Land your dream remote job

Title: Mandarin Speaking Psychiatric Mental Health Nurse Practitioner (PMHNP)

Location: California

Type: Contract-1099

Workplace: remote

Category: Nurse Practitioners

JobDescription:

Our mission is to empower everyone living with ADHD to reach their fullest potential. We meet that mission by providing a patient-first, technology-powered ADHD treatment platform that keeps costs down and reduces patient wait times. With guidance from the most advanced clinical leadership and board-certified psychiatrists, we have created a platform that provides a patient-first healthcare experience and the highest quality of ADHD care for our patients.

Perks:

• Flexible and Sustainable Work Schedule :Set your own Schedule, anywhere from 7am – 10pm, Monday – Sunday, the Flexibility is one of the many perks here at Done.
• Dedicated Clinical Admin Team Just for You :Your Assigned Care Team will be responsible for Non-Clinical Support from Patient Scheduling to Pharmacy Communications and more to allow you to focus on the most important thing – providing care to the patients.
• Comfortable & Fun Remote Work Environment:Work from anywhere you like alongside our enthusiastic, tight-knit team of medical doctors, other clinicians, engineers, and care team staff.
• On-Site Training :Get medical guidance and advice for complex patient cases from our expert psychiatrists and mental health clinicians.
• Internal Opportunities to Cross-License
• Full-time Hiring Option: After working with us for a while, you will have the opportunity to convert to full-time hours and earn additional compensation and benefits.
• Malpractice Liability Insurance Provided
• Collaborating Physician Provided (If Applicable)
• Physical Office (If Applicable)

What we are looking for:

• A Provider who is Passionate about our Mission and Recognition of the impact on the Healthcare Industry
• Comfort working independently as well as with the Done team
• Comfort operating in a fast-moving, high-growth environment
• Experience diagnosing and treating patients with ADHD

What you’ll do:

• Conduct psychiatric evaluations
• Manage your patients medication regimens you prescribe and adjust medication and dosages as needed
• Respond to EHR messages, refill requests, and conduct occasional remote follow-up appointments with your patient panel

Role:

• Conduct ADHD Evaluations
• On-Going Patient Management

Requirements:

• PMHNP
• Board Certified
• Applicable Valid DEA / License
• Computer Proficiency
• Excellent Written and Verbal communication skills
• Bilingual in Mandarin/English

Done. does not discriminate on the basis of race, sex, color, religion, age, national origin, marital status, disability, veteran status, genetic information, sexual orientation, gender identity or any other reason prohibited by law in provision of employment opportunities and benefits.

LPN/RN Quality Review and Audit Lead Representative, Work from Home , Anywhere, USA in Nashville, Tennessee

Job Summary:

The HEDIS Abstraction Lead Representative works under the direction of the HEDIS Abstraction Lead within the Cigna Medicare Quality Department. These home-based positions are responsible for working independently to review and abstract pertinent medical record information in accordance with multiple study criteria and in alignment with the HEDIS specifications. The information to be abstracted will be obtained from medical records copied from physician offices/healthcare facilities and sent to CIGNA.

These personnel abstract clinical data into HEDIS nonstandard supplemental sources for HEDIS year round working in partnership with Medicare Quality, Stars, Network Operations. They are also responsible for identifying gaps in documentation to share back to providers and market staff for future improvement of HEDIS rates. During the annual HEDIS Medical Record Review (MRR) project (January-May), they also serve as a member of the HEDIS MRR abstraction/over-read team. Must possess proven ability and prior experience using HEDIS software, abstraction and identifying medical chart opportunities for providers. Demonstrates understanding of HEDIS technical Specifications and ability to apply knowledge in a fast-paced environment.

Additionally, the HEDIS Abstraction Specialist may collaborate with non-clinical personnel regarding collection of medical records from physician offices for additional medical record pursuits or may collect the information themselves. All medical records that are copied or received in the Cigna offices must be kept confidential, in accordance with federal and local requirements, and maintained at the Cigna office. Other duties as assigned to improve HEDIS rates including: gleaning records for additional information, utilization research applying measure probability logic to create additional HEDIS chase pursuits, and HEDIS MRR measure team lead.

Minimum Requirements:

• Current active RN or LPN/LVN license preferred
• Three years’ experience with HEDIS MRR or HEDIS abstraction/over-read preferred.
• Experience with data entry and audit.
• Experience with electronic medical records
• Intermediate Level experience working with Microsoft Office Products. (Outlook, Word, Excel,and PowerPoint).

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

About Cigna Healthcare

Cigna Healthcare, a ision of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Coding Specialist

locations

Remote – Nationwide

time type

Full time

job requisition id

R020554

Thank you for considering a career at Ensemble Health Partners!

Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference

The Opportunity:

Advanced outpatient coding position that reviews medical record documentation and accurately assign ICD-10-CM, ICD-10-PCS, as well as CPT IV codes based on the specific record type and abstract specific data elements for each case in compliance with federal regulations. This position codes all types of outpatient visits to include ancillary, urgent care, emergency department, observation, same day surgery, and interventional procedures. Follows the Official Guidelines for Coding and Reporting, the American Health Information Management Association, (AHIMA,) Coding Ethics, as well as the American Hospital Association, (AHA) Coding Clinics, CMS directives and Bulletins, Fiscal Intermediary communications. Utilizing Coding Applications in accordance with established workflow. . Follows Policies and Procedures and maintains required quality and productivity standards.

Job Responsibilities:

• Reviews medical record documentation and accurately assigns appropriate ICD-9-CM, ICD-10, CPT IV, and HCPCS codes utilizing the 3M software tools for all OP Work Types (Ancillary, ED Charge/Code, Same Day Surgery, and Observation. . The assigned codes must support the reason for the visit and the medical necessity that is documented by the provider to support the care provided. When applicable, apply the appropriate charges such as the Evaluation & Management, (E&M) level and injections and infusions, and/or other necessary requirements for Observation cases, using a third party software systems such as LYNX.

• Correctly abstract required data per facility specifications.

• Perform “medical necessity checks” for Medicare and other payers as required per payment guidelines.

• Responsible for monitoring and working of accounts that are Discharged Not Final Billed, failed claims, stop bills, and epremis as a team, ensure timely, compliant processing of outpatient claims in the billing system.

• Responsible to maintain established productivity requirements, key performance indicators established for 3M 360 CAC for CRS & Direct Code as well as ensure accuracy to maintain established quality standards.

• Remain abreast of current requirements of the Centers for Medicare & Medicaid Services, (CMS,) to include National Coverage Determinations, (NCD) and Local Coverage Determinations, (LCD) guidelines, related to the assignment of modifiers, to ensure the submission of a clean claim the first time through.

• Maintains competency and accuracy while utilizing tools of the trade, such as the 3M encoder, Computerized Assisted Coding, (CAC,) Medical Necessity software, abstracting system, code books, and all reference materials. Reports inaccuracies found in Coding Software to HIM Management/Supervisor, reports any potential unethical and/or fraudulent activity per compliance policy

• Follows all established Mercy Health policies and procedures to include abiding by paid time off, (PTO) requirements.

• Attends required system, hospital and departmental meetings and educational sessions as established by leadership, as well as completion of required annual learning programs, to ensure continued education and growth.

• Assist in the mentoring and training of Coders as required.

Experience We Love:

• 1 year of previous of coding experience
• Current coding certification
• Experience in cardiovascular coding, preferred
• CRCR Certification required, or willingness to obtain within 9 months of hire

#LI-HB1

#LI-REMOTE

Join an award-winning company

Three-time winner of Best in KLAS 2020-2022

2022Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

• Innovation
• Work-Life Flexibility
• Leadership
• Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:

• Associate Benefits We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Our Culture Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
• Growth We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• Recognition We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble Health Partners provides reasonable accommodations to qualified iniduals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact [email protected].

EEOC Know Your Rights

FMLA Rights – English

La FMLA Espaol

Job Title: Utilization Management Nurse Reviewer

Location: West Palm Beach FL US

JobDescription:

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of medical procedures, tests, and treatments.

Utilization Management Nurse Reviewers collaborate with healthcare providers, insurance companies, and patients to optimize healthcare delivery, control costs, and maintain quality care. Their responsibilities include assessing medical necessity, coordinating care, conducting utilization reviews, providing recommendations for care plans, and ensuring adherence to regulations and guidelines. This role requires strong clinical knowledge, critical thinking skills, communication abilities, and the ability to make informed decisions regarding patient care pathways.

Shift Times:

• 9 am start time
• 11:00am start time
• weekend shift 10 hours (Thurs- Sun) Start time 8 am.

MAJOR DUTIES & RESPONSIBILITIES

• Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria).
• Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services.
• Offer clinical expertise and serve as a clinical reference for non-clinical staff members.
• Input and manage essential clinical details within various medical management platforms.
• Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review.
• Apply clinical reasoning to determine the suitable evidence-based guidelines.
• Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director.

Requirements

• Proficient in both written and spoken communication.
• Capable of maintaining professional communication with physicians and clients.
• Skilled at handling multiple tasks and adjusting swiftly in a dynamic office setting.
• Possesses a keen organizational sense and pays close attention to details.
• Adept at resolving intricate and multifaceted problems.
• Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook.
• Background in medical or clinical practice through education, training, or professional engagement.
• Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a nursing degree from an accredited college (for RNs).

Additional Duties

• May provide oversight to the work of the team members.
• Continuously improves processes that help to facilitate better turnaround time, peer to peer success rates and lessens returned reports by clients for clarification purposes, ultimately resulting in higher client satisfaction.
• Responsible for the final approval on cases for release to the client.
• Will act as a liaison and coordinate quality issue reports along with all new reviewer reports with the VP of Clinical Operations.

EDUCATION/CREDENTIALS:

Licensed Practical/Vocational Nurse with an active and unrestricted license to practice.

JOB RELEVANT EXPERIENCE:

2 yrs minimum clinical nursing experience is required. One year of previous experience in Utilization Management is preferred.

JOB RELATED SKILLS/COMPETENCIES:

Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills. Possess a proficient understanding of computer operations, particularly the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows. Show the capability to acquire new skills and competencies to address the evolving requirements of systems, software, and hardware.

WORKING CONDITIONS/PHYSICAL DEMANDS:

Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.

WORK FROM HOME TECHNICAL REQUIREMENTS:

Supply and support their own internet services.

Maintaining an uninterrupted internet connection is a requirement of all work from home position.

Benefits

We offer generous Paid Time Off, excellent benefits package and a competitive salary. Apple equipment and media stipend is provided for remote work space. Come up to speed quickly with our strong training program! If you want to work in an exciting, fast-paced environment where you can provide meaningful contributions, then we encourage you to apply.

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful, astute forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers. We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

Outpatient Coder

Location:US -Remote(Any location)

Full time

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Do:

• Oversees the maintenance of medical records and the coding of data from medical records.
• Participates in the preparation of reports, provides information and prepares correspondence regarding patient admissions, treatment, discharges and deaths in accordance with departmental policies and legal requirements governing the release of medical information.
• Works collaboratively with providers, other health care professionals and coding team to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes and quality is captured for the level of service rendered to each patient, as well as ensuring compliant reimbursement of patient care services.
• Infusion and Injection Charging
• E/M Leveling

What You Will Need:

• High school diploma and 3-5 years of prior relevant experience
• CCS or CPC

What Would Be Nice To Have:

CPC

The annual salary range for this position is $43,400.00-$65,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

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

Benefits include:

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

About Guidehouse

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

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

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

Bilingual Front Office Medical Assistant (Remote)

Remote

Nice to meet you, were Vesta Healthcare.

Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these iniduals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center.

Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others’ needs ahead of her own, keeping the hearth warm so the home and family can function.

We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. Its an insurance covered benefit, so its available to most adults with Caregivers free of charge to them.

We seek team members who are passionate about making home the best place it can be for people with home care needs and see the important role Caregivers play. Our team members are collaborative data-driven optimists who always focus on doing whats best for patients and their caregivers. We see ourselves as being 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 customer focused inidual who responsible for assisting the team in coordinating the care of members enrolled in Medicare’s chronic care management program during each calendar month. This will primarily entail periodic telephonic outreach calls to members, caregivers, and other care team members as directed with documentation in the appropriate platform to ensure compliance. The Care Coordinator will collaborate with the supervising provider and staff to conduct outreach, assessment and service planning to coordinate care for the CCM patients.

The ideal teammate would be able to:

• Provide practice support including: contacting members, caregivers, and care team members as directed, work closely with the clinical team to improve the health and care of our members
• Coordinating care for members of the program
• Data entry within operating dashboards, reporting and workflow platforms
• Ensure Data Quality and Accuracy
• Other administrative support

Would you describe yourself as someone who has:

• Fluency in English and Spanish/Mandarin/Cantonese/Russian (writing, reading and speaking) (required)
• A minimum of 2 years of experience working in a healthcare setting (required)
• The ability to work alternating weekends – 10H Sat/Sun with flex hours on the week days OR 9-6pm rotating on Sat/Sun(required)
• Knowledge and understanding of medical terminology (required)
• 2+ years working in a medical practice with front office experience and/or medical receptionist experience (required)
• Knowledge and understanding of chronic care management processes (required)
• A customer service mindset for both internal and external customers (required)
• Medical Assistant and or Medical Scribe Certification (required)
• A strong proficiency in computer software navigation; data entry and data cleansing
• A fundamental knowledge of Google Docs, Sheets, Slides or similar
• A demonstrated ability to work effectively as a member of an interdisciplinary team, displaying good judgment and decision-making skills
• Ability to perform duties as assigned or requested

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 rate is $20.00 hourly.(The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

Menopause Nurse Practitioner – 100% Remote

at Midi Health

Remote

Midi is seeking an experienced Nurse Practitioner with strong experience in caring for women in peri-menopause and menopause to care for our patients on a full time basis.

We offer:

• $124,800 annual salary plus benefits (based on 40 hours/week)
• 100% Remote telehealth with synchronous visits
• Flexible schedule (we care for patients seven days, 7:00 am – 7:30 pm)
• Opportunity to join a cutting edge, mission-minded medical practice at the ground level

The qualified candidate will have:

• Active, unrestricted, unencumbered Nurse Practitioner license (multiple state licenses strongly preferred)
• Minimum of 5 years of experience in direct patient caremanaging women 40+ in all stages of menopause
• Strong HRT and menopause experience.
• Strong desire to care for women experiencing menopause symptoms
• Experience treating menopause symptoms with a variety of methods, including both traditional medicine and naturopathic methods

Midi is on a mission to bring compassionate, high quality medical care to women 40+, and to offer a new standard of care for women in midlife.

Join us!

Title: Clinical Documentation Integrity Coder (remote)

Location: Remote

JobDescription:

About Our Company

Vytalize Health is a leading value-based care platform. It helps independent physicians and practices stay ahead in a rapidly changing healthcare system by strengthening relationships with their patients through data-driven, holistic, and personalized care. Vytalize provides an all-in-one solution, including value-based incentives, smart technology, and a virtual clinic that enables independent practices to succeed in value-based care arrangements. Vytalize’s care delivery model transforms the healthcare experience for more than 250,000+ Medicare beneficiaries across 36 states by helping them manage their chronic conditions in collaboration with their doctors.

About our Growth

Vytalize Health has grown its patient base over 100% year-over-year and is now partnered with over 1,000 providers across 36-states. Our all-in-one, vertically integrated solution for value-based care delivery is responsible for $2 billion in medical spending. We are expanding into new markets while increasing the concentration of practices in existing ones.

Why you will love working here

We are an employee first, mission driven company that cares deeply about solving challenges in the healthcare space. We are open, collaborative and want to enhance how physicians interact with, and treat their patients. Our rapid growth means that we value working together as a team. You will be recognized and appreciated for your curiosity, tenacity and ability to challenge the status quo; approaching problems with an optimistic attitude. We are a erse team of physicians, technologists, MBAs, nurses, and operators. You will be making a massive impact on peoples lives and ultimately feel like you are doing your best work here at Vytalize.

Your opportunity

The CDI Specialist supports clinical documentation to ensure complete, accurate, and compliant coding for Medicare and Medicare Advantage beneficiaries. Proficient in ICD-10-CM coding and risk adjustment methodologies, you optimize coding integrity, conducting chart reviews specifically addressing the CMS-HCC model. This role emphasizes production coding with a focus on enhancing clinical documentation through compliant risk adjustment chart review programs (minimum 30 charts per day).

As a CDI Specialist, you significantly contribute to ensuring accurate and compliant documentation, aligning beneficiaries health burden with risk scores for appropriate Medicare reimbursement. Your expertise in precision and excellence supports the organization’s commitment to providing high-quality healthcare services.

What you will do

Clinical Documentation Enhancement:

• Validate and ensure the completeness, accuracy, and integrity of coded data.
• Support and enhance clinical documentation to ensure comprehensive, accurate, and compliant coding for Medicare and Medicare Advantage beneficiaries.

Coding Proficiency:

• Demonstrate proficiency in ICD-10-CM coding, CPT codes, HCPCS codes, and risk adjustment methodologies to optimize coding integrity.
• Comply with HIPAA laws and regulations.

Chart Reviews:

• Review and accurately code medical records and encounters for ICD-10 diagnoses and procedures codes related to Risk Adjustment and HCC coding guidelines.

Production Coding:

• Oriented towards production coding, with a primary emphasis on improving clinical documentation through effective risk adjustment coding.
• Maintain productivity standards averaging 30 charts per day.

Documentation Alignment:

• Ensure documentation aligns with regulatory guidelines and standards, emphasizing precision in risk adjustment processes.
• Stay up to date with the latest coding guidelines, rules, and regulations related to Risk Adjustment and HCC coding.

Contribution to Accuracy:

• Contribute significantly to accurate and compliant documentation, aligning beneficiaries health burden with risk scores for appropriate Medicare reimbursement.

Quality Assurance:

• Ensure exemplary attention to detail and completeness, ensuring coding is consistent with ICD-10-CM, CMS-HCC, and other relevant coding guidelines.
• Uphold a commitment to precision and excellence, maintaining at least a 95% coding accuracy rate.

EHR Knowledge and Proficiency:

• Demonstrate knowledge and expertise in various Electronic Health Record (EHR) systems to optimize chart reviews across multiple platforms.

What will make you successful in this role

• Minimum of 2 years HCC/Risk Adjustment coding experience required, 3+ years preferred.
• Strong communication skills, including clear verbal and written communication, effective collaboration, and the ability to convey complex coding concepts.
• Knowledge of medical records coding procedures and ICD-10/CPT Coding Systems required.
• Must hold a Certified Risk Adjustment Coder (CRC) and Certified Professional Coder (CPC) certification.

Perks/Benefits

• Competitive base compensation
• Annual bonus potential
• Health benefits effective on start date; 100% coverage for base plan, up to 90% coverage on all other plans for iniduals and families
• Health & Wellness Program; up to $300 per quarter for your overall wellbeing
• 401K plan effective on the first of the month after your start date; 100% of up to 4% of your annual salary
• Company paid STD/LTD
• Unlimited (or generous) paid “Vytal Time”, and 5 paid sick days after your first 90 days
• Technology setup
• Ability to help build a market leader in value-based healthcare at a rapidly growing organization

Salary $60,000-65,000 DOE + 10% annual bonus potential + benefits (see above)

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

Please note at no time during our screening, interview, or selection process do we ask for additional personal information (beyond your resume) or account/financial information. We will also never ask for you to purchase anything; nor will we ever interview you via text message. Any communication received from a Vytalize Health recruiter during your screening, interviewing, or selection process will come from an email ending in @vytalizehealth.com

Nurse Case Manager

Fully Remote

Job Type

Full-time

Description

Valenz Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity, and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan, and member. By establishing true transparency and offering data-driven solutions that improve cost, quality, and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare.

