Paralegal

United States

GENERAL PURPOSE OF JOB

Support and assist the legal team with a variety of responsibilities including contracts, case management, and other legal matters related to clients, vendors, and the healthcare industry.

KEY RESPONSIBILITIES

• Act as liaison among various internal departments, funnel legal requests, and manage work allocation for the Legal team.
• Develop resources and tools for the business to self-serve legal issues, and training resources for the Legal team to use with business partners.
• Assist attorneys with drafting, reviewing, and revising legal documents, including provider, vendor, corporate, and client contracts as well as legal correspondence and memoranda.
• Assist attorneys with management of healthcare-related litigation, including discovery, subpoenas, and preparing documents for hearings or trials.
• Assist attorneys with legal research, case preparation, and document management related to healthcare law and regulatory matters.
• Maintain and organize agreements and files, ensuring proper documentation and compliance with legal standards.
• Support enterprise contract lifecycle management system.
• Support the legal team in ensuring compliance with federal, state, and local healthcare regulations, including HIPAA.
• Monitor regulatory changes that impact the healthcare industry and provide timely updates to the legal team.
• Assist in responding to subpoenas and requests for medical records and patient information.
• Other duties as assigned.

JOB REQUIREMENTS

Education: 

• Associates or bachelor’s in paralegal studies or a related field, or Paralegal certification.

Experience: 

• At least 8 years’ experience working as a paralegal either in corporate or law firm environment.
• Experience in a healthcare environment preferred.

Certificates, Licenses, Registrations:  

• Paralegal certification preferred; required in the absence of Associate and/or bachelor’s degree in paralegal studies.

Knowledge, Skills & Abilities:  

• Ability to follow projects through to completion.
• Strong attention to detail and accuracy.
• Flexibility and ability to manage time independently and efficiently.
• General familiarity with legal matters.
• Excellent written and verbal communication skills.
• Intermediate Proficiency in Microsoft Applications: Word, Excel, PowerPoint.
• Strong interpersonal skills.
• Must maintain a professional demeanor.
• Must work well in a fast-paced, team-oriented environment and be able to take on independent responsibility.
• Strong prioritization, organization, and project management skills.
• Proven ability to work successfully with erse populations and demonstrated commitment to promote and enhance ersity and inclusion.

Title: Coding Specialist 4 – Integrated procedures

Location: Seattle United States

Req #:239439

Department:UW MEDICINE ENTERPRISE RECORDS & HEALTH INFO

Job Location: Remote/Hybrid

Salary:$5,749 – $8,228 per month

Other Compensation:

Union Position:Yes

Shift:First Shift

Benefits:As a UW employee, you will enjoy generous benefits and work/life programs. For a complete description of our benefits for this position,

Job Description:

UW Medicine Enterprise Records and Health Information has an outstanding opportunity for a CODING SPECIALIST 4, INTEGRATED PROCEDURES.

WORK SCHEDULE

100% FTE, Days

100% Remote

POSITION HIGHLIGHTS</p>

Implements the mission and goals of Enterprise Records and Health Information and incorporating a “patients are first” service culture

Performs daily activities related to coding and charge submission of abstract Current Procedural Terminology (CPT) professional fee and facility integrated procedure coding and billing

Analyzes the medical record to assign International Classification of Diseases (ICD), CPT and/or Healthcare Common Procedure Coding System (HCPCS) codes to ensure correct code assignment and optimal reimbursement in compliance with state and federal guidelines.

DEPARTMENT DESCRIPTION

Enterprise Records and Health Information (ERHI) is a Shared Service Department that supports all aspects of the patient medical record from governance, integrity, documentation timeliness, completion, clinical coding, billing, release, and tracking to management of access, retention, and destruction.

ERHI provides advice and resources related to the lifecycle management of all UW Medicine records

ERHI is an integral part of the Enterprise Revenue Cycle and has a unique role in the organization that supports both clinical and operational activities.

PRIMARY JOB RESPONSIBILITIES

Reviews available electronic and other appropriate documentation within Epic, or other source system to identify all billable procedures and services requiring facility and/or professional fee coding, ensuring all necessary codes use the appropriate ICD, CPT and/or HCPCS code

Ensure coded services, charges and clinical documentation meet appropriate guidelines or standards.

Queries physicians and/or consults with clinical department representatives, as appropriate, to verify services rendered and documented

Provides feedback to assist in the understanding of coding and documentation issues and opportunities.

Maintains seven- day turnaround times for Integrated Coding areas Cardiology, Gastroenterology and Pulmonology for those services and procedures that ERHI is responsible for coding; and understands charge lag impacts for facility and professional fee services

REQUIRED POSITION QUALIFICATIONS

High school diploma or equivalent

Three years of coding experience or equivalent education/experience.

Certified as a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC), Certified Interventional Radiology Cardiovascular Coder (CIRCC), Radiology Certified Coder (RCC) or Radiation Oncology Certified Coder (ROCC).

UW Medicine – Where your Impact Goes Further

UW Medicine is Washington’s only health system that includes a top-rated medical school and an internationally recognized research center. UW Medicine’s mission is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrow’s physicians, scientists and other health professionals.

All across UW Medicine, our employees collaborate to perform the highest quality work with integrity and compassion and to create a respectful, welcoming environment where every patient, family, student and colleague is valued and honored. Nearly 29,000 healthcare professionals, researchers, and educators work in the UW Medicine family of organizations that includes: Harborview Medical Center, UW Medical Center – Montlake, UW Medical Center – Northwest, Valley Medical Center, UW Medicine Primary Care, UW Physicians, UW School of Medicine, and Airlift Northwest.

Certified Coder

Category

Professional & Business Support

Job Family

Remote / Work from Home / Virtual

Department

Revenue Cycle-Physician Billng

Schedule

Full-time

Facility

Castleway / Castleton Office Park

Castleway Drive

Indianapolis, IN 46250 United States

Shift

Day Job

Hours

Works remotely

Must be available for training from 7:30am – 3:00pm or 8:00am – 4:30pm EST

Job Description:

Join Community

Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, “community” is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered – and we couldn’t do it without you.

Make a Difference

The Certified Coder codes and abstracts inpatient or outpatient hospital, ambulatory surgery centers, professional services, or home health using software and coding books, as appropriate for current work assignment.

Exceptional Skills and Qualifications

Applicants for this position should be able to manage time effectively, have excellent communication skills, and a positive attitude toward problem-solving.

• High School Diploma or GED required
• CPC (Certified Professional Coder) Certification through the AAPC required
• 2 (two) or more years of coding experience preferred
• Successful completion of an accredited coding program, including medical terminology, anatomy and physiology preferred
• Ability to communicate effectively with patients, families, staff, and physician
• Meet accuracy and productivity requirements
• Demonstrates accountability for own actions with an openness to change and learning
• Demonstrates customer service skills to provide exceptional patient experience

Community caregivers performing work remotely are permitted to live in the following states: Indiana, Illinois, Ohio, Michigan, Kentucky, Florida and Texas. Caregivers are not allowed to perform work remotely outside of the above states. Applicants from other states may apply; however, if hired, they will be required to relocate to one of the above states within 60 days of their employment date.

Why Community?

At Community Health Network, we build teams that deliver exceptional care through empathy, communication and collaboration. We consider ALL an integral part of the exceptional patient experience. We PRIIDE ourselves on not having employees but Caregivers. Join our Community as we make a difference in your community.

Title: E/M & Hospitalist OP Ancillary/Physician Coder

Location: Fountain Valley, CA (Predominantly Remote)

Job Description:

MEM008343

Department: Document Improvement

Status: Full-Time

Shift: Days (8hr)

Pay Range*: $31.25/hr – $45.32/hr

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare’s recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

Under the direction of the Coding Compliance Manager, the OP Ancillary/Physician Coder will play a key role in reviewing and analyzing billing and coding for charge processing. This role will be responsible for reviewing and accurately coding office, hospital, and surgical procedures for reimbursement, as well as ensuring accurate and compliant medical coding for both inpatient and outpatient services, diagnostic tests, and other medical services rendered to each patient.

Essential Functions and Responsibilities of the Job

1. Proficient in Microsoft Office suite

2. Proficient in Epic software

3. Possess analytical skills

4. Possess critical thinking and problem-solving skills

5. Solid understanding of the health care revenue cycle

6. Strong communication skills with the ability to communicate information accurately and clearly

7. Provide excellent customer service

8. The ability to manage interpersonal relationships and effectively communicate with clinical partners and fellow business center teams

9. Detail oriented

10. Strong work ethic, honest, and dependable

11. Collaborative team player with the ability to adapt to the ever-changing healthcare environment

12. Professional demeanor at all times

13. Maintain patient confidentiality

14. Maintain a safe and orderly work area

15. Personal time management skills – the ability to organize, prioritize, and multitask

16. Be at work and be on time

17. Follow company policies, procedures and directives

18. Interact in a positive and constructive manner

19. Prioritize and multitask

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family.

Qualifications

Minimum Requirements

Qualifications/Work Experience:

·3-years’ experience working in a hospital or physician’s office as a medical coder and interacting with physicians;

·Expert knowledge of ICD10, CPT and HCPCS

·Strong knowledge of medical terminology, anatomy and physiology

·Epic software experience highly desired

·Proficient Microsoft skills

Education/Licensure/Certification:

·High School diploma or GED required;

·CPC, CCS, or equivalent certification required

Primary Location: United States-California-Fountain Valley

Job: Coder

Organization: MemorialCare Medical Foundation

Schedule: Full-time

Employee Status: Regular

Job Level: Staff

Work Schedule: 8/40 work shift hours

Shift: Day Job

Department Name: Document Improvement

Title: HIM Clinical Inpatient Coder II – (Remote)

Location: United States

Status: Full-Time

Standard Hours per Week: 40

Job Category: Finance

Regular, Temporary, Per Diem: Regular

Remote Eligibility: Full-Time Remote

Job Description:

Under direction of HIM Coding leadership, abstracts, sequences and assigns diagnosis and procedure codes according to CMS Coding guidelines, CMS Correct Coding initiatives, ICD 10 CM and ICD-10-PCS coding conventions and Uniform Hospital Discharge Data Set UHDDS definitions to medical records of complex discharged inpatients including cases such as congenital conditions, trauma, post procedure complications, more complex fractures, spinal fusions and VP shunts. Assure timely completion for billing and reporting, as required for reimbursement and maintenance of patient database.

The HIM Clinical Inpatient Coder II – Remote will be responsible for:

• Reviewing and interpreting medical information, physician treatment plans, course, and outcome to determine appropriate ICD codes for diagnoses and procedures.
• Abstracting data elements to satisfy statistical requests by the hospital, health system, medical staff, etc., and entering all coded/abstracted information into the designated system.
• Utilizing standard coding guidelines, principles, and coding clinics to assign the appropriate ICD-10-CM codes for inpatient records to ensure accurate reimbursement.
• Assuring the diagnosis and procedures are sequenced in order of their clinical significance to accurately assign the appropriate DRG for accurate reimbursement. Reviewing coding for accuracy and completeness prior to submission to billing systems utilizing coding edits.
• Ensuring efficient management of medical information and DNB as it pertains to the unbilled coding report.
• Keeping informed of the changes/updates in ICD guidelines by attending appropriate training, reviewing coding clinics, and other resources, and implementing these updates in daily work.
• Being proficient in technology usage such as Epic, Solventum (3M 360) systems.
• Knowing Computer Assisted Coding (CAC).
• Knowing when to escalate issues for resolution.
• Acting as a mentor and subject matter expert to others.
• Engaging in process improvement with coding team and management.
• Working remotely.
• Performing other duties as assigned or required.

To qualify, you must have:

• High School / GED and an inpatient coding certification program or an Associate’s Degree in Health Information Management is required
• Current AHIMA or AAPC Coding Certifications : CCS, CCSP, or CPC is preferred.
• A minimum of one year of progressively complex Acute care inpatient setting inpatient is required
• Fully remote position

Boston Children’s Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.

#LI-Remote

Title: Nurse Care Manager (Adult), Temp to Hire

Location: Remote

Type: Contractor

Workplace: remote

Category: Clinical Strategy and Services

Job Description:

We’re looking for Nurse Care Managers for our Care and Case Management team, who are passionate about caring for members holistically through their healthcare journey and ensuring needs are met with industry-leading interventions. The telephonic Nurse Care Manager will guide members through complex medical and behavioral Health situations, partnering with a multidisciplinary clinical team that includes a variety of healthcare professionals, care coordinators, and records specialists, to deliver integrated remote care in an innovative way. The Nurse Care Manager should enjoy spending time on the phone, listening to members’ needs, answering questions, and serving as an advocate. They should also excel at creating cohesive care plans, and should possess the clinical acumen to guide members clinically and navigate available benefits and resources. Nurse Care Managers will support members through complex care management, disease management, and acute case management, ensuring they receive longitudinal care that results in excellent health outcomes.

Responsibilities:

• Deliver coordinated, patient-centered virtual Care Management by telephone and/or video that improves members’ health outcomes.
• Generate impactful care plans together with members and our multidisciplinary care team, and help members achieve the desired goals.
• Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.
• Partner with the members’ local providers to ensure coordinated care.
• Provide compassionate, longitudinal follow-up care, building supportive relationships.
• Assist throughout acute healthcare episodes, such as hospitalizations and rehabilitation stays, providing coordinated Case Management to support the member and their family.
• Coordinate necessary resources that holistically address members’ problems, whether clinical or social

Qualifications:

• Bachelor of Science in Nursing (BSN).
• Must have current CCM Certification
• 5+ years of experience in nursing preferred.
• 2+ years experience working in care management
• Must reside in a compact NLC state.
• Active Compact RN license in good standing with the nursing board of their state.
• Active California Nursing License preferred
• Willingness to become (and maintain) licensure in multiple states.
• Work until 6pm PST (Preference for those based in MST/PST time zones)
• Be comfortable discussing a wide variety of medical conditions and experience with populations across the age ranges
• Spanish speaking desirable
• Experience working remotely preferred; Comfortable with technology, as well as strong competence and ability to use multiple computer/medical record systems.
• Be highly empathetic. We work with patients and their families who are going through challenging times. Ideal candidates practice empathy and reassure patients that we are available to help them.
• Must be able to work efficiently. We are a fast growing company and we are busy. Our team is expected to meet volume goals without sacrificing quality. Good judgment for balancing priorities is a must.
• Be flexible and comfortable with working in a rapidly-changing environment.
• Strictly follow security and HIPAA regulations to protect our patients’ medical information.
• Be pleasant, responsive, and willing to work with and learn from our team.
• Strong verbal and written communication skills. A lot of time is spent on the phone with patients and families, as well as a lot of time communicating with colleagues. Therefore, the ability to gather a clinical history, answer questions at a patient level, and succinctly summarize findings is critical.
• Excellent grammar, attention to detail, and efficient at writing medical information in easy-to-understand, patient-centric language.

Schedule: M-F 9a-6p PST

About Included Health

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

—–

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

Registered Nurse

Title: RN Daytime Triage – Remote

Location: Minneapolis United States

Job Description:

Number of Job Openings Available:

1

Date Posted:

October 04, 2024

Department:

62000635 Allina Health Group Daytime RN Triage

Shift:

Day (United States of America)

Shift Length:

8 hour shift

Hours Per Week:

32

Union Contract:

Non-Union

Weekend Rotation:

Every 3rd

Job Summary:

Allina Health is a not-for-profit health system that cares for iniduals, families and communities throughout Minnesota and western Wisconsin. If you value putting patients first, consider a career at Allina Health. Our mission is to provide exceptional care as we prevent illness, restore health and provide comfort to all who entrust us with their care. This includes you and your loved ones. We are committed to providing whole person care, investing in your well-being, and enriching your career.

Key Position Details:

Remote Role: Must live within one hour of Apple Valley, MN

• .8 FTE (64-hours per 2-week schedule)
• 8-hour day shifts
• Every third weekend rotation
• High Volume Phone Triage
• Will also be cross trained to complete medication refills
• Rotating Holiday schedule
• Benefit Eligible

Job Description:

Nursing is the diagnosis and treatment of human response to actual or potential health problems. This includes establishing an intentional therapeutic relationship between a registered nurse and a patient and family. As a leader and the integrator of care, the professional nurse has the responsibility, authority, and accountability for planning, coordinating and evaluating the patient’s care needs.

Provides patient care support for centralized nursing program, outpatient and home care services. This includes Triage services, Anti-coagulation, and refill. Iniduals in this role will work in an outpatient clinic setting.

Principle Responsibilities

• Assessment.
• Collects, prioritizes and synthesizes comprehensive data pertinent to the patient’s health or situation.
• Collects and prioritizes data in a systematic and ongoing process that involves the patient, family, other health care providers and environment as appropriate.
• Integrates data relevant to the situation to identify needs, patterns and variances.
• Uses appropriate evidence based assessment techniques and instruments in data collection.
• Diagnosis.
• Analyzes assessment data to determine nursing diagnoses.
• Interprets assessment information to identify each patient’s needs relative to age, developmental stage and culture.
• Formulates, revises and resolves nursing diagnoses that reflect the current patient status.
• Validates and communicates nursing diagnoses with the patient, family and other health care team members.
• Documents nursing diagnoses in compliance with the patient care guidelines.
• Outcomes Identification.
• Identifies expected outcomes inidualized to the patient.
• Establishes, in the collaboration with the family, patient, realistic and measurable patient expected outcomes based on nursing diagnoses, patients present and potential capabilities, goals, available resources and plan for continuity of care.
• Planning.
• Develops a plan that prescribes interventions to attain expected outcomes.
• Develops an inidualized plan considering patient characteristics or the situation as appropriate in conjunction with the patient, family and others.
• Establishes a plan that provides for continuity of care.
• Incorporates evidence based nursing practice takes into consideration current statutes, rules and regulations when developing the plan of care.
• Implementation.
• Implements the identified plan.
• Implements interventions in a safe, timely, appropriate manner.
• Utilizes evidence-based interventions and treatments specific to the diagnoses as appropriate.
• Coordinates implementation of the plan of care if appropriate
• Documents interventions according to documentation guidelines.
• Evaluation.
• Evaluates the patient’s progress towards attainment of the outcome.
• Evaluates the patient’s/family’s understanding of and response to the plan of care.
• Utilizes systematic and ongoing assessment data to revise diagnoses, outcomes and the plan of care.
• Involves the patient, family, and health care team members in the evaluation process when appropriate.
• Documents revisions in diagnoses, outcomes and the plan of care according to documentation guidelines.
• Quality of Practice.
• Systematically enhances the quality and effectiveness of nursing practice.
• Participates in quality improvement activities related to nursing practice.
• Incorporates available QI data to improve nursing practice and outcome.
• Education.
• Attains knowledge and competency that reflects current nursing practice.
• Participates in educational activities related to nursing practice.
• Acquires and applies the knowledge gained from educational experiences to current nursing practice.
• Professional Practice Evaluation.
• Evaluates one’s own nursing practice in relation to professional practice standards and regulatory guidelines.
• Engages in self-evaluation of practice on a regular basis, identifying strengths and goals for professional development.
• Obtains informal feedback regarding one’s own practice from patients, peers, professional colleagues, and others.
• Collegiality.
• Contributes to the professional development of peers, colleagues, and others.
• Shares knowledge and skills in practice settings.
• Provides immediate and ongoing positive and constructive feedback to colleagues regarding their performance.
• Contributes to a supportive and healthy work environment.
• Collaboration.
• Collaborates with patient, family, and others in the conduct of nursing practice.
• Partners with others to effect change and generate positive outcomes through knowledge of the patient or situation.
• Ethics.
• Acts in an ethical manner.
• Maintains a therapeutic and professional patient-nurse relationship with appropriate professional role boundaries.
• Serves as a patient advocate assisting patients in developing skills for self-advocacy
• Uses available resources to help formulate ethical decisions.
• Research.
• Integrates research findings in practice.
• Utilizes the best evidence, including research findings, to guide practice decisions.
• Resource Utilization.
• Incorporates factors related to safety, effectiveness, cost, and impact on practice in planning and delivering patient care.
• Utilizes resources related to standards of care in a safe, effective and ethical manner.
• Manages resources to assure they will be accessible to other in the future.
• Leadership.
• Provides leadership in the professional practice setting and the profession.
• Functions as a professional role model.
• Promotes a positive work environment.
• Participates in shared decision-making.
• Environmental Health.
• Practices in an environmentally safe and healthy manner.
• Attains knowledge of environmental health concepts, such as implementation of environmental health strategies.
• Promotes a practice environment that reduces environmental health risks for workers and healthcare consumers.
• Communicates environmental health risks and exposure reduction strategies to healthcare consumers, families, colleagues and communities.
• Charge Nurse (only when acting in this role).
• Demonstrates ability to coordinate and direct unit operation so the patient and family needs are met and resources are efficiently utilized in a safe manner.
• Promotes an environment that encourages inidual growth, nurtures professional practice and fosters teamwork.
• Collaborates effectively with unit staff, leadership and other disciplines.
• Preceptor (only when acting in this role).
• Demonstrates ability to identify the orientee’s learning needs and plans appropriate learning experiences.
• Demonstrates ability to implement an inidualized orientation plan for the orientee.
• Demonstrates ability to validate clinical competence of orientee.
• Facilitates development of organizational and prioritization skills of orientee.
• Demonstrates ability to evaluate interpersonal sills of orientee.
• Serves as a professional role model.
• Facilitated socialization of orientee into the organization and work group.
• Other duties as assigned.

Required Qualifications

• Associate’s or Vocational degree in nursing
• Minimum 3 years RN experience

Preferred Qualifications

• Experience in triage, anticoagulation, or remote nursing support

Licenses/Certifications

• Licensed Registered Nurse-MN Board of Nursing required
• Licensed Registered Nurse-WI Dept of Safety & Professional Services required by completion of orientation

Physical Demands

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

Registered Nurse

Location: United States

A modern approach to weight requires modern practices, and that means radically remodeling how intensive lifestyle intervention programs operate and scale. As part of our clinical program team, you’ll deliver several critical components of the Calibrate program: outreach and support for members to enhance their program progress, clinical program coordination, and confirmation of clinical appropriateness for clinical care pathways, introduction to our method, and setting program plans with members.

In addition to providing exceptional patient care, your feedback on how we can continue to improve our program to help patients achieve-and maintain-their metabolic health and weight loss goals will help shape and improve the program.

This is a part-time, hourly role with a rate of $50.00 per hour. Benefits are not included. There are two shifts being offered: 10am-6pm EST or 11am-7pm EST

Additional Details:

• • Malpractice coverage provided by employer

• • Weekdays plus possible weekend hours required

• • Ability to flex hours up based on business needs during peak time

• • Training will require a full-time weekday schedule for 3 weeks with some training during EST working hours

KEY RESPONSIBILITIES

• • Consistently provide a world-class level of patient experience and clinical care

• • Utilize and support a detailed clinical treatment paradigm, developed and updated by the Calibrate team and specialized to support obese patients achieve weight-loss goals

• • Provide care management for patients who need additional clinical support throughout the program

• • Serve as a program ambassador to address clinical and programmatic questions for patients at all stages of their Calibrate journey

• • Engage cross-functionally with physicians, nurse practitioners, and support teams to coordinate care for patients

• • Review and manage daily tasks; patient messaging and callbacks

BACKGROUND AND EXPERIENCE

• • Bachelor of Science Degree in Nursing (BSN) graduate of an accredited school of nursing

• • Current state license(s) in the state(s) practicing

• • At least three years of direct clinical experience required, leadership experience preferred

• • At least one year of health tech experience required

• • At least two licenses required, one of which must be from the following list: Compact or, OR, IL, CT, HI, AK, CA

• • Primary/preventative care, acute care, or emergency medicine experience required

• • Demonstrated excellent written/verbal communication skills and virtual “bedside” manner

• • Excellent communicator & critical thinker, with a customer service mentality

• • Experience with project management, and strong organizational and time management skills

• • Creative problem-solving skills that can be leveraged to empower others and drive member outcomes

• • Self starter, solutions-oriented mentality

• • Excited to build and deliver a new model for achieving lasting weight health

• • Adaptable and flexible, but always puts the patient first

• • Excellent at forging successful and respectful relationships with the entire team

• • Quick learner, comfortable using a variety of applications and software

BENEFITS

• • Competitive salary with opportunity for equity in an early stage, high growth business

• • Generous paid time off, including an all-company holiday over Thanksgiving week

• • Calibrate-funded health benefits (medical, dental, vision) – starting at zero cost to you

• • Calibrate-paid disability and basic life insurance to give you peace of mind during unforeseen events

• • Therapy on your time with free access to Headspace and HeadspaceCare

• • An employee assistance program through Guardian to provide counseling across a range of personal topics

• • Remote-first team

• Competitive Paid Parental Leave for parents

Health Services Coordinator -Sales Account Coordination

Remote

Full Time

Entry Level

The Power of Prevention encompasses all that we do at Life Line Screening.

Do you have a passion for building and maintaining relationships and accounts? We’re looking for someone who believes in what we do and wants to help grow by identifying new locations and following up on previous partnerships that utilize our services hosting events for members of their communities and surrounding areas. This role is ideal for someone with a background in community outreach and marketing, fundraising, and following up on warm leads. This is a remote work from home position and requires experience in that type of setting with discipline and the ability to work independently meeting and exceeding goals and expectations.

What you’ll do:

The Community Sales Coordinator (known internally as Health Services Coordinator) will be responsible for effectively calling potential leads and developing long-term relationships with various community organizations. Plan, schedule, and coordinate a minimum of 32 to 35 community health events on a monthly basis, while prospecting for future events. Strong attention to detail and follow-through are required to book quality sites, effectively increasing overall revenue opportunities and providing a top-notch environment for our customers.

What you’ll need to be successful:

• High School diploma or equivalent required
• The ability to educate and gain buy-in from key stakeholders to book spaces
• 1-2 years’ experience with inside sales or call center (similar role/responsibilities)
• 1-2 years’ experience working in a remote/work from home capacity with little direction or supervision needed
• Goal-oriented and motivated by a fast-paced environment
• Ability to negotiate rates and be mindful of budget
• Salesforce experience is a plus but not required
• Excellent verbal and written communication skills
• Strong attention to detail and organizational skills
• Proven success in the sales and account management field
• Ability to work within deadlines
• Ability to make “cold-calls”
• Skills in meeting and logistic coordinators
• “Grass-roots” marketing experience

Life Line Screening is proud to be an equal opportunity employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age disability, protected veteran status, or other characteristics protected by law. Life Line Screening will only employ those who are legally authorized to work in the United States for this opening. Any offer of employment is conditional upon the successful completion of a background check and drug screen.

Nurse Case Manager – Workers’ Compensation

Job Number: 234727

Join Forbes’ 2024 Best Employer for Diversity!

As a nurse case manager on our Workers’ Compensation Claims team, you’ll focus on telephonic medical case management, prioritizing early intervention and return-to-work strategies. In this role, you’ll coordinate high-quality medical care for claims involving disability and medical treatment. Additionally, you’ll provide in-house medical reviews to ensure compliance with claims handling laws and regulations.

Must-have qualifications

• · Bachelor’s degree or higher from an accredited institution in a health or human services field, a minimum of five years clinical experience, and an active nursing license (i.e. RN, LCSW)

Preferred skills

• Workers’ compensation or occupational accident experience
• Insurance case management experience
• Understanding of diagnosis codes (i.e., ICD-10)
• Exposure to a broad severity of injuries, including catastrophic

Compensation

• $70,100- $93,500/year
• Gainshare bonus up to 24% of your eligible earnings based on company performance

Benefits

• 401(k) with dollar-for-dollar company match up to 6%
• Medical, dental & vision, including free preventative care
• Wellness& mental health programs
• Health care flexible spending accounts, health savings accounts, & life insurance
• Paid time off, including volunteer time off
• Paid & unpaid sick leave where applicable, as well as short & long-term disability
• Parental & family leave; military leave & pay
• Diverse, inclusive & welcoming culture with Employee Resource Groups
• Career development & tuition assistance

Energage recognizes Progressive as a 2024 Top Workplace for: Innovation, Purposes & Values, Work-Life Flexibility, Compensation & Benefits, and Leadership.

Equal Opportunity Employer

For ideas about how you might be able to protect yourself from job scams, visit our scam-awareness page at https://www.progressive.com/careers/how-we-hire/faq/job-scams/

#LI-Remote

Job: Claims

Primary Location: United States

Schedule: Full-time

Employee Status: Regular

Work From Home: Yes

Title: TPR Pro Fee Coding Compliance Auditor (Remote based in US)

Location: United States

Job Description:

The Coding Compliance Auditor conducts risk-based coding audits of professional fee diagnosis and procedural assignments in accordance with the official coding guidelines, as supported by clinical documentation in health record.

Essential Duties and Responsibilities:

• Understands, interprets, and applies professional fee coding guidelines for coding audits. Audits include a complex review of the medical record to determine coding accuracy as well as compliance with other professional fee services such as teaching physician, incident-to and split/shared services.
• Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the organization.
• Identifies documentation that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
• Stays current with AMA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM, CPT, and HCPCS coding. Completes online education courses and attends mandatory coding workshops and/or seminars (ICD-10-CM, HCPCS and CPT updates), as directed. Reviews AMA, CMS, and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates.
• Others may be assigned.

Knowledge, Skills, Abilities:

• Ability to consistently and accurately audit complex coding of professional fee services
• Ability to create clear and concise audit reports
• Expert level knowledge of medical terminology, ICD-10-CM/PCS and CPT coding guidelines and methodologies
• Must be detail oriented and with the ability to work independently and in team setting
• Computer knowledge of MS Office
• Must display excellent written and verbal communication skills
• Ability to demonstrate initiative and discipline in time management and assignment completion
• Ability to research difficult coding and documentation issues and follow through to resolution
• Ability to work in a virtual setting under minimal supervision

Education / Experience

• High school diploma/GED is required.
• Associates degree in relevant field preferred or combination of equivalent of education and experience.
• Three (3) years coding experience of professional fee services with experience in multiple specialties.
• One (1) year of experience in coding audit or quality review work.
• AAPC Coding Credential is required.

Compensation:

• Pay: $35.00 to $48.80 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Observed holidays receive time and a half.

Benefits:

The following benefits are available, subject to employment status:

• Medical, dental, vision, disability, life, AD&D and business travel insurance
• Paid time off (vacation & sick leave)
• Discretionary 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance.
• For Colorado employees, paid leave in accordance with Colorado’s Healthy Families and Workplaces Act is available.

Tenet Healthcare complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

#LI-DM4

2403029636

Title: Profee – Facility Surgery Coder

Location: Irving United States

Job Description:

Who we are.

We are a team of passionate experts with a clear ambition: applying digital technology to advance what matters for our clients and society.

Together we create reliable and responsive digital foundations for the world’s businesses, institutions, and communities.

Profee – Facility Surgery Coder

Location: Remote (US Wide)

Requirements:

3+ years coding experience

2+ years of Oncology coding experience.

Minimum of 1 Coding Certification from AHIMA or AAPC; RHIA, RHIT, CPC, CCS

HCPCS – EPIC/ 3M 360 CAC experience required.

Experience in multi-specialty Oncology coding.

Experience in coding physician and facility, DX & CPT, Must be able to code for both.

Coder will assign medical diagnoses and procedures using appropriate classifications for assigned areas/record types. Responsibilities: Reviews medical records to determine all appropriate diagnostic and procedural code assignments using the appropriate classifications systems. Communicates with department manager/supervisor on coding, compliance and documentation issues. Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding. Enhances coding knowledge and skills with continuing education activities and by reviewing pertinent literature. Within scope of job, requires critical thinking skills, decisive judgement and the ability to work with minimal supervision.

Rewards and benefits:

• Law and Superior Benefits
• Wellbeing programs & work-life balance – integration and passion sharing events.
• Opportunities for professional growth and career advancement.
• Benefits platform -culture, shopping, sport, etc.
• Continuous learning programs and online courses.
• Possibility to participate to charity and eco initiatives.

Future career path:

• After your 1st year in Atos you can apply to any position to keep growing as a professional.

If you’re ready to embark on this exciting adventure with us, sign in on jobs.atos.net.

For any questions, please contact our recruiter Luis Chapa – [email protected]

Join our phenomenal team to grow together!

#LI-US #LI-REMOTE

Learn more about us

At Atos, we embrace ersity as the ultimate engine of ingenuity for our clients, and we constantly strive to create a culture where people feel supported and encouraged. Read more about our commitment here.

Whether it is fighting climate change, promoting digital inclusion, or ensuring trust in data management – tech for good sits at the core of our identity. With numerous global recognitions for our ESG practices, we are committed to building a better future for all by harnessing the power of technology. Learn more here

Title: Outpatient Coder – Same Day Surgery – Remote – FT/PRN

Location: Remote United States

Requisition ID

2024-37522

# of Openings

1

Category (Portal Searching)

HIM / Coding

Position Type (Portal Searching)

PRN

Equal Pay Act Minimum Range

$20.00 – $30.00 per hour

Job Description:

Overview

Full Time & PRN Opportunities

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

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

We’re looking for experienced and credentialed outpatient coders to become an integral part of our team. The ideal candidate for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing you to help shape the future of healthcare from your own workspace!

We’re actively seeking Same Day Surgery/Observation Coders with the following experience:

• Infusions/Injections
• Facility E/M Leveling
• Emergency Department
• Ancillary
• Academic facility coding

Responsibilities

What you will do:

• Review medical records and assign accurate codes for diagnoses and procedures.
• Assign and sequence codes accurately based on medical record documentation.
• Assign the appropriate discharge disposition.
• Abstract and enter the coded data for hospital statistical and reporting requirements.
• Communicate documentation improvement opportunities and coding issues to appropriate personnel for follow up and resolution.
• Maintain a 95% coding accuracy rate and a 95% accuracy rate for APC assignment and meet site-designated productivity standards.
• Be responsible for tracking continuing education credits to maintain professional credentials.
• Attend Datavant Health sponsored education meetings/in-services.
• Demonstrate initiative and judgment in the performance of job responsibilities.
• Communicate with co-workers, management, and hospital staff regarding clinical and reimbursement issues.
• Function in a professional, efficient, and positive manner.
• Adhere to the American Health Information Management Association’s code of ethics.
• Be customer-service focused and exhibit professionalism, flexibility, dependability, and a desire to learn.
• Handle a high complexity of work function and decision-making.
• Possess strong organizational and teamwork skills.
• Be willing and able to travel when necessary if applicable.
• Comply with all HIM Division Policies.

Qualifications

What you will bring to the table:

• Excellent written and verbal communication skills
• AHIMA certified credentials (RHIA, RHIT, CCS) or AAPC certified credentials (CPC, CPC-H, COC, CIC or CRC).
• Strong written and verbal communication skills, adeptness in remote work, and exceptional time management skills.
• Experience in computerized encoding and abstracting software.
• Required to take and pass annual Introductory HIPAA examination and other assigned testing to be given annually
• Proficiency with most or all of these coding specialties (Emergency Department, Same Day Surgery, Ancillary, Observation, Injections/Infusions, E/M leveling)

Bonus points if:

• Must be able to communicate effectively in the English language.
• 2+ years of coding experience in a hospital and/or coding consulting role.
• Experience in computerized encoding and abstracting software
• Passing annual Introductory HIPAA examination and other assigned testing to be given annually in accordance with employee review

Perks:

• 20-24 free CEUs per year, provided by Datavant
• AAPC/AHIMA dues compensation
• Company equipment will be provided to you (including computer, monitor, etc.)
• Comprehensive training led by a credentialed professional coding manager

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

This position requires that you provide a high-speed internet connection, subject to applicable expense reimbursement requirements (if any), and a work environment free from distractions. Please note that 1 or more assessments may be required as a condition to being hired for this role. There is no COVID vaccine requirement for this role.

Pay ranges for this job title may differ based on location, responsibilities, skills, experience, and other requirements of the role. The estimated pay range for this role is $20 – $30 per hour.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

This job is not eligble for employment sponsorship.

Equal Pay Act Minimum Range

$20.00 – $30.00 per hour

Title: Specialty Clinic Coding Spec (Non-Exempt)

Location: United States

Business Professional

Other Professional Non-Clinical

Days

Regular

Full Time

Remote

Job Description:

We’re a Little Different

Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service.

At Mercy, we believe in careers that match the unique gifts of unique iniduals – careers that not only make the most of your skills and talents, but also your heart. Join us and discover why Modern Healthcare Magazine named us in its “Top 100 Places to Work.”

This is a Remote Position

Please make sure you have your relevant certification(s) listed in your resume or application so we can verify eligibility for this position.

*Please note that as of the posting date of this job announcement, Mercy is unable to offer immigration sponsorship or visa assistance for this position. We encourage all eligible candidates, including U.S. citizens, permanent residents, and those with existing work authorization, to apply.

Overview:

The coder is responsible for reviewing and analyzing documentation present in the medical record for inpatient, outpatient and/or professional services to assign diagnoses/procedure codes as described by the physician(s) of record. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.

Qualifications:

• Experience: 3 years coding experience in ICD-10-CM diagnoses/procedure coding and HCPCS/CPT procedure coding in the acute care inpatient/outpatient hospital or professional services setting.
• Education: High school diploma
• Certifications: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or Certified Interventional Radiology Cardiovascular Coder (CIRCC)
• Other: Working knowledge and high level of experience with the ICD-10-CM and/or CPT/HCPCS coding classification systems, MS-DRG’s, APC’s, MPFS/RVU’s, POA’s, and HAC’s; dependent upon whether an IP, OP, or Professional Services Coder. The physical demands described here are the representative of the minimums that must be met by an employee to perform all essential functions of the job. Most physical demands are below, plus: Frequent: Repetitive motion involves approximately 25% keyboard and 75% mouse for data entry.

We Offer Great Benefits:

Day-one comprehensive health, vision and dental coverage, PTO, tuition reimbursement and employer-matched retirement funds are just a few of the great benefits offered to eligible co-workers, including those working 32 hours or more per pay period!

We’re bringing to life a healing ministry through compassionate care.

At Mercy, our supportive community will be behind you every step of your day, especially the tough ones. You will have opportunities to pioneer new models of care and transform the health care experience through advanced technology and innovative procedures. We’re expanding to help our communities grow. Join us and be a part of it all.

Title: Nurse Case Manager

Location: United States, OH

Job Description:

Note: This position allows you the flexibility to work at home within the state of Ohio. We are looking for applicants that have a strong clinical case management background. Medicare experience is a plus.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and inidual plans.

Under limited supervision, the RN Case Manager evaluates and provides support to members, their families, and physicians in addressing member needs. Educates members and families to make informed personal health care decisions and determines the most effective treatment options. Facilitates communication between member, physician, and community.

Responsibilities

• Independently manages complex health care cases by multiple means such as phone, email, and video conferencing. Verifies eligibility, benefits, enrollment history, clinical history, and demographics. Assesses patient needs by gathering information from the member, family, provider, and other stakeholders to monitor and evaluate for medical appropriateness and quality of care. Educates members and assists them in removing barriers and with various treatment options.
• Facilitates and implements interventions based on agreed upon care treatment plan developed in collaboration with all participants in the members healthcare team. Coordinates services with community resources and support groups with members.
• Keeps up to date on and maintains appropriate documentation within Company and regulatory guidelines, policies, and practices.
• Performs other duties as assigned.

Qualifications

Education and Experience:

• Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor’s Degree preferred.
• 3 years as a Registered Nurse with a combination of clinical and case management experience, preferably in the health insurance industry.
• Case Management and Home health care experience is a plus.

Professional Certification(s):

• Registered Nurse with current State of Ohio unrestricted license. Multiple state licensure preferred and may be required.
• Certified Case Manager (CCM) or other industry recognized certification preferred (required within 3 years of hire).
• Certification in Motivational Interviewing preferred.

Technical Skills and Knowledge:

• In depth knowledge of health insurance benefits, health plans, and industry trends, and the ability to apply knowledge to achieve positive outcomes.
• Strong knowledge of behavioral change techniques and health coaching (ex. readiness to change and motivational interviewing)
• Knowledge of, and the ability to apply fundamental concepts related to HIPAA compliance and related regulations.
• Knowledge of disease continuums, expected patient outcomes and community services available.
• Intermediate proficiency navigating windows and web-based systems and basic Microsoft Office skills.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That’s why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance – insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay idends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and inidual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

Clinical Navigation, Nurse Practitioner – Physician Assistant

Location: Remote

Type: Full-time

Workplace: remote

Category: Clinical Strategy and Services – Clinical Team

Job Description:

The Clinical Navigation NP/PA will connect with members using various modalities to assess their needs and goals, provide clinical guidance, and navigate members to resources to improve their health outcomes. This clinician will work with a multidisciplinary team to help optimize patients’ health outcomes.

Responsibilities:

• Talk with patients, assess their needs, gather important clinical history, provide appropriate clinical guidance, and navigate them to Included Health services and external benefits as appropriate
• Demonstrate strong clinical acumen across a variety of Included Health Service Lines, including Expert Medical Opinion, Treatment Decision Support, Healthy Days, and other service lines based on business needs
• Meet Volume Targets: Ensure that the volume of patient encounters meets the established targets. This includes scheduling and conducting a specified number of encounters as outlined by departmental goals.
• Maintain Quality of Services: Deliver high-quality clinical services that adhere to established standards and protocols.
• Continuous Improvement: Participate in continuous improvement initiatives aimed at optimizing the efficiency and effectiveness of clinical services. This includes staying current with best practices and emerging trends in healthcare delivery.
• Collaboration and Coordination: Work closely with other healthcare professionals and administrative staff to coordinate care and ensure that service delivery aligns with overall organizational objectives.
• Collaborate across a multidisciplinary team with clinical and non-clinical members to deliver a seamless, top-quality care experience to our patients.
• Evaluate, triage and manage pediatric and adult patients for both acute, chronic and mental health conditions
• Collaborate on pilots, projects, and workflow changes to increase efficiency and improve member experience
• Demonstrate empathy and excellent patient advocacy. You’ll work with patients and their families who are going through challenging times. You need to maintain perspective, demonstrate empathy, and be efficient and reassuring.
• Function autonomously and document findings appropriately and timely
• Strictly follow security and HIPAA regulations to protect our patients’ medical information
• Scheduling flexibility to include evenings and weekends
• Other responsibilities based on business need

Required Qualifications

• Be a licensed NP/PA provider in good standing with your state board.
• Maintain board certification
• At least 3 years of NP/PA experience in a clinical setting is required
• Willingness to obtain and maintain additional licenses as necessary.
• Strong communication skills, with an emphasis on clear and detailed medical documentation.
• High empathy and the ability to reassure patients and their families during challenging times.
• Strong judgment and efficiency in balancing priorities.
• Flexibility to work cross-functionally in a fast-paced environment.
• Proficiency and enthusiasm for adopting new technologies, including AI, Electronic Health Records (EHR), and Google apps.
• Comfortable providing care to all age groups, from newborns to adults.
• Ability to thrive in a dynamic work environment while working independently.

Preferred Qualifications

• 5+ years of NP/PA experience in a clinical setting is preferred
• Virtual care/telemedicine experience is preferred

Schedule

• 2,080 annual hours
• 40 hours per week / 80 hours per pay period
• Shifts from 8 AM – 5 PM or 9 AM – 6 PM Pacific Time

Physical/Cognitive Requirements:

• Regular attendance at assigned work location.
• Ability to thrive in a fast-paced, high-intensity work environment.
• Ability to remain seated for extended periods.
• Manual dexterity sufficient to operate office equipment.
• Occasional exertion of up to 20lbs. (e.g., lifting a laptop) may be required.
• Professional interaction with leadership, employees, and members.

The United States new hire base salary target ranges for this full-time position are:

Zone A: $108,890 – $141,560 + equity + benefits

Zone B: $125,224 – $162,794 + equity + benefits

Zone C: $136,113 – $176,950 + equity + benefits

Zone D: $141,557 – $184,028 + equity + benefits

This range reflects the minimum and maximum target for new hire salaries for candidates based on their respective Zone. Below is additional information on Included Health’s commitment to maintaining transparent and equitable compensation practices across our distinct geographic zones.

Starting base salary for the successful candidate will depend on several job-related factors, unique to each candidate, which may include, but not limited to, education; training; skill set; years and depth of experience; certifications and licensure; business needs; internal peer equity; organizational considerations; and alignment with geographic and market data. Compensation structures and ranges are tailored to each zone’s unique market conditions to ensure that all employees receive fair and competitive compensation based on their roles and locations. Your Recruiter can share details of your geographic alignment upon inquiry.

In addition to receiving a competitive base salary, the compensation package may include, depending on the role, the following:

Remote-first culture

401(k) savings plan through Fidelity

Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)

Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents

Generous Paid Time Off (“PTO”) and Discretionary Time Off (“DTO”)

12 weeks of 100% Paid Parental leave

Family Building Benefit with fertility coverage and up to $25,000 for Surrogacy & Adoption financial assistance

Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment)

11 Holidays Paid with one Floating Paid Holiday

Work-From-Home reimbursement to support team collaboration and effective home office work

24 hours of Paid Volunteer Time Off (“VTO”) Per Year to Volunteer with Charitable Organizations

About Included Health

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

—–

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

Case Manager Nurse – RN

Job Location US-Remote

Job ID

2024-3545

Category

Care Management

Type

Regular Full-Time

Now is the time to join us!

We’re Personify Health. We’re the first and only personalized health platform company to bring health, wellbeing, and navigation solutions together. Helping businesses optimize investments in their members while empowering people to meaningfully engage with their health. At Personify Health, we believe in offering total rewards, flexible opportunities, and a erse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

Responsibilities

Who are you?

Telephonically manage cases on a long- or short-term basis per established Company guidelines, policies and procedures, as well as other standardized criteria in the healthcare industry.

In this role you will wear many hats, but your knowledge will be essential in the following:  

• Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
• Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs.
• Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals.
• Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions.
• Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care.
• Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
• Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis.
• Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.
• Establish and maintain working relationships with healthcare providers, client/group, and patients to provide emotional support, guidance and information.
• Evaluate and make referrals for wellness programs.
• Maintain complete and detailed documentation of case managed patients in Eldorado and UM Web; maintain site specific files ensuring confidentiality; prepare reports and updates at 30-day intervals for high-risk cases and 90 days interval for low risk cases ensuring confidentiality according to Company policy and HIPAA
• Perform Utilization Review for assigned members.
• Serve as mentors to LVNs and provide guidance on complicated cases as it relates to clinical issues.

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

Qualifications

What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

• Knowledge of medical claims and ICD-10, CPT, HCPCS coding.
• Ability to critically evaluate claims data and determine treatment plan; discharge planning experience.
• Ability to work independently making decisions and problem solving
• Knowledge of community resources and alternate funding programs.
• Computer proficiency or working knowledge of Microsoft Office Suite.
• Excellent interpersonal, communication and negotiation skills.
• Strong customer orientation.
• Good time management skills and highly organized.
• Graduation from an accredited RN program and possession of a current California RN license.
• Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience.
• Prefer case management experience, emergency room, critical care background or some other area of clinical care that is pertinent to case management.

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

Personify Health is an equal opportunity organization and is committed to ersity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $66,000 to $76,000. Note that salary may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.

We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.

#WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded

Licensed Nurse Practitioner

Title: Licensed Nurse Practitioner – Urgent Care

Location: Remote

Type: Modified Full Time

Workplace: remote

Category: Clinical Team

Job Description:

We are seeking a highly motivated nurse practitioner with an active and unrestricted AZ State license and additional state licenses who enjoys management of all health conditions and who is passionate about raising the standard of healthcare for everyone. The Nurse Practitioner will be responsible for caring for patients, maintaining accurate and current patient records, and working collaboratively with our provider and support teams. Start a conversation with us and learn how you can positively impact the lives of patients and play a role in improving healthcare.

Currently unable to consider:

* Candidates residing in the following states: AL, GA, MS, MO, OK, SC, TN

Responsibilities:

• Function autonomously to perform age-appropriate history and virtual examinations, evaluate, diagnose, recommend treatment plan and document findings appropriately and timely
• Deliver high quality patient care while maintaining safety
• Document medical information of patients and review patient history at each visit
• Request consultation or referral with other health care providers when appropriate
• Counsel and educate patients
• Order and interpret diagnostic tests as needed
• Evaluate, triage and manage pediatric and adult patients for both acute, chronic and mental health conditions
• Actively maintain knowledge of current medical research and trends
• Provide administrative support or cross-coverage for reviewing laboratory test results
• Scheduling flexibility to include evenings and weekends

Required Qualifications:

• Current and active Advanced Practice Registered Nurse (APRN) licensure in AZ State
• Board certified – Current national certification as a Family Nurse Practitioner through AANp or ANCC
• Multi-state licensure is required
• Licensed Nurse Practitioner who also maintains an active RN license
• Ability to obtain both RN and NP licensure in additional states
• Graduate of an accredited school of nursing
• Graduate of Master’s Degree level accredited Family Nurse Practitioner Program
• 3+ years of clinical experience as a Nurse Practitioner in primary care (preferred) or urgent care required
• Experience/Comfortable with providing care for all ages, newborn to adult populations
• Ability to function within an integrated medical practice
• Outstanding clinical expertise
• Excellent communication and interpersonal skills
• Comfortable with technology
• Demonstrate flexibility

Preferred Qualifications:

• Telemedicine or virtual care experience preferred
• Experience with Athena EMR preferred

Shift and Scheduling Obligations:

• 32 hours per week/64 hours per pay period
• Weekly shifts must include a minimum of 8 evening hours scheduled between 5p-11p in clinician’s time zone
• Every other weekend, both Saturday AND Sunday shifts; 8 hours per day, scheduled between 7am-11pm in the clinician’s time zone. Rotating day/evening shifts
• 3 holiday shifts required per calendar year

Physical/Cognitive Requirements:

• Prompt and regular attendance at assigned work location (virtually).
• Ability to remain seated in a stationary position for prolonged periods.
• Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment.
• No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required.
• Ability to interact with leadership, employees, and members in an appropriate manner.

The duties and responsibilities in this job description are neither exclusive nor exhaustive and will be updated on a regular basis and may be amended in the light of changing circumstances or business needs. While this job description is intended to be an accurate reflection of the current job, Included Health reserves the right to add, modify, or exclude any duty or requirement at any time or without any notice. Finally, this job description is not intended in any way to create a contract of employment. Unless you have a written employment agreement signed by an authorized Included Health or Doctor On Demand representative, you are employed at-will.

The United States guaranteed base salary for this position is $75,810+ equity + benefits, with a target per-visit compensation of $18,699 (for a target compensation of approximately $94,509.20).

Included Health also offers  additional productivity incentives for employees that exceed the visit target. Details of the incentive structure will be discussed during the interview process.

In addition to receiving a competitive base salary, the compensation package may include, depending on the role, the following:

– Remote-first culture401(k) savings plan through Fidelity

– Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)

– Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents

– Generous Paid Time Off (“PTO”) and Discretionary Time Off (“DTO”)

– 12 weeks of 100% Paid Parental leaveFamily Building Benefit with fertility coverage and up to $25,000 for Surrogacy & Adoption financial assistance

– Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment)

– 11 Holidays Paid with one Floating Paid Holiday

– Work-From-Home reimbursement to support team collaboration and effective home office work

– 24 hours of Paid Volunteer Time Off (“VTO”) Per Year to Volunteer with Charitable Organizations

#LI-Remote #LI-SK1

About Included Health

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

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

Regulatory Coordinator

Location:

United States

Category:

Clinical Trials Operations

Job Type:

Full-time

Pay Rate:

$34.64 – $53.70 per hour

As a Regulatory Coordinator at City of Hope, you’ll play a crucial role in assisting our investigators with the submission of human subject research to regulatory committees, contributing to the advancement of critical medical research. Reporting to the Portfolio Supervisors, Senior Director, Clinical Trial Office, and the CTO leadership team, you’ll facilitate prompt protocol submissions, serving as a liaison to external IRBs.

As a successful candidate, you will:

New Research Study Submission:

• • Develop and maintain knowledge of institutional protocol submission procedures.
  • Coordinate the preparation and submission of new studies to appropriate committees.
  • Keep stakeholders informed of protocol approval and activation status.

Post Initial Approval Submissions:

• • Prepare and submit amendments, continuing reviews, and deviations to appropriate committees.
  • Participate in research audits and communicate status to the PI and research staff.

Regulatory Documents:

• • Assist in maintaining Regulatory Binders for each study.
  • Liaise with Protocol Coordinators, investigators, and sponsors.
  • Attend meetings, conferences, and contribute to the training of new clinical trials staff.

Qualifications

Your qualifications should include:

• Bachelor’s degree.
• Two or more years of experience related to the management and conduct of clinical trials in an academic setting.
• Working knowledge of clinical trials, Federal, State, and Local Regulations, IRB requirements, consent form, and protocol development.

Behavioral Health Care Coordinator

Remote USA

Full time

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, erse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology – to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we’ve grown fast and now serve members across the United States.  And we’ve just started. So join us on this mission!

Job Description

A bit about this role: 

Devoted Medical was founded on the belief that if we treat each member like we would our loved ones, we can improve healthcare experiences and outcomes for our patients.  The Behavioral Health Program is at the heart of this goal.

Devoted Medical has designed a Behavioral Health program to manage and coordinate care in a manner consistent with Devoted’s values of treating every member like family. Members with Behavioral Health conditions often lack access to high-quality care because of lack of access to community resources or personal barriers associated with their behavioral health needs that prevent them from following through to seek care.

We are on a mission to provide well coordinated behavioral health care to Devoted members. Our team combines short term intervention alongside seamless care coordination to support our members securing, and staying committed to community behavioral health intervention.

As a Behavioral Health Care Coordinator you will have the opportunity to provide care coordination services to members referred for Behavioral Health support.

Required skills and experience:

• Bachelor’s Degree and 3 years’ work experience in a healthcare setting
• Two (2) years of experience in a behavioral health setting
• The ability to comfortably multi-task: you’ll be listening, talking and typing all at the same time
• Comfortable working with internal and external stakeholders to advocate for our patients

Desired skills and experience: 

• Prior experience with customer service
• Bilingual preferred (English/Spanish) but not required
• Geriatric experience or experience coworking with a Medicare population
• Health insurance experience, particularly MA or Medicaid
• Prior experience working with complex patients and/or underserved populations

Your Responsibilities and Impact will include: 

• Serve as Behavioral Health’s “Care Traffic Controller,” working closely with patients and other Devoted teams to facilitate and track resolution of clinical needs, such as locating in network behavioral health services, scheduling appointments, collaborating with members to secure ongoing care in their community
• Respond with unconditional positive regard and love in your heart to all members who call into Behavioral Health looking for an in-network BH provider
• Complete telephonic customer support with patients and provider offices
• Prepare for, and actively participate in, weekly Interdisciplinary Team Meetings, helping the team to identify high risk patients, resource needs, and next steps
• Provide continuous administrative and outreach support for patients transitioning from Devoted’s Behavioral Health team to longer term care in their community, ensuring safe, smooth transitions
• Coordinate relationships with community behavioral health partners including locating and confirming in network and community based providers and services as well as performing outreach and engagement with these services
• Operate independently, be self-sufficient, be unwilling to suffer in silence, be vocal when support is needed, be comfortable with ambiguity, and be willing to go the extra mile to ensure Devoted patients are treated like family.

Salary Range:  $22.00 – $29.00 / hour

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the inidual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more….

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Title: Director Nursing Services

Location: United States

Job Description:

Full-Time

We Impact Lives Through Purpose-Driven Work in A People First Culture

Ascend Learning is the connection between a powerful portfolio of brands serving students, educators, and employers with outcomes-based, data driven solutions across the lifecycle of learning.

Our values-driven culture unifies our teams and inspires a mindset of action, innovation, and collaboration, with a relentless focus on customers.

We’re always looking for talented, passionate professionals to join us in our mission to help change lives. If this sounds like an environment where you’d thrive, read on to learn more.

The Client Success Team is responsible for supporting clients purchasing nursing solutions with product training, implementation, integration, consultation, and test preparation delivery to achieve client centric outcomes. The team leads the success planning, onboarding, training, SaaS implementation, ongoing proactive and reactive client support, consulting services, and the delivery of nursing products for Ascend’s nursing brands: ATI, APEA and NursingCE. The CS team is accountable for delivering high quality services and subsequently capturing and tracking key business performance indicators to client success including, client satisfaction, product adoption and usage, NCLEX pass rate, and institutional and student retention.

WHAT YOU’LL DO

The Director of Nursing Services is responsible for overseeing the delivery of domain expert services to customers including nursing consultation services, professional development, and advanced practice test prep delivery. The role requires expert knowledge in undergraduate and graduate nursing curriculum, accreditation procedures, faculty professional development, and advanced practice certification. The role partners with internal and external key stakeholders to ensure quality, outcome-driven, and up to date nursing services are delivered to customers. The role will manage a team of nursing domain experts delivering services to promote Nursing solutions as the leader in the industry for clients to achieve outcomes that support sales renewals and financial targets.

WHERE YOU’LL WORK

This position will work remote in the United States and will require up to 10% travel.

HOW YOU’LL SPEND YOUR TIME

• Manage a team of domain expert nurse consultants and educators delivering expert services to customers.
• Ensure the delivery of quality advanced practice products and certification prep reviews for client outcome achievement and satisfaction.
• Collaborate with internal and external key stakeholders in Sales, Marketing, Product, Client Success and other key stakeholders for consistency in resource development and delivery. Ensure services lead to financial targets of the company for renewals.
• Analyze industry trends and norms to lead strategy and development of professional development offerings at the regional and national level.
• Analyze industry trends and norms to lead strategy and development of professional development offerings at the regional and national level.
• Envision, lead creation, and present evidence-based presentations for thought leadership on nursing topics at regional and national conferences based on emerging industry trends.
• Ensure compliance with ANCC guidelines for provider accreditation, record-keeping and virtual visits for ANCC self-study report, and company industry events and ensure ANCC guidelines are met for professional development offerings.
• Support self-study virtual visit for ANCC provider accreditation.

WHAT YOU’LL NEED

• Master’s Degree in Nursing, Doctorate in Nursing strongly preferred
• 5+ years of experience working in:
  • Nursing Program Accreditation and Self-Study experience
  • Graduate Advanced Practice and Undergraduate curriculum expertise
  • Leadership and Administration in Nursing Academia
  • Direct management experience of people

• Embody expert knowledge of nursing accreditation and self-study process and procedures.
• Strong experience and expert knowledge working in undergraduate and graduate nursing curriculum and test prep.
• Innovative thinker with creative problem-solving and continuous improvement skills.
• Ability to communicate, actively listen, and lead focus groups by creating a trusting environment throughout the process.
• Demonstrates strong analytical skills with the ability to interpret data and present findings to inform leaders of valuable insights that drive effective decision making.
• Detail oriented with thoroughness and accuracy when accomplishing a task.
• Strong organizational skills with ability to successfully manage and prioritize daily tasks and responsibilities.
• Proficient with current technology and experience with MS Office and webinar platforms.
• Assess and understand unique program curriculums and solve for accreditation changes. Ability to listen to client needs and solve for integration set ups and builds that lead to client retention. Collaborate with cross functional teams including product, marketing, innovative technology solution teams.

BENEFITS

• Flexible and generous paid time off
• Competitive medical, dental, vision and life insurance
• 401(k) employer matching program
• Parental leave
• Wellness resources
• Charitable matching program
• Hybrid work
• On-site workout facilities (Leawood, Gilbert, Burlington)
• Community outreach groups
• Tuition reimbursement

Fostering A Sense of Belonging

We seek out and celebrate all people and perspectives and cultivate an inclusive culture where everyone can thrive, feel valued and be their authentic selves. Our culture is firmly rooted in the belief that by embracing our differences and drawing on erse perspectives, we are a stronger, more innovative, and more successful organization where employees experience a sense of belonging.

About Ascend Learning

As a tech-enabled services company, Ascend Learning is a national leader in developing and delivering data-driven online educational content, software, assessments, analytics, and simulations serving institutions, students and employers across healthcare, fitness and wellness, public and workplace safety, skilled trades, insurance, financial services, cybersecurity, and higher education. We’re committed to accelerating the learning pathways that can move people into careers where they have the knowledge and skills to have an impact and help change lives in the communities they serve. Headquartered in Burlington, MA with additional office locations and hybrid and remote workers in cities across the U.S., Ascend Learning was recognized by Newsweek and Plant-A Insights Group as one of America’s 2023 Greatest Workplaces for Diversity.

Ascend Learning, LLC is proud to be an equal opportunity employer (M/F/Vets/Disabled). No agency or search firm submissions will be accepted. Applications for U.S. based positions with Ascend Learning, LLC must be legally authorized to work in the United States and verification of employment eligibility will be required at the time of hire.

Title: Registered Nurse Home Hospital- Virtual- 24-Noc

Location: United States

Job Description:

This RN Virtual position will be located at our New Logistic Command Center- Assembly Row, Somerville, MA.

24 hour/Night

The position to which you are applying is represented by a collective bargaining unit, Massachusetts Nurses Association.

The MGB Home Hospital Virtual Registered Nurse (VRN) is responsible for providing essential elements of the inpatient care delivery model into the patient’s defined living space. The MGB Home Hospital VRN provides quality care to patients through the implementation of nursing process, applied through a team-based nursing model, employing technology and remote care coordination to facilitate care delivery.

The MGB Home Hospital VRN will provide high quality, patient-centered, nursing care to our acute care patients during hospitalization. The VRN will work with a robust interdisciplinary team to promote highest patient outcomes. This role will utilize remote patient monitoring, assessment, planning, intervention, and critical thinking skills to care for acute care patient populations in the home. Leveraging the resources and expertise of the MGB Home Hospital team to implement collaborative workflows, standards, policies, protocols, guidelines, and documentation systems to support safe, reliable, high-quality evidence-based care within clinical protocols as the foundation.

Role Responsibilities

• Performs and documents nursing process, assessment, diagnosis, planning, implementation, and evaluation of patients receiving care remotely, in their defined home.
• Performs virtual care, patient assessment, remote patient monitoring and works with the clinical care team to provide care, trend data and respond accordingly.
• Provide protocol driven assessments, care coordination and intervenes as appropriate and defined by MGB Healthcare at home protocols.
• Exhibits sound clinical decision making and critical thinking skills for a erse patient population.
• Maintain and practice in accordance with nursing guidelines, as well as institutional, local, and state regulations.
• Performs admissions, discharges, and episodic visits within MGB Home Hospital, through high quality virtual patient-centered care.
• Serve as a role model for professional nursing practice.
• Utilize nursing knowledge to identify, prevent and or solve complex acute and/or recurring patient care problems.
• Sharing expertise with multidisciplinary teams to serve as a staff resource.
• Supporting research efforts to advance knowledge and promote evidence-based practice.
• Perform other duties and responsibilities as assigned by Nursing Leadership.
• Provide medication teaching, assist with medication administration and education to patients and families. Collaborate closely with pharmacy and care team regarding medication reconciliation process.
• This RN will provide nursing care to patients in a team model, as well as, inidual.
• Timely documentation of all nursing care to reflect in epic.
• Answers, directs, and provides follow up on incoming clinical patient concerns.

Quality and Safety

• Ensure compliance with reporting requirements in RL Solutions.
• Participate in quality and safety education, rounds, and evaluations.
• Promoting professional practice and a culture of safety; required to engage in process improvement efforts.
• Must be able to work in a HIPPA compliant environment.

Qualifications

Education

• Graduation from an accredited school of nursing. BSN preferred.
• Emergency Nursing and Critical Care nursing experience is preferred.
• BLS
• Current license to practice as a Registered Nurse in Massachusetts
• Excellent clinical and interpersonal skills.

Experience

• Recent 3 years bedside nursing required. Emergency & Medical/Surgical Experience is preferred.
• Excellent communication, interpersonal and organizational skills required.
• Experience working in a start-up environment and or willingness to adapt to continuous change encouraged.
• Telehealth, remote-patient monitoring experience preferred.
• Proficiency with Epic, Microsoft outlook, Microsoft teams and web-based skills preferred.

Title: Coder Phys Pract

Location: Phoenix United States

Job Description:

Remote

locations

Remote Idaho

time type

Full time

Primary City/State:

Department Name: Coding Ambulatory

Work Shift:

Day

Job Category:

Revenue Cycle

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.

Are you a superstar strong OBGYN Physician Complex Coder | Medical Coderlooking for the opportunity to code a wide variety of accounts? The ideal candidate would have 3 years+ of coding experience ideally in OBGYN.There are also opportunities for overtime with special projects from time to time. This requires being fully CPC (AAPC) or CCS or CCA (AHIMA)certified. Come join a strong team of 10 Coder with an Associate Director and Associate Manager.

If you are interested in a career with OBGYN, then Banner is the place you want to be. With our complex OBGYN Coder position, you will have the opportunity to code in our academic or non-academic team. Here at Banner you will be exposed to not only OBGYN services within our OBGYN teams we have subspecialties that belong to our clinics, such as Maternal Fetal Medicine where you would be coding for high risk pregnancies and deliveries, ultrasounds and some procedures,you will see specialized surgical cases related to pelvic organ prolapse and urinary retention, In Gynecology Oncology with this specialty you would be coding more complex Hysterectomies, pelvic exenterating, and robotic cases related to female cancers. With this group of subspecialties in OBGYN you have more opportunities to learn other services with our specialties that not all OBGYN offices perform is on this team. Production expectations depend on placement anywhere from 6 to 12 charts an hour. This is a great opportunity to build your OBGYN coding resume.

Banner Health provides your equipment when hired. You will be fully supported in training with continued support throughout your career here!

This is a fully remote position and available if you live in the following states only: AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, 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. Generally, any 8-hour period between 7am – 7pm can work, with production being the greatest emphasis.

Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits

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

Evaluates medical records, provides clinical and surgical abstraction and assigns appropriate clinical diagnosis and procedure codes in accordance with nationally recognized coding guidelines.

CORE FUNCTIONS

1. Analyzes medical information from medical records. Accurately codes diagnostic and procedural information in accordance with national coding guidelines and appropriate reimbursement requirements. Consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes. Provides thorough, timely and accurate coding in accordance to department specific productivity and quality standards. Codes ICD CM and CPT4 for accurate APC assignment. Addresses National Correct Coding Initiative (NCCI) edits as appropriate. Reconciliation of charges as required.

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

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

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

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

MINIMUM QUALIFICATIONS

High school diploma/GED or equivalent working knowledge and specialized formal training equivalent to the two year certification course in medical record keeping principles and practices, anatomy, physiology, pathology, medical terminology, standard nomenclature, and classification of diagnoses and operations, or an Associate’s degree in a related health care field.

Requires at least one of the following: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician (CCS-P), Certified Coding Associate (CCA), Certified Professional Coder – Apprentice (CPC-A), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT), in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC). Certification may also include a general area of specialty.

Six months providing professional coding services or other related healthcare experience within a broad range of health care facilities.

Must demonstrate a level of knowledge and understanding of ICD and CPT coding principles as recommended by the American Health Information Management Association coding competencies, and as normally demonstrated by certification by the American Academy of Professional Coders.

Must be able to work effectively and efficiently in a remote setting, utilizing common office programs, coding software and abstracting systems.

PREFERRED QUALIFICATIONS

Specialty Certification.

Additional related education and/or experience preferred.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment

Title: Medical Coder II – Outpatient

Location: FL-Jupiter

Job Type: Perm

Category: Medical Coder

Pay Rate: $46k – $58k (estimate)

Job Description: Job Description

Insight Global is seeking a Medical Coder II to join a hospital system in Jupiter, Florida. The Outpatient Coder will review and assign the correct ICD-10-CM codes based on documentation in the patients chart or script, demonstrate knowledge of current coding practices and have the ability to receive ongoing education pertaining to coding changes/updates mandated by CMS and various insurance entities. The Coder must be able to accurately facilitate the completion of incomplete medical records, monitor deficiencies, and meet established proficiency and productivities standards. Theyre responsible for reviewing ER document (HED) and assigning the appropriate points/procedure/CPT for E&M/Procedure levels using the HIC application for ER and IP patient types. The Coders are required to code I Lab, VLB, OBS, SDS and ERD, and Ancillary charts daily. The team sits fully remote and reports to the Director of HIM. They will be joining a team of 15 other Medical Coders

We are a company committed to creating erse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances.

Required Skills & Experience

-High school diploma, GED or equivalent

-CPC (Certified Professional Coder) -1 year of experience with outpatient coding -ICD-10-CM, CPT Assistant and Coding Clinics, Medial Terminology and Anatomy, AMA Coding Clinics and Faye Brown -Strong communication, consistent and attention to detail

Nice to Have Skills & Experience

-CCS (Certified Coding Specialist)

-Experience with EPIC

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.

Title: TPR Coding Compliance Auditor (Remote based in US)

Location: United States

Job Description:

The Coding Compliance Auditor conducts risk-based coding audits of professional fee diagnosis and procedural assignments in accordance with the official coding guidelines, as supported by clinical documentation in health record.

Essential Duties and Responsibilities:

• Understands, interprets, and applies professional fee coding guidelines for coding audits. Audits include a complex review of the medical record to determine coding accuracy as well as compliance with other professional fee services such as teaching physician, incident-to and split/shared services.
• Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the organization.
• Identifies documentation that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
• Stays current with AMA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM, CPT, and HCPCS coding. Completes online education courses and attends mandatory coding workshops and/or seminars (ICD-10-CM, HCPCS and CPT updates), as directed. Reviews AMA, CMS, and CPT quarterly coding update publications. Attends all internal conference calls for Quarterly Coding Updates.
• Others may be assigned.

Knowledge, Skills, Abilities:

• Ability to consistently and accurately audit complex coding of professional fee services
• Ability to create clear and concise audit reports
• Expert level knowledge of medical terminology, ICD-10-CM/PCS and CPT coding guidelines and methodologies
• Must be detail oriented and with the ability to work independently and in team setting
• Computer knowledge of MS Office
• Must display excellent written and verbal communication skills
• Ability to demonstrate initiative and discipline in time management and assignment completion
• Ability to research difficult coding and documentation issues and follow through to resolution
• Ability to work in a virtual setting under minimal supervision

Education / Experience

• High school diploma/GED is required.
• Associates degree in relevant field preferred or combination of equivalent of education and experience.
• Three (3) years coding experience of professional fee services with experience in multiple specialties.
• One (1) year of experience in coding audit or quality review work.
• AAPC Coding Credential is required.

Compensation:

• Pay: $35.00 to $48.80 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Observed holidays receive time and a half.

Benefits:

The following benefits are available, subject to employment status:

• Medical, dental, vision, disability, life, AD&D and business travel insurance
• Paid time off (vacation & sick leave)
• Discretionary 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance.
• For Colorado employees, paid leave in accordance with Colorado’s Healthy Families and Workplaces Act is available.

Tenet Healthcare complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

#LI-DM4

2403029636

Pay Range: $30.60 – $48.80 hourly **Inidual wages are determined based upon a number of factors including, but not limited to, an inidual’s qualifications and experience

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

Tenet participates in the E-Verify program. Follow the link below for additional information.

Title: Coding Auditor & Educator (Remote)

Location: United States

Job Description:

Employment Type: Full-Time

Shift: Days

(SUMMARY) Position Highlights:

• Competitive pay
• Additional Benefits: tuition reimbursement, free parking, employee discounts
• Quality of Life: Flexible work schedules
• Advancement: professional growth within the organization
• Location: Holy Cross Health has two hospitals and four healthcare centers all a short driving distance from Washington DC and Baltimore, MD.

Description:

• Monday-Friday

The Professional Coding Auditor Educator performs medical record audits including but not limited to analysis of medical record documentation, validation of primary and secondary diagnoses and procedures; and ensuring proper assignment of diagnosis and procedure codes using coding guidelines established by the Centers for Medicare and Medicaid Services (CMS).

Responsibilities:

• Monitors accuracy of centralized coders’ charge capture and coding with proper ICD-10, CPTs, as well as proper modifiers, adhering to local ministry and Trinity practices and policies.
• Partners with leadership to improve HCC, high risk scoring, with provider and coder education.
• Conducts ongoing reviews of patient medical record documentation and procedural and diagnosis coding by each practitioner.
• Responsible for practitioner education in areas related to coding, documentation, and compliance.
• Works closely with leