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Managed Care Manager Nurses

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

Responsibilities:

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

Qualifications

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

Job Specifications:

Reference: 2023-54029

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

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

Education Level: Travel: As Needed

Title: Remote Mental Health Therapist (GA)

Location: Atlanta, Georgia or Remote

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

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

Being a Sondermind Mental Health Therapist means you can:

Facilitate treatment with comprehensive tools and community engagement:

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

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

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

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

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

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

Mental Health Therapist Requirements:

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

Mental Health Therapist Benefits:

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

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

• Remote, Remote
• Position Type
• Full time
• Requisition ID
• 27030
• Level of Education
• Years of Experience

About Exela

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

Health & Wellness

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

Military Hiring:

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

LexiCode

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

Position Type – Non-Exempt

Location – Remote

Duration – Full-Time positions available

Job Summary

Observation Services coder openings are available now for positive and self-motivated coding professionals on our growing remote services team. You can work full-time coding from your home office for our clients.

LexiCode is the leading provider of HIM Coding and Consulting Services nationwide and our exceptional employees make this possible. For more than 35 years LexiCode has provided quality HIM coding and consulting services to healthcare providers nationwide. Our team works to enhance operations in every type and size of healthcare provider environment. Today LexiCode, an Exela brand, remains the industry leader in coding compliance solutions. The pay range for this position is $26.00-$34.00 per hour; however, base pay offered may vary depending on job-related knowledge, skills, and experience. Bonus opportunities may be provided as part of the compensation package, in addition to a full range of medical, financial, and/or other benefits, dependent on the position offered.

Job Description

Essential Functions and Responsibilities

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

LexiCode Offers

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

Qualifications

Required:

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

Preferred:

• Experience with EMR, multiple encoders and abstracting systems

Benefits That Matter

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

EEO Statement:

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

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

Title: Medical Coder Lead

Location: United States

Work from Home/Remote Full-Time

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

Duration 3-month contract position, with possible extension.

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

Responsibilities:

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

Qualifications:

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

Base pay range $40-48/hr.

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

Clinical Documentation and Coding Accuracy Educator

at VillageMD

Remote

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

Join the frontlines of today’s healthcare transformation

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

Why VillageMD?

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

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

Could this be you?

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

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

How you can make a difference

Education

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

Operations

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

Compliance Support

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

Skills for success

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

Experience to drive change

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

How you will thrive

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

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

Our unique VillageMD culture how inclusion and ersity make the difference

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

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

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

Explore your future with VillageMD today.

Patient Navigator (Nurse, Remote)

Works With: Director of Community Relations

FLSA Status: Exempt, Full Time

Background:

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

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

Position Summary:

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

Essential Duties and Responsibilities:

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

Education & Experience:

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

Required Skills, Knowledge, & Abilities:

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

Work Environment:

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

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

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

Coding Specialist

at Signify Health (View all jobs)

Remote

How will this role have an impact?

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

This role will report to our Senior Coding Manager!

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

What will you do?

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

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

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

We are looking for someone with:

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

About Us:

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

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

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

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

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

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

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

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

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

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

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

The ideal teammate would be…

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

The ideal candidate would be able to:

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

Would you describe yourself as someone who has:

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

Pay range is $35 per hour.

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

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

Risk Adjustment Medical Coder

Remote – US

Part time

R29850

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

Work Location: Fully Remote – U.S.

Position:

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

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

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

Core Responsibilities:

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

Requirements:

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

Preferred Qualifications:

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

Working Conditions/Physical Requirements:

• General office demands

Unique Benefits*:

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

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

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

The base pay range for this position is $0.00 – $0.00

Diversity, Equity & Inclusion:

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

Title: Payment Posting Specialist

Location: US National

Full-Time

Description

Who We Are Looking For

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

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

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

What You Should Have to Qualify

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

Ideally, You Would Also Have These

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

Culture is at our Core

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

About Us

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

Company Perks

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

#LI-Remote

Qualifications

Skills

Preferred

Medical Billing

Intermediate

Experience

Required

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

2 years: Experience posting large batches of payments.

Nurse Navigator

Remote

US – Remote

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

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

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

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

Responsibilities for the Triage RN, Nurse Navigator:

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

Candidate Profile for the Triage RN, Nurse Navigator:

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

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

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

Billing Support Specialist

Remote

Full Time

Corporate

Entry Level

About Us

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

Benefits

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

About the Billing Support Specialist Role

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

What You’ll Do

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

Qualifications of the Billing Support Specialist

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

Job Type: Full Time

Remote Experienced Medical Writer

Job Locations: United States

Category: Medical Writing

Job Summary

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

Responsibilities

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

Qualifications

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

Medpace Overview

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

Why Medpace?

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

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

Medpace Celebrates 30 Years

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

Medpace Perks

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

Awards:

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

Patient Record Specialist – Remote

Hamilton Township, New Jersey, United States

Remote

Description

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

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

Duties and Responsibilities include:

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

Requirements

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

Benefits

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

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

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

Provider Data Analyst

Remote

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

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

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

SCOPE OF ROLE

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

ROLE RESPONSIBILITIES

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

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

SUPERVISORY RESPONSIBILITIES

This position does not have supervisory responsibilities.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

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

EEO/AFFIRMATIVE ACTION STATEMENT

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

We’re Making Healthcare Right. Together.

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

Focusing on Consumers

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

Building on Alignment

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

Powered by Technology

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

Scheduling Assistant Manager

at Incredible Health

Remote

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

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

Responsibilities:

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

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

Requirements:

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

Location:  US Locations Only; 100% Remote

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Clinical

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

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  $5,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS

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

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

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

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

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

Primary Responsibilities:

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

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

Required Qualifications:

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

Preferred Qualifications:

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

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

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

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

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

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

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

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

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

Location:  US Locations Only; 100% Remote

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Clinical

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

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$3,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS

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

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

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

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

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

Primary Responsibilities:

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

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

Required Qualifications:

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

Preferred Qualifications:

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

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

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

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

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

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

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

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

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

Director of Operations

Job Location(s) US-TX-Irving

ID

2023-3939

Category

Corporate Departments

Role Overview

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

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

A Smarter Career Investment

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

Benefits

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

Job Summary

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

What you will do in this role

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

Key Deliverables

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

What qualifications you will need

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

Competencies

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

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

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

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

Landon Owens, Sr. Director of Talent Acquisition and Strategy

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

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

Title: Code Edit Support Team Medical Coding Coordinator 3

Location: United States – Remote

Description

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

Responsibilities

Where you Come In

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

This is a remote position from anywhere in the US

What Humana Offers

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

Required Qualifications What it takes to Succeed

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

Preferred Qualifications

• Medicare/Medicaid experience

Additional Information – How we Value You

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

Work-At-Home Requirements

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

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

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

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

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

Scheduled Weekly Hours

40

Remote Nurse Practitioner-Endocrinology

at Perry Health Inc (View all jobs)

Fully Remote

THE HIGHLIGHTS

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

OUR MISSION

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

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

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

ABOUT THE ROLE

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

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

KEY RESPONSIBILITIES

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

QUALIFICATIONS

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

ABOUT OUR TEAM

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

OUR VALUES

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

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

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

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

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

Clinical Coder – Nurse Auditor (Remote)

REMOTE

United States

Quality

Full time

Description

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

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

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

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

Requirements

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

Benefits

WORKING AT VATICA HEALTH ADVANTAGES

Prosperity

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

Good Health

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

Happiness

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

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

Title: Care Coordinator – Clinical Operations – Remote

Location: United States

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

About Us:

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

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

PlushCare Care Coordinator – Remote

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

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

Candidates must have all of the following qualifications:

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

Skills that’ll help:

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

Full-time employees receive the following benefits:

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

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

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

Utilization Management Nurse

Remote

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

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

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

General Purpose

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

Duties and Responsibilities:

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

Experience:

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

Licensures and Certifications:

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

We’re Making Healthcare Right. Together.

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

Focusing on Consumers

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

Building on Alignment

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

Powered by Technology

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

Title: Senior Account Manager, Recoveries (Remote Friendly)

Location: United States

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

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

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

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

About you:

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

The impact you’ll make:

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

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

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

You’ll thrive in this role if:

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

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

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

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

*Benefits may vary by location

More about Mission Lane:

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

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

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

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

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

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

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

ProFee Coding Lead

Job Locations: US-Remote

Requisition ID: 2022-29340

# of Openings: 1

Category: HIM / Coding

Position Type: Employee Full-Time

Overview

Who we are…

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

What we offer…

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

What we need…

Responsibilities

Role and Responsibilities

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

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

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

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

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

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

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

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

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

· Conduct and recommend trainings to improve team performance.

· Ensure management is informed of any employee personnel issues.

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

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

· Other duties as assigned.

Qualifications and Education Requirements

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

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

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

· Previous supervisory/team lead experience

Preferred Skills

· Effective oral and written communication skills

· Strong knowledge of ICD 10 and Profee coding guidelines

· Strong analytical skills to interpret data

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

· Strong critical thinking skills and decision-making skills

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

· Billing/denial experience

Additional notes

· Auditing experience is a plus

· Education/Training experience is a plus

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

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

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

*Except for states where legally prohibited to enforce mandates.

Remote Sr. Coding Specialist

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

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

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

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

Job Summary

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

Job Details

Job Responsibilities:

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

Education:

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

Certifications:

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

Complexity of Work:

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

Work Experience:

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

Physical Requirements:

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

Personal Protective Equipment:

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

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinic Health System’s Smoking Policy will be permitted to reapply for open positions after 90 days.

Cleveland Clinic Health System administers an influenza prevention program as well as a COVID-19 vaccine program. You will be required to comply with both programs, which will include obtaining an influenza vaccination on an annual basis, and being fully vaccinated against COVID-19, or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.

Please review the Equal Employment Opportunity poster.

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

Title: Coding, Auditing Training Lead

Location: United States – Remote Full time

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

Qualifications:

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

Technical Specifications:

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

Schedule:

• Monday to Friday

Experience:

• ICD-10: 1 year (Preferred)

Patient Account Representative (Remote)

Job Details

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

JOB SUMMARY

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

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

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

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

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

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

KNOWLEDGE, SKILLS, ABILITIES

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

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

EDUCATION / EXPERIENCE

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

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

PHYSICAL DEMANDS

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

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

WORK ENVIRONMENT

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

• Call Center environment with multiple workstations in close proximity

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

Principal Medical Writer (Remote)

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

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

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

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

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

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

Travel: Yes, 10 % of the Time

Job Type: Experienced

Schedule: Full-time

Senior Group Director, Healthcare Communications (Remote USA)

Remote – USA

Full time

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

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

Job Scope & Responsibility:

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

What You Will Do:

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

This position is a Perfect Fit for You If

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

What You Should Have:

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

Pay Range: $175,000 – $219,000

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

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

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

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

Lead Medical Assistant

REMOTE, USA

OPERATIONS – CENTRAL OPERATIONS

FULL TIME

REMOTE

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

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

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

About the Role

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

Why You’ll Love Working at Truepill…

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

You’re Excited About This Opportunity Because…

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

We’re excited about you because…

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

Pay Range – $24 to $26 per hour

Diversity, Equity & Inclusion

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

PACE Risk Adjustment Coder

Remote

Contracted to Full Time

Audit Services

Mid Level

SHARE

This is a remote contract position.

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

What You’ll Do:

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

Experience You’ll Need:

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

Certification Requirements:

• CRC or 5 years’ experience coding risk adjustment

Billing and Follow Up Rep – Remote

Job ID 195932BR

• Rochester, Minnesota
• Full Time
• Finance

Apply Now

Not ready to apply? Join our talent community

Why Mayo Clinic

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

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

Position description

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

Qualifications

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

Additional qualifications

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

License or certification NA

Exemption status Non-exempt

Compensation Detail $22.99 – $31.05 / hour

Benefits eligible Yes

Schedule Full Time

Hours / Pay period 80

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

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

Weekend schedule n/a

Remote Yes

International Assignment No

Site description

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

EOE

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

Title: Credentialing Coordinator (Contract)

Location: Remote

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

JOB DESCRIPTION

About the job:

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

Responsibilities:

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

DIVERSITY STATEMENT

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

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

Title: Nurse Triage Position

Major Responsibilities:

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

Licensure, Registration, and/or Certification Required:

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

Education Required:

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

Experience Required:

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

Knowledge, Skills & Abilities Required:

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

Physical Requirements and Working Conditions:

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

Title: Hospital Coding Quality Specialist

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

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

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

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

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

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

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

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

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

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

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

Scheduled Hours

Monday through Friday First Shift

This is a REMOTE Opportunity

Licenses & Certifications

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

Degrees

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

Required Functional Experience

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

Knowledge, Skills & Abilities

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

Coder I (Outpatient) HIMS Coding

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

Coder I (Outpatient)

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

Work location: Remote

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

HIMS Coding Department Highlights:

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

Here’s What You Need

Education

H.S. Diploma or Equivalent General Studies REQUIRED or

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

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

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

Experience

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

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

Licenses and Certifications

CCA Certified Coding Associate 12 Months REQUIRED or

COC Certified Outpatient Coder 12 Months REQUIRED or

RHIT Registered Health Information Technician 12 Months REQUIRED or

CPC Certified Professional Coder 12 Months REQUIRED or

RHIA Registered Health Information Administrator 12 Months REQUIRED

Skills

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

What You Will Do

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

Additional perks of being a Texas Heath Coder

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

Title: Patient Services Associate

About Us

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

Benefits Offered Depending on Eligibility:

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

Job Responsibilities

PATIENT SERVICES ASSOCIATE – REMOTE WORK FROM HOME OPPORTUNITY

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

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

Specific duties include, but are not limited to:

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

Position Requirements

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

Title: Registered Nurse – Financial Clearance Specialist

Job Summary:

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

Key Position Details:

Work from home.

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

Job Description:

Job Requirements

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

Principle Responsibilities

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

Intake Coordinator (WFH/Remote)

United States, Remote 

Marketing – Intake and Consultation

Full-time

Remote

Full-time Non-Exempt

Direct Hire

100% Remote

$18 – $22 per hour

About Expressable:

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

About the Role:

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

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

What you would be doing at Expressable

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

What you bring to Expressable

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

Key competencies for success in this role

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

Benefits at Expressable

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

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

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

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

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

Utilization Management Nurse

Remote

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

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

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

SCOPE OF ROLE

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

ROLE RESPONSIBILITIES

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

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

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

LICENSURES AND CERTIFICATIONS

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

WORK ENVIRONMENT

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

We’re Making Healthcare Right. Together.

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

Focusing on Consumers

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

Building on Alignment

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

Powered by Technology

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

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

Nurse Case Manager – Oncology

• Houston, TX
• Remote

Full time

REQ202212-011

About Accolade

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

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

Responsibilities

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

Qualifications

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

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

What is important to us…

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

We find joy and purpose in serving others

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

We are strong inidually and together, we’re powerful

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

We roll up our sleeves and get stuff done

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

We’re boldly and relentlessly reinventing healthcare

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

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

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

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

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

2nd.MD

Ambulance Coder

locations

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

time type

Full time

job requisition id

R30447

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

Ambulance Coder

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

Work Location:

Fully Remote – U.S

Position:

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

Requirements:

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

Preferred Qualifications:

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

Working Conditions/Physical Requirements:

General office demands

Unique Benefits*:

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

Diversity and Inclusion:

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

#LI-remote

Feeling Inspired? Ready to #MakeAChange? Apply today!

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

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

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

Diversity, Equity & Inclusion:

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

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

Feeling Inspired? Ready to #MakeAChange? Apply today!

COVID Vaccination Requirements

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

Equal Opportunity/Affirmative Action Statement

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

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

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

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

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

Auditor, Coding & Clinical Validation (Episode of Care)

Job Locations: US-Remote

ID2022-9473

Category

Audit – Healthcare

Position Type

Regular

Overview

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

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

Responsibilities

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

Qualifications

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

Work Environment:

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

#LI-JJ1

#LI-Remote

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

Title: Full Time Bilingual Day/weekend Shift Triage Registered Nurse (English/Spanish) Remote

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

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

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

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

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

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

The ideal teammate would be…

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

The ideal candidate would be able to:

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

Would you describe yourself as someone who has:

• Fluency in English and Spanish, in writing, reading and speaking (required)
• Graduated from an accredited nursing program (required)
• Current RN License in good standing in the states of NY and/or Compact License (required)
• A Registered Nurse license with at least 2 years of emergency department, urgent care, triage and/or inpatient/acute experience (required)
• A Registered Nurse with experience providing care to adult and geriatric patient populations (required)
• The availability for days, evenings, rotational weekends and holiday shifts (required)
• Confidence with clinical skills in performance of telephonic triage (required)
• The ability to work remotely and has a private area with a computer in their home/workspace (required)
• A genuine, compassionate desire to serve others and help those in need
• High speed home WiFi/data connection to support company provided IT equipment

In addition to amazing teammates, we also offer:

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

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

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

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

Fertility Billing Analyst

at Carrot Fertility

Remote

About Carrot:

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

The Role:

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

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

Minimum Qualifications:

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

Compensation:

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

Why Carrot?

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

Utilization Review Nurse- PRN- Weekends

locations

Remote – Other

time type

Part time

job requisition id

R011197

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

Responsibilities

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

Qualifications

Required

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

Preferred

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

Expectations

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

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

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

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

Psychiatric Nurse Practioner

Location: Remote – United States

About the Psych Nurse Practitioner at Headspace Health:

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

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

About the Role

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

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

Direct Care

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

What you’ve accomplished:

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

Preferred but not required:

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

About the Company:

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

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

How to get started:

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

How we feel about Diversity & Inclusion:

Headspace Health is committed to bringing together humans from different backgrounds and perspectives, providing employees with a safe and welcoming work environment free of discrimination and harassment. We strive to create a erse & inclusive environment where everyone can thrive, feel a sense of belonging, and do impactful work together.

As an equal opportunity employer, we prohibit any unlawful discrimination against a job applicant on the basis of their race, color, religion, gender, gender identity, gender expression, sexual orientation, national origin, family or parental status, disability*, age, veteran status, or any other status protected by the laws or regulations in the locations where we operate. We respect the laws enforced by the EEOC and are dedicated to going above and beyond in fostering ersity across our workplace.

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

Headspace Health participates in the E-Verify Program.

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

Title: Billing, Coding Specialist

Location: United States

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

Company Description

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

Job Description

Title/Position: CODER/BILLER+ Specialist

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

Overview of the Role:

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

Primary Job Duties:

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

Qualifications

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