trial Execution and CROs, reviewing Pre-trial Assessment outputs , approving sites, and assessing site activation plans Leads study risk planning process in context of site and subject Coordinates study/protocol training & investigator meetings Develops and provides key inputs to Clinical Trial Budget (e.g., Per Subject Costs) Accountable for the delivery of the study against approved plans Leads inspection readiness activities related to study management and site readiness May produce or review model Informed Consent Document (ICD) and study/country/site level ICD, as appropriate May expand study design document into approved protocol template while incorporating input from other team members (e.g., Clinician, Clinical Pharmacology Lead, Supply Chain Lead, Statistician, Outcomes Research Representative, Clinical Assay Group, etc.) Study Management Oversight Approves the Study Startup, Study Monitoring & protocol recruitment plans Approves & oversees drug supply management manages flow of drug supply to the sites & set up Interactive Voice Randomisation System with Supply Chain Lead Reviews consolidated Pre-trial assessment reports, feasibility outputs, etc. May support study level submission readiness

Education:

Minimum BS degree

Skills:

Extensive global clinical trial/study management experience

Working knowledge of Good Clinical Practices, monitoring, clinical and regulatory operations

Prior Experience Preferred:

Demonstrated study management / leadership experience

Demonstrated oversight of CROs

Demonstrated experience in managing Per Subject Costs, vendor & ancillary, and monitoring costs

Coding Specialist

Outpatient, Remote, Health Information Management, FT, 08A-4:30P-130870

Baptist Health South Florida is the largest healthcare organization in the region, with 12 hospitals, more than 24,000 employees, 4,000 physicians and 100 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. A not-for-profit organization supported by philanthropy and committed to its faith-based charitable mission of medical excellence, Baptist Health has been recognized by Fortune as one of the 100 Best Companies to Work For in America and by Ethisphere as one of the World’s Most Ethical Companies.

Everything we do at Baptist Health, we do to the best of our ability. That includes supporting our team with extensive training programs, millions of dollars in tuition assistance, comprehensive benefits and more. Working within our award-winning culture means getting the respect and support you need to do your best work ever. Find out why we’re all in for helping you be your best.

Description

• Accurately codes Emergency and Outpatient Diagnostic records for the classification of all diseases, injuries, procedures, and operations using the ICD10CM and CPT4 coding system for BHSF facilities.
• Ensures compliance of coding rules and regulations according to Regulatory Agencies (CMS, OIG).
• Works as a team to meet departmental goals and AR goals.
• Abstracts prescribed data elements from the medical records.
• Estimated pay range for this position is $20.32 – $26.42 / hour depending on experience.

Qualifications

Degrees:

• High School,Cert,GED,Trn, Exper Licenses & Certifications: AHIMA Certified Coding Specialist

Additional Qualifications:

• Required completion of an AHIMA accredited certified coding specialist program and Coding Certificate, preferred Certified Coding Specialist (CCS).
• Required completion of a medical terminology and anatomy and physiology college course within past five years.
• Knowledge of encoder system, outpatient prospective payment system, APCs. Knowledge of National Local Coverage Determinations (NCD and LCD) Policies. Competency in Word and Excel.
• Ability to communicate effectively with coworkers, management staff and physicians.
• Required CCS certification within 2 years of employment, if not CCS certified for all entities except for Boca.
• For Boca they are required to have either CCA, CPC,COC,RHIT or RHIA. Minimum Required Experience:

Job

Corporate

Primary Location

• Remote

Organization

Corporate

Schedule Full-time

EOE

Nursing Education Coordinator (Remote) – Enterprise Nursing Resources

• Rochester, Minnesota
• Full Time
• Benefit Eligible

Overview

At Mayo Clinic, you will become a vital member of a dynamic team at one of the world’s most exceptional health care institutions. Our Nursing Care Model combines Relationship-Based Care with an evidence-based approach. This allows for a stronger connection between patient and caregiver, and a more inidualized, appropriate type of care. You will also discover a culture of teamwork, professionalism and mutual respect, and most importantly a life-changing career.

Job Description

City-Rochester

State-Minnesota

Telecommute-Remote

Department-Nursing

Description:

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

***This is a remote position. The position will support the Enterprise Nurse Staffing Pool program, supporting staffing needs across the Midwest, Rochester, Arizona and Florida practice sites.***

The Nursing Education Coordinator (NEC) must be able to manage many activities and challenges simultaneously with minimal direction. The Nursing Education Coordinator acts as a facilitator and resource person in planning, providing and evaluating the Enterprise Staffing Pool (ESP) program in collaboration with the ESP nursing leadership team, site nursing leadership teams, and staff.

This role requires use of good judgment in facilitating questions, phone calls, meeting scheduling, database management, and other assignments. The Nursing Education Coordinator has oversight of programs and projects and assures appropriate documentation to meet the needs of governing/accrediting agencies. The Nursing Education Coordinator promotes a positive image and maintains positive relationships with internal and external customers.This inidual will be expected to exercise initiative, exhibit organizational skills and use problem solving and decision making skills to perform tasks.

Qualifications

• Bachelor’s degree in communications, healthcare, administration, business or related field.
• Two (2) years’ experience in communications, healthcare, administration or business environment.

Note: Internal Applicants must attach their three (3) most recent performance appraisals to their talent profile.

Additional qualifications

• Demonstrated leadership, professionalism, problem-solving, and self-directive skills.
• Demonstrated ability to work effectively as a member of a team.
• Excellent written and verbal communication skills.
• Demonstrated skills in collaboration and coordination. Able to make independent decisions and meet deadlines.
• Ability to collect, compare, sort, and prioritize information to be used in the decision-making process. Working knowledge of word processing, data base management, and meeting management software.

License or certification

None

Exemption status

Non-exempt

Compensation Detail

$26.90 – $40.36 / hour, based on experience and internal equity

Benefits eligible

Yes

Schedule

Full Time

Hours / Pay period

80

Schedule details

• Remote position
• Shift: Days
• Work Days: Monday through Friday
• Flexible hours.

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.

Hospital Outpatient Coding – Remote

• Full Time
• Finance

Why Mayo Clinic

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

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

Position description

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

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

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

Qualifications

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

Additional qualifications

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

License or certification

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

Exemption status

• Non-exempt

Compensation Detail

• $24.13 – $32.59 / hour

Benefits eligible

• Yes

Schedule

• Full Time

Hours / Pay period

• 80

Schedule details

• Monday – Friday.

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

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

Weekend schedule

• N/A

Remote

• 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.

Recruiter Oo Her

EOE

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

Title: Medical Records Coordinator

Location: US National – Remote

About Kindbody

Kindbody is a leading fertility clinic network and family-building benefits provider for employers offering comprehensive virtual and in-person care. Kindbody’s clinically managed program includes fertility assessments and education, fertility preservation, genetic testing, in vitro fertilization (IVF), donor and surrogacy services, and adoption, as well as physical, mental, and emotional support from preconception through postpartum. Kindbody is the trusted fertility benefits provider for more than 90 employers, covering more than 2.4 million lives. Many thousands more receive their fertility care directly from Kindbody throughout the country at signature clinics, mobile clinics, and partner clinics. As the fertility benefits provider, technology platform, and direct provider of high-quality care, Kindbody delivers a seamless, integrated experience with superior health outcomes at lower cost, making fertility care more affordable and accessible for all. Kindbody has raised $154 million in funding from leading investors including Perceptive Advisors, GV (formerly Google Ventures), RRE Capital, Claritas Health Ventures, Rock Springs Capital, NFP Ventures, and TQ Ventures.

About the Role

As an experienced Medical Records Coordinator reporting to our Medical Records Manager you will be working in a fast-paced, rapidly growing environment where you will be relied on for your expertise, professionalism, and collaboration.

This role is a full time position and the hours are 7:30am-4pm Central Time.

Responsibilities

• Provides efficient and timely release of medical records and efficiently processes incoming medical records
• Compiles, processes, and maintains medical records of patients in a manner consistent with medical, administrative, ethical, legal, and regulatory requirements of the health care system
• Protects the security of medical records to ensure that confidentiality is maintained
• Releases information to persons and agencies according to regulations
• Retrieves medical records and critical information from referring provider(s) prior to patient consults
• Ensures that all necessary laboratory, imaging test results, and medical records are obtained
• Adheres to all standards, policies, and procedures associated with safety, sanitation, confidentiality, and company operations
• And other responsibilities and ad-hoc projects from time to time, based on business needs.

