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Coding/Reimbursement Specialist

• Job ID: 333549306
• Status: Full-Time
• Regular/Temporary: Regular
• Hours:
• Shift: Day Job
• Facility: Corporate Revenue Cycle
• Department: Rev Cyc Coding
• Location: Work From Home
• Union Position: No
• Salary Range: $20 to $33.22 / hour

Description

UPMC Corporate Revenue Cycle is hiring a Coding Reimbursement Specialist to join our team! This role will work Monday through Friday during daylight business hours. The position will work fully remote!

The position ensures that accurate claim submission and reimbursement has been met for all account types by identifying ICD-9, CPT and modifier usage thorough review of the medical record, which includes understanding anatomy, physiology, medical terminology, and disease processes, as well as payer reimbursement guidelines.

Do you have prior experience in Emergency Department coding? If so, this could be the next step in your coding career.

Responsibilities:

• Monitor and resolve coding edits and denials in a timely manner to ensure optimal reimbursement while adhering to major payer regulations prohibiting unbundling, and resolve issues related to unlisted procedures or procedures with -22 modifier to ensure additional reimbursement.
• Partner with providers and coders to investigate payers’ coding and reimbursement policies for new and/or existing services.
• Adhere to internal and system-wide competencies/behaviors, policies and procedures to ensure efficient work processes. Actively participate in periodic coding meetings and shares ideas and suggestions for operational improvements.
• Contact payer representatives to discuss policy exceptions and make appeals to optimize reimbursement. Incorporate any necessary charges into the department’s daily process flow.
• Demonstrate proficiency in utilizing computer to access various software applications and resources essential to completing coding, edit, and denial processes efficiently, such as Epic (Resolute), payer reimbursement websites, and electronic medical record repositories.
• Ensure adherence to all applicable SOX coding/reimbursement controls, including, but not limited to Decentral Edit/Denial Processes and Review of Controllable Losses.
• Review applicable payer coding policy, submit appeals according to guidelines and update bulletins and communicate changes to coding staff and providers. Incorporate any necessary changes into the department’s daily process flow.
• Engage management to escalate issues when needed to assist in issue resolution.
• Develop and maintain a thorough knowledge of the department’s overall workflow with a general understanding of all functions and the importance of completing each task in a timely manner.
• Make forward progress within the training period toward meeting coding accuracy standards of the departments within the first year of employment. Meet appropriate coding productivity standards within the time frame established by the management staff.
• Provide education to staff and physicians to prevent similar edits or conflicting or ambiguous documentation in the future.
• Perform reimbursement training for new coders.

Qualifications

• High school graduate or equivalent.
• Graduate of a CPC or a certified coding program preferred.
• A minimum of two years experience with E/M and surgical CPT/ICD9 coding and five years payer reimbursement experience related to E/M and surgical coding in a hospital or provider office base setting or combined seven years experience.
• Must have experience with modifiers and their effect on payer reimbursement.
• Must be able to problem solve effectively and be knowledgeable in medical terminology, human anatomy/physiology, pharmacology, pathology, principles of ICD-9-CM and CPT Classification Systems.
• Must have experience with researching payer regulations and policies related to reimbursement. Proficient computer skills required, including payer websites and excel.

Licensure, Certifications, and Clearances:

• CPC or eligible preferred. CCS acceptable.

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

Clinical Nurse Supervisor

locations: US-Remote

time type: Full time

job requisition id: JR4762

RESPONSIBILITIES

• The Clinical Nurse Supervisor will be responsible for directing, organizing and supervising the work of their assigned group of Patient Care Managers, including registered nurses (RNs), licensed practical nurses (LPNs).
• Will manage a smaller population of patients and also coordinate nursing efforts to ensure that effective patient care is being provided and that quality standards are met.
• Responsible for evaluating the performance of the Care Managers, providing feedback and mentoring, developing education programs, contributing to staff professional development, interviewing and hiring nurses.
• Responsible for orienting and training new employees.
• Will recognize trends and work with Management to create solutions.
• Are responsible for approving time and vacation as well as yearly reviews.
• The Nurse Supervisor will also support the mission of the Company and the Care Management department.

