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Title: Pro Fee Coder- General Surgery

Location: United States

US – Remote (Any location)

Full time

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Do:

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

Demonstrates the ability to perform quality surgical coding on General and Trauma surgery chart types as assigned.

Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing. Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards. Achieves and maintains 95% accuracy in coding while maintaining a high level of productivity. Accuracy will be monitored during monthly reviews either within the facility. Works the review queue daily to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary. Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process. See re-bill policy in facility guidelines. Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility. Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request. Coders must maintain their current professional credentials while working for Guidehouse. Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility. Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy) It is the responsibility of each coder to review and adhere to the coding ision policy and procedure manual content. Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services.

What You Will Need:

Minimum 3-5 years General Surgery Coding experience, both IP and OP coding for physician claims.

2-3 years coding Trauma or other complex procedures.

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

What Would Be Nice To Have:

COSC credential from AAPC

Multiple EMR and/or practice management systems experience E/M experience along with surgical coding experience (Office, OP and OR procedures

#LI- Remote

The annual salary range for this position is $40,200.00-$72,300.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

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

Benefits include:

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

About Guidehouse

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

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

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 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.

Billing and Coding Specialist

Location: Virtual – Work From Home

Job Id: 1437

# of Openings: 1

About Revecore

Revecore is an innovative, technology-driven company that is committed to helping our clients, our employees, our company, and our communities thrive. An award-winning services firm, partnering with hospitals and health systems, providing the momentum they need to maintain a strong revenue cycle amid today’s evolving healthcare environment.

With a 20+ year history, Revecore is the leading provider of revenue integrity and complex claims solutions for hospitals.

We offer a dynamic and flexible work environment, full of opportunity for motivated, hands-on team players. We strive each day to solve complex business problems and find new ways to enhance the efficiency, effectiveness, and quality of our services. If those attributes resonate with you, regardless of where you are locatedwe want you on our team!

Position Summary

Performs retrospective outpatient coding and both inpatient and outpatient billing reviews in coordination with internal staff in our mission to capture full, fair, and accurate reimbursement for our hospital clients

Duties and Responsibilities

• Support internal and external customers by providing accurate and timely responses to coding and billing questions
• Perform retrospective coding and billing reviews on inpatient and outpatient hospital claims
• Provide correction recommendations to internal associates or clients, and support recommendations with rationale that may include coding guidelines, industry standard billing guidelines, or payer specific guidelines
• Research and stay current on industry changes with regards to coding guidelines and payer specific billing guidelines for commercial and government payers
• Ability to comprehend payment methodologies and how they apply to billing and coding scenarios
• Build strong, lasting relationships with Revecore personnel
• Attend department and company meetings as required
• Comply with federal and state laws, company and department policies and procedures
• Assist with other related responsibilities to meet the needs of the business

Skills and Experience

• Coding certification required, with 1+ years hospital coding/ auditing experience i.e. CPC, COC, CIC, CCS-P, CCS
• Entry level understanding of Managed Care, Medicare and Medicaid billing and reimbursement guidelines
• Entry level understanding of inpatient and outpatient hospital reimbursement methodologies a plus
• Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook
• Mathematical skills sufficient to apply the concepts of claim payment methodologies
• Ability to read and interpret an extensive variety of documents such as claims, instructions, policies and procedures in written (in English) and diagram form
• Ability to present ideas on complex, detailed issues with ease
• Ability to define problems, collect data, establish facts and draw valid conclusions
• Strong team player, with willingness to adapt to changing priorities

Physical Demands and Work Environment

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

• Physical Demands: While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to handle or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
• Work Environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time. The noise level in the work environment is usually moderate.

Title: Full Time Bilingual Pennsylvania (PA) Licensed Nurse Practitioner (NP) – (English/Spanish) (Remote)

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

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

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

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

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

The ideal teammate would be…

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

The ideal teammate would be able to:

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

Would you describe yourself as someone who has:

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

Pay range is $125K – $130K 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).

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

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

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

MEI Support Specialist

US-Remote

2023-32908

# of Openings: 2

Administrative

Employee Full-Time

Overview

Who we are…

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

What we offer

At Ciox Health we offer all employees a place to grow and expand their current skills to create a career that you can be proud of. We offer you complete training and long-term career goals. Our environment is what most of our employees are the proudest of. Give us just a few moments to explain why we need you and hope you will help us change how the health Industry manages its’ medical records.

What we need

The MEI Support Specialist position serves as a key role within the Service Operation Division within Ciox. This position will support the Manager of Embedded Support (MEI) Team with performing daily administrative and clerical tasks that will enable the MEI and Service Operations teams to meet customer SLAs and to focus on critical client tasks. The position has specific responsibility for maintaining communication with MEI Leadership at a specific project level, to ensure the strategic plan is executed, as well as incorporating escalation as needed to facilitate completion of retrieval method identified.

Responsibilities

What You Will Do…

• Work closely with MEIs to understand project needs and assist with successful completion of same.
• Ensure timely delivery of reports to MEIs on a daily, weekly and/or monthly basis.
• Perform basic online research, move providers, create new Outreaches, Resolve SH Codes, Set Retrieval Methods, etc. within Ciox Chartfinder platform.
• Perform basic research in Ciox Healthsource platform.
• Log all transactions into the designated Ciox platform.
• Maintain accurate record keeping and data management
• Maintain an excel spreadsheet of daily work as directed.
• Other duties as assigned

Qualifications

What You Need…

• 6-12 months experience in a role similar to ROI medical record retrieval preferred
• Basic computer skills including Windows based applications (Excel and Outlook) and the ability to perform other basic computer functions.

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

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

Title: Triage Registered Nurse (Nights)

Location: Remote

Type: Full-time

Workplace: remote JobDescription:

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

Shift/Schedule:

Sunday-Thursday 7p-4a PST (Pacific Standard Timezone)

Essential Job Duties:

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

Requirements:

• Bachelor of Science in Nursing required
• Registered Nurse, currently residing and licensed in a compact state with eligibility to obtain RN licensure in all 50 states
• 2+ years experience in a triage setting, preferably some of that experience being focused on phone triage, or 2+ years experience in an emergency room, or 4+ years experience in an ambulatory primary care role that included triage
• Ability to work in PST Timezone
• Rotating holiday and weekend rotation (every 3rd weekend for Full Time and every other weekend for Part Time)
• Expertise in advanced clinical decision making
• Comfortable working with a wide variety of medical conditions for both pediatric and adult populations
• Experience in engagement in complex decision making, including situations of uncertainty
• Excellent written and verbal communication skills. The ability to gather a clinical history, answer questions at a patient level, and succinctly summarize findings is critical.
• Strong competence and ability to use multiple computer/medical record systems, as well as Google suite
• Must be able to work efficiently. We are a fast growing company and we are busy. Our team is expected to meet role specific metrics without sacrificing quality. Good judgment for balancing priorities is a must.
• Maintain current nursing licensure by completing applications for renewal in a timely manner and by complying with all requirements for continuing education.

Other Skills/Abilities:

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

#LI-Remote

About Included Health

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

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

Manager, Coding

Location: Remote, United States

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

Reports to: Director, Coding

Responsibilities:

• Client management, including emails, phone calls, and video meetings with client staff as well as physicians
• Aid clients in denial management and coding reviews
• Manage a coding team consisting of Team Leads and production coders
• Approve employee time and contractor payroll entries
• Provide training and ongoing education to coders
• Participate in meetings, trainings, and conferences as needed
• Other responsibilities as assigned

Role Information:

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

Job Requirements:

Required Knowledge, Skills, Abilities & Education:

• Coding certification through AAPC or AHIMA (CPC, COC, RHIT, CCS, etc., no apprentice designation)
• High school diploma or equivalent
• 5+ years of surgical coding experience (ASC or Same-Day Surgery)
• 3+ years management experience
• Extensive knowledge of medical terminology, anatomy, and physiology
• Ability to stay on task, working independently
• Must have a dedicated home office space with reliable high-speed internet (desktop computer will be provided)
• Experience managing a remote team
• ASC revenue cycle knowledge
• Presentation experience
• Ability to work independently and as part of a team
• Strong attention to detail and speed while working within tight deadlines
• Exceptional ability to follow oral and written instructions
• A high degree of flexibility and professionalism
• Excellent organizational skills
• Outstanding communications skills; both verbal and written

Preferred Knowledge, Skills, Abilities & Education:

• Bachelor’s Degree in healthcare related field
• 4-6 years management experience

Physical Demands:

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

Key Competencies:

• Leadership
• Job Knowledge/Technical Knowledge
• Communication
• Initiative/Execution
• Quality Control

Compensation Information

$57,600 – $72,000 based on skills and qualifications.

US Pay Ranges

$59,287.50—$71,493.75 USD

About Surgical Notes

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

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

Privacy Statement

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

Title: Nurse Care Manager

Location: Remote

Company Description

This is an exciting opportunity in a fast-paced, growing digital health startup. The Clinic by Cleveland Clinic, a joint venture between Cleveland Clinic and Amwell, was launched in 2019 to unlock access to the world’s best healthcare expertise so no one is left behind. This startup company’s initial focus is transforming the $5 billion global second opinion market, with additional digital health solutions in development. The Clinic offers virtual care from Cleveland Clinic’s highly-specialized experts through Amwell’s leading-edge digital health technology platform. Learn more at www.theclinic.io.

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey.

Amwell is a leading telehealth platform in the U.S. and globally, connecting and enabling providers, insurers, patients, and innovators to deliver greater access to more affordable, higher quality care. Amwell solutions are used by 240 health systems and 55 health plan partners, covering over 150 million lives.

The position is remote. The role reports to the Director, Clinical Operations.

Brief Overview:

We are looking for an experienced and dynamic nurse committed to delivering empathetic, concierge services to our consumers of the Virtual Second Opinion Services. You will be responsible for establishing a relationship with patients via online/telephone intake through active listening and questioning process, documenting these encounters and providing instruction and creating an opinion timeline based on established protocol.

A strong background in an ambulatory, hospital or telehealth with the ability to function independently in an organized fashion managing a portfolio of patients through the virtual second opinion process is essential to success in this position.

Core Responsibilities:

• Responsible for establishing a relationship with patients and effectively triaging and providing care guidance and resolution to all contacts and patients.
• Assesses patient needs, determines and initiates appropriate action or response to meet identified needs.
• Assesses patient and physician needs, provides requested information and/or guidance or service as appropriate or forwards to the appropriate person on the clinical management team.
• Initiates and independently implements appropriate clinical activities, including communication with patient/caregiver, physician (as applicable) and complete documentation of events.
• Maintains consistent communication with patients.
• Assists, reviews, researches, and resolves active patient and referral concerns and complaints and records outcomes accordingly to meet regulatory compliance standards.
• Other duties as assigned.

Qualifications:

• Graduate of an accredited school of professional nursing. BSN preferred or other allied health professional degree.
• Current Ohio RN and/or multistate compact license
• Other Allied Health license
• Good clinical judgment, careful listening, critical thinking skills and assessment skills.
• Strong customer service skills, including both verbal and written communication skills.
• Strong computer skills
• Ability to be self-directed, excel in critical thinking and problem solving skills.
• Minimum of 2 years nursing or clinical experience (preferred in ambulatory, hospital, med/surg, long term care, home care, hospice or palliative care setting)
• Prior phone triage or telehealth services.
• Manual dexterity to operate office equipment. May require periods of sitting or standing for long periods of time.
• Requires good visual acuity through normal or corrected vision. Must be able to hear normal conversation. Must be able to lift at least 20 pounds.

Additional information

Working at The Clinic

This Clinic is a partnership between American Well and Cleveland Clinic, where the two parent organizations founded the company on the mission of To make it easier for patients to get the best care by aligning world-class clinical expertise with innovative digital technology.’ The vision for The Clinic is to unlock access to the world’s best healthcare expertise so no one is left behind. We are a group of visionaries defining and realizing the global possibilities of digital health. We believe in: patient centricity; being bold, daring, and decisive; having a passion to win; teamwork and collaboration; transparency and trust. The pace is fast, the work rewarding and the outcomes, deeply satisfying.

Benefits

• The Clinic offers a competitive benefits package that includes health, dental, and vision insurance, paid holidays, and paid vacation.

Compliance Team Assistant

remote type

Fully Remote

Allina Commons

Part time

Shift Length:

Hours Per Week:

32

Union Contract:

Non-Union

Weekend Rotation:

None

Job Summary:

Coordinates the day-to-day activities for office support and management, scheduling and staffing, and data management. Collaborates with leaders to address questions and resolve issues.

Key Position Details:

32 Hours a week-64 Hours in a pay period

4 Days/flexible day off

No Weekends

8:00AM-4:30PM

Remote Role

Job Description:

Principle Responsibilities

• Obtains information for insurance authorization
• Faxes information to companies as requested
• Follows up to obtain authorization responses
• Reports results to Care Manager and puts in computer
• Advises clinicians of need for Auth action/completion
• Ensures clinical is completed so data can be processed in a timely manner
• Tracks date status so Recert clinical are sent timely to MD as necessary.
• Runs and prepares quarterly insurance reports as directed.
• Maintains other reports as needed for the team
• Assists Supervisor in projects as needed

Job Requirements

• Must be 18 years of age with education and/or experience needed to meet required functional competencies as listed on the job description, and High school diploma or GED preferred
• Associate’s or Vocational degree preferred or
• Bachelor’s degree preferred
• 0 to 2 years healthcare/home care and/or hospice experience preferred and
• 0 to 2 years Strong customer service, office and computer skills preferred
• Certified Nursing Assistant (CNA), Licensed Practical Nurse (LPN) or Health Unit Coordinator (HUC) Certified Nursing Assistant (CNA, Licensed Practical Nurse (LPN) or Health Unit Coordinator (HUC) Upon Hire preferred

Functional Competencies

• Analytical Thinking: Practices investigative techniques to determine the best approach.
• Business Impact: Role has impact on the department.
• Collaboration: Develops partnerships with internal team members.
• Communication Skills: Able to communicate well in straight-forward situations.
• Problem Solving: Uses common sense to solve routine issues.

Physical Demands

Sedentary: Lifting weight Up to 10 lbs. occasionally, negligible weight frequently

Physician Coding Liaison II – Urgent Care

Remote

Full time

10395 Revenue Cycle – Coding & HIM Clinician Support

Status:Full time

Benefits Eligible:Yes

Hours Per Week:40

Schedule Details/Additional Information:First Shift

This is a REMOTE Opportunity

Major Responsibilities:

• Provides service line/specialty specific coding/documentation education and feedback related to coding changes (CPT including E&M, modifiers, ICD-10-CM, and HCPCS), annual code updates, payer requirements, and payer rejection resolution to assigned Physicians/APCs. Partners with CMOs to standardize coding processes across a specific specialty. Shares and/or presents coding/documentation education presentations to Chief Medical Officers (CMOs), Physicians/APCs, Senior Director Administrators across the organization. Coordinates with PSA Liaisons to provide adequate Physician/APC and/or clinical team member support.
• Conducts orientations for all Physicians/APCs, residents/students and clinical team members on specialty specific coding and documentation related education. Performs new clinician documentation reviews for specialty specific coding, and documentation feedback, as requested.
• Coordinates responses to Physicians/APCs, Locum Tenens, residents/student’s questions and feedback from various sources and partners, including Senior director administrators, CMOs, Medical Group Compliance, Internal Audit, Physician Compensation, Clinical Informatics/Clinical Informatics Educators, Quality Improvement Coordinators, and/or other external partners.
• Queries Physician/APC, Locum Tenens, residents/students when prompted by Professional Coding Department production coders to assist in resolving coding and documentation questions. Relays any coding changes, feedback, and education to Physician/APC, Locum Tenens, residents/students and/or clinic leadership, as appropriate.
• Monitors and works to resolve charge sessions requiring additional information for assigned clinicians and/or service line/specialty in the Epic work queues and/or other transfer work queues to ensure Clinicians are completing work timely to ensure proper supporting documentation for billing and timely filing.
• Attends and provides service line/specialty specific coding and documentation information, as requested, to CMOs, Physicians/APCs and/or Clinic/Site Department meetings. These may be virtually and/or in-person. Virtually attends Physician/APC education that include coding and/or documentation topics, such as Documentation Specialist clinician low risk review meetings, Risk Adjustment/HCC meetings, and/or Medical Group Compliance reviews/meetings.
• Collaborates with PSA Liaison to review and provide coding/documentation guidance on Epic order entry, diagnosis, and charge capture preference lists as well as SmartSets and templates.
• Develops Physician/APC monthly service line/specialty newsletters to continually educate and communicate updates from various coding resources including specialty society organizations. Communicates new services performed by Physician/APCs to Professional Coding department leadership.
• Identifies service line/specialty specific trending data and opportunities to capture revenue through documentation improvement. Attends service line/specialty specific coding and/or society conferences, as requested, to gain further knowledge that is uniquely relevant to that specialty and how coding, documentation, and billing are affected. Maintains expert knowledge of Medicare, Medicaid, and other regulatory requirements pertaining to nationally accepted coding policies and standards.

Licensure, Registration, and/or Certification Required:

• Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), or
• Coding Specialist – Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), or
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or
• Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), or
• Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC), and
• Specialty Medical Coding Certification issued by the American Academy of Professional Coders (AAPC) needs to be obtained within 1 year.

Education Required:

• Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist.

Experience Required

• Typically requires 5 years of experience in expert-level professional coding and least 3 years educating/training licensed clinicians.

Knowledge, Skills & Abilities Required:

• Specialty Medical Coding Certification must be held in the area(s) you will support.
• Excellent communication (oral and written), adult education, and interpersonal skills. Ability to develop rapport and maintain positive, professional partnerships primarily with employed Physicians, APCs, CMOs, Senior director administrators, Medical Group Operations, and physician coding team members.
• Advanced computer skills including the use of Microsoft office products, electronic mail, video/web conferencing, including exposure or experience with electronic coding and EHR systems or applications.
• Excellent/comprehensive skills in organization, prioritization, problem solving, facilitation skills as well as the ability to have meaningful, albeit, difficult conversations with CMOs/Physicians/APCs and/or Senior Director Administrators.
• Highly proficient in critical thinking and analytical skills with an extensive 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 work in multiple work environments (ie virtual, office, clinic/hospital, other).

Physical Requirements and Working Conditions:

• Exposed to normal office environment.
• Position requires travel which will result in exposure 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.

Remote Pro Fee Coder (Denials Review)

Location: LOUISVILLE Kentucky; United States

Job Description & Requirements

Pay Rate: $26.00 – $34.00

TYPE OF JOB ORDER: Remote Pro Fee Coder (Denials Review)

REQUIRED SKILLS: 3- 5 Yrs.

Pro Fee Experience. Denials exp a plus

Academic Level -1 – IP and OP settings

#OF WEEKS: 20 + Weeks

SHIFT/HOURS: M-F Flexible hours

EXPECTED HOURS: 40

LICENSE/CRED. REQ: Prefer a CPC

SYSTEMS: 3M EPIC, Cerner

NOTES: Must be comfortable with Trauma 1 Academic Medical Centers, Remote Work Setting. Appeals and Denials Coding Specialist Profee (Physician-based). Within RCM Dept

Job Benefits

Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary but the perks don’t stop there. There are many additional benefits to enjoy, including:

• Medical, dental and vision benefits
• Earned time off and paid holidays
• Paid continuing education time
• 401(K) retirement planning
• Short-term disability, life insurance, paid jury duty
• Access to the largest network of facilities and providers in the country
• Industry experienced workforce management team
• Licensure and certification reimbursement

CERTIFIED CODER

REMOTE

• Molina Healthcare
• United States
• Job ID 2020989

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.

About Us

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

Job Type: Full Time

Coder II-Anesthesia

locations

Remote

time type

Full time

job requisition id

R82520

Department:

10271 Revenue Cycle – Professional Production Coding Specialty

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

First Shift

This is a REMOTE Opportun

Anesthesia experience preferred.

Major Responsibilities:

• Reviews medical documentation at a proficient level from clinicians, qualified health professionals and hospitals in order 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 an EMR and/or Computer Assisted Coding software.
• Adheres to the organization and departmental guidelines, policies and protocols.
• Reviews all clinician documentation to support assigned codes in the health information record so that all significant diagnoses and procedures may be captured for reimbursement and data purposes.
• Conduct independent research to promote knowledge of coding guidelines, regulatory policies and trends.
• 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.
• Maintains the confidentiality of patient records. Reports any perceived non-compliant practices to the coding leader or compliance officer.
• Meets then exceeds departmental quality and productivity standards.
• Recommend modifications to current policies and procedures as needed to coincide with government regulations.
• Responsible for processing Coding Claim Denials and Coding Claim Rejections, when applicable

Licensure, Registration, and/or Certification Required:

• Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), or
• Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), or
• Coding Specialist -Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA)

Education Required:

• Advanced training beyond High School in Medical Coding or related field (or equivalent knowledge)

Experience Required:

• Typically requires 3 years of experience in professional coding that includes experiences in either hospital or professional revenue cycle processes and health information workflows.

Knowledge, Skills & Abilities Required:

• Advanced knowledge of ICD, CPT and HCPCS coding guidelines. Advanced knowledge of medical terminology, anatomy and physiology.
• Intermediate computer skills including the use of Microsoft officeproducts, electronic mail, including exposure or experience with electronic coding systems or applications.
• Advanced communication (oral and written) and interpersonal skills.
• Advanced organization, prioritization, and reading comprehension skills.
• Advanced 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.

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.

MEDICAL CODING SPECIALIST

WORK AT HOME

MultiPlan United States of America (Remote) Full-Time

Job Details

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

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

JOB SUMMARY: The Medical Coding Specialist is responsible for providing billing analysis of claims and applying coding standards and federal regulations to ensure correct billing practices. In this role, you will perform bill and chart reviews in identifying any variation from quality of billing as well as monitor patient bills for accuracy and compliance.

JOB ROLES AND RESPONSIBILITIES:

1. Review and analyze inpatient, outpatient, and provider billing for medical appropriateness of treatment; analysis of charges of various revenue centers with consideration to patient diagnosis, procedures, age and facility type; and any additional information relevant to the negotiation process.
2. Apply recommendation of national coding and regulation standards to claims billed.
3. Prepare clear, concise and legible findings.
4. Research, review and provide internal response based on receipt of itemized bills, claims, operative notes and other documentation as needed.
5. Assist with, create or enhance internal claim and review recommendations.
6. Communicate with co-workers and management regarding clinical and reimbursement findings.
7. Assist with clinical education of staff as it relates to clinical aspects of claims, suggesting additional negotiation talking points or tools, and communicating overall industry or regulatory changes which affect the department.
8. Monitor, research, and summarize trends, coding practices, and regulatory changes.
9. Research and review inidual claims, claim trends or detailed itemized bills, operative notes and other documentation as needed.
10. Collaborate, coordinate, and communicate across disciplines and departments.
11. Ensure compliance with HIPAA regulations and requirements.
12. Demonstrate commitment to the Company’s core values.
13. Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
14. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

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

The salary range for this position is $60,000-$75,000. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

Job Requirements:

JOB REQUIREMENTS (Education, Experience, and Training):

• Minimum completion of educational curriculum required of medical license or coding certification held with Bachelor’s Degree preferred; or minimum Bachelor’s Degree in healthcare related field and at least 2 years of coding experience.
• Current nursing certification and/or current certified coder (CCS, CCS-P or CPC), Registered Health Information Technician (RHIA/RHIT).
• Minimum 2 years experience in direct patient care, medical procedure billing, medical insurance auditing, line item review, audits, coding, and/or reimbursement.
• Knowledge of inpatient/outpatient hospital billing requirement including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD-9/10 diagnoses and procedure codes, DRG, APCs.
• Knowledge of professional claim billing requirements including HCFA­1500s, CPT codes and ICD-9/ICD-10 diagnoses codes.
• Knowledge of payer reimbursement policies, state and federal regulations, medical necessity criteria and applicable industry standards.
• Knowledge of commonly used medical data resources such as MDR, Medical Fees in the US, etc.
• Auditing and health information management experience in a healthcare setting preferred.
• Excellent communication (verbal and written), teamwork, training, presentation, negotiation and organizational skills.
• Ability to use hardware, software and peripherals related to job responsibilities, including MS Office Suite and database software.
• Ability to handle multiple tasks in a fast paced environment.
• Ability to read and abstract medical records.
• Knowledge of medical terminology, anatomy, and physiology.
• Ability to interact and discuss audit results with providers.
• Required licensures, professional certifications, and/or Board certifications as applicable.
• Inidual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

BENEFITS

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

Your benefits will include:

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

EEO STATEMENT

MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please

Job Snapshot

Employee Type

Full-Time

Location

United States of America (Remote)

Job Type

Health Care

Experience

Not Specified

Title: Inbound Engagement Specialist (Bilingual)

Location: Remote

Position Description:

This is a rare chance to have a significant personal impact in changing the lives of people and communities dealing with the effects of addiction. In this role, you are responsible for engaging with iniduals who may be struggling with substance use disorders and helping them understand the whole-person care and inidualized support that Eleanor Health provides. Through these interactions, you will lay the foundation of trust and understanding which lets them know that Eleanor Health is there for them when they need us. You will also help guide them to the appropriate Eleanor Health services if they choose to seek our help.

This role will report to Eleanor’s Access Team Supervisor

Candidate Responsibilities:

• Understand Eleanor Health’s care mode and be able to communicate it’s value in a clear, compassionate and non-judgmental way
• Understand how insurance works, including the plans our patients have, and be able to effectively verify insurance eligibility and communicate patient cost sharing responsibility
• Field inbound communications through various intake channels inquiring about the nature of Eleanor Health’s services, qualify patients for Eleanor Health’s care, and schedule them with the appropriate appointments in EMRs.
• Facilitate successful telehealth by performing virtual intakes, communicating with members to remind them about upcoming telehealth sessions and coaching them on accessing their sessions.
• Collaborate online with other care team members to facilitate the enrollment of new members to Eleanor Health, including making appointments, verifying insurances and collecting co-payments
• Outreach to iniduals identified as having Substance Use Disorders to establish a relationship and let them know about Eleanor Health’s services

You’ll be a good fit if you:

• Are Bilingual English/Spanish
• Have 3-4 years of customer facing experience, preferably in a healthcare setting, particularly behavioral health or substance use treatment
• Have experience working from home in a contact center environment, fielding a high number of calls each day
• Have experience and comfortable using technology such as computer telephony & EMR software to document patient interactions & schedule patients for appointments
• Have strong interpersonal communication skills, written communication skills, and active listening abilities
• Are highly empathetic, non-judgmental, open-minded and resilient
• Are able to build trust quickly and can translate complex concepts such as insurance and care into easily understood conversations that put potential patients at ease.
• Strong interpersonal and written communication skills, active listening abilities, and motivational interviewing skills
• Are highly motivated and self-directed with the ability to multitask between phone calls, documentation, and collaboration with other team members
• Enjoy working in a fast-paced, collaborate environment
• Our current hours are Monday – Friday from 8am-8pm EDT you must be available to work any shift during these hours

Benefits:

The total target compensation range for this position is $20-22 an hour. The actual compensation offered depends on a variety of factors, which may include, as applicable, the applicant’s qualifications for the position; years of relevant experience; specific and unique skills; level of education attained; certifications or other professional licenses held; other legitimate, non-discriminatory business factors specific to the position; and the geographic location in which the applicant lives and/or from which they will perform the job.

Eleanor Health offers a generous benefits package to full-time employees, which includes:

• Flexible time off that includes 80 annual hours of PTO accrued monthly + 10 wellness days granted on day 1 – unplug, relax, and recharge!
• 9 observed company holidays + 3 floating holidays- if you need a mental health day, celebrate a special holiday, or just want to take your birthday off and celebrate!
• Fully covered medical and dental insurance plan, with affordable vision coverage.– We are a health first company and we strive to make our plans affordable and accessible
• 401(k) plan with 3% match. We want our team members to be excited about their future and retirement
• Short-term disability- We understand that things happen, we want you to feel comfortable to take the time to recover. Fully paid by Eleanor!
• Long Term Disability – Picks up where Short Term Disability leaves off.
• Life Insurance – Both Eleanor and employee-paid options are available.
• Family Medical Leave- Eleanor Health’s Paid Family & Medical Leave ( PFML ) is designed to provide flexibility and financial peace of mind for approved family and medical reasons such as the birth, adoption, or fostering of a child, and for serious health conditions that they or a family member/significant other might be facing.
• Wellness Perks & Benefits- Mental Health is important to us and we want our employees to have the accessibility they deserve to talk things through, zen with a mindfulness app, or seek assistance from health advocates
  • Mindfulness App Reimbursement
  • 1 year subscription to TalkSpace
  • Paid Membership to Health Advocate, One Medical, and Teladoc

About Eleanor Health:

Eleanor Health is the first outpatient addiction and mental health provider delivering convenient and comprehensive care through a value-based payment structure. Committed to health and wellbeing without judgment, Eleanor Health is focused on delivering whole-person, comprehensive care to transform the quality, delivery, and accessibility of care for people affected by addiction.

To date, Eleanor Health operates multiple clinics and a fully virtual model statewide across Louisiana, Massachusetts, New Jersey, North Carolina, Ohio, Texas, Florida, and Washington, delivering care through population and value-based partnerships with Medicare, Medicaid, and employers.

If you are passionate about providing high quality, evidence based care for iniduals with substance use disorder through an innovative practice and about building a great business that makes a difference, Eleanor Health is an ideal opportunity for you. We seek highly skilled, motivated and compassionate iniduals who take responsibility and adapt quickly to change to join our deeply committed and collaborative team.

Job Types: Full-time

Title: Triage Unit Manager – Registered Nurse (RN) (NY/Compact License) (Remote)

Location: Remote US

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a startup with a simple mission: Delivering extraordinary outcomes by unlocking the power of caregivers. Caregivers are one of the largest, most untapped resources in the healthcare delivery system and are the unsung heroes of their care recipients. Yet despite their vital role, they are largely unsupported and invisible to the healthcare ecosystem.

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

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

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

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

The ideal teammate would be

• A nursing leader who is passionate about caring for our members, teammates, and clients and can leverage technology to create new programs, systems, and processes to drive exceptional clinical team performance
• Someone who has a proven track record of using data to drive high quality and efficient clinical outcomes
• Someone who has experience with triage, telehealth, remote patient monitoring, and valuable based care of vulnerable populations
• Love learning and helping others learn: you’re excited to bring your wisdom and coach others, and you’re equally energized to learn from other’s experience (such as product managers, software engineers, and data scientists), and then continue improving how Vesta does care management as we learn more together
• Comfortable working in an ambiguous environment within an organization that is growing and changing quickly
• Enjoy moving back and forth between direct care management with members when needed to helping us build out a care management program
• Curious about changing regulations within the space and how they can be leveraged to create additional revenue streams

The ideal teammate would be able to:

• Provide leadership, coaching, and development to a team of nurses and eventually additional multidisciplinary iniduals performing triage
• Develop triage protocols following evidence based guidelines while helping patients stay healthy at home
• Develop and maintain strong relationships with our provider and vendor partners, identifying inefficiencies and creating and implementing process improvement to achieve member satisfaction and provider satisfaction
• Partner with Vesta’s data analytics team and clinical leadership to develop ongoing reporting and analysis to drive the efficiency, quality, and effectiveness of the clinical team and outcomes
• Participate in prioritization efforts and help shape the clinical roadmap
• Continue to push the boundaries of what technology can do to empower our caregivers and clinicians to improve health outcomesfor our patients
• Support the development of strategies to help scale the program. Assist in evaluating capacity planning, hiring, training, and measuring and managing productivity including creating operational metrics and benchmarks

Would you describe yourself as someone who has:

• Registered Nurse License with unrestricted license within NY and/or compact states with ability to obtain additional licenses within 1 month (required)
• 4+ years of nursing experience within acute care, triage, and/or RPM (required)
• 2+ years of experience leading/managing a clinical team overseeing several complex projects simultaneously (required)
• 3-4 years of experience working in an ER or Urgent Care (required)
• 2-3 years of experience managing a clinical team (required), ideally remotely (preferred)
• Bachelor’s degree from an accredited institution (preferred)
• Passionate about our mission to improve people’s lives
• Digital health or hybrid digital health experience (preferred)
• An ability and humility to roll up your sleeves
• Detail- and process-oriented, ability to context- and mode-switch easily, fast learner
• Excellent communication skills, combined with the ability to collaborate across functions and use available tools
• Self-driven, self-starter and excited to support new technology

In addition to amazing teammates, we also offer:

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

Pay range is $110K-$130K based on experience. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

We look forward to speaking with you!

