location: remoteus
Pathology Support Coordinator
Remote
PRIMARY RESPONSIBILITIES:
- Review select cases for accuracy of tissue request and escalate to PAs when needed, complete accurate data entry.
- Assist other PSCs in resolving issues with their cases and provide feedback on the quality of their work.
- Ensure that necessary notes and holds are placed on cases for non-conforming samples, discrepancies and/or missing information so that timely follow-up by the Customer Care team is made.
- Compose professional emails/faxes using proper grammar and spelling to communicate with other departments for case escalation and/or case status updates.
- Perform outbound calls to pathology labs for specimen information (confirmation of accession numbers, specimen locations, pathology fax numbers, address confirmation, etc
- Attend interdepartmental meetings if needed and provide feedback on the current process or workflow.
- Monitor errors and metrics for all tissue cases
- This role works with PHI on a regular basis both in paper and electronic form and have an access to various technologies to access PHI (paper and electronic) in order to perform the job
- Employee must complete training relating to HIPAA/PHI privacy, General Policies and Procedure Compliance training and security training as soon as possible but not later than the first 30 days of hire.
- Must maintain a current status on Natera training requirements.
- Performs other duties as assigned.
QUALIFICATIONS:
- High School Diploma (or equivalent) required.
- 2+ years of medical industry related experience.
- Previous computer experience is required.
- Previous data entry experience is required.
KNOWLEDGE, SKILLS, AND ABILITIES:
- Trained on all product types and able to accession with high accuracy and efficiency consistently.
- Ability to handle most escalations, discrepancies, and holds.
- Firm understanding and knowledgeable in all aspects of the
- Accessioning process and SOPs
- Typing speed of at least 45wpm with high accuracy
- Excellent oral and written communication skills required
- Excellent critical thinking skills and the ability to use good judgment
- Ability to perform required duties with a high degree of accuracy and attention to detail
- Positive attitude and ability to work well with others
#LI-REMOTE
The pay range is listed and actual compensation packages are based on a wide array of factors unique to each candidate, including but not limited to skill set, years & depth of experience, certifications and specific office location. This may differ in other locations due to cost of labor considerations.
Remote USA
$19.04$23.80 USD
Title: NP Clinical Documentation Specialist (Remote)
Location: Remote
Job Description:
Nice to meet you, were Vesta Healthcare.
Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these iniduals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center.
Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others’ needs ahead of her own, keeping the hearth warm so the home and family can function.
We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. Its an insurance covered benefit, so its available to most adults with Caregivers free of charge to them.
We seek team members who are passionate about making home the best place it can be for people with home care needs and see the important role Caregivers play. Our team members are collaborative data-driven optimists who always focus on doing whats best for patients and their caregivers. We see ourselves as being here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids).
The ideal teammate would be
A detail-oriented, clinically trained Nurse Practitioner who can provide expertise, education and guidance on clinical practice and documentation to improve our clinical outcomes as well as increase capture of pertinent diagnosis codes and quality measures. A role model and facilitator for the clinical team and a support the leadership team with execution on the departments vision for quality and appropriate code capture. An inidual that is self-directed and possesses advanced analytical skills, critical thinking, creativity, and the ability to anticipate and identify opportunities and potential problems. Someone who is an educator and enjoys supporting fellow Nurse Practitioners to improve their documentation. This is a salaried 40 hours per week position, Monday through Friday 9:00am to 6:00pm EST.
The ideal teammate would be able to:
- Develop, design, revise and execute our comprehensive clinical documentation accuracy and HCC documentation program
- Collaborate extensively with Nurse Practitioners, collaborating physicians, nursing staff, other care team members, and coding staff to improve the quality and completeness of documentation/auditing of care provided and coded for coordination, abstraction, and submission of accurate data required for billing and improved clinical outcomes
- Facilitate modifications to clinical documentation to ensure appropriate reimbursement based on clinical severity and services rendered to patients
- Support timely, accurate, and complete documentation of clinical information used for measuring and reporting clinician and team outcomes/productivity
- Continuously monitor metrics with an eye to increase/improve quality, satisfaction, and savings
- Communicate with and educate all clinical staff concerning accurate and effective clinical documentation
- Complete accurate and timely review to ensure the integrity of the documentation compliance resulting in accurate diagnosis and procedure classification used for reimbursement and quality metrics
- Recognize opportunities for documentation improvement and sound judgment in decision making keeping reimbursement considerations in balance with regulatory compliance
- Strategically educate clinicians and staff regarding the need for accurate and complete documentation in the health record that includes regulations and compliance guidelines
- Solve complex problems and takes a new perspective on existing solutions; exercises judgment based on the analysis of multiple sources of information
- Meet patient and patient family needs; take responsibility for a patient’s safety, satisfaction, and clinical outcomes; use appropriate interpersonal techniques to resolve difficult patient situations and regain patient confidence
Would you describe yourself as someone who has:
- Masters Degree with current active Nurse Practitioner license (required)
- 3+ years of clinical documentation improvement experience, coding experience or equivalent (required)
- Active Certified Risk Adjustment Coder Certification (CRC) (required)
- 5+ years of adult/geriatric care experience (required)
- 1+ year of experience working with advanced practice providers as well as other clinical and non-clinical staff (required)
- Experience with risk adjustment and value based care delivery systems
- Motivated self-starter and creative problem-solver who is comfortable working in a fast-paced, dynamic environment
- Experience with Powerpoint/Excel and/or Google Slides/Sheets
- Experience working in a remote environment
In addition to amazing teammates, we also offer:
- Health, dental, and vision insurance with a choice of many different plans/costs partially subsidized by us
- Paid vacation
- Paid Sick/personal days
- 12 paid holidays
- One time reimbursement to set up your home office
- Monthly reimbursement for internet or other home office expenses
- Monthly gym reimbursement to be used for gyms, online classes, etc
- Basic Life & AD&D, Short-term and Long-term Disability Benefits paid fully by us
- Voluntary benefits such as Pet, Home and Auto, Legal Insurance plus more
- Pre-tax Flex Spending/Dependent Care/Transit accounts
- 401k with 4% match
We look forward to speaking with you!
Pay range is $125,000-$130,000 based on experience. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).
Vesta Healthcare is committed to leveraging the talent of a erse workforce to create great opportunities for our business and our people. Vesta Healthcare is an Equal Opportunity/Affirmative Action Employer. Candidates are selected without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.
At Vesta, we are constantly searching for the most dynamic and best talent to join our team with a mission of empowering caregivers in the home! If you are ever contacted by e-mail from any domain other than https://vestahealthcare.com, please do not respond, as there is a likelihood it could be a scam as it is not a legitimate Vesta email. You might see things from a similar domain address, but with a slight misspelling, for example. We have no responsibility for any communication that does not come from the https://vestahealthcare.com domain, and we strongly advise that you not provide information or respond if not from the legitimate Vesta domain. If you have any concerns that outreach might not be legitimate, please reach out to [email protected] for confirmation.
location: remotework from anywhere
Title: Enterprise Sales Director, Healthcare (Remote)
Location: Remote
Type: Full Time
Workplace: remote
Category: Healthcare
JobDescription:
Description Ushur is transforming the way enterprises communicate and engage with customers. Fueled by consumers self-service demands, enterprises are modernizing customer engagement and experience models. Ushur is fast becoming the platform of choice for Customer Experience Automation, enabling these enterprises to leapfrog their digital native counterparts and deliver delightful customer and employee experiences.With cutting-edge Conversational AI, Machine Learning andIntelligentProcess Automation technologies, Ushur has enabled Fortune 100 enterprises including some of the worlds most well known brands in healthcare, insurance, banking and financial services sectors to automate their customer engagement. Cloud-native, 100% no-code and purely workflow-driven, Ushur empowers citizen developers within business operations teams to build AI-powered, fully-automated and omni-channel experience to digitally transform customer journeys end-to-end.Responsibilities
- Develop a set of strategic account plans assigned to you for your select verticals and region that includes how you will engage leaders responsible for digital transformation, customer experience and operations
- Become a trusted advisor to Clients by understanding their needs and business objectives, demonstrating industry awareness and co-creating high impact business solutions with the Ushur platform
- Focus relentlessly on bringing new Clients into the Ushur family and expand the business inside existing Client accounts
- Collaborate internally with Sales Consultants and Industry Market Leaders to create industry relevant presentations and demonstrations for the target market and function
- Develop proposals, business cases and ROI model for and with Clients
- Partner with Customer Success Teams to ensure Client success with Proofs of Concept and Programs in Production
- Acquire and maintain a working knowledge of the Ushur Platform
Requirements
- 4-5 years proven success selling SaaS-based Enterprise Software Solutions with at least 3+ years of experience selling to Health Plans and other Healthcare Organizations in the Fortune 1000
- A demonstrated track record where you consistently have met or exceeded annual quota
- Subject matter expertise in healthcare with rich experience working with health plans and benefits
- Possess a deep understanding of how technology is leveraged both within health plans and how they interact with their members, brokers and other key stakeholders
- Familiar with how health plans and healthcare companies select technology and solution providers
- Experience at a fast-paced high growth startup environment
- Capable of presenting sophisticated technology solutions at the C-level
- Superb written and oral communications skills
- Ability to own the entire sales cycle from Lead Generation to Contract Close
- Bias to action, high sense of urgency and energy
Title: Physician (Remote)
Location: Remote
Type: Remote / Independent Contractor
Workplace: remote
Category: Clinical
Job Description:
Plume is a passion-fueled, mission-driven, trans-founded company focused on radically increasing access to healthcare for the transgender and gender-nonconforming communities. Our vision is to transform healthcare for every trans life and build a virtual care home for the trans community.
As a rapidly expanding organization, we are now proudly available to more than 1 million transgender iniduals in 45 states. We are an organization formed through the lived experience of trans people and fierce allies and we welcome other heart-forward, talented iniduals to join our team on this journey.
We are currently hiring Independently Contracted Physicians (MD/DOs) to serve our members. We welcome all state licenses but are specifically in need of folks with Texas, California, Arkansas, North Carolina, Florida, Missouri, Tennessee, Kentucky, Michigan, Indiana, Wisconsin, Oklahoma, and Georgia licenses at the moment.
About the role:
As an independently contracted clinician with Plume, you will join our awesome team of erse clinicians who provide GAHT (gender-affirming hormone therapy) and depression/anxiety management for our adult patients throughout the United States. As we expand our clinical services, we are looking specifically for providers with broad, primary care experience.
You will provide longitudinal care for a panel of patients so your time will be spent onboarding new patients and providing follow-up care for them (lab management, prescription management, answering clinical questions).
This is a completely virtual work-from-home role with flex scheduling. You schedule your hours when you want to work. We require a minimum of 10 hours of synchronous time per week. We have a large support team that takes care of patient account logistics so you can focus on clinical care.
We are a healthcare startup, so we are seeking folks excited about changing the paradigm of medical care so patients and clinicians are truly centered. We heavily leverage technology, so being comfortable with computers and electronic medical record systems in a rapidly changing environment is critical to do this work.
Must-Haves:
- At least two active licenses and in good standing with your professional board
- At least one DEA License
- Experience providing primary care services to adult patients
- Experience and comfort in collaborating with erse teams
- Comfortable with 100% remote patient care
- Strong technical background (familiarity with EMRs, email communication, app-based platform use, etc.)
- Strong organization and communication skills
- Availability of 10 hours per week for synchronous visits
Nice-To-Haves:
- At least 5 active licenses – preference for Texas, California, Arkansas, North Carolina, Florida, Missouri, Tennessee, Kentucky, Michigan, Indiana, Wisconsin, Oklahoma, and Georgia.
- Ability to commit at least 20 hours of synchronous time per week
- Experience with telehealth and preferably direct-to-consumer (DTC) telehealth/startup work
- Experience prescribing GAHT
- Experience prescribing behavioral health medications (depression and anxiety)
- Familiarity with and experience using established GAHT guidelines, including an informed consent model of care
- CAQH profile
Compensation & Benefits:
- Working for an amazing company that is changing the world
- MD/DO Providers are paid per appointment at the following rates:
- $37.50 per 15 min visit
- $68 per 30 min visit
- 50% of the regular rate for no-shows or visits canceled within 24 hours.
- Quarterly Bonus Opportunities
- License Reimbursements for Providers who offer 20 hours of synchronous time per week
Plume is an equal-opportunity employer. Trans and gender-nonconforming iniduals are strongly encouraged to apply, particularly those who identify as people of color. We positively encourage applications from suitably qualified and eligible candidates regardless of age, color, disability, national origin, ancestry, race, religion, gender, sexual orientation, gender identity and/or expression, veteran status, genetic information, or any other status protected by applicable law.
Read more about Plume at www.getplume.co
location: remoteus
Title: Registered Dietitian (Remote)
Location: Remote (US)
Type: Part-Time
Workplace: remote
Category: Clinical
JobDescription:
This requisitionis an advertisement for part-time positions that Foodsmart hires for regularly throughout the year. It is a way for Foodsmart to build a database of qualified, interested iniduals for a particular job function so that when there is a need to fill that type of role, the hiring process will be faster. By applying to an Evergreen Requisition, you are expressing your interest for a particular job function within Foodsmart. Please see our other Registered Dietitian postings for specific states in which we are currently hiring. Who Is Foodsmart? At Foodsmart, were knee-deep in changing the food and nutrition landscape and were leveraging technology and our team of bright minds with big hearts to make it happen. We believe that eating well should be within reach for all, not some. That food should be accessible and affordable and the foundation of good health. And that we have a role to play in addressing the nutrition insecurity that plagues too many, and that has a direct impact on our health and susceptibility to illness. We know the Foodsmart approach works, and we know it matters because we have the clinical outcomes published in major journals, serve >20% of the Fortune 500 and 4 out of 5 major health plans, and have the community engagement to back it up. And because were all Foodsmart customers. We are working parents. We are doctors. We are patients. We have busy lives, tight budgets and need to feed picky eaters. We have lived in households that used SNAP and clipped coupons. So we built a platform that truly changes health outcomes and improves lives. Our registered dietitians work with iniduals to offer personalized nutrition guidance and connect them to the Foodsmart digital platform available on mobile and web, to create sustainable behavior change and deliver real results. Our integrated healthy food marketplace, including partners such as Walmart, Instacart, Grubhub, and others, allow iniduals to go from meal planning to grocery delivery in minutes saving them time and money. We are a Series C startup based in San Francisco but support a remote working model. Are you ready to join our team and help solve one of the biggest problems facing the world today? Learn more at www.foodsmart.com About You Foodsmart is seeking Registered Dietitians (RDs) to support the comprehensive nutrition care mission of Foodsmart Nutrition Network, which is grounded in evidence-based clinical nutritional standards including use of a whole food plant based (WFPB) diet. Our Foodsmart RDs leverage Foodsmart’s digital platform to provide a broad range of nutrition and health-related consultations, educational sessions, and training to Foodsmart’s clients, partners, and users. Populations Served In this role, you will work with members from various health plans, including Medicaid populations. Foodsmart creates lasting and sustainable change in Medicaid communities by tackling the root causes of food and nutrition insecurity. We provide members with personalized guidance, access to affordable healthy food options, and access to SNAP benefits if they qualify. In turn, we see improved food and nutrition security, more health equity, and better engagement and enrollment.What Does Success Looks Like In This Role?
- You are completing at least 6 follow-up visits with your patients
- You are receiving an NPS of 80% and above
- You find value in developing lasting relationships with your patients to support them towards sustainable behavior change and improved health outcomes
Responsibilities
- Provide inidualized medical nutrition therapy (MNT) via remote sessions to patients with a variety of health and lifestyle needs
- Document care in electronic medical record according to Nutrition Care Process
- Assist patients in getting the most utility out of Foodsmart’s digital platform
- Manage a panel of clients/patients with a variety of chronic health conditions and backgrounds
- Communicate effectively and empathetically with clients/patients through HIPAA-compliant video calls and electronic messaging
Required Skills
- Active credentialing as a Registered Dietitian by the Commission on Dietetic Registration (CDR) and Licensed Dietitian
- Must have at least one state licensure
- Willingness to apply for additional licensure in at least one other state
- Minimum of one (1) to two (2) years of professional experience in providing nutritional counseling
- Ability to work in the U.S.
Preferred Skills
- Multilingual (native level) language capabilities
- Multiple active state licenses or certifications
- Experience delivering services via a telehealth platform
Compensation
- $12/unit for Medical Nutrition Therapy (MNT). Each unit for MNT is 15 minutes, so you’d earn $48 for a visit that lasted for one hour. Most of our visits are one hour
- RDs who offer over 20+ hours of weekly availability for at least a year qualify for CDR fee reimbursement ($70)
Manager, Coding Validation & Quality Assurance
locations
Remote
time type
Full time
job requisition id
33530
Position:Manager, Coding Validation and Quality Assurance
Department: Clinical Documentation
Schedule: Full Time / Remote
POSITION SUMMARY:
Responsible for the professional development of the coding staff and for providing a hospital-wide educational program to assist coders in continued coding and documentation education. Performs quality assurance reviews of inpatient and outpatient records to assess and report on the effectiveness of training programs and quality of coders. Provides in-service training and feedback to coding staff regularly, including coding changes and updates. Designs and implements programs on coding and clinical documentation audit and education to improve performance and efficiency. Partners with CDCI management to develop appropriate guidelines regarding IP and OP coding. Enforces correct application of Official Coding Rules and Regulations and follows appropriate guidelines including Coding Clinic. The Manger, Coding Validation and Quality Assurance may help represent the Clinical Documentation Coding Integrity (CDCI) Department at clinical meetings when requested to serve as a resource for coding guidelines and interpretation.
REQUIREMENTS
EDUCATION:
Bachelors degree or equivalent combination of formal education and experience.
CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:
CCS and AHIMA Certified ICD-10 Trainer credentials required.
Additional RHIA, RHIT, RN, or other coding credential is preferred.
EXPERIENCE:
Must have at least five years of experience in coding; experience must include education/mentoring/training. Minimum of five years acute care hospital experience coding with ICD-9/10-CM/PCS and CPT-4, academic medical setting or trauma center preferred. Minimum of three years management experience required; five years preferred.
Prior experience working claim edits and denials.
KNOWLEDGE AND SKILLS:
- Command of the ICD-9/10-CM and CPT4/HCPCS coding conventions, E&M coding, diagnosis-related groupings (DRG) and ambulatory patient groupings (APG) methodology. Work also requires concepts of human anatomy, physiology and pathology.
- Excellent skill in providing hands-on education to CDCI staff based on audit finding and need.
- Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
- Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
- Ability to work with accuracy and attention to detail.
- Ability to solve problems appropriately using job knowledge and current policies/procedures.
- Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.
- Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.
- Must possess extensive knowledge of hospital inpatient and outpatient reimbursement methodologies.
- Work requires in-depth knowledge of medical terminology, ICD-10-CM/PCS and CPT-4 Coding conventions and knowledge of the various DRG systems (CMS DRGs, AP-DRG, and APR-DRGs). Work also requires basic concepts of human anatomy, physiology and pathology.
- Strong knowledge of health records, computer systems, Microsoft applications, data integrity, and processing techniques required.
- Ability to mentor, guide and motivate direct reports through demonstration of best practices and leading by example.
- Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
- Ability to solve problems appropriately using job knowledge and current policies/procedures.
- Ability to maintain and enforce strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.
- Must possess extensive knowledge of payer claim edits and payer denials. Work requires in-depth knowledge of medical terminology, ICD-10-CM and CPT-4 Coding conventions (including E&M coding), Ambulatory Patient Classifications (APC), Ambulatory patient Groupings (APG) methodologies, and Fiscal Intermediary Local Coverage Determinations, CMS National Coverage Determinations and various other applicable coding regulations and law.
IND123
Equal Opportunity Employer/Disabled/Veterans
location: remoteus
Title: RN Supervisor, Clinical Operations
Location: United States
Job Description:
Company Overview
Cohere Health is illuminating healthcare for patients, their doctors, and all those who are important in a patients healthcare experience, both in and out of the doctors office. Founded in August, 2019, we are obsessed with eliminating wasteful friction patients and doctors experience in areas that have nothing to do with health and treatment, particularly for diagnoses that require expensive procedures or medications. To that end, we build software that is expressly designed to ensure the appropriate plan of care is understood and expeditiously approved, so that patients and doctors can focus on health, rather than payment or administrative hassles.
Opportunity overview
Coheres Service Operations team is responsible for ensuring that our healthcare partners are supported throughout their lifecycle of using the platform. The RN Supervisor, Clinical Operations position is a crucial role in our organization. In this role, you are responsible for coaching, mentoring, evaluating and developing the RN Reviewer team. The RN Supervisor will use established operational tools to ensure all RN staff are meeting or exceeding performance metrics and quality standards established by the leadership team.
As an RN Supervisor, you will work closely with the leadership team at Cohere and report to the Director/Manager of Clinical Operations. You will be responsible for providing daily operational guidance to the RN Reviewers to allow them to meet or exceed operational objectives and metrics. You will leverage both your creative skills and communication skills to promote a high performing clinical team.
The RN Supervisor will be highly organized in order to plan daily operational activities and provide oversight of the RN Reviewer team. You will use your professionalism, personality, and communication skills to inspire the team to meet or exceed all performance standards. At a growing organization, this is a position that offers the ability to make a substantive mark on the company and its partners with exponential growth opportunities.
Last but not least: People who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that erse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.
What will you do
- Oversee the RN Reviewer team including one RN Team Lead
- Establish a plan for the day and communicate to all staff daily
- Manage the daily timeliness report and ensure all cases meet expected turnaround times
- Monitor the nurse productivity reports daily and provide feedback to the nurses, managing performance to ensure consistency
- Lead weekly team meetings
- Capture process efficiency ideas from the team and work with the appropriate stakeholders to recommend and lead changes needed to improve nurse efficiency.
- Meet inidually with all direct reports on bi-weekly cadence to develop solid work relationships with each team member and to share any performance feedback, positive and constructive.
- Working with the RN Reviewer Leads, track hourly nurse productivity, keeping the Director/Manager informed on productivity results as needed.
- Train and Develop new RNs who join the team.
- Oversee daily newsletter publication
- May be asked to help with other projects as needed.
Your background & responsibilities
- Registered Nurse with an active and unencumbered license to practice
- 2-3 years of supervisory/management experience
- Knowledge of NCQA/CMS requirements
- Experience using MCG, CMS NCDs/LCDs, clinical criteria guidelines
- Prior Authorization or Utilization Management experience
- Excellent computer skills and familiarity with a Mac.
- Experience supervising and training in a remote work environment.
- Ideal shift will be between the hours of 10AM-8PM EST
We cant wait to learn more about you and meet you at Cohere Health!
Equal Opportunity Statement
Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, its personal.
The salary range for this position is $75,000 to $85,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Inidual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.
#LI-Remote
Manager, Patient Account Specialist
Remote, United States |Billing
Description
Position at GoHealth Urgent Care
JOB SUMMARY
This Position is responsible for the day-to-day management of patient account receivables payments and billing customer service. This includes the supervision of the of the billing customer service call center and email / website inquires along with third-party vendor relations supporting relevant functions. Also included is management of cross-departmental work needed to adequately address patient concerns regarding claim processing or patient account billing along with overall customer service.
JOB REQUIREMENT
Education
High School Diploma or GED required.
Bachelors degree in Business Administration or related field preferredWork Experience
5 years of healthcare experience required.
3 years of progressive management experience requiredRequired Licenses/Certifications
CPAR Certified Patient Account Representative preferred
Additional Knowledge, Skills and Abilities Required
Strong knowledge of the Accounts Receivable process
Excellent phone, communication, organizational skills, computer skills and mathematical skills Ability to maintain patient confidentiality. Strong knowledge of process and understanding of practice management systemsAdditional Knowledge, Skills, and Abilities Preferred
Epic or eClinicalWorks experience
Experience with Microsoft Excel and WordESSENTIAL FUNCTIONS
Maintain Daily communication with direct reports and team leads.
Maintain a high level customer service and collaboration when working with other revenue cycle departments, payors, legal, compliance, the GoHealth customer experience team, health system partners, and center operations Establish and maintain a high level customer service approach to working with all patients Handle all level 4 support calls with centers and patients With support of other leadership; interview, hire, and review team members Implement audits of teams adherence to script, customer service and system documentation Produce and maintain key metrics for statement collection rates, medium collection rates and hard collection rates Recommend team for structured quarterly bonus calculation Provide training for all staff With other leaders, establish policies for patient collection process and maintain those policies Implement and maintain ACD (Automatic Call Distribution) for inbound patient calls Works with vendors to resolve any issues Establish monthly calls with vendors to discuss performanceRequired knowledge, skills and ability:
Customer service skills:
Ability to represent the Department in a professional manner when interacting with customers, patients, co-workers, and health system partners Ability to handle service issues timely and professionally Ability to follow through with customers completely and in a timely mannerCommunication Skills:
Ability to communicate effectively to patients about the financial aspects of their care Ability to communicate effectively to patients, centers, and staff regarding departmental policyKeyboard skills:
Ability to type proficiently Ability to effectively utilize spreadsheetsTeamwork:
Ability to function effectively as extension of the Centers and other GoHealth departments Be flexible and open-minded in thought processes Maintain focus under pressure Share relevant information with other team members proactivelyMedical Terminology & Insurance
Ability to understand basic medical terminology Ability to calculate deductible and co-insurance correctly Abilty to read and understand carrier Explanation of BenefitsAll other duties as assigned.
Note: this job description is not inclusive of all the duties of the position. You may be asked by leaders to perform other duties. Management reserves the right to revise this position description at any time.
location: remoteus
Certified Medical Coder
Location: United States – Remote
Nice to meet you, were Vesta Healthcare.
Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these iniduals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center.
Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others’ needs ahead of her own, keeping the hearth warm so the home and family can function.
We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. Its an insurance covered benefit, so its available to most adults with Caregivers free of charge to them.
We seek team members who are passionate about making home the best place it can be for people with home care needs and see the important role Caregivers play. Our team members are collaborative data-driven optimists who always focus on doing whats best for patients and their caregivers. We see ourselves as being here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids).
The ideal teammate would be
Someone whos passionate about our mission to help older adults live fulfilling lives in their home and who gets excited about diagnosis codes! They are current on their understanding of CMS guidelines and coding protocol. This person wants to be part of a team working together to change the way older adults age at home.
The ideal teammate would be able to:
- Independently perform analysis of claims on a pre and post-payment basis utilizing clinical, coding and claims processing background to ensure claims are coded correctly according to CPT and ICD-10 guidelines
- Review pertinent medical records to validate/invalidate potential issues identified on claims
- Thoroughly document identified issues to support claim adjustments (including supporting medical record, clinical or coding rationale)
- Identify and document upstream process gaps driving incorrect payment
- Responsible for the security and privacy of any and all protected health information that may be accessed during normal work activities
- Leverages clinical and coding expertise to assure proper documentation is available in the medical record and that it is complete for coding requirements and claim submission
- Reports non-entered charges and reconciles errors for claim submission
- Identifies opportunities to educate, medical staff and professionals regarding documentation
- Meet expectations regarding productivity, code assignment accuracy, deadlines and documentation consistency
- Collaborate with the clinical team and Director of Revenue Cycle to resolve queries and ensure progression of the claim through the revenue cycle management process
- Adapt to new platforms and coding situations quickly and enjoy learning new processes
Would you describe yourself as someone who has:
- 1+ years of ICD-10 coding experience (required)
- Active Professional Medical Coding Certification (CPC, CCS, etc.) (required)
- Experience (1+ year(s)) with chart extraction for risk adjustment coding (highly preferred)
- ICD-10 Coding Certification (preferred)
- Experience with eClinicalWorks electronic medical records system (preferred)
- Experience with medical record documentation, medical chart auditing/quality experience (preferred)
- Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology
In addition to amazing teammates, we also offer:
- Health, dental, and vision insurance with a choice of many different plans/costs partially subsidized by us
- Paid vacation
- Paid Sick/personal days
- 12 paid holidays
- One time reimbursement to set up your home office
- Monthly reimbursement for internet or other home office expenses
- Monthly gym reimbursement to be used for gyms, home equipment, online classes, etc
- Basic Life & AD&D, Short-term and Long-term Disability Benefits paid fully by us
- Voluntary benefits such as Pet, Home and Auto, Legal Insurance plus more
- Pre-tax Flex Spending/Dependent Care/Transit accounts
- 401k
Pay range is $50,000-60,000 annually. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).
location: remoteus
Remote RN Case Manager, Outpatient (Must have California RN License)
Location: Remote-US, California US
Job Number6401
Workplace Type:Fully Remote
Remote-US,California
By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?
At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether thats in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career with us.
Overview of the Role:
Alignment Health is seeking a remote, telephonic, RN case manager to join the outpatient case management team. As an RN case manager, you will be responsible for health care management and coordination, within the scope of licensure, for members with complex and chronic care needs. You will also deliver care to members utilizing the nursing process and effectively interacts with members, care givers, and other interdisciplinary team participants. Thecase manager will assist with closing gaps in care and resolving barriers that prevent members from attaining improved health. The Case Manager will connect with members telephonically.
Responsibilities:
- Coordinate care by serving as a resource for the member, their family and their physician.
- Ensure access to appropriate care for members with urgent or immediate needs facilitating referrals/authorizations within the benefit structure as appropriate.
- Complete comprehensive assessments within their scope of practice that includes assessing the member’s current health status, resource utilization, past and present treatment plan and services.
- Collaborates with the member, the PCP and other members of the care team to implement a plan of care.
- Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners and specialists on the development of care management treatment plans.
- Provide education and self-management support based on the members unique learning style.
- Assists in problem solving with providers, claims or service issues.
- Works closely with delegated or contracted providers, groups or entities to assure effective and efficient care coordination.
- Maintains confidentiality of all PHI in compliance with state and federal law and Alignment Healthcare Policy.
Required Skills and Experience:
- Minimum 1-3 years’ clinical experience,
- Minimum 2 years case management experience; or any combination of education and experience, which would provide an equivalent background.
- Health plan experience preferred
- Must have and maintain an active, valid, and unrestricted RN license inCalifornia
- Possess a high level of understanding of community resources, treatment options, home health, funding options and special programs
- Extensive knowledge of the management of chronic conditions
- Bilingual English and Spanish, Chinese, or Vietnamese preferred
- Excellent verbal and written communications skills
- Team player who builds effective working relationships
- Able to work independently
- Experience using standardized clinical guidelines required
- Strong organizational skills
- Strong proficiency in Microsoft Office suite (Word, Excel, PowerPoint, etc.)
Pay range: $78,000 – $118,000 annually.
Please note: All clinical positions are contingent upon successful engagement with Alignment Healths COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER:Please beware of recruitment phishing scams affecting Alignment Health and other employers where iniduals receive fraudulent employment-related offers in exchange for money or other sensitive personal information.Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company.If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission athttps://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Healths talent acquisition team, please [email protected].
location: remoteus
Title: Intake Specialist
Location: Remote – United States
JobDescription:
About Us
NOCD is the #1 telehealth provider for the treatment of obsessive-compulsive disorder (OCD). OCD is one of the most severe, prevalent, and misunderstood mental health conditions. NOCD creates access to online therapy for people with OCD through our telehealth platform. In the NOCD app, members can quickly access and schedule live, face-to-face video therapy sessions with our national network of licensed therapists that specialize in Exposure and Response Prevention Therapy (ERP) – considered the “gold standard” in OCD treatment.
At NOCD, we help people reclaim their lives with clinically proven OCD treatment, by removing barriers to OCD care, and reducing the stigma associated with OCD. Were changing the world and need other like-minded iniduals to accelerate and expand our efforts.
About the Role
- Member Advocates (Intake Specialists) represent the first impression of NOCD and your role would be to provide an extraordinary customer experience while communicating the services we have to offer.
- As a member of the Intake team, you will be responsible for inside sales, as well as patient advocacy.
- The Member Advocate is responsible for selling tele-therapy services to consumers who contact us via phone, text, and email, and completing the intake process to confidently and accurately get them started on the road to treatment.
- Job duties include inside sales of tele-therapy services, appointment coordination, registering and scheduling of therapy appointments as well as post-sales support.
- No cold calling.
- This is a goal-oriented team environment at a fast-growing company where we are all united in providing a top-notch patient experience.
Preferred Qualifications:
- Empathy-driven relationship building skills
- 1-3 years of inside sales or related experience
- Extremely detail-focused and technologically savvy, capable of using multiple software programs at once
- Ability to adapt in a fast-paced environment, common with start-ups and ever changing processes
- Ability to thrive under moderate pressure in a sales environment
Minimum Requirements:
- Must be perceived by the patient to be caring, courteous, professional, competent, and able to communicate effectively and with empathy
- Enhance the reputation of NOCD by creating a positive customer experience, including understanding and articulating the value of NOCD to the OCD community
- Demonstrate consistent, excellent customer service with both internal and external customers
- Demonstrate effective communication and interpersonal relation skills
- High School Diploma or GED required; Bachelor’s degree strongly preferred
What We Offer
- Casual, challenging, and engaging startup environment with an outstanding, mission-driven team atmosphere
- Competitive compensation and comprehensive benefits package including medical, dental, and vision coverage
- Hours: Thursday – Monday (off Tuesday/Wednesday); Weekday hours are 11:30 AM – 8 PM CST, Weekend hours are 9 AM – 5:30 PM CST
If you’re interested, we’d love to hear from you. Tell us why you’d be a good fit. A well written cover letter helps us understand who you are and what you want to be, and a resume tells the story of where you’ve been.
NOCD is proud to be an equal opportunity employer. We do not discriminate in hiring or any employment decision based on race, color, religion, national origin, age, sex (including pregnancy, childbirth, or related medical conditions), marital status, ancestry, physical or mental disability, genetic information, veteran status, gender identity or expression, sexual orientation, or other applicable legally protected characteristic. NOCD is also committed to providing reasonable accommodations for qualified iniduals with disabilities and disabled veterans in our job application procedures.
Applicants have rights under Federal Employment Laws. Family and Medical Leave Act (FMLA); Equal Employment Opportunity (EEO); Employee Polygraph Protection Act (EPPA).
https://www.treatmyocd.com/employee-privacy-notice
location: remoteus
Title: Registered Nurse
Location: Remote – Work From Home
JobDescription:
**MUST HAVE EXPERIENCE WORKING WITH CLIENTS WITH EATING DISORDERS **
*MUST HAVE COMPACT LICENSE OR ELIGIBLE TO APPLY FOR ONE*
Job Summary:
The Registered Nurse (RN) will function as a member of a larger multidisciplinary treatment team. They will work closely with clients and monitor providers in order to provide the best care possible to our eating disorder clients. They will be responsible for assessing clients, contributing to the multidisciplinary treatment plan, and carrying out related nursing interventions. They will facilitate, and co-facilitate, groups throughout the week. They will also serve as a liaison with clients, families, providers, community organizations and other health related service agencies to provide quality care to our clients. The RN specializes in working with clients with eating disorders, is thoughtful, sensitive, respectful, flexible, and brings a loving, positive attitude to our expert Clinical Team. Shift times will vary and may include on-call hours at night and on weekends.
Major Area of Responsibility:
- Perform focused nursing assessments utilizing remote patient monitoring devices.
- Oversee a team of therapists, dietitians, and care partners providing recommended treatments for clients.
- Document all client interactions appropriately and within designated timeframes.
- Conduct weekly family coaching calls.
- Coordinate care and program services with patient, family, treatment team, and outpatient team.
- Educate clients, and family members when appropriate, regarding medical complications of eating disorders.
- Educate clients, and family members when appropriate, regarding psychiatric medications.
- Provide in-the-moment feedback by utilizing between-session messaging to motivate and support clients and families .
- Alert medical and clinical professionals to intervene during emergencies.
- Maintain strict client confidentiality.
- Participate in Staff meetings.
- Participate in scheduled Partnership Meetings.
- Participate in scheduled Family Partnership Meetings.
- Facilitate or co-facilitate groups as appropriate.
- Attend supervision and department meetings.
- Participate in initial and ongoing training.
- Provide case management for clients, ensuring effective communication with those involved in the recovery process, including school administrators, law enforcement, attorneys, etc.
- Communicate with clients, family members, team members, & outpatient teams in a timely and consistent manner.
- Give direction and direct feedback to different team members.
- Other related duties as assigned based on need.
Qualifications:
- Active, unrestricted, unsupervised RN license, with willingness to obtain additional RN licenses or Compact license in multiple states.
- 3+ years experience as an RN in an eating disorder or behavioral health setting.
- Minimum 1 year of supervisory experience.
- Strong communicator, both verbally and in writing.
- Ability to foster teamwork and create a cohesive work environment in a virtual setting.
- Experience treating clients with eating disorders and Disordered Eating preferred.
- Ability to demonstrate understanding of a variety of models and theories of eating disorders, trauma, mental illness, and related issues.
- Knowledge of philosophies, practices, policies and outcomes of models of treatment, recovery, relapse prevention, and continuing care for dually diagnosed populations.
- Understanding of diagnostic criteria for co-occurring conditions and ability to conceptualize modalities and placement criteria within the continuum of care.
- Understanding of erse cultures and gender specific issues and ability to incorporate needs of gender and culturally erse groups into practice settings.
- Excellent organizational and time management skills.
- Ability to prioritize workload and work independently.
Physical and Environmental Requirements:
- Employees are required to read, review, prepare and analyze written data and figures, using a computer or similar, and should possess visual acuity.
- This position answers and places telephone calls as well as video conferences and must be able to converse.
- Must be able to converse with colleagues via telephone and computer programs.
- Must be able to operate a computer and navigate applications within a smart-phone, iPhone, MacBook computer and/or tablet.
- Able to sit for the majority of shifts.
- Must have reliable internet connection.
- This is a work-from-home position. Work should be performed in a private, quiet space with minimal background noise.
Pay Range: $85-90k/Year
location: remoteus
Title: REMOTE Full Time NY / Pennsylvania Licensed Nurse Practitioner (NP)
Location: Remote
JobDescription:
Nice to meet you, were Vesta Healthcare.
Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these iniduals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center.Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others’ needs ahead of her own, keeping the hearth warm so the home and family can function.
We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. Its an insurance covered benefit, so its available to most adults with Caregivers free of charge to them.
We seek team members who are passionate about making home the best place it can be for people with home care needs and see the important role Caregivers play. Our team members are collaborative data-driven optimists who always focus on doing whats best for patients and their caregivers. We see ourselves as being here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids).
The ideal teammate would be able to:
- Conduct video visits for chronic care management and remote patient monitoring to create an appropriate care plan for the member
- Conduct care coordination and recommend/identify cost effective research based treatment and intervention
- Utilize strong clinical skills in physical assessment and chronic disease management for at risk adults and apply member specific Care Management and inidualized care planning
- Be comfortable with advanced care planning discussions with caregivers and members
- Serve as a consulting resource on care management practice as needed
- Attend meetings, training sessions and participates on committees as needed
- Possess a strong knowledge of clinical procedures, standards and quality control checks
- Possess a strong knowledge of medical conditions, interventions and treatment
- Provide members, caregivers and facility education
- Monitor the quality of members care and updates plan of care
Would you describe yourself as someone who has:
- Certified and licensed as a Nurse Practitioner in good standing in the state of New York and Pennsylvania (required)
- Masters or doctoral degree from an accredited institution for nurse practitioners (required)
- Medicare participation and ability to have the company bill for services on your behalf (required)
- Certification from ANCC (or equivalent) as an Adult, Family, Geriatric, and/or Acute Nurse practitioner (required)
- 1+ years of Nurse Practitioner Experience (required), qualified for independent practice in your licensed jurisdiction (preferred)
- 1+ years of telephonic triage or equivalent experience (required)
- 2+ years of clinical experience working with complex adult populations (required)
- Ability to practice independently with little clinical support (required)
- Comfort using technology like Google Suite, multiple EMRs, Slack (required)
- The ability to work remotely and has a private area with a computer in their home/workspace (required)
- Experience working in home care and/or family medicine, geriatrics (preferred)
- Experience working within a clinical team environment
- Strong organizational skills, including the ability to prioritize
- Passionate about our mission to improve peoples lives
- Comfortable in a dynamic and always evolving startup environment
In addition to amazing teammates, we also offer:
- Health, dental, and vision insurance with a choice of many different plans/costs partially subsidized by us
- Paid vacation
- Paid Sick/personal days
- 12 paid holidays
- One time reimbursement to set up your home office
- Monthly reimbursement for internet or other home office expenses
- Monthly gym reimbursement to be used for gyms, online classes, etc
- Basic Life & AD&D, Short-term and Long-term Disability Benefits paid fully by us
- Voluntary benefits such as Pet, Home and Auto, Legal Insurance plus more
- Pre-tax Flex Spending/Dependent Care/Transit accounts
- 401k plus match
Pay range is $125K – $130K annually. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).