Who You Are

• Patient or customer service experience
• Undergraduate degree from an accredited institute strongly preferred
• Experience in a medical office setting is preferred
• Experience in fertility or women’s health preferred

Perks and Benefits

Kindbody values our employees and wants to do everything to ensure that our employees are happy and professionally fulfilled, but also that they have the opportunity to be healthy. We are committed to providing a number of affordable and valuable health and wellness benefits to our full time employees, such as paid vacation and sick time; paid time off to vote; medical, dental and vision insurance; FSA + HSA options; Company-paid life insurance; Short Term + Long Term Disability options; Paid Parental Leave (up to 12 weeks fully paid dependent on years of service); 401k plans; free Peloton membership, monthly guided meditation and two free cycles of IVF/IUI or egg freezing and free egg storage for as long as you are employed.

Additional benefits, such as paid holidays, commuter transit benefits, job training & development opportunities, social events and wellness programming are also available. We are constantly reevaluating our benefits to ensure they meet the needs of our employees.

In an effort to protect our employees and our patients, Kindbody strongly encourages all employees to be fully vaccinated against Covid-19. However, some states are requiring that all healthcare workers be fully vaccinated. Candidates seeking employment at Kindbody in the following states will be required to be fully vaccinated against COVID-19 and provide proof of your COVID-19 vaccine prior to your start date of employment: California, Colorado, Illinois, New York, New Jersey and Washington. All other states are exempt from this requirement. If you cannot receive the COVID-19 vaccine because of a qualifying legal reason, you may request an exception to this requirement from the Company.

Title: Manager, Medical Coding

Location: US National

Work at Home (ANYWHERE IN THE US)

Description

The Manager, Medical Coding oversees the coding team that is reviewing inpatient records for appropriate coding to include ICD-10, CPT, and HCPCS.

The Manager, Medical Coding works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

The Manager, Medical Coding confirms appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Required Qualifications

• RHIA, RHIT, or CCS Certification
• Verifiable inpatient (MSDRG) coding/auditing experience
• Demonstrated leadership skills
• MS-DRG auditing or APR auditing experience
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Bachelor’s Degree
• Leadership Experience
• Multiple years of technical experience

Additional Information

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

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

Scheduled Weekly Hours

40

Location:  US Locations Only; 100% Remote

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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 Candidates

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

Combine two of the fastest – growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making Healthcare data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.^SM

This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

We’re focused on improving the health of our members, enhancing our operational effectiveness and reinforcing our reputation for high-quality health services. As a Senior Inpatient Facility 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.

What makes your clinical career greater with UnitedHealth Group? You’ll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you’ll open doors for yourself that simply do not exist in any other organization, anywhere.

As a part of our continued growth, we are searching for a new Senior Inpatient Facility Coder to join our team…

The Senior Inpatient Facility 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.  The work schedule is flexible. Typically, Sunday through Thursday or Tuesday through Saturday with set hours as established between manager and coder may require weekend and/or holiday coverage to meet business needs as well as the possibility of mandatory overtime.

Employees are will have the opportunity to choose between Tuesday – Saturday or Sunday – Thursday (1 weekend day is required) – 40 hours/week

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

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)
• 3+ years of Acute Care Inpatient medical coding experience (hospital, facility, etc.)
• Professional coder certification with credentialing from AHIMA and/or AAPC (ROCC, CPC, COC, CPC-P, CCS) to be maintained annually
• Experience 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 (Sunday – Thursday OR Tuesday – Saturday)

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 PC in a Windows environment, including Microsoft Excel (create, edit, save, and send spreadsheets) and EMR systems

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people’s lives. This is where it’s happening. This is where you’ll help solve the problems that have never been solved. We’re freeing information so it can be used safely and securely wherever it’s needed. We’re creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.^SM

Colorado, Connecticut, Nevada or New York City Residents Only: The salary range for Colorado residents is $21.68 – $38.56. The salary range for Connecticut / Nevada / New York City residents is $23.94 – $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

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

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.

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Psychiatric Nurse Practitioner

Remote

Description:

Under direction of the Chief Executive Officer, or supervising psychiatrist, the psychiatric nurse practitioner provides direct psychiatric care to a group of clients. Additionally, the psychiatric nurse practitioner works closely with a multidisciplinary team, providing psychiatric expertise for complex cases, and performs special assignments and related work as required.

Major Areas of Responsibility:

• Provides patient assessment, diagnosis and treatment plans in accordance with statutes, regulations and protocols regulating the profession.
• Collaborates with the multidisciplinary team to ensure best patient outcomes
• Provides psychiatric health services, education, counseling and emotional support to all assigned clients on a regular basis
• Refers patients for higher level of care, in collaboration with the staff psychiatrist and multidisciplinary team, as necessary.
• Issues medication prescriptions in accordance with treatment guidelines.
• Orders laboratory tests, interprets and explains the test results to patients.
• Provides patient education regarding medications, risks, benefits and reasonable outcome expectations.
• Communicates with patients, and parents/legal guardians, and engages in follow-up as necessary.
• May also provide primary medical care services as indicated, in accordance with statutes, regulations and protocols regulating the profession.
• Performs other duties as assigned and agreed upon

Knowledge, Experience and Skills:

To perform this job successfully, an inidual must be able to perform each essential function successfully. 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.

• Up-to-date clinical practice of psychiatry, including the recovery model, strengths based treatment, and dual diagnosis treatment, with client/family involvement.
• Up-to-date in the application and effectiveness of a variety of behavioral health treatment modalities utilized in a comprehensive treatment system.
• Knowledge of the principles and practices of evaluation of effective and evidenced-based mental health treatment programs and services.
• Knowledge of the methods, principles and practices of developing, implementing, coordinating and administering behavioral health services.
• Knowledge of Federal, State, and County laws and regulations applicable to mental health programs, and the relationship of Federal and State programs to local government services and programming.
• Ability to plan, organize, supervise and administer the clinical programs and services provided.
• Ability to establish and maintain collaborative working relationships with community members and organizations.
• Ability to speak and write clearly and concisely.
• Must possess a valid Psychiatric Nurse Practitioner license and be willing to obtain licenses in additional states as needed.
• Must possess a current DEA number

Pay Range: $105k – $120k/Year (Depending on experience and location)

Certified Inpatient Coder – IRF/PPS

locations

Remote – Other

time type

Full time

job requisition id

R011119

Do you code medical records for Inpatient Medical Rehabilitation?

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

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

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

Knowledge and skills:

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

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

Expectations

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

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

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

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

Medical Coding & Risk Adjustment Specialist

New York City or Remote

ABOUT US

Traditional health care is broken. Galileo is here to fix it. We’re a rapidly growing health startup that combines intuitive design and clinical expertise to deliver affordable, quality care for all.

Galileans, as we like to call ourselves, are dedicated to flipping the traditional health care model into a modern solution for todayand beyond. Our empathetic, mission-driven culture puts our patients first, celebrates creative problem solving, and moves quickly to build great products. Our teams work collaboratively, so there’s plenty of day-to-day interaction. We believe in a hybrid, flexible working environment and have team members across the U.S. and the UK.

ABOUT THE ROLE

Galileo is seeking an experienced Risk Adjustment Specialist to work within the Revenue Cycle team to oversee the review, documentation, and coding of medical claims. Your expertise in ICD-10-CM and select CPT code sets will support the providers in documenting visits and ensuring accurate reimbursement for all the services we provide. You’ll be responsible for accurate coding and documentation of care while building relationships with providers to create an efficient claims workflow.

Here’s what you’ll do:

• Code visits using ICD-10 and select CPT guidelines, ensuring all services are captured and the provider documentation supports all billed codes
• Query providers on documentation gaps ensuring documentation is complete and accurate
• Audit patient charts and claims for previously-billed services ensuring documentation is complete and coded accurately to the highest level of specificity following coding guidelines
• Work closely with providers and Director of Coding & Risk Adjustment to educate on coding and documentation best practices
• Report findings of chart audits and clinical documentation improvement (CDI) opportunities to providers to maximize the coding of ongoing risk-adjusted conditions
• Support an ongoing program that minimizes any organization risk of audit
• Remain current on coding guidelines and risk adjustment reimbursement reporting requirements

ABOUT YOU

We would love to hear from you if you have the following or equivalent experience:

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required (no CCA or CPC-A certifications will be considered for this role
• Certified Risk Adjustment Coder (CRC) a plus
• Requires the knowledge typically acquired over four or more years of work experience in risk adjustment
• Working knowledge of medical records and EHR systems
• Working knowledge of STARS and HEDIS measures
• Experienced in medical claims submission and billing process
• Working knowledge of medical terminology and disease processes as needed for chart reviews and documentation
• Strong clinical knowledge related to chronic illness diagnosis, treatment and management
• Strong written and verbal communications skills

COMPENSATION RANGE: $17.30 – $29.00 per hour based upon prior experience, performance, and market dynamics

BENEFITS

• Medical / Dental / Vision insurance
• Flexible Spending Account
• Health Savings Account + match
• Company paid STD/LTD, AD&D, and Life insurance
• Paid Family Leave
• 401K + match
• Paid Time Off

Title: Health Services Registered Nurse

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.