About Our Opportunity

As a Nurse Case Manager, you will play a critical role in coordinating and managing healthcare services for patients, ensuring optimal care delivery and facilitating effective communication among various healthcare providers. With your nursing expertise and case management skills, youll provide comprehensive care coordination and support to patients throughout their healthcare journey.

The Nurse Case Manager collaborates with patients, families, physicians, and other healthcare professionals to develop and implement personalized care plans, monitor patient progress, and advocate for the best possible outcomes.

Things Youll Do Here:

• Coordinate and manage healthcare services for patients, ensuring comprehensive care delivery and effective communication among healthcare providers.
• Assess patients’ healthcare needs and develop personalized care plans based on their conditions and goals.
• Advocate for patients’ rights, preferences, and needs, and help them navigate the healthcare system.
• Monitor patients’ progress, adherence to treatment plans, and evaluate the effectiveness of interventions.
• Maintain accurate documentation of patient assessments, care plans, and outcomes.
• Generate reports on patient progress, outcomes, and utilization of healthcare resources.
• Provide patient education on medication administration, and self-care techniques.
• Offer emotional support and counseling to patients and their families, addressing their concerns and fears.
• Promote health and wellness by encouraging preventive measures and healthy lifestyle choices.
• Adhere to the applicable URAC Standards, CMSAs Standards of Practice, state, local, and federal laws and Valenzs policies and procedures.
• Partner with internal teams to identify health plan coverage savings as appropriate.

Reasonable accommodation may be made to enable iniduals with disabilities to perform essential duties.

Where Youll Work

This role is a fully remote role.

Why You Will Love Working Here

We offer employee perks that go beyond standard benefits and compensation packages see below!

At Valenz, our team is committed to delivering on our promise toengage early and often for smarter, better, faster healthcare. We want everyone engaged within our ecosystem to bestrong, vigorous, and healthy.Youll find limitless growth opportunities as we grow together. If you’re ready to utilize your skills and passion to make a significant impact in the healthcare self-funded space, Valenz might be the perfect place for you!

Perks and Benefits

• Generously subsidized company-sponsored Medical, Dental, and Vision insurance.
• Spending account options: HSA, FSA, and DCFSA
• 401K with company match and immediate vesting.
• Flexible working environment.
• Generous Paid Time Off to include Vacation, Sick, and Paid Holidays.
• Paid maternity and paternity leave.
• Community giveback opportunities, including paid time off for philanthropic endeavors.

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and inidual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.

Requirements

What Youll Bring to the Team:

• 3+ years of direct case management experience, with a demonstrated ability to develop, implement, and monitor personalized care plans, coordinate healthcare services, and collaborate with multidisciplinary teams for optimal patient outcomes.
• RN License with an active and unrestricted license to practice in the state of primary residence – compact license preferred.
• Experience in a deadline driven environment with a knack for organization and detail.
• Ability to comprehend the consequences of various problem situations and to refer such problems to the appropriate inidual (or supervisor) for decision-making.
• Excellent communication skills to liaise between patients, families, and healthcare professionals.
• Patience and resilience, especially when faced with challenging situations.

A plus if you have:

• Additional state licensures
• Certified Case Manager (CCM), Chronic Care Professional (CCP), etc. or willingness to obtain CCM in 18 months of hire.

Title: Medical Video Content Creator (Contract Position)

Location: Remote

Type: Contract

Workplace: remote

Category: Growth, Sales, and Marketing

JobDescription:

Overview

Hey there, health gurus! Are you a licensed MD, ND, or PhD with a knack for the camera and a passion for functional medicine? Rupa Health is on the hunt for a Medical Content Creator who can turn complex medical jargon into engaging, informative videos. Join us in our mission to educate millions on the harmony of conventional and functional medicine, and let’s spread the word about root cause medicine together!

A little about Rupa – The future is personalized, root-cause healthcare.

Rupa makes lab testing simple. We turn an archaic 15 hour-a-week process into a delightful 15 min task for practitioners ordering lab testing for their patients.

Lab testing is the key to a more personalized and holistic approach to medicine, and Rupa is paving the way with critical infrastructure for this next generation of healthcare. Through Rupa, practitioners can order specialty testing, such as DNA testing, microbiome testing, advanced fertility and hormone testing, blood labs, and more.

This comprehensive and personalized approach to healthcare is the missing piece for the millions of people suffering from complex, chronic health conditions. Rather than band-aid solutions, practitioners utilize our platform to understand, diagnose, and treat the root cause of people’s health issues through testing. At Rupa, we are building the infrastructure to make this root-cause approach the standard of care for every person on the planet.

Starting with lab testing, Rupa is bringing tools and resources to trailblazing practitioners who are practicing medicine in a way that truly helps people get well.

What This Role Will Own

As our Medical Content Creator, you’ll be the maestro of our video content, orchestrating everything from content ideation to the final cut. Here’s what you’ll own:

Video Wizardry: Script, propose, and record at least two stellar videos per month that will captivate our audience.

Idea Generator: Unleash your creativity to regularly propose fresh and engaging content ideas to the Rupa Health Team.

Collaborative Spirit: Be the friendly face that works well with others, embraces feedback, and upholds integrity in every action.

Communication Pro: Keep in touch with our team through Slack and Email, ensuring your messages are as clear as your video content.

Quality Champion: Deliver videos with world-class video and audio quality – don’t worry, we’ve got the gear you need!

Hard Requirements

Licensed Professional: You must be a licensed MD, ND, or PhD.

Functional Medicine Fanatic: A deep passion and understanding of functional medicine is non-negotiable.

Editorial Expertise: You’ve got a solid grasp of the editorial process and can craft content that educates and engages.

Communication Skills: Your communication skills are top-notch, both on and off camera.

Nice To Have Requirements

Social Savvy: Experience with social media and a knack for engaging with a digital audience.

Tech-Friendly: Comfortable with using video editing software and equipment.

Innovative Thinker: Always thinking of new ways to present content that sets us apart from the rest.

Quick Note

We’re all about embracing ersity and fostering an inclusive environment here at Rupa Health. We’re proud to be an equal opportunity employer. We celebrate our differences and are committed to creating an inclusive environment for all employees, regardless of race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Heads up, folks! Rupa Health will always reach out from our official rupahealth.com domain. We won’t slide into your DMs on messaging apps or ask for bank details or purchases during the hiring process. If something seems off, hit us up at [email protected] to confirm you’re chatting with our legit team.

Requirements:

• [Record Videos] Able to script, propose, and record at least two videos per month
• [Licensed Professional] You must be a licensed MD, ND, or PhD.
• [Propose Content Ideas] Create content on the topics of your choice and propose content ideas regularly to the Rupa Health Team
• [Team Player] A friendly human who is pleasant to work with, gives & takes feedback well, is responsible (does what they say they will), and performs their job with integrity
• [Communication] Able to communicate with our team promptly on Slack and Email
• [Quality of Work] The videos you submit will be world class video and audio quality – we will provide equipment if necessary

Senior Account Support Coordinator

locations

Home

time type

Full time

job requisition id

R-11505

Our work matters. We help people get the medicine they need to feel better and live well. We do notlose sight of that. It fuels our passion and drives every decision we make.

Job Description Summary

Supports a variety of administrative and project tasks for the account management team, including tracking client projects and assigned tasks.

Job Description

• Managesprojectand reporting for the client management process to ensure that due dates and deliverables are tracked and on schedule for all client activities as assigned by manager and team.
• Attends client conference calls and onsite meetings to document client deliverables, client summary notes and follow up items.
• Prepares and develops client presentations.
• Assists in the development, coordination and materials necessary for site visits/client meetings.
• Exercises independent judgment and discretion responding to requests, arranging meetings and interacting with key contacts.
• Independently handles the setting up and maintenance of client project tracking reports and processes.
• Coordinates or independently completes special projects according to manager’s general instructions.
• Assists manager or other staff members with more complex and detailed client projects.
• Participates in additional client support related activities at the direction manager, and interacts with team to meet internal reporting requirements and deliverables

Responsibilities

• Knowledge of Pharmacy and Medical Claims.
• Strong working knowledge of Microsoft Office Suite and Adobe software.
• 5+ years’ related experience in healthcare setting in customer service or account management, training or education.

Work Experience

Work Experience – Required:

Marketing

Education

Education – Required:

A Combination of Education and Work Experience May Be Considered., Associates

Education – Preferred:

Bachelors

Potential pay for this position ranges from $52,250.00 – $78,390.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

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

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

Positions will be posted for a minimum of five consecutive workdays.

Coding Specialist

Remote

Join us. Lets make a direct impact in healthcare.

Being an Iodine employee means becoming part of something bigger: using clinical AI technology to drive smarter healthcare processes and positively impact patient care.

Who we are:

Iodine is an enterprise AI company that is championing a radical rethink of how to create value for healthcare professionals, leaders, and their organizations: automating complex clinical tasks, generating insights and empowering intelligent care. Powered by one of the largest sets of clinical data and use cases available, our groundbreaking clinical machine-learning engine, Cognitive ML, constantly ingests the patient record to generate real-time, highly focused, predictive insights that clinicians and hospital administrators can leverage to dramatically augment the management of care delivery.

What were looking for:

Reporting to the Chief Clinical Strategist, the Coding Specialist is a member of the Customer Success organization who will provide coding subject matter expertise, insight and an active role to our clinical and business goals including product innovation and development.

What youll do:

Coding

• Research and develop inpatient coding criteria that identifies common areas of coding error or discrepancy
• Conduct coding and documentation audits to assess product compliance with coding guidelines and regulations.
• Identify areas for product improvement and provide recommendations for enhancing accuracy.
• Stay informed about industry updates on coding guidelines and materials to ensure product compliance and competitiveness.
• Collaborate with internal teams to understand the implications of coding and clinical documentation requirements on product development.
• Engage with client partners to assess coding practices and responsibilities that would impact product development.
• Research healthcare technology changes and trends affecting documentation and coding, guiding product development accordingly.
• Evaluate coding processes, systems, and documentation practices, implementing strategies to optimize product performance and efficiency.
• Design workflow processes to ensure efficiency and quality for users.
• Collaborate with cross-functional teams, especially the clinical team, to ensure clinical and coding compliance and support organizational initiatives.
• Stay up-to-date with changes in coding regulations, guidelines, and industry trends.
• Prepare coding-related reports, analyses, and recommendations for product development and strategic decision-making.

Product

• Collaborate with cross-functional teams, serving as the coding subject matter expert
• Collaborate with Data Science to improve inputs to models
• Conduct and coordinate audits and quality checks of product capabilities

What wed love to see:

• Bachelor’s degree in Health Information Management (RHIA) or Bachelor degree in related field with appropriate coding certification
• Certification: PCC and/or CIC required, CPC preferred
• Experience in monitoring and assessing coding accuracy
• Experience managing a second level review process that identifies coding error or discrepancies
• Experience in developing new technology highly preferred
• 5+ years of inpatient coding experience required
• Experience in coding consulting role preferred
• Ability to travel 15-20% of the time

Please note this position is not restricted solely to the responsibilities listed above and that the job scope and responsibilities are subject to change.

RN Clinical Documentation Specialist

locations

Remote – Nationwide

time type

Full time

job requisition id

R018291

Thank you for considering a career at Ensemble Health Partners!

Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference

The Opportunity:

The CDI Specialist facilitates and obtains appropriate physician documentation for any patient clinical condition or procedure to support the appropriate severity of illness, expected risk of mortality, and complexity of care as documented in patient medical records. Extensive medical record review and interaction with physicians, nursing staff, other patient care givers and HIM coding professionals is done to ensure the documentation is complete and accurate.

Job Responsibilities:

• Completes initial patient medical record review within 24-48 hours of patient’s admission; completes subsequent reviews of patient’s medical record reviews every 24-48 hours and enters review findings in CDE software system
• Assigns Principal diagnosis, CC/MCC (complication and comorbidity/major complication and comorbidity), evaluate for Severity of Illness (SOI) and Risk of Mortality (ROM) on all patients while in-house. Assigns working ICD-10-CM and PCS codes and DRG (Diagnosis Related Group) using encoder in CDE software.
• Clarifies with physicians regarding missing, unclear, unsupported or conflicting health record documentation by requesting and obtaining additional documentation from physicians when needed. Face to face physician interaction and written clarifications are used.
• Educates key healthcare providers such as physicians, nurse practitioners, allied health professionals, nursing and care coordination regarding clinical documentation improvement, documentation guidelines and the need for accurate and complete documentation in the health record.
• Partners with coding professionals to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine the working and final DRG assignment. Reviews DRG denial letters and writes denial appeal letters.
• Collaborates with care coordination, nursing staff and other ancillary staff regarding interaction with physicians on documentation and to resolve physician clarifications prior to patient discharge.
• Maintains and upholds all clinical documentation regulatory guidelines
• Formulates and submits timely, well prepared appeals for reconsideration by third party administrators (payors). Including supporting documented clinical evidence, Coding/CDE Guidelines and other regulatory standards/guidelines as appropriate. Works collaboratively with co-works and management to effectively resolve root cause issues that impact payor contracts, hospital operations, or departmental to maintain reimbursement and minimize appeal requests and/or denials.

Experience We Love:

• Minimum of five years acute care nursing experience with specific medical/surgical, Intensive Care, or Emergency Department experience
• Excellent interpersonal skills including excellent verbal and written communication skills; proficient in and demonstrate excellent physician relations
• Ability to organize and present information clearly and concisely; excellent computer and keyboarding skills; high degree of prioritization skills

Minimum Education

• Current RN Licensure

Certifications:

• CRCR Required within 9 months of hire

#LI-LS1

#LI-REMOTE

Join an award-winning company

Three-time winner of Best in KLAS 2020-2022

2022Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

• Innovation
• Work-Life Flexibility
• Leadership
• Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:

• Associate Benefits We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Our Culture Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
• Growth We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• Recognition We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble Health Partners provides reasonable accommodations to qualified iniduals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact [email protected].

Benefits Verification Specialist

locations

Remote, USA

time type

Full time

job requisition id

R245157

Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthier futures, and every person here is essential to us being able to deliver on that purpose. If you want to make a difference at the center of health, come join our innovative company and help us improve the lives of people and animals everywhere.

What you will be doing

Location: Remote, USA

Hours: 8:30am to 5:30pm EST, Monday through Friday

PRIMARY DUTIES AND RESPONSIBILITIES:

Reviews all patient insurance information needed to complete the benefit verification process.

Triages cases with missing information to appropriate program associate. Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options. Identifies any restrictions and details on how to expedite patient access. Could include documenting and initiating prior authorization process, claims appeals, etc. Completes quality review of work as part of finalizing product. Reports any reimbursement trends/delays to management. Performs related duties and special projects as assigned. Applies company policies and procedures to resolve a variety of issues.

What your background should look like

PRIMARY DUTIES AND RESPONSIBILITIES:

Reviews all patient insurance information needed to complete the benefit verification process.

Triages cases with missing information to appropriate program associate. Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options. Identifies any restrictions and details on how to expedite patient access. Could include documenting and initiating prior authorization process, claims appeals, etc.

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

High school diploma or GED required.

Requires minimum of two (2) years directly related and progressively responsible. experience in customer service, medical billing and coding, benefits verification, healthcare, business administration or similar vocations. A bachelors degree is preferred. An equivalent combination of education and experience will be considered.

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

Advanced customer service experience.

Proficient Windows-based experience including fundamentals of data entry/typing. Proficient with Microsoft Outlook, Word, and Excel. Strong interpersonal skills and professionalism. Independent problem solver and ability to make , good decisions. Robust analytical skills. Strong attention to detail. Effective written and verbal communication. Familiarity with verification of insurance benefits preferred. Attention to detail, flexibility, and the ability to adapt to changing work situations.

What Cencora offers

We provide compensation, benefits, and resources that enable a highly inclusive culture and support our team members ability to live with purpose every day. In addition to traditional offerings like medical, dental, and vision care, we also provide a comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness. This encompasses support for working families, which may include backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, and paid caregiver leave.

To encourage your personal growth, we also offer a variety of training programs, professional development resources, and opportunities to participate in mentorship programs, employee resource groups, volunteer activities, and much more.

For details, visit https://www.virtualfairhub.com/amerisourcebergen

Schedule

Full time

Salary Range*

$31,500 – 46,530

*This Salary Range reflects a National Average for this job. The actual range may vary based on your locale. Ranges in Colorado/California/Washington/New York State-specific locations may be up to 10% lower than the minimum salary range, and 12% higher than the maximum salary range.

Affiliated Companies:

Affiliated Companies: Lash Group, LLC

Equal Employment Opportunity

Cencora is committed to providing equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, disability, veteran status or membership in any other class protected by federal, state or local law.

The companys continued success depends on the full and effective utilization of qualified iniduals. Therefore, harassment is prohibited and all matters related to recruiting, training, compensation, benefits, promotions and transfers comply with equal opportunity principles and are non-discriminatory.

Cencora is committed to providing reasonable accommodations to iniduals with disabilities during the employment process which are consistent with legal requirements. If you wish to request an accommodation while seeking employment, please call 888.692.2272 or email [email protected]. We will make accommodation determinations on a request-by-request basis. Messages and emails regarding anything other than accommodations requests will not be returned

Title: Inpatient Medical Records Coder (Certified)

Location: Lake Success, NY

Job Responsibility:

1. Analyzes and interprets the medical record in its entirety to ensure accurate, complete and consistent selection of diagnoses and procedures to assure the production of quality healthcare data and accurate facility payment.
2. Applies understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable codes.
3. Utilizes resources and reference materials (e.g., on-line sources, manuals) to identify appropriate codes and reference code applicability, rules and guidelines.
4. Applies the Uniform Hospital Discharge Data Set (UHDDS) definitions as well as any additional regulatory guidelines and/ or coding references to select the principal diagnosis, secondary diagnoses, all significant procedures, indicating the patient’s acuity, severity of illness and risk of mortality (if applicable), as documented in the medical record.
5. Codes and reports diagnoses and their associated present on Admission (POA) Indicator and procedures in accordance with the established International Classification of Diseases 10th Revision Procedure Classification System (ICD-10-PCS) Official Guidelines for Coding and Reporting.
6. Accurately assigns discharge disposition for all records as required and in accordance with the Centers for Medicare and Medicaid Services (CMS) rules and regulations.
7. Make determinations on medical coding and takes initiative to complete reviews and coding independently, to avoid delays in the workflow process
8. Manages multiple work demands simultaneously to maintain relevant efficiency and turnaround time standards for completing coding/DRG assignment
9. Assigns and reports all other data elements required for Statewide Planning and Research Cooperative System (SPARCS) data collection, Congenital Malformations and Expirations.
10. For outpatient encounters, applies coding conventions and official coding guidelines approved by the Current Procedural Terminology (CPT) rules established by the American Medical Association (AMA), and any other official rules and guidelines established for use with the mandated outpatient procedure code sets.
11. Assigns appropriate discharge physician in the system.
12. Generates compliant physician queries to clarify any incomplete/ambiguous or conflicting documentation and applies post-query responses to make final coding determinations.
13. Demonstrates basic knowledge of the impact of coding decisions on revenue cycle.
14. Assists in the education of physicians and other clinicians by advocating proper documentation practices, further specificity, resequencing and inclusion of diagnoses or procedures when needed to more accurately reflect the acuity, severity of illness and risk of mortality as indicated..
15. Attends and participates in required hospital education programs in order to maintain and enhance their coding skills and stay abreast of changes in codes, coding guidelines and regulations.
16. Maintains the minimum data standards for accuracy and efficiency as defined by the facility.
17. Maintains certified coding credentials in accordance with the certified coding requirements and demonstrates annual compliance.
18. Performs related duties, as required.