QUALIFICATIONS

• Education: Minimum of an Associate’s Degree in Nursing required
• Previous Experience: Eight (8) years of experience in the healthcare field or clinic setting with knowledge of oncology required.
• Management experience preferred.
• Office experience: procedure entry with experience in insurance and medical terminology preferred.
• Core Capabilities: Attention to detail,
• excellent math skills,
• excellent deduction skills,
• the ability to work independently,
• good communication skills,
• data entry,
• knowledge of Excel
• Certifications/Licenses: Active RN license in state of employment is required.
• An OCN certification is preferred
• A valid Florida Driver’s License is required

Inpatient Facility Coder (Full Time) K

Job ID: 2022-2733

# of Openings: 1

Job Locations: US-Virtual/Remote

Category: Medical Coding

Minimum Hours: 40

Overview

Inpatient Facility Coding Specialist – Full Time

GeBBS Healthcare Solutions, an industry leader in Health Information Management (HIM) and Revenue Cycle Management (RCM) solutions, is seeking highly motivated iniduals with a passion for excellence & collaboration, for careers in the healthcare industry.

We have an immediate need for a full-time Inpatient Facility Coder. This is a remote W-2 position with flexible work schedules.

Eligible for a $5000 sign on bonus!

Responsibilities

This position will be responsible for medical coding for one of facility clients. Coder will be responsible for reviewing charts, coding appropriate charges and ensuring high quality standards are achieved.

Qualifications

• RHIA, RHIT, CCS certification through AHIMA required
• Minimum 3 years inpatient coding experience in facility setting
• The Inpatient Coder is responsible for assigning diagnostic and procedural codes to patient charts using ICD-10-CM, ICD-10-PCS or any other designated coding classification system in accordance with coding rules and regulations. The coder will abstract required clinical information. This position requires a thorough knowledge of medical terminology, disease processes, pharmacology, Medicare’s Inpatient Prospective Payment System (IPPS), Official Coding Guidelines for ICD-10-CM and ICD-10-PCS codes, and documentation requirements for correct and accurate coding.
• Maintain standard industry productivity rates for Inpatient coding (3 charts/hour)
• Demonstrated ability to maintain high quality standards of 95% or greater
• Proficient in utilizing technology (computer, VPN, MS Office, coding software) to perform responsibilities
• Strong verbal and written communication skills
• Must have ICD-10 coding experience and have completed an ICD-10 course
• Experience with trauma and highly complex cases, orthopedic, and cardiology preferred
• Hours must to be worked between 6a-6:30p Pacific time Mon-Fri only. Hours can flex between those times daily to reach 40 hrs/week.

Aviacode provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identification, disability, or genetics. In addition to federal law requirements, Aviacode complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Aviacode expressly prohibits any form of workplace harassment based on protected classes. Improper interference with the ability of Aviacode’s employees to perform their job duties may result in discipline up to and including discharge.

Specialist I, Patient Educ Job

Location: Valencia, CA, US, 91355

Additional Location(s): US-CA-Valencia

Diversity – Innovation – Caring – Global Collaboration – Winning Spirit – High Performance

At Boston Scientific, we’ll give you the opportunity to harness all that’s within you by working in teams of erse and high-performing employees, tackling some of the most important health industry challenges. With access to the latest tools, information and training, we’ll help you in advancing your skills and career. Here, you’ll be supported in progressing whatever your ambitions.

This position has the flexibility to sit remote in the U.S.

About the role:

Patient Education Specialist acts as a direct contact for Territory Manager (TM) and TM team, along with physician’s offices and hospitals to educate prospective patients. You will be responsible for maintaining pipeline of candidates, contacting, educating, and progressing patients along their journey to potentially receiving a trial with the local physician, TM and team. You will be accountable for complying with all Regulatory requirements with respect to complaint handling and maintaining the accuracy of the data within BSC business systems. This is a great opportunity to provide patient care in an office-based setting.