Health Services Registered Nurse (New York license required)

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

Work Location:

• Fully Remote – U.S.

Position:

The Health Services RN position is in a Managed Services organization (does not reside on Client/Practice site). The RN telephonically assists and guides patients toward self-management and behavior modifications that result in improved patient outcomes. The RN is the primary point of contact, coordinating with schedulers, pharmacists, providers of medical and behavioral health care and social services. Success is measured in terms of improved patient outcomes, prevention of patient adverse events and unnecessary inpatient readmissions, satisfied customers, meeting, or exceeding quality measures, producing consistent and high-quality work and collaboration with other care team members. Our ideal candidate is an experienced nurse, able to perform tasks independently and once trained, without significant guidance.

Core Responsibilities:

Provides Nursing support for health service providers via phone in areas including but not necessarily limited to:

• Telephonic nurse triage services
• Provide education to patients, deploying best practices and standard workflow in their daily activities
• Apply their expertise across the various areas of responsibility, understand how their interactions with patients affect customer satisfaction and can make recommendations to improve processes
• Apply established protocols, criteria, and contract guidelines
• Coordination of the team approach to management of patient care
• Analyze, investigate, and resolve inidual care quality, coordination of care, service and access issues
• Contact patients and providers regarding clinical needs for continuity of care.

Requirements:

• 3+ years of relevant work experience, in related clinical, managed healthcare or healthcare setting
• New York RN License required.

Preferred Qualifications:

• Excellent understanding of health-service related processes relevant to assigned role and responsibilities
• Strong analytical and interpersonal skills and ability to interact with senior level clients, and high level of computer literacy
• Very good knowledge of healthcare, government, and insurance industry trends.

Working Conditions/Physical Requirements:

• Office environment – work from home office
• Solid internet connectivity.

Unique Benefits*:

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

Clinical CC I – RN

Work from Home, United States

req11167

We’re looking for colleagues who are ready to Think Big, Go Fast, Deliver Awe, and Win Together. These core values embody our erse and inclusive culture and help us live out our mission of “getting people the care they need when they need it.” Over the last 30 years, our company has established itself as the market leader in managed care for the workers’ compensation industry. We are committed to making a positive impact in the lives of the injured workers we serve, and we have fun doing it.

Salary Range: 19.04 – 28.56 Hourly

Salary may vary based on location, years of experience, qualifications, and skill set.

Benefits Summary:

In return for your commitment to our company’s mission, we offer a vast array of benefits to help support the whole you.

• Opportunities to work from home
• Competitive wages with opportunities to earn annual merit increases
• Paid development hours to use for professional and community development!
• Generous paid time off, 8 company holidays, and 2 floating holidays per year
• $1,000 Colleague Referral Program
• Enterprise Recognition Program rewarding colleagues for their extraordinary work
• Exclusive discounts on travel, activities, and merchandise via work discount program
• Colleague Assistance Program that provides free counseling and financial services
• Tuition Reimbursement Program including certifications
• Quantum Health: A healthcare navigation platform to help our colleagues make the best, most cost-effective healthcare decisions
• Medical, dental, and vision insurance
• Pre-Tax FSA and HSA health savings accounts
• 401(k) matching
• Company paid life insurance
• Company paid short term and long-term disability
• Referral program
• Healthcare concierge
• The One Call Foundation which aims to help colleagues during unexpected emergencies, from car accidents to natural disasters.

JOB SUMMARY:

Provides support to the carrier in coordination of workers’ compensation patients until the case is closed by the carrier and/or discharged by the physician.

Clinical Care Coordinator I

Entry level role. Basic skills with moderate level of proficiency. Generally performs a high volume of basic inquires about One Call Care Management’s products and services by following standard scripts and procedures. Works under close supervision without latitude for independent judgment. Consults with senior peers and team leads on non-complex issues to learn through experience. Typically requires zero to one year of experience in a call center or customer service-related position in a service industry. Zero- 2 years of experience in the workers compensation industry. Associates will handle one service line or more and will become knowledgeable in these areas before moving into a level II role.

GENERAL DUTIES & RESPONSIBILITIES:

· Manages the completion on any portion of process that Care Coordinator was unable to complete, if any.

· Facilitates flow of evaluation(s), orders, and progress notes from provider(s) to Nurse Case Manager or adjuster per One Call Care Management’s nursing department protocol.

· Reviews MD orders, initial assessments/evaluations and progress notes on patient, and communicates with provider and carrier per One Call Care Management’s Nursing department procedure to provide updates and ensure progress of patient.

· Locates provider(s) or contact established provider(s) to arrange additional service for current patient.

· Communicates with Nurse Case Manager/adjuster and/or provider to ensure appropriate physician orders are obtained and followed.

· Contacts Nurse Case Manager or Adjuster to obtain authorization for additional or continued service(s).

· Creates purchase order(s) per One Call Care Management’s nursing department procedure to authorize additional or continuation of service(s) to provider.

· Utilizes appropriate tracking tools, i.e. authorization logs, Outlook Calendar or Task function, to ensure follow-up on critical timelines as outlined in One Call Care Management’s nursing department procedures for obtaining evaluations/notes, tracking authorizations, and contacting carriers.

· Coordinates quality assurance issues or concerns involving patient care, retrieval of evaluations and/or notes, and authorization of services closely with assigned Quality Assurance nurse.

· Maintains thorough, up-to-date documentation on each patient in patient database.

· Closes file per One Call Care Management’s nursing department procedure once Nurse Case Manager or adjuster cease authorization or physician discharges from home care.

· Notifies appropriate One Call Care Management’s department(s) of referrals requiring their expertise.

· Assists in training new associates as requested by Nursing Department Training Leader.

· Performs special projects as assigned and prioritized by management.

EDUCATIONAL REQUIREMENTS:

Registered Nursing degree; (R.N., L.P.N., or M.A.) with a minimum of two (2) years of experience in acute setting, home care, or front and back medical office.

GENERAL KNOWLEDGE, SKILLS & ABILITIES:

· Knowledge of the company’s products, services and business operations to enable resolution of customer inquiries

· Excellent customer service skills that build high levels of customer satisfaction

· Excellent verbal and written communication skills

· Computer navigation and operation skills

· Demonstrates effective people skills and sensitivities when dealing with others

· Ability to work both independently and in a team environment

Remote – Medical Coding Quality Auditor- Hospital Outpatient

• Virtual, United States
• Client Services
• 19859

Overview

Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and erse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies.

Position Summary

Internal Quality Reviewer – Outpatient shall report directly to the Internal Quality Control Director and will be responsible for accessing and reviewing the medical record documentation, coding and abstracting accuracy as defined in quality review policies and facility guidelines utilizing ICD-10 CM/PCS and CPT coding classification systems. Review of patient records will be conducted via facility EMR, scanning technology or other established method. All reviews will be entered daily into Guidehouse proprietary quality review tracking and trending software and will respond to coder rebuttals in a timely manner (timeline defined in quality review policies and procedures). This position will perform any and all related job duties as assigned.