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

Senior Clinical Trial Manager

Remote US

The Senior Clinical Trial Manager (Senior CTM) plays a key role in leading Glooko’s Clinical Research projects. The Senior CTM will manage existing clinical projects and should have specialist knowledge of applicable regulations, nationally and internationally as appropriate. The Senior CTM will provide operational management skills in the planning and execution of multiple studies.

Areas of Responsibility:

• Responsible for supporting external, internal, decentralized, and virtual clinical trials and registries.
• Responsible for ensuring clinical trials are conducted, recorded, and reported in accordance with the protocol, standard operating procedures (SOPs), ICH-GCP, and all applicable regulatory requirements.
• Leading operational aspects of clinical trials, including the development of study and source materials (SOPs, IRB forms, etc.).
• Supporting internal departmental quality compliance.

Core Responsibilities:

• Manage multiple ongoing clinical research studies.
• Coordinate clinical study materials, including scope definition documents, study procedure guidelines, informed consent forms, IRB submissions/approvals, monitoring plans and tools, case report forms, data management plans, safety plans, close-out plans, and clinical study reports.
• Responsible for developing and implementing training for study sites.
• Ensure compliance with SOPs and regulatory requirements (e.g., GCP and US and OUS guidelines).
• Work closely with the Customer Support, Product/Engineering, and Data Science teams to ensure the quality of clinical trials.
• Responsible for ensuring trials are ready for audit.
• Coordinate activities of associates and investigators to ensure compliance with protocol and overall clinical objectives.
• Participate in project and departmental team meetings.
• Participate in meetings with customers and partners as needed.
• Work closely with major device, pharma companies, and CROs to support external clinical research studies and Glooko’s Clinical Research Product Team, including clinical operations, data management, and auditors.
• Track and record safety concerns and adverse events/SAEs.
• Understand diabetes and comorbid conditions.

Qualifications and Requirements:

• Excited to work on a team that cares deeply about helping those living with chronic conditions.
• Advanced degree in a health-related field is preferred with 7+ years of experience in clinical trials.
• Clinical research certification from DIA, ACRP, or SOCRA is preferred.
• Experience with running decentralized or virtual trials using remote data collection tools like wearables, devices, smartphones.
• Strong knowledge of the clinical research process including working knowledge of all functional areas of clinical trials.
• Excellent organization and customer service skills and is comfortable communicating with key stakeholders internally and externally.
• Possess problem-solving skills, attention to detail, and resourcefulness; respect and responsibility are critical to success in this role.
• Broad understanding of applicable Good Clinical Practices (GCP), International Conference of Harmonization (ICH), and Code of Federal Regulations (CFR).
• Able to work independently to manage clinical tasks and deliverables to meet timelines with a customer service orientation.
• Strong interpersonal and communication skills across all levels of the organization.
• Ability to collaborate cross-functionally with internal and external key stakeholders including the clinical studies team, data management, clinical site investigators, global clinical, and other internal customers.
• Commitment to inidual and team success.
• Is responsive and approaches work with a bias for action. Will thrive in a fast-paced, changing environment with limited structure that requires flexibility, resourcefulness, efficiency, and communicate effectively in a remote environment.
• Travel for customer meetings and conferences may be required for up to 10%.

About Glooko:

There are over 420 million people in the world with diabetes and Glooko helps them, as well as their physicians and care team, manage the disease more easily and cost effectively. Glooko is the Unified Platform for Diabetes Management and provides an FDA cleared, HIPAA compliant Web and Mobile (iOS and Android) application for people with diabetes and the clinicians who treat them. The platform seamlessly unifies data from over 80 of the leading blood glucose meters, insulin pumps, continuous glucose monitors, activity trackers, and biometric devices to deliver insights that improve personal and clinical decision support.

Glooko’s mobile app and web dashboard enable patients to easily track and proactively manage all aspects of their diabetes care. Glooko’s Population Tracker and APIs offer diabetes-centric analytics and supply insightful reports, graphs and pattern-triggered notifications to patients, health systems, and payers. The Glooko platform also allows customers and third-party developers to create branded modules for Glooko users.

Launched in 2010, Glooko is funded and managed by visionary technologists and leaders in healthcare.

Glooko Benefits Include:

• Having a meaningful impact on people’s lives
• Competitive salary based on experience
• Pre-IPO stock incentives
• Full benefits: medical, dental, vision, and transportation incentives
• Annual reimbursement on fitness expenses (gym memberships, running shoes, yoga classes, etc.)
• 401(k) matching program
• Have a meaningful impact on people’s lives

Glooko provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, or disability. In addition to federal law requirements, Glooko complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Posted positions are not open to third party recruiters/agencies and unsolicited resume submissions will be considered free referrals.

Position: Events and Operations Associate

Location: Philadelphia, PA

Job Id: 1626

# of Openings: 1

Events and Operations Associate

Headquartered in Brisbane, CA, CareDx, Inc. is a leading precision medicine solutions company focused on the discovery, development, and commercialization of clinically differentiated, high-value healthcare solutions for transplant patients and caregivers. CareDx offers products, testing services, and digital healthcare solutions along the pre- and post-transplant patient journey, and is the leading provider of genomics-based information for transplant patients.

The Events and Operations Associate with support CareDx’ presence at various medical conferences and customer events including RFP execution, vendor evaluation, contract negotiation, and budget management. Additionally, the candidate will oversee the Healthcare professionals (HCP) business process and operational management, ensuring compliance, accurate data analysis, and documentation completion, while also supporting reporting and facilitation/training activities. This role is a US remote-based role with travel 20%.

Responsibilities:

Events Management (50% of time)

• Manage and execute CareDx’s presence at national, regional and local medical conferences, as well as CareDx-led customer events and internal meetings.
• Execute RFPs, venue sourcing and site selection for best fit locations; evaluate vendor services and venues according to industry standards and stakeholder requirements.
• Effectively manage contracts and hotels, venues, production, audio-visual, and food and beverage vendors.
• Produce pre-event communications (eg on-site materials), and post-event analysis to drive general improvement and efficiency recommendations.
• Manage event budgets including creating accurate budgets, tracking costs, initiating purchase orders &invoice approval, tracking spend against budget, and driving accountability for accurate budget reconciliation.

Business Process and Operational Management (50% of time)

• Manage contracts and agreements with healthcare professionals (HCP) and sponsorship agreements of healthcare organizations (HCO), ensuring compliance with relevant activities for certification.
• Oversee payment processes and ensure accurate & complete data analysis and documentation.
• Manage the purchase order process for payments to HCPs and HCOs based on agreed work agreements, including setting up contracts in the company’s system and monitoring expenses.
• Collaborate cross functionally to facilitate engagement process activities, ensure compliance and provide process improvement feedback.
• Review and verification of aggregate spend data to ensure accuracy and completeness as required per Stark Law tracking process.
• Other duties as assigned.

Qualifications:

• 3+ years of related experience in event management, hospitality, or related fields with exposure to executives
• Bachelors degree or equivalent experience
• Ability and flexibility to travel and perform weekend work, as needed for the position (20% of time)
• Experience working in highly regulated environment, pharmaceutical/Medical Device experience preferred.
• Strong interpersonal skills, including written and verbal communication skills, collaboration, and empathy with stakeholders
• Ability to project manage, including effective management of cross-functional teams and adherence to project timelines
• Recent experience working with Microsoft Office applications.

Additional Details:

Every inidual at CareDx has a direct impact on our collective mission to improve the lives of organ transplant patients worldwide. We believe in taking great care of our people, so they take even greater care of our patients.

Our competitive Total Rewards package includes:

• Competitive base salary and incentive compensation
• Health and welfare benefits including a gym reimbursement program
• 401(k) savings plan match
• Employee Stock Purchase Plan
• Pre-tax commuter benefits
• And more!

In addition, we have a Living Donor Employee Recovery Policy that allows up to 30 days of paid leave annually to a full-time employee who makes the selfless act of donating an organ or bone marrow.

With products that are making a difference in the lives of transplant patients today and a promising pipeline for the future, it’s an exciting time to be part of the CareDx team. Join us in partnering with transplant patients to transform our future together.

CareDx, Inc. is an Equal Opportunity Employer and participates in the E-Verify program.

By proceeding with our application and submitting your information, you acknowledge that you have read our U.S. Personnel Privacy Notice and consent to receive email communication from CareDx.

******** We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.

Title: Inpatient Coder

Remote

C: 13.54

Contract

The Judge Group is currently hiring fully remote inpatient coders.

Job Duties

• Identify appropriate assignment of ICD-10-CM and ICD-10-PCS Codes for inpatient services provided in a hospital setting and understand their impact on the DRG with reference to CC/MCC, while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
• Abstract additional data elements during the Chart Review process when coding, as needed.
• Adhere to and maintain required levels of performance in both coding quality and productivity as established by
• Provide documentation feedback to providers and query physicians when appropriate Participate in coding department meetings and educational events.

Required Experience:

• High school diploma or equivalent required.
• 3+ years of Inpatient medical coding experience (hospital, facility, etc.)
• Professional coder certification from AHIMA and/or AAPC
• DRG coding experience

Nurse Health Specialist, Virtual Care Center

Location: Remote-US, California US

Job Number: 5995

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 that’s 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.

RN Health Specialist, VCC

Position Summary:

Provides triaging service for patients who call into the virtual care center. Expected to escalate patient calls to APC when appropriate. Responsible for managing patient care and treatment in collaboration with the Physician and Nurse Practitioner/Physician Assistant.

General Duties/Responsibilities:

(May include but are not limited to)

• Answering all in bound calls into the virtual care center
• Expected to use clinical judgement to address patient concerns
• Collaborates with primary care physician, Extensivist, and Nurse Practitioner/PA, and Case Manager to develop care plan for members. For non care anywhere patients
• Conduct outbound calls and virtual visits to complete patient follow up
• Daily review of vitals for patients enrolled in remote patient monitoring program
• Support disease management referrals
• Interprets and evaluates diagnostic tests to identify and assess patients’ clinical problems and health care needs.
• Educates members on topics such as disease process, end of life, medication, and compliance.
• Discusses case with physician/Nurse Practitioner/PA when appropriate.
• Use of Electronic Medical Records required.

Minimum Requirements:

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

1. Minimum Experience:
2. Knowledge of clinical standards of care
3. Minimum 1 year experience as an RN
4. Education/Licensure:
5. Requires successful completion of an accredited Nursing Program; BSN preferred, Registered Nurse preferred
6. Current, unrestricted license in the state for which you are applying
7. Must have CPR certification
8. Other:
9. Experience in gerontology, adult care, preferred
10. Experience in palliative/hospice and complex care management, preferred
11. Experience in Home Health including wound care, preferred
12. Knowledge of Medicare Managed Care Plans, preferred
13. Excellent administrative, organizational and verbal skills
14. Effective communication skills with seniors
15. Computer literate and able to navigate the internet
16. Ability to work independently
17. Detail oriented
18. Dependable and reliable
19. EMR experience is strongly preferred
20. Bilingual skills valued (Spanish preferred)
21. Must be flexible with schedule position is active 24 hours 7 days a week
22. Work Environment:
23. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable iniduals with disabilities to perform the essential functions.

Essential Physical Functions:

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

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Alignment requires all new hires to follow local and/or state requirements regarding the COVID-19 vaccine and booster. If applicable, proof of vaccination and booster will be required as a condition of employment subject to legal exemptions. This policy, which Alignment reserves the right to modify, is part of Alignment’s ongoing efforts to ensure the safety and well-being of its staff and community and to support public health efforts.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for ersity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].

*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 at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].

Title: Remote Inpatient Claims Edit Medical Coder

Location: United States

Full-Time

Job Details

Description

Position Summary:

This is a remote coding position. As an experienced IP/OP Claims Edit coder you will be responsible for providing coding and abstracting services for clients IP/OP records using ICD-10 CM/PCS and CPT/HCPCS coding systems. You will use established coding principles, software and your knowledge and experience to assign diagnostic and procedural codes after a thorough review of the medical record.

The coding editor will be responsible for correcting and final coding accounts. These accounts are primarily outpatient to inpatient patient class change accounts. Work will include:

• Checking diagnosis codes when appropriate
• Adding POA indicators on diagnoses
• Coding within the encoder to determine a DRG for inpatient stay
• Approving and completing OP to IP accounts
• Medical necessity clarification
• Reviewing denied claims
• Performing observation charge reviews
• Review/correcting account errors for final bill
• Reviewing modifiers/bundling/unbundling of accounts/edits

Essential Functions:

-Reviews medical records to identify pertinent diagnoses and procedures relative to the patient’s health care encounter.

-Selects the principal diagnosis and principal procedure, along with other diagnoses and procedures using UHDDS definition.

-Ensures appropriate DRG assignment.

-Abstracts appropriate information from the medical record based on the guidelines provided by the client and after a thorough review of the medical record.

-Solicits clarification from the physician regarding ambiguous or conflicting documentation in the medical record using guidelines provided by the client.

-Maintains current knowledge of the information contained in the Coding Clinic, CPT Assistant, and the Official Guidelines for Coding and Reporting.

Requirements:

-Strong working knowledge of inpatient claim edits

-EPIC & 3M experience preferred

-Must have a minimum of 3 years of IP claim edits experience; 5-7 years preferred.

-Some understanding of laboratory CPT codes

-Understands medical terminology, anatomy, physiology, surgical technology, pharmacology and disease processes.

-Extensive knowledge of ICD-10 CM/PCS and CPT/HCPCS coding principles and guidelines, reimbursement systems, federal, state and payor-specific regulations and policies pertaining to documentation, coding and billing.

-Must pass coding proficiency test.

Why Work for Aquity? We offer competitive benefits such as:

-Competitive salary

-Three weeks of paid time off (120 hours) annually

-Seven paid holidays annually

-Job related education reimbursement, CEU and credentials

-Opportunity to work remotely and can work flexible hours contingent on clients needs.

Qualifications

Experience

Required

3 years: Experience with E-request, Meditech, HPF.

3 years: At least 3 years of IP facility coding experience as well as experience with IP claim edits.

Licenses & Certifications

Required

Regd. Health Info Tech

Cert. Coding Specialist

Preferred

Regd. Health Info Admin

HIM Coder III – Inpatient (Fully Remote)

Remote Location

Full time

227844

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

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

Location Cleveland

Facility Remote Location

Department HIM Coding-Finance

Job Code U99927

Shift Days

Schedule 8:00am-4:30pm

Job Summary

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

The Coder III position is dedicated to either hospital inpatient or hospital outpatient coding. Codes and abstracts clinical information from inpatient or outpatient charts for the purpose of reimbursement, research, and compliance with federal regulations and other agencies utilizing established coding principles and protocols. Inpatient: Identifies, reviews, and assigns complex ICD-10-CM codes, PCS, POA and PSI indicators for inpatient charts.

Outpatient: Identifies, reviews, and assigns complex ICD-10-CM codes and CPT for ambulatory surgery and observation charts.

The ideal caregiver is someone who:

• Has excellent critical thinking skills.
• Has EPIC experience.

Our HIM Coder III’s have the opportunity to advance to Coding Reimbursement Coordinators (CRC’s), Auditors and Supervisors based on background and coding knowledge. We have a dedicated education team that provides monthly education and CEUs for AHIMA and AAPC credential holders.

At Cleveland Clinic, we know what matters most. That’s why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you’ll find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future.

When you join Cleveland Clinic, you’ll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare.

Job Details

Responsibilities:

• Clarifies complex discrepancies in documentation and coding and assures accurate ICD-10-CM and PCS coding/abstracting assignment for inpatient to expedite the billing process and to facilitate data retrieval for physician access and ongoing patient care.
• Follows up on complex coding of medical records as a result of internal or external reviews which have identified Coding or DRG discrepancies.
• Supports special studies in relation to coding and abstracting information according to policies and procedures.
• Maintains knowledge and skills via written coding resources, clinical information, videos, etc.
• Meets or exceeds productivity and quality standards and established department benchmarks.
• Extracts pertinent information from clinical notes, operative notes, radiology reports, laboratory reports, (including Pathology), procedure records, specialty forms, etc.
• Determines complex code assignment pertinent to diagnostic workups, surgical techniques, advanced technology and special services.
• Identifies medical and surgical complications and untoward events for accurate MS-DRG / APR-DRG for inpatient charts or APC assignment for outpatient charts.
• Other duties as assigned.

Education:

• High School Diploma is required.