ADA Essential Functions

Job Qualifications:

• Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Specialist-Physician (CCSP), Certified Inpatient Coder (CIC), or Certified Outpatient Coder (COC), required.
• Successful completion of a medical coding course, required.

AND

Minimum of two (2) year experience as an ICD-10 Outpatient/Inpatient medical records coder, in an acute care facility, required.

Competent in the utilization of an electronic medical record, and computerized coding/abstracting systems, required. Experience with Computer Assisted Coding preferred.

Additional Salary Detail:

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member’s base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity

The salary range for this position is $39.68-$46.26/hour

Revenue Integrity / RN Senior Consultant

Office Location:Homebased – US

Introduction to Craneware

Lets transform the business of healthcare! At The Craneware Group, we are dedicated to empowering our customers with industry-defining insights that pave the way for a brighter future.

If you are an energetic, forward-thinking inidual with a passion for innovation, we invite you to join our thriving team of more than 750 dedicated professionals. Together, we’ll fuel the expansion of our SaaS platform and develop cutting-edge applications that redefine the healthcare landscape.

The Team

At The Craneware Group, we have a talented mix of employees from erse backgrounds, which brings a high level of innovation and collaboration to deliver excellent customer service. We are currently seeking an experiencedRevenue Integrity/Registered Nurse Senior Consultantto join our team. We are seeking an RN with Revenue Integrity Experience who is AAPC certified, with 3 5 years of experience in claims auditing and appeals writing.

Come join a seasoned team of Clinical Revenue Integrity industry experts. If you are looking for a fast-paced position where you can apply your clinical and revenue integrity skills, while driving project from end to end, this may be the perfect position for you. This position allows you to be innovative along with your colleagues to support Customers from a Clinical Revenue Integrity perspective.

You Will Be

• Assessing andanalyzingServices offerings provided by Consulting; Document Best Practice;DriveContinuous Process Improvement.
• Acting as a resource/go-to person for TCG key stakeholders (i.e., Product Management, Development, Sales, Customer facing teams).
• Providingmastery level consulting to hospitals seeking insights and guidance to ensure best practices.
• Servingas a Project Manager to oversee the daily operations of the specific services provided to ensure best practices.
• Completingrevenue cycle assessments by reviewing current operations and conducting key interviews to identify opportunities for improvement.
• Performing comprehensive assessments of charge capture and reconciliation procedures to ensure all services provided are charged.
• Assessing charge ticket and interface mappings to the CDM to identify discrepancies.
• Testing claim logic within billing and scrubber systems to ensure accurate flow of coded data to the bill and to the payor.
• Conducting CDM reviews to assure all lines are coded correctly and all services rendered are available to charge.
• Conducting audits to assess the accuracy and completeness of the bills, coding, medical record documentation, and/or level of care assignment to ensure regulatory compliance and maximize revenue opportunities.
• Reviewing medical records and utilize clinical knowledge and regulatory guidance as well as knowledge of payer requirements to determine reasons for denial and whether an appeal is warranted.

You Will Bring

• Educated toBachelorDegreelevel
• RN, BSN, CPC, COC or CCS certification
• 7+ years experience in specific services provided and healthcare operations
• 5 years experience managing project teams
• In-depth knowledge and understanding of healthcare services, health information technology, regulatory requirements, clinical data management, project management
• Exceptional communication skills both written and verbal
• Dedication to staying current with industry changes and advances
• 5+ years experience working with commonly used financial systems and transaction processing systems such as EPIC, McKesson, Cerner, Meditech, Paragon, CPSI, GE, and Siemens
• Proficiency with Microsoft Office and associated TCG products
• Research and analysis skills
• Demonstrates a high level of commitment to superior customer satisfaction through the entire duration of the customer relationship.
• Highly accountable and results oriented, burning desire to get things done and a sense of urgency, resourceful with excellent planning skills
• AAPCCertification with 3-5 yearsexperiencein claims auditingand appealswriting

AAPC Certification with 3-5 years experience

Utilization Management Nurse Reviewer

RemoteUnited States

Description

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of medical procedures, tests, and treatments.

Utilization Management Nurse Reviewers collaborate with healthcare providers, insurance companies, and patients to optimize healthcare delivery, control costs, and maintain quality care. Their responsibilities include assessing medical necessity, coordinating care, conducting utilization reviews, providing recommendations for care plans, and ensuring adherence to regulations and guidelines. This role requires strong clinical knowledge, critical thinking skills, communication abilities, and the ability to make informed decisions regarding patient care pathways.

Shift Times:

• 9 am start time
• 11:00am start time
• weekend shift 10 hours (Thurs- Sun) Start time 8 am.

MAJOR DUTIES & RESPONSIBILITIES

• Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria).
• Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services.
• Offer clinical expertise and serve as a clinical reference for non-clinical staff members.
• Input and manage essential clinical details within various medical management platforms.
• Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review.
• Apply clinical reasoning to determine the suitable evidence-based guidelines.
• Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director.

Requirements

• Proficient in both written and spoken communication.
• Capable of maintaining professional communication with physicians and clients.
• Skilled at handling multiple tasks and adjusting swiftly in a dynamic office setting.
• Possesses a keen organizational sense and pays close attention to details.
• Adept at resolving intricate and multifaceted problems.
• Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook.
• Background in medical or clinical practice through education, training, or professional engagement.
• Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a nursing degree from an accredited college (for RNs).

Additional Duties

• May provide oversight to the work of the team members.
• Continuously improves processes that help to facilitate better turnaround time, peer to peer success rates and lessens returned reports by clients for clarification purposes, ultimately resulting in higher client satisfaction.
• Responsible for the final approval on cases for release to the client.
• Will act as a liaison and coordinate quality issue reports along with all new reviewer reports with the VP of Clinical Operations.

EDUCATION/CREDENTIALS:

Licensed Practical/Vocational Nurse with an active and unrestricted license to practice.

JOB RELEVANT EXPERIENCE:

2 yrs minimum clinical nursing experience is required. One year of previous experience in Utilization Management is preferred.

JOB RELATED SKILLS/COMPETENCIES:

Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills. Possess a proficient understanding of computer operations, particularly the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows. Show the capability to acquire new skills and competencies to address the evolving requirements of systems, software, and hardware.

WORKING CONDITIONS/PHYSICAL DEMANDS:

Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.

WORK FROM HOME TECHNICAL REQUIREMENTS:

Supply and support their own internet services.

Maintaining an uninterrupted internet connection is a requirement of all work from home position.

Benefits

We offer generous Paid Time Off, excellent benefits package and a competitive salary. Apple equipment and media stipend is provided for remote work space. Come up to speed quickly with our strong training program! If you want to work in an exciting, fast-paced environment where you can provide meaningful contributions, then we encourage you to apply.

Executive Editor

Location:Remote, United States

• Product Development
• Professional
• Remote

Overview

Build the Future

When was the last time you experienced the impact of your work? Our ProfessionalEducationproduct team thrives on building meaningful relationships with innovative medical authors and Educators.

How can you make an impact?

As TheExecutive Editoryou will be reporting to the Senior Publisher of Medical Content and will be responsible for managing the revision and acquisition of titles across the allied health markets managing a large number of author teams and will also directly supervise Editors working within allied health and nursing practice.This is aremoteposition open to applicants within the United States

What you will be doing:

• Work with the Global Publisher set strategy for the main products in the MHP allied health lists.
• Propose 5-10 new and revised book contracts per year and publish 5-10 books per year.
• Manage MHPs publishing lines in physical therapy and pharmacy and establish productive working relationships with author teams.
• Work with the Global Publisher and platform team to identify desirable content for the AccessPharmacy and AccessPhysiotherapy subscription platforms, and acquire such content from credible sources.
• Represent the allied health lists to MHP sales, marketing, and user services teams.
• Manage 2-3 editors and provide guidance and direction for print and digital strategy and execution in those lists
• Align closely with internal platform and Product Management teams to produce product roadmaps and priorities for execution

You should apply if:

• 5 Years+ experience in editorial acquisitions and content development in medical publishing.
• Proven experience in strategic planning for an allied health market list.
• Knowledge of digital platforms and digital product development and maintenance a plus.
• Strong analysis, product development, management, and communication skills.
• Demonstrated successfulcontractnegotiation and implementation skills.
• Digital content development
• Working knowledge of digital platform and content workflows
• Roadmap planning and execution
• Strong project management skills, including the ability to manage collaboration across internal departments.
• Outstanding writing and presentation skills.
• BA/BSdegreerequired.

Why work for us?

The work you do at McGraw Hill will be work that matters. We are collectively designing content that will build the future ofeducation. Play your part and experience a sense of fulfilment that will inspire you to even greater heights. If you are curious, open to new ideas and ready to make a difference, we want to talk to you.

The pay range for this position is between $100,000 – $130,000 annually; however, base pay offered may vary depending on job-related knowledge, skills, experience and location.An annual bonus plan may be provided as part of the compensation package, in addition to a full range of medical and/or other benefits, depending on the position offered.

Manager, HCC Risk Adjustment Coding

Remote, United States

Datavant is a data logistics company for healthcare whose products and solutions enable organizations to move and connect data securely. We are a data logistics company for healthcare whose products and solutions enable organizations to move and connect data securely. Datavant has a network of networks consisting of thousands of organizations, more than 70,000 hospitals and clinics, 70% of the 100 largest health systems, and an ecosystem of 500+ real-world data partners.

By joining Datavant today, youre stepping onto a highly collaborative, remote-first team that is passionate about creating transformative change in healthcare. We hire for three traits: we want people who are smart, nice, and get things done. We invest in our people and believe in hiring for high-potential and humble iniduals who can rapidly grow their responsibilities as the company scales. Datavant is a distributed, remote-first team, and we empower Datavanters to shape their working environment in a way that suits their needs.

What we need

Manager, HCC Codingis responsible forthe oversight and management of coding production, quality, and vendor management. This roleis responsible forensuring adherence to departmental goals, quality standards, metrics, policies, etc. They will provide leadership and guidanceregardingactivity, status, trends, coaching/feedback methods and coordination ofadditionalresources to support coding production and quality.

You Will:

• Create and manage teams daily, weekly and monthly production and quality goals to ensure that department objectives are met.
• Cross functional collaboration to ensure that QA, trends and education is provided timely and accurately to team members.
• Maintain internal coding policies and procedures to ensure compliance, coding consistency and up to date coding practices.
• Oversee onboarding, staffing plans and staff performance to ensure optimal talent management and utilization.
• Effective team management and utilization to achieve coding operational KPIs.
• Accountability and mentoring of supervisors and staff to business values and coding operations KPIs
• Reporting to coding leadership on business trends and project coding patterns as well as an obstacles to achieving KPIs or deadline.
• Collaboration with the Training/Education Department with a focus on content development/design, training coordination and facilitation
• Manage all aspects of the Auditing and Quality Department for remote coding teams as well as field teams as necessary.
• Monitor and report effectiveness of training programs from research, benchmark, propose training and development opportunities to drive continuous improvement.
• Approve team members PTO and manage staffs time out of office while continuing to meet department Auditing and Quality goals.
• Knowledge and expertise in use of NLP and AI technology in coding business.
• Collaboration with coding production to achieve 95% coding quality accuracy at project level.
• Accountability and mentoring of quality and audit supervisors and audit staff to business values and coding operations KPIs.
• Vendor oversight performing production and quality oversight for both onshore and offshore vendors.
• Facilitate communication in regards to production and quality KPI metrics with vendors.
• Monthly reconciliation of vendor performance metrics to assist with billing and SLA penalties if applicable.
• Provide operational assistance to vendors regarding training, project assignment and system support.
• Business related travel up to 20%.

What You Will Bring to the Table:

• Bachelors Degree or a minimum of five years of equivalent experience in quality and/or coding management role(s) with increasing level of responsibility.
• A minimum of 5 years of experience in risk adjustment coding and/or auditing experience.
• Experience with adult learning methodologies and distance learning preferred
• Excellent written and oral communication skills.
• Strong managerial, leadership, and interpersonal skills.
• Outstanding organizational skills.
• Ability to communicate effectively with all levels of the organization.
• Ability to work effectively in a remote, team environment.
• Flexibility in work schedule to meet departmental needs.
• Strong analytical and problem-solving skills to grasp the key points from complicated details and provide direction/ coaching to members of the team.
• A strongknowledge base of medical terminology, medical abbreviations, pharmacology and disease processes.
• Ability to analyze data to determine the root cause of identified quality/production concerns.
• Must be able to follow instructions, meet deadlines and work independently.
• Intermediate Excel skills and the ability to use other Microsoft applications
• Working knowledge of the business use of computer hardware and software to ensure effectiveness and quality of the processing and security of the data.
• AHIMA certified credentials (RHIA, RHIT, CCS) or AAPC certified credentials (CPC, CPC-H, COC, CIC, or CRC)

Nurse Clinical Reviewer – RN (Remote U.S.)

Remote

United States

Operations

Full time

ZNE

Job Description:

CNSI and Kepro are now Acentra Health! Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the companys mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes making this a great time to join our team of passionate iniduals dedicated to being a vital partner for health solutions in the public sector.

Acentra seeks a Nurse Clinical Reviewer RN (Remote U.S.) to join our growing team.

Job Summary:

Our Nurse Clinical Reviewer RN will use clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and decision-making skills to determine medical appropriateness while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with NCQA, URAC, and other regulatory standards.

Job Responsibilities:

• Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care.
• Determines if the medical record documentation supports the need for services.
• Determines approval or initiates a referral to the physician consultant and processes physician consultant decisions ensuring the reason for the denial is described in sufficient detail on correspondence.
• Fosters positive and professional relationships and acts as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
• Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for review.
• Always maintains medical records confidentiality through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies.
• Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following Acentra policies, procedures, and guidelines.
• Actively cross-trains to perform duties of other contracts within the Acentra network to provide a flexible workforce to meet client/consumer needs.
• Other duties as assigned.

Requirements

Required Qualifications/Experience:

• Active unrestricted RN license in the State of North Dakota or a compact state license.
• Utilization Review (UR) and/or Prior Authorization or related experience.
• Direct experience in a clinical setting or other applicable State and/or Compact State clinical experience.
• Strong clinical assessment and critical thinking skills.
• Knowledge of InterQual OR American Society of Addiction Medicine (ASAM) guidelines.
• Ability to prioritize, assign, and follow up on work.
• Ability to problem solve.
• Ability to provide technical consultation and policy interpretation.
• Excellent customer service.
• Excellent written and verbal communication skills.
• Microsoft Office basic skills.

Preferred Qualifications/Experience:

• Knowledge of InterQual OR American Society of Addiction Medicine (ASAM) criteria.
• Knowledge of current National Committee for Quality Assurance (NCQA)/Utilization Review Accreditation Commission (URAC) standards.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people’s lives nationwide. Our company cares about our employees, giving you the tools and encouragement you need to achieve the finest work of your career.

Thank You!

We know your time is valuable, and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may interest you. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra.com/careers/

EOE AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide additional protection, security, and support for your career and life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay range for this position is $36.06 – 38.47 / hour.

Based on our compensation philosophy, an applicants placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.

Customer Care Nurse

Location:United States -Remote

100%Remote

Full time

Customer Care Nurse – CQ09CN

Were determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals and to help others accomplish theirs, too. Join our team as we help shape the future.

Our team is committed to driving profitability by delivering exceptional customer service, great claim outcomes and returning people to work! We have some of the best claims leaders and handlers in the industry!As a Customer Care Nurse, you will work in a fast-paced incoming call environment where you play a pivotal role in the claim intake process for an injured claimant! This dynamic and experienced team of medical professionals work remotely across the United States to facilitate Short-Term (STD) and Long-Term Disability (LTD) case files. The successful Customer Care Nurse typically handles 35-40 calls per day which allow them to obtain critical medical information relevant to the disability claim file. During these short 15 minute intake calls, the Customer Care Nurses use their keen clinical skillset to assess, document and review the medical acuity of a claimants condition. Our exceptional team of clinical professionals model empathy and compassion as they walk the claimant thru the intake process.

RESPONSIBILITIES:

• Provide the claimant with the explanation of intake and subsequent claims process expectations
• Effectively assess, evaluate and document a claimants medical information to initiate the claim process while simultaneously reviewing functional limitations or work accommodations
• Gather medically diagnosed restrictions and/or limitations for Return To Work expectations
• Determine the medical complexity and appropriate assignment duration and/or a medical milestone for the assigned claim
• Accurately enter employee/employer/physician intake information into our claim technology platform for the appropriate tracking of all clinical impressions which enables a Claims Ability Analyst to facilitate a claimdecision based on a claimants functional condition
• Effectively communicate complex medical information to a claimant in a clear, simple and concise manner
• Demonstrate sound medical knowledge and clinical assessment in a time-sensitive claim intake

QUALIFICATIONS:

• Prefer candidates in either the West or Central time zones
• An active LPN/LVN license is required, RN licenses will be considered
• Minimum of 12 months of practicing clinical experience with broad spectrum knowledge about anatomy and physiology
• Clinical Case Management experience preferred
• Excellent communication skills (oral/written)
• Excellent keyboard/automation skills
• Working proficiency of MS Office (Word, Excel, Outlook & PowerPoint)

ADDITIONAL INFORMATION:

• Start date: Monday, June 3rd, 2024
• Location: This is a 100% remote, work from home opportunity
• Training hours: 10:00 AM – 6:30 PM EST, Monday thru Friday for the first 8 weeks of employment. Time off during training is not accommodated
• Post training: 11:30 AM – 8:00 PM EST, Monday thru Friday
• Internet Connectivity Requirement/Remote Positions: For 100% remote positions, we require that (1) you have high speed broadband cable internet service with minimum upload/download speeds of 10Mbps/100Mbps and (2) your Internet provider supplied device is to be hardwired to the Hartford issued router and/or computer. To confirm whether your Internet system has sufficient speeds, please visit http://www.speedtest.net from your personal computer.

Compensation

The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartfords total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:

$63,760 – $95,640

Telehealth Nurse Practitioner

Location:Remote, USA

Contract

Department

Operations

ImmediateRemoteWork Opportunity – Competitive Pay!

Expand your practice, earn additional income, and gain flexibility and balance in your career.

Wheel is seeking nurse practitioners with multiple state licenses to join our network of world-class clinicians deliveringvirtualcare. This role will supportone of our fastest-growing clientswho challenges the notion that providing high-quality, accessible health care is unachievable and has created a system where quality care is affordable and available to everyone.

This is a unique opportunity with Wheel, where you will work with one highly reputable client that provides nationwide care on avirtualplatform, treating adult and pediatric patients with primary care needs. You will have ongoing support from Wheels clinical leadership and administrative team so you can focus on what you do best and deliver qualityvirtualcare to patients.

Benefits:

• 100 %Remote. Provide rewarding patient care from the comfort and safety of yourhomeor office.
• Competitive Salary.This client offers a very competitive hourly rate.
• Equipment.This client will provide you with a company laptop.
• Work on your schedule.Create your own schedule and work when you want, whether thats evenings,part-time, or full-time.
• Clinician community. Join a collaborative community of clinicians working invirtualcare.
• Clinical, operational, administrative, and technical support.Wheel works to offer guidance and support for yourvirtualcare practice, handling payments, credentialing, training, and more.
• Simple to use.Utilize our secure and HIPAA-compliant platform, including video conferencing, scheduling, and patient information tools.
• We protect clinicians. We vet all of our telehealth company partners for clinical safety and standard-of-care procedures to help protect your clinical practice. We also provide liability insurance coverage.

Requirements:

• Multiple-state licensed as a Nurse Practitioner including at least one of the following states – CA, NY, or DC
• 3+ years of experience as a nurse practitioner within Primary Care
• Desire to perform synchronous and asynchronous patient visits
• Experience and willingness to treat pediatric patients
• Minimum 10 hrs/week (roughly 40 hrs per month) with at least 8 weekend hours per month
• Outstanding clinical expertise
• A passion for human-centered primary care
• The ability to successfully communicate with and provide care to iniduals of all backgrounds
• The ability to effectively use technology with little to no assistance to deliver high-quality care
• Clinical proficiency in evidence-based primary care
• The desire to be an integral part of a team dedicated to changing healthcare delivery
• Strong verbal and written communication skills

This is a 1099 Contractor position.

About Wheel

Wheel offers a better way to work invirtualcare by enabling clinicians to work with multiple telehealth companies all in one platform. Clinicians in our nationwide network are credentialed, trained, and matched with vetted companies delivering the highest quality patient care. With Wheel, you can build yourvirtualcare practice on aflexibleschedule, see more patients, and start earning additional income on your terms.

Our mission is to change the way healthcare works by focusing on clinicians, because happier clinicians make healthier patients. Based in Austin, Wheel has delivered nearly a million patient consults and has a 90% clinician retention rate. We help clinicians like you gain freedom and flexibility with opportunities invirtualcare, so apply to join The Wheel Care Team today!

Remote Medical Coder- Interventional Radiology/Cardiac Cath

US – Remote (Any location)

Full time

17721

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Do:

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 for interventional radiology and cardiac cath for facility coding. Under the direction of the coding managerthe coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. What You Will Need:

• 3-5 years ICD-10 and CPT coding experience
• 1-5 years minimum experience coding outpatient hospital interventional radiology and cardiac cath
• Must have one of the following credentials: CCS, CPC, RHIA, RHIT, or COC
• High school diploma or equivalent

What Would Be Nice To Have:

• Strong knowledge and application of government and other payer guidelines as they relate to compliant coding.
• Strong knowledge of Revenue Integrity and/or medical necessity requirements
• Experience in professional coding for intentional radiology and cardiac cath.

#Indeedsponsored

#LI- Remote

The annual salary range for this position is $43,400.00-$65,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

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

Benefits include:

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

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Title: Clinical Triage Coordinator

Location: Remote

Job Description:

About Kindbody

Kindbody is a leading fertility clinic network and global family-building benefits provider for employers offering the full-spectrum of reproductive care from preconception to postpartum through menopause. Kindbody is the trusted fertility benefits provider for 127 leading employers, covering more than 2.7 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 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 $315 million in funding from leading investors.

Founded in 2018, CB Insights recognized Kindbody as one of the worlds promising health companies. Kindbody was named to Inc.s Best In Business list of most admired companies, Forbes Best Startup Employers, Fast Companys Brands that Matter, 2023 Linkedin Top 50 Startups list, and Fierce Healthcare named Kindbody to its Fierce 15 list of 2022, which recognizes the most promising healthcare companies in the industry world. Kindbody was named to the 2023 CNBC Disruptor 50 list for revolutionizing the way fertility care is delivered in the U.S.

About the Role

As an experienced Nurse Triage Coordinator reporting to our Director of Clinical Services, 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 remote position.

The hours will be determined based on availability and need, with occasional weekend and holiday shifts.

Nursing Support Responsibilities:

• Act as a liaison between CX and clinical support
• Develop and maintain key clinical FAQs and scripts for CX
• Handle all inbound patient questions regarding cycle management, pharmacy logistics, emergent clinical needs that enter through messaging platforms and phone lines
• Manage all inbound secure messages for medical team

Nursing Responsibilities:

• Work with team to oversee patients cycling questions – injection administration questions, consent questions, medication questions, and answer general process questions throughout the cycle
• Provides patient/couple counseling, procedure teaching, communicates physician orders and instructions
• Ensure all patient information is documented appropriately in our EMR according to our procedures
• Establishes a compassionate environment by providing emotional and psychological support to patients and patients families
• Works independently to assure the program goals are achieved
• Support and promote excellence in customer service
• Provide feedback to HQ on process improvement and job specifications to help gain efficiencies in your day to day

Who you are:

• 1-2 years experience as a nurse in a fertility practice or Ob/GYN
• Current Registered Nurse license
• Experienced in EMR and G-Suite
• Experience in and a passion for womens health & fertility
• Strong communication skills & a team player
• Willingness to be flexible and roll with the punches
• Detail oriented
• Exemplifies strong customer service skills and professionalism

Perks and Benefits

Compensation Range for this role is approximately $50,000-$60,000 depending on experience and education.

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; equity offering, 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 employeesto be fully vaccinated against COVID-19. However, some states are requiring that all healthcareworkers be fully vaccinated. Candidates seeking employment at Kindbody in the following stateswill be required to be fully vaccinated against COVID-19 and provide proof of your COVID-19vaccine prior to your start date of employment: New York. 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. If this is a remote position, the requirement would not apply.

Kindbody is an Equal Employment Opportunity employer. We strongly support the principles of equal employment opportunity in all of our employment and hiring policies and practices and believe that a more erse and inclusive workplace will benefit our patients, care partners, and Kindbody employees. We administer our employment and hiring policies and practices without regard to race, color, religion, sex, gender, gender identity, gender expression, pregnancy, citizenship, national origin, ancestry, age, disability, medical condition, military service, military or veteran status, genetic information, creed, marital status, sexual orientation, or any other status protected by federal, state, or local law.

Remote opportunity – Open to candidates anywhere in the greater United States

SUMMARY:

The Medical Director, Medical Affairs will serve as one of the internal medical affairs experts for the USMA function and medical & scientific expert for assigned brand (s) under a therapeutic area. The medical director will ensure the team develops strong strategic input in pursuit of co-development of brand strategy. The medical director is responsible for building and growing strong internal relationships (e.g. US Brand Teams, Global Medical Affairs) as well as external relationships ensuring accurate, robust, and appropriate medical/scientific exchange of knowledge and clinical expertise. The medical director will work closely with Sr. Medical Director and serve as the internal medical/scientific US cross-functional and cross-Alliance (if applicable) point of contact (Global, Clinical Development, Health Outcomes, Scientific Communications, Regulatory, Brand Teams, etc.) driving corporate objectives and goals.

ESSENTIAL FUNCTIONS:

• By leading the Brand Medical Strategy the Medical Director will ensure the co-development of brand overall strategy in alignment with cross-functional and, if applicable, cross-alliance partners .
• Responsible for keeping intimately aware on evolving disease areas trends to continuously anticipate changes and assess impact to US and Global scientific and brand strategy.
• Builds strong networks in the US medical community by developing relationships with key opinion leaders in the scientific community; building productive relationships with investigators, thought leaders and centers of excellence across the scientific community.
• The Medical Director will work closely with Sr. Medical Director to define the most effective strategy team structure depending on business needs (i.e. Medical Strategy Teams, Brand Team Meetings, Global)
• Leads brand evidence generation plans working closely with Value Evidence and participates in the local clinical and IIT proposal process by the development and review of proposals and protocols of studies.
• Provides medical input and serves as first point escalation into Promotional Advertising Review Committee for all promotional and external materials, and participation in Labeling meetings, where appropriate, with sign-off authorization
• Provides US medical and scientific input to the pharmacovigilance group (may serve as member of the safety committee) regulatory documents and interactions
• Depending on size and needs of the team the medical director will lead, manage, coach, and develop team members (such as Associate Directors) to support high performance, and to align with strategic direction for Lundbeck

REQUIRED EDUCATION, EXPERIENCE and SKILLS:

• Accredited advanced clinical and/or scientific degree MD, PharmD, DNP, PhD.
• 6+ years of progressive medical/scientific affairs experience within the pharmaceutical, biotech industry or at a consulting firm that supports the pharmaceutical or biotech industry; at least 3 years driving medical strategy
• Strong experience of collaborating with cross-functional teams, global medical affairs, and commercial teams. Previous experience with alliance partners is a plus.
• Ability for building partnerships and working collaboratively with others to meet shared objectives.
• Strong interpersonal skills to work closely with both external physicians/scientists and in-house cross-functional teams
• High proficiency in driving decision-making, problem-solving ability and strong scientific analytical skills
• Excellent planning and organization skills.
• Ability to maintain the highest degree of confidentiality and integrity, representing the company’s high ethics, moral behavior, and professionalism.

PREFERRED EDUCATION, EXPERIENCE AND SKILLS:

• Medical Degree
• Clinical or Pharma experience in Therapeutic Area highly desired
• Clinical experience within academia or clinical practice desired
• Specialty MD training in Therapeutic Area (board certification or eligibility in psychiatry or neurology).
• Experience in product launches and/or conducting clinical studies
• Management and professional development of staff at several levels
• Experience with copy approval and promotional review
• Regulatory knowledge and exposure, including experience with FDA.

TRAVEL

• Willingness/Ability to travel up to 40% domestically. International travel may be required.

The range displayed is a national range, and if selected for this role, may vary based on various factors such as the candidate’s geographical location, qualifications, skills, competencies and proficiency for the role.Salary Pay Range:$230,000 – $280,000andeligibilityfor a25%bonustargetbased on company and inidual performance,and eligibilityto participate in the company’s long-term incentive plan.Benefits for this position include flexible paid time off (PTO), health benefits to include Medical, Dental and Vision, and company match 401k.Additional benefits information can be found onour site . #LI-LM1, #LI-Remote

Why Lundbeck

Lundbeck offers a robust and comprehensive benefits package to help employees live well and protect their health, family, and everyday life. Information regarding our benefit offering can be found on theU.S. career site (https://www.lundbeck.com/content/dam/lundbeck-com/americas/united-states/careers/Lundbeck_Benefits_Summary.pdf) .

Lundbeck is committed to working with and providing reasonable accommodations to disabled veterans and other iniduals with disabilities during our employment application process. If, because of a disability, you need a reasonable accommodation for any part of the application process, please visit theU.S. career site (https://www.lundbeck.com/us/careers/your-job/eeo-accommodations-policy) .

Lundbeck is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, protected veteran status, and any other characteristic protected by law, rule, or regulation. Lundbeck participates inE-Verify (https://www.lundbeck.com/content/dam/lundbeck-com/americas/united-states/careers/E-Verify_Participation_Poster_Eng_Es.pdf) .

About Lundbeck

Lundbeck is a global pharmaceutical company specialized in brain diseases. For more than 70 years, we have been at the forefront of neuroscience research.

We are tirelessly dedicated to restoring brain health, so every person can be their best. We are committed to fighting stigma and discrimination against people living with brain diseases and advocating for broader social acceptance of people with brain health conditions. Our research programs tackle some of the most complex challenges in neuroscience, and our pipeline is focused on bringing forward transformative treatments for brain diseases for which there are few, if any therapeutic options.

About Lundbeck

Lundbeck is a global pharmaceutical company specialized in brain diseases. For more than 70 years, we have been at the forefront of neuroscience research.

We are tirelessly dedicated to restoring brain health, so every person can be their best. We are committed to fighting stigma and discrimination against people living with brain diseases and advocating for broader social acceptance of people with brain health conditions. Our research programs tackle some of the most complex challenges in neuroscience, and our pipeline is focused on bringing forward transformative treatments for brain diseases for which there are few, if any therapeutic options.

Patient Advocate – Medical Assistant

Location: United States

Remote

Category

Clinical / Utililization Management

OVERVIEW

As a Patient Advocate, you will work in a high-volume call center environment making outbound calls to patients recently discharged from the hospital and answering inbound calls from a queue.

You will ask non-clinical triage questions to determine if the Nurse Coach program could be beneficial to athomerecovery or if other services are needed, such as transportation to doctors appointments.You will collect and document required data for end-to-end care to support the clinical program goals. For patients further along in the program, you will contact patients to ensure successful recovering athome.

Schedule Options:

Tuesday-Saturday 9am-6pm EST (Sun/Mon OFF) or Sun-Thursday 9am-6pm EST ( Fri/Sat OFF)

Hiring for multiple positions!

Location 100%Remote

Hourly Rate– $18/hr plus monthly bonus incentive program

Training & Nesting Period 3 to 5 Weeks

Training & Nesting Hours Monday Friday 8:30am 5:30pm EST

Available Shift After Training & Nesting: Tuesday-Saturday 9am-6pm EST (Sun/Mon OFF)ORSun-Thursday 9am-6pm EST ( Fri/Sat OFF)

Responsibilities

In this role, you will:

• Resolve non-clinical issues for patients, including answering questions and/or setting them up for a Nurse Coach assessment.
• Coordinate care for patients.
• Communicate with physicians and clinical staff regarding patient care.
• Support clinicians to ensure service levels and requirements are met.
• Escalate issues to Nurse Coaches or management as needed.
• Participate in and contribute to performance and process improvement activities.
• Perform other duties as needed.

This role is for you if:

• You can gain/build instant rapport with people over the phone.
• You have great empathy and the patience to deal with difficult callers or complex requests.
• You are results driven with strong attention to detail.
• You can comply with all company policies, including HIPAA/PHI policy.
• You strive to meet/exceed inidual performance goals in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives.
• You are fun to work with! We are looking for team members who bring joy to the work they do.

QUALIFICATIONS

• High School Diploma or GED.
• 1 year of experience working in the healthcare or medical services industry as a Medical Assistant required.
• 1 year Customer Service experience in a call center environment preferred.
• Ability to navigate dual monitors and multiple applications.
• Intermediate keyboarding abilities (at least 30 WPM, data entry while active listening).
• Basic PC & Search Engine abilities (for example: use the mouse to click, troubleshooting, working with Microsoft Office including basic Word and Excel, opening a browser, typing in URLs in the right location, bookmarking a site, and navigating the use of back/forward buttons).

What we offer:

• Starting Pay for external hires is $18.00 / hour + Monthly Incentive Bonus Opportunity.
• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
• Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demandVirtualFitness Training and more.
• Advancement Opportunities, professional skills training, and tuition /exam reimbursement.
• PayActiv – access earned income in between paychecks.
• Walgreens Discount – receive up to 25% off eligible items.
• Great culture with a sense of community.

Title: Hospital Coding Specialist III (Remote)

Location: WI-Beaver Dam

Job Description:

Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!

Job Title:

Hospital Coding Specialist III (Remote)

Cost Center:

101651098 HIM-Facility Coding

Scheduled Weekly Hours:

40

Employee Type:

Regular

Work Shift:

Mon-Fri; day shifts (United States of America)

JOB SUMMARY

Hospital Inpatient Coding:

The Hospital Coding Specialist III accurately codes inpatient conditions and procedures as documented in the International Classification of Diseases (ICD) Official Guidelines for Coding and Reporting and in the Uniform Hospital Discharge Data Set (UHDDS) and assignment of the appropriate MS-DRG (Medicare Severity-Diagnosis Related Group) or APR-DRG (All Patients Refined Diagnosis Related Groups) for complex, multi-specialty inpatient services. This inidual understands and applies applicable medical terminology, anatomy and physiology, surgical technology, pharmacology and disease processes. The Hospital Coding Specialist III reviews professional and hospital inpatient medical record documentation and properly identifies and assigns:

• ICD CM and PCS codes for all reportable diagnoses and procedures. This includes determining the correct principal diagnosis, co-morbidities and complications, secondary conditions, surgical procedures and/or other procedures.
• MS-DRG /APR-DRG
• Present on admission indicators
• HAC (Hospital Acquired conditions) and when required, report through established procedures
• PSI conditions and report through established procedures
• Discharge Disposition code
• Works collaboratively with the Clinical Documentation Improvement Specialists to address documentation concerns and DRG assignments
• Assists in the preparation of responses to DRG validation requests and other third party payer inquiries related to coding and DRG assignments as requested

JOB QUALIFICATIONS

Minimum Required: Medical Coding Diploma or American Health Information Management Association (AHIMA) approved Health Information Management Degree or related program.

Preferred/Optional: None

EXPERIENCE

Minimum Required: Three years of progressive inpatient coding experience in an acute care facility in addition to the following;

• Knowledge of medical terminology, anatomy and physiology, pharmacology, disease process, and surgical procedures
• Knowledge of accepted medical abbreviations and their meanings
• Knowledge in the use of specialized references such as the ICD medical dictionaries and texts, and medical journals
• Must have extensive knowledge of Coding Clinic and all official coding guidelines
• Advanced knowledge of hospital information systems, encoders and other technology to facilitate a successful work environment while maintaining maximum communication and adhering to HIPAA security standards
• Advanced knowledge Microsoft Outlook, Excel and Word functions
• Technical skills required to learn and navigate a variety of software systems and trouble shoot computer problems
• Strong written and verbal communication skills
• Ability to think and work independently, yet interact positively with team
• Advanced problem solving skills
• Attention to detail is crucial to this position

Preferred/Optional: Experience with electronic health record systems. Academic or level I or II trauma experience is a plus.

CERTIFICATIONS/LICENSES

The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position

Minimum Required: Active credential of Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) through the American Health Information Management Association (AHIMA) required at the time of hire.

Preferred/Optional: None

Given employment and/or payroll requirements of inidual states, Marshfield Clinic Health System supports remote work in the following states:

Alabama

Alaska

Arkansas

Florida

Georgia

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Michigan

Minnesota

Mississippi

Missouri

Nebraska

North Carolina

North Dakota

Ohio

Oklahoma

South Carolina

South Dakota

Tennessee

Texas

Utah

West Virginia

Wisconsin

Wyoming

Marshfield Clinic Health System will not employ iniduals living in states not listed above.

Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.

At Marshfield Clinic Health System, we are fully committed to addressing health equity, ersity and inclusion for our employees and providers, our patients, and the communities we serve. We believe that every inidual should have the opportunity to attain their highest level of health. We embrace ersity and welcome differences in who we are and how we think. We believe that any inidual or group should feel welcomed, respected and valued. View our Equity and Inclusion Statement here.

Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.

Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

Nurse Care Manager (Senior Care Product) Field Based

WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Inidual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, no matter their circumstances.

Its an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

WellSense Health Planis recruiting for motivated, compassionate, mission-driven nurses to join our Senior Care Options (SCO) program clinical team. The SCO program is designed to deliver high-quality, compassionate care to seniors in their home. Were looking for nurses who are driven by a passion to serve the under-served and are committed to making a difference in elders lives.

The Care Manager serves a central role on an interdisciplinary team committed to helping seniors stay in their communities and maintain their independence. The Care Manager acts as the clinical link with the members Primary Care Team (PCT) which includes the Member, Caregiver(s), Primary Care Provider, community agency providers, pharmacists, social workers, and others involved with the Members care.

The Care Managers work is primarily conducted in the field and includesa variety of erse and complex face-to- face and telephonic care management responsibilities. The Care Manager provides care coordination for at-risk and complex iniduals through a member-centric, team-based approach. The Care Manager ensures the right care is provided in the right setting and at the right time.