Essential Job Functions

• Strong computer knowledge (well versed in excel and word)
• Excellent verbal and written communication skills
• Meet review productivity and quality standards
• Maintain HIPAA compliant workstations, strong knowledge of protected health information guidelines.
• Advanced Coding Skills, ICD-10-CM/PCS and CPT
• Strong knowledge of official coding guidelines as well as associated government regulations
• Ability to work independently and multi-task

Duties and Responsibilities

• Quality reviewer will be responsible for reviewing the entire patient record documentation for the date of service being audited to validate all code and abstracting data elements.
• Validation of the applicable code elements i.e. DRG, diagnosis, procedure, modifier and/or Evaluation and Management code level assignments are based on the following: supporting patient record documentation, Official Coding Guidelines (ICD-10 CM/PCS and CPT), Coding Clinics, CPT Assistant and any other federal coding guidance or regulation. All codes assigned should be supported by chart documentation and clinical evidence and/or treatment and monitoring.
• Ensure 3-5% coding quality review (or percentage stipulated in client contract) of each coder’s work is conducted monthly for facilities the reviewer is assigned.
• Coding quality review will be conducted to identify abstracting (to include dc disposition and POA indicators), ICD-10-CM, ICD-10-PCS, CPT, modifier, and HCPCS coding errors for codes assigned by the coding team (see quality review policies for review details).
• Reviewer will run coder productivity reports (where applicable) to pull random sample accounts for review and to ensure review numbers or percentages are met
• Review coding and abstracting (as defined by the facility) on patient types assigned to review: inpatient, ambulatory surgery, observation, emergency room with or without E/M levels, clinic, ancillary, diagnostics, etc to assure 95% coder accuracy (or as stipulated by client contract).
• Become familiar with any facility specific coding guidelines and know where to access on the Guidehouse portal.
• Required to read all Coding Clinics and CPT Assistant updates published by the education team and stay abreast of all new coding guidelines.
• Ensure code recommendations entered into GuideAudit are supported by quoting AHA official Coding guidelines, Coding Clinics, CPT Assistant and/or other official coding references. Reviewers shall also document the specific record documentation that supports any code recommendation.
• Notifies each coder when monthly review has been completed and respond to coder rebuttals in timely manner (see quality policy and procedures for required timeline requirements)
• Enter review findings daily into quality software daily OR at a minimum within 24 hours of review (exception is pre bill accounts which MUST be entered same day received and reviewed)
• Conduct coder pre bill reviews as priority and complete the review and corresponding data entry into GuideAudit same day received
• Communicate (via email) coder quality pre bill score to coder, coding managers (onshore and offshore), Coding Director, IQC Director and/or Pro Fee Supervisor and VP Quality
• Communicate in a professional, educational, non-threatening mentorship manner with the coding team in coding quality recommendations and rebuttal discussions.
• Follows review escalation policy when coder/review disagreements occur (see quality review policy/procedures).
• Notify Director and VP of Quality when coders fall below accuracy standard, coding risk areas and error trends are identified for a specific facility and/or coder.
• Assist Coders in answering coding/abstracting questions resulting from quality reviews.
• Will conduct coder intensification reviews for Coders who fall below the stipulated accuracy rate as part of the corrective action plan (per guidance of Review Lead or IQC Director)
• Maintain working knowledge of ICD-10-CM/PCS and CPT coding principles, government regulations, official coding guidelines, and third party requirements regarding documentation and billing.
• Ability to maintain review productivity standards as follows:
  • Inpatients 1.5 – 2 charts per/hour
  • Outpatient surgery – 3 charts per/hour
  • Emergency room/clinics – 11 charts per/hour
  • Emergency room with Evaluation & Management leveling – 7-8 charts per/hour
  • Ancillary/diagnostic – 15 charts per/hr.

** This excludes outliers (i.e. long length of stay, voluminous or very complex records etc) which will be captured on activity review summary

• Complete review activity summary daily (productivity summary) for each facility and submit to IQC Director, Professional Fee Supervisor and VP of Quality on a weekly basis (utilized in calculation of quality review FTEs and productivity).
• Assist as needed in the review of external coding audit company findings and assist in in formulating a response as requested
• Participate in client conference calls and mandatory monthly quality team stand-up calls. Responsible to review the minutes of monthly quality stand up calls if not able to dial into the conference call (minutes are posted on the portal).
• Provide company support for the creation, maintenance and ongoing operation of an efficient and accurate Quality Improvement Plan that is compliant with Local, State, and Federal Government Regulations.
• Work with the Coding Solutions Division to provide on-going coding education resulting from the Quality Reviews when requested
• Maintain open lines of communication serving as a liaison between client, Coders, and Coding Solutions Division to ensure that all parties are kept up to date on specific hospital guidelines/policies.
• Participate in company Coding Solutions Division Meetings as requested.
• Reviewer must be able to work independently while maintaining productivity standards.
• Advanced computer skills are required to handle connection issues, downloads and to review specific programs.
• Reviewer downtime due to connectivity issues (client system, GuideAudit or other) must be reported immediately to the IQC Director and/or Pro Fee Supervisor immediately to ensure appropriate actions taken to resolve to ensure minimal downtime and interruption to work flow/productivity.
• Facility access/connectivity problems should be reported to onshore Guidehouse Coding Manager for the facility, IQC Director and/or Pro Fee Supervisor to provide direction about next steps to resolve the issue as soon as possible.
• Reviewers are responsible for checking and responding to Guidehouse email system at the beginning of their shift, at least every two hours during working hours AND at the end of their shift. These same requirements apply to the client secure email system.
• Reviewers are responsible for maintaining HIPAA compliant workstations (reference HIPAA work station policy).
• Reviewers are responsible for maintaining patient privacy at all times (reference company handbook policy).
• Reviewers are responsible for signing a confidentiality statement.
• It is the responsibility of each reviewer to review and adhere to the coding ision coding policy and procedures on the Guidehouse portal.
• Works well with other members of the facility coding and billing team to insure maximum efficiency and accurate reimbursement for documented services.
• Communication in emails should be professional and collaborative at all times (reference e-mail p

Qualifications

Education /Qualifications /Experience

• Must hold one of the following credentials: (RHIT, RHIA, CCS, CPC, CIC or COC).
• Must maintain coding credential while employed by Guidehouse.
• Must pass Guidehouse coding competency exam.
• Must have three years of coding or review experience for the type of work being assigned.
• Abide by all client policies and procedures.
• Abide by all Guidehouse policies and procedures.
• Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and excellence in customer service.

Experience in the following areas:

• Outpatient Facility Coding
• Facility ED and E&M leveling
• Injection and Infusion

Additional Requirements

• The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.

  The salary range for this role is $38.00 – $40.00 , may vary based on experience and location.

Disclaimer

About Guidehouse

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

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

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

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

Rewards and Benefits

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 and Adoption Assistance
• 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

Registered Nurse Consultant (Hybrid/Remote Opportunity)

REMOTE

Alpharetta, Georgia, United States

Clinical Operations, Registered Nurses

Full time

Description

We are hiring NATIONWIDE (this posting shows the location as Atlanta but there are opportunities in various markets available)

The role is considered hybrid/remote. There will be opportunity to work remotely from home, based on the market you reside in, expectations to go onsite to practices locally will be determined by market. The distance to commute to a providers office could be up to 60 miles.

Are you an RN looking for a career opportunity in healthcare technology? Vatica Health is seeking clinically experienced and detailed-oriented nurses to join our team. As a Nurse Consultant, you will collect, review and analyze patient data to improve care coordination, quality metrics, and medical cost savings.

The ideal candidate has a track record of critical thinking strong attention to detail, expertise in navigating various electronic medical record (EMR) systems and building strong work relationships with providers and office staff. And of course, a GREAT PERSONALITY!

At this time Vatica Health does not require the COVID-19 vaccination. Please note this could change based on State and/or Federal guidelines or should you manage a practice that requires staff to be vaccinated.

Responsibilities

• Create detailed and comprehensive patient medical records. Research and gather information from multiple sources and consolidate into one comprehensive and detailed view. Use clinical judgement and data to reconcile conflicting information from various sources.
• Build strong relationships with providers and staff; ability to embed yourself in multiple practices and be a contributing and valuable member of each team
• Become an expert in our technology, train and support providers and practice staff on process.
• Follow-up: ability to persuade and persist with providers to meet deadlines.
• Share best practices and clinical knowledge with your fellow Clinical Consultants

Requirements

• Minimum of 3 years of recent clinical experience as a Registered Nurse (RN)- preferably in an acute care setting, critical care and/or ED
• Proficient with Diagnosis, Billing, and Quality Measures Coding a plus a plus
• Excellent interpersonal skills that include the ability to effectively communicate with physicians, advanced practice providers and medical office personnel such as Practice and Billing Manager, both verbally and written
• Understanding of health insurance benefit structure; especially Medicare and Medicaid
• Must be technically savvy; this is critical to the role. Understanding and interest in software and technology a must
• Solid clinical skills
• Flexible, energetic self-starter with the ability to work in a non-structured environment
• Willingness to travel/commute to various locations for training and support; willingness/ability to work from home
• Strong ability to organize, prioritize, make decisions and work independently
• Must possess and have proven problem resolution skills
• Excellent organizational skills with the ability to multi-task
• Corporate acumen

Benefits

VATICA HEALTH ADVANTAGES

• Every single person at Vatica Health is working to fight the good fight every single day. What we do matters, a lot. If you are looking for a job that has real meaning and you’d like to work with people who care deeply about what they do, we’ve got that.
• We work hard (see point above), but we don’t forget to have fun. I want a job that is dull, said no one ever.
• We believe in fostering a culture of servant leadership command and control is so 1990s. We look for brilliant people that are great at what they do because they love what they are doing.
• We know that teams are exponentially more successful than the sum of their iniduals. Our teams value what each member brings to the table and also values continuous improvement of each team member as well as the whole team.
• We love learning. And we love working with people who love learning. Our industry changes every single day; stagnation is not an option.
• And of course, we offer the usual goodies Medical / dental insurance, PTO, 401k match, and the like.