If yes, then we look forward to speaking to you!
Vesta Healthcare is committed to leveraging the talent of a erse workforce to create great opportunities for our business and our people. Vesta Healthcare is an Equal Opportunity/Affirmative Action Employer. Candidates are selected without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.
At Vesta, we are constantly searching for the most dynamic and best talent to join our team with a mission of empowering caregivers in the home! You might see things from a similar domain address, but with a slight misspelling, for example.
location: remoteus
CERTIFIED CODER – REMOTE
Molina Healthcare
Job ID 2024266
JOB DESCRIPTION
Job Summary
Provides support to the business by making sure proper ICD-10 and CPT codes are reported accurately to maintain compliance and to minimize risk and denials.
KNOWLEDGE/SKILLS/ABILITIES
- Performs on-going chart reviews and abstracts diagnosis codes
- Develop an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly
- Documents results/findings from chart reviews and provides feedback to management, providers, and office staff
- Provides training and education to network of providers on how to improve their risk adjustment knowledge as well as provide coding updates related to Risk Adjustment
- Builds positive relationships between providers and Molina by providing coding assistance when necessary
- Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education
- Assists in coordinating management activities with other departments in Molina including Finance, Revenue analytics, Claims and Encounters, and Medical Directors
- Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies
- Contributes to team effort by accomplishing related results as needed
- Other duties as assigned
- 2 years previous coding experience
- Proficient in Microsoft Office Suite
- Ability to effectively interface with staff, clinicians, and management
- Excellent verbal and written communication skills
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
- Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers
- Maintain knowledge in the latest coding guidelines (official through CMS) as well as AHA Coding Clinic guidance
JOB QUALIFICATIONS
Required Education
Associates degree or equivalent combination of education and experience
Required License, Certification, Association
- Certified Professional Coder (CPC)
- Certified Coding Specialist (CCS)
Preferred Education
Bachelor’s Degree in related field
Preferred Experience
- Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model
- Background in supporting risk adjustment management activities and clinical informatics
- Experience with Risk Adjustment Data Validation
Preferred License, Certification, Association
- Certified Risk Adjustment Coder – (CRC)
- Certified Professional Payer – Payer (CPC-P)
- Certified Coding Specialist – Physician based (CCS-P)
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $17.85 – $38.69 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time
location: remoteus
REMOTE Full Time NY Licensed Nurse Practitioner (NP)
at Vesta Healthcare
Remote
Nice to meet you, we’re Vesta Healthcare.
Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these iniduals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center.Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others’ needs ahead of her own, keeping the hearth warm so the home and family can function.
We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. It’s an insurance covered benefit, so it’s available to most adults with Caregivers free of charge to them.
We seek team members who are passionate about making home the best place it can be for people with home care needs and see the important role Caregivers play. Our team members are collaborative data-driven optimists who always focus on doing what’s best for patients and their caregivers. We see ourselves as being here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids).
The ideal teammate would be able to:
- Conduct video visits for chronic care management and remote patient monitoring to create an appropriate care plan for the member
- Conduct care coordination and recommend/identify cost effective research based treatment and intervention
- Utilize strong clinical skills in physical assessment and chronic disease management for at risk adults and apply member specific Care Management and inidualized care planning
- Be comfortable with advanced care planning discussions with caregivers and members
- Serve as a consulting resource on care management practice as needed
- Attend meetings, training sessions and participates on committees as needed
- Possess a strong knowledge of clinical procedures, standards and quality control checks
- Possess a strong knowledge of medical conditions, interventions and treatment
- Provide members, caregivers and facility education
- Monitor the quality of member’s care and updates plan of care
Would you describe yourself as someone who has:
- Certified and licensed as a Nurse Practitioner in good standing in the state of New York (required)
- Master’s or doctoral degree from an accredited institution for nurse practitioners (required)
- Medicare participation and ability to have the company bill for services on your behalf (required)
- Certification from ANCC (or equivalent) as an Adult, Family, Geriatric, and/or Acute Nurse practitioner (required)
- 1+ years of Nurse Practitioner Experience (required), qualified for independent practice in your licensed jurisdiction (preferred)
- 1+ years of telephonic triage or equivalent experience (required)
- 2+ years of clinical experience working with complex adult populations (required)
- Ability to practice independently with little clinical support (required)
- Comfort using technology like Google Suite, multiple EMRs, Slack (required)
- The ability to work remotely and has a private area with a computer in their home/workspace (required)
- Experience working in home care and/or family medicine, geriatrics (preferred)
- Experience working within a clinical team environment
- Strong organizational skills, including the ability to prioritize
- Passionate about our mission to improve people’s lives
- Comfortable in a dynamic and always evolving startup environment
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 plus match
Pay range is $125K – $130K annually. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).
If yes, then we look forward to speaking to you!
Vesta Healthcare is committed to leveraging the talent of a erse workforce to create great opportunities for our business and our people. Vesta Healthcare is an Equal Opportunity/Affirmative Action Employer. Candidates are selected without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.
At Vesta, we are constantly searching for the most dynamic and best talent to join our team with a mission of empowering caregivers in the home! If you are ever contacted by e-mail from any domain other than https://vestahealthcare.com, please do not respond, as there is a likelihood it could be a scam as it is not a legitimate Vesta email. You might see things from a similar domain address, but with a slight misspelling, for example. We have no responsibility for any communication that does not come from the https://vestahealthcare.com domain, and we strongly advise that you not provide information or respond if not from the legitimate Vesta domain. If you have any concerns that outreach might not be legitimate, please reach out to [email protected] for confirmation.
Licensed Triage Nurse Practitioner
Nice to meet you, we’re Vesta Healthcare.
Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these iniduals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center.Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others’ needs ahead of her own, keeping the hearth warm so the home and family can function.
We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. It’s an insurance covered benefit, so it’s available to most adults with Caregivers free of charge to them.
We seek team members who are passionate about making home the best place it can be for people with home care needs and see the important role Caregivers play. Our team members are collaborative data-driven optimists who always focus on doing what’s best for patients and their caregivers. We see ourselves as being here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids).
The ideal teammate would be able to:
- Be a point of contact for weekend call escalations
- Chart reviews
- Review remote patient monitoring alerts
- Conduct video visits for chronic care management and remote patient monitoring to create an appropriate care plan for the member
- Conduct care coordination and recommend/identify cost effective research based treatment and intervention
- Utilize strong clinical skills in physical assessment and chronic disease management for at risk adults and apply member specific Care Management and inidualized care planning
- Be comfortable with advanced care planning discussions with caregivers and members
- Serve as a consulting resource on care management practice as needed
- Attend meetings, training sessions and participates on committees as needed
- Possess a strong knowledge of clinical procedures, standards and quality control checks
- Possess a strong knowledge of medical conditions, interventions and treatment
- Provide members, caregivers and facility education
- Monitor the quality of member’s care and updates plan of care
Would you describe yourself as someone who has:
- The ability to work every Saturday AND Sunday from either 8am-8pm OR 8pm-8am ET, every week and weekend (required)
- Certified and licensed as a Nurse Practitioner in good standing in the state of New York (required)
- Master’s or doctoral degree from an accredited institution for nurse practitioners (required)
- Medicare participation and ability to have the company bill for services on your behalf (required)
- Certification from ANCC (or equivalent) as an Adult, Family, Geriatric, and/or Acute Nurse practitioner (required)
- 1+ years of Nurse Practitioner Experience (required), qualified for independent practice in your licensed jurisdiction (preferred)
- 1+ years of telephonic triage or equivalent experience (required)
- 2+ years of clinical experience working with complex adult populations (required)
- Ability to practice independently with little clinical support (required)
- Comfort using technology like Google Suite, multiple EMRs, Slack (required)
- The ability to work remotely and has a private area with a computer in their home/workspace (required)
- Experience working in home care and/or family medicine, geriatrics (preferred)
- Experience working within a clinical team environment
- Strong organizational skills, including the ability to prioritize
- Passionate about our mission to improve people’s lives
- Comfortable in a dynamic and always evolving startup environment
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 plus match
Average compensation $70-$80 hourly based on visit completion.
If yes, then we look forward to speaking to you!
Vesta Healthcare is committed to leveraging the talent of a erse workforce to create great opportunities for our business and our people. Vesta Healthcare is an Equal Opportunity/Affirmative Action Employer. Candidates are selected without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.
At Vesta, we are constantly searching for the most dynamic and best talent to join our team with a mission of empowering caregivers in the home! If you are ever contacted by e-mail from any domain other than https://vestahealthcare.com, please do not respond, as there is a likelihood it could be a scam as it is not a legitimate Vesta email. You might see things from a similar domain address, but with a slight misspelling, for example. We have no responsibility for any communication that does not come from the https://vestahealthcare.com domain, and we strongly advise that you not provide information or respond if not from the legitimate Vesta domain. If you have any concerns that outreach might not be legitimate, please reach out to [email protected] for confirmation.
location: remoteus
Coding Specialist III
Remote – USA
Full time
R3122
Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).
The Coding Specialist III can maintain up to two concurrent client assignments that are short-term in nature.
For each client, the Coding Specialist III reviews documentation to code diagnoses and procedures for inpatient hospital-based claims and data needs. For both professional and technical claims and data needs, the Coding Specialist III reviews clinical documentation to code diagnoses, EM level, and surgical CPT codes. Additionally, this role also validates MS-DRG and APC calculations, abstracts clinical data, mitigates diagnosis, EM level, surgical CPT, and/or PCS coding-related claims scrubber edits, and may interact with client staff and providers.
Essential Duties & Responsibilities:
- Assigns either ICD-10-CM and PCS codes for inpatient visits or assigns ICD-10 CM codes, professional and technical EM levels, and surgical CPT codes for physician visits at commercially reasonable production rates and at a consistent 95% or greater quality level.
- Validates either MS-DRG or APC assignments, as applicable.
- Abstracts clinical data appropriately.
- Mitigates either hospital inpatient coding-related claims scrubber edits or professional and technical coding-related claims scrubber edits.
- Tolerates short-term assignments for up to two different clients.
- Participates in client and Savista meetings and training sessions as instructed by management.
- Maintains an ongoing current working knowledge of the coding convention in play at client assignments.
- Performs other related duties as required.
Minimum Qualifications:
- An active AHIMA (American Health Information Association) credential or an active AAPC (American Academy of Professional Coders) credential
- One year of relevant, productive coding experience for the specific patient type being hired and within the last six months
- Passing score of 80% on specific pre-employment tests assigned
SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.
location: remoteus
Medical Billing Associate
Location: Remote United States
Hazel partners with schools and families to provide physical and mental virtual health care that helps students feel better and get back to learning. As telehealth becomes more and more relevant in the lives of children, Hazel is experiencing tremendous company growth. Our innovative response to our nation’s call for equitable, affordable, and safe virtual access to healthcare has been recognized by Fast Company as “one of the world’s most innovative places to work” in 2023.
Helping students and their families feel better takes a team of smart, dedicated people. As an integral member of the Hazel team, you will…
- Make an Impact: Work with a team that is increasing equitable access to quality healthcare experiences for students and their families
- Enable Scale: Work with a team that is building and professionalizing a high-growth high impact social enterprise
- Feel Valued: Work with a team that is being compensated competitively, developed professionally, and celebrated frequently for making a meaningful difference
At Hazel Health, we believe talent is everywhere, and so is opportunity. While we have physical offices in San Francisco and Dallas, we have embraced working remotely throughout the United States.
While some roles may require proximity to our San Francisco or Dallas offices, remote roles can sit in any of the following states: AZ, CA, CO, DC, DE, FL, GA, HI, IL, ME, MD, MA, MI, MO, NE, NV, NJ, NM, NY, NC, OR, PA, SC, TN, TX, VT, VA, WA and WI. Please only
apply if you live and work full-time in one of the states listed above or plan to relocate to one of these states before starting your employment with Hazel. State locations and specifics are subject to change as our hiring requirements shift.
The Role: The Medical Billing Associate will support various functions of the Hazel Revenue Operations team, including securing real-time insurance benefits eligibility and coverage information for patients, following up on rejected/outstanding claims, and collaborating with third-party partners on data and clarification requests.
Role title: Medical Billing Associate
Location: Remote
What You’ll Bring:
Insurance Verification:
- Verifies detailed insurance benefits, medical necessity, and authorization/referral guidelines, consistently prioritizing and following the established verification process
- Read and interpret insurance Explanations of Benefits (EOB)/Remittance Advice (RA) with understanding and take appropriate steps to resolve issues.
- Verify all information obtained is correctly documented in the patient’s account, in the correct format.
- Communicate with insurance providers via phone and electronically via web portals to validate patient benefits, check authorization requirements, and review authorization status.
Billing/General
- Review regular data feeds from third party billing partner and research patient insurance coverage and billing status using internal and external tools.
- Create and utilize spreadsheets and other tools to track visit statuses and contracting/credentialing data.
- Ensures compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards.
- Performs other duties as required or assigned within the scope of responsibility, including supporting other functions and teams within Revenue Operations.
What excites us:
- Passionate for our mission to transform healthcare for all children
- 2+ years experience in insurance verification with experience in Medicaid, Managed Medicaid and commercial payers across multiple states. Experience with California and Florida Medicaid strongly preferred.
- 1+ years or more experience with Google Suites (google sheets, google docs)
- 1+ years experience with Change Healthcare or other online eligibility healthcare tools
- 1+ years experience with claims adjudication/follow-up
- Experience navigating state Medicaid, Managed Medicaid, and commercial insurance portals
- Highly detail-oriented and comfortable with insurance, claims, and other data sources
- Ability to understand how job performance affects the outcomes of key performance indicators such as billing rates, denials, and write-offs.
- Self-motivated with excellent decision making and time management skills
- Ability to meet remote work expectations, including but not limited to active participation in virtual meetings and real-time communication via Slack
- Exceptional communication and collaboration skills, especially in a virtual work environment.
- 2+ years / Associate Degree, preferred
The compensation range for this role is $22.00-$26.00/hour with a 401k match, healthcare coverage, paid time off, and a broad range of other benefits.
Remote IP Coding
Location: EMERYVILLE California
JobDescription: Job Description & Requirements
Remote IP Coding StartDate: ASAP Pay Rate: $30.00 – $40.00 Position DescriptionJOB SUMMARY:
Under indirect supervision, is responsible for accurate coding of all inpatient services at a University Acute Care Facility with Trauma, procedures, diagnoses and conditions, working from the appropriate documentation in the medical record. All work is carried out in accordance with the rules, regulations and coding conventions of the American Hospital Association (Coding Clinic), ICD-10-CM/PCS, Centers for Medicare and Medicaid Services (CMS).
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
Must have Inpatient Coding Experience in a Teaching Trauma Acute Care Facility.
Must possess a thorough knowledge of ICD-10-CM/PCS coding principles and applications as they relate to acute care hospital coding and grouping Thorough knowledge of Official Coding Guidelines and payer specific requirements When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards. Maintain 95% DRG and overall accuracy rate Maintain average productivity standards. Works the review queue on a daily basis to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary. The coder is responsible for coding or pending every chart placed in their queue.OTHER REQUIREMENTS
Smart Phone Workstation – Dual Monitors Standard Windows PC Internet Access with DSL or Cable VPN compatibility Printer/FaxEDUCATION AND SKILLS
High school diploma or equivalent required. Requires one of the following coding credentials: AHIMA (CCS, CCS-P, or RHIT); AAPC (CPC, CPC, CPC-H). Must be proficient with Facilities Coding Standards. Minimum of five (5) years’ experience in medical coding. Working knowledge of ICD-10-CM/PCS.SALARY AND BENEFITS
Paid Time Off and Sick Time 401K Medical, Dental, Life and Long/Short term disability Insurance Paid Association Dues Paid Educational Benefits AMN Healthcare is an EEO/AA/Disability/Protected Veteran Employer.We encourage minority and female applicants to apply.
AMN Healthcare is committed to fostering and maintaining a erse team that reflects the communities we serve. Our commitment to the inclusion of many different backgrounds, experiences and perspectives enables our innovation and leadership in the healthcare services industry. Apply today and one of our team members will be in touch to help you find the role that best fits your skills and goals.Job Benefits
Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary—but the perks don’t stop there. There are many additional benefits to enjoy, including:- Medical, dental and vision benefits
- Earned time off and paid holidays
- Paid continuing education time
- 401(K) retirement planning
- Short-term disability, life insurance, paid jury duty
- Access to the largest network of facilities and providers in the country
- Industry experienced workforce management team
- Licensure and certification reimbursement
About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.location: remoteus
FULL AND PART TIME OPPORTUNITIES
About This Role
Are you ready to make a difference? Come work with Parallel!
We are looking for remote school psychologists with experience providing direct and indirect psychological services in schools and conducting comprehensive psycho-educational evaluations to join our talented team of clinicians. Our ideal candidate has a passion for supporting families and children with learning differences by ensuring they receive the best care and tools for success!
Why Join Us?
Parallel makes it easy to administer quality care! By taking care of the daily hassles of running a business, we empower you to focus on providing services. We provide:
- Easy Scheduling through our in-house scheduling system
- Templates & Databases so you can spend less time on administrative tasks
- Smart Matching to pair you with school districts/schools
- Student History & Eligibility information so you have the information you need
- Testing Materials so you have the tools to succeed!
We also offer:
- Flexibility: Ability to set your own schedule and work on your own time
- Testing & Licensure Programs: Cross-licensing programs & necessary test materials are covered by Parallel
- Innovation: Your feedback will help shape the program for providers and clients in the future!
- Community Events: Collaborate with top clinicians and educators to solve acute problems
- Growth: Access leadership and growth opportunities as we rapidly scale
- A Great Mission: Directly contribute to bettering the lives of students across the country
What You’ll Do
- Provide direct and indirect psychological services to support students with IEPs
- Conduct comprehensive psycho-educational evaluations of students’ academic, cognitive, social\emotional, and/or behavioral functioning
- Write social\emotional\behavioral IEP goals and monitor students’ goal progress
- Serve as a critical member of students’ multi-disciplinary teams
What You’ll Need
To succeed in this role, you’ll need:
- An EdS degree (or equivalent) in school psychology from a NASP-approved program
- A valid state license or certificate as a school psychologist
- NCSP preferred but not required
- At least 1 year of experience practicing full time as an on-site school psychologist (excluding practicum and internship years)
- Experience practicing as a remote school psychologist is preferred but not required
- Expertise across all NASP domains of practice
- Experience providing direct psychological services (e.g., intervention, counseling) within an MTSS framework of service delivery
- Experience consulting with educators and families
- Experience completing comprehensive psycho-educational evaluations of students’ academic, cognitive, social, emotional, and behavioral functioning
- Excellent communication skills, specifically the ability to communicate with children of different ages and from different cultural and socioeconomic backgrounds
- Tech-savvy and experience with conducting tele-health services on virtual meeting platforms
- A private workspace with a reliable computer, webcam, and secure internet connection
- Availability during traditional school hours (8:00am-3:00pm) and days (Monday-Friday). Minimum availability of 15 hours per week
Parallel is an equal opportunity employer that does not discriminate against applicants or employees and ensures equal employment opportunity for all persons regardless of their race, creed, color, religion, sex, sexual orientation, gender identity, pregnancy, national origin, age, marital status, disability, citizenship, military or veterans’ status, or any other classifications protected by applicable federal, state or local laws. Parallel’s equal opportunity policy applies to all terms and conditions of employment, including but not limited to recruiting, hiring, training, promotion, job benefits and pay.
About Us
Parallel is the first tech-forward provider of care for learning and thinking differences across the United States. We believe learning differences are parallel ways of thinking that should be celebrated! Our mission is to provide students with the resources and encouragement to succeed in the classroom and beyond. To us, this means helping them build confidence in their unique strengths and create strategies to work around their challenges.
Parallel simplifies the process of getting support for learning differences by consolidating providers and resources on a single platform. We connect students with qualified professionals while significantly reducing waiting times, costs, and confusion. We provide a variety of services, including:
- Psychological Assessment & Therapy
- Counseling
- Speech-Language Therapy
- Special Education
- And more!
Want to know what it’s like working here? Check out our Glassdoor reviews!
Our commitment to ersity, equity, and inclusion
At Parallel, we believe in celebrating differences. This belief extends from schools into our workplace and through the ways we work together toward our mission. We are committed to fostering a erse, accessible environment that represents many different cultures, backgrounds, viewpoints, and abilities by championing ersity, equity and inclusion.
This is why we are committed to having and fostering a erse workforce, including those from historically marginalized groups, and are committed to a work environment where employees’ strengths are championed, differences are celebrated, and no one is discriminated against based on age, race, ancestry, religion, sex, gender identity and expression, sexual orientation, pregnancy, marital status, physical or mental disability, military or veteran status, national origin, or any other characteristic.
We are a proud equal opportunity employer, and we are committed to building a erse, equitable, and inclusive organization in order to build the foundation for different learners and thinkers to thrive.
location: remoteus
Remote Same Day Surgery Coder
Location: EMERYVILLE California; United States
Job Description & Requirements
Pay Rate: $25.00 – $38.00
TYPE OF JOB ORDER: Remote Facility OP Same Day Surgery CoderREQUIRED SKILLS: Under indirect supervision, is responsible for accurate coding of outpatient surgery services, procedures, diagnoses and conditions, working from the appropriate documentation in the medical record. Classification systems include ICD-10, CPT, Procedures (PCS), Healthcare Common Procedure Coding System (HCPCS) as well as other specialty systems as required by diagnostic category. All work is carried out in accordance with the rules, regulations and coding conventions of the American Hospital Association (Coding Clinic), ICD-10, Centers for Medicare and Medicaid Services (CMS), Office of Statewide Health Planning and Development (OSHPD), and organizational/institutional coding guidelines.
Other responsibilities include:
*Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third party requirements regarding documentation and billing.
• Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards.
• Ability to maintain average productivity standards.
• Works the review queue on a daily basis to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary.
• The coder is responsible for coding or pending every chart placed in their queue.
• Coders must maintain their current professional credentials.
# OF WEEKS: 52 weeks
SHIFT/HOURS: 1st shift 7a – 6p Pacific Time Zone
EXPECTED HOURS: FT M-F business hours Pacific Time Zone – some flexibility.
LICENSE/CREDENTIALS REQ: RHIA, RHIT, CCS, CCS-P, CPC, CPC-H, CDIP, CCDS one or more is permitted.
SYSTEMS: 3M & EPIC.
NOTES: Will be a long-term project for the right fit.
Job Benefits
Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary—but the perks don’t stop there. There are many additional benefits to enjoy, including:- Medical, dental and vision benefits
- Earned time off and paid holidays
- Paid continuing education time
- 401(K) retirement planning
- Short-term disability, life insurance, paid jury duty
- Access to the largest network of facilities and providers in the country
- Industry experienced workforce management team
- Licensure and certification reimbursement
Manager, Central Billing Office Coding (National, Remote) in Grand Rapids, Michigan
The Opportunity
Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.
Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients.
Joining the Huron team means you’ll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.
Join our team as the expert you are now and create your future.
Position Summary
Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.
Munson Healthcare revenue cycle operations are jointly operated by Huron and Munson Healthcare. Huron provides strategic revenue cycle operations leaders (managers and above are employed by Huron), while revenue cycle associates and supervisors are badged and employed by Munson Healthcare. Munson Healthcare, like all other providers in the market, is under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Munson, in collaboration with Huron, must empower leaders, clinicians, employees, affiliates, and communities to build a culture that fosters innovation to achieve the best outcomes for patients and succeed long-term.
Learn more about Munson Healthcare here: https://www.munsonhealthcare.org/.
Joining the Huron Managed Services team means you’ll help Munson Healthcare evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.
Join our team as the expert you are now and create your future.
Manages and oversees the system-wide compliance program in areas that relate to the revenue cycle. Works with Adventist Health compliance leadership in maintaining oversight of system-wide revenue cycle functions including health information management, coding, billing and registration. Manages projects related to the design, implementation, revision and maintenance of system-wide processes and systems that promote compliance related to the revenue cycle. Supervises and directs the activities of various levels of assigned personnel utilizing both professional and supervisory discretion and independent judgment. Manages large program(s) with substantial budget/impact. Manages and coordinates the diagnostic and procedural coding processes with Federal/State regulations and payer requirements for legal compliance. Ensures compliance with all applicable federal, state and local regulations, as well as with institutional/organizational standards, practices, policies and procedures. Supervises and directs the activities of various levels of assigned personnel utilizing both professional and supervisory discretion and independent judgment.
Supports Huron’s Compliance Program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, and other laws applicable to Huron’s business practices. This includes: becoming familiar with Huron’s Code of Ethics, attending training as required, notifying management when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations.
DUTIES & RESPONSIBILITIES:
- Develop, recommend and oversee the implementation and administration of policies and procedures of respective areas.
- CPC (Certified Professional Coder) Certification Required
- Evaluate processes and procedures coordinating with the management team to ensure efficient areas of focus and adhere to federal and local laws and regulations.
- Demonstrate, through plans and actions, a consistent standard of excellence to which all department work is expected to conform.
- Focus on continuous improvement working with the Senior Manager and respective teams Managers across the Health System with a goal of delivering the highest degree of quality service possible.
- Provide support for Human Resource guidance.
- Complete, review, manage and monitor department budget.
- Directs and leads the patient access team in the daily operations.
- Performs other duties as assigned.
REQUIRED SKILLS:
- Effective and efficient organization and planning skills with the proven ability to manage complex multi-workstream performance improvement projects or multiple concurrent client engagements, while delegating and overseeing the work of junior team members.
- Proven analytical and critical thinking skills required to synthesize complex data sets and interpret qualitative and quantitative data and and trends to implement recommendations resulting in measurable performance improvement and successful organizational change.
- Impactful and professional written and verbal communication setting clear project team direction.
- Develop key deliverables, escalate risks and influence key stakeholders inclusive of client and internal senior leadership.
- Ability to collaborate with team members and client counterparts to understand business challenges, adapt implementation methodologies and approaches to ensure results align with client’s business objectives.
- Team leadership experience including building talent, training, supervising, coaching/mentoring and performance management.
Qualifications
- Living location can be anywhere within the contiguous 48 states and near a major airport
The estimated salary range for this job is $100,000 – $120,000. The range represents a good faith estimate of the range that Huron reasonably expects to pay for this job at the time of the job posting. The actual salary paid to an inidual will vary based on multiple factors, including but not limited to specific skills or certifications, years of experience, market changes and required travel. This job is also eligible to participate in Huron’s annual incentive compensation program, which reflects Huron’s pay for performance philosophy and Huron’s benefit plans which include medical, dental and vision coverage and other wellness programs. The salary range information provided is in accordance with applicable state and local laws regarding salary transparency that are currently in effect and may be implemented in the future.
Posting Category
Healthcare
Opportunity Type
Regular
Country
United States of America
At Huron, we’re redefining what a consulting organization can be. We go beyond advice to deliver results that last. We inherit our client’s challenges as if they were our own. We help them transform for the future. We advocate. We make a difference. And we intelligently, passionately, relentlessly do great work…together.
Are you the kind of person who stands ready to jump in, roll up your sleeves and transform ideas into action? Then come discover Huron.
Whether you have years of experience or come right out of college, we invite you to explore our many opportunities. Find out how you can use your talents and develop your skills to make an impact immediately. Learn about how our culture and values provide you with the kind of environment that invites new ideas and innovation. Come see how we collaborate with each other in a culture of learning, coaching, ersity and inclusion. And hear about our unwavering commitment to make a difference in partnership with our clients, shareholders, communities and colleagues.
Huron Consulting Group offers a competitive compensation and benefits package including medical, dental, and vision coverage to employees and dependents; a 401(k) plan with a generous employer match; an employee stock purchase plan; a generous Paid Time Off policy; and paid parental leave and adoption assistance. Our Wellness Program supports employee total well-being by providing free annual health screenings and coaching, bank at work, and on-site workshops, as well as ongoing programs recognizing major events in the lives of our employees throughout the year. All benefits and programs are subject to applicable eligibility requirements.
Huron is fully committed to providing equal employment opportunity to job applicants and employees in recruitment, hiring, employment, compensation, benefits, promotions, transfers, training, and all other terms and conditions of employment. Huron will not discriminate on the basis of age, race, color, gender, marital status, sexual orientation, gender identity, pregnancy, national origin, religion, veteran status, physical or mental disability, genetic information, creed, citizenship or any other status protected by laws or regulations in the locations where we do business. We endeavor to maintain a drug-free workplace.
Manager, Central Billing Office Coding (National, Remote) in Chicago, Illinois
The Opportunity
Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.
Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients.
Joining the Huron team means you’ll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.
Join our team as the expert you are now and create your future.
Position Summary
Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.
Munson Healthcare revenue cycle operations are jointly operated by Huron and Munson Healthcare. Huron provides strategic revenue cycle operations leaders (managers and above are employed by Huron), while revenue cycle associates and supervisors are badged and employed by Munson Healthcare. Munson Healthcare, like all other providers in the market, is under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Munson, in collaboration with Huron, must empower leaders, clinicians, employees, affiliates, and communities to build a culture that fosters innovation to achieve the best outcomes for patients and succeed long-term.
Learn more about Munson Healthcare here: https://www.munsonhealthcare.org/.
Joining the Huron Managed Services team means you’ll help Munson Healthcare evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.
Join our team as the expert you are now and create your future.
Manages and oversees the system-wide compliance program in areas that relate to the revenue cycle. Works with Adventist Health compliance leadership in maintaining oversight of system-wide revenue cycle functions including health information management, coding, billing and registration. Manages projects related to the design, implementation, revision and maintenance of system-wide processes and systems that promote compliance related to the revenue cycle. Supervises and directs the activities of various levels of assigned personnel utilizing both professional and supervisory discretion and independent judgment. Manages large program(s) with substantial budget/impact. Manages and coordinates the diagnostic and procedural coding processes with Federal/State regulations and payer requirements for legal compliance. Ensures compliance with all applicable federal, state and local regulations, as well as with institutional/organizational standards, practices, policies and procedures. Supervises and directs the activities of various levels of assigned personnel utilizing both professional and supervisory discretion and independent judgment.
Supports Huron’s Compliance Program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, and other laws applicable to Huron’s business practices. This includes: becoming familiar with Huron’s Code of Ethics, attending training as required, notifying management when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations.
DUTIES & RESPONSIBILITIES:
Develop, recommend and oversee the implementation and administration of policies and procedures of respective areas.
CPC (Certified Professional Coder) Certification Required
Evaluate processes and procedures coordinating with the management team to ensure efficient areas of focus and adhere to federal and local laws and regulations.
Demonstrate, through plans and actions, a consistent standard of excellence to which all department work is expected to conform.
Focus on continuous improvement working with the Senior Manager and respective teams Managers across the Health System with a goal of delivering the highest degree of quality service possible.
Provide support for Human Resource guidance.
Complete, review, manage and monitor department budget.
Directs and leads the patient access team in the daily operations.
Performs other duties as assigned.
REQUIRED SKILLS:
Effective and efficient organization and planning skills with the proven ability to manage complex multi-workstream performance improvement projects or multiple concurrent client engagements, while delegating and overseeing the work of junior team members.
Proven analytical and critical thinking skills required to synthesize complex data sets and interpret qualitative and quantitative data and and trends to implement recommendations resulting in measurable performance improvement and successful organizational change.
Impactful and professional written and verbal communication setting clear project team direction.
Develop key deliverables, escalate risks and influence key stakeholders inclusive of client and internal senior leadership.
Ability to collaborate with team members and client counterparts to understand business challenges, adapt implementation methodologies and approaches to ensure results align with client’s business objectives.
Team leadership experience including building talent, training, supervising, coaching/mentoring and performance management.
Qualifications
- Living location can be anywhere within the contiguous 48 states and near a major airport
The estimated salary range for this job is $100,000 – $120,000. The range represents a good faith estimate of the range that Huron reasonably expects to pay for this job at the time of the job posting. The actual salary paid to an inidual will vary based on multiple factors, including but not limited to specific skills or certifications, years of experience, market changes and required travel. This job is also eligible to participate in Huron’s annual incentive compensation program, which reflects Huron’s pay for performance philosophy and Huron’s benefit plans which include medical, dental and vision coverage and other wellness programs. The salary range information provided is in accordance with applicable state and local laws regarding salary transparency that are currently in effect and may be implemented in the future.
Posting Category
Healthcare
Opportunity Type
Regular
Country
United States of America
At Huron, we’re redefining what a consulting organization can be. We go beyond advice to deliver results that last. We inherit our client’s challenges as if they were our own. We help them transform for the future. We advocate. We make a difference. And we intelligently, passionately, relentlessly do great work…together.
Are you the kind of person who stands ready to jump in, roll up your sleeves and transform ideas into action? Then come discover Huron.
Whether you have years of experience or come right out of college, we invite you to explore our many opportunities. Find out how you can use your talents and develop your skills to make an impact immediately. Learn about how our culture and values provide you with the kind of environment that invites new ideas and innovation. Come see how we collaborate with each other in a culture of learning, coaching, ersity and inclusion. And hear about our unwavering commitment to make a difference in partnership with our clients, shareholders, communities and colleagues.
Huron Consulting Group offers a competitive compensation and benefits package including medical, dental, and vision coverage to employees and dependents; a 401(k) plan with a generous employer match; an employee stock purchase plan; a generous Paid Time Off policy; and paid parental leave and adoption assistance. Our Wellness Program supports employee total well-being by providing free annual health screenings and coaching, bank at work, and on-site workshops, as well as ongoing programs recognizing major events in the lives of our employees throughout the year. All benefits and programs are subject to applicable eligibility requirements.
Huron is fully committed to providing equal employment opportunity to job applicants and employees in recruitment, hiring, employment, compensation, benefits, promotions, transfers, training, and all other terms and conditions of employment. Huron will not discriminate on the basis of age, race, color, gender, marital status, sexual orientation, gender identity, pregnancy, national origin, religion, veteran status, physical or mental disability, genetic information, creed, citizenship or any other status protected by laws or regulations in the locations where we do business. We endeavor to maintain a drug-free workplace.
location: remote
Location: US Locations Only; 100% Remote
The Enrollment Specialist contacts patients to explain our Chronic Care Management Program and offer them the opportunity to enroll. In addition, the Enrollment Specialist gains consent to enroll and manages the enrollment process. Enrollment Specialists spend the majority of their time speaking with patients via telephone in a contact center environment.
Essential Duties:
-
Educating potential program participants on the benefits of the Chronic Care Management program
-
Retrieving patient information to determine suitability for the Chronic Care Management Program
-
Interpreting and explaining information such as eligibility requirements, application details, program pricing, and what to expect after enrollment
-
Protecting the security of patient information
-
Complying with HIPAA and Medicare Fraud, Waste, and Abuse rules and regulations at all times
-
Maintaining knowledge of Medicare Part A and Part B insurance
-
Meeting Key Performance Indicators (KPIs) required for the role, including daily enrollment minimum, quality, and attendance
-
Other duties as assigned
Skills and Abilities Required:
-
High level of critical thinking
-
Exceptional sales skills
-
Computer proficiency with the ability to learn new applications
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Ability to accurately type 40 words per minute
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Ability to accurately document call content and chart transcription with strong attention to detail
-
Ability to clearly articulate thoughts and ideas
-
Active listening skills
-
Meet productivity requirements established by the company
Physical Requirements:
This position requires the following physical activities with or without accommodation.
-
Must be able to remain in a stationary position 50% – 85% of the time.
-
Frequent communication with others requires the exchange of accurate information.
Work Environment
-
This job operates in a fully remote professional office environment.
-
This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.
Required Education:
High School Diploma or equivalent
Location: US Locations Only
location: remote
Location: US Locations Only; 100% Remote
ChartSpan is the largest chronic care management (CCM) managed service provider in the US. CCM programs focus on patients who have multiple (two or more) chronic conditions that are expected to last at least 12 months or more.
An LPN Patient Care Coordinator at ChartSpan plays a key role in caring for the patients in our program while working in conjunction with the patient care team to facilitate and address existing and new chronic health issues. We provide an essential service that helps providers stay in touch with and meet their patients’ healthcare needs in between office visits.
Your role is to support and assist patients in obtaining the resources they need to improve their health, happiness, and longevity. LPN Patient Care Coordinators are patient advocates who form ongoing, collaborative relationships with patients to help improve their lifestyles for the better. This is a fully remote role.
Responsibilities
- Provides monthly care coordination through a collaborative process of planning, facilitation, and advocacy for options and services to meet patient’s health needs. Communicates resources and services available to patients through the continuum of care.
- Identifies patient-specific problems, goals, and interventions designed to meet the patient’s needs as identified by the clinical assessment/reassessment that are action-oriented and time-specific.
- Maintain patient chart compliance through proper documentation and updates of medical history, medication, immunizations, allergies, surgical history, and family history.
- Demonstrates awareness of circumstances necessitating revisions to the plan of care, such as changes in the client’s condition, lack of response to the care plan, preference changes, transitions across settings, and barriers to care and services.
- Documents relevant, comprehensive information and data using standard assessments and tools supporting the plan of care and organized care coordination systems aimed at improving the outcomes of patients.
- Provide appropriate health education.
- Escalate patient concerns to the triage nurse team.
Qualifications
- Licensure: License and current registration to practice as a Licensed Practical Nurse in a COMPACT state.
- Education: An LPN degree from an approved program is required.
- Pass background check
Job Type: Full-time (Remote)
Location: US Locations Only
location: remoteus
UTILIZATION REVIEW NURSE
(REMOTE)
- Baltimore, MD
- SINAI HOSPITAL
- UTILIZATION REVIEW
- Full-time w/Weekend Commitment – Day shift – 8:00am-4:30pm
- RN Other
- 81138
- Posted: Today
Summary
UTILIZATION REVIEW NURSE (remote)
Position Summary: Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment.
Essential Functions:
Chart Review: Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption.
Enters clinical reviews into the software program. Maintains close communication with external reviewers/internal financial counselors/patient access personnel and performs certification activities as required by payor.
Denial Management: Monitors and identifies patterns or trends in utilization management
Monitors potential and actual denials and coordinates with nurse Care Manager and/or Social Worker for any follow up necessary. Documents in software program the actions taken to coordinate care and avoid denials. Assists nurse Care Managers in communicating with the patient denied hospital days as well as the issuance of Medicare forms including HINN, Detailed Notice of Discharge to patients/family/significant other when they are in disag
Qualifications/Requirements:
Education/Knowledge: Basic professional knowledge; equivalent to a Bachelor’s degree; working knowledge of theory and practice within a specialized field Education/Knowledge:
Education Discipline: Minimal degree requirement: Bachelor of Science in Nursing (BSN’s from A CCNE accredited school)
Certification or Licenses: Maryland Registered Nurse License REQUIRED
Experience:
- Medical terminology (Frequently)
- Nursing Process skills based on MD Nurse
- Practice Act (Frequently)
- Critical thinking skills (Frequently) Midas (Frequently)
- Healthstream (Occasionally)
- Utilization Review Criteria (Frequently)
- Microsoft Office Suite (Frequently)
- Basic computer skills (Frequently)
- Cerner (Frequently)
- Standard Office Equipment (Frequently)
Additional Comments Work from home will be 95% or greater. Training/remediation may be onsite with occasional onsite meetings.