Responsibilities include assessment, the development, implementation, and evaluation of the Inidual Plan of Care (IPC) and managing the members care through the health care continuum. Perform other duties as requested.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

KeyFunctions/Responsibilities:

• Manages a panel of high risk, medically complex members
• Completes timely initial and on-going face-to-face comprehensive assessments with Member to evaluate Members medical, behavioral health, functional status, and socioeconomic needs
• Administers MDS-HC assessments and other required assessment tools
• Facilitates meetings of the PCT and serves as clinical subject matter expert and advocate for Member
• Develops and communicates an Inidual Plan of Care (IPC) with Member, caregiver(s), providers and other PCT members to address identified needs and ensures its implementation
• Utilizes evidence-based guidelines to develop Inidualized Plans of Care (IPC)
• Evaluates the effectiveness of the IPC and progress against goals and reviews the IPC as needed
• Utilizes evidence-based guidelines to assist Member in understanding their disease process and increase their capacity for self-management and optimal health
• Utilizes data to ensure that clinical interventions result in improved clinical outcomes and appropriate utilization of services at the right time, right place, and right setting
• Evaluates the effectiveness of alternative care services and ensures that cost effective, quality care is
• Facilitates Member and caregiver access to community resources relevant to the Members needs
• Documents clinical assessments and coordination of care in the medical management information system in a timely manner that meets regulatory and accreditation standards
• Provides culturally competent care coordination in keeping with the Members racial, ethnic, linguistic and sexual orientation
• Facilitates sharing of essential clinical or psychosocial information related to the Members care
• Must become knowledgeable in the full contractual requirements of the Care Management agreement with EOHHS and CMS (D-SNP Agreements)
• Must become proficient in contracts with vendors and agencies of whom the company outsources for the population
• Maintains HIPAA standards and confidentiality of protected health information
• Reports critical incidents and information regarding quality of care issues
• Serves and participates in pertinent committees and meetings as needed
• Assists with new staff training
• Must use a cell phone and provide on-call services, per a rotating schedule
• Regular and reliable attendance is an essential function of this position
• Other duties as assigned

Qualifications:

Education:

• Registered Nurse
• Bachelors degree or an equivalent combination of education, training and experience is required

Preferred/Desirable:

• 3 years experience in Medical Case Management working with the geriatric population, preferred
• Masters degree in nursing, geriatric NP, or health related/public health field preferred
• Certification in case management (CCM) preferred

Certification or Conditions of Employment:

• Active Massachusetts RN license required

Competencies, Skills, and Attributes:

• Strong knowledge and use of the MDS-HC assessments and other required assessment tools
• Excellent clinical and assessment skills
• Experience with the Medicaid, Medicare, and Senior population
• Experience with ASAPs preferred
• Ability to work collaboratively and build strong relationships with providers, Members, and the PCT
• Proficiency in InterQual Level of Care through the continuum
• Excellent working knowledge of Windows and Microsoft Office products
• Must have the ability to use a laptop, or tablet for accessing the company systems to include documentation in the medical management information system
• Flexible, independent, self-starter with an ability to thrive in a fast paced environment
• Demonstrates commitment to quality
• Projects positive, team-oriented demeanor
• Demonstrates strong interpersonal skills including effective listening and ability to support, motivate and guide others
• Strong oral and written communication skills; ability to interact within all levels of the PCT
• Demonstrated ability to successfully plan, organize and manage within a person centered integrated care team
• Detail oriented

Working Conditions and Physical Effort:

• Attendance and participation at PCT meetings required which may include early mornings or evenings
• Travel within the SCO geographic network required

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Inidual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

Important info on employment offer scams:

According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not reach out to iniduals via text, we do not ask or require downloads of any applications, or apps, and applicant screenings, interviews and job offers are not conducted over text messages or social media platforms. We do not ask iniduals to purchase equipment for, or prior to employment. To avoid becoming a victim of an employment offer scam, please followthese tips from the FTC.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees.

Specialty Coder Inpatient Academic – REMOTE

locations

Remote

Oak Brook Support Center – 2025 Windsor Dr

time type

Full time

job requisition id

R99187

Department:

10407 Revenue Cycle – Facility Production Coding Inpatient

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

First shift Monday – Friday

This is a REMOTE opportunity. Desired Experience of coding challenging academic charts

Desired certification/s:

• Certified 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)
• This role will have all responsibilities of coder I, II and III in addition to: reviews complex inpatient documentation at a highly skilled and proficient level to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software.
• Adhere to organizational and internal department policies and procedures to ensure efficient work processes.
• Responsible for coding high dollar and long length of stay cases for all patient types.
• Expertise in query guidelines, and coding standards. Follow up and obtain clarification of inaccurate documentation as appropriate.
• Serves as a subject matter expert to Coding department leaders and peers. Recommends modifications to current policies and procedures as needed to coincide with government regulations.
• Maintain continuing education by attending webinars, reviewing updated CPT assistant guidelines and updated coding clinics. Knowledgeable in researching coding related topics and issues.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement.
• Collaborates with the Clinical Documentation Improvement and Quality teams, to ensure a match in the DRG and reconciles each Medicare case with the working DRGs from a CDI perspective.
• Responsible for clinician communication related to disease processes on a clinical level to ensure accurate coding.
• Participates in payer audits and meetings by acting as a resource for coding-related audits, as requested.
• Attends meetings with clinical teams regarding updates in codes for complex specialties.
• Maintains the confidentiality of patient records. Reports any perceived non-compliant practices to the coding leader or compliance officer.
• Meets and exceeds departmental quality (95% or more) and productivity standards (100%). Achieves productivity expectations to support discharged not final billed (DNFB).
• Performs any other assigned duties since the duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Licensure, Registration, and/or Certification Required:

• Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA)

Education Required:

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

Experience Required:

• Typically requires 7 years’ experience inpatient coding in acute care tertiary facility that includes experience in revenue cycle processes, Clinical Documentation Improvement, Research and health information workflows.

Knowledge, Skills & Abilities Required:

• Advanced profiency of ICD, CPT and HCPCS coding guidelines. Advanced knowledge of medical terminology, anatomy and physiology.
• Excellent computer skills including the use of Microsoft office products, electronic mail, including exposure or experience with electronic coding systems or applications.
• Excellent communication (oral and written) and interpersonal skills.
• Excellent organization, prioritization, and reading comprehension skills.
• Excellent analytical skills, with a high attention to detail.
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment.
• Ability to take initiative and work collaboratively with others.

Physical Requirements and Working Conditions:

• Exposed to a normal office environment.
• Must be able to sit for extended periods of time.
• Must be able tocontinuously concentrate.
• Position may be required to travel to other sites; therefore, may be exposed to road and weather hazards.
• Operates all equipment necessary to perform the job.
• This job description indicates the general nature and level of work expected of the incumbent. It is not designed
• to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Advocate Aurora Health is one of the 10th largest not-for-profit, integrated health systems in the U.S. with nearly 3 million patients served at more than 500 sites of care in Illinois and Wisconsin, including 28 hospitals. We’re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in a variety of specialties. Advocate Aurora Health is one of the 10th largest not-for-profit, integrated health systems in the U.S. with nearly 3 million patients served at more than 500 sites of care in Illinois and Wisconsin, including 28 hospitals. We’re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in a variety of specialties.

Title: Certified Medical Assistant (Contract)

Location: Nationwide

Workplace: remote

Category: Clinical Contractors

JobDescription:

Everly Health’s mission is to transform lives with modern, diagnostics-driven care, and we believe that the future of healthcare is meeting people where they are. Headquartered in Austin, Texas, Everly Health is the parent company to Everlywell, Everly Health Solutions, Natalist, and Everly Diagnostics. We’ve set a new standard of people-focused, diagnostic-driven care that puts patients at the center of their own health journey.

Our infrastructure guides the full testing experience with the support of a national clinician network that’s composed of hundreds of physicians, nurses, genetic counselors, PharmDs, and member care specialists. Our solutions make world-class virtual care more attainable with rigorous clinical protocols and best-in-class science to tackle some of the healthcare industry’s biggest problems.

We are looking for a certified medical assistant who is passionate about expanding access to care by providing assistance to our clinician teams to ensure an effective daily flow of the clinical practice in a telehealth setting.

Who You Are:

• Ensures completion and reconciliation of patient intake information.
• Ensures up-to-date EMR patient records and chart completion.
• Facilitates medical documentation.
• Provides follow-up with patients after consultation as appropriate.
• Manages clinical staff inbox with provider and enterprise oversight.
• Responsible for indexing of clinical patient records as requested.

Skills Required:

• High School diploma or equivalent.
• Completion of a nationally recognized accredited medical assistant training program.
• Must be in compliance with HIPAA regulations and our privacy policies.
• 1+ year of telehealth experience a plus.
• Must be tech savvy.
• Able and willing to learn/adjust to changes in protocols and/or workflows.
• Familiarity with EMR software.
• Athena EMR experience required

Benefits:

• Flexible schedule
• Professional Liability Insurance

Standard Shift:

• Day shift between the hours of 8:00am-8:00pm for a minimum of 16 hours a week.

Job Type:

• Full-time

Title: Clinical Data Abstractor

Location: United States

JobDescription:

At Carta Healthcare, we believe in a multidisciplinary approach to solving problems. Our mission is to automate and simplify the work that burns out clinical staff, so they can focus on patient care. Our AI Enabled Technology offers a complete solution (people, process and technology) to support the Healthcare Registry Data Market. We design products that transform the way hospitals use data to deliver care. We make analyzing data fast, easy, and useful for everyone. We give clinicians time back to focus on research and care that improve patient lives by reducing paperwork. Carta Healthcare is a remote organization with headquarters in San Francisco and Portland, Oregon.

To learn more about our AI Enabled Solutions and more about our company, please visit www.carta.healthcare

Were looking for Clinical Data Abstractors who will work under the direction of the Lead Data Abstractor to abstract and code information in the prescribed format to satisfy the requirements of the target registry by reviewing patient records and abstracting key data elements.

With the support of our software, Atlas, the Clinical Data Abstractor identifies and validates specific information abstracted and reported from various reports, medical records and electronic files. This critical role completes assignments within a designated time frame, with high accuracy and according to specifications.

We are pleased to offer flexible work schedules and a fully remote work environment. This will initially be a part-time role.

Required Qualifications :

• 2+ years direct Clinical Registry Abstraction experience for a Health System or Hospital
• Current abstracting experience. Actively abstracting within the past 12 months in one or more of the following clinical registries:
• CathPCI
• Chest Pain MI
• EPDI / ICD
• NCDR
• LAAO
• TVT
• AFib
• GWTG
• NSQIP – SCR Certified
• TQIP – CSTR Certified
• STS
• VQI
• Knowledge of basic medical terminology, proficiency in EMR, and exposure to a healthcare environment is appropriate.
• Ownership approach to workload, ability to work independently
• Organized with a high attention to detail and commitment to accuracy
• Team player who is collaborative with excellent communication skills
• Remote training and onboarding compatible
• Wants to grow with the company and believes in the mission

Responsibilities:

• Data collection and entry for multiple registries for Carta Healthcare clients
• Collaborate with nurse practitioners, physician assistants, physicians, other medical professionals to complete patient encounters
• Ensure quality submission of all data in specified registries maintaining a high accuracy threshold.
• Communicate with Carta team and reporting hospitals to streamline data management
• Provide data analysis to reporting hospital managers, as appropriate
• Keeps up to date on mandated regulatory/publicly reported data requirements as specified by federal, state, payer and other agencies.
• Any or other additional responsibilities as assigned

Bonus points:

• Prior experience working remotely
• Experience working with a SaaS, Healthtech or Software company
• RN or LPN credentials

The target wage range for this role is $28.00 -$32.00 per hour. Compensation decisions are dependent on multiple factors including but not limited to skills, experiences, licensure and certifications.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire. All applicants are required to residewithinthe continentalUnited States.

Carta Healthcare is dedicated to building a erse and inclusive company because we serve health systems across the country; weve seen how our product and impact are strengthened the more we reflect that ersity. In addition, we have found and strongly believe that erse teams are higher-performing, and we embrace the varied perspectives that our team members share with each other. As such, we are an Equal Opportunity Employer.

#LI-Remote #BI-Remote

Triage Oncology Registered Nurse- Remote

locations

United States

time type

Full time

job requisition id

JR12571

Country:

United States of America

Location:

Florida – Remote

WHY JOIN FCS

At Florida Cancer Specialists & Research Institute, we believe our people are our strength and we invest in them. In addition to having a positive impact on the people and communities we serve, associates benefit from significant professional opportunities, career advancement, training and competitive wages.

Offering competitive salaries and comprehensive benefits packages to include tuition reimbursement, 401-K match, pet and legal insurance.

A LITTLE BIT ABOUT FCS

Since 1984, Florida Cancer Specialists & Research Institute & Research Institute (FCS) has built a national reputation for excellence. With over 250 physicians, 220 nurse practitioners and physician assistants and nearly 100 locations in our network. Utilizing innovative clinical research, cutting-edge technologies, and advanced treatments, we are committed to providing world-class cancer care. We are recognized by the American Society of Clinical Oncology (ASCO) with a national Clinical Trials Participation Award, FCS offers patients access to more clinical trials than any private oncology practice in Florida. Our patients have access to ground-breaking therapies, in a community setting, and may participate in national clinical research studies of drugs and treatment protocols. In the past five years, the majority of new cancer drugs approved for use in the U.S. were studied in clinical trials with FCS participation prior to approval.

Through our partnership with Sarah Cannon, we are one of the largest clinical research organizations in the United States. Often, FCS leads the nation in initiating research studies and offering ground-breaking new therapies to patients.

Come join us today!

SUMMARY:

A Triage Nurse is a professional registered nurse with oncology-specific clinical knowledge that offers inidualized care and clinical guidance to patients, families, and caregivers to assist with ongoing healthcare needs.

PRIMARY TASKS AND RESPONSIBILITIES:

• Under general supervision, following established policies, procedures, and professional guidelines, provides care to patients by triaging oncology patient calls regarding treatment, surgery, and appointment information.
• Monitor and provide patient symptom management.
• Manage high risk, complex patient care with the goal of minimizing emergency department and inpatient readmission.

• Assess barriers to care to address patient, care giver, or family needs to achieve optimal patient outcome.
• Provide patient-centered inidualized ongoing education, resources, and referrals to internal and external resources to patient and caregivers.
• Assist the physician and PA-C/ARNP with specific patient/family interaction needed to resolve clinical issues.
• Complete requested clinical documentation as needed.
• Establish and maintain professional role boundaries with patients, caregivers, and the multidisciplinary care team in collaboration with manager as defined by job description
• Facilitate communication among members of the multidisciplinary cancer care team to prevent fragmented or delayed care that could adversely affect patient outcomes.
• Reviews, evaluates, and reports diagnostic tests to assess patient’s condition.
• Provides patient education and clinical direction by answering questions following chemotherapy, radiation, and infusion treatments and post-surgery.
• Work as an integral team player and is expected to adhere to and abide by the rules and regulations set forth by the Florida State Board of Nursing.

EDUCATION/CERTIFICATIONS & LICENSES:

• Registered Nurse multistate or Florida single state licensure required
• Minimum of Associate Degree in Nursing, Bachelors Degree preferred.
• Certification as an Oncology Certified Nurse (OCN) preferred

EXPERIENCE:

• Three (3) years or more of experience as an RN
• Two (2) years or more of oncology experience required

CORE COMPETENCIES, KNOWLEDGE/SKILLS/ABILITIES:

• Strong organizational skills
• Ability to prioritize and reprioritize quickly
• Ability to develop collaborative relationships both internally and externally
• Strong written communication skills
• Strong telephonic assessment and communication skills
• Ability to work autonomously and with a virtual team in a remote work environment
• Strong oncology side effect/ triage management
• Proficient in Microsoft Word, Excel, Outlook
• Possess high level critical-thinking skills

VALUES:

• Patient First Keeping the patient at the center of everything we do
• Accountability Taking responsibility for our actions
• Commitment & Care Upholding FCS vision through every action
• Team Working together, one team, one mission

Expectations for all Employees

Every FCS employee is expected to regularly conduct themselves in a professional and respectful manner, to comply with all labor laws, workplace policy and workplace practices. Employees are expected to bring issues of any forms of workplace harassment, discrimination or other potential improprieties to the attention of their management or the human resources department.

EEOC

Florida Cancer Specialists & Research Institute (FCS) is committed to helping iniduals with disabilities to participate in the workforce and ensure equal opportunity to compete for jobs. If you require an accommodation to submit a resume for positions at FCS, please email FCS Recruitment ([email protected]) for further assistance. Please note this email address is intended to request an accommodation as part of the application process. Any other correspondence will not receive a response.

FCS is an EEO/Affirmative Action Employer and does not discriminate on the basis of age, race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, protected veteran status, disability or any other legally protected status.

SCREENINGS Background, drug, and nicotine screens

Safeguarding our patients and each other is an important part of how we deliver the best care possible to the communities we serve. All offers of employment at Florida Cancer Specialists & Research Institute are contingent upon clear results of a thorough background screening. Additionally, as a condition of employment, FCS requires all new hires to receive various vaccinations, including the influenza vaccine, barring an approved exemption. In addition, FCS is a drug-free workplace, and all new hires will be subject to drug/ nicotine testing.

Title: Psychiatric Mental Health Nurse Practitioner (PMHNP) – Pennsylvania

Location: Remote (United States)

JobDescription:

Our Company:

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

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

• 82% of clientsreport an improvement in their anxiety symptoms after using Cerebral.
• 75% of clientswho report improvement in their depression see improvement within 60 days.
• 50% of clientswho initially report suicidal ideation no longer harbor suicidal thoughts after treatment with Cerebral.

This is just the beginning for Cerebral, and we wont stop building, growing, and iterating until everyone, everywhere can access high-quality, evidence-based mental health care without high costs and/or long wait times. Were looking for mission-driven leaders who share these values, and we need your help as we transform access to high-quality mental health care in the United States and beyond.

The Role:

We are hiring a full-time Psychiatric Mental Health Nurse Practitioner! Cerebral provides evidence-based treatment for adults seeking mental health care. Our telemedicine prescribers collaborate with Therapists and Psychiatrists to support clients during their mental health journey. This PMHNP role provides direct patient care for a panel of clients and allows for flexibility when client sessions can be scheduled. You can see clients during traditional business hours, evenings, or on weekends. This PMHNP will work within our clinical coverage team, providing additional support to clients between their sessions. This includes checking the client ticketing queue x3 daily during normal business hours.

We are looking for clinicians with state licenses from the following states: California, Illinois, New Jersey, New York, Pennsylvania, Oklahoma, and/or Minnesota.

Who you are:

• You are PMHNP licensed and in good standing
• Board certification (AANP or ANCC)
• Minimum of a Master’s degree in nursing, specializing in psychiatric mental health
• Comfortable assessing and formulating evidence-based treatment plans for clients with mental illness
• Maintain a strong evidence-based clinical skill set while practicing & implementing outcome-focused care within the clinical coverage team
• Empathetic and intuitive listening
• Strong verbal and written communication
• Knowledgeable in crisis response
• Comfortable working autonomously in a telemedicine environment
• Tech-savvy with the ability to navigate various systems & tools with ease (this includes, but is not limited to Google Workspace, proprietary EMR, etc.)
• Passionate about our mission of improving access to high-quality mental health care
• An entrepreneurial spirit or previous experience within a startup or fast-paced environment is preferred

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

• Hold thoughtful and engaged sessions with clients; 30 minute initial sessions and 15 minute follow up sessions
• Provide a minimum of 36 hours of weekly availability for client-facing care that includes client sessions and clinical coverage during normal business hours
• Maintain and provide direct care to a panel of clients
• Respond to client clinical questions and needs as part of our clinical coverage program; this includes checking the client ticketing queue x3 daily during normal business hours so our clients have additional support between their sessions
• You will work collaboratively with other mental health care partners at Cerebral to ensure the most beneficial level of evidence-based treatment plans for our clients
• Work alongside other like-minded clinicians that have a common goal to positively impact the lives of others, and create an environment that leads to favorable outcomes for clients

What we offer:

• Mission-driven impact:
  • Shape the future of the #1 largest and fastest growing online mental health care company in the world
  • Build a platform that is improving the lives and well-being of hundreds of thousands of people
  • Join a community of high achievers who have a passion for promoting mental health
• Path to develop & grow:
  • Readily available psychiatrists and clinician leadership for case consultations to ensure you always receive the support you need
  • Access to innovative technology to support you in delivering the highest quality of care to your clients
  • Access to UpToDate for continued education (free CEU offering)
• Remote-first model:
  • Flexibility to choose the hours and schedule that work best for you
  • Work virtually from anywhere in the United States
• Culture & connectivity:
  • Highly-responsive and supportive team of clinical and operational management
  • Decreased administrative time for clinicians through ongoing technology improvements and automations
  • Fully integrated, data-enabled EMR with embedded clinical decision support, monthly prescriber metric reports, and task management system
  • Opportunity to participate in strategic development initiatives to improve our clinical quality and safety and/or clinical processes across the organization

The national base salary range (OR the national hourly range for nonexempt positions) offered for this position is outlined below. Cerebral is committed to equal pay for equal work; however, business reasons may dictate variations in pay that are attributed to objective factors, such as a candidate’s qualifications and years of experience.