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 match 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

• 4 weeks of PTO (Everyone deserves a vacation now and then)
• M-F work week (No working weekends, overnights, on call shifts, or holidays) We believe family comes first!
• Reimbursement for RN license and Continuing Education Credits
• 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!

Billing Representative – REMOTE

Munson Medical Group United States Central Billing Office On-Call Day shift

Requisition #: 53519

Total hours worked per week: flex

Description

ENTRY REQUIREMENTS

Education

• High school diploma or GED required.
• Associates Degree in Business or Healthcare field or two years medical office experience preferred.

• Medical Terminology required or successful completion of medical terminology course within 180 days of hire.

Experience

• Two years of related work experience in customer service, healthcare or business field required.

Computer Skills

• Intermediate computer skills required including Microsoft Office experience. Must have knowledge and ability to learn, access and utilize the relevant computer programs listed below within 180 days of hire.
  • Microsoft Office
  • Star Navigator
  • Claims Administrator
  • PowerChart
  • OTG Application Extender
  • TRAC system modules
  • PC Print
  • Medicare team members will be required to navigate DDE/FISS.
  • Commercial team members will need to navigate the websites for Priority Health, Cofinity, Tricare, Federal Work Comp, and United Healthcare.
  • Blue Cross team members will need to be able to access Web-Denis and FCC.
  • Medicaid team members will be required to navigate the Michigan Medicaid online CHAMPS system

Other Entry Requirements

• Above average oral and written communication skills needed. Must be warm, friendly and sensitive to the feelings and concerns of others.
• The ability to succeed in a minimally supervised work situation and utilize proven decision-making skills.
• Intermediate math skills are required.
• Knowledge of third-party payer reimbursement required.
• Applicant must be able to meet productivity standards within 180 days of hire.

ORGANIZATION

Under the general supervision of the Business Office Manager and Patient Financial Services leadership team.

Applicants will have daily contact and interaction with other departments within Munson Medical Center and other internal/external customers.

AGE OF PATIENTS SERVED

X No direct clinical contact with patients

SPECIFIC DUTIES

1. Supports the Mission, Vision and Values of Munson Healthcare
2. Embraces and supports the Performance Improvement philosophy of Munson Healthcare.
3. Promotes personal and patient safety.
4. Has basic understanding of Relationship-Based Care (RBC) principles, meets expectations outlined in Commitment To My Co-workers, and supports RBC unit action plans.
5. Uses effective customer service/interpersonal skills at all times.
6. Exercises a high degree of control over confidential medical information.
7. Able to establish priorities and meet deadlines with strong problem solving ability.
8. Keeps current with changing billing requirements, and shares pertinent information with billing team members.
9. Follows the daily priority matrix consistently on all assigned tasks.
10. Completes transmission process on electronic billing system for all current claims. Prepares and mails required hard copy claims to insurance companies, patients and/or other responsible parties.
11. Unpaid claims followed up on every 30 days after the initial 45/60 day-processing period.
12. Review and document procedures as appropriate.
13. Review rejections to ensure compliance with third party payers and take concerns to management.
14. Produce credit reports quarterly as required by Medicare. Report all credit balances to the appropriate insurance payer and process according to the payer’s requirements within 30 days.
15. Demonstrates understanding of Hospital reimbursement contracts. Determines if the payment received is in accordance with the third party payors required reimbursement.
16. Processes coordination of benefits claims, complying with no-fault rules and regulations and all third party payers’ guidelines, in a timely manner.
17. Analyzes and initiates corrective action for patient claims. This analysis includes: auditing charges, 72/24 hour requirements, payments and contractual agreements. Must be able to resolve payment questions with insurance companies.
18. Verifies insurance benefits on problem accounts and assists patients resolve MSP/COB issues.
19. Reviews records in Power Chart to confirm services as separate and distinct when multiple charges have been added to an account.
20. Apply a working knowledge of 3M CCI edits.
21. Uses Power Chart to collect and print records to send with all hard copy Auto Accident and Workers’ Comp claims.
22. May provide billing services for multiple facilities.
23. Reports to financial class billing coordinator and should support team structure with emphasis on commitment to my co-worker.
24. Performs other duties and responsibilities as assigned.

Location:  US Locations, must live in Mountain Time; 100% Remote

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

This Position is in MST and the Work Hours are from: 8 am to 5 pm MST ( You must live in the MT time zone)

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.(sm)

The Home Health Care Coordinator (HHCC) is responsible for the management of authorization requests for home health services in accordance with CMS and nationally recognized standards. As a member of the Home Health team, the HHCC reviews clinical documentation from home health providers and evaluates the medical necessity of requests for services by utilizing InterQual or internally developed clinical criteria. As necessary, the HHCC collaborates with naviHealth Medical Directors and/or health plan care management staff to determine the most appropriate course of action for a member based on clinical factors.

You will enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Document requests for authorization for home health into naviHealth’s clinical documentation system
• Review OASIS documentation and clinical notes from providers and utilize InterQual criteria to determine medical necessity and appropriate authorization for home health services
• Understand and apply CMS Chapter 7 guidelines for home health
• Follow up with providers as necessary for clarification of clinical documentation of patients’ status
• Collaborate with intake team, home health team, appeals/denials teams, and Medical Directors to ensure efficient processing of home health authorization requests in accordance with mandated turnaround times and quality metrics
• Notify the health care provider of denials reviewed by the Medical Director • Participate in the regular review of departmental reports on key quality metrics and identify opportunities for systemic improvement
• Maintain active clinical licensure in state of residence and knowledge of nationally recognized utilization management, CMS home health regulations, NCQA and URAC standards of practice
• Attend naviHealth meetings as requested
• Adhere to organizational, departmental, and regulatory policies and procedures
• Promote a positive attitude and work environment
• Complete cross-training and maintain knowledge of multiple contracts/clients to support coverage needs across the business.
• Perform other duties and responsibilities as required, assigned, or requested

What are the reasons to consider working for UnitedHealth Group?   Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at: http://uhg.hr/uhgbenefits

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:

• Active, unrestricted registered clinical license in state of residence – Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist
• 1+ years of experience in geriatric care management in a home health setting
• Intermediate proficiency with Microsoft Office applications including Outlook, Word, Excel and PowerPoint

Preferred Qualifications:

• 2+ years of recent experience in utilization management role
• 2+ years of experience in an acute care setting
• 2+ years of Wound care experience
• Knowledgeable of ICD-10 coding
• Knowledgeable with NCQA and URAC standards
• Proficient in medical terminology

Soft Skills:

• Proven documentation skills
• Proven ability to use various office equipment, such as e-fax and telephone system
• Independent problem identification/resolution and decision-making skills
• Proven excellent written skills and oral communication skills to complete the role telephonically
• Demonstrated ability to be detail oriented and able to prioritize, plan, and handle multiple tasks/demands simultaneously

Work Conditions and Physical Requirements:

• Ability to establish a home office workspace
• Ability to manipulate laptop computer (or similar hardware) between office and site settings
• Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard period of time
• Ability to communicate with clients and team members including use of cellular phone or comparable communication device
• Ability to remain stationary for extended time periods (1 – 2 hours)

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. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So, when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)

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

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $31.78 to $56.88. The salary range for Connecticut / Nevada residents is $35.00 to $62.45. 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  

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 Pacific Time Zone; 100% Remote

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

This Position is in PST and the Work Hours are from: 8 am to 5 pm PST ( You must live in the PT time zone)

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.(sm) 

The Home Health Care Coordinator (HHCC) is responsible for the management of authorization requests for home health services in accordance with CMS and nationally recognized standards. As a member of the Home Health team, the HHCC reviews clinical documentation from home health providers and evaluates the medical necessity of requests for services by utilizing InterQual or internally developed clinical criteria. As necessary, the HHCC collaborates with naviHealth Medical Directors and/or health plan care management staff to determine the most appropriate course of action for a member based on clinical factors.