Certifications:

• Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) is required and must be maintained. The Certified Outpatient Coder (COC) by American Academy of Professional Coders will be considered for the outpatient Coder III role.

Complexity of Work:

• Coding assessment relevant to the work may be required.
• Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision.

Work Experience:

• A minimum of two years of experience abstracting, identifying, reviewing, and assigning complex ICD-10-CM, PCS codes, POA and PSI indicators, surgical complications for inpatient charts or CPT for outpatient charts is required.
• Successful completion of the Cleveland Clinic Coder Trainee Program with a focus on moderately complex cases may offset the experience requirement.

Physical Requirements:

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

Personal Protective Equipment:

• Follows Standard Precautions using personal protective equipment.

Nurse Case Manager

remote type

Hybrid

locations

United States – Remote

time type

Full time

job requisition id

R2313945

You are a driven and motivated problem solver ready to pursue meaningful work. You strive to make an impact every day & not only at work, but in your personal life and community too. If that sounds like you, then you’ve landed in the right place.

As Nurse Case Manager, we seek to improve on our patients’ abilities! This position is part of a dynamic, fast-paced team of experienced Nurse Case Manager located remotely across the United States. The ideal candidate for the Nurse Case Manager role will oversee Workers’ Compensation claims with complex medical conditions referred for medical assessment, clarification of limitations/restrictions or case management. On average, a Nurse Case Manager shall manage 50-60 cases with a moderate degree of complexity and acuity of medical condition. This inidual will have the opportunity to collaborate with claims staff, the injured worker, an employer, and other healthcare professionals to promote quality medical care with a focus on returning our patients back to work. Our goal is to achieve optimum, cost-effective medical and vocational outcomes.

RESPONSIBILITIES:

• Through the use of clinical tools, telephonic interviews, and clinical information/data, completes assessments that will take into account information from various sources to address all conditions including biopsychosocial, co-morbid and multiple diagnoses that impact recovery and return to work.
• Leverages critical thinking, extensive clinical knowledge, experience, and skills in a collaborative process to develop a comprehensive strategy for the injured worker to become medically stable and/or return to work.
• Independently identifies complex situations where communication with internal and/or external partners is needed to reach a full understanding of the factors involved with the assessment of the mechanism of injury, causality, and ability to return to work.
• Application, Interpretation and Compliance with clinical criteria and guidelines, applicable policies and procedures, regulatory standards, and jurisdictional guidelines to determine eligibility and integration with available internal/external resources and programs.
• Using holistic approach to focus on medical and ability management activities resulting in accurate and timely treatment and return to work.
• Consults with supervisor and others to address and problem solve barriers to meeting goals and objectives, participate in roundtables and claim meetings with claim partners to focus and benefit overall claim management.

QUALIFICATIONS:

• RN with current unrestricted state licensure required.
• Associate degree in Nursing required.
• 3 years clinical practice experience required.
• Bachelor’s degree in nursing preferred, but not required.
• Certification as a CCM (CDMS, CRC, CVE and/or current CRRN), or willingness to pursue.
• Workers Compensation case management experience preferred.

Key Competencies:

• Basic Computer proficiency (Microsoft Office Products including Word, Outlook, Excel, Power Point); which includes navigating multiple systems.
• Ability to effectively communicate telephonically and in written form.
• Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer.
• Work requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor.
• Ability to synthesize large volumes of medical records & facilitate multi-point care coordination.
• Must meet productivity & quality expectations.
• Ability to organize and prioritize daily work independently and effectively.

Additional Competencies:

• Strategic thinking
• Customer focus
• Business knowledge
• Problem solving
• Collaboration – partnership
• Decision making skills
• Communication skills

Additional Information:

*This role can be Hybrid or Remote as aligned with the Hartford’s Return to Office initiative:

• Hybrid: If you live within 25 miles an office, you will work in office at least 2 days a week
• Remote: If beyond 25 miles from an office, this role will be 100% Remote, with the expectation of occasional in-office presence as business needs dictate.

For full-time, occasional, part-time, or remote positions: (1) high speed broadband internet service is required, we do not recommend or support DSL, wireless, Mifi, Hotspots, Fiber without a modem and Satellite; (2) Internet provider supplied modem/router/gateway is hardwired to the Hartford issued computer with an ethernet cable; and (3) minimum upload/download speeds of 5Mbps/30Mbps will be required. 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 Hartford’s 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:

$66,000 – $99,000

Equal Opportunity Employer/Females/Minorities/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age

About Us | Culture & Employee Insights | Diversity, Equity and Inclusion | Benefits

Medical Case Manager – CT08GE

About Us

Human achievement is at the heart of what we do.

We believe that with the right encouragement and support, people are capable of achieving amazing things.

We put our belief into action by ensuring iniduals and businesses are well protected, and by going even further – making an impact in ways that go beyond an insurance policy.

Nearly 19,000 employees use their unique talents in careers that span a variety of disciplines – from developing the latest technology to creating and promoting our products to evaluating future financial risks.

We’re also committed to programs that drive education and support volunteerism, which put human beings first. We do it because it’s the right thing to do, and because when our customers, communities and employees succeed, we all do.

Nurse Advocate

REMOTE

CANDIDATE EXPERIENCE

FULL-TIME (REMOTE)

REMOTE

What is Trusted Health?

Trusted, Inc. is the leading digital labor marketplace and workforce management solution for the healthcare industry. We are headquartered in San Francisco but we’ve taken a digital-first approach to building our workforce and the majority of our team resides across the US and abroad.

Trusted was founded in 2017 with a focus on the largest profession in healthcare: nursing. Since then, we’ve taken a process dominated by recruiters and phone calls and converted it to a fully digital experience, connecting nurses directly to job opportunities and handling benefits, payroll, onboarding, and compliance. Our platform provides full employer of record services for employers in all 50 states and the District of Columbia.

In 2020, we launched our proprietary staffing platform, Works. Works helps hospitals solve one of their biggest challenges: filling every shift in an environment where demand for healthcare services and labor costs are increasing exponentially. With Works, facilities can create their own on-demand nursing workforce and manage all the details from a single system. Using predictive insights and recommendations, Works helps hospitals react to fluctuations in demand, while its staffing marketplace creates competition to fill open job requisitions with high-quality, active talent.

Trusted has support from top institutional investors such as Craft Ventures, Felicis Ventures, StepStone Group, and Founder Collective, as well as healthcare innovators like Texas Medical Center, Mercy Health, Intermountain Ventures, Town Hall Ventures, and Healthbox. Most recently we closed a $149 million Series C round to fund our next stage of growth.

What we’re looking for:

We’re seeking a nurse who is not only passionate about embarking on a unique transition to Trusted, but also possesses a strategic approach to work that is focused on customer service, sales and negotiation skills. You are self-motivated, learn quickly, and take initiative, routinely demonstrating a positive attitude and doing whatever it takes to get the job done. You adapt easily when faced with adversity, seizing at any opportunity to take on a challenge or problem to solve. Your curiosity, innovative mindset, and drive to push yourself and others’ to show up as the best version of yourselves each day makes you a natural leader and contributor to the greater good of the team.

You have a natural enthusiasm and ability to connect with clinicians to get them excited about working with Trusted. Your unique relatability to the clinicians on our platform will foster relationships that build trust, ensure our clinicians feel informed as to why Trusted is different, and consistently leave them feeling excited, energized, and inspired to work with us many times during their career journey in healthcare.

You will be adaptable to frequent changes in our processes and have an innovative mindset that contributes valued feedback to optimize our workflows. Your willingness to lean into challenges while preserving an optimistic perspective is an empowering and uplifting contribution to the team culture. Your clinical insight, communication expertise, and clinician-first outlook will supplement our technology to provide the best experience possible for clinicians as you help them navigate their job search, landing them their dream job with Trusted time and time again.

Your responsibilities

• • Quickly connect and foster strong relationships with clinicians while ensuring they feel excited and understand how Trusted works and what to expect throughout their journey
  • Placing candidates in jobs: Job Search Win Rate + Rebooking Rate + Conversions utilizing outreach points
  • Utilize clinical insight and expertise to supplement the Trusted matching and qualification process to recognize opportunities for advocacy and ensure clinicians are qualified and competent for their desired roles, being tactical as they move through our job funnel
  • Effectively educate clinicians on the unique aspects of the Trusted process and autonomy in navigating their career in order to foster a collaborative and successful partnership throughout the job search process
  • Consistently engage with clinicians throughout their job search, understanding their intent so you can strategically advocate for an outcome that aligns with their desires. Continue engagement throughout their working staff period, to keep them working with us through extension or through a new placement
  • Strategically coordinate with teammates to help clinicians move quickly through the job search funnel to placement
  • Contribute to the team culture in a positive way and regularly surface feedback in a productive manner that has an impact on the growth and success of the organization
  • Ability to cover the Emergency phone line (after hours) about 4 days per quarter

Who you are

• • Communicator. You have a natural passion and way of connecting with others. Your tone is genuine and friendly, encompassing empathy while exuding confidence and clarity. You are engaging, ensuring you gauge others’ intent and understanding by asking open-ended questions. When faced with difficult conversations, you remain poised, respectful, and provide clear direction or next steps – always leaving the listener feeling supported and cared for. You are able to teach, tailor, and take control in conversations with clinicians, and use your experience in negotiation and sales to advocate for the right job for the clinician.
  • Contributor. You’re genuinely a team player, striving to help and support your fellow teammates in their work to contribute to overall team success. You identify and push for solutions, habitually keep others’ informed, sharing your own knowledge and expertise to drive the team forward through continuous improvement. You go above and beyond what’s expected of you without being asked, seek out ways to take on additional responsibilities and exude a sincere positive attitude towards getting things done.
  • Resilient. Like other early-stage startup companies, Trusted moves at a very fast pace encountering a wide variety of both challenging and rewarding situations each day. It’s very important that you are able to separate the emotions that derive from the stresses of the job versus what needs to be done each day to drive successful outcomes necessary for your job. As every day is an opportunity for growth, you search for and handle feedback productively and immediately are able to put it into action. You are self aware and are able to regulate your own thoughts, actions and emotions, coping especially well in times of high stress. Your mental agility and aptness to maintain an optimistic perspective, enable you to bounce back quickly from a failure or challenge. You demonstrate a constructive approach to conflict, engaging in a calm, forthright and direct way.
  • Self-motivated. You act with speed and accuracy. Working for an early-stage startup is exciting to you and you thrive when there is a little bit of ambiguity in the air. You’re excited about picking up new things and you think learning curves are more like runways. You understand that getting started is always the first step in and don’t hesitate to do so. You thrive in fast-paced environments, feed off growth, and are motivated by the energy of others. You don’t wait for direction, you seize the opportunity and want to be on a team that thinks the same way.

You have

• • 3+ years of experience in a clinical setting; charge and/or preceptor experience are a plus and an active nursing license; travel experience is a plus
  • Experience in sales or recruitment preferred
  • Experience in tech and/or high-growth customer focused start up highly preferred
  • Highly organized and able to manage many relationships, issues, and projects simultaneously
  • Customer / patient service and relations, including conflict management, resolution and de-escalation
  • Knowledge of clinical practice across various specialties and care settings to ensure Candidates’ success on-assignment and promote retention
  • A high level of comfort and ease learning and managing different technology systems
  • Extensive practice with time management, critical thinking, and decision making in a fast-paced and dynamic setting

We offer

• • Paid vacation & sick time, paid family leave, and flexible work hours
  • Employer-paid health insurance, vision, and dental
  • Employer-paid life insurance
  • Mindfulness and fitness reimbursement
  • Monthly cell phone reimbursement
  • Employer-sponsored 401k

$65,000 – $72,000 a year

Trusted reasonably anticipates the salary range for this role to be $65,000-$72,000 annually, plus bonus and equity. The final compensation for this position will vary based on geographic location and candidate experience relative to what Trusted reasonably anticipates for this position. We are committed to transparency, and any compensation questions will be addressed early in our recruitment process.

#LI-Remote #LI-EK1

Travel Nurse Recruiter, Long Term Care

at Aya Healthcare (View all jobs)

Remote, US

Join Aya Healthcare, winner of multiple Top Workplace awards!

The Recruiter will cultivate relationships with healthcare professionals interested in travel career opportunities within the long term care service line. He or she will provide the best possible experience for our travel healthcare professionals through initiating contact, maintaining exceptional rapport and providing extraordinary customer service.

WHO WE ARE:

We’re a $10+ billion, rapidly growing workforce solutions provider in the healthcare industry. We deliver tech-enabled services that help healthcare organizations meet and manage their contingent labor needs. We build and manage tech-enabled marketplaces for national and local healthcare talent and deliver contingent labor management solutions through our proprietary software platform.

At Aya, we’re obsessed with creating exceptional experiences for our clients, clinicians and employees. In fact, we put employee satisfaction above all else. Our team members are responsible for incomparable customer experience and we know that happy employees are critical to maintaining happy clients. We foster an entrepreneurial, high-energy, low-bureaucracy culture and value innovative thinking and creative problem solving. We embrace ersity in thought and backgrounds unified by a commitment to high achievement. When you join Aya, you’ll be surrounded by teammates who care about you as an inidual and leaders who will help you grow both personally and professionally.

RESPONSIBILITIES:

• Identify and recruit qualified healthcare professionals for short-term career assignments for long term care facilities
• Proactively contact and recruit prospective candidates to establish relationships, understand their needs and qualify them for job opportunities
• Educate prospective candidates on the personal and professional benefits of a temporary healthcare career move
• Generate leads through various recruiting channels, strategic planning and referrals
• Build and maintain unique relationships with travel healthcare professionals
• Strive for continuous improvement and career advancement
• Strong motivation to achieve results and meet recruiting goals
• Ability to work in fast-paced environment and maintain a sense of urgency
• Client-centered mentality and passion for customer service

REQUIRED QUALIFICATIONS:

• Bachelor’s Degree
• MUST have a minimum 1 year of proven success in a metrics driven sales or recruitment environment
• Obsessed with creating great experiences for travel healthcare professionals
• Outside the box thinkers
• Career oriented with a desire for advancement
• Enthusiastic about being part of an recruiting organization that recognizes your talent

WHAT WE OFFER:

• Free premium medical, dental, life and vision insurance
• Generous 401(k) match
• Aya also offers other benefits to those that are eligibleand where required by applicable law, including reimbursementsand discretionary bonuses
• Aya provides paid sick leave in accordance with all applicable state, federal, and local laws. Aya’s general sick leave policy is that employees accrue one hour of paid sick leave for every 30 hours worked. However, to the extent any provisions of the statement above conflict with any applicable paid sick leave laws, the applicable paid sick leave laws are controlling
• Celebrations! We hit our goals and reward ourselves.
• Company-sponsored virtual events, happy hours and team-building activities are always on the horizon plus, you get a special treat on your birthday!
• UnlimitedDTO we believe in time off!
• Virtual yoga, meditation or boot camp classes offered daily

COMPENSATION: Aya reasonably anticipates the pay scale for this position to be $70,000 starting annually, plus commissions.

The pay scale for this position may vary if applicant possesses experience outside of what Aya reasonably anticipates for this position. Bonuses are subject to the role and your manager’s discretion.

Aya is an Equal Opportunity Employer (EEO), including Disability / Vets,and welcomes all to apply. Please clickherefor our EEO policy.

Outpatient Coder III

Job ID

2023-129379

Department

HIM Outpatient Coding

Site

HMH Hospitals Corporation

Job Location

US-NJ-Hackensack

Position Type

Full Time with Benefits

Standard Hours Per Week

40

Shift

Day

Shift Hours

Day Shift

Weekend Work

Every Other Weekend

On Call Work

No On-Call Required

Holiday Work

As Needed

Overview

Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better – advancing our mission to transform healthcare and serve as a leader of positive change.

The Outpatient Coder III is responsible for accurately abstracting data following the Official International Classification of Diseases (ICD)-10-Clinical Modification (CM), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) Guidelines for Coding and Centers for Medicare and Medicaid Services (CMS) directives across Hackensack Meridian Health (HMH) network. Performs data entry of required abstracted patient information into the electronic medical record system. Queries physicians when appropriate.

This is a fully remote position.