Additional Information
As one of the largest health care providers in Maryland, with 13,000 team members, We strive to CARE BRAVELY for over 1 million patients annually. LifeBridge Health includes Sinai Hospital of Baltimore, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital and Grace Medical Center, as well as our Community Physician Enterprise, Center for Hope, Practice Dynamics, and business partners: LifeBridge Health & Fitness, ExpressCare and HomeCare of Maryland.
location: remoteus
Licensed Clinical Social Worker
Job description
We are looking for full-time Licensed Therapists to join our team and provide outpatient services through our telehealth program! Benefits: _ Our team works 100% remotely from their own homes! _ W2, Full-time Compensation package includes a base plus bonus! $66K-$100k earning potential. Monday – Friday schedule; No weekends! Liability insurance covered and annual stipend for growth & education opportunities We not only partner with commercial health plans, but are also a licensed Medicaid and Medicare provider and see patients across the lifespan Requirements: Brave licensed therapists may be based anywhere in the US, but must have an active FL license to get started. Don’t yet have one of these licenses but interested? Let’s talk! Brave will provide reimbursement for associated licensure fees for new hires. Master’s level degree (LCSW, LMHC, LCPC, LMFT, or equivalent credential) Eligibility to work in the United States Work from home space must have privacy for patient safety and HIPAA purposes Fluency in English, Spanish preferred; proficiency in other languages a plus Meets background/regulatory requirements Skills: Knowledge of mental health and/or substance abuse diagnosis Treatment planning Comfortable with utilizing technology at all points of the day, including telehealth software, video communication, and internal communication tools Experience working in partnership with clients to achieve goals Ability to utilize comprehensive assessments Why We’re Here: Brave Health is on a mission to expand access to high-quality, affordable care for behavioral health conditions. We utilize the power of technology to eliminate barriers and expand access to high quality mental health and substance use disorder treatment. Through telehealth services we are able to reach those in need, when and where they need it. As a community based start-up, our goal is to make quality mental health services accessible for all. Brave Health is very proud of the erse team we have that cares for our erse population of patients. We are an equal opportunity employer and encourage all applicants from every background and life experience without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status_ Job Type: Full-time Pay: $66,000.00 – $100,000.00 per year Benefits: Dental insurance Employee assistance program Health insurance Life insurance Paid time off Professional development assistance Vision insurance Schedule: Monday to Friday Work setting: Remote People with a criminal record are encouraged to apply Application Question(s): Are you currently licensed as a FL LCSW, FL LMHC, or FL LMFT? On average, how many clients are you seeing daily? Do you have experience using an Electronic Medical/Health Record (EMR or EHR)? What year did you obtain your license? I would like to receive updates from a Brave Health recruiter about my application via SMS. (Yes / No) Work Location: Remote C: 0.300location: remoteus
Nurse Case Manager
remote type
Hybrid
locations
United States – Remote
time type
Full time
job requisition id
R2415557
Medical Case Manager – CT08GE
We’re determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals – and to help others accomplish theirs, too. Join our team as we help shape the future.
As Nurse Case Manager, we seek to improve on our patients’ abilities! This position is part of a dynamic, fast-paced team of experienced Nurse Case Manager located remotely across the United States.
The ideal candidate for the Nurse Case Manager role will oversee Workers’ Compensation claims with complex medical conditions referred for medical assessment, clarification of limitations/restrictions or case management. On average, a Nurse Case Manager shall handle 50-60 cases with a moderate degree of complexity and acuity of medical condition. This inidual will have the opportunity to collaborate with claims staff, the injured worker, an employer, and other healthcare professionals to promote quality medical care with a focus on returning our patients back to work. Our goal is to achieve optimum, cost-effective medical and vocational outcomes.
RESPONSIBILITIES include but are not limited to:
- Through the use of clinical tools, telephonic interviews, and clinical information/data, completes assessments that will take into account information from various sources to address all conditions including biopsychosocial, co-morbid and multiple diagnoses that impact recovery and return to work.
- Leverages critical thinking, extensive clinical knowledge, experience, and skills in a collaborative process to develop a comprehensive strategy for the injured worker to become medically stable and/or return to work.
- Independently identifies complex situations where communication with internal and/or external partners is needed to reach a full understanding of the factors involved with the assessment of the mechanism of injury, causality, and ability to return to work.
- Application, Interpretation and Compliance with clinical criteria and guidelines, applicable policies and procedures, regulatory standards, and jurisdictional guidelines to determine eligibility and integration with available internal/external resources and programs.
- Using holistic approach to focus on medical and ability management activities resulting in accurate and timely treatment and return to work.
- Consults with supervisor and others to address and problem solve barriers to meeting goals and objectives, participate in roundtables and claim meetings with claim partners to focus and benefit overall claim management.
QUALIFICATIONS:
- RN with current unrestricted state licensure required.
- Associate degree in nursing required.
- 3 years clinical practice experience required.
- Bachelor’s degree in nursing preferred, but not required.
- Certification as a CCM (CDMS, CRC, CVE and/or current CRRN), or willingness to pursue.
- Workers Compensation case management experience preferred.
Key Competencies:
- Basic Computer proficiency (Microsoft Office Products including Word, Outlook, Excel, Power Point); which includes navigating multiple systems.
- Ability to effectively communicate telephonically and in written form.
- Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone, and typing on the computer.
- Work requires the ability to perform close inspection of handwritten and computer-generated documents as well as a PC monitor.
- Ability to synthesize large volumes of medical records & facilitate multi-point care coordination.
- Must meet productivity & quality expectations.
- Ability to organize and prioritize daily work independently and effectively.
Additional Competencies:
- Strategic thinking.
- Customer focus.
- Business knowledge.
- Problem solving.
- Collaboration – partnership.
- Decision making skills.
- Communication skills.
Additional Information:
Start date: 4/29/2024
- This role can have a Hybrid or Remote work arrangement. Candidates who live near one of our offices and will have the expectation of working in an office 3 days a week (Tuesday through Thursday). Candidates who do not live near an office will have a remote work arrangement, with the expectation of coming into an office as business needs arise.
For full-time, occasional, part-time, or remote positions: (1) high speed broadband internet service is required, we do not recommend or support DSL, wireless, Mifi, Hotspots, Fiber without a modem and Satellite; (2) Internet provider supplied modem/router/gateway is hardwired to the Hartford issued computer with an ethernet cable; and (3) minimum upload/download speeds of 5Mbps/30Mbps will be required. To confirm whether your Internet system has sufficient speeds, please visit http://www.speedtest.net from your personal computer.
Compensation
The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartford’s total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:
$67,680 – $101,520
Equal Opportunity Employer/Females/Minorities/Veterans/Disability/Sexual Orientation/Gender Identity or Expression/Religion/Age
Title: Clinical Trial Nurse Navigator
Location: USA-
Why LLS
How many people can answer the question, “What do you do for a living?” with the answer, “I help find cures for cancer.” At LLS, employees take our mission seriously. Whether you work in one of our chapters, are an accountant at the national office or a specialist in our Information Resource Center, you work each day on making our mission a reality: Cure leukemia, lymphoma, Hodgkin’s disease and myeloma, and improve the quality of life of patients and their families. Join us and give new meaning to the word, “job.”
Overview
Works with patients, family members and/or health-care providers to assist patients in their efforts to identify appropriate clinical trials and help overcome obstacles to enrollment. Utilizes nursing assessment skills, online databases, and information from clinical sites to determine qualification for clinical trials. Educates patients and family members about the patient’s blood cancer diagnosis, helps them to understand both standard of care and clinical trial treatment options, and provides support around decisions to end treatment. Collaborates with The LLS’ Information Resource Center (IRC) staff to provide education, services and support to patients and family members.
As a valued member of LLS, you are eligible for a comprehensive benefits package. Our offerings include medical, dental, and vision insurance; life insurance; flexible spending accounts; a 403b retirement plan along with generous paid time off. In addition, we observe federal paid holidays throughout the year, and offer a wellness program and an employee assistance program.
While employees may be permitted to work remotely, travel to the assigned office, HUB or Satellite Offices may be required as determined by the employee’s manager and the employee’s Strategic Talent Partner.
Additional Position Information
Reports to: Director of Clinical Trial Support Center
Responsibilities
Duties and Responsibilities:
+ Independently maintain own caseload of patients seeking enrollment into clinical trials; this includes assessing, educating, and objectively presenting information to patients about available treatment options, including clinical trials
+ Use problem solving skills to help patients overcome obstacles to enrollment
+ Collaborates with LLS’s Information Resource Center (IRC) staff to educate and support patients and family members in their efforts to understand their diagnosis, treatment options and available services
+ Serve in consulting role to the Information Resource Center about clinical trials
+ Serves as a resource to The LLS Patient and Professional Education staff as they develop clinical trial related materials and programs.
+ Maintain/increase knowledge and understanding of hematologic cancers, blood and bone marrow transplant and psychosocial aspects of living with cancer
+ Contribute to continual process improvement of Clinical Trial Support Center procedures
+ Develop effective working relationships within The Leukemia & Lymphoma Society and with trial site staff, investigators, sponsors, patient and professional organization
+ Exhibit comprehensive understanding of ethical standards and federal regulations in human subjects research
#LI-Remote
Qualifications
Education, Experience, and Qualifications:
+ Bachelor’s degree in Nursing required; Masters preferred. Master’s degree in non-nursing area considered.
+ Current RN licensure required
+ Oncology experience preferred; specialty training in Oncology/Hematology preferred; OCN certification preferred; clinical research experience preferred
+ Ability and desire to excel in independent work and in a team environment
+ Spanish speaking preferred
Position Requirements:
+ Outstanding critical thinking, problem-solving, and collaboration skills
+ Excellent ability to communicate verbally and in writing
+ Ability and desire to excel in independent work and in a team environment
+ Demonstrated commitment to independent learning and skill enhancement
+ Expertise in Microsoft Office including Excel, Word, and OneNote
Physical Demands & Work Environment:
+ Physical demands are minimal and typical of similar jobs in comparable organizations
+ Work environment is representative and typical of similar jobs in comparable organizations
+ Occasional travel to national oncology/hematology meetings and meetings at the National Office of LLS
+ Must have reliable internet; minimum download speed 50mbps minimum upload speed 50mbps. Recommended download speed 100mbps recommended upload speed 100mbps.
+ Average salary range is $95K-$110K, open to further discussion based on geography.
Disclaimer
The statements herein are intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of employees. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of the Company. Reasonable accommodations may be made to enable iniduals with disabilities to perform the essential functions.
Job LocationsUS-(REMOTE – Work from Home)
Job ID 2024-8009
# of Openings 1
Category Hidden (58428)
FLSA Status Exempt
Type Full Time Regular
location: remoteus
Credentialing Coordinator Remote
Job Category: Managed Care
Requisition Number: CREDE020819
Full-Time
USA Remote
United StatesJob Details
Description
The Credentialing Coordinator administers the provider credentialing process for Ambulatory Surgery Centers. This is a Full-Time remote position.
ESSENTIAL FUNCTIONS:- Process initial and re-credentialing provider applications for Ambulatory Surgery Centers
- Conducts primary source verification via various state and national sources
- Maintains working knowledge of various provider credentialing policies and required procedures/forms
- Data entry of provider demographics information in the credentialing software
Other assigned duties as required
*2 Years Experience of provider level credentialing with a CVO, surgery centers or hospitals preferred.
ABILITIES:
- Maintains strict confidentiality with demonstrated experience applying good judgment and discretion
- Strong detail oriented skills
- Effective verbal and written communication skills and work effectively with medical staff and external agencies
- Identify, analyze and solve provider enrollment and credentialing issues
- Handle multiple projects and reach multiple deadlines.
- Exercise sound judgment in decision-making
- Excellent time management skills
- Exceptional ability to plan, organize, and implement a plan to completion
- Work effectively within a team environment
- Deal courteously with internal and external customers
- Prioritize duties and be self-motivated
- Microsoft Office and other industry specific software
- Type 40-50 wpm.
location: remoteus
Title: Assistant, Nurse
Location: USA-
Cardinal Health
Assistant, Nurse in United States What Inidualized Care contributes to Cardinal HealthClinical Operations is responsible for providing clinical specialties support and expertise in the areas of advice and consulting, research and patient care to internal business units and external customers.
Inidualized Care provides care that is planned to meet the particular needs of an inidual patient.
Job Summary
The Nurse, Inidualized Care promotes high-quality patient care and treatment through patient education. With a focus on the products and treatments of a small number of pharmaceutical clients, the Nurse receives inbound calls from patients and schedules outbound calls for patients who have begun treatment with one or more of the client’s products. The Nurse educates patients on their treatments and disease states, refers patients to a variety of additional services, and reports adverse events in accordance to FDA and client requirements.
Qualifications
- 0-2 years of experience preferred
- BA, BS or equivalent experience in related field preferred
- LVN is required
- 2-4 years of Case Management experience is preferred
- Demonstrate effective, empathetic and professional communication
- Clear knowledge of Medicare (A, B, C, D)
- 1-2 years of experience with Prior Authorization and Appeal submissions
- Must be able to manage multiple concurrent assignments
- Must communicate clearly and effectively in both a written and verbal format
- Ability to work with high volume production teams with an emphasis on quality
- Able to thrive in a competitive and dynamic environment
- Intermediate to advanced computer skills and proficiency in Microsoft Office including but not limited to Word, Outlook, and preferred Excel capabilities
- Previous medical experience is preferred
Responsibilities
- Deliver virtual or telephonic educational support to identified patients, caregivers, Healthcare Professionals (HCPs) and their staff to meet all relevant standards as set by the client company
- Be a champion for each patient and consented care partner(s)
- Answer inbound inquiries of patients, care partners and HCPs
- Act as primary point of contact for patients and HCPs
- Understand a patient’s support needs and interaction preferences to deliver a seamless, tailored patient experience that helps each patient complete their pathway to treatment as prescribed by their HCP
- Provide support and guidance to help ensure patients have access to the patient support program resources by compliantly navigating reimbursement, and mitigating any patient out-of-pocket barriers, as applicable
- Experience in supporting time sensitive requests and prioritization of assignments and working with a sense of urgency.
- Investigate and resolve patient/healthcare provider inquiries and concerns in a timely manner
- Work closely with patients, patient caregivers, healthcare providers. Sonexus Health reimbursement team, the manufacturer’s employees, third party vendors to clearly identify issues and provide resolution.
- Responsible for meeting the newly identified patient, patient caregivers, healthcare providers over the phone to provide education on the drug, disease process, diagnostic testing, support services provided by the manufacturer and review benefit information.
- Exhibit effective communication and tele-management skills.
- Proactive follow-up with various contacts to ensure patient access to therapy.
- Converse with callers in an empathetic manner and build rapport
- Act as patient and healthcare providers single point of contact for all inquiries
- Possess effective organizational skills, including working on multiple cases simultaneously.
- Responsible for the identification, intake, documentation, and submission of all Adverse Event Reports occurring in patients which are taking or have previously taken the manufacturer’s product.
- Submit all adverse event reports to manufacturer/third party vendor within stipulated timeframe; additionally follow up if requested to do so.
- Responsible for addressing Medical Information inquiries from consumers, healthcare providers and other entities, including but not limited to, requests for product information, inquiries about side effects, guidelines for appropriate use of the product, etc.
- Provide identification, intake, documentation, and submission of all reported Product Complaints, per the manufacturer guidelines.
- Perform other activities related to the internal initiatives and/or the manufacturer’s programs as assigned.
- Responsible for maintaining HIPAA guidelines.
- Must adhere to strict guidelines regarding the protection of proprietary educational materials and product information that may be printed or available via email, websites, or other electronic means, provided by the manufacturer.
- Concurrently handle multiple outstanding issues and ensure all items are resolved in a timely manner to the satisfaction of all parties
What is expected of you and others at this level
- Applies basic concepts, principles and technical capabilities to perform routine tasks
- Works on projects of limited scope and complexity
- Follows established procedures to resolve readily identifiable technical problems
- Works under direct supervision and receives detailed instructions
- Develops competence by performing structured work assignments
Training and Work Schedules:
Your new hire training will take place 8:00am – 5:00pm CST, mandatory attendance is required.
This position is full-time (40 hours/week). Employees are required to work Monday – Friday, 8:00am – 5:00pm CST.
Remote Details:
You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following:
Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location.Dial-up, satellite, WIFI, Cellular connections are NOT acceptable.
- Download speed of 15Mbps (megabyte per second)
- Upload speed of 5Mbps (megabyte per second)
- Ping Rate Maximum of 30ms (milliseconds)
- Hardwired to the router
- Surge protector with Network Line Protection for CAH issued equipment
Anticipated hourly range: $25.80 per hour – $36.85 per hour
Bonus eligible: No
Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
- Medical, dental and vision coverage
- Paid time off plan
- Health savings account (HSA)
- 401k savings plan
- Access to wages before pay day with myFlexPay
- Flexible spending accounts (FSAs)
- Short- and long-term disability coverage
- Work-Life resources
- Paid parental leave
- Healthy lifestyle programs
Application window anticipated to close: 03/04/2024 *if interested in opportunity, please submit application as soon as possible.
Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.
Cardinal Health supports an inclusive workplace that values ersity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.
We are a team of nearly 48,000 mission-driven partners striving each day to advance healthcare and improve lives. We are Essential to care.
Headquartered in Dublin, Ohio, Cardinal Health, Inc. (NYSE: CAH) is a distributor of pharmaceuticals, a global manufacturer and distributor of medical and laboratory products, and a provider of performance and data solutions for health care facilities
We are a crucial link between the clinical and operational sides of care, working with more than 4,500 sourcing and manufacturing partners to deliver end-to-end solutions and data-driven insights that advance healthcare and improve lives every day. With deep partnerships, erse perspectives and innovative digital solutions, we build connections across the continuum of care.
With 50 years of experience, approximately 44,000 employees and operations in more than 30 countries, Cardinal Health seizes the opportunity to address healthcare’s most complicated challenges — now, and in the future.
On Thursday, Jan. 7, 2021, we celebrated the day our founder, Bob Walter, had the vision to start a business that became known as Cardinal Health.
One of the most important ways we celebrated was by giving back to the communities where we live and work. 2021 was a “Year of Service” for all Cardinal Health employees around the world.
View Cardinal Health on YouTube
Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Title: Coordinator Quality Coding, Inpatient
Location: CO-Denver
This is a full-time, remote/work from home, exempt/salary position on UCHealth’s Inpatient Coding team based in Denver, CO. Potential opportunity for eligible out-of-state applicants. Responsible for coding data integrity by reviewing diagnosis and procedure code assignments, and validating MS-DRG and APR-DRG designations. Works closely with Leadership, CDI, Physician Advisors and other internal quality departments, providing answers to coding questions and correctly applying Official Coding guidelines, Coding Clinics and other official guidance which support your recommendations.
Job Duties
+ Conducts internal quality reviews, in accordance with the Coding Compliance Plan. Reviews government, commercial and other external audits. Performs internal audits as requested by other departments. Monitors and reports issues/trends.
+ Presents coding education to staff, leadership and others throughout the Health System. Provides training as necessary. Assists with developing and guiding SMEs responsibilities.
+ Responds to coding questions submitted throughout the Health System. Reviews physician queries for appropriateness, and related correspondence.
+ Reviews coded claims data in response to denials and customer service requests. Provides thorough rationale and explanation for proper code assignments.
+ Within scope of job, requires critical thinking skills, decisive judgement and the ability to work with minimal supervision. Must be able to work in a fast-paced environment and take appropriate action.
Requirements
+ + High School Diploma or GED
+ Coding-related certification from AHIMA or AAPC
+ 3 years of relevant coding experience
Preferred
+ Associate’s Degree
+ CCS
+ The pay range for this position is: $29.54 – $44.31 / hour. Pay is dependent on applicant’s relevant experience.
UCHealth offers a Five Year Incentive Bonus to recognize employee’s contributions to our success in quality, patient experience, organizational growth, financial goals, and tenure with UCHealth. The bonus accumulates annually each October and is paid out in October following completion of five years’ employment.