You will enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Document requests for authorization for home health into naviHealth’s clinical documentation system
• Review OASIS documentation and clinical notes from providers and utilize InterQual criteria to determine medical necessity and appropriate authorization for home health services
• Understand and apply CMS Chapter 7 guidelines for home health
• Follow up with providers as necessary for clarification of clinical documentation of patients’ status
• Collaborate with intake team, home health team, appeals/denials teams, and Medical Directors to ensure efficient processing of home health authorization requests in accordance with mandated turnaround times and quality metrics
• Notify the health care provider of denials reviewed by the Medical Director • Participate in the regular review of departmental reports on key quality metrics and identify opportunities for systemic improvement
• Maintain active clinical licensure in state of residence and knowledge of nationally recognized utilization management, CMS home health regulations, NCQA and URAC standards of practice
• Attend naviHealth meetings as requested
• Adhere to organizational, departmental, and regulatory policies and procedures
• Promote a positive attitude and work environment
• Complete cross-training and maintain knowledge of multiple contracts/clients to support coverage needs across the business.
• Perform other duties and responsibilities as required, assigned, or requested

What are the reasons to consider working for UnitedHealth Group?   Put it all together – competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at: http://uhg.hr/uhgbenefits

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:

• Active, unrestricted registered clinical license in state of residence – Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist
• 1+ years of experience in geriatric care management in a home health setting
• Intermediate proficiency with Microsoft Office applications including Outlook, Word, Excel and PowerPoint

Preferred Qualifications:

• 2+ years of recent experience in utilization management role
• 2+ years of experience in an acute care setting
• 2+ years of Wound care experience
• Knowledgeable of ICD-10 coding
• Knowledgeable with NCQA and URAC standards
• Proficient in medical terminology

Soft Skills:

• Proven documentation skills
• Proven ability to use various office equipment, such as e-fax and telephone system
• Independent problem identification/resolution and decision-making skills
• Proven excellent written skills and oral communication skills to complete the role telephonically
• Demonstrated ability to be detail oriented and able to prioritize, plan, and handle multiple tasks/demands simultaneously

Work Conditions and Physical Requirements:

• Ability to establish a home office workspace
• Ability to manipulate laptop computer (or similar hardware) between office and site settings
• Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard period of time
• Ability to communicate with clients and team members including use of cellular phone or comparable communication device
• Ability to remain stationary for extended time periods (1 – 2 hours)

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. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So, when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)

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

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $31.78 to $56.88. The salary range for Connecticut / Nevada residents is $35.00 to $62.45. 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 

 

 

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.

REGISTERED NURSE: INPATIENT REVIEW (CALIFORNIA LICENSED – REMOTE)

Molina Healthcare

United States

Job ID 2017217

JOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSE

For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. CALIFORNIA LICENSURE IS REQUIRED FOR THIS ROLE IMMEDIATELY UPON HIRE. CALIFORNIA IS NOT A COMPACT STATE AT THIS TIME. Excellent computer multi tasking skills and analytical thought process is important to be successful in this role. Productivity is important with turnaround times. Further details to be discussed during our interview process.

This department operates 365 days a year and we need staff who can be flexible and willing to work some weekends and holidays. This is a remote position and you may work from home. Please consider that scheduling flexibility is important before you apply to this role.

Further details to be discussed during our interview process.

JOB DESCRIPTION

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

• Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
• Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.
• Processes requests within required timelines.
• Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.
• Requests additional information from members or providers in consistent and efficient manner.
• Makes appropriate referrals to other clinical programs.
• Collaborates with multidisciplinary teams to promote Molina Care Model.
• Adheres to UM policies and procedures.
• Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the inidual State Plan.

JOB QUALIFICATIONS

Required Education

• Graduate from an Accredited School of Nursing.
• Required Experience
• 3+ years hospital acute care/medical experience.
• Required License, Certification, Association
• Active, unrestricted State Registered Nursing (RN) license in good standing.
• Must have valid driver’s license with good driving record and be able to drive within applicable state or locality with reliable transportation.

State Specific Requirements:

CALIFORNIA LICENSURE IS REQUIRED

Preferred Education

Bachelor’s Degree in Nursing Preferred Experience Recent hospital experience in ICU, Medical, or ER unit. Preferred License, Certification, Association Active, unrestricted Utilization Management Certification (CPHM).

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $26.41 – $51.49 an hour*

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time

Title: Reimbursement Coordinator – Infusion

WellSky Reimbursement Services is a Home Infusion Reimbursement business. We are a part of the WellSky family. Looking for a career that will stimulate your analytical thinking? The iniduals who excel in this role are highly ambitious, results driven, and willing to “think outside the box”. This position requires a high level of professional customer service, attention to detail, and the ability to work well as part of a fast paced team. The ideal candidate for this position has a high level of multitasking abilities and is driven by moving metrics to achieve success!

The Reimbursement Coordinator generates and collects Home Infusion and Durable Medical Equipment (DME) claims for submissions to patients and/or third-party payers. These claims result from products and services delivered to or administered to patients on behalf of our clients. Perform collection follow up on primary and secondary claims as well as patient balances as assigned using the techniques outlined in the Guidelines for Success’ document.

A day in the life!

You will be responsible for the following:

• Obtain billing information from Clients and generate daily claims.
• Perform Q.A. of charges received from Clients and make modifications/changes as required to produce a clean claim
• Review contract/details of new payers before billing. Work with supervisor/manager on changes needed in the billing system (e.g., CPR+, CareTend)
• Track pending claims.
• Submit claims to insurance companies in a timely fashion and within the inidual insurance company’s timely filing period.
• Prepare and/or print all secondary claims that do not automatically cross over from Medicare or other primary payer
• Follow up on patient balances within established timeframes.
• Obtain claim’s status by calling the payer and/or using an online payer portal.
• Utilize reports to determine tasks that require follow up.
• Take appropriate action for escalating claims not paid within 60 days or for denied appeals.
• Prepare write-off request when bad debt is identified. Document description of the reason for the write-off.
• Research claim payments, partial payments, over payments.
• Prioritize claims to identify Top Ten high balance accounts. Keep accounts current until complete. Prepare report of Top Ten accounts monthly for supervisor/manager review.
• Prepare status report with supporting documentation of all claims over 90/120 days.

Do you have what it takes?

• Healthcare insurance claims processing knowledge
• HC billing knowledge
• HC collections knowledge
• working knowledge of word and excel

Required Experience:

• High school diploma or GED.
• Two years of billing and/or collections or insurance claims processing

Do you stand above the rest?

Preferred Experience:

• Home infusion and durable medical equipment billing and collection experience preferred, IV field experience, medical billing certification, some college education

Adolescent Mental Health Specialist

GRS is a rapidly growing adolescent health organization that leverages the power of soccer to educate, inspire, and mobilize at-risk youth in developing countries to overcome their greatest health challenges, live healthier, more productive lives, and be agents for change in their communities. Since 2002, GRS programs have reached 13 million young people in over 60 countries with life-saving HIV prevention and sexual and reproductive health information and services. GRS is looking to continue scaling its impact via technical assistance and partnerships over the next five years.

In January 2022, GRS launched a multi-year strategy to guide organizational growth in adolescent mental health and elevate it as an organizational priority alongside existing focus issues such as HIV and sexual and reproductive health. Since this launch, GRS has already started mental health programming in Kenya, Mozambique, South Africa, and Zambia. To achieve our goal of improving adolescent mental health and well-being, GRS is pursuing a set of four strategic priorities: INTEGRATE mainstream positive mental health content in all GRS SKILLZ programs; INNOVATE develop innovative mental health promotion and prevention programs; ADVOCATE reduce stigma and create environments that support adolescent mental health; and EVALUATE identify a clear and compelling research and learning agenda for adolescent mental health.

Role Overview

The Adolescent Mental Health Specialist is a dynamic and passionate public health professional who will help coordinate and grow Grassroot Soccer’s (GRS) new adolescent mental health practice area. As member of the GRS Global Research & Development Team, the Specialist will provide cross-functional support to GRS impact teams and functional units with a range of adolescent mental health activities, including program design, curriculum development, training, research, monitoring and evaluation, business development, and strategic communications/marketing. While remote, the position is expected to travel 25-30% within Sub-Saharan Africa to provide technical assistance to GRS country teams and programs.

Responsibilities

• Work closely with assigned teams to ensure high-quality implementation of mental health activities, guided by the organization’s approach and mental health strategy.
• Work closely with curriculum and training teams to produce adolescent mental health information, education, and communication (IEC) materials such as educational curricula and magazines.
• Travel to country programs to lead mental health trainings and project support visits.
• Please see full job description for additional responsibilities.

Specifications & Competencies

• 3-5 years of project management and/or coordination experience, involving both project management and people
• Bachelor’s degree with experience in and/or deep understanding of public health, mental health, and education
• Experience with adolescent/youth programming strongly preferred
• Please see full job description for additional information and to apply.