National Base Salary Range: $110,000$135,000 USD

Who we are (our company values):

• Client-first Focus– relentless focus on advancing the quality of care, clinical experience, and patient safety
• Ethics & Integrity– do what is right and demonstrate ethical principles, even when no one is watching
• Commitment– accountable for fully delivering on commitments to our clients and each other
• Impact & Quality– make a positive impact and deliver high quality outcomes, based on data and evidence
• Empathy– act compassionately, listen to seek understanding, and cultivate psychological safety with clients and colleagues
• Collaboration– achieve our goals together as a united team, strengthened by mutual openness, trust, and ersity of thought
• Thoughtful Innovation– continuously evolve our ability to deliver on our mission, prioritizing long-term, strategic bets over short-term gains

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

___________________

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

Title: Certified Hospital Inpatient Medical Coder (Remote)

Location: Denver Colorado United States

Job Description:

Remote Hospital Inpatient Coder

This is a full-time, remote/work from home, hourly position on the UCHealth Inpatient Coding team. Potential opportunity for eligible out-of-state applicants. Flexible work schedule. All required hardware/software provided, including dual monitors, keyboard, mouse. Assigns ICD-10-CM and PCS codes using computer-assisted-coding tools, and applies appropriate coding classifications for assigned service lines.

Job duties

• Responsible for accurately assigning and sequencing ICD-10 CM and PCS codes and POA indicators, identifying query opportunities, and abstracting data based on medical record documentation for all acute care hospital patient types.
• Appropriately applies official coding guidelines and relevant coding references to all inpatient coding scenarios.
• Collaborates with CDI, Quality, and leadership to capture necessary quality measures.
• Enhances coding knowledge and skills with continuing education.

Requirements

• High School diploma or GED
• Coding-related certification from AHIMA or AAPC
• 1 year of Inpatient coding experience OR 3 years of Outpatient coding

Preferred

• Certified Coding Specialist (CCS) highly desired
• 3+ years of hospital inpatient coding experience highly desired
• Level I Trauma coding experience
• Epic experience
• 3M encoder experience
• Computer-assisted coding

The pay range for this position is: $24.11 – $36.17 / hour. Pay is dependent on applicant’s relevant experience.

UCHealth offers a Five Year Incentive Bonus to recognize employee’s contributions to our success in quality, patient experience, organizational growth, financial goals, and tenure with UCHealth. The bonus accumulates annually each October and is paid out in October following completion of five years’ employment.

UCHealth offers their employees a competitive and comprehensive total rewards package:

• Full medical, dental and vision coverage
• Retirement plans to include 403(b) matching
• Paid time off. Start your employment at UCHealth with PTO in your bank
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition and continuing education reimbursement
• Wellness benefits
• 5-year incentive bonus
• Full suite of voluntary benefits such as identity theft protection and pet insurance
• Education benefits for employees, including the opportunity to be eligible for 100% of tuition, books and fees paid for by UCHealth for specific educational degrees. Other programs may also qualify for up to $5,250 pre-paid by UCHealth or in the form of tuition reimbursement each calendar year

Loan Repayment: UCHealth is a qualifying employer for the federal Public Service Loan Forgiveness (PSLF) program! UCHealth provides employees with free assistance navigating the PSLF program to submit their federal student loans for forgiveness through Savi.

At UCHealth, we do things differently

We believe in something different: a focus on the iniduality of every person. In big ways and small, we exist to improve the extraordinary lives of all those we serve. As Colorado’s largest and most innovative health care system, we as a team deliver on the commitment to provide the best possible experience for our patients and their families. We foster a true human connection and give people the freedom to live extraordinary lives. A career at UCHealth is more than a job, it’s a passion.

Going beyond quality requires the perfect balance of talent, integrity, drive and intellectual curiosity. We are looking for iniduals who recognize, like us, that the world of medicine is ever-changing and are motivated to do what is right, not what is easy. We support creativity and curiosity so that each of us can find the extraordinary qualities within ourselves. At UCHealth, we’ll do everything in our power to make sure you grow and have a meaningful career. There’s no limits to your potential here.

Be Extraordinary. Join Us Today!

UCHealth recognizes and appreciates the rich array of talents and perspectives that equal employment and ersity can offer our institution. As an affirmative action/equal opportunity employer, UCHealth is committed to making all employment decisions based on valid requirements. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the inidual’s race, creed, color, religion, gender, national origin or ancestry, age, mental or physical disability, sexual orientation, gender identity, transgender status, genetic information or veteran status. UCHealth does not discriminate against any “qualified applicant with a disability” as defined under the Americans with Disabilities Act and will make reasonable accommodations, when they do not impose an undue hardship on the organization.

AF123

Certified Coder – REMOTE

Molina Healthcare Job ID 2024925

JOB DESCRIPTION

Job Summary

Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.

KNOWLEDGE/SKILLS/ABILITIES

• Performs on-going chart reviews and abstracts diagnosis codes
• Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly
• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff
• Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment
• Builds positive relationships between providers and Molina by providing coding assistance when necessary
• Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education
• Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies
• Contributes to team effort by accomplishing related results as needed
• Other duties as assigned
• 2 years previous coding experience
• Proficient in Microsoft Office Suite
• Ability to effectively interface with staff, clinicians, and management
• Excellent verbal and written communication skills
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers
• Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance

JOB QUALIFICATIONS

Required Education

Associates degree or equivalent combination of education and experience

Required License, Certification, Association

• Certified Professional Coder (CPC)
• Certified Coding Specialist (CCS)

Preferred Education

Bachelor’s Degree in related field

Preferred Experience

• Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model
• Background in supporting risk adjustment management activities and clinical informatics
• Experience with Risk Adjustment Data Validation

Preferred License, Certification, Association

• Certified Risk Adjustment Coder (CRC)
• Certified Professional Payer Payer (CPC-P)
• Certified Coding Specialist Physician based (CCS-P)

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: $17.85 – $38.69 / HOURLY

*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.

Nurse Practitioner – Southeast

Location: Remote US

Saving Lives with Early Detection

The mission of HALO Diagnostics (HALO DX) is to improve human health and wellbeing via local and easy access to advanced diagnostics. HALO Diagnostics has a unique approach bringing together pioneers in the fields of radiology and other medical disciplines, molecular diagnostics and software development to create unparalleled levels of services and patient outcomes. Leveraging technology and collaborating with our own physicians and centers, we will make an impact on a personal level for each patient and their family, as well as raise the standard for improved accuracy in diagnostics.

Join HALO Precision Diagnostics as a Nurse Practitioner. Thisremote+travel(30-50%) full-time opportunity has aflexible, largely Monday – Friday 8am – 5pm PST schedule. We are hiring a crucial team member to support our genetic testing, imaging and laboratory teams. You will have the opportunity to counsel patients on hereditary cancer risks, screen patients for hereditary cancers, collaborate with clinicians based on medical guidelines, and provide metrics on program performance with your team. This opportunity comes with benefits, including stock options in a growing health-tech company focusing on early detection and precision-focused healthcare.

Nurse Practitioners with experience in hereditary cancer genetics, oncology, urology, men’s/women’s health, and radiology highly preferred.

Required: Graduate of accredited NP program, NP licensure

Why join us we offer you the following!

• The ability to save lives with early detection!
• A Monday Friday schedule
• Full benefits including medical/dental/vision/life – most are paid 100% by the company
• Stock options
• Paid vacation / holidays and sick time
• 401k plan
• Advancement and training opportunities
• Pay Range: $120,000-165,000

Title: Clinical Documentation Integrity Coder – HCC (remote)

Location: Remote

JobDescription:

About Our Company

Vytalize Health is a leading value-based care platform. It helps independent physicians and practices stay ahead in a rapidly changing healthcare system by strengthening relationships with their patients through data-driven, holistic, and personalized care. Vytalize provides an all-in-one solution, including value-based incentives, smart technology, and a virtual clinic that enables independent practices to succeed in value-based care arrangements. Vytalize’s care delivery model transforms the healthcare experience for more than 250,000+ Medicare beneficiaries across 36 states by helping them manage their chronic conditions in collaboration with their doctors.

About our Growth

Vytalize Health has grown its patient base over 100% year-over-year and is now partnered with over 1,000 providers across 36-states. Our all-in-one, vertically integrated solution for value-based care delivery is responsible for $2 billion in medical spending. We are expanding into new markets while increasing the concentration of practices in existing ones.

Visit www.vytalizehealth.com for more information.

Why you will love working here

We are an employee first, mission driven company that cares deeply about solving challenges in the healthcare space. We are open, collaborative and want to enhance how physicians interact with, and treat their patients. Our rapid growth means that we value working together as a team. You will be recognized and appreciated for your curiosity, tenacity and ability to challenge the status quo; approaching problems with an optimistic attitude. We are a erse team of physicians, technologists, MBAs, nurses, and operators. You will be making a massive impact on peoples lives and ultimately feel like you are doing your best work here at Vytalize.

Your opportunity

The CDI Specialist supports clinical documentation to ensure complete, accurate, and compliant coding for Medicare and Medicare Advantage beneficiaries. Proficient in ICD-10-CM coding and risk adjustment methodologies, you optimize coding integrity, conducting chart reviews specifically addressing the CMS-HCC model. This role emphasizes production coding with a focus on enhancing clinical documentation through compliant risk adjustment chart review programs.

As a CDI Specialist, you significantly contribute to ensuring accurate and compliant documentation, aligning beneficiaries health burden with risk scores for appropriate Medicare reimbursement. Your expertise in precision and excellence supports the organization’s commitment to providing high-quality healthcare services.

What you will do

Clinical Documentation Enhancement:

• Validate and ensure the completeness, accuracy, and integrity of coded data.
• Support and enhance clinical documentation to ensure comprehensive, accurate, and compliant coding for Medicare and Medicare Advantage beneficiaries.

Coding Proficiency:

• Demonstrate proficiency in ICD-10-CM coding, CPT codes, HCPCS codes, and risk adjustment methodologies to optimize coding integrity.
• Comply with HIPAA laws and regulations.

Chart Reviews:

• Review and accurately code medical records and encounters for ICD-10 diagnoses and procedures codes related to Risk Adjustment and HCC coding guidelines.

Production Coding:

• Oriented towards production coding, with a primary emphasis on improving clinical documentation through effective risk adjustment coding.
• Maintain productivity standards averaging 30 charts per day.

Documentation Alignment:

• Ensure documentation aligns with regulatory guidelines and standards, emphasizing precision in risk adjustment processes.
• Stay up to date with the latest coding guidelines, rules, and regulations related to Risk Adjustment and HCC coding.

Contribution to Accuracy:

• Contribute significantly to accurate and compliant documentation, aligning beneficiaries health burden with risk scores for appropriate Medicare reimbursement.

Quality Assurance:

• Ensure exemplary attention to detail and completeness, ensuring coding is consistent with ICD-10-CM, CMS-HCC, and other relevant coding guidelines.
• Uphold a commitment to precision and excellence, maintaining at least a 95% coding accuracy rate.

EHR Knowledge and Proficiency:

• Demonstrate knowledge and expertise in various Electronic Health Record (EHR) systems to optimize chart reviews across multiple platforms.

What will make you successful in this role

• Minimum of 2 years HCC/Risk Adjustment coding experience required, 3+ years preferred.
• Strong communication skills, including clear verbal and written communication, effective collaboration, and the ability to convey complex coding concepts.
• Knowledge of medical records coding procedures and ICD-10/CPT Coding Systems required.
• Must hold a Certified Risk Adjustment Coder (CRC) and Certified Professional Coder (CPC) certification.

Perks/Benefits

• Competitive base compensation
• Annual bonus potential
• Health benefits effective on start date; 100% coverage for base plan, up to 90% coverage on all other plans for iniduals and families
• Health & Wellness Program; up to $300 per quarter for your overall wellbeing
• 401K plan effective on the first of the month after your start date; 100% of up to 4% of your annual salary
• Company paid STD/LTD
• Unlimited (or generous) paid “Vytal Time”, and 5 paid sick days after your first 90 days
• Technology setup
• Ability to help build a market leader in value-based healthcare at a rapidly growing organization

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

Please note at no time during our screening, interview, or selection process do we ask for additional personal information (beyond your resume) or account/financial information. We will also never ask for you to purchase anything; nor will we ever interview you via text message. Any communication received from a Vytalize Health recruiter during your screening, interviewing, or selection process will come from an email ending in @vytalizehealth.com

Title: Psychiatric Mental Health Nurse Practitioner or Physician Assistant

Location: Remote United States

Type: Full-Time

Workplace: remote

Category: Psychiatry

JobDescription:

Equip is the leading virtual, evidence-based eating disorder treatment program on a mission to ensure that everyone with an eating disorder can access treatment that works. Created by clinical experts in the field and people with lived experience, Equip builds upon evidence-based treatments to empower iniduals to reach lasting recovery. All Equip patients receive a dedicated care team, including a therapist, dietitian, physician, and peer and family mentor. The company operates in all 50 states and is partnered with most major health insurance plans. Learn more about our strong outcomes and treatment approach at www.equip.health

Founded in 2019, Equip has been a fully virtual company since its inception and is proud of the highly-engaged, passionate, and erse Equisters that have created Equips culture. Recognized by Time as one of the most influential companies of 2023, along with awards from Linkedin and Lattice, we are grateful to Equipsters for building a sustainable treatment program that has served thousands of patients and families.

About this role:

Equip Health is seeking a passionate, driven Psychiatric Nurse Practitioner to join its rapidly growing clinical care team caring for children and adults with eating disorders in a 100% virtual Telehealth platform. Psychiatric Nurse Practitioners are essential members of Equips treatment team, working alongside a therapist, peer mentor, medical provider, dietitian and family mentor to help people recover from an eating disorder.

Responsibilities:

• Provide comprehensive assessments and diagnosis of eating disorders and co-occurring psychiatric conditions
• Implement medication treatment plans for eating disorders and co-occurring conditions in a virtual clinic (i.e. telehealth) setting
• Collaborate with a multidisciplinary treatment team of physicians, dietitians, therapists, patient mentors, and family mentors, along with outside providers
• Utilize between-session messaging to support patients and communicate with the treatment team through Equips EMR in accordance with Equips policies and procedures
• Engage and collaborate in treatment team meetings, supervision, and department meetings

Time Expectations:

• Your time will be ided between:
• Team meetings: 2 hours per week. Treatment Team Meeting and Medical/Psychiatric Team Meeting
• Inidual supervision: 0.5 -1hr/week
• Clinic Time: 65% of your Clinic Time is devoted to sessions with patients.
• Administrative Time: 20% of your Clinic Time is scheduled to respond to between-session messages or hold unanticipated sessions
• There is no call requirement; major and minor holidays are off without patient obligations
• Hours are in EST

Requirements:

• Board Certification as a Psychiatric Mental Health Nurse Practitioneror Licensed Physician Assistant
• Maintain an active license to practice in the state(s) that their patients reside and/or be willing to become licensed in other states (paid by Equip)
• Demonstrate a commitment to providing excellent evidence-based care, advancing clinical skills, and a passion for professional development
• Communicate effectively with patients and patients carers, and respond to messages within a timely mannerBe curious, enjoy learning, and participate enthusiastically in a multidisciplinary team
• Comfort and experience treating patients with emotion dysregulation, suicidal ideation, substance use, trauma, mood disorders, anxiety disorders, personalIty disorders, attention deficit/hyperactivity disorder, and substance use disorders. Equip uses a HAES and gender affirming approach to care
• Ability to provide care 2 evenings per week (Till 7 pm in EST)
• Monday – Friday 40 hours

Bonus if you have the following:

• Fluent in English and Spanish
• 1-2 years of clinical experience
• Experience treating patients with eating disorders

The pay range for this position in the US is $125,000 – $150,000/yr; however, base pay offered may vary depending on job-related knowledge, skills, and experience. We are open to compensation negotiations. This role can be located anywhere in Eastern USA.

Equip offers a comprehensive benefit package, including medical, dental and vision insurance, 401k, paid time off, family and short-term disability leave.

Compensation and Benefits:

Equip offers competitive compensation and benefits programs as well as, career development opportunities, and exciting team retreats to ensure community and connection. The Talent Acquisition team will provide candidates with our benefit guide and share compensation information beyond posted bands. Below we have highlighted a list of some of our most popular benefits.

Short and long term incentives, including yearly bonus potential

Remote work from home

Flexible PTO & Leave programs

Health, dental, and vision insurance

Wellness and reproductive care programs

401k retirement savings plan

Home office set-up stipend

Co-working monthly stipend

Equal Employment Opportunity:

At Equip, we believe that our erse perspectives are our biggest strengths and that embracing them will create real change in healthcare. As an equal opportunity employer, we provide equal opportunity in all aspects of employment, including recruiting, hiring, compensation, training and promotion, termination, and any other terms and conditions of employment without regard to race, ethnicity, color, religion, sexual orientation, gender identity, gender expression, familial status, age, weight, disability and/or any other legally protected classification protected by federal, state, or local law.

Supervisor, Medical Review Coding (Outpatient)

United States (Remote)

Full time

job requisition id R-2024-02-00081

ABOUT PERFORMANT:

At Performant, were focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture then Performant is the place for you!

ABOUT THE OPPORTUNITY:

Hiring Range: $77,350.00 $90,000.00

TheSupervisor, Medical Review Coding(Outpatient) leverages their breadth of outpatient and/or inpatient coding knowledge, medical claims and coding audit expertise, and experience leading others to manage staff and operational results for a remote team of coders and other audit roles, performing coding audits. Responsible leveraging first-hand experience and knowledge of claims auditing, for supporting management with strategy activities such as needs assessments, capacity planning, preparing staffing models, ensuring required staffing levels, cost/benefit analysis, and establishing productivity and quality standards.

Key Responsibilities:

• Regularly performs limited volume of Inpatient coding reviews on medical records to maintain subject matter expertise, and additionally as needed to support business needs.
• Performs audit quality assurance reviews to supplement QA team activity as necessary based upon business need or special projects.
• Contributes to the resolution of quality review rebuttals.
• Performs appeals review/activity to supplement Appeals team based upon business need.
• Actively identifies and recommends opportunities for cost savings and improving outcomes that can have a direct impact to the company’s profitability.
• Effectively contributes to the development of medical review guidelines and training.
• Supports audit management and segment specialists with activities for new concept implementation, maintenance of medical review guidelines for existing concepts.
• Use data, reports and experience to proactively identify potential backlogs and align resources to meet business needs and SLAs.
• Oversee and review audit determinations in order to ensure consistency in decision-making.
• Collaborate with other departments to resolve operational problems.
• Proactively monitors and in alignment with applicable management ensures activity required to meet team staffing levels necessary for assigned business segment objectives.
• Provides support as needed to ensure auditors are equipped with tools and resources required to perform audits.
• Supervise daily activities of coding audit staff members.
• Provide audit guidance to medical review staff; identify trends and present solutions.
• Routinely provides production and quality performance-based progress reports, coaching, and constructive feedback to staff.
• Manages team Time and Attendance (time off/use of accruals, attendance, attendance points and timecards for hourly staff, etc.) in accordance with applicable policies and procedures.
• Collaborates with HR for applicable corrective action as applicable.
• Complete and conduct performance reviews for assigned staff.
• Conduct team meetings with direct reports on a regular basis.
• Provide leadership to team members, provide solutions, and resolve conflicts.
• Escalate to management and collaborate with HR as applicable to bring appropriate solutions to employee matters.
• Provide reporting and updates to management as required and appropriate for operational and staff activity and results.
• Participates in and contributes to applicable department meetings.
• May participate to client-facing meetings; research and analyze issues; present findings and solutions; and/or provider training.
• May support management with activities to monitor inventory and activity of 3rdparty/subcontractors.
• Become subject matter expert for assigned business segment(s).
• Maintain current knowledge and changes that affect our industry and clients as it pertains to medical practice, technology, regulations, legislation, and business trends.
• May support training material/tools and best practices development.
• Identify needs and ensure team receives necessary training.
• Support training activities for new audit staff or provide supplemental training for existing staff as needed.
• Contributes to positive team environment that fosters open communication, sharing of information, continuous improvement, and optimized business results.
• Receives feedback and adjusts work priority for self and team as necessary.
• Leads by example and conducts work in accordance with company policies, government regulations and law.
• Perform other incidental and related duties as required and assigned to meet business needs.