UCHealth offers their employees a competitive and comprehensive total rewards package:
+ Full medical, dental and vision coverage
+ Retirement plans to include 403(b) matching
+ Paid time off. Start your employment at UCHealth with PTO in your bank
+ Employer-paid life and disability insurance with additional buy-up coverage options
+ Tuition and continuing education reimbursement
+ Wellness benefits
+ 5 year incentive bonus
+ Full suite of voluntary benefits such as identity theft protection and pet insurance
+ Education benefits for employees, including the opportunity to be eligible for 100% of tuition, books and fees paid for by UCHealth for specific educational degrees. Other programs may also qualify for up to $5,250 pre-paid by UCHealth or in the form of tuition reimbursement each calendar year
Loan Repayment:
UCHealth is a qualifying employer for the federal Public Service Loan Forgiveness (PSLF) program!
UCHealth provides employees with free assistance navigating the PSLF program to submit their federal student loans for forgiveness through Savi.
At UCHealth, we do things differently
We believe in something different: a focus on the iniduality of every person. In big ways and small, we exist to improve the extraordinary lives of all those we serve. As Colorado’s largest and most innovative health care system, we as a team deliver on the commitment to provide the best possible experience for our patients and their families. We foster a true human connection and give people the freedom to live extraordinary lives. A career at UCHealth is more than a job, it’s a passion.
Going beyond quality requires the perfect balance of talent, integrity, drive and intellectual curiosity. We are looking for iniduals who recognize, like us, that the world of medicine is ever-changing and are motivated to do what is right, not what is easy. We support creativity and curiosity so that each of us can find the extraordinary qualities within ourselves. At UCHealth, we’ll do everything in our power to make sure you grow and have a meaningful career. There’s no limits to your potential here.
Be Extraordinary. Join Us Today!
UCHealth recognizes and appreciates the rich array of talents and perspectives that equal employment and ersity can offer our institution. As an affirmative action/equal opportunity employer, UCHealth is committed to making all employment decisions based on valid requirements. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the inidual’s race, creed, color, religion, gender, national origin or ancestry, age, mental or physical disability, sexual orientation, gender identity, transgender status, genetic information or veteran status. UCHealth does not discriminate against any “qualified applicant with a disability” as defined under the Americans with Disabilities Act and will make reasonable accommodations, when they do not impose an undue hardship on the organization.
location: remoteus
Remote Inpatient Coder
Location: FRANKLIN Tennessee; United States
Job Description & Requirements
Pay Rate: $30.00 – $40.00
TYPE OF JOB ORDER: Remote Inpatient Coder (Community Hospital Setting)
REQUIRED SKILLS: 3-4 Years Inpatient Coding in an Acute Care setting
#OF WEEKS: 26 Weeks
SHIFT/HOURS: Flexible M-F some Weekends
EXPECTED HOURS: 40
LICENSE/CREDENTIALS REQ: RHIT, CCS, RHIA, CPC-H
SYSTEMS: 3M 360 CAC & Encoder; Cerner, eCharms, Legacy, McKesson, MedHost
***Must Have Cerner****
NOTES: Under indirect supervision, is responsible for accurate coding of all inpatient services, procedures, diagnoses, and conditions, working from the appropriate documentation in the medical record at a community based Health System. All work is carried out in accordance with the rules, regulations, and coding conventions of the American Hospital Association (Coding Clinic), ICD-10-CM/PCS, Centers for Medicare and Medicaid Services (CMS).
Facility Location
Franklin, close neighbor to the much larger Nashville, is a livable city with a lovely historic downtown. The city’s Main Street bustles with thriving small businesses and eateries, offering visitors and residents no shortage of entertainment options. The Franklin Theatre, established in 1937, is a cultural icon, boasting an ever-impressive roster of regional and national touring musicians, and showing classic movies on a weekly basis. Two annual Main Street Festivals reinforce the vibrant identity of the city and Pumpkinfest is a resident favorite, welcoming in autumn in style.Job Benefits
Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary but the perks don’t stop there. There are many additional benefits to enjoy, including:- Medical, dental and vision benefits
- Earned time off and paid holidays
- Paid continuing education time
- 401(K) retirement planning
- Short-term disability, life insurance, paid jury duty
- Access to the largest network of facilities and providers in the country
- Industry experienced workforce management team
- Licensure and certification reimbursement
About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.location: remoteus
Clinical Data Coder/Specialist-Temp
Remote
Position Summary:
The Clinical Data Coder/Specialist – Pre Claims is responsible for the accurate and timely work to effect filing of Insurance claims. Qualified inidual will demonstrate clinical claims detailed knowledge, coding and delivering resolutions to missing/ incomplete order data. This person will identify invalid clinical values to help drive clean claims and revenue pull through on all products and services.
This position will support the Revenue Cycle function and report to the Front End Manager of Revenue Cycle.
Essential Duties and Responsibilities:
– Identify order and reimbursement deficiencies – both clinical and code related
– Investigate and correct, where appropriate, deficient clinical claim information
-Identify and escalate missing, and sometimes invalid, clinical order data for timely contact resolution with supporting cross functional teams
– Partner with multiple internal cross-functional teams and successfully manage multiple product projects simultaneously.
-Research claim and account information using various systems and portals internal and external
-Stay current with relevant medical billing regulations, rules and guidelines
-Complete position responsibilities within the appropriate time frame while adhering to quality standards
-Ability to interact with various insurances/ third party payors accurately and timely to ensure that authorizations are obtained and necessary documents are available for claim support based on internal and external policies and regulations
– Participate in clinical data management activities including leading clinical data initiatives, analysis and optimization of our clinical data capture workflows
– Translate data into meaningful information and knowledge that supports decision making or determining action that drives performance improvement and quality
– Identifies and uses internal and external sources of information for benchmarking and comparative performance, which includes networking with clinical communities, researching literature and agencies, and staying current on new indicators and other requirements
-Act as SME for multiple purposes where coding and clinical operations data is relevant
– Support and comply with the company’s policies and procedures.-Maintains strictest confidentiality, and adheres to all HIPAA guidelines/regulations
– Regular and reliable attendance. – Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.-Perform analytical and special projects, prepare ad hoc reports/data queries as may be assigned/requested, working with leadership
Qualifications:
Minimum Qualifications:
– Bachelor degree in relevant field is preferred
– 3+ years professional coding experience with current certification including International Classification of Diseases (ICD-10) and Coding Procedure Terminology (CPT) and HCPCS coding. – Authorization to work in the United States without sponsorship.– Certified coder designation/ certification by AHIMA or AAPC required
– Superior organization skills, detail oriented, and ability to be persistent and follow through
– Problem-solving, ability to adapt, flexibility in approaches to accomplishing tasks, and ability to independently arrive at creative solutions to problems
– Excellent communication skills, both verbal and written, particularly the ability to convey technical information in an accessible and understandable manner
– Ability to work both independently and in collaboration with iniduals from various disciplines
Preferred Qualifications:
– 5+ years of experience coding in the medical/healthcare billing area- Lab a plus
– Any years of experience in the revenue cycle function to include third party payer experience. – Thorough understanding of professional coding, documentation, medical billing processes. – Deep familiarity with payer/insurance Medical policy, Prior Auth, claims, appeals and reimbursement processes. – Knowledge and familiarization with Medicare billing regulations and reimbursement methodologies for LaboratoryThe pay range is listed and actual compensation packages are based on a wide array of factors unique to each candidate, including but not limited to skill set, years & depth of experience, certifications and specific office location. This may differ in other locations due to cost of labor considerations.
Remote USA
$20$30 USD
OUR OPPORTUNITY
Natera is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. Our aim is to make personalized genetic testing and diagnostics part of the standard of care to protect health and enable earlier and more targeted interventions that lead to longer, healthier lives.
The Natera team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions, who care deeply for our work and each other. When you join Natera, you’ll work hard and grow quickly. Working alongside the elite of the industry, you’ll be stretched and challenged, and take pride in being part of a company that is changing the landscape of genetic disease management.
WHAT WE OFFER
Competitive Benefits – Employee benefits include comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents. Additionally, Natera employees and their immediate families receive free testing in addition to fertility care benefits. Other benefits include pregnancy and baby bonding leave, 401k benefits, commuter benefits and much more. We also offer a generous employee referral program!
For more information, visit www.natera.com.
Natera is proud to be an Equal Opportunity Employer. We are committed to ensuring a erse and inclusive workplace environment, and welcome people of different backgrounds, experiences, abilities and perspectives. Inclusive collaboration benefits our employees, our community and our patients, and is critical to our mission of changing the management of disease worldwide.
All qualified applicants are encouraged to apply, and will be considered without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, age, veteran status, disability or any other legally protected status. We also consider qualified applicants regardless of criminal histories, consistent with applicable laws.
If you are based in California, we encourage you to read this important information for California residents.
Link: https://www.natera.com/notice-of-data-collection-california-residents/
Please be advised that Natera will reach out to candidates with a @natera.com email domain ONLY. Email communications from all other domain names are not from Natera or its employees and are fraudulent. Natera does not request interviews via text messages and does not ask for personal information until a candidate has engaged with the company and has spoken to a recruiter and the hiring team. Natera takes cyber crimes seriously, and will collaborate with law enforcement authorities to prosecute any related cyber crimes.
location: remoteus
Virtual Care Nurse Practitioner (California Licensed)
Los Angeles, California, United States
About Us:
Founded in 2017 by Carolyn Witte and Felicity Yost, Tia is the modern medical home for women. We are trailblazing a new paradigm for women’s healthcare that treats women as whole people vs. parts or life stages. Blending in-person and virtual care services, Tia’s Whole Woman, Whole Life care model fuses gynecology, primary care, mental health and evidence-based wellness services to treat women comprehensively. By making women’s health higher quality and lower cost, Tia makes women healthier, providers happier, and the business of care delivery stronger setting a new standard of care for women everywhere.
Tia has raised more than $132 Million in venture capital funding to date, including a recent $100 Million Series B investment, one of the largest early-stage rounds ever for a healthcare company focused on women. Tia has ambitious plans to scale its whole-woman, whole-life model to more than 100,000 women by 2023. We’ll do this by growing virtual and in-person operations in existing and new markets while expanding its service lines to care for women throughout their entire lives — from puberty to menopause. Since launching in 2017, Tia has grown to serve thousands of women aged 18-80 with blended in-person and virtual care in New York City, Los Angeles, Phoenix and soon San Francisco.
We’re building a world class team to reimagine women’s healthcare. We’re an interdisciplinary team of clinicians, researchers, designers, technologists and operators who have seen firsthand how broken the healthcare system is for women. We’re united by a powerful mission to enable every woman to achieve optimal health, as defined by herself, as well as a shared set of values and principles that define our business, products, and culture.
Tia is building a culture of excellence in people, process and product. This is our northstar value;
What is excellence, exactly?
Excellence about constantly elevating yourself, it is the process of constantly striving to perform to the best of your abilities, and identifying your top potential through constant learning, experimentation and evolution. Excellence is not about achieving perfection, as that insinuates a pinnacle. Instead, in our terms, excellence is about the pursuit of constant improvement. We’re looking for people who want to go on that hard journey of constantly setting new personal records, and organizational records.
We practice excellence at Tia by demonstrating the following types of behaviors: We chose (and actively choose) excellence as Tia’s highest order value because it crystalizes into one word several behaviors that we hold dear, specifically:
- A drive to constantly improve through experimentation, reflection. and an insatiable growth mindset said another way, we’re energized by the possibility of invention, innovation, and iteration
- Being present in and grateful for the journey not just the goal line. Perfection is static. Excellence is a process (more on this important distinction below)
- Asking why, then why again because accepting this is just the way it is is not good enough
- Grit & perseverance a maker mentality that involves rolling up your sleeves, but also deep care for oneself and for others
- A commitment to uncovering talents to unlock rock star potential across every inidual
Furthermore, excellence reflects the bigness and the boldness of Tia’s mission and vision a world in which every woman can achieve optimal health, as defined by herself.
Said another way, Tia’s mission is NOT to make healthcare incrementally better for women. Instead, we’ve intentionally set out to create a fundamentally new paradigm for modern women’s healthcare that’s truly excellent. We believe that creating a company that operates in a culture of excellence will manifest in our product. Reaching this goal is not an overnight pursuit or a one and done. We have not and will not get it right with the first swing. Rather, this higher order goal is a moving target one we have not and will not ever fully achieve. By design, we will never be done with this work, but instead, we will be continuously in pursuit of our mission. It is this continuous pursuit the journey, not the finish line that truly embodies excellence.
Location: This is a fully remote position. (Active NP license for the state of CA required for this role but you may live outside of CA with the active CA license)
About the role:
We’re looking for a Full-Time Nurse Practitioner (active NP license for the state of CA) passionate about women’s health for Tia’s Virtual Care Team. As a Virtual Nurse Practitioner, you will be an integral part of the care delivery system. You will see patients virtually and deliver comprehensive and integrative care spanning across gynecology and primary care services: from virtual annual visits to birth control consults to flu/cold consults and dermatology management. Further, you will remotely triage, diagnose, and treat patients via our proprietary chat software.
Nurse Practitioners are integral to the formation and iteration of our technology development and care model. In addition to your clinical role, you’ll have an opportunity to shape the Tia care model and improve our technology tools. You’ll collaborate with our product & engineering teams to share insights and feedback.
Schedule is set with some flexibility. Start times are 7a-9a for early shifts and or 10a-12p for later shifts. Expectation is that you take two evening shifts per week. However we do have some flexibility depending on availability.
A bit about you:
Values and abilities you’ll bring to Tia:
- You’re motivated to elevate women’s care by bringing a shared-decision making approach to women’s health.
- You believe that each woman knows her body best, though she may need help interpreting what the signs mean. Your mission as a woman’s healthcare provider is to help your patients understand those signs and develop robust, multi-faceted treatment plans to reach health goals. You practice this by being a true partner on a patient’s health journey, never dogmatic, rigid or glued to institutions.
- You are an incredibly good question-asker & prober, this allows you to identify nuances of a patient’s life that could be pertinent to their story. You’re like a detective — but you do this with an elegance that makes the patient feel at ease sharing deeply personal information.
- You’re facile with technology, comfortable and experienced providing high quality care digitally via telemedicine and interested in the process of developing new technology to support the highest quality clinical care..
- You’re data driven and consistently incorporate new and evolving research into your day-to-day practice
- You’re a high functioning multi-tasker who has an incredible ability to stay calm and focused under pressure – this is a given – you are a NP after all! .
- You are a tolerant and inclusive thinker. You believe in sex-positive, no judgement and radically inclusive healthcare for every person, and espouse these values in your everyday life.
Skills and assets you’ll bring to Tia:
- You’re a board certified Nurse Practitioner (family nurse practitioner or women’s health nurse practitioner), with active and unrestricted licenses in the state of California and able to provide primary care and support of all aspects of women’s health with compassion and empathy. You have experience and a passion for delivering high quality integrated care via telemedicine and are highly tech savvy. While experience as a direct digital care provider in the past is not a must – it is highly desired!
- Deep clinical expertise in providing primary care and women’s health experience (at least 2 years of post-graduate clinical experience) including: STD screens, UTI & Vaginal infections consults, Pelvic Pain, Vaginal Bleeding, Birth Control counseling, annual exams and urgent care concerns (coughs, sore throat, abdominal pain, basic dermatological conditions) with an ability to take this brick and mortar experience and translate it to virtual delivery.
- Exceptional written and verbal communication skills.
- Demonstrated excellence in Interpreting and act on clinical labs + ultrasound results
- Willingness to work evenings + weekends as needed by schedule
- Authorized to work in the US
Other nice to have skills:
- As an organization that seeks to create an environment for all women to feel safe, heard, recognized and avowed in their health, bodies and lives, we are consistently seeking providers with backgrounds that are meaningfully different from those already forming our team. You bring a erse background, a range of care experiences in different communities or various modalities.
- Formal professional training in the following areas is highly valued: care delivery for women who have experienced trauma including having a lived experience of abuse, decision making support for low-income women, care delivery for LGBTQ identified folks, care delivery for immigrant or migrant or english-as-a-second-language support populations.
- A strong understanding of & interest in chronic stress and trauma as it relates to immune system compromise and inflammatory response systems is a plus.
- Experience or formal training weaving integrative medicine practices into your care plan development.
- Contracted with major payers (BCBS / Anthem, Cigna, Aetna, United)
Benefits
- Remote role with flexibility to work from home
- Market competitive salary ( 120-140K depending on experience for 40 hour work week)
- Annual CME stipend
- Medical and dental benefits
- Paid holidays, vacation, and sick leave
location: remoteus
Remote Corporate Outpatient Coder
Job Category: Billing,Coding/Collection
Requisition Number: REMOT020771
Full-Time
Tampa, FL 33603, USA
USA Remote
United StatesJob Details
Description
JOB TITLE: Corporate Coder (Remote)
GENERAL SUMMARY OF DUTIES:
The Corporate Coder (Remote) supports and contributes to the service excellence mission of Surgery Partners.
ESSENTIAL FUNCTIONS:
- Assisting with ensuring timely, accurate and complete coding of ICD-10-CM, PCS, CPT and HCPCS for ALL patient types in various facilities/case mix.
EDUCATION/EXPERIENCE:
- Required 5 years of hospital coding experience
- Outpatient CPT and HCPCS coding experience required
- Demonstrated success in coding with consistent accuracy
- One or more of the following Credential(s): RHIA, RHIT, CCS, COC, CPC
- Prefer Bachelors or Associates degree in Health Information Technology with RHIA or RHIT and CCS, Desired
QUALIFICATIONS:
- Must have knowledge of multiple hospital information systems
- Must be able to work independently and handle multiple tasks in fast-paced environment
- Must possess excellent leadership, verbal and written communication and problem-solving skills
- Must be able to maintain strict confidentiality at all times
- Must be capable of fostering a team environment
- Must have experience with computers and coding software
location: remoteus
Title: Supervisor Coding and Billing – Remote
Location: United States
Full-Time
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
Supervisor Coding and Billing
Location
Cleveland
Facility
Remote Location
Department
HIM Coding-Finance
Shift
Days
Schedule
7:00am-3:30pm
Job Summary
Job Details
Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.
As the coding Supervisor, you will supervise employees within the Coding section. You will assist the Manager with personnel-related duties as well as organize, direct, coordinate, and control coding section activity. You will assess, develop, and implement efficient systems that meet CCHS, JCAHO, and other government regulations. You may serve as a liaison between the Coding section and other CCHS Departments and interact with Revenue Cycle Management regarding billing issues and claims denials.
At Cleveland Clinic, we know what matters most. That’s why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you’ll find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future. When you join Cleveland Clinic, you’ll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare.
Responsibilities:
- Supervises coding section personnel in daily operational activities.
- Directs the performance of inpatient coding and outpatient coding for the purpose of accurate patient billing.
- Supports internal and external coding review and education.
- Maintains and monitors performance indicators for unbilled coding accounts receivable and formulates action plans to reduce the number of outstanding cases.
- Identifies all problem areas and areas of opportunity regarding unbilled accounts.
- Monitors and maintains data on employee compliance with productivity and quality standards and takes appropriate action.
- Interacts with downstream departments on Revenue Cycle Management, Liaison and ITD, regarding billing related questions and/or accounts receivable.
- Management-level responsibilities include: hiring, performance appraisals, disciplinary actions, training, work distribution and flow, and employee engagement.
- Administers corrective action for areas of responsibilities.
- Develops and implements efficient systems and work flow to meet both CCF and government regulations.
- Protects the confidentiality of patient information per HIPAA regulations.
- May develop, implement, process and maintain clinical data computer systems.
- May protect the interest of the Clinic with HIM vendors. Interacts with ITD in the support of systems and processes in the section.
- Facilitates/trains coding staff on daily activities. Monitors and ensures time and attendance policy for the section.
- Interacts with the Coding Quality and Education Supervisor to support Coding Quality and Education initiatives.
- Interacts with the Supervisor of CDI to support the program initiatives and strategic planning goals.
- Promotes good morale and cooperation: encourages others, values their input, shares information and seeks ways to add value both to the customer and to the team.
- Anticipates and responds to changing skills requirements.
- Seeks opportunities to learn new skills and actively coaches and encourages team members to do the same.