Location

Full-time Remote Position

Job Type

Full Time

Instructor / Clinical Instructor – Family Nurse Practitioner

locations

Home Office

time type

Full time

job requisition id

JR-012608

If you’re passionate about building a better future for iniduals, communities, and our country and you’re committed to working hard to play your part in building that future consider WGU as the next step in your career.

Driven by a mission to expand access to higher education through online, competency-based degree programs, WGU is also committed to being a great place to work for a erse workforce of student-focused professionals. The university has pioneered a new way to learn in the 21st century, one that has received praise from academic, industry, government, and media leaders. Whatever your role, working for WGU gives you a part to play in helping students graduate, creating a better tomorrow for themselves and their families.

Essential Functions and Responsibilities:

• Acts as a steward for carrying out WGU’s mission and strategic vision by demonstrating effective and consistent commitment to learner-centered, competency-based educational support.
• Provides expertise in assigned content area and maintains current knowledge in their field.
• Fosters student learning through innovative, effective teaching practices.
• Responds with urgency to meet student needs and communicates professionally and respectfully with students and all other members of the WGU community.
• Offers timely support and outreach to students.
• Uses technology-based teaching and communication platforms to aid students in the development of competencies.
• Collaborates with other professionals within the university to promote a positive, student-obsessed atmosphere.
• Participates in all required training activities.
• Responds with urgency to changing requirements, priorities, and short deadlines.
• Consistently exhibits WGU Leadership Principles.
• Other duties and responsibilities may be assigned as the position evolves.

Knowledge, Skill and Abilities:

• Demonstrated ability to customize instructional support for learners with a variety of needs and educational backgrounds.
• Must demonstrate technological competency: Proficiency in Microsoft Office (or similar) applications, virtual instructional platforms, and student management systems.
• Extraordinary customer service orientation.
• Strong verbal and written communication skills, with ability to present information clearly, concisely, and accurately; friendly, persuasive speaking and writing style.
• Well organized – conscientious and detail oriented.
• Ability to use data to make decisions.
• Strong understanding, acceptance, adherence, and promotion of the tenets of competency-based education in the WGU model.

Competencies:

Organizational or Student Impact:

• Accountable for decisions that impact inidual students.
• Creates or facilitates learning experiences that support students attainment of knowledge and skills.
• With specific guidance from senior faculty and program leaders, acts independently in executing teaching practice.

Problem Solving & Decision Making:

• Works on erse matters of limited complexity
• This position receives general direction from their immediate supervisor or manager.
• Able to effectively utilize resources to address student concerns and inquiries.
• Supports student needs to help them achieve course or program outcomes at the inidual student level.
• Inidual follows university and department established policies and best practices.

Communication & Influence:

• Communicates with students as appropriate to support student questions and needs.
• This role communicates with fellow faculty members as appropriate within and outside of the department.
• Expected to provide feedback regarding discipline and practice leadership.

Leadership & Talent Management

• Considered a contributing and collegial team member.
• Inidual adheres to learning and operational quality guidance and instructions.
• Supports initiatives within the area of specialty.
• Displays a positive attitude toward change and supports change management practices.

Minimum Qualifications:

• Master of Science in Nursing. Education must be from an accredited institution. Education is verified.
• Current FNP certification
• Active, unencumbered license to practice as a Registered Nurse
• Minimum of 2 years FNP experience / Currently working FNP
• Minimum of 2 years providing student support and instruction.

Preferred Qualifications:

• Doctorate, or terminal degree in a specific content area. Education must be from an accredited institution. Education is verified.
• Experience with distance education and distance learning students is preferred.

#LI-Remote

#LI-TT1

As an equal opportunity employer, WGU recognizes that our strength lies in our people. We are committed to ersity.

Billing Coordinator (Remote)

US – Remote (Any Location)

Full time

job requisition id R134800

In a world of possibilities, pursue one with endless opportunities. Imagine Next!

When it comes to what you want in your career, if you can imagine it, you can do it at Parsons. Imagine a career working with intelligent, erse people sharing a common quest. Imagine a workplace where you can be yourself. Where you can thrive. Where you can find your next, right now. We’ve got what you’re looking for.

Job Description:

Billing Coordinator (Remote)

Ready to put your basic billing skills to work with departments and teams that change the fabric of our community? Would you enjoy assisting top level Accounting managers helping to keep projects running on task? Parsons is now hiring an Billing Coordinator for our rapidly expanding team.

Parsons extensive experience combined with your attention to detail and skill with account analysis, account reconciliations, and financial reports, will propel your career forward. At this level, the Coordinator analyzes accounts, computes standard ratios, and prepares standard financial statements. In this role, you will produce invoices for moderately difficult client contracts. Collaborates with project staff regarding client invoice requirements on new contracts. Organizes, manages, and streamlines the client invoicing process for assigned contacts.

What you will be doing:

• Prepares, distributes, revises, coordinates approval process, and finalizes invoices for all contract types.
• Ensures monthly invoices are submitted to client by a preestablished due date.
• Works with project staff to ensure that bills go forward as quickly as possible, following up on needed approvals to finalize bills.
• Establishes Excel based invoices in client prescribed formats. These invoices often require the development and maintenance of automated spreadsheets to prompt the user for required information.
• Also establishes procedures, routines, and related documentation regarding billing and contract maintenance.
• Troubleshoots billing errors, reconciling differences between billed and cost amounts.
• Performs other responsibilities associated with this position as may be appropriate

What we need from you:

• Associate’s or equivalent degree in Business Administration (or equivalent)
• 2+ years related experience is required
• Strong written and oral communication, organizational, and interpersonal skills are required, as well as a working knowledge of contract provisions regarding client invoicing and payment processes.
• Must possess extensive knowledge of all aspects of client invoicing requirements. Must demonstrate strong math skills and understanding of the budget and client invoicing process, as well as a demonstrated proficiency in using MS Excel.
• Able to work West Coast (PST) hours
• US Person

Urgent Care Nurse Practitioner Remote (PT) Evenings/Weekends

REMOTE

CLINICAL STRATEGY AND SERVICES – CLINICAL TEAM

PART-TIME

The Nurse Practitioner will be responsible for caring for patients, maintaining accurate and current patient records, and working collaboratively with our provider and support teams. Best-in-class EMR platform: User-friendly, web-based EMR platform highly rated by our clinician staff. Start a conversation with us and learn how you can positively impact the lives of patients and play a role in improving healthcare.

Duties/Responsibilities:

• Function independently to perform age-appropriate history and physical examinations
• Order and interpret diagnostic tests as needed
• Determine, plan, and initiate appropriate treatment, and adjust treatment if necessary
• Prescribe medications
• Document medical information of patients and review patient history at each visit
• Evaluate response to treatments and medications
• Request consultation or referral with other health care providers when appropriate
• Counsel and educate patients
• Provide preventative care
• Manage pediatric and adult patients for both acute and chronic conditions
• Create patient care plans and contribute to existing care plans
• Actively maintain knowledge of current medical research and trends
• Provide administrative support or cross-coverage for reviewing laboratory test results and prescription clarifications
• Scheduling flexibility to include evenings and weekends

Required Skills/Abilities:

• Ability to function within an integrated medical practice
• Strong written and interpersonal skills
• Ability to obtain both RN and NP licensure in additional states
• Outstanding clinical expertise
• Comfortable with technology

Education and Experience:

• Licensed Nurse Practitioner who also maintains an active RN license
• 3+ years of clinical experience in a family practice setting
• Graduate of an accredited school of nursing
• Graduate of Master’s Degree level accredited Family Nurse Practitioner Program
• Current Advanced Practice Registered Nurse (APRN) Licensure

Shift Obligations:

• Averages 20 hours/week or 40 hours per pay period. This would include two eight hour shifts every other weekend of rotating one weekend on and one weekend off, and the remaining hours to be worked throughout the week.
• The shifts will be evening shifts in the hours of 4pm and forward.

About Included Health

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

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

Nurse Practitioner

USA-REMOTE

MEDICAL

FULL TIME

Quit Genius is the #1 digital clinic for substance addictions. We are on a mission to help 100 million people overcome tobacco, alcohol and opioid addictions by combining technology, healthcare and design. It’s an ambitious mission, but one we fully believe in and we hire people who share our aspirations and core values.

We are a global team of doctors, designers, engineers and researchers who are aligned by one common goal. Authenticity, creativity, purpose and thoughtfulness are at the heart of everything we do to deliver that goal, so finding exceptional people to come on the journey is everything to us. Quit Genius has scaled to dozens of health plans and employers, covering over 2 million lives and has already helped more than 750,000 members conquer their addictions. As of 2021, we have raised $78M from leading global investors and now work with 100+ world-class team members across our New York, London, and remote offices.