Knowledge, Skills, and Abilities Needed:

• Strong knowledge of medical documentation requirements and an understanding CMS, Medicaid and/or Commercial insurance programs, particularly the coverage and payment rules and regulations.
• Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10/MS-DRG coding.
• Proficiency with MCS 1500/UB 04 forms
• Working knowledge of encoder
• Proven ability to review, analyze, and research medical billing, documentation, and coding issues
• Reimbursement policy and/or claims software analyst experience
• Familiarity with interpreting electronic medical records (EHR)
• Basic understanding of accounting principles for accounts payable and receivable as it relates to medical billing.
• Willing and able to lead, communicate ideas, take initiative and drive the team to achieve organizational goals.
• Experience in developing, documenting and implementing process and procedures.
• Experience in inventory management, resource planning and report generation.
• Skill in analyzing information, identifying trends and presenting solutions.
• Understands inventory management objectives, activities, and key drivers in achieving operational goals.
• Demonstrated ability to consistently apply sound judgment and good effective decision making.
• Excellent communication skills, both verbal and written; ability to communicate effectively and professionally at all levels within the organization, both internal external.
• Demonstrated ability to collaborate effectively in a variety of settings and topics.
• Excellent editing and proofreading skills.
• Demonstrated ability to successfully develop, lead, and motivate a team to high performance; effectively provides constructive feedback and coaching for successful outcomes.
• Ability to independently organization, prioritize and plan work activities effectively for self and others; develops realistic action plans with the ability to multi-task effectively.
• Excellent time management and delivers results balancing multiple priorities.
• Strong analytical skills; synthesizes complex or erse information; collects and researches data; uses experience to compliment data.
• Leverages strong critical thinking, questioning, and listening skills to research and effectively resolve complex issues.
• Demonstrated ability to identify areas of opportunity and create efficiencies in workflows and procedures.
• Demonstrated ability to be proactive; identifies and resolves problems in a timely manner; develops alternative solutions.
• Ability to create documentation outlining findings and/or documenting suggestions.
• Strong general technical skills, including, but not limited to Desktop and MS Office applications (Intermediate Excel Skills), application reporting tools, and case management system/tools to review and document findings.
• Solid technical aptitude with demonstrated ability to quickly learn and adapt to new systems and tools.
• Ability to be flexible and thrive in a high pace environment with changing priorities.
• Adaptable to applying skills to erse operational activities to support business needs.
• Self-starter with the ability to work independently in remote setting withminimum supervision and direction in the form of objectives.
• Serves as positive role model; and demonstrates characteristics that align and contribute to a collaborative culture of continuous improvement and high performing teams.
• Limited travel may be required.
• Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours.

Required and Preferred Qualifications:

• Current certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P
• High School Diploma or GED Required
• Not currently sanctioned or excluded from the Medicare program by OIG
• 2+ years of performing medical record audits in a provider setting, or in a payer setting for a health insurance company.
• 5+ years of DRG coding for hospital, physicians office or other acute inpatient facility setting (Inpatient/SNF Facility), AND 2+ years of facility Outpatient services, OR equivalent demonstrated experienced gained through prior experience conducting applicable Inpatient/Outpatient coding reviews (less years of experience may be considered for internal candidates based upon demonstrated skills and results).
• 3+ years relevant supervisory or leadership experience in similar business environment (preferably experience overseeing remote staff).
• Prior experience in payer edit development, and/or reimbursement policy experience a plus.

WHAT WE OFFER:

Performant offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, disability coverage options, life insurance coverage, 401(k) savings plans, paid family/parental leave, 11 paid holidays per year, as well as sick time and vacation time off annually. For more information about our benefits package, please refer to our benefits page on our website or ask your Talent Acquisition contact during an interview.

Physical Requirements & Additional Notices:

If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employees responsibility to maintain this Internet access at their home office location.

The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each inidual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.
• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).
• Regularly sit/stand 8 or more hours per day.
• Occasionally lift/carry/push/pull up to 10lbs.

Performant is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.
• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.
• Must complete the Performant Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.
• Other requirements may apply.

All employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Performants policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Performant is committed to the full inclusion of all qualified iniduals. In keeping with our commitment, Performant will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a 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 Performants Human Resources team to discuss further.

Our ersity makes Performant unique and strengthens us as an organization to help us better serve our clients. Performant is committed to creating a erse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.

THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED

Title: Billing Specialist

Location: Remote

JobDescription:

Within Health is a Virtual company for Eating Disorders. As this company was started in 2021 we are looking for a quality team member to join our Revenue Cycle team.

**MUST HAVE EATING DISORDER OR INSTITUTIONAL CLAIMS FOR MENTAL HEALTH EXPERIENCE**

Job Summary:

The Billing Specialists primary responsibility is to oversee the billing process for clients. Ensure timely and accurate submission and processing of client invoices and insurance claims. The Billing Specialist will also research and resolve all provider and client inquiries in a timely and customer-focused manner.

Major Areas of Responsibility:

• The primary function is to take ownership of the error free completion of the entire weekly bill cycle to include:
• Checking eligibility and benefit verification for services provided as needed
• Conduct client and guarantor welcome orientations on the insurance/private pay/balance billing process
• Maintain communication with clients on the billing process, status of their claims
• Manage the status of client accounts and balances and identify inconsistencies
• Create, send and collect on bi-weekly invoices for balance billing and SCA, private pay clients
• Follow up, collect, charge and post large client balances
• Professionally answer and respond to calls, and emails from patients, payers, and other team members re: claims, balances, eligibility, etc., promptly.
• Accurately prepare, review, and submit claims within timely filing to various insurance companies electronically, or in some case via paper using correct revenue, HCPCS, CPT and ICD10 codes
• Post insurance and patient payments from ERAs or EOBs within a timely matter.
• Follow-up on open, denied, underpaid, overpaid and non-paid claims and re-submit, send back, appeal as needed
• Write, compile medical records, etc. for appeals, retrospective reviews, authorizations as needed; and follow up accordingly.
• Collaborate with clients and insurance companies, team members to resolve billing inconsistencies and errors.
• Review patient accounts for trends that indicate where additional assistance might be needed.
• Constructively handle patient complaints and report to your supervisor immediately.
• Support billing team as needed when inidual tasks are completed, or if help needed to complete a project.
• Monitor your daily, weekly performance and submit daily delegations to billing manager.
• Plan, organize, direct and control to meet all billing objectives.
• Maintain and track your personal calendar, calls, and deadlines.
• Motivate yourself to perform well.
• Communicate potential opportunities for optimization.
• Constantly strive toward continuing professional growth
• Accurate and timely processing of all adjustments (debits and credits), initiated by either external (client-related) or internal (Shared Services) requests
• Timely research and resolution of all billing inquiries to the assigned mailboxes utilizing the highest level of customer service

QUALIFICATIONS:

• High school diploma or equivalent require, some college preferred
• 3 years experience in billing, preferably in the Staffing or Medical field
• 3-5 years of demonstrated analytical sense with excellent attention to detail
• Medical billing experience, specifically insurance company follow up and balance billing
• Understanding of billing on UB-04 forms and revenue, CPT, HCPCS, ICD10 codes
• Compliance of HIPAA, understanding of medical terminology
• Strong attention to detail and efficient data entry
• Strong organization, time management and prioritization abilities
• Excellent communication and Customer Service skills
• Strong computer skills, including knowledge of EMRs, PM systems, and Microsoft Office suite

Physical and Environmental Requirements:

• Employees are required to read, review, prepare and analyze written data and figures, using a computer or similar, and should possess visual acuity.
• This position answers and places telephone calls as well as video conferences and must be able to converse
• Must be able to converse with colleagues via telephone and computer programs.
• Must be able to operate a computer and navigate applications within a smart-phone, iPhone, MacBook computer and/or tablet.
• Able to sit for the majority of shifts.
• Must have reliable internet connection.
• This is a work-from-home position. Work should be performed in a private, quiet space with minimal background noise.
• Ability to prioritize workload and work independently.

Wage Range: $50-$60k/Year

Pathology Support Coordinator

Remote

PRIMARY RESPONSIBILITIES:

• Review select cases for accuracy of tissue request and escalate to PAs when needed, complete accurate data entry.
• Assist other PSCs in resolving issues with their cases and provide feedback on the quality of their work.
• Ensure that necessary notes and holds are placed on cases for non-conforming samples, discrepancies and/or missing information so that timely follow-up by the Customer Care team is made.
• Compose professional emails/faxes using proper grammar and spelling to communicate with other departments for case escalation and/or case status updates.
• Perform outbound calls to pathology labs for specimen information (confirmation of accession numbers, specimen locations, pathology fax numbers, address confirmation, etc
• Attend interdepartmental meetings if needed and provide feedback on the current process or workflow.
• Monitor errors and metrics for all tissue cases
• This role works with PHI on a regular basis both in paper and electronic form and have an access to various technologies to access PHI (paper and electronic) in order to perform the job
• Employee must complete training relating to HIPAA/PHI privacy, General Policies and Procedure Compliance training and security training as soon as possible but not later than the first 30 days of hire.
• Must maintain a current status on Natera training requirements.
• Performs other duties as assigned.

QUALIFICATIONS:

• High School Diploma (or equivalent) required.
• 2+ years of medical industry related experience.
• Previous computer experience is required.
• Previous data entry experience is required.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Trained on all product types and able to accession with high accuracy and efficiency consistently.
• Ability to handle most escalations, discrepancies, and holds.
• Firm understanding and knowledgeable in all aspects of the
• Accessioning process and SOPs
• Typing speed of at least 45wpm with high accuracy
• Excellent oral and written communication skills required
• Excellent critical thinking skills and the ability to use good judgment
• Ability to perform required duties with a high degree of accuracy and attention to detail
• Positive attitude and ability to work well with others

#LI-REMOTE

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

Remote USA

$19.04$23.80 USD

Title: NP Clinical Documentation Specialist (Remote)

Location: Remote

Job Description:

Nice to meet you, were Vesta Healthcare.

Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these iniduals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center.

Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others’ needs ahead of her own, keeping the hearth warm so the home and family can function.

We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. Its an insurance covered benefit, so its available to most adults with Caregivers free of charge to them.

We seek team members who are passionate about making home the best place it can be for people with home care needs and see the important role Caregivers play. Our team members are collaborative data-driven optimists who always focus on doing whats best for patients and their caregivers. We see ourselves as being 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 detail-oriented, clinically trained Nurse Practitioner who can provide expertise, education and guidance on clinical practice and documentation to improve our clinical outcomes as well as increase capture of pertinent diagnosis codes and quality measures. A role model and facilitator for the clinical team and a support the leadership team with execution on the departments vision for quality and appropriate code capture. An inidual that is self-directed and possesses advanced analytical skills, critical thinking, creativity, and the ability to anticipate and identify opportunities and potential problems. Someone who is an educator and enjoys supporting fellow Nurse Practitioners to improve their documentation. This is a salaried 40 hours per week position, Monday through Friday 9:00am to 6:00pm EST.

The ideal teammate would be able to:

• Develop, design, revise and execute our comprehensive clinical documentation accuracy and HCC documentation program
• Collaborate extensively with Nurse Practitioners, collaborating physicians, nursing staff, other care team members, and coding staff to improve the quality and completeness of documentation/auditing of care provided and coded for coordination, abstraction, and submission of accurate data required for billing and improved clinical outcomes
• Facilitate modifications to clinical documentation to ensure appropriate reimbursement based on clinical severity and services rendered to patients
• Support timely, accurate, and complete documentation of clinical information used for measuring and reporting clinician and team outcomes/productivity
• Continuously monitor metrics with an eye to increase/improve quality, satisfaction, and savings
• Communicate with and educate all clinical staff concerning accurate and effective clinical documentation
• Complete accurate and timely review to ensure the integrity of the documentation compliance resulting in accurate diagnosis and procedure classification used for reimbursement and quality metrics
• Recognize opportunities for documentation improvement and sound judgment in decision making keeping reimbursement considerations in balance with regulatory compliance
• Strategically educate clinicians and staff regarding the need for accurate and complete documentation in the health record that includes regulations and compliance guidelines
• Solve complex problems and takes a new perspective on existing solutions; exercises judgment based on the analysis of multiple sources of information
• Meet patient and patient family needs; take responsibility for a patient’s safety, satisfaction, and clinical outcomes; use appropriate interpersonal techniques to resolve difficult patient situations and regain patient confidence

Would you describe yourself as someone who has:

• Masters Degree with current active Nurse Practitioner license (required)
• 3+ years of clinical documentation improvement experience, coding experience or equivalent (required)
• Active Certified Risk Adjustment Coder Certification (CRC) (required)
• 5+ years of adult/geriatric care experience (required)
• 1+ year of experience working with advanced practice providers as well as other clinical and non-clinical staff (required)
• Experience with risk adjustment and value based care delivery systems
• Motivated self-starter and creative problem-solver who is comfortable working in a fast-paced, dynamic environment
• Experience with Powerpoint/Excel and/or Google Slides/Sheets
• Experience working in a remote environment

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 4% match

We look forward to speaking with you!

Pay range is $125,000-$130,000 based on experience. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

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

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

Title: Enterprise Sales Director, Healthcare (Remote)

Location: Remote

Type: Full Time

Workplace: remote

Category: Healthcare

JobDescription:

Description Ushur is transforming the way enterprises communicate and engage with customers. Fueled by consumers self-service demands, enterprises are modernizing customer engagement and experience models. Ushur is fast becoming the platform of choice for Customer Experience Automation, enabling these enterprises to leapfrog their digital native counterparts and deliver delightful customer and employee experiences.With cutting-edge Conversational AI, Machine Learning andIntelligentProcess Automation technologies, Ushur has enabled Fortune 100 enterprises including some of the worlds most well known brands in healthcare, insurance, banking and financial services sectors to automate their customer engagement. Cloud-native, 100% no-code and purely workflow-driven, Ushur empowers citizen developers within business operations teams to build AI-powered, fully-automated and omni-channel experience to digitally transform customer journeys end-to-end.

Responsibilities

• Develop a set of strategic account plans assigned to you for your select verticals and region that includes how you will engage leaders responsible for digital transformation, customer experience and operations
• Become a trusted advisor to Clients by understanding their needs and business objectives, demonstrating industry awareness and co-creating high impact business solutions with the Ushur platform
• Focus relentlessly on bringing new Clients into the Ushur family and expand the business inside existing Client accounts
• Collaborate internally with Sales Consultants and Industry Market Leaders to create industry relevant presentations and demonstrations for the target market and function
• Develop proposals, business cases and ROI model for and with Clients
• Partner with Customer Success Teams to ensure Client success with Proofs of Concept and Programs in Production
• Acquire and maintain a working knowledge of the Ushur Platform

Requirements

• 4-5 years proven success selling SaaS-based Enterprise Software Solutions with at least 3+ years of experience selling to Health Plans and other Healthcare Organizations in the Fortune 1000
• A demonstrated track record where you consistently have met or exceeded annual quota
• Subject matter expertise in healthcare with rich experience working with health plans and benefits
• Possess a deep understanding of how technology is leveraged both within health plans and how they interact with their members, brokers and other key stakeholders
• Familiar with how health plans and healthcare companies select technology and solution providers
• Experience at a fast-paced high growth startup environment
• Capable of presenting sophisticated technology solutions at the C-level
• Superb written and oral communications skills
• Ability to own the entire sales cycle from Lead Generation to Contract Close
• Bias to action, high sense of urgency and energy

Compensation: The pay range for this position is $240,000-$300,000 OTE (on target earnings) plus equity. However, base pay offered may vary depending on skills, experience, job-related knowledge and location. Benefits Great Company Culture. We pride ourselves on having a values based culture that is welcoming, intentional, and respectful. Our internal NPS of over 65 speaks for itself – employees recommend Ushur as a great place to work! Bring your whole self to work. We are focused on building a erse culture, with innovative ideas where you and your ideas are valued. We are a start up and know that every person has a significant impact! Rest and Relaxation. Unlimited PTO, wellness days, paid holidays, and more! Health Benefits. Comprehensive health, dental, and vision. We offer a variety of plans to meet the needs of you and your loved ones. We care about your Future. Access to 401(k) so you can contribute and generous stock options. Keep learning. One of our core values is Growth Mindset – we believe in lifelong learning. Whether you are a previous student, or currently enrolled in higher education, we can help cover some of those expenses and support your ongoing development and career growth. Flexible Work. In-office, work-from-home, or hybrid, depending on position and location. We seek to create an environment for all of our employees where they can thrive in both their professional and personal lives.

Title: Physician (Remote)

Location: Remote

Type: Remote / Independent Contractor

Workplace: remote

Category: Clinical

Job Description:

Plume is a passion-fueled, mission-driven, trans-founded company focused on radically increasing access to healthcare for the transgender and gender-nonconforming communities. Our vision is to transform healthcare for every trans life and build a virtual care home for the trans community.

As a rapidly expanding organization, we are now proudly available to more than 1 million transgender iniduals in 45 states. We are an organization formed through the lived experience of trans people and fierce allies and we welcome other heart-forward, talented iniduals to join our team on this journey.

We are currently hiring Independently Contracted Physicians (MD/DOs) to serve our members. We welcome all state licenses but are specifically in need of folks with Texas, California, Arkansas, North Carolina, Florida, Missouri, Tennessee, Kentucky, Michigan, Indiana, Wisconsin, Oklahoma, and Georgia licenses at the moment.

About the role:

As an independently contracted clinician with Plume, you will join our awesome team of erse clinicians who provide GAHT (gender-affirming hormone therapy) and depression/anxiety management for our adult patients throughout the United States. As we expand our clinical services, we are looking specifically for providers with broad, primary care experience.

You will provide longitudinal care for a panel of patients so your time will be spent onboarding new patients and providing follow-up care for them (lab management, prescription management, answering clinical questions).

This is a completely virtual work-from-home role with flex scheduling. You schedule your hours when you want to work. We require a minimum of 10 hours of synchronous time per week. We have a large support team that takes care of patient account logistics so you can focus on clinical care.

We are a healthcare startup, so we are seeking folks excited about changing the paradigm of medical care so patients and clinicians are truly centered. We heavily leverage technology, so being comfortable with computers and electronic medical record systems in a rapidly changing environment is critical to do this work.