Responsibilities

A day in the life of an Outpatient Coder III includes:

• Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines and coding conventions.
• Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
• Analyzes medical records and identifies documentation deficiencies.
• Reviews and verifies documentation supports existing diagnoses, procedures and other charges.
• Identifies reportable elements, complications, and other quality measures.
• Communicates with physicians to clarify information via the physician query process
• Assign CPT, HCPCS and ICD-10-CM codes.
• Knowledge of and ability to address National Correct Coding Initiative (NCCI) and National Coverage Determinations (NCD) / Local coverage determinations (LCD) edits.
• Maintains required productivity and quality requirements.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• High School Diploma or higher.
• Minimum of 2+ years of coding experience, Trauma Level 1 and Academic Teaching facility.
• Strong understanding of physiology, medical terms and anatomy.
• Proficiency in computer skills including typing speed and accuracy.
• Excellent written and verbal communication skills.
• Proficient computer skills including but not limited to Microsoft Office and Google Suite platforms.
• Proficient in coding Observation and Procedure Room such as Endoscopies and Cardiac Cath.
• Proficient in coding Emergency Department and Infusion based services such as Oncology.
• Proficient in coding Ancillary Accounts such as Diagnostic Radiology and Cardiology.

Licenses and Certifications Required:

• An approved American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) coding credential.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

Title: Full Time NY Licensed Bilingual Triage Nurse Practitioner (NP) (Remote) (English/Spanish)

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

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

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

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

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

The ideal teammate would be…

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

The ideal teammate would be able to:

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

Would you describe yourself as someone who has:

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

Pay range is $125K – $135K 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).

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

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

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

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

Virtual Care Nurse Practitioner

(California Licensed)

at Tia

Remote

About Us:

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

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

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

Tia is building a culture of excellence — in people, process and product. This is our northstar value;

What is excellence, exactly?

Excellence about constantly elevating yourself, it is the process of constantly striving to perform to the best of your abilities, and identifying your top potential through constant learning, experimentation and evolution. Excellence is not about achieving perfection, as that insinuates a pinnacle. Instead, in our terms, excellence is about the pursuit of constant improvement. We’re looking for people who want to go on that hard journey of constantly setting new personal records, and organizational records.

We practice excellence at Tia by demonstrating the following types of behaviors: We chose (and actively choose) excellence as Tia’s highest order value because it crystalizes into one word several behaviors that we hold dear, specifically:

1. A drive to constantly improve through experimentation, reflection. and an insatiable growth mindset — said another way, we’re energized by the possibility of invention, innovation, and iteration
2. Being present in and grateful for the journey — not just the goal line. Perfection is static. Excellence is a process (more on this important distinction below)
3. Asking why, then why again — because accepting “this is just the way it is” is not good enough
4. Grit & perseverance — a maker mentality that involves “rolling up your sleeves”, but also deep care for oneself and for others
5. A commitment to uncovering talents to unlock “rock star” potential across every inidual

Furthermore, excellence reflects the “bigness” and the “boldness” of Tia’s mission and vision — a world in which every woman can achieve optimal health, as defined by herself.

Said another way, Tia’s mission is NOT to make healthcare incrementally better for women. Instead, we’ve intentionally set out to create a fundamentally new paradigm for modern women’s healthcare that’s truly excellent. We believe that creating a company that operates in a culture of excellence will manifest in our product. Reaching this goal is not an overnight pursuit or a “one and done.” We have not and will not “get it right” with the first swing. Rather, this higher order goal is a moving target — one we have not and will not ever fully “achieve.” By design, we will never be “done” with this work, but instead, we will be continuously in pursuit of our mission. It is this continuous pursuit — the journey, not the finish line — that truly embodies excellence.

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

About the role:

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

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

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

A bit about you:

Values and abilities you’ll bring to Tia:

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

Skills and assets you’ll bring to Tia:

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

Other “nice to have” skills:

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

Benefits

• Remote role with flexibility to work from home
• Market competitive salary ( 120-140K depending on experience for 40 hour work week)
• Annual CME stipend
• Medical and dental benefits
• Paid holidays, vacation, and sick leave

This position may require attendance at company and team off-sites and is subject the Company’s vaccine requirement, as permitted by law and subject to reasonable accommodation.

Tia is an equal opportunity employer. We are proud to foster a workplace free from discrimination. We strongly believe that ersity of experience, perspectives, and background will lead to a better environment for our employees and a better product for our users and patients. We strongly encourage people of color and members of the LGBTQ+ community to apply.

If you are committed to collaborative problem solving, creating high-quality and user-centric products, and want to make waves in women’s healthcare, join us!

Coding Auditor

Remote – Nationwide

Full time

R017002

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:

Duties/Responsibilities:

• Performs quality reviews of coders ensuring accuracy with coding guidelines and policies for complete, precise, and consistent coding.
• Reviews include Outpatient ICD-10, CPT, Modifiers, ED E&M and professional coding and E&M assignments.
• Knowledge expert and maintains up-to-date working knowledge of coding guidelines in order to act as a resource and point person for issues and question for coders, customers or project teams.
• Provides education to our coding associates and leaders as required by the deliverables of our SLA
• Reviews physician documentation for coding appropriateness and accuracy following coding guidelines.
• Provides feedback to coders and providers on coding corrections, appropriately citing authoritative resources.
• Assists with the interpretation of codes and other information requested for accurate code assignment.
• Communicate with management regarding clinical, coding, and reimbursement issues as needed.
• Function in a professional, efficient, and positive manner with strong critical thinking and decision-making skills.
• Utilizes our client’s electronic medical record (EMR), encoder, and computer-assisted coding (CAC) software as directed.
• Ensures optimal reimbursement while maintaining compliance with CMS and third-party payor policies and guidelines.
• Maintains compliance with Ensemble and client’s coding policies, procedures, and guidelines.
• Consistently maintains 95% or above accuracy rate while meeting established productivity standards.
• Completes daily production log and daily time keeping requirements.
• Attends and participates in Ensemble and client meetings as requested.
• Completes coding continuing education and maintains auditing credentials.
• Ensures HIPAA compliance at all times.

Minimum Requirements:

• 5+ years of coding experience.
• 3+ years of auditing experience.
• Proficiency in multiple EMR’s, encoders, and the Microsoft Office suite.
• Educated in HIPAA regulations; must maintain strict confidentiality of patient and client information.
• Consistently achieves quality and productivity standards.
• Ability to organize and complete work in a timely manner.
• Ability to read, write and effectively communicate in English.
• Ability to understand medical/surgical terminology.
• Above average written and verbal communication skills.

Required Certifications:

Candidates must have and keep current at least one of the following professional certifications (CPC, CPMA or CCS Preferred):

• CPC (Certified Professional Coder)
• CCS-P (Certified Coding Specialist-Phys Based)
• CCS (Certified Coding Specialist)
• CMPA (Certified Professional Medical Auditor)
• RHIA (Registered Health Information Administrator)
• RHIT (Registered Health Information Technician)

#LI-LS1

#LI-REMOTE

Join an award-winning company

Three-time winner of Best in KLAS 2020-2022

2022 Top 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.

Coding Quality Coordinator, Inpatient Coding

Location: Denver, CO, United States

Category: Professional/Management

Job Type: Full Time

Job ID: 139754

Description

Coding Quality Coordinator, Inpatient Coding

This is a full-time, remote/work from home, exempt/salary position on UCHealth’s Inpatient Coding team based in Denver, CO. Potential opportunity for eligible out-of-state applicants.

Responsible for coding data integrity by reviewing diagnosis and procedure code assignments, and validating MS-DRG and APR-DRG designations. Works closely with Leadership, CDI, Physician Advisors and other internal quality departments, providing answers to coding questions and correctly applying Official Coding guidelines, Coding Clinics and other official guidance which support your recommendations.

Job Duties

• Conducts internal quality reviews, in accordance with the Coding Compliance Plan. Reviews government, commercial and other external audits. Performs internal audits as requested by other departments. Monitors and reports issues/trends.
• Presents coding education to staff, leadership and others throughout the Health System. Provides training as necessary. Assists with developing and guiding SMEs responsibilities.
• Responds to coding questions submitted throughout the Health System. Reviews physician queries for appropriateness, and related correspondence.
• Reviews coded claims data in response to denials and customer service requests. Provides thorough rationale and explanation for proper code assignments.

Requirements

• High School Diploma or GED
• Coding-related certification from AHIMA or AAPC
• 3 years of relevant coding experience

Preferred

• Associate’s Degree
• CCS

The pay range for this position is: $29.54 – $44.31 / 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:

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.

• Full medical, dental and vision coverage
• Retirement plans to include pension plan and 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

Title: Nurse Care Manager

Location: Remote – United States

About Quartet Health

Quartet is a purpose driven value-based behavioral healthcare company, building the nation’s leading behavioral health home. We deliver integrated care and better outcomes to improve the health of communities across America. Quartet is a trusted partner of health insurance plans, health systems, community behavioral health centers, certified community behavioral health clinics, and federally qualified health centers in 36 states across the country. We identify people in need of care and connect them directly to high quality behavioral care providers, including Quartet’s own medical group.

At Quartet, our values guide the way that we work together, starting with our commitment to putting patients first, and our shared focus on collaboration and innovation, so that we together can improve lives, one person at a time.

Quartet is backed by top investors like Oak HC/FT, GV (formerly Google Ventures), F-Prime Capital Partners, Polaris Partners, Deerfield Management, Centene Corporation, Independence Health Group, and Echo Health Ventures.

Our Benefits

We’re proud to offer the following benefits to all clinicians:

• Competitive compensation
• 100% cost coverage for a ll required licensing /credentialing fees
• IT equipment and support
• Mental health benefits via our EAP, with up to 5 free counseling sessions per concern

W e offer additional benefits to our team members working full time:

• A generous accrued PTO policy
• T en paid holidays each year
• R obust medical, dental and vision insurance plans
• A 401 (k ) plan with employer match
• 100% employer-paid life insurance , short-term and long-term disability insurance
• Annual continuing education unit (CEU) budge t
• Up to 12 weeks of paid maternity leave

The Behavioral Health Nurse Care Manager works to assess, evaluate, and support members who are challenged by both severe mental illness and complex medical situations. The Behavioral Health Care Manager follows established guidelines and procedures and collaborates with other departments. They will work as part of a multidisciplinary team that assesses, facilitates, plans, and coordinates an integrated delivery of care across the continuum. The goal of the Behavioral Health Care Manager is to support members to achieve or maintain optimal health in both mind and body.

The Behavioral Health Care Manager employs their clinical judgment with inidualized strategies to manage a member’s physical, environmental and psycho-social health issues. The Behavioral Health Care Manager monitors members’ progress towards desired outcomes and helps to ensure the member receives quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

By continuously monitoring patient care, the Behavioral Health Care Manager conducts regular assessments and identifies and resolves barriers that hinder effective care. The Behavioral Health Care Manager will create and update member care plans and participate in the Interdisciplinary Care Team as needed.

Responsibilities

• Completes clinical assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member’s health or psychosocial wellness, and triggers from the HRA
• Develops and implements a care management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member’s support network to address the member needs and goals.
• Conducts telephonic outreach as needed
• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventional achievement, and suggest changes accordingly.
• Maintains ongoing member case load for regular outreach management
• Promotes integrations of services for members including behavioral health care and long -term services and supports to enhance the continuity of care for Troy members.
• Facilitates interdisciplinary care team meetings and informal ICT collaboration.
• Uses motivational interviewing to educate, support, and motivate change during member contacts.
• Assesses for barriers to care, provides care coordination and assistance to members to address concerns
• Collaborates with other care managers/supervisors as needed
• Participates in CM and company wide meetings as directed.

Qualifications

• Current, unrestricted NC RN license or Compact License Preferred.
• Previous Behavioral Health Experience
• Minimum 2 years experience required with Dual Special Needs Plans (D-SNP)
• Certified Case Manager (CCM), preferred
• Basic understanding of insurance products, benefits, coverage limitations, laws and regulations as it applies to the health plan.
• Proficient in Google Suite as well as ability to work with multiple applications
• Strong counseling or customer service background and can implement functional treatment plans
• Experience in managing members with both Medical and Behavioral Health needs and/or Substance Abuse needs.

Quartet actively encourages applicants of all backgrounds to apply and is proud to be an equal opportunity employer. We do not discriminate on the basis of race, color, ancestry, religion, national origin, sexual orientation, age, citizenship, marital or family status, disability, gender, gender identity or expression, pregnancy or caregiver status, veteran status, or any other legally protected status. To perform this job successfully, an inidual must be able to perform essential job duties – reasonable accommodations may be made to enable qualified iniduals with disabilities to perform essential job functions. If you require assistance in completing this application, interviewing, or otherwise participating in the employee selection process, please direct your inquiries to [email protected]

Have someone to refer? Email [email protected] to submit their details to us.

Title: REMOTE Full Time NY and Texas Licensed Nurse Practitioner (NP) – Remote

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

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

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

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

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

The ideal teammate would be…

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

The ideal teammate would be able to:

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

Would you describe yourself as someone who has:

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

Pay range is $125K – $135K annually for FT and $70-$80 hourly for PD based on experience

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

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

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

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

Coder-Risk Adjustment

Finance / Accounting

Remote

ID:2015025

Full-Time/Regular

It’s 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.

The Coding Validation Program Coder manages the day-to-day responsibilities of chart abstraction, vendor auditing and reporting in accordance with state and federal regulations. The coder will abstract from in-patient and out-patient medical records and record findings via electronic data base and or excel spread sheets.

The coder ensures that all claims accurately reflect the appropriate diagnosis information as outlined in the member’s medial record. The coder will respond to interdepartmental and provider inquiries guaranteeing that all work is in compliance with internal and external protocols and compliance requirements.

Responsibilities

• Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation.
• Ability to code government and state models. This includes code everything projects.
• Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes.
• Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations.
• Ability to maintain a 95% accuracy rate on all coding projects.
• Handle other related duties as required or assigned.
• Coders assist with code abstraction and coding quality audits using the Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and procedures.

Requirements

• Current core coding credentials through AHIMA or AAPC (RHIT, CCS, CCS-P, CPC, CIC, etc.) The AAPC CRC (Certified Risk Adjustment Coder) coding certification is highly recommended.
• Strong organizational skills
• Technical savvy with high level of competence in basic computer skills, Microsoft Outlook, Word, Excel and Outlook.
• Strong written and verbal communication skills
• Ability to work independently in a remote environment.
• Private lockable office space to ensure security of Member PHI
• Minimum of 5 years coding experience with at least 3 of those years in Risk Adjustment coding.
• High School Diploma
• Completion of an accredited medical coding program with current unencumbered credentials.

Required education:

• High School Diploma
• CPC/CRC Certification

Required experience:

• Risk Adjustment coding: 3 years
• Coding: 5 years

Supervision Received

• General supervision is received weekly.

Medical Coder

Remote 

Operations Revenue Cycle

Full-Time

Remote

As a physician-founded and led organization, ensuring everyone has access to quality healthcare is what inspires us. That’s why we hire people who genuinely care about patients, solving healthcare challenges, and making a positive impact every day. Join us and help change the future of healthcare for the better.

120+ locations and growing, along with vast virtual coverage

1 million+ patients to-date

2,000+ caring clinicians and support staff serving their communities

Backed by investors such as CVS Health Ventures and Blackstone Horizon

This role will be responsible for reviewing medical record documentation for accurately assigning diagnostic and procedural coding relative to revenue and reimbursement for all encounters associated with Carbon Health entities. This will also include translating patient information into alpha-numeric medical codes using patient treatment, health history, diagnosis, and related information. ICD-10-CM and CPT code assignments must be consistent with CMS’Official Guidelines and any regulatory agency guidelines. We will look to your knowledge of CPT, ICD-10 coding guidelines, compliance and professional billing practices; including knowledge of Evaluation and Management Guidelines to coordinate with Coding Leadership to identify provider education and revenue opportunities.

What You’ll Do

• Complete accountable work related to pended charges in work queue review to ensure timely billing in conjunction with billing and compliance guidelines
• Select correct code assignment by proficient analysis and translation of diagnostic statements, physicians’s orders, and other pertinent documentation
• Responsible for keeping abreast of current ICD-10 and CPT coding guidelines and regulatory guidance; including responsibility for maintaining current coding certification status
• Participates in process improvement assignments and other duties as assigned incoordination with billing for documentation review as needed for rebill and appeals

About You

• 4+ years coding experience, billing for professional services, and related experience
• Associate degree in related field or equivalent experience may be substituted
• Current AAPC Certified Professional Coder (CPC) certification
• Expertise of Coding and Billing Guidelines for multiple specialties
• Technical knowledge and skills of electronic medical records

Perks

Forward-thinking, transparent, and inclusive company culture

Competitive salary, generous paid time off, learning time off, and paid holidays

Comprehensive benefits package including medical, dental & vision insurance

401k employee contributions, FSA, HSA, and dependent care options

Employee referral bonus program, employee resource groups, and professional development

All benefits dependent on role and eligibility

All candidate email communication will be done through an @carbonhealth.com email address. If you ever receive communication regarding a job posting from an entity that does not match that or seems concerning, please contact [email protected].