If you are passionate about making an impact on the health of others, join us and make it happen!

We are looking for a Nurse Practitioner to help us treat patients suffering from addictions. The NP will help care for Quit Genius members utilizing Quit Genius’ telemedicine services. The NP will care for the member directly through scheduled video/audio visits. The NP will also triage and asses whether a member is appropriate for treatment amongst many other responsibilities.

Additional Details About the Role:

• Facilitate live and interactive clinical assessments, treatments, and medication management via telehealth
• Make appropriate assessments, treatment plans, and referrals for patient problems
• Collaborate with clinical staff
• Provide patient education and referrals specific to patient’s assessed needs and abilities
• Assist with developing and implementing, as necessary, care and treatment protocols, standards, policies, and procedures
• Utilize good communication skills, verbal and written
• Maintain accurate records on patients treated
• Participate in case reviews, consultations, and utilization review

To Succeed in This Role You Will Need:

• License to practice with a DEA license in 2 or more states.
• Hold a DATA 2000 Waiver with the ability to treat up to 275 patients.
• Ability and willingness to be licensed in multiple states
• Hold state controlled substance license or in the process of obtaining it
• Registered with the Drug Enforcement Administration (DEA)

Benefits

• Full Malpractice coverage.
• Full Tail Coverage.
• Remote working
• Reimbursement for licensure renewal
• Regular training, education and clinical supervision
• Unlimited vacation policy
• Company-wide yoga sessions
• Calm subscription
• Accelerated career growth opportunities to match the fast-paced growth of the business.
• Join a talented, passionate and ambitious team of doctors, designers and technologists with a fun-loving culture.

Our teams at Quit Genius are made up of an incredible range of talented people from all walks of life. We believe that ersity of any description leads to innovation, idea sharing and collaboration.

Lead Faculty Nursing- CTU Online (Job Number: 45413)

Description

Provide guidance and/or supervision to faculty relative to instructional methods, course content and professional development; provide curriculum direction; complete administrative tasks to meet compliance standards; and serve as faculty member within appropriate department.

• Teach a maximum of 3 courses per term
• Fulfill responsibilities of an instructor to include, but not be limited to: preparation for courses, provide a high level of academic instruction, clearly document student progress through assessment activities, communicate with Academic Advisors regarding at risk students, post student attendance and final grades within prescribed timeframe; engage in professional development and faculty development activities as required
• Serve as faculty lead for academic program
• Participate in nursing program committee meetings
• Create and manage course schedule, assign faculty and hire new faculty, in collaboration with the Executive Program Director
• Monitor, guide and mentor faculty on the delivery of course content based on nursing programmatic standards and best practices
• Actively participates in the initial collection, preparation and periodic updates of all documentation required to meet accreditation and regulatory requirements for the faculty file, as well as nursing programmatic accreditation.
• Observes faculty, monitors applicable data, reports and dashboards, and reviews course elements to ensure quality of instruction and faculty activities meet Colorado Technical University’s faculty expectations.
• Conduct classroom observations and annual reviews of faculty; provide feedback to faculty regarding performance
• Reviews student-based and other evaluation sources, shares evaluations with faculty, identifies opportunities for improvement, and works collaboratively to implement solutions.
• Provides support to faculty in times of need by professionally and expediently answering questions, addressing faculty issues, and resolving faculty complaints.
• Provides support to students in times of need by professionally and expediently answering questions, addressing student issues, and resolving student complaints.
• Monitor faculty effectiveness through review of student course evaluations
• Handle day-to-day administrative functions
• Maintain high level of faculty morale.
• Conducts monthly faculty meetings.
• Assist in the orientation of new faculty members; serve as team member for faculty in-service meetings and new faculty orientation meetings
• Supports all CTU retention and graduation initiatives.
• Understands the mission, vision, goals and academic standards policies of the University and espouses them in the performance of duties.
• Adhere to all CTU policies, procedures, integrity and ethical standards.
• Performs all other duties as assigned.
• Occasional overnight travel
• Although this position is remote, lead faculty are expected to maintain normal business hours of 8-5 CST.
• Provides flexibility in scheduling as needed, including evenings and weekends to meet student and business requirements.
• History and continuation of nursing thought leadership or scholarly activities is expected

Qualifications

Education and Experience:

• Terminal degree in Nursing required (DNP, DNSc, or PhD in Nursing)

• MSN with active, unencumbered RN with a minimum of 5 years of nursing experience required.

• Minimum 3 years’ experience in an online learning environment required.

Remote Nurse Case Manager

locations

Portland, OR

Remote, USA

time type

Full time

job requisition id

REQ003123

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

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

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

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

JOB PURPOSE

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

PRINCIPAL ACCOUNTABILITIES / ESSENTIAL FUNCTIONS

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

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

ESSENTIAL FUNCTION REQUIREMENTS

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

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

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

QUALIFICATIONS

Education: BS or MS in a related field.

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

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

#LI-REMOTE

Note: The Standard is required to provide a reasonable estimate of the salary for this role when hiring a Colorado resident. The salary for employees working in Colorado in this role is listed below. The Standard’s package also includes incentive plan participation and comprehensive benefits including medical, dental, vision, retirement, and paid time off.

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

Salary Range:

$62,000.00 – $93,900.00

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

Nurse Supervisor

US – Remote

NURSE SUPERVISOR

This position is for a Full-Time 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 3+ years of management experience to work at Pager. This is a full-time position which may require some flex-hours and weekend work. An active compact unencumbered RN license is required for this position.

The ideal candidate for this role enjoys partnering with an interdisciplinary team to offer creative solutions to healthcare needs in an always moving and fast-paced, virtual, patient setting. Key aspects of this role will be supervising quality of patient care provided by Nurse Navigators and challenging the Nursing team to constantly improve the patient experience.

Pager is committed to offering a challenging yet supportive environment that accelerates your career via meaningful projects, exposure to senior leaders, room for development of this unique role, and continuing education opportunities to build on your core competencies.

Responsibilities for the Nurse Supervisor:

• Ensure the highest quality customer service
• Develop creative solutions to narrow patient healthcare gaps
• Review patient encounters to ensure all team/patient safety and quality is maintained through clinically validated protocols
• Actively participate as a member of the quality assurance team
• Prove Supervisory support for Nurse Navigator team members to provide meaningful and actionable feedback
• Motivate, encourage, and coach team to exceed goals
• Collaborate with clinicians and leaders to provide a seamless patient experience
• Monitor team success metrics
• Troubleshoot real time technology needs
• Lead new initiatives and projects

Candidate Profile for the Nurse Supervisor:

• Passionate about patient care and triage
• 3+ years of experience managing a Nurse team
• Must have an unencumbered RN license
• Minimum of Associates in Nursing
• Passionate about team growth and exceptional patient care experience
• Enjoys helping others
• Relishes solving problems, seeking out answers, and trying new things
• Is kind, empathetic and possess a strong social perceptiveness
• Positive, energetic, and fun!
• Outstanding multitasking skills
• Enthusiasm and savviness for new technology
• Excellent oral and written language skills
• Flexible and fast learner, comfortable in a fast-paced and changing environment
• Comfortable working inidually and in group setting with ever changing priorities and ambiguity
• Comfortable troubleshooting different technologies
• Detail oriented and an organized self-starter with outstanding interpersonal skills

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.

Medical Records Specialist I

Job Locations US-Remote

Requisition ID 2022-28761

# of Openings 1

Category (Portal Searching)

Operations

Overview

Position Highlights

• Opportunity to work a full-time schedule. Monday – Friday 7:40 AM – 4:00 PM EST
• Receive full benefits including medical, dental, vision, 401K, tuition reimbursement
• Paid time off (including major holidays)
• Virtual and in-person training
• Opportunity for growth within the company

Typical Day

• Preferred understanding of HIPAA requirements for releasing medical records and medical record requests
• Handling inbound and outbound calls, email, fax and other administrative tasks
• Assisting walk up patients and/or clients

What We’re Looking For:

• Great customer service skills
• Administrative/clerical experience
• Previous experience working in a medical office environment (preferred, not required)
• Willingness to learn and grow within Ciox Health

Who we are…

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

What we offer…

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

What we need…

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

Responsibilities

What You Will Do…

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

Qualifications

What Helps You Stand Out…

Required

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

Preferred

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

Working conditions & physical demands

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

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

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

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

*Except for states where legally prohibited to enforce mandates.