- Prepares and presents at meetings.
- Integrates team into the coding process to promote their development.
- Other duties as assigned.
Education:
- Bachelor‘s Degree in Health Information Management or related field.
- High School Diploma/GED and five years of coding experience, including three years in a lead role may substitute for degree requirements.
- Associate’s degree and three years of coding experience, including one year in a lead role may substitute for degree requirement.
Certifications:
- Depending on department needs the Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA) is required and must be maintained.
Complexity of Work:
- Coding assessment relevant to the work may be required.
- Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
- Must be able to work in a stressful environment and take appropriate action.
- Knowledge of medical record technology, statistics, and organization sufficient to identify and interpret clinical data, integrity of the data.
- Knowledge of supervisory techniques and methods and ability to train others in abstracting techniques and methods.
- Advanced knowledge of supervision, training/development, public relations and project management practices preferred.
- Comfortable with public speaking.
Work Experience:
- One year of coding experience in a lead role in a Professional Fee Coding environment required.
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 caregivers 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. All offers of employment are follwed by testing for controlled substances and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System’s Smoking Policy will be permitted to reapply for open positions after one year.
Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.
location: remoteus
Title: Senior Coder Complex Inpatient
Location: United States
Primary City/State:
Arizona, Arizona
Department Name:
Coding-Acute Care Hospital
Work Shift:
Day
Job Category:
Revenue Cycle
Primary Location Salary Range:
$26.29 – $39.44 / hour, based on education & experience
In accordance with State Pay Transparency Rules.
A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you’re looking to leverage your abilities you belong at Banner Health.
As part of the Banner Health Revenue Cycle Team, there are opportunities within that team. We specialize in Inpatient coding on the facility side. We do not do pro-fee coding. We are a team of 4 Inpatient Coding Managers who cover for each other and report to the Director of Acute Care Coding. Each Associate Director leads a team of no more than 19 coders so that there is ample opportunity for communication between staff and leaders. These positions offer opportunities for growth within the coding department, including roles such as Coding Educator, Coding Quality Analyst, and supervisory/management opportunities. Additionally, as part of the Revenue Cycle team, there are opportunities within that team as well. There are also paid education opportunities, internal education, and opportunities for growth in this exceptional team environment.
Looking for a motivated, experienced Senior Complex Inpatient Facility | Acute Care | HIMS Coder –Remote | Medical Coder to join our talented Acute Care HIMS Coding Team. Ideally a minimum 5 years of inpatient coding experience in Acute Care inpatient facility coding (physician or pro-fee coding for IP is not needed). This requires Certified Coding Specialist (CCS) or Certified Outpatient Coder (COC) or Certified Professional Coder (CPC) or Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) or other appropriate coding certification in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).
Candidate should have experience coding all service lines including, but not limited to; Trauma, ICU, Cardiac, Transplant, Orthopedics, High-Risk OB, NICU, and more. Must have ICD-10-PCS coding experience. Banner has facilities in major metro areas as well as rural communities. The opportunity to code encounters from newborn babies to hospice patients and all service types in between presents itself on a daily basis. Banner has internal Acute Care Coding Educators that work directly with the new employee until such time as they are deemed proficient in the role they are hired for. Our IP coding expectation is 1.2 charts an hour when coding the mid-range charts ( $100,000-249,000) and 1.9 charts per hour when coding both mid-range and low-dollar ( less than $100,000) charts while maintaining a DRG accuracy rate of 95% or higher. We use the number of accounts for specific patient types and specialties in combination with the Case Mix Index and case financial information to formulate performance to Banner standards, which are currently more stringent than most national standards identified. Banner uses Optum eCAC – Optum Enterprise CAC applies clinically intelligent Optum natural language processing (NLP) to review medical records and deliver comprehensive, accurate code suggestions.
Meeting Accounts Receivable goals supports Banner Financial goals. In most of our Coding roles, there is a Coding Assessment given after each successful interview. Banner Health provides your equipment when hired. You will be fully supported in training for anywhere from 1 month+ according to inidual need, with continued support throughout your career here!
This is a fully remote position and available if you live in the following states only: AK, AL, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, LA, MD, MI, MN, MO, MS, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI & WY
The hours are flexible as we have remote Coders across the Nation. The hours are flexible with some minor parameters. Generally, any 8 hour period between 7am 7pm can work, with production being the greatest emphasis.
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 provides coding and abstracting for high tiered complexity range of acute care services at all Banner hospitals. Reviews diagnosis and diagnostic information and codes and abstracts diagnoses and/or procedures on inpatient records using ICD CM and PCS coding classification systems. Completes MS-DRG and APR-DRG assignments on inpatient records as appropriate. Ensures ethical and accurate coding in accordance with all regulatory requirements and AHIMA Standards of Ethical Coding. Acts as subject-matter expert regarding experimental and newly developed procedural and diagnostic inpatient coding. This includes highest level of complexity of accounts encountered in Banner’s Academic, Trauma and high acuity facilities. Will serve as a role model for less experienced acute care coding Inpatient team members.
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 timely and accurate coding in accordance to department specific productivity and quality standards thorough assignment of ICD CM and PCS codes, MS-DRGs, APR-DRGs and POAs for highest level of complexity of Inpatient accounts encountered in Banner’s Academic, Trauma and high acuity facilities.
2. Abstracts clinical diagnoses, procedure codes and documents other pertinent information obtained from the patient encounter. Seeks out missing information and creates complete records, including items such as disease and procedure codes, discharge disposition, date of surgery, attending physician, consulting physicians, surgeons and anesthesiologists. Refers inconsistent patient treatment information or documentation to coding support tech, coding quality analyst or coding manager for clarification/additional information for accurate code assignment.
3. Provides coding 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. Ability to address related and complex matters independently with regard to interpretation of coding guidelines.
4. Acts as a knowledge resource for internal and external customers. Acts as subject-matter expert regarding experimental and newly developed procedural and diagnostic inpatient coding. Will provide mentorship to less experienced or otherwise identified staff members. Will collaborate with Acute Care Coding Leaders and Education team in identifying need for new and/or ongoing training for ACC team.
5. Works under general supervision using specialized expertise in the subject matter. Works within a set of defined rules. Ability to address related and complex matters independently with regard to interpretation of coding guidelines prior to referral to senior manager, educator or Coding Quality Analyst.
MINIMUM QUALIFICATIONS
High school diploma/GED or equivalent working knowledge and specialized formal training 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 health care field.
Requires Certified Coding Specialist (CCS) or Certified Outpatient Coder (COC) or Certified Professional Coder (CPC) or Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) or other appropriate coding certification in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).
Must demonstrate a level of knowledge and understanding of ICD CM and PCS coding principles as recommended by the American Health Information Management Association coding competencies.Requires five or more years of inpatient coding experience in Acute Care inpatient facility or healthcare system.
Must be able to work effectively and efficiently in a remote setting, utilizing common office software and coding software and abstracting systems.
PREFERRED QUALIFICATIONS
Associates degree in a job-related field or experience equivalent to same.
Previous experience in large, multi-system healthcare organization.
Additional related education and/or experience preferred.
location: remoteus
Registered Nurse (Remote)
Location
Remote – United States, California
Type
Full time
Department
Clinical
Our Mission
Path’s mission is to make mental healthcare work for everyone.
Who we are
Path is a healthcare company powered by technology, dedicated to making mental health care work for everyone. Path takes a patient-first approach, where treatment is more accessible, personalized, and effective. With Path, it’s easy to find a high-quality therapist or psychiatric clinician who accepts insurance and is actively accepting new patients.
We are deeply committed to providing high-quality care that improves the lives of patients, investing in the providers who deliver that care, and always operating in an ethical and compliant manner.
What we’re solving
Over 65 million Americans have a treatable mental health issue that’s 1 in 5 people. Today it’s difficult to find a provider, and for those with complicated conditions, it’s nearly impossible to find coordinated care. There’s a good chance someone close to you could have used the help, even if it wasn’t obvious to the people around them. We’re here to fix this.
About the Role
Join our dynamic and fully remote Psych Clinical team at Path, where you will play a pivotal role in providing accessible, comprehensive, and personalized mental health care for a erse range of patients. As a psychiatric remote RN, you will play a pivotal role in supporting our PMHNP’s by triaging and providing crucial clinical support to patients in between video appointments. By assessing medication concerns, addressing safety issues, managing refills, and processing standing orders, the psychiatric RN ensures a seamless patient experience while our Nurse Practitioners engage in direct patient care. Collaborating closely with our Virtual Assistants and Care Navigators, you will oversee prior authorizations and paperwork requests. What sets this role apart is the opportunity to work at the forefront of telehealth, leveraging your organizational and tech-savvy skills to ensure effective communication between all team members and patients while fostering a collaborative culture. Your impact will extend beyond direct patient care, as you contribute to creating evidence-based protocols, policies, and workflows that elevate the standard of care we provide. If you’re passionate about delivering safe, patient-centered psychiatric care in a fast-paced and innovative environment, join us on our mission to make quality psychiatric care accessible to all. Your journey at Path begins with transforming lives, one virtual connection at a time.
Required Qualifications
- Experience:
- Two (2) years of recent experience in an outpatient mental health setting.
- Familiarity with psychiatric medications and DSM-5 diagnoses, demonstrating expertise in patient education.
- Education and Licensure:
- Graduate of an accredited nursing school with a BSN.
- Current RN licensure with an active CA license.
- Telehealth and Technology:
- Experience in a telehealth environment or utilizing technology for mental health services.
- Strong EHR and general tech literacy.
- Clinical Skills:
- Exceptional prioritization skills for assessing, triaging, and addressing patient requests.
- Clear and effective verbal and written communication, including concise clinical documentation.
- Operational Knowledge:
- Strong operational knowledge with an interest in developing and implementing workflows, policies, and procedures in compliance with healthcare regulations.
- Availability:
- Available to work 5 days a week for 8-hour shifts, with regular and reliable attendance.
- Willingness to cover during 4th of July holiday week and last week of the year on a rotational basis
Preferred Qualifications
While having the preferred qualifications enhances your candidacy, having all of them is not mandatory. We encourage all interested applicants to apply, even those who may not meet every preferred requirement.
- Interdisciplinary Support:
- Experience supporting a erse range of providers and their patients within an interdisciplinary team.
- Supervisory and Leadership Experience:
- Two (2) years of staff supervisory experience.
- Two (2) years of leadership/management experience with a healthcare team.
- Work Style:
- Self-motivated and thrives in a fast-paced, innovative environment.
As Part Of Our Team, Full-Time Employees Receive
- 100% remote work environment from anywhere in the US
- Competitive pay and benefits that don’t change based on location
- Health benefits: medical, dental, vision, life, disability, and FSA/HSA
- Access to our 401(k) plan
- Generous time off policies, including 2 company-wide shutdown weeks each year (for most employees) to focus on self-care
- Paid parental leave
- Employee Assistance Program (EAP)
- Stipend to ensure your home office sets you up for success
- Quarterly department stipend for team building or in-person gatherings
- Wellness events and lunch & learns spanning many topics
Our Team
The people of Path are what truly define our mission and determine our impact on the communities we serve. We believe in building not only a team, but a erse community, inspiring each other by taking on big challenges, growing and succeeding together.
location: remoteus
Title: Global Safety Senior Manager
US Remote
Location: DC-Washington
If you feel like you’re part of something bigger, it’s because you are. At Amgen, our shared mission—to serve patients—drives all that we do. It is key to our becoming one of the world’s leading biotechnology companies. We are global collaborators who achieve together—researching, manufacturing, and delivering ever-better products that reach over 10 million patients worldwide. It’s time for a career you can be proud of.
Global Safety Senior Manager
Live
What you will do
Let’s do this. Let’s change the world. In this vital role you will be part of the Combination Product Global Safety Team within the Combination Products Safety group ensuring the excellence of Amgen products for the portfolio.
Responsibilities
- Assessing potential impact of quality findings on patient user safety for all clinical and commercial products in conjunction with members of the Global Safety Team
- Providing consultation to Therapeutic Area Safety for the review of adverse event data to detect potential product quality issues for commercial products
- Providing consultation for device combination product diagnostic safety data collection, analysis, and reporting
- Provide expertise for device combination product risk management activities
- Contribute to assigned product Safety Advisory Team/ Global Safety Team pharmacovigilance activities when they pertain to device, companion diagnostic and digital health safety, including single case assessment, aggregate data analysis, and risk management activities.
- Provide combination product safety expertise to protocol, ICF, CSR review and preparation of filing documents.
- Support responses to regulatory queries for safety information as required.
- Conduct review of adverse event aggregate data to detect potential product/device quality issues.
- For assigned products, provide review of and input to device risk management documents, including hazard analysis, use risk assessments, human factors protocols and reports, etc.
- Perform authoring of device combination product system risk/benefit analyses
- Be representative and point of contact for Health Authority Inspection and Internal Process Audits within the remit of role and responsibility
Win
What we expect of you
We are all different, yet we all use our unique contributions to serve patients. The safety professional we seek is a collaborative partner with these qualifications.
Basic Qualifications:
Doctorate degree in Science and 2 years of safety experience
Or
Master’s degree in Science and 6 years of safety experience
Or
Bachelor’s degree in Science and 8 years of safety experience
Or
Associate’s degree in Science and 10 years of safety experience
Or
High school diploma / GED and 12 years of safety experience
Preferred Qualifications:
- Relevant scientific training OR clinical experience in activities relevant to utilization of medical devices and/or companion diagnostics.
- Previous experience creating Medical Opinion Memos, Health Hazard Assessments, or Medical Inputs for product complaints.
- Solid understanding of clinical trial device safety monitoring regulations and standards
- Strong knowledge of device development and commercialization principles
- Knowledge of post market safety reporting regulations/standard methodologies for devices/combination products globally.
- Basic understanding of signal detection principles for drugs/biologics.
Thrive
What you can expect of us
As we work to develop treatments that take care of others, we also work to care for our teammates’ professional and personal growth and well-being.
Amgen offers a Total Rewards Plan comprising health and welfare plans for staff and eligible dependents, financial plans with opportunities to save towards retirement or other goals, work/life balance, and career development opportunities including:
- Comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts.
- A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
- Stock-based long-term incentives
- Award-winning time-off plans and bi-annual company-wide shutdowns
- Flexible work models, including remote work arrangements, where possible
Apply now
for a career that defies imagination
Objects in your future are closer than they appear. Join us.
careers.amgen.com
Amgen is an Equal Opportunity employer and will consider you without regard to your race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.
We will ensure that iniduals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.
location: remoteus
Remote Pro Fee Coder (Denials Review)
Location: LOUISVILLE Kentucky; United States
Job Description & Requirements
Pay Rate: $26.00 – $34.00
TYPE OF JOB ORDER: Remote Pro Fee Coder (Denials Review)
REQUIRED SKILLS: 3- 5 Yrs.Pro Fee Experience. Denials exp a plus. Neurosurgical or General Surgical Coding experience required.
Academic Level -1 – IP and OP settings
#OF WEEKS: 18 + Weeks
SHIFT/HOURS: M-F Flexible hours
EXPECTED HOURS: 40
LICENSE/CRED. REQ: Prefer a CPC
SYSTEMS: 3M EPIC, Cerner
NOTES: Must be comfortable with Trauma 1 Academic Medical Centers, Remote Work Setting. Appeals and Denials Coding Specialist Profee (Physician-based). Within RCM Dept
Facility Location
Kentucky s largest city is identified by its plethora of parks and green space and its affinity for all things fun. Cheer for your favorite horse at the world famous Kentucky Derby or catch a live performance at the Actors Theatre of Louisville, one of the cultural staples of the city. Countless other museums, performing arts venues, distinguished eateries and exhilarating night-life venues make up this famous city.Job Benefits
Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary but the perks don’t stop there. There are many additional benefits to enjoy, including:- Medical, dental and vision benefits
- Earned time off and paid holidays
- Paid continuing education time
- 401(K) retirement planning
- Short-term disability, life insurance, paid jury duty
- Access to the largest network of facilities and providers in the country
- Industry experienced workforce management team
- Licensure and certification reimbursement
About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.location: remoteus
Title: Certified Professional Coder (Outpatient/Same Day Surgery)
Role: Certified Coder, Professional
Location: Remote. Must work in a location within the United States.
Travel: No travel required.
Classification: Hourly, Non-Exempt
Reports to: Coding Leadership
Salary Range: Commensurate with experience
About the role:
The Certified Coder (Professional) is responsible for reviewing and evaluating clinical information within medical records to ensure high quality and compliant coding. They re able to analyze information and make decisions independently. Our coders have an eye for detail and an aptitude for accuracy.
Responsibilities:
- Reviews and/or evaluates relevant clinical and demographic information from the medical record to identify accurate and appropriate code selection and claim information.
- Selects CPT/HCPCS codes (including modifiers) and ICD-10 codes to the highest specificity with correct sequencing to ensure accuracy and maximum reimbursement.
- Solicits additional information from providers regarding ambiguous or conflicting documentation in the medical record. Corrects coding discrepancies as needed.
- Investigates and resolves coding-related system edits, rejections from payers, and/or insurance denials when needed.
- Identifies and escalates system or process breakdowns to leadership; assists with resolution when requested.
- Serves as a resource for coding and revenue cycle leadership.
- Consistently achieves productivity and quality metrics.
- Complies with and holds with utmost regard all compliance requirements to protect patient privacy and confidentiality.
- Stays curious, kind and contributes positively to the revology culture. The health + harmony of the team is everybody s responsibility at revology.
The statements stated in this job description reflect the general duties as necessary to describe the basic function, essential job duties/responsibilities, job requirements, physical requirements and working conditions typically required, and should not be considered an all-inclusive listing of the job. Iniduals may perform other duties as assigned, including work in other functional areas to cover absences or relief, to equalize peak work periods or otherwise balance the workload.
Requirements:
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) license or similar from a nationally accredited medical coding organization required; Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) accepted.
- Must remain current on coding guidelines, rules and regulations, and new codes. Must complete mandatory continuing education.
- Must demonstrate effective written and verbal communication skills.
- Ability to work independently to accomplish goals in a dynamic environment.
- High school diploma or equivalent required; bachelor s degree or equivalent experience preferred.
Remote work requirements:
Internet capability must be a high-speed internet connection.
Physical requirements:
Must be able to perform physical activities, such as, but not limited to: moving or handling (lifting, pushing, pulling and reaching overhead) office equipment and supplies weighing 1 to 25 lbs. unassisted. Frequently required to sit for extended periods during the workday. Manual dexterity and visual acuity required. Must be able to communicate effectively on the telephone and in person.
Working conditions:
Work will generally be performed indoors in an office environment. Must maintain a professional appearance and manner.
Employment eligibility:
Candidates must be legally authorized to work in the United States without sponsorship.
About revology:
revology is a technology-enabled healthcare revenue cycle management (RCM) firm providing outsourced services to hospitals, health systems, and physician groups. Our tech smart-from-the-start strategy enables us to break through conventional barriers and empower each revologist to drive a higher standard of revenue cycle performance. This is possible because we spend our lives in the sweet spot where smart tech and good humans reach their highest potential and maximize outcomes.
At revology, we are committed to stewarding and empowering an inclusive environment within our company and our communities. While we believe in culture – we don t believe in culture fit . We encourage every single revologist to bring their unique perspective, lived experience and authentic selves to the table. revology is an equal opportunity employer and we encourage everyone to apply for our available positions – including women, people of color, iniduals with disabilities and those in the LGBTQIA+ community.
location: remoteus
LPN Care Coach
Remote
Atlanta, Georgia, United States
Care Coach
Contract
Description
Our Mission:
CircleLink Health is a company of passionate clinicians, technologists and business people tackling the $600B problem of preventable chronic condition complications. Our mission is to accelerate the shift to preventative care (from status quo reactive care) through our world-class preventative care platform.
Your Impact On Our Mission:
As a Care Coach you will work remotely for 20-25 hours per week with a team of nurses to manage patients with chronic conditions enrolled in Medicare’s Chronic Care Management program.
Your day to day is
- Educating patients on self-management skills and goal setting. Chronic conditions include: Diabetes, CHF, COPD/Asthma, Hypertension, CAD, Ischemic Heart Disease, Anxiety, Depression.