Your responsibilities will include:

• Enter in all candidate information received from web site, post cards, local events and physician offices/hospitals into CRM tracking system.
• Contact all patient candidates within acceptable timeframe as determined by management.
• Educate candidates on spinal cord stimulation, pain management, insurance, psychological evaluations, and other requirements needed to get to a trial.
• Responsible for knowing all potential objections to SCS-therapy and respond per training.
• Provide summary reports to TM and local offices on a weekly basis.
• Draft written communication for letters and e-mails to candidates, TM and physician offices as needed.
• Support local TM and physicians with any education events and candidate follow-up as needed.
• Position will require periodic travel to meet with local sales reps, physicians, and customer staff.
• Perform other related duties as assigned, including special projects.

What we’re looking for in you:

Basic Qualifications

• Bachelor’s Degree in Engineering, IT, Health Science, Business, Nursing, Computer Science, Communications, Psychology, History.
• Knowledge of computer skills Microsoft Office.
• Excellent written and oral communication skills and organizational skills.

Preferred Qualifications:

• At least 1-year experience in a fast-paced customer service environment.
• Experience in medical device industry
• Biology, medical terminology, medical products or manufacturing

Requisition ID: 532762

As a leader in medical science for more than 40 years, we are committed to solving the challenges that matter most united by a deep caring for human life. Our mission to advance science for life is about transforming lives through innovative medical solutions that improve patient lives, create value for our customers, and support our employees and the communities in which we operate. Now more than ever, we have a responsibility to apply those values to everything we do as a global business and as a global corporate citizen.

So, choosing a career with Boston Scientific (NYSE: BSX) isn’t just business, it’s personal. And if you’re a natural problem-solver with the imagination, determination, and spirit to make a meaningful difference to people worldwide, we encourage you to apply and look forward to connecting with you!

At Boston Scientific, we recognize that nurturing a erse and inclusive workplace helps us be more innovative and it is important in our work of advancing science for life and improving patient health. That is why we stand for inclusion, equality, and opportunity for all. By embracing the richness of our unique backgrounds and perspectives, we create a better, more rewarding place for our employees to work and reflect the patients, customers, and communities we serve. Boston Scientific is proud to be an equal opportunity and affirmative action employer.

Boston Scientific maintains a drug-free workplace. Pursuant to Va. Code 2.2-4312 (2000), Boston Scientific is providing notification that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the workplace and that violations will result in disciplinary action up to and including termination.

Please be advised that certain US based positions, including without limitation field sales and service positions that call on hospitals and/or health care centers, require acceptable proof of COVID-19 vaccination status. Candidates will be notified during the interview and selection process if the role(s) for which they have applied require proof of vaccination as a condition of employment. Boston Scientific continues to evaluate its policies and protocols regarding the COVID-19 vaccine and will comply with all applicable state and federal law and healthcare credentialing requirements. As employees of the Company, you will be expected to meet the ongoing requirements for your roles, including any new requirements, should the Company’s policies or protocols change with regard to COVID-19 vaccination.

School Social Worker

Join our team of highly-qualified speech-language therapists, physical therapists, occupational therapists, school counselors, school social workers, and school psychologists. You’ll enrich kids’ lives every day while enhancing your own!

Positions available in over 30 states. Opportunities with assistance in pursuing additional licensure available.

Position Overview:

Therapists are responsible for providing IEP-based Mental Health services to K-12 students in a virtual manner.

Job responsibilities for School Social Workers:

• Provide direct mental health counseling services in accordance with the mandated IEP
• Conduct comprehensive evaluations for initial eligibility or re-evaluations
• Complete daily SOAP notes
• Complete monthly or quarterly progress reports
• Attend IEP meetings and submit IEP paperwork as needed

Required Qualifications:

• Professional Social Work License
• School Social Worker Certification
• Minimum of 10 hours daytime availability
• Minimum of 1 year IEP experience (post-master’s) working in a school-based setting Job

Benefits:

• Work from home – there is zero commute time!
• Be your own boss and manage your own caseload
• Therapist has the ability to choose the number of hours according to his/her preference
• Competitive pay
• Excellent training from highly qualified lead clinicians
• Outstanding ongoing technical and clinical support from GT Support Team
• Online assessments and evaluation resources are available in our library free of charge
• Gain access to a complete online resource library of fun and engaging activities for you and your students to enjoy
• An online team of like-minded friends, mentoring lead therapists, and dedicated school relationship managers help make your job easier

Required Skills:

• Self-motivated and eager to create a positive difference in the lives of students
• Strong communication skills and dedicated to working collaboratively with an interdisciplinary team and support staff
• Excellent organization, problem-solving, and time management skills
• Sufficient technological skills including the ability to learn new softwares and programs, complete digital paperwork requirements, communicate effectively via email, and has a willingness to learn new skills/complete basic troubleshooting

Supervisor Hospital Coding Outpatient

locations: Remote

time type: Full time

job requisition id: R21808

Department: 10460 WI Revenue Cycle – Hospital Coding Administration

Status: Full time

Benefits Eligible: Yes

Hours Per Week: 40

Oversees day to day operational workflow and processes for hospital and home health coding. This position oversees a team of coders including managing work queues, prioritizing accounts to be coded, implementing strategies and making real-time adjustments based on account acuity and volume. Handles human resources responsibilities for staff including coaching and evaluations. This positions also manages software applications and hardware requirements for the coding staff. Serves as an expert resource for hospital related health information outpatient coding and Ambulatory Patient Categories. Identifies opportunities to improve coding and data abstracting accuracy and practices. Establishes work assignments and training of coding staff. Acts as a liaison between coding and other entities of the organization such as the quality team, patient accounts and Information Services.

Major Responsibilities:

• Monitors daily work queues to ensure timely coding of outpatient accounts across multiple hospital sites. Plans and implement strategies to achieve or exceeds the expected target DNFC goals. Makes real time adjustments to work assignment based on account acuity and volume.
• Tracks and provides feedback to the coding team regarding coder productivity. Manages PTO requests, work schedules, performance evaluations, and timecards for the coding team. Recommends to Coding Manager when additional working hours are needed (cross state coverage, overtime, contracted coding etc).
• Serves as liaison between area of responsibility and other groups within Advocate Aurora Healthcare such as patient access, quality and denials management. Works with Health Information Technology to implement and test computer updates. Ensures timely, compliant and efficient processes exist to process records through the outpatient coding and abstracting function. Assists in ensuring coding compliance with federal, state and/or other regulatory agencies, research cases, government payers and other selected third party payers.
• Manages the software applications and hardware requirements. Provides first line assistance for system users and coordinates communications internally. Reports any software issues to appropriate IT personnel for resolution. Tracks issues to resolution, providing support for hardware and software problem resolution.
• Identifies any technology learning needs for the coding team which includes verification of coder competency for all software applications utilized including 3M360, Epic, Allegra, Cardone, Care Connection, and Advocate Works.
• Performs human resources responsibilities for staff which includes coaching on performance, completes performance reviews and overall staff morale. Recommends hiring, compensation changes, promotions, corrective action decisions, and terminations.
• Responsible for understanding and adhering to the organization’s Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization’s business.

Licensure, Registration, and/or Certification Required:

• 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

Education Required:

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

Experience Required:

• Typically requires 3 years of experience in integrated acute care hospital coding.

Knowledge, Skills & Abilities Required:

• Demonstrated leadership skills and abilities including organization, prioritization, project management, delegation, team building, customer service, and conflict resolution.
• 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 and CPT coding systems, G-codes, HCPCS codes, Current Procedural Terminology (CPT) modifiers and Ambulatory Patient Categories (APC).
• 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.
• Intermediate computer skills including experience with Microsoft Office or similar applications.
• 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.

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

Title: Inpatient Medical Coding Auditor

Location: United States – Remote

time type: Full time

It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving power that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate inidual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans. Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign’s Corporate Equality Index; was named on the Best Companies for Women to Advance List 2020 by Parity; and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

The Inpatient Medical Coding Auditor is responsible for verifying the accuracy of DRG (inpatient) claims reimbursement, coding, and billing in accordance with the Plans’ provider agreements and the National Healthcare Billing Audit guidelines. The Auditor will collaborate with a variety of business units including Market Operations, Claims, Health and Medical Management (including Medical Directors), Network Management and our external Provider community. The successful candidate must be capable of building and maintaining strong working relationships with key internal and external constituents and working effectively in a matrixed environment.

Responsibilities

• Conduct Diagnosis Related Grouper Validation (DRG) audits to verify the accuracy of claims reimbursement by applying National Healthcare Billing Audit standards, ICD-10 -CM/PCS guidelines and related American Hospital Association Coding Clinic guidelines, and the Plans’ agreements including published policies.
• Select claims samples for medical record reviews in accordance with pre-selection criteria, billing trends, and supporting documentation.
• Monitor existing/emerging trends and keep relevant stakeholders informed of risk areas and concerns that may require additional attention or result in additional savings.
• Participates in and/or leads inter-departmental process improvement initiatives. Acting as a subject matter expert with internal and external stakeholders in reference to coding, billing practices, and accuracy of assigned ICD-10 codes and DRGs.
• Identifies compliance risks and financial opportunities based on chart reviews. Performs concurrent review of hospital bills to document unbilled, under billed, and overbilled items/services
• Educate stakeholders on post audit findings and close audits in timely manner using audit program databases that incorporate 3M software.
• Identify potential quality of care issues and service or treatment delays. Make referrals for follow-up as necessary.
• Identify possible fraud and abuse, document billing errors, and benefit cost management and savings opportunities.
• Actively participate in internal/external meetings, training activities and other cost and trend initiatives.
• Identify and pursue new opportunities for cost avoidance savings that contribute to the company’s annual financial and service targets.
• Meet deadlines and commitments by tightly managing deliverables, coordinating matrixed inputs, and ensuring all tasks are performed to bring projects to timely closure.
• Represent department on cross functional workgroups and projects as needed.
• Conduct audits remotely using the EVH Payment Integrity platform and electronic medical record documentation.

The Experience You’ll Need (Required):

• Active Certified coder (CIC or CCS) required. Candidate would need to maintain active certification.
• In-depth knowledge of and ability to interpret ICD-10-CM/PCS, HCPCS/CPT, APR-DRG, MS-DRG codes and DRG grouping systems and Plan benefit designs.
• Ability to travel for onsite audits as needed.
• 1-2 years’ experience reviewing and auditing medical records, working in a health plan or health insurance, or similar environment.
• Strong quantitative, analytical, interpersonal, organizational, project management, problem-solving and communication skills.
• Ability to navigate and manage through difficult, complex conversations with positive outcomes.
• Strong computer skills: – proficient in MS Word, Excel, PowerPoint and Outlook, familiarity with Electronic Medical Record systems.
• Ability to work as part of a team with a positive attitude while also able to work independently.

Finishing Touches (Preferred):

• Clinical Documentation Improvement (CDI/CDEO) certification
• Hands-on work with complex medical and billing information preferred

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Compliance Nursing Supervisor

locations

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

time type: Full time

job requisition id: R-278568

Description

The Supervisor, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Supervisor, Compliance Nursing works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of variable factors to solve basic problems; collaborates with management and top professionals/specialists in selection of methods, techniques, and analytical approach.

Responsibilities

The Supervisor, Compliance Nursing ensures mandatory reporting completed. Conducts and summarizes compliance audits. Collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and iniduals. Decisions are typically are related to schedule, plans and daily operations. Performs escalated or more complex work of a similar nature, and supervises a group of typically support and technical associates; coordinates and provides day-to-day oversight to associates. Ensures consistency in execution across team. Holds team members accountable for following established policies.

Required Qualifications

• Current Unrestricted RN licensed in the state in which you reside with no disciplinary action.
• Two or more years of prior experience in auditing, compliance oversight, and/or utilization management for an insurance health plan.
• Two or more years of direct leadership experience (as defined by having direct reports) to include hiring, training, coaching and up to termination.
• Knowledge of regulations governing the Medicare line of business.
• Proficient in Microsoft Office applications including Word, Excel, Outlook and PowerPoint.
• Strong problem solving, data-analysis, and critical-thinking skills with the ability to operate and drive progress with limited information and ambiguity.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
• Work hours for this position are 8AM- 5 PM Monday- Friday Eastern Time, with occasional overtime to support business needs.
• Training: Virtual training, approximately 3 months
• This is a Remote position; you will be expected to work in Eastern Time zone regardless of what time zone you reside in.
• You will be expected to report to the Market office with advanced notice for meetings and/or planned work functions.

Preferred Qualifications

• Bachelor’s Degree
• Certification(s) relevant to area of expertise, such as certification in healthcare compliance (CHC).
• Prior Medicare health plan experience.
• Experience with writing and/or auditing member denial letters.
• Experience working with and interpreting CMS regulations and criteria.

Additional Information

• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

• 40

Hospitalist Coder Remote

• Banner Health Corp Mesa (525 W Brown Rd)
• Remote Anaheim CA
• Remote Ava MO
• Remote Flushing MI
• Remote Tampa Bay FL
• Remote Burns TN
• Remote Lincoln NE
• Remote Casper WY
• Remote Ocean Springs MS
• Remote Cannon Falls MN
• Remote Phoenix AZ
• Remote Denver CO
• Remote West Islip, NY
• Remote Seattle WA
• Remote Glen Allen VA
• Remote Dallas TX
• Remote San Francisco CA
• Remote Bellevue NE
• Remote Woodbridge VA
• Remote Jacksonville, AR
• Remote Sparks NV
• Remote Avon Lake OH
• Remote Boise ID
• Remote Bismarck ND
• Remote Blauvelt NY
• Remote Norfolk VA
• Remote Centerton AR
• Remote Marion KY
• Remote San Diego CA
• Remote Salt Lake City UT
• Remote Fort Collins CO
• Remote San Antonio TX
• Remote Portland OR
• Remote Cedar Springs MI
• Full time
• R73364

Primary City/State:

Mesa, Arizona

Department Name:

Coding Ambulatory

Work Shift:

Day

Job Category:

Revenue Cycle

Primary Location Salary Range:

$18.32/hr – $27.48/hr, based on education & experience

In accordance with Colorado’s EPEWA Equal Pay Transparency Rules.

Health care is full of possibilities. Medical Coders play a pivotal role in ensuring patients receive the best at Banner Health. If you’re looking to leverage your abilities – you belong at Banner Health.

Are you a superstar Hospitalist Coder with the ability to support charge capture of Hospitalist and Intensivist service lines, consider joining our team! Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. We code for Hospitalists and Intensivists both in teaching settings and standard hospital settings. We have over 200 providers, which also includes split/shared visits. Currently we have a team of 7, with more than 20 years of coding experience. Hospitalist and Intensivist coding and charges are worked as a team with shared responsibility, productivity reviewed on a weekly basis.

As a Hospitalist Coder you will have the remarkable opportunity to work remotely and still be part of an engaged team who works hard every day to make healthcare easier, so life can be better. You will use your attention to detail, as well as your Coding Certification skills to accurately translate physician’s notes to ensure patients are billed correctly. Shift will start 8:00am-5:00pm then will be flexible following training.

Our remote coders are required to live in one of the following states: Arizona, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Kentucky, Michigan, Mississippi, Minnesota, Missouri, Nebraska, Nevada, New York, North Dakota, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, and Wyoming!

Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you’ll find many options for contributing to our award-winning patient care.

POSITION SUMMARY

This position evaluates medical records, provides clinical abstracts and assigns appropriate clinical diagnosis and procedure codes in accordance with nationally recognized coding guidelines.

CORE FUNCTIONS

1. Analyzes medical information from medical records. Accurately codes diagnostic and procedural information in accordance with national coding guidelines and appropriate reimbursement requirements. Consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes. Provides thorough, timely and accurate assignments of ICD and/or CPT4 codes, MS-DRGs, APCs, POAs and reconciliation of charges.

2. Abstracts clinical diagnoses, procedure codes and documents other pertinent information obtained from the medical record into the electronic medical records. Seeks out missing information and creates complete records, including items such as disease and procedure codes, point of origin code, discharge disposition, date of surgery, attending physician, consulting physicians, surgeons and anesthesiologists, and appropriate signatures/authorizations. Refers inconsistent patient treatment information/documentation to coding quality analysis, supervisor or inidual department for clarification/additional information for accurate code assignment

3. Provides quality assurance for medical records. For all assigned records and/or areas assures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards.

4. As assigned, compiles daily and monthly reports; tabulates data from medical records for research or analysis purposes.

5. Works independently under regular supervision. Uses specialized knowledge for accurate assignment of ICD/CPT and MS-DRG codes according to national guidelines. May seek guidance for correct interpretation of coding guidelines and LCDs (Local Coverage Determinations).

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

MINIMUM QUALIFICATIONS

• High school diploma/GED or equivalent working knowledge and specialized formal training equivalent to the two year certification course in medical record keeping principles and practices, anatomy, physiology, pathology, medical terminology, standard nomenclature, and classification of diagnoses and operations, or an Associate’s degree in a related health care field.
• Must demonstrate a level of knowledge and understanding of ICD and CPT coding principles as recommended by the American Health Information Management Association coding competencies, and as normally demonstrated by certification by the American Academy of Professional Coders. Six months providing coding services within a broad range of health care facilities. Must be able to achieve an acceptable accuracy rate on the coding test administered by the hiring facility according to pre-established company standards.
• Must be able to work effectively with common office software, coding software, and abstracting systems.

PREFERRED QUALIFICATIONS

Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC) in an active status or or Certified Coding Specialist-Physician (CCS-P) with American Health Information Management Association or American Academy of Professional Coders is preferred. Will consider experience in lieu of certification/degree. Additional related education and/or experience preferred.

Additional related education and/or experience preferred.

Clinical Research Coordinator

at Vault

Remote

About Us:

At Vault, we believe quality healthcare is a human right. Our mission is to make better health outcomes more accessible and affordable for everyone. Our platform makes this possible by bringing remote diagnostics and specialty care to patients in their homes, on their home screens, and within their hometown communities wherever they choose. We are reimagining the 21st century healthcare experience for patients, practitioners and providersmaking the promise of better health more attainable through our end-to-end healthcare platform.

The Opportunity:

Vault Health is seeking an experienced Clinical Research Coordinator (CRC) who will oversee the day to day operations of clinical studies. The CRC will develop, implement, and coordinate research and administrative procedures for the successful management of clinical studies.

Responsibilities:

• Responsible for coordination of a designated study or group of studies.
• In research projects, oversees the recruitment of subjects, implementation of study procedures, and the collection and processing of data.
• Adhere to Research SOPs, Good Clinical Practice and study protocols.
• Ensure scientific integrity of data and protect the rights, safety and wellbeing of patients enrolled in clinical studies.
• If applicable, participate in the virtual informed consent process.
• If applicable, schedule patient visits and procedures consistent with protocol requirements.
• Keeps accurate and up-to-date records.
• Ensure all serious and non-serious adverse events are documented and reported.
• Work with the regulatory team to ensure all regulatory documents are filed and maintained.
• Ensures availability of supplies and/or equipment for studies
• Liaisons with agencies and pharmaceutical companies, laboratories, and equipment and supply companies, as needed.
• Other duties as assigned

Qualifications:

• Bachelor’s degree, preferably in science, public health, health education or a related field.
• Ambitious iniduals with strong organizational and analytical skills will be considered. 1-3 years experience in research or related experience is preferred but not required.
• Qualified candidates must be able to effectively communicate with all levels of the organization.

Work Environment:

Vault is a high growth, fast paced organization. The ability to be productive and successful in an intense work environment is critical. Willingness and ability to travel domestically (and potentially internationally) is required, it is anticipated that this will be less than 15 % of work time.

Who You Are:

• Dynamic, gregarious inidual with a constant focus on the patient experience
• Background in the life sciences / healthcare / clinical trials space with an understanding of the space
• High comfort level with ambiguity; adapting to change, learning, and growth
• Proactive, forward-looking, flexible and creative team player who enjoys collaborating and getting things done without an ego
• Open to receiving and giving feedback
• Highly effective written and verbal communication skills
• Organized, with a strong ability to multitask and shift priorities when needed
• Entrepreneurial approach to responsibilities

Vault Health is an equal opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, age, disability, or veteran status.

Licensed Practical Nurse Patient Care Manager

locations: US-Remote

time type: Full time

Responsibilities

• LPN Patient Care Manager will support of Florida Cancer Specialists (FCS) values by providing care management services to clients and families to help in the coordination of care and the management of a patient’s inidual health needs through and beyond the course of treatment.
• The LPN Patient Care Manager works under the supervision of the RN Patient Care Managers.
• LPN Patient Care Manager will assist the RN Patient Care Managers with the management of patient caseloads by providing prompt response to telephone inquiries and other issues of a clinical nature as requested.
• Will work as an integral team player providing support to the RN Patient Care Managers as needed and is expected to adhere to and abide by the rules and regulations set forth by the Florida State Board of Nursing.
• Prescription refill experience desired.

Qualifications

• A Valid Florida LPN license.
• One (1) year of clinical oncology experience preferred.
• One (1) year of experience in Care Management preferred.
• Strong organizational and interpersonal skills.
• Must possess the ability to utilize a clinical reasoning process for planning, implementing and evaluating the patient’s plan of care while ensuring that coordination of services are done in a timely manner.
• Demonstrates sound knowledge and actions in the care and decision making for the oncology patient population and seeks guidance appropriately.
• Strong/Proficient computer skills, Microsoft Office (word, excel, outlook) required.

Coding Consultant Outpatient

Requisition ID

2022-25499

# of Openings

1

Category (Portal Searching)

HIM / Coding

Overview

Our people, process and technology give healthcare organizations an HIM edge. If you share our commitment to providing service that is second-to-none, we invite you to join our team of industry leading HIM specialists, healthcare veterans and thought-leaders nationwide. If you are passionate about

what you do, then you belong with the leading provider of full suite HIM solutions.

CIOX Health Coding/HIM Consulting/EMR Abstraction Division is looking for HIM professionals to join our rapidly growing team! We are currently hiring Remote Outpatient coders for full-time employment opportunities.

Responsibilities

• Reviews medical records and assigns accurate codes for diagnoses and procedures
• Assigns and sequences codes accurately based on medical record documentation
• Assigns the appropriate discharge disposition
• Abstracts and enters the coded data for hospital statistical and reporting requirements
• Communicates documentation improvement opportunities and coding issues to appropriate personnel for follow up and resolution
• Maintains 95% coding accuracy rate and 95% accuracy rate for APC assignment and maintains site designated productivity standards
• Responsible for tracking continuing education credits to maintain professional credentials
• Attend CIOX Health sponsored education meetings/in-services
• Demonstrate initiative and judgment in performance of job responsibilities
• Communicate with co-workers, management, and hospital staff regarding clinical and reimbursement issues
• Function in a professional, efficient and positive manner
• Adhere to the American Health Information Management Association’s code of ethics.
• Must be customer-service focused and exhibit professionalism, flexibility, dependability and desire to learn
• High complexity of work function and decision making
• Strong organizational and teamwork skills
• Willing and able to travel when necessary if applicable
• Must have excellent communications skills- email and verbal
• Reports to work as scheduled
• Complies with all HIM Division Policies
• Expected to frequently use the following equipment: Desktop PC or thin client, phone (with voice mail), fax machine, and other general office equipment.

Qualifications

• Associate or Bachelor’ degree from AHIMA certified HIM Program or Nursing Program or completion of certificate program with CCS, CPC or CCSP.
• Must be able to communicate effectively in the English language.
• One to five years of coding experience in a hospital and/or coding consulting role.
• Experience in computerized encoding and abstracting software
• Passing annual Introductory HIPAA examination and other assigned testing to be given annually in accordance with employee review

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.