Must-Haves:

• At least two active licenses and in good standing with your professional board
• At least one DEA License
• Experience providing primary care services to adult patients
• Experience and comfort in collaborating with erse teams
• Comfortable with 100% remote patient care
• Strong technical background (familiarity with EMRs, email communication, app-based platform use, etc.)
• Strong organization and communication skills
• Availability of 10 hours per week for synchronous visits

Nice-To-Haves:

• At least 5 active licenses – preference for Texas, California, Arkansas, North Carolina, Florida, Missouri, Tennessee, Kentucky, Michigan, Indiana, Wisconsin, Oklahoma, and Georgia.
• Ability to commit at least 20 hours of synchronous time per week
• Experience with telehealth and preferably direct-to-consumer (DTC) telehealth/startup work
• Experience prescribing GAHT
• Experience prescribing behavioral health medications (depression and anxiety)
• Familiarity with and experience using established GAHT guidelines, including an informed consent model of care
• CAQH profile

Compensation & Benefits:

• Working for an amazing company that is changing the world
• MD/DO Providers are paid per appointment at the following rates:
• $37.50 per 15 min visit
• $68 per 30 min visit
• 50% of the regular rate for no-shows or visits canceled within 24 hours.
• Quarterly Bonus Opportunities
• License Reimbursements for Providers who offer 20 hours of synchronous time per week

Plume is an equal-opportunity employer. Trans and gender-nonconforming iniduals are strongly encouraged to apply, particularly those who identify as people of color. We positively encourage applications from suitably qualified and eligible candidates regardless of age, color, disability, national origin, ancestry, race, religion, gender, sexual orientation, gender identity and/or expression, veteran status, genetic information, or any other status protected by applicable law.

Read more about Plume at www.getplume.co

Title: Registered Dietitian (Remote)

Location: Remote (US)

Type: Part-Time

Workplace: remote

Category: Clinical

JobDescription:

This requisitionis an advertisement for part-time positions that Foodsmart hires for regularly throughout the year. It is a way for Foodsmart to build a database of qualified, interested iniduals for a particular job function so that when there is a need to fill that type of role, the hiring process will be faster. By applying to an Evergreen Requisition, you are expressing your interest for a particular job function within Foodsmart. Please see our other Registered Dietitian postings for specific states in which we are currently hiring. Who Is Foodsmart? At Foodsmart, were knee-deep in changing the food and nutrition landscape and were leveraging technology and our team of bright minds with big hearts to make it happen. We believe that eating well should be within reach for all, not some. That food should be accessible and affordable and the foundation of good health. And that we have a role to play in addressing the nutrition insecurity that plagues too many, and that has a direct impact on our health and susceptibility to illness. We know the Foodsmart approach works, and we know it matters because we have the clinical outcomes published in major journals, serve >20% of the Fortune 500 and 4 out of 5 major health plans, and have the community engagement to back it up. And because were all Foodsmart customers. We are working parents. We are doctors. We are patients. We have busy lives, tight budgets and need to feed picky eaters. We have lived in households that used SNAP and clipped coupons. So we built a platform that truly changes health outcomes and improves lives. Our registered dietitians work with iniduals to offer personalized nutrition guidance and connect them to the Foodsmart digital platform available on mobile and web, to create sustainable behavior change and deliver real results. Our integrated healthy food marketplace, including partners such as Walmart, Instacart, Grubhub, and others, allow iniduals to go from meal planning to grocery delivery in minutes saving them time and money. We are a Series C startup based in San Francisco but support a remote working model. Are you ready to join our team and help solve one of the biggest problems facing the world today? Learn more at www.foodsmart.com About You Foodsmart is seeking Registered Dietitians (RDs) to support the comprehensive nutrition care mission of Foodsmart Nutrition Network, which is grounded in evidence-based clinical nutritional standards including use of a whole food plant based (WFPB) diet. Our Foodsmart RDs leverage Foodsmart’s digital platform to provide a broad range of nutrition and health-related consultations, educational sessions, and training to Foodsmart’s clients, partners, and users. Populations Served In this role, you will work with members from various health plans, including Medicaid populations. Foodsmart creates lasting and sustainable change in Medicaid communities by tackling the root causes of food and nutrition insecurity. We provide members with personalized guidance, access to affordable healthy food options, and access to SNAP benefits if they qualify. In turn, we see improved food and nutrition security, more health equity, and better engagement and enrollment.

What Does Success Looks Like In This Role?

• You are completing at least 6 follow-up visits with your patients
• You are receiving an NPS of 80% and above
• You find value in developing lasting relationships with your patients to support them towards sustainable behavior change and improved health outcomes

Responsibilities

• Provide inidualized medical nutrition therapy (MNT) via remote sessions to patients with a variety of health and lifestyle needs
• Document care in electronic medical record according to Nutrition Care Process
• Assist patients in getting the most utility out of Foodsmart’s digital platform
• Manage a panel of clients/patients with a variety of chronic health conditions and backgrounds
• Communicate effectively and empathetically with clients/patients through HIPAA-compliant video calls and electronic messaging

Required Skills

• Active credentialing as a Registered Dietitian by the Commission on Dietetic Registration (CDR) and Licensed Dietitian
• Must have at least one state licensure
• Willingness to apply for additional licensure in at least one other state
• Minimum of one (1) to two (2) years of professional experience in providing nutritional counseling
• Ability to work in the U.S.

Preferred Skills

• Multilingual (native level) language capabilities
• Multiple active state licenses or certifications
• Experience delivering services via a telehealth platform

Compensation

• $12/unit for Medical Nutrition Therapy (MNT). Each unit for MNT is 15 minutes, so you’d earn $48 for a visit that lasted for one hour. Most of our visits are one hour
• RDs who offer over 20+ hours of weekly availability for at least a year qualify for CDR fee reimbursement ($70)

Foodsmart is an Equal Opportunity Employer. It is our firm policy to extend equal employment and advancement opportunity to all applicants and employees without regard to race, color, national origin, citizenship status, religious creed, age, sex (including pregnancy, childbirth, breastfeeding, medical conditions related to pregnancy, childbirth and/or breastfeeding), gender, gender identity and expression, sexual orientation, marital status, disability (physical or mental) and/or a medical condition, genetic information, ancestry, veteran status or service in the uniformed services, and any other characteristic protected by applicable federal, state or local law.

Manager, Coding Validation & Quality Assurance

locations

Remote

time type

Full time

job requisition id

33530

Position:Manager, Coding Validation and Quality Assurance

Department: Clinical Documentation

Schedule: Full Time / Remote

POSITION SUMMARY:

Responsible for the professional development of the coding staff and for providing a hospital-wide educational program to assist coders in continued coding and documentation education. Performs quality assurance reviews of inpatient and outpatient records to assess and report on the effectiveness of training programs and quality of coders. Provides in-service training and feedback to coding staff regularly, including coding changes and updates. Designs and implements programs on coding and clinical documentation audit and education to improve performance and efficiency. Partners with CDCI management to develop appropriate guidelines regarding IP and OP coding. Enforces correct application of Official Coding Rules and Regulations and follows appropriate guidelines including Coding Clinic. The Manger, Coding Validation and Quality Assurance may help represent the Clinical Documentation Coding Integrity (CDCI) Department at clinical meetings when requested to serve as a resource for coding guidelines and interpretation.

REQUIREMENTS

EDUCATION:

Bachelors degree or equivalent combination of formal education and experience.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

CCS and AHIMA Certified ICD-10 Trainer credentials required.

Additional RHIA, RHIT, RN, or other coding credential is preferred.

EXPERIENCE:

Must have at least five years of experience in coding; experience must include education/mentoring/training. Minimum of five years acute care hospital experience coding with ICD-9/10-CM/PCS and CPT-4, academic medical setting or trauma center preferred. Minimum of three years management experience required; five years preferred.

Prior experience working claim edits and denials.

KNOWLEDGE AND SKILLS:

• Command of the ICD-9/10-CM and CPT4/HCPCS coding conventions, E&M coding, diagnosis-related groupings (DRG) and ambulatory patient groupings (APG) methodology. Work also requires concepts of human anatomy, physiology and pathology.
• Excellent skill in providing hands-on education to CDCI staff based on audit finding and need.
• Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
• Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
• Ability to work with accuracy and attention to detail.
• Ability to solve problems appropriately using job knowledge and current policies/procedures.
• Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.
• Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.
• Must possess extensive knowledge of hospital inpatient and outpatient reimbursement methodologies.
• Work requires in-depth knowledge of medical terminology, ICD-10-CM/PCS and CPT-4 Coding conventions and knowledge of the various DRG systems (CMS DRGs, AP-DRG, and APR-DRGs). Work also requires basic concepts of human anatomy, physiology and pathology.
• Strong knowledge of health records, computer systems, Microsoft applications, data integrity, and processing techniques required.
• Ability to mentor, guide and motivate direct reports through demonstration of best practices and leading by example.
• Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
• Ability to solve problems appropriately using job knowledge and current policies/procedures.
• Ability to maintain and enforce strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.
• Must possess extensive knowledge of payer claim edits and payer denials. Work requires in-depth knowledge of medical terminology, ICD-10-CM and CPT-4 Coding conventions (including E&M coding), Ambulatory Patient Classifications (APC), Ambulatory patient Groupings (APG) methodologies, and Fiscal Intermediary Local Coverage Determinations, CMS National Coverage Determinations and various other applicable coding regulations and law.

IND123

Equal Opportunity Employer/Disabled/Veterans

Title: RN Supervisor, Clinical Operations

Location: United States

Job Description:

Company Overview

Cohere Health is illuminating healthcare for patients, their doctors, and all those who are important in a patients healthcare experience, both in and out of the doctors office. Founded in August, 2019, we are obsessed with eliminating wasteful friction patients and doctors experience in areas that have nothing to do with health and treatment, particularly for diagnoses that require expensive procedures or medications. To that end, we build software that is expressly designed to ensure the appropriate plan of care is understood and expeditiously approved, so that patients and doctors can focus on health, rather than payment or administrative hassles.

Opportunity overview

Coheres Service Operations team is responsible for ensuring that our healthcare partners are supported throughout their lifecycle of using the platform. The RN Supervisor, Clinical Operations position is a crucial role in our organization. In this role, you are responsible for coaching, mentoring, evaluating and developing the RN Reviewer team. The RN Supervisor will use established operational tools to ensure all RN staff are meeting or exceeding performance metrics and quality standards established by the leadership team.

As an RN Supervisor, you will work closely with the leadership team at Cohere and report to the Director/Manager of Clinical Operations. You will be responsible for providing daily operational guidance to the RN Reviewers to allow them to meet or exceed operational objectives and metrics. You will leverage both your creative skills and communication skills to promote a high performing clinical team.

The RN Supervisor will be highly organized in order to plan daily operational activities and provide oversight of the RN Reviewer team. You will use your professionalism, personality, and communication skills to inspire the team to meet or exceed all performance standards. At a growing organization, this is a position that offers the ability to make a substantive mark on the company and its partners with exponential growth opportunities.

Last but not least: People who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that erse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

What will you do

• Oversee the RN Reviewer team including one RN Team Lead
• Establish a plan for the day and communicate to all staff daily
• Manage the daily timeliness report and ensure all cases meet expected turnaround times
• Monitor the nurse productivity reports daily and provide feedback to the nurses, managing performance to ensure consistency
• Lead weekly team meetings
• Capture process efficiency ideas from the team and work with the appropriate stakeholders to recommend and lead changes needed to improve nurse efficiency.
• Meet inidually with all direct reports on bi-weekly cadence to develop solid work relationships with each team member and to share any performance feedback, positive and constructive.
• Working with the RN Reviewer Leads, track hourly nurse productivity, keeping the Director/Manager informed on productivity results as needed.
• Train and Develop new RNs who join the team.
• Oversee daily newsletter publication
• May be asked to help with other projects as needed.

Your background & responsibilities

• Registered Nurse with an active and unencumbered license to practice
• 2-3 years of supervisory/management experience
• Knowledge of NCQA/CMS requirements
• Experience using MCG, CMS NCDs/LCDs, clinical criteria guidelines
• Prior Authorization or Utilization Management experience
• Excellent computer skills and familiarity with a Mac.
• Experience supervising and training in a remote work environment.
• Ideal shift will be between the hours of 10AM-8PM EST

We cant wait to learn more about you and meet you at Cohere Health!

Equal Opportunity Statement

Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, its personal.

The salary range for this position is $75,000 to $85,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Inidual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.

#LI-Remote

Manager, Patient Account Specialist

Remote, United States |Billing

Description

Position at GoHealth Urgent Care

JOB SUMMARY

This Position is responsible for the day-to-day management of patient account receivables payments and billing customer service. This includes the supervision of the of the billing customer service call center and email / website inquires along with third-party vendor relations supporting relevant functions. Also included is management of cross-departmental work needed to adequately address patient concerns regarding claim processing or patient account billing along with overall customer service.

JOB REQUIREMENT

Education

High School Diploma or GED required.

Bachelors degree in Business Administration or related field preferred

Work Experience

5 years of healthcare experience required.

3 years of progressive management experience required

Required Licenses/Certifications

CPAR Certified Patient Account Representative preferred

Additional Knowledge, Skills and Abilities Required

Strong knowledge of the Accounts Receivable process

Excellent phone, communication, organizational skills, computer skills and mathematical skills Ability to maintain patient confidentiality. Strong knowledge of process and understanding of practice management systems

Additional Knowledge, Skills, and Abilities Preferred

Epic or eClinicalWorks experience

Experience with Microsoft Excel and Word

ESSENTIAL FUNCTIONS

Maintain Daily communication with direct reports and team leads.

Maintain a high level customer service and collaboration when working with other revenue cycle departments, payors, legal, compliance, the GoHealth customer experience team, health system partners, and center operations Establish and maintain a high level customer service approach to working with all patients Handle all level 4 support calls with centers and patients With support of other leadership; interview, hire, and review team members Implement audits of teams adherence to script, customer service and system documentation Produce and maintain key metrics for statement collection rates, medium collection rates and hard collection rates Recommend team for structured quarterly bonus calculation Provide training for all staff With other leaders, establish policies for patient collection process and maintain those policies Implement and maintain ACD (Automatic Call Distribution) for inbound patient calls Works with vendors to resolve any issues Establish monthly calls with vendors to discuss performance

Required knowledge, skills and ability:

Customer service skills:

Ability to represent the Department in a professional manner when interacting with customers, patients, co-workers, and health system partners Ability to handle service issues timely and professionally Ability to follow through with customers completely and in a timely manner

Communication Skills:

Ability to communicate effectively to patients about the financial aspects of their care Ability to communicate effectively to patients, centers, and staff regarding departmental policy

Keyboard skills:

Ability to type proficiently Ability to effectively utilize spreadsheets

Teamwork:

Ability to function effectively as extension of the Centers and other GoHealth departments Be flexible and open-minded in thought processes Maintain focus under pressure Share relevant information with other team members proactively

Medical Terminology & Insurance

Ability to understand basic medical terminology Ability to calculate deductible and co-insurance correctly Abilty to read and understand carrier Explanation of Benefits

All other duties as assigned.

Note: this job description is not inclusive of all the duties of the position. You may be asked by leaders to perform other duties. Management reserves the right to revise this position description at any time.

Certified Medical Coder

Location: United States – Remote

Nice to meet you, were Vesta Healthcare.

Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these iniduals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center.

Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others’ needs ahead of her own, keeping the hearth warm so the home and family can function.

We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. Its an insurance covered benefit, so its available to most adults with Caregivers free of charge to them.

We seek team members who are passionate about making home the best place it can be for people with home care needs and see the important role Caregivers play. Our team members are collaborative data-driven optimists who always focus on doing whats best for patients and their caregivers. We see ourselves as being 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

Someone whos passionate about our mission to help older adults live fulfilling lives in their home and who gets excited about diagnosis codes! They are current on their understanding of CMS guidelines and coding protocol. This person wants to be part of a team working together to change the way older adults age at home.

The ideal teammate would be able to:

• Independently perform analysis of claims on a pre and post-payment basis utilizing clinical, coding and claims processing background to ensure claims are coded correctly according to CPT and ICD-10 guidelines
• Review pertinent medical records to validate/invalidate potential issues identified on claims
• Thoroughly document identified issues to support claim adjustments (including supporting medical record, clinical or coding rationale)
• Identify and document upstream process gaps driving incorrect payment
• Responsible for the security and privacy of any and all protected health information that may be accessed during normal work activities
• Leverages clinical and coding expertise to assure proper documentation is available in the medical record and that it is complete for coding requirements and claim submission
• Reports non-entered charges and reconciles errors for claim submission
• Identifies opportunities to educate, medical staff and professionals regarding documentation
• Meet expectations regarding productivity, code assignment accuracy, deadlines and documentation consistency
• Collaborate with the clinical team and Director of Revenue Cycle to resolve queries and ensure progression of the claim through the revenue cycle management process
• Adapt to new platforms and coding situations quickly and enjoy learning new processes

Would you describe yourself as someone who has:

• 1+ years of ICD-10 coding experience (required)
• Active Professional Medical Coding Certification (CPC, CCS, etc.) (required)
• Experience (1+ year(s)) with chart extraction for risk adjustment coding (highly preferred)
• ICD-10 Coding Certification (preferred)
• Experience with eClinicalWorks electronic medical records system (preferred)
• Experience with medical record documentation, medical chart auditing/quality experience (preferred)
• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology

In addition to amazing teammates, we also offer:

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

Pay range is $50,000-60,000 annually. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

Remote RN Case Manager, Outpatient (Must have California RN License)

Location: Remote-US, California US

Job Number6401

Workplace Type:Fully Remote

Remote-US,California

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether thats in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career with us.

Overview of the Role:

Alignment Health is seeking a remote, telephonic, RN case manager to join the outpatient case management team. As an RN case manager, you will be responsible for health care management and coordination, within the scope of licensure, for members with complex and chronic care needs. You will also deliver care to members utilizing the nursing process and effectively interacts with members, care givers, and other interdisciplinary team participants. Thecase manager will assist with closing gaps in care and resolving barriers that prevent members from attaining improved health. The Case Manager will connect with members telephonically.

Responsibilities:

• Coordinate care by serving as a resource for the member, their family and their physician.
• Ensure access to appropriate care for members with urgent or immediate needs facilitating referrals/authorizations within the benefit structure as appropriate.
• Complete comprehensive assessments within their scope of practice that includes assessing the member’s current health status, resource utilization, past and present treatment plan and services.
• Collaborates with the member, the PCP and other members of the care team to implement a plan of care.
• Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners and specialists on the development of care management treatment plans.
• Provide education and self-management support based on the members unique learning style.
• Assists in problem solving with providers, claims or service issues.
• Works closely with delegated or contracted providers, groups or entities to assure effective and efficient care coordination.
• Maintains confidentiality of all PHI in compliance with state and federal law and Alignment Healthcare Policy.

Required Skills and Experience:

• Minimum 1-3 years’ clinical experience,
• Minimum 2 years case management experience; or any combination of education and experience, which would provide an equivalent background.
• Health plan experience preferred
• Must have and maintain an active, valid, and unrestricted RN license inCalifornia
• Possess a high level of understanding of community resources, treatment options, home health, funding options and special programs
• Extensive knowledge of the management of chronic conditions
• Bilingual English and Spanish, Chinese, or Vietnamese preferred
• Excellent verbal and written communications skills
• Team player who builds effective working relationships
• Able to work independently
• Experience using standardized clinical guidelines required
• Strong organizational skills
• Strong proficiency in Microsoft Office suite (Word, Excel, PowerPoint, etc.)

Pay range: $78,000 – $118,000 annually.

Please note: All clinical positions are contingent upon successful engagement with Alignment Healths COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER:Please beware of recruitment phishing scams affecting Alignment Health and other employers where iniduals receive fraudulent employment-related offers in exchange for money or other sensitive personal information.Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company.If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission athttps://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Healths talent acquisition team, please [email protected].