- Implement and improve the Plan of Care by updating medications, appointments due, record biometrics, vital signs, and care coaching provided.
- Utilize Motivational Interviewing or other behavior change techniques to coach and assist the patient with self-management.
- Conduct Transitional Care Management activities to high risk patients discharged from the hospital and the ER to reduce unnecessary readmissions, including medication reconciliation, medication adherence, identify red flags, address barriers, encourage follow-up care, how and when to seek appropriate level of care.
- Reduce care gaps by encouraging or assisting with preventive care, and chronic care management, i.e. annual well visits, follow up visits, medication management, pre-visit labs, diagnostic tests due, preventive cancer screens.
- Connect the patient with community resources as needed, including transportation, personal care needs, homemaker or chore services, social services, etc.
Requirements
Required Skills and Abilities:
- Fluent in English.
- Meet communication skills, must be self-directed, able to work independently with little supervision while meeting performance metrics
- Passion for nursing.
- Detail-oriented.
- Excellent organizational and time management skills.
- Strong communication and telephonic skills.
- Strong critical thinking and problem solving skills.
- Commitment to certain number of hours per day and days of week
- Availability to make calls on weekdays between 9am-7pm.
- LPN needs a STRONG internet-connected computer.
Education and Experience:
- Current, unrestricted Compact LPN license
- Proficiency with electronic health records and web based applications
- 5+ years experience as a Licensed Practical Nurse
Preferred Education and Experience, but not required:
- Case Management or Chronic Disease Management experience
- Case Management Certification
- Certified Diabetes Educator
- Transitional Care Management experience
- Experience with Motivational Interviewing or other behavior change communication techniques
Benefits
Compensation:
This is a 1099 contract position with no end date. Care Coaches are responsible for their own taxes and insurance.
Compensation is paid at the rate of $10.00 per initial clinical encounter per patient per month. A clinical encounter occurs after two criteria are met: a patient has a successful clinical call, and the patient has 20 minutes or more of time in their chart timer. Ex: If in one hour you called and spoke with 2 patients and spent 20 minutes with each of them, your pay for that hour would be $20.00 ($10.00/pt. reached x 2).
- In addition to successful clinical encounters, Care Coaches shall be entitled to $3.00 in the event that a patient within their caseload withdraws from the Chronic Care Management Program.
- Additionally, a compensation of $4.00 will be paid out following five unsuccessful attempts to contact the patient without receiving a response.
About CircleLink Health:
CircleLink is a digital healthcare company that improves health for the chronically ill by engaging patients through personal phone calls and/or mobile technology, helping to solve the ~$600 billion problem of preventable chronic complications. Our patient engagement software and services enable physicians to monitor and manage their patients’ chronic conditions between office visits without investing in additional staff or technology.
Location: MN-Minneapolis
Position Description:
Sr. Regulatory Affairs Program Manager reporting to Minneapolis, MN. Focus on tactical, operational activities for a major program with broad or ongoing impact. Coordinate with business partners to develop regulatory strategies to support the business goals and translate the strategies into work plans for the RA teams to implement. Coordinate and prepare guidance for documentation packages for regulatory submissions and regulatory readiness for internal audits and inspections. Establish processes for submission material compilation, license renewal and registrations. Recommend changes for labeling, advertising and marketing literature for regulatory compliance. Establish procedures and processes for the update to EU and UK Technical Documentation and for the preparation of pre-market and post market submissions for the EU and UK whilst providing guidance on impact to US FDA and International submissions. Communicate with regulatory agencies for pre-submissions and submissions under review. Review and interpret the US FDA and international regulations to ensure compliance of the quality management system for medical devices. Understand and navigate industry regulations to include 21 CFR 820, ISO 13485 and ISO 14971, EU Medical Device Directive (EU MDD 93/42/EEC), EU Medical Device Regulation and Canadian Medical Device Regulation (CMDR). Provide guidance on regulatory strategies for medical devices in accordance with applicable FDA and international regulations leveraging knowledge of product development processes. *This position is open to telecommuting from anywhere in the United States.
Basic Qualifications:
Requires a Master’s degree in Regulatory Affairs, Biomedical Engineering, Medical Technology or related field and five (5) years of experience as a regulatory affairs specialist or related occupation in regulatory affairs. Requires a minimum of five (5) years of experience with each of the following: Regulatory Affairs for Class II and Class III medical devices; EU Technical Documentation in accordance with the EU Medical Device Directive or EU Medical Device Regulation; Pre-market and post-market medical device submissions to the EU and US FDA and International submissions; Communicating with regulatory agencies including EU Notified Bodies for the tracking of pre-submissions and submissions under review and key alignment decisions; Review and interpretation of the US FDA and international regulations for medical devices and compliance in the Quality Management System; and 21 CFR 820, ISO 13485, ISO 14971, and Canadian Medical Device Regulation (CMDR). *This position is open to telecommuting from anywhere in the United States.
#LI-DNI
Min Salary
171800
Max Salary
237000
It is the policy of Medtronic to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Medtronic will provide reasonable accommodations for qualified iniduals with disabilities.
location: remoteus
Medicare Part C Medical Review Nurse
Job Location
Remote
Position Type
Full-Time/Regular
Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving iniduals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.
Our Investigations MEDIC (I-MEDIC) clinical team is seeking a Medical Review RN (Claims Analyst II) with superior analytical skills and a proven ability to evaluate medical claims data. If you love digging into the data, this is the perfect job for you! As a Claims Analyst II on the I-MEDIC, you will play a key role on a team that detects and prevents fraud, waste and abuse in the Medicare Part C program on a national level. This is a home-based, full-time position with excellent benefits.
Job Summary:
Mid-level professional performs medical record and claims review for Medicare Part C and/or other claims data in order to ensure that proper guidelines have been followed. As a member of an investigative team, may act as a facilitator as well as a case manager regarding assessment for potential overpayment, fraud, waste, and abuse with regards to Medicare, Medicaid, and/or other claims.
Essential Duties and Responsibilities include some or all of the following. Other duties may be assigned.
- Review beneficiary, provider, and/or pharmacy cases for drug seeking, drug selling, beneficiary and other potential overpayment, fraud, waste, and abuse.
- Completes desk review to meet applicable contract requirements and to identify evidence of potential overpayment or fraud.
- Effectively identifies and resolves claims issues and determines root cause.
- Consults with Benefit Integrity investigation experts and pharmacists for advice and clarification.
- Completes inquiry letters, investigation finding letters, and case summaries.
- Investigates and refers all potential fraud leads to the Investigators/Auditors.
- Has basic understanding of the use of the computer for entry and research.
- Responsible for case specific or plan specific data entry and reporting.
- Participates in internal and external focus groups and other projects, as required.
- Identifies opportunities to improve processes and procedures.
- Has the responsibility and authority to perform their job and provide customer satisfaction.
- May participate as an audit/investigation team member for both desk and field audits/investigations
- Has developed expertise with standard concepts, practice and procedures in field. Relies on limited experience and judgment to plan and accomplish goals.
- Testifies at various legal proceedings as necessary.
- May mentor and provide guidance to other analysts.
- Performs a variety of tasks some requiring independent thought and research. A degree of creativity and latitude is required.
Required Skills
To perform the job successfully, an inidual should demonstrate the following competencies:
- Analytical – Synthesizes complex or erse information; Collects and researches data; Uses intuition and experience to complement data.
- Problem Solving Gathers and analyses information skillfully; Identifies and resolves problems.
- Judgment – Supports and explains reasoning for decisions.
- Written Communication – Writes clearly and informatively; Able to read and interpret written information.
- Quality Management – Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
- Interpersonal Skills – 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.
- Teamwork – Balances team and inidual responsibilities; Exhibits objectivity and openness to others’ views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; able to build morale and group commitments to goals and objectives; Supports everyone’s efforts to succeed.
- 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.
- Computer Applications – Must have intermediate level experience with Microsoft Office to include Excel.
Required Experience
Education and/or Experience
- BSN OR an RN with additional current and active degree/license/certification/s in a relevant healthcare discipline (i.e., CPC, CPHM, CFE, CCM, HCAFA).
- Must possess at least five years clinical experience.
- At least one year healthcare experience that demonstrates expertise in conducting utilization reviews.
- ICD-10 coding, CPT coding, and knowledge of Medicare regulations preferred.
- Prior successful experience with CMS, State Medicaid, and OIG/FBI or similar agencies preferred.
- Medicare Advantage experience preferred
- Experience writing case summaries. Writing sample will be required.
- Legal case experience preferred.
Certificates, Licenses, Registrations: Current, active and non-restricted RN licensure required. An LVN does not meet requirements.
Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Iniduals with Disabilities.
location: remoteus
CODING SUPERVISOR – REMOTE
Molina Healthcare
Job ID 2023465
Job Description
Job SummaryThe Supv, Coding is responsible for providing assistance to the department leadership by ensuring compliance with coding guidelines. Subject Matter Expert who researches coding, coding relating issues, and reporting findings to management, providers and staff while providing direction and leadership to the team.
Knowledge/Skills/Abilities
Assist department leadership with oversight of coders’ day to day work including supervision of the internal coding staff to include hiring, performance management, recognition and development.
Ensures quality, productivity standards, and adherence to state and federal guidelines are met. Monitors compliance with corporate policies and procedures.
Identifies, assists, develops, and maintains corporate documentation, policy and procedures for standardized operations.
Acts as a coach and positive role model for staff and colleagues establishing/maintaining a positive work environment.
Coordinates staff schedules to ensure staging levels meet business needs.
Develops processes to ensure complete and accurate coding of assigned product lines.
Tracks coding issues and reviews coding inaccuracies to highlight areas of improvement.
Collaborates with interdepartmental or cross-functional teams for any assigned projects and provides departments with coding issues and updates to be shared with providers
Maintains a library of coding material and relevant resources to be available to personnel, when necessary.
Maintains a positive relationship with all clients and serves as a resource for clients and co-workers in regards to coding inquiries.
Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies as necessary or required. Maintains current knowledge of health care billing laws, rules and regulations and developments.
- Healthcare insurance experience
- 4+ years of medical coding experience
- Proven ability to perform strategic planning and priority setting for a coding department.
- High attention to detail
Job QualificationsRequired Education
Bachelor’s Degree or equivalent experience
Preferred Education
Bachelor’s Degree in related fieldTo all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.Pay Range: $49,430.25 – $107,098.87 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time
location: remoteus
Coding Denial Specialist
US – Remote (Any location)
Full time
15602
Job Family:
General Coding
Travel Required:None
Clearance Required:None
What You Will Do:
The Coding Denial Specialist will review assigned coding denials across multiple specialties, determine root cause and following established client workflow resolve and/or appeal denials based on clinical documentation and diagnostic results in alignment with Federal & State Coding regulations; including the National Correct Coding Initiative, CPT, HCPC’s and ICD10 CM Guidelines This position is full time as and 100% remote. What You Will Need:- High School diploma and 1-3 years of prior relevant experience
- Minimum 3 years physician Coding experience
- Minimum 1 year physician coding denial management experience
- CPC certification from AAPC
- Must maintain credential throughout employment
- Excellent verbal, written and interpersonal communication skills
- Basic knowledge of Excel, Word and PowerPoint
- High level of accuracy and attention to detail
- Strong Working Knowledge of Federal & State Coding regulations; including the National Correct Coding Initiative
- Strong working knowledge of CPT, HCPC’s and ICD10 CM Guidelines
- Good working knowledge of HIPAA regulations, hospital operations, and working with electronic health record (EHR) systems such as EPIC or Cerner
What Would Be Nice To Have:
- Epic experience
- AAPC specialty credential(s)
- Proficient in the interpretation of Claim Adjustment and Remittance Advice Reason Codes
The annual salary range for this position is $39,200.00-$58,700.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.
What We Offer:Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a erse and supportive workplace.
Benefits include:
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Position may be eligible for a discretionary variable incentive bonus
- Parental Leave
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
About Guidehouse
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.location: remoteus
Title: Strategic Account Manager – Remote – Medical Benefit Products and Processes
Location: Orlando, FL
The Account Manager cultivates and maintains AssistRx’s relationship with our Pharmaceutical manufacturing partners. In this role, you’ll be working with pharmaceutical executives (Associate Director and above) on a daily basis to ensure they are receiving maximum value from iAssist’s features and services. The Pharmaceutical Account Manager presents new ideas and innovations to clients, upselling and enhancing their product and is the liaison between the Pharmaceutical Brand Teams and all key AssistRx stakeholders.
Responsibilities:
- Forms strategic partnership with clients by developing a working knowledge of their business goals, technical challenges and infrastructure configurations to ensure an outstanding customer experience.
- Establish and maintain a role as advisor to clients and colleagues.
- Present new ideas and innovations to client to upsell and enhance their products and services.
- Research high-level solutions for the client.
- Develop the relationship with the client through regular meetings/conference calls to review service quality and ensure they are receiving maximum benefit from iAssist’s features and benefits
- Works with Client Services to solve complex support issues effectively.
- Manages the delivery of recommended/agreed-upon services to achieve high client satisfaction and trust.
- Determines most effective method of problem resolution by utilizing internal resources when necessary.
- Primary point of contact for sales and service.
- Determines most effective method of problem resolution by utilizing internal resources when necessary.
- Participates in client quarterly reviews, attends annual Plan Of Action meetings and other travel as needed.
- Plan milestones and track progress.
- Effectively keeps others adequately informed by presenting information to everyone involved.
Requirements:
- Ability to effectively express ideas and thoughts verbally and in written form.
- Exhibits good listening skills and comprehension.
- Effectively keeps others adequately informed by presenting information to everyone involved.
- Ability to define problems, collect data, establish facts and draw valid conclusions.
- Bachelor’s Degree (B.A.) from four-year college or university or equivalent experience.
- Minimum three years of experience working in a customer support and/or sales capacity role.
- Experience working for or in Pharma.
- Experience working with Pharmaceutical Brand Teams is essential.
- Project Management, HUB Operations or Specialty Pharmacy Operations/Account Management strongly desired.
- Technical skills a must
Benefits:
- Supportive, progressive, fast-paced environment
- Competitive pay structure
- Matching 401(k) with immediate vesting
- Medical, dental, vision, life, & short-term disability insurance
AssistRx, Inc. is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors, or any other protected categories protected by federal, state, or local laws.
All offers of employment with AssistRx are conditional based on the successful completion of a pre-employment background check.
In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Sponsorship and/or work authorization is not available for this position.
AssistRx does not accept unsolicited resumes from search firms or any other vendor services. Any unsolicited resumes will be considered property of AssistRx and no fee will be paid in the event of a hire
PAC Nurse
Job Locations Remote
Job ID
2023-15347
Category
Clinical / Post Acute Care
Min
USD $28.85/Yr.
Max
USD $38.46/Yr.
Overview
The PAC Nurse is a telephonic position responsible for managing the length of stay (LOS) for Long Term Acute Hospital (LTACH), Skilled Nursing Facility (SNF), and Institutional Rehab Facility (IRF) for their assigned post-acute care facilities through collaboration PAC Nurse will also collaborate with key facility personnel as well as with CareCentrix internal Medical Directors, Market Engagement Directors and Nurse Managers to develop and maintain a timely discharge plan.
Responsibilities
In this role, you will:
- For assigned post-acute facilities:
- Establish scheduled telephonic touch points with each facility point person to review each member within that facility and confirm appropriateness for continued stay.
- Authorize continued stay at SNF, IRF, LTACH and Home Health care (if delegated) using approved medical care guidelines and collaboration with key facility personnel within the healthcare setting.
- Use clinical expertise, review clinical information and clinical criteria to determine if the service/device meets medical necessity for the member.
- Ensure case review and elevation to complete the determination is rendered within the contractual and regulatory turnaround time standards to meet both contractual and regulatory requirements.
- Interact with the PAC Medical Director as needed to ensure proper medical necessity decisions are being rendered. Partner closely with the PAC Medical Director in care planning and goal setting, reviewing discharge plans and length of stay status to ensure optimal outcomes.
- Act as a clinical resource for unlicensed Post-Acute Care Coordinators, providing clinical expertise and helping to clarify referral source directives. Receive/respond to requests from unlicensed staff regarding scripted clinical questions and issues.
- Act as the primary contact to the post-acute facility or facilities to which they are assigned to obtain all clinical information required and to proactively obtain patient status updates.
- Through the Supervisor, work closely with Market Engagement Directors to efficiently address potential facility concerns, pushback or gaps in process.
- Communicate customer service/provider issues to supervisor for logging and resolution.
Support the following additional duties as requested:
- Participate in performance and operational improvement activities.
- Participate in and contribute to ongoing quality assessment/improvement activities, ensures the collection of data for improvement analysis and prepares reports as requested.
- Assist team in implementing and maintaining standardized operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.
- Participate in special projects and performs other duties as assigned.
- Participate in an annual Inter-rater reliability Testing Process.
- Schedule options vary with this role based on business needs, currently we need nurses willing to work weekend schedules.
Qualifications
You should reach out if:
- You hold a current and unrestricted license as a Licensed Practical Nurse or Registered Nurse
- You have Associate’s Degree or Diploma in Nursing/Practical Nursing or the equivalent
- You possess a minimum of 2 years clinical experience in a clinical setting
- You are an expert in Utilization Management and knowledge of URAC & NCQA standards
- You have a broad knowledge of health care delivery/managed care regulations and experience with evidence based care guidelines (i.e. MCG/Milliman, InterQual)
- You have excellent negotiation, influencing, problem solving and decision making skills required
- You possess organizational skills and are able to effectively manage and prioritize tasks
- You can work independently, utilizing sound clinical judgment and critical thinking skills under minimal supervision
- You must have a strong commitment to quality and standards
What we offer:
- Salary Range: $32.00 – $36.00 / hour plus Annual Corporate Bonus incentive
- Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match
- Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more
- Advancement Opportunities, professional skills training, and tuition /exam reimbursement
- PayActiv – access earned income in between pay checks
- Walgreens Discount – receive up to 25% off eligible items
- Great culture with a sense of community
CareCentrix maintains a drug-free workplace
#IDCC
We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.
Job Title: Certified Medical Billing and Coding Specialist
Location: Remote
$25 $30 Hourly
Job Type: Full-Time
Company Overview:
Flow Health is a rapidly growing clinical diagnostic laboratory services provider, leading the way in inidualized, data-driven diagnostics. Based in Los Angeles, we hold both CAP accreditation and CLIA certification, uniquely positioned to combine the power of artificial intelligence (AI) with an end-to-end full service laboratory diagnostics platform. Our mission is clear: to revolutionize how clinicians and patients order and access personalized diagnostic insights, ultimately improving clinical outcomes and patient care.
Job Description:
We are seeking a highly skilled and detail-oriented Certified Medical Billing and Coding Specialist to join our laboratory team. The successful candidate will play a crucial role in ensuring accurate coding processes, contributing to the financial health of our organization. The ideal candidate should possess strong analytical skills, knowledge of medical terminology, and a deep understanding of coding principles and regulations within the diagnostic laboratory setting. The role is 100% remote, offering the applicant outstanding work flexibility.
Key Responsibilities:
- Assign appropriate codes to diagnoses, procedures, and laboratory services based on documentation provided by healthcare providers and laboratory professionals.
- Ensure compliance with all relevant coding guidelines, specifically ICD-10.
- Stay up-to-date with changes in coding regulations, payer policies, and healthcare laws relevant to diagnostic laboratory coding.
- Conduct regular audits to ensure compliance with coding and billing standards specific to diagnostic laboratory services.
- Demonstrate sound knowledge of laboratory coding guidelines and regulations to assist providers with the impact of diagnosis coding on risk adjustment payment models.
- Requires solid oral and written communication skills, and strong attention to detail.
Qualifications:
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification is required.
- Associate s degree in Medical Billing and Coding or related field is preferred.
- Minimum of 2 years experience in medical billing and coding, ideally within a clinical or laboratory setting.
- Familiarity with medical billing software and claims processing systems specific to laboratory services.
- Expertise in ICD-10, with emphasis on diagnostic codes.
- Must have excellent time management skills, be highly organized, and self-motivated.
Updated over 1 year ago
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