Carbon Health is a leading national healthcare provider with a mission to make high-quality healthcare accessible to everyone. We offer primary and urgent care to nearly two-thirds of the U.S. Leveraging our unique technology platform, we meet patients where they are by delivering care across a variety of access points, including in-person clinics and virtual care. Carbon Health also focuses on value-based care and other value-add services to employers, health plans, health systems and other ecosystem partners.

We recognize that the key to success lies in valuing the minds, experiences and perspectives of people from all walks of life. Carbon Health is proud to value ersity and be an equal opportunity employer. Pursuant to the San Francisco Fair Chance Ordinance and the Los Angeles Fair Chance Initiative for Hiring, we will consider for employment qualified applicants with arrest and conviction records. Carbon Health is an E-Verify employer.

Subject Matter Expert-Complementary and Alternative Medicine in Advanced Practice Nursing

Job Category: RAS Adjunct

Requisition Number: SUBJE004909

Posting Details

• Part-Time
• Locations: Online / Remote

Job Details

Description

Subject Matter Expert– Complementary and Alternative Medicine in Advanced Practice Nursing

Rasmussen University

ABOUT RASMUSSEN UNIVERSITY:

Rasmussen University is a regionally accredited private university dedicated to changing lives and the communities it serves through high-demand and flexible educational programs. As a pioneer in career-focused education since 1900, the University is defining a new generation of higher education that focuses on competency-based education, technology and transferrable skills. Rasmussen offers undergraduate and graduate programs online and in person at 23 campuses around the country. The University is designed to lift and support its students every step of the way, from their first credential to their last. Rasmussen is dedicated to global enrichment, serving the underserved and meeting the evolving needs of erse students, communities and economies. Rasmussen encourages its students, faculty and staff to strive for academic excellence, community enrichment and service to the public good. For more information about Rasmussen University, please visit www.rasmussen.edu.

Competencies in Complementary and Alternative Medicine in Advanced Practice Nursing Course:

• Differentiate the types of massage therapy techniques.
• Compare types of Chinese Medicine that can be incorporated into the comprehensive plan of care for patients across the lifespan.
• Assess the potential impact of herbal and supplemental therapies in health promotion and disease management for primary care patients.
• Create a treatment plan using the principles of homeopathic medicine for primary care patients across the lifespan.
• Evaluate concept of mind and body therapies to address health challenges for patients in a primary care setting.
• Develop a treatment plan that involves elements of functional medicine for primary care patients across the lifespan.

Reporting Relationships:

Subject Matter Experts (SME’s) will act as Contractors assigned to collaborate with the appropriate school curriculum and course experts.

Position Summary:

Participate in a Kickoff call

All Subject Matter Experts (SMEs) are expected to participate in a kickoff call with the appropriate Development Owner. The goal of the call is to create a shared vision for the course, discuss any special considerations, and get started on mapping out the course.

Produce raw content for the following deliverables:

• SME Development Template.
• CBE (competency-based education) for course content depending on the course’s program.
  • Suggestions for assessments, learning activities, and rubric criteria.
  • Video scrips and storyboards.
  • Supplemental content in support of learning outcomes.
  • Multimedia development suggestions.
  • Notes/answer keys/ teaching suggestions to be included as a Faculty Guide.
• Test Outs as necessary.

Produce original instructional materials for online learning

Subject Matter Experts are hired to provide expertise in the subject area. As such, we are looking to the SME to provide original content and not only rely solely on the textbook or publisher materials.

This content should:

• Translate expected learning outcomes into instructional material that allows students to achieve weekly learning outcomes.
• Meet Rasmussen’s course development style standards.
• Be checked for accuracy and consistency of spelling, grammar, and other mechanical and style issues before submission.
• Incorporate constructive feedback into online tests, exams, and quizzes. If necessary, provide feedback prompts to other non-objective assignments that instructors can use when teaching the course

Deliver the content using the appropriate templates

The content development template provides content that can be directly translated into the finished course. What you see in the document is what will appear in the course.

Deliver the content in a timely manner

There are many people involved in the creation of an online course. Each is dependent on the others to have their part completed by a certain time; therefore, it is imperative that delivery milestones are met.

Participate in regular review sessions with the Development Owner

The Development Owner will be regularly reviewing the work submitted by the SME. Hence, the SME must be available for a regularly scheduled feedback call or email with the Development Owner. Development Owner and SME will come to an agreement on the time, frequency, and form of these communications.

You are responsible for a finished product. Do your best to submit your most polished effort, rather than a rough draft. Your Development Owner will support you in these efforts.

Be an available resource

The SME is expected to be an available resource throughout the entire course development process.

After the design phase, the course is turned over to our Instructional Design team to review the content the SME has developed.

Fulfill all the above responsibilities

SME must fulfill all the stated responsibilities for a positive collaboration.

Credentials:

• Terminal Degree in Nursing with area: PMHNP, AGNP, FNP or PNP
• 2+ years teaching at the graduate level
• Strong Communication/Writing skills

Location:

This position is remote but not available to CO residents

Washington and NYC Pay Transparency Statement:

If you are a Washington or New York City resident and this role is available remotely, you may be eligible to receive additional information about the compensation and benefits for this role, which we will provide upon request. Please send an email to [email protected]

At Rasmussen, we are proud to be an equal opportunity employer. We are committed supporting and encouraging ersity in the workplace. We welcome our employee’s differences regardless of race, color, creed, religion, gender, national origin, sexual orientation, marital status, age, gender identity, disability, or veteran status.

Title: Deal Strategy Manager

Location: Remote, USA

Omada Health is on a mission to inspire and engage people in lifelong health, one step at a time.

Job overview:

As part of our growing Commercial Operations function at Omada, the Deal Strategy Manager will play a critical role in supporting Omada’s Commercial team by leading the process around crafting winning responses to all proposal requests to Omada. This role will be instrumental in supporting sales opportunities with our enterprise customers, partners, and health plans by collaborating with the Sales team to deliver timely and high quality bids.

About you:

As a Deal Strategy Manager, you are the go-to person for all inbound bid requests. The Deal Strategy Manager will be responsible for driving the execution of winning bids, in line with the commercial strategy and goals. You will oversee all aspects of proposal preparation, ensuring quality, and making sure compelling bids are submitted in a timely manner. You will become an expert in Omada’s products and value proposition so that it is reflected in all of our bid activity. You will be a key partner to the Sales leadership team in determining how and when we respond to what bids, and with what priority.

Specific duties include:

• Works with key stakeholders to identify win themes, sales strategy approach, and a work plan, to complete pursuit activities.
• Engages with Omada sales leaders, executives, and SME’s to ensure necessary support for bid efforts.
• Drives effective collaboration with all partners involved in the pursuit.
• Tracks progress of the pursuit effort and routinely reports status to Commercial Effectiveness and Sales Management.
• Directs support resources assigned to the creation, editing and production of presentations, proposal and contract documentation.
• Ensures pursuit activities are conducted in compliance with Omada’s policies.
• Ensures all pertinent knowledge artifacts from bid effort are captured and appropriately archived for future reference.
• Participates in Win / Loss Reviews and captures key lessons learned.

You will love this job if you:

• A highly effective communicator, both written and verbal
• A cross-functional team member who is able to work with internal stakeholders to ensure alignment between internal teams and Commercial teams
• Highly organized with exceptional time management skills
• Industrious with a collaborative working style
• Passionate about creating and scaling an end to end sales process
• Passionate about supporting a mission to improve healthcare through innovation and technology!

Bonus points for:

• Experience in the healthcare space and/or partner sales

Benefits:

• Competitive salary with generous annual cash bonus
• Stock options
• Remote first work from home culture
• Flexible vacation to help you rest, recharge, and connect with loved ones
• Generous parental leave
• Health, dental, and vision insurance (and above market employer contributions)
• 401k retirement savings plan
• Work from Home stipend
• Two giftable Omada enrollments per calendar year
• …and more!

It takes a village to change health care. As we build together toward our mission, we strive to embody the following values in our day-to-day work. We hope these hold meaning for you as well as you consider Omada!

• Start with Trust. We listen closely and we operate with kindness. We provide respectful and candid feedback to each other.
• Seek Context. We ask to understand and we build connections. We do our research up front to move faster down the road.
• Act Boldly. We innovate daily to solve problems, improve processes, and find new opportunities for our members and customers.
• Deliver Results. We reward impact above output. We set a high bar, we’re not afraid to fail, and we take pride in our work.
• Succeed Together. We prioritize Omada’s progress above team or inidual. We have fun as we get stuff done, and we celebrate together.
• Remember Why We’re Here. We push through the challenges of changing health care because we know the destination is worth it.

About Omada Health: Omada is a virtual-first chronic care provider that nurtures lifelong health, one day at a time. Our care teams implement clinically-validated behavior change protocols for iniduals with prediabetes, diabetes, hypertension, and musculoskeletal issues for consistent improvements that stack up. With more than a decade of experience and data, and 24 peer-reviewed publications that showcase our clinical and economic results, we improve health outcomes and help contain healthcare costs.

Our scope exceeds 1,800 customers, including health plans, health systems, and employers ranging in size from small businesses to Fortune 500s. Omada is the first virtual provider to join the Institute for Healthcare Improvement’s Leadership Alliance, reflecting our aim to complement primary care providers for the benefit of our members, and affirming our guarantee to every partner: Omada works different.

Omada is thrilled to share that we’ve been certified as a Great Place to Work! Please click here for more information.

We carefully hire the best talent we can find, which means actively seeking ersity of beliefs, backgrounds, education, and ways of thinking. We strive to build an inclusive culture where differences are celebrated and leveraged to inform better design and business decisions. Omada is proud to be an equal opportunity workplace and affirmative action employer. We are committed to equal opportunity regardless of race, color, religion, sex, gender identity, national origin, ancestry, citizenship, age, physical or mental disability, legally protected medical condition, family care status, military or veteran status, marital status, domestic partner status, sexual orientation, or any other basis protected by local, state, or federal laws.

Below is a summary of salary ranges for this role in the following geographies:

California, New York State and Washington State Base Compensation Ranges: $121,600 – $152,000*, Colorado Base Compensation Ranges: $109,440 – $136,800*. Other states may vary.

This role is also eligible for participation in annual cash bonus and equity grants.

*The actual offer, including the compensation package, is determined based on multiple factors, such as the candidate’s skills and experience, and other business considerations.

Please click here for more information on our Candidate Privacy Notice.

Account Resolution Specialist – REMOTE

Status (FT/PT): Full-Time

Shift: Day shift

Req ID: 56862

Description

Find more than your next job. Find your community.

• We’re northern Michigan’s largest healthcare system and we are deeply rooted in the communities we serve. That means that our patients are often our family, friends and neighbors and it’s special to be able to care for them. And as one of the top healthcare systems to work for in Michigan by Forbes (American’s Best Employers by State 2022), we’re committed to your ongoing growth and development.
• After work, you’ll find things to do in every season beaches, outdoor recreation, unique restaurants, world-class wineries, arts and entertainment.

Summary:

Acts as a resource to ensure patient accounts are accurate and handled appropriate for: prior authorizations, Acts as a resource for collection issues. Is responsible for a variety of collections processes, including but not limited to: performing general collection functions; keeping abreast of trends and/or regulation changes in collections process; and sending, verifying, and balancing on-site collections.

Why work as an Insurance Verifier at Munson Healthcare?

• Offers a remote work schedule
• Our dynamic work environment includes many opportunities for growth and development
• Be a part of a team that nurtures a culture of caring every day
• Our employees work in positive, supportive, and compassionate environments built on our organizational values.

What’s Required:

• High school graduate or equivalent required. Post high school education preferred.
• Two to three years medical billing and collection experience, with understanding of medical insurance product guidelines.
• Effective verbal, written, and interpersonal communication skills with the ability to comfortably interact with erse populations.

The Benefits of Working at Munson:

• Competitive salaries
• Full benefits, paid holidays, and paid time off (up to 19 days your first year)
• Tuition reimbursement and ongoing educational opportunities
• Retirement savings plan with employer match and personal consulting
• Wellness plans, an employee assistance program and employee discounts

Assistant Nurse Manager (Remote)

Remote

Nice to meet you, we’re Vesta Healthcare.

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

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

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

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

The ideal teammate would be

• A nursing leader who is passionate about caring for our members, teammates, and clients and can leverage technology to create new programs, systems, and processes to drive exceptional clinical team performance
• Someone who has a proven track record of using data to drive high quality and efficient clinical outcomes
• Someone who ideally has experience in chronic care management, remote patient monitoring, and valuable based care of vulnerable populations
• Love learning and helping others learn: you’re excited to bring your wisdom and coach others, and you’re equally energized to learn from other’s experience (such as product managers, software engineers, and data scientists), and then continue improving how Vesta does care management as we learn more together
• Comfortable working in an ambiguous environment within an organization that is growing and changing quickly
• Enjoy moving back and forth between direct care management with members when needed to helping us build out a care management program
• Curious about changing regulations within the space and how they can be leveraged to create additional revenue streams

The ideal teammate would be able to:

• Provide leadership, coaching, and development to a team of nurses and other multidisciplinary iniduals performing care management
• Identify inefficiencies and opportunities for quality improvement. Create process improvement to achieve member and clinician satisfaction
• Partner with Vesta’s data analytics team and clinical leadership to develop ongoing reporting and analysis to drive the efficiency, quality, and effectiveness of the clinical team and outcomes
• Serve as a subject matter expert for chronic care management (CCM), Transitions of Care (TOC) and remote patient monitoring (RPM)
• Continue to push the boundaries of what technology can do to empower our caregivers and clinicians to improve health outcomes for our patients
• Support the development of strategies to help scale the program. Assist in evaluating capacity planning, hiring, training, and measuring and managing productivity including creating operational metrics and benchmarks
• Collaborate with cross departmental leads in analytics, product/engineering and business operations to drive efficiencies and quality improvement
• Assist manager with making sure team is appropriately staffed and find coverage when needed
• Assist in implementing new clinical programming across our clinical PODS
• Support team to address escalated member challenges
• Perform direct care management activities as assigned

Would you describe yourself as someone who has:

• Registered Nurse with unrestricted license within NY and/or compact with ability to obtain additional licenses within 1 month (required)
• Bachelor’s degree from an accredited institution (preferred)
• 4+ years of nursing experience within acute care, care management, and/or homecare (required)
• 2+ years of experience leading/managing a clinical team overseeing several complex projects simultaneously (required)
• Experience managing a remote team (preferred)
• Passionate about our mission to improve people’s lives
• Digital health or hybrid digital health experience (preferred)
• An ability and humility to roll up your sleeves
• Detail- and process-oriented, ability to context- and mode-switch easily, fast learner
• Excellent communication skills, combined with the ability to collaborate across functions and use available tools
• Self-driven, self-starter and excited to support new technology

In addition to amazing teammates, we also offer:

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

Pay range is $90K – $101K annually plus bonus. (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).

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

Utilization Review Nurse- PRN Weekends Only (Sat/Sun)

locations

Remote – Other

time type

Part-time

job requisition id

R011500

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

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

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

Responsibilities

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

Qualifications

Required

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

Preferred

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

Expectations

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

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

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the inidual can provide proof of valid prescription to Netsmart’s third party screening provider.

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

Global Therapist (Contractor)

Our mission: We’re on a mission to help iniduals and organizations thrive by eliminating every barrier to mental health. Spring Health is the leading comprehensive mental health benefit for employers. We help employees understand their mental health issues and connect with best-in-class providers to get the right treatment at the right time. From early detection to full recovery, Spring Health is the only clinically validated solution in the market proven to be more effective than traditional mental healthcare. By combining the latest technology with vetted providers, we help engage 1 in 3 employees, reduce recovery times, and lower healthcare costs. We are an award-winning, passionate, and mission-driven team with the support of leaders in psychiatry. We are seeking qualified, part-time internationally licensed psychotherapists to join our provider network and deliver care with a tech-enabled, AI/machine-learning platform that puts patient outcomes first.

What You’ll Do:

• Provide counseling to clients with benefits ranging from short-term goal-focused EAP, to employer health plans allowing many sessions as medically necessary.
• Treat adults who have completed brief, evidence-based online screenings identifying their symptoms and areas of concern.
• Preferably, also be open to treating additional populations such as children, adolescents, couples, or families.
• Maintain a calendar displaying your availability and complete session documentation in a timely manner within our scheduling system.
• Use evidence-based treatment modalities and interventions that are tailored to your client’s needs.
• Collaborate with our dedicated provider support team, our licensed clinical care navigation team, and our administrative care support team whenever you need assistance.
• Provide culturally competent and empathetic care, upholding our values of ersity and inclusion for all races, ethnicities, and genders.

Who You Are:

• You have an unrestricted license to practice counseling (Psychologist, Masters level counselor, etc.) in a country outside of the United States. We are not able to accept applications from anyone requiring licensed supervision.
• Post-graduate experience with at least 1 year of post-licensed experience.
• You’re comfortable with technology and are telehealth competent.
• You have training and experience in evidence-based modalities of care such as CBT, DBT, EMDR, ACT, CPT.
• You are comfortable with providing safety planning and intervention during situations where a client might present with higher risks.
• You are committed to quality clinical care and want to expand your capabilities and increase your effectiveness by being informed of client progress or challenges.
• You like working independently, but would also enjoy having the support of a team and opportunities for connections and collaboration with other providers and our master’s level clinical care navigators.

• You’ll set your own schedule to fit your professional and personal needs.
• Work from anywhere, as long as you have a confidential, private location with stable internet.
• No need to spend time marketing your practice, checking insurance eligibility, collecting fees, or submitting claims—we take care of the administrative work so that you can focus on clinical care.
• Grow your ability to provide effective care through feedback from evidence-based measures that help you identify what is working with your clients.
• Join a dynamic community where you will be supported, your work appreciated, and you’ll have the opportunity to help us shape the future of mental health care!

In addition to finding people who are truly excellent at what they do, we take our values at Spring Health seriously:

Members Come First We are genuine member advocates.

Move Fast to Change Lives We build with urgency and intention.

Take Ownership We extend trust and hold ourselves accountable.

Embrace Diverse Teams & Perspectives We find strength in the ersity of cultural backgrounds, ideas, and experiences.

Science Will Win We will achieve impact by innovation and evidence based frameworks.

Candor with Care We are open, honest and empathetic.

Compliance Operations Manager

Location: US-TX-Dallas Requisition ID: 2023-11041 Job Category: Health Strategies Additional Locations Diversity Distribution US – Top 57 Position Type: Full Time

Overview

Now is the time to join us and make a difference. Be a relentless force for a world of longer, healthier lives. Here at the American Heart Association, you matter and so does your career.

The American Heart Association has an excellent opportunity for a Compliance Manager in our Quality, Outcomes Research & Analytics (QORA) department!

This position can be home based.

The Association offers many resources to help you maintain work-life harmonization through your changing needs and life situations. To help you be successful, you will have access to Heart U, our award-winning corporate university, as well as additional training and support, locally.

Responsibilities

The Compliance Audit Manager is responsible for planning, coordinating and implementing all activities pertaining to clinical data quality audits in order to protect the integrity and credibility of the American Heart Association and the representations that we make to the public. They will ensure that the data acquired from patient records gathered in the patient registry are consistent with audit standards used to measure the Get With The Guidelines (GWTG) and/or other quality recognition programs. The incumbent reports to the Senior Manager, Registry Research. The incumbent works with the Quality Senior Team, Internal Audit, Legal and other departments, when required; and follows departmental policies and procedures as well as limited instructions in carrying out daily compliance tasks. The Department’s vision is to build a fully developed clinical data quality audit function that proactively delivers valuable results to the Quality and Health IT department and its Volunteers. This position will also lead the Risk Control Self-Assessment (RCSA) of the department’s risks and provide mentorship to implement appropriate controls; as well as be responsible for other areas that require compliance oversight, including but not limited to business agreements with hospitals and business partners. This is accomplished by evaluating risks in achieving organizational objectives and proposing value-added and efficient measures for controlling and leading those risks. Assisting management by reviewing the organization’s operations, the adequacy of internal controls, the compliance with laws and regulations, the adherence to policy and procedures, the safeguarding of assets, and the accuracy of reported financial activities. Supporting governance by assuring the organization about the state of the control environment.

Build a network of meaningful volunteer partnerships to advance the mission of the American Heart Association/American Stroke Association. Provide timely direction, framework and resources to volunteers while at the same time relying on their expertise, abilities and willingness to demonstrate their networks to drive the goals of the organization. Share meaningful opportunities for volunteers, so they can apply their passion to further the mission of the organization. Give recognition to volunteers for their efforts to help ensure their success and drive happiness. Hold each other accountable, both volunteers and staff, while being accessible and build collaborative staff-volunteer partnerships that are based on a foundation of mutual trust. Build a collaborative environment where staff from various functions work together to achieve results across health, revenue and volunteerism goals for the organization.

• Conducts on-site and remote audits of hospitals participating in quality programs and research
• Facilitate audit by leading all aspects of the project management of specified activities
• and ensuring the audit process is carried through to completion
• Develop data quality and clinical research audit plans, including objectives, testing criteria for how audits shall be conducted. Ensures staff are implementing process changes that appropriately address audit findings
• Conduct abstractor training, IRB activities, and other duties as assigned to support research efforts
• Communicate audit protocols and findings expertly and effectively with consultants, clinical directors, senior management, clinicians, and colleagues, internally and at all levels in external organizations
• Lead department Risk Control Self-Assessment (RCSA) by reviewing adequacy of internal controls and assist management by reviewing the organization`s operations, the adequacy of internal controls, the compliance with laws and regulations, the adherence to policy and procedures, the safeguarding of assets, and the accuracy of reported financial activities

Qualifications

• Bachelor’s Degree and/or Registered (RN) and/or Certification in Healthcare Research Compliance and/or Certified Professional Coder – Hospital (CPC-H)
• Two (2) – Five (5) years of proven experience
• Experience with clinical setting or clinical trials or utilization reviews
• Knowledge of laws and regulations i.e. HIPPA, PHI
• Communicate expertly and optimally with healthcare professional
• Microsoft Office proficiency
• Project Management experience
• Strong interpersonal/relationship building skills
• Some travel will be required

Preferred Experience:

• Health IT data audit Experience

Compensation & Benefits

The American Heart Association invests in its people. Here are the main components of our total rewards package. Visit Rewards & Benefits to see more details.

• Compensation Our goal is to ensure you have a competitive base salary. That’s why we regularly review the market value of jobs and make adjustments, as needed.
• Performance and Recognition You are rewarded for achieving success by merit increases and incentive programs, based on the type of position.
• Benefits We offer a wide array of benefits including medical, dental, vision, disability, and life insurance, along with a robust retirement program that includes an employer match and automatic contribution. As a mark of our commitment to employee well-being, we also offer an employee assistance program, employee wellness program and telemedicine, and medical consultation.
• Professional Development You can join one of our many Employee Resource Groups (ERG) or be a mentor/mentee in our professional mentoring program. HeartU is the Association’s national online university, with more than 100,000 resources designed to meet your needs and busy schedule.
• Work-Life Harmonization The Association offers Paid Time Off (PTO) at a minimum of 16 days per year for new employees. The number of days will increase based on seniority level. You will also have a total of 12 paid holidays off each year, which includes several days off at the end of the year.
• Tuition Assistance – We support the career development of all employees. This program provides financial assistance to employees who wish to further their education and career in relation to their current duties and responsibilities, or for potential future positions in the organization.

The American Heart Association’s 2024 Goal: Every person deserves the opportunity for a full, healthy life. As champions for health equity, by 2024, the American Heart Association will advance cardiovascular health for all, including identifying and removing barriers to health care access and quality.

At American Heart Association | American Stroke Association, ersity, inclusion, and equal opportunity applies to both our workforce and the communities we serve as it relates to heart health and stroke prevention.

Benefit Administration Product Specialist

Product Management

Remote

ID:2015020

Full-Time/Regular

It’s 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.

The Benefit Administration Product Specialist is responsible for day-to-day benefit/product administration operations, ensuring the alignment of business processes and decisions with the benefit/product strategy as well as ensuring compliance from a benefit perspective including the development and management of Evidence of Coverage (EOC), Product Contract Documents, Member Handbooks, Schedules of Benefits (SOBs), Schedule of Benefit and Contract documents (SBC), etc., as well as ensuring compliance from a claims configuration and adjudication perspective.

Our Investment in You:

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

Key Functions/Responsibilities:

• Supports, develops and maintains the EOCs, SOBs, SBCs, Covered Services Lists, amendments, handbooks and all internal benefit resource documentation for all products
• Using an in-depth knowledge of Medicare, Medicaid, Commercial (HMO, PPO and POS), and other state and federal regulatory requirements, including product specific contracts, clinical operations and medical benefit requirements, this inidual will serve as the Plans product and benefit expert for the product(s) they represent
• Support all implementation steps needed to support mandated changes, internal benefit changes, new codes, and new employer-group specific benefit designs for both internal and external information
• Closely monitor state and federal legislative changes that have an impact on Plan benefits, policies and develop implementation plans for addressing such issues
• Support operational issues related to benefits, new mandates or contract changes with regulatory products
• Serve as the primary liaison between the internal product managers/external partners and the plan supporting benefit questions and adhoc inquiries and requests as they relate to contract, configuration, adjudication, and regulatory submissions
• Participate as a benefits subject matter expert (SME) on cross-functional, operational teams (Reimbursement Policy, Clinical Operations Subgroup, CCB, Claims Payment Subgroup etc.)
• Other duties as assigned

Qualifications:

Education Preferred:

• Bachelor’s Degree in Business Administration, Public Health Administration, Public Policy or a related field
  • The equivalent combination of training and experience acceptable

Experience Required:

• Minimum of 3-5 years in the Healthcare industry, particularly in positions that are familiar with product and or regulatory compliance is required
• Experience with commercial, Medicaid, and/or Medicare
  • Medicare experience preferred

Experience Preferred/Desirable:

• Experience working with Medicaid, Medicare and commercial coding rules/ regulatory requirements
• Experience working with ICD-10 and CPT coding principles
• Medical claims processing experience

Competencies, Skills, and Attributes:

• Effective collaborative and proven process improvement skills
• Strong oral and written communication skills; ability to interact within all levels of the organization
• A strong working knowledge of Microsoft Office products
• Demonstrated ability to successfully plan, organize and manage projects
• Detail oriented, excellent proof reading and editing skills
• Strong analytic skills in terms of ability to interpret regulations and assess impact to products, configuration, etc.
• Ability to work independently and collaboratively, manage multiple projects and meet scheduled deadlines
• Demonstrates strong organization skills and ability to work in a rapidly changing environment
• Familiarity with government programs such as Medicare
• Claims or other experience using industry standard coding
• Experience applying analytical results to decision-making
• Must be able to understand and identify operational interdependencies between departments, particularly those leading contracts/rates, clinical coverage, benefits, and technical

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.

*WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.

Bilingual Referral Coordinator

Remote

Our mission is to make healthcare right. Together. We are a value-driven healthcare company committed to providing personalized care to aging and underserved populations. We do this by aligning stakeholders across the healthcare ecosystem. Together, we can improve consumer experience, optimize clinical outcomes, and reduce total cost of care.

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

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

SCOPE OF ROLE

The role of the Referral Coordinator is to facilitate consistency of information shared across practices to promote care coordination and effective member co-management for behavioral and non-behavioral practitioners. The Referral Coordinator collaborates with clinical team members to evaluate the potential over and under-utilization of specialty services based on clinical protocols.

ROLE RESPONSIBILITIES

• Prioritizes assigned patient cohorts to ensure specialty referral completion and ensures stat and expedited referrals are completed based on timeliness standards
• Schedules patients (Preferred Providers List of Specialists) and notifies them of appointment information, including, date, time, location, etc.
• Ensures missed specialty appointments are rescheduled and communicated to the physician/clinician.
• Ensures specialist notifications of referral status
• Completes exchange of information by retrieving and ensuring upload of specialty consultation and follow-up notes
• Completes documentation based on standardized documentation; to include, but not limited to location, notification of specialist, notification of patient, status of appropriateness reviews
• Enters all Inpatient and Outpatient elective procedures in EMR and contacts specialist for post-procedure referral needs
• Follows up on all Home Health and DME orders to ensure the patient receives the services ordered.
• Completes appropriateness review based on clinical protocols and appropriately refers to Nurse or Medical Director
• Addresses referral based phone calls for Primary Care Physicians panel and completed phone messages timely
• Facilitates escalation of denied referrals to the clinical team for appeal reviews.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• High School Diploma
• Minimum 2 years of experience in medical management.
• Capacity to interpret health plan benefit decisions

LICENSURES AND CERTIFICATIONS

• Certification as a Medical Assistant preferred

WORK ENVIRONMENT

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

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

Manager, Nurse Advocates

REMOTE

CANDIDATE EXPERIENCE

FULL-TIME (REMOTE)

REMOTE

What is Trusted Health?

Trusted, Inc. is the leading digital labor marketplace and workforce management solution for the healthcare industry. We are headquartered in San Francisco but we’ve taken a digital-first approach to building our workforce and the majority of our team resides across the US and abroad.

Trusted was founded in 2017 with a focus on the largest profession in healthcare: nursing. Since then, we’ve taken a process dominated by recruiters and phone calls and converted it to a fully digital experience, connecting nurses directly to job opportunities and handling benefits, payroll, onboarding, and compliance. Our platform provides full employer of record services for employers in all 50 states and the District of Columbia.

In 2020, we launched our proprietary staffing platform, Works. Works helps hospitals solve one of their biggest challenges: filling every shift in an environment where demand for healthcare services and labor costs are increasing exponentially. With Works, facilities can create their own on-demand nursing workforce and manage all the details from a single system. Using predictive insights and recommendations, Works helps hospitals react to fluctuations in demand, while its staffing marketplace creates competition to fill open job requisitions with high-quality, active talent.

Trusted has support from top institutional investors such as Craft Ventures, Felicis Ventures, StepStone Group, and Founder Collective, as well as healthcare innovators like Texas Medical Center, Mercy Health, Intermountain Ventures, Town Hall Ventures, and Healthbox. Most recently we closed a $149 million Series C round to fund our next stage of growth.

What we’re looking for

The Manager, Nurse Advocates will lead a team of Nurse Advocates by empowering them to utilize their clinical background and expertise to foster relationships with clinicians, and ultimately place clinicians in jobs they love and build the lives they want. They will also build relationships with key stakeholders and cross functional partners, to successfully collaborate in removing barriers for the team as well as improve processes and workflows so that the team is successful in placing candidates in jobs.

Your responsibilities

• • Manage a team of customer facing nursing professionals (Nurse Advocates) in a role that supports clinicians through their Trusted job search and working phases by building rapport, engagement, and supplementing the Trusted platform through human relationship.
  • Hire, train, coach and develop the team of Nurse Advocates in customer success and sales, leveraging their strengths to create an environment of autonomy and professional growth
  • Collaborate cross functionally to be the voice of our customer with marketing, product, and operations teams, in order to drive better user experience for our clinicians.

Who you are

• • Resilient. You coach yourself and others through change as we scale by normalizing the challenges of growth, sharing your own experiences and engaging others in adaptive thinking practices. You lead others to learn from setbacks and recover swiftly. You are a role model for dealing with hardships, and you build a team culture that can face adversity with strength.
  • Customer Focused. You are a champion for the needs of the clinician. You have a deep understanding of who our customer is, what they need, and how we can serve them. You lead your team to build and cultivate new relationships, while strengthening existing ones. You are able to speak on behalf of the clinician in every cross-functional partnership, keeping the clinician’s viewpoint in mind for all solutions.
  • Courageous. You take control in high stakes situations and are able to lead your team through times of uncertainty. You make tough or unpopular decisions when needed. You communicate difficult topics with your team, holding them accountable for what is in their control. You foster an environment where people are encouraged to grow, take risks, and develop into effective and efficient Nurse Advocates.
  • Effective Communicator. You create a venue and set high standards for transparent and constructive dialogue within your team and across the organization. You discuss issues in a direct, thoughtful and forthright manner that builds trust, understanding and commitment. You are able to adapt your communication style in order to effectively work with non-clinicians within Trusted.

You have

• Preferred
  • 4+ years of leadership experience people-managing, coaching, and up-leveling a high performing team
  • 4+ years of professional experience, ideally in a healthtech or high growth, customer focused start up
  • RN required
  • BSN/MSN, MHA, MBA preferred
  • Project, process, and/or operations management
  • Customer/patient relations and incident or conflict management
  • Experience with databases and enterprise tools such as Salesforce, Asana, Front, Slack, and/or GSuite.

We offer

• • Paid vacation & sick time, paid family leave, and flexible work hours
  • Employer-paid health insurance, vision, and dental
  • Employer-paid life insurance
  • Mindfulness and fitness reimbursement
  • Monthly cell phone reimbursement
  • Employer-sponsored 401k

$108,000 – $158,000 a year

Trusted reasonably anticipates the salary range for this role to be $108k-$158k annually, plus equity. The final compensation for this position will vary based on geographic location and candidate experience relative to what Trusted reasonably anticipates for this position. We are committed to transparency, and any compensation questions will be addressed early in our recruitment process.

#LI-Remote #LI-EK1

Member Advocate

Remote 

Operations

Full-time

Remote

Our health system is broken, and it’s a huge problem. Costs are rising out of control while the patient experience gets worse. At Sana, we’re passionate about fixing this problem by bringing accessible and affordable health plans to small and medium businesses. We’ve built an innovative team with top talent from across the health insurance and tech industries to create engaging, modern plans for our clients. This allows our customers to offer competitive benefits packages while paying an average of 20% less than traditional plans.

We are looking for a hard-working, empathetic person to join our member advocacy team. We’re building a team of social workers, patient advocates, health coaches, nutritionists, and nurses to support our members in solving everyday problems.

This is a remote role and we encourage all applicants to apply, regardless of location. We are particularly looking for candidates who can work on mountain time or pacific time hours.

What you will do

• Provide accurate and easy-to-understand guidance in the complex world of health insurance and employer benefits across multiple channels (phone, text, chat, and email).
• Help new customers with their onboarding, making sure members understand and select appropriate health plans and other steps.
• Assist members with issues around their care journey – whether it’s finding a provider, helping with claims issues, or referring them to expert clinical care managers.
• Give feedback to the product team about member support issues so they can design better experiences.
• Generally strive to make sure members feel taken care of and love our service.

About you

• Bachelor’s degree with 2 years of related experience in social work, patient advocacy, or health coaching preferred.
• Comfortable with remote work.
• Excellent communicator.
• Strong preference for candidates fluent in Spanish and English.
• Some knowledge of healthcare and/or insurance benefits preferred.
• Entrepreneurial. Self-directed. Excited to build something from scratch.
• Values-oriented. You care about making our healthcare system work better for people and business owners.
• Gritty. You aren’t worried about getting your hands dirty and working hard when you need to.
• Comfortable with change. We are a startup and need people who are ok doing things outside of their traditional job description.
• Comfortable with modern web applications. We are building all of our software in-house and you will be a key constituent in its development.

Benefits

• Stock options in rapidly scaling startup
• Flexible vacation
• Medical, dental, and vision Insurance
• 401(k) and HSA plans
• Parental leave
• Remote worker stipend
• Wellness program
• Opportunity for career growth
• Dynamic start-up environment

$55,000 – $55,000 a year

Our cash compensation amount for this role is targeted at $55,000 per year for all US-based remote locations. Final offer amounts are determined by multiple factors including candidate experience and expertise and may vary from the amounts listed above.

About Sana

Sana is a modern health plan solution for small and medium businesses. We use a more efficient financing structure and integrated technology solutions to cut out wasteful spending and get members access to better quality care at lower cost. Founded in 2017, we are an experienced team of engineers, designers and health system operators. We have the financial backing of Silicon Valley venture firms and innovative reinsurance partners. If you are excited about building something new and being a part of fixing our broken healthcare system from the inside, please reach out!

Payment Integrity Medical Coder

locations

Remote

time type

Full time

job requisition id

J229270

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job is responsible for educating providers on proper billing behavior and proper usage of procedure codes and/or modifiers who are identified as outliers in regards to billing Highmark for certain targeted codes; outreach may occur in various formats including written letters, emails, and consultations via telephone. Documents explanations from Provider Outliers to be used in the analysis of billing behavior and cost savings.

ESSENTIAL RESPONSIBILITIES

• Performs outreach via telephone or other means to identified Outlier Providers informing them of their inclusion as an Outlier; meaningfully discusses the Outlier Providers’ billing practices and provides education on proper usage of procedure codes and/or modifiers. May also field incoming calls from providers.
• Applies medical coding knowledge to determine applicable education for Outlier Provider’s on industry standards and guidelines as well as Payer Reimbursement Policies to enhance and ensure compliance with industry standards.
• Documents communications and explanations from Outlier Providers regarding why billing behavior is outside of the norm.
• Other duties as assigned or requested.

EXPERIENCE

Required

• 3 years of medical coding experience
• 1 year of experience with commercial claims
• 3 years of experience with the Common Procedure Coding System (HCPCS)
• 3 years of experience with International Classification of Diseases (ICD-10) coding

Preferred

• None

SKILLS

• Knowledge of the Common Procedure Coding System (HCPCS)
• Knowledge of International Classification of Diseases (ICD-10) coding
• Understands and applies appropriate Centers for Medicare and Medicaid (CMS) guidelines to coding
• Knowledge of anatomy, physiology and medical terminology
• Excellent verbal and written communication skills
• Data Entry

EDUCATION

Required

• High school/Ged

Preferred

• Associates degree in health care or related field
• Bachelors degree in health care or related field

LICENSES or CERTIFICATIONS

Required

• Certified Professional Coder (CPC)

Preferred

• None

Language (Other than English):

None

Travel Requirement:

0% – 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$17.93

Pay Range Maximum:

$32.26

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified iniduals based on their status as protected veterans or iniduals with disabilities, and prohibit discrimination against all iniduals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment iniduals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity (https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf)

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

Inpatient Coder

Location Chicago, Illinois, USA

76960 USD – 83200 USD/Year

This is a 100% REMOTE position for Inpatient Coders in the US.

Description

• The Inpatient Coder II is the coding and reimbursement expert for ICD-10-CM diagnosis coding and ICD-10-PCS procedure coding for complex inpatient acute care discharges. This person possesses a strong foundation in coding conventions, instructions, Official Guidelines for Coding and Reporting, and Coding Clinics. The Inpatient Coder II has a deep understanding of disease processes, anatomy/physiology, pharmacology, and medical terminology.
• Utilizes technical coding expertise to assign appropriate ICD-10-CM and ICD-10-PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II’s typically see average CMI’s of 2.2609. This index score demonstrates higher patient complexity and acuity.
• Utilizes expertise in clinical disease process and documentation, to assign Present on Admission (POA) values to all secondary diagnoses for quality metrics and reporting.
• Thoroughly reviews the provider notes within the health record and the Findings from the Clinical Documentation Nurse in the Clinical Documentation
• Improvement (CDI) Department who concurrently reviewed the record and provided their clinical insight on the diagnoses.
• Utilizes resources within CAC (Computerized Assisted Coding) software to efficiently review documentation and select or assign ICD-10-CM/PCS codes using autosuggestion or annotation features.
• Reviews Discharge Planning and nursing documentation to validate and correct when necessary, the Discharge Disposition which impacts reimbursement under Medicare’s Post-Acute Transfer Policy.
• Utilizes knowledge of MS-DRGs, APR-DRGs, and AHRQ Elixhauser risk adjustment to sequence the appropriate ICD-10-CM codes within the top 24 fields to ensure correct reimbursement and NM’s ranking in US News and World Report.
• Collaborate with CDI on approximately 45% of discharges regarding the final MS or APR DRG and comorbidity diagnoses.
• Educates CDI on regulatory guidelines, Coding Clinics, and conventions to report appropriate ICD-10-CM diagnoses.
• Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to determine the Principal Diagnosis, secondary diagnoses, and procedures
• Follows the ICD-10-CM Official Guidelines for Coding and Reporting, ICD-10-PCS Official Guidelines for Coding and Reporting, Coding Clinic for ICD-10-CM and ICD-10-PCS, coding conventions, and instructional notes to assign the appropriate diagnoses and procedures.
• Utilizes coding expertise and knowledge to write appeal letters in response to payor DRG downgrade notices.
• Resolves Nosology Messages/Alerts and Coding Validation Warning/Errors.
• Meets established coding productivity and quality standards.

Top Skills Details:

• Medical coding, RHIT, RHIA, CCS, Inpatient, Hospital, Academic, Trauma 1, AHIMA

Additional Skills & Qualifications:

• 3 years of inpatient coding experience in an academic facility (teaching hospital)
• RHIA, RHIT or CCS credential
• AHIMA membership

Nurse Practitioner (Remote – Telemedicine)

at Found

Remote

Found is a modern weight care platform and community focused on integrated support. According to a recent CDC study, nearly 50% of Americans want to lose weight, and on average, Americans have gained 30 lbs during the pandemic. But the existing weight loss industry focuses on shame – if you don’t have the willpower to eat less and workout more, you aren’t trying hard enough.

Modern science shows us that weight care is complex – food and movement are important, but so are hormones, genetics, sleep, stress, mental health, and daily habits. Found’s unique approach incorporates resources and tools for behavior changes, a digital app with guided programming, an online community, and if indicated, medical and prescription solutions.

Research shows that addressing weight health reduces the long-term risk of diabetes, heart disease, and some forms of cancer. We believe in giving our community tools that will help them add years to their lives and reach their goals. We believe it’s not just what you’ve lost, it’s what you’ve Found. Found has raised more than $130mm from leading investors, including Atomic, GV, WestCap, IVP, TCG, Define Ventures and more.

Why Clinicians Love Found:

• Meaningful work in leading obesity care practice, one of the largest in the US
• Flexible work schedule
• Custom built, easy to use EMR that allows you to focus on delivering patient care

What You’ll Do:

• Conduct asynchronous consultations with patients, including health assessment, lab screening, diagnoses related to obesity, prescribing medication & follow-up care for patients as indicated
• Educate patients on appropriate treatments and care plans for their health history, weight loss objectives, and access to medication
• Provide ongoing clinical support to patients as they navigate their weight care journey (managing medication side effects, change treatment plan based on changes in patient’s health, weight loss progress, &/or insurance coverage)
• Provide compassionate and meaningful care employing shared decision making with your patients
• Complete required onboarding training, engage in quality assurance processes, and adhere to company guidelines and policies

What You’ll Bring:

• Passion for working in a rapidly growing business with curiosity, humility, humor, and professionalism
• Must have 2+ years experience in hospital/clinic setting, with at least one of those in an obesity care setting
• Ideally will have a certification with the Obesity Medicine Association
• At least one year of working in a telehealth setting
• Excellent written and verbal communication with an emphasis on clarity and compassion
• The ability to pick up new technologies quickly, you are proactive, organized, & detail-oriented.
• A clean malpractice history
• Multiple state licenses required, preference for at least one license in CA or TX

Title: Full Time Bilingual New York (NY) Licensed Nurse Practitioner (NP) – (English/Spanish) (Remote)

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

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

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

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

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

The ideal teammate would be…

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

The ideal teammate would be able to:

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

Would you describe yourself as someone who has:

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

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

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.

This role will be paying up to $125,000 depending on experience.

Inpatient Medical Coding Supervisor – Hospital

locations

US – Remote (Any location)

time type

Full time

job requisition id

10747

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Need:

The Inpatient Medical Coding Supervisor- Hospital supervises the coding unit including inpatient coders, inpatient denials and inpatient coding auditors. Prioritizes and coordinates work to meet delivery standards.

• Identifies productivity and quality standards for coders. Monitors performance against standards monthly and provide feedback to the staff on their results. Quality reviews will include ICD-10CM, ICD-10PCS, DRG accuracy and completeness. Ensures that staff is reaching productivity and quality targets.
• Develops and maintains hospital and department specific coding guidelines, training manuals, policies and procedures. Upon completion submits to Director of HIM Facility Coding for approval.
• Oversees staffing including preparing weekly, holiday, PTO, and vacation schedules, including completing payroll approvals. Tracking staffing levels, e-learning and annual health assessments. Interview prospective staff. Completes at least monthly staff meetings providing formal monthly communication. Evaluates employees annually completing by March of the following year.
• Provides support, training and education for staff including orientation to new staff. Continue to develop knowledge, talents and skills of staff.
• Serves as a resource to customers including HIM and other departments, UHS system members and assist with HIM coding issues. Continuously seeking innovative ways to improve.
• Codes charts and review for clinical documentation to maintain skills and relationship with staff.
• Serves as a resource to UHS system members and facility staff on coding issues.
• Participates in all section, department and committee meetings as appropriate.
• Monitosr reports of records un-billed for 3M over 5 days, coding hold list, and denials and audits results lists and allocates resources to ensure timely completion of discharged records.
• Assists physicians or other providers with questions when code assignments are not straight forward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes. Providing information/education as needed.
• Coordinates and facilitates external coding compliance, reviews/audits as needed.
• Understands 3M integration with Soarian, Document Imaging, and SMART. Coordinates changes with those necessary to ensure smooth implementation of changes. Monitors 3M integration and Epic work queues.
• Reviews the current OIG work plan for DRG risk areas in the HIM department. Review these charts to identify patterns, trends, and variation in these cases. Once identified, evaluate the causes of change or problems and takes appropriate action to resolve or explain variances.
• Maintains credentials and appropriate CEU’s.

What You Will Need

• RHIT, RHIA, CCS, CPC, or CIC certification
• Three (3) to five (5) years of experience in coding
• Working knowledge of MS- DRG’s, APR’s, hospital coding and electronic medical record
• Experience with electronic medical records.

What Would Be Nice To Have:

• RHIA
• Three to Five (5) years of supervisory experience.
• Experience with regulatory agencies and third party payers.
• Associate’s Degree or Bachelor’s Degree in HIT.

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The annual salary range for this position is $78,900.00-$138,200.00. 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.

Provider Enrollment Specialist

at Grow Therapy

Remote

About us:

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

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

What You’ll Be Doing:

We’re looking for an experienced Provider Enrollment Specialist who is passionate about improving the landscape for mental healthcare. In this role, you’ll own the credentialing processes for 5-10 of our payors, so you’ll play a key role in getting our providers in-network with some of the country’s largest health plans. Responsibilities include:

• Ensuring our providers are credentialed in a timely manner by monitoring and maintaining the end-to-end submission process for 5-10 of our payors.
  • Monitor our submission processes to make sure that all applications are submitted within SLA. Understand our submission protocols and update them as needed.
  • Monitor the follow up process applications, and communicate with the payors directly to ensure that applications are staying on-track.
  • Conduct regular reviews to validate the accuracy of our internal credentialing data against the payor’s data to ensure our credentialing data serves as a source of truth across the organization.
  • Maintain documentation for each process to ensure smooth operations.
  • Work with the Revenue Cycle Management team on any Credentialing related claim denials.
• Assist in building out new payor operations as we onboard new payors.
  • Create the Submission Protocol for new payors so that applications can be submitted in a standardized format.
  • Work with the payor to understand the best way to follow up on applications, and document the process accordingly.
  • Determine the best way to regularly review the accuracy of internal credentialing data whether it be requesting a report from the payor or checking a portal.
• Provide a synthesis of each payor’s credentialing operations to the Senior Manager, Credentialing Operations on a biweekly basis based off the data you’re monitoring in our credentialing system

Salary range: $52,625 – $75,750

You’ll Be a Good Fit If:

• You’re a behavioral health credentialing expert. You’ve communicated with payors directly in the past, and you meet the following requirements:
  • Certified Provider Credentialing Specialist (CPCS) with at least two years of experience in Provider Credentialing OR at least four years of experience in Provider Credentialing
  • Strong familiarity with credentialing processes, terminology and primary source verification resources; these include: CAQH, NPDB, PECOS, State Licensing, Accreditation and Certification agencies
• You’re great at problem perception and escalating when you need help. You know when you need to loop someone in because you’re not getting what you need or something seems off.
• You have excellent communication skills. You have the ability to be persuasive and credible with a wide variety of audiences both internal and external.
• You know how to hold people accountable. You drive clarity on what’s needed to get something done, and you ensure deadlines are met.
• You’re tech savvy. You’ve efficiently learned new software in the past, and you’re willing to learn HubSpot, Verifiable, Slack, and Excel if you don’t know how to use them already.
• You’re comfortable with a face-paced, high growth environment.

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

Benefits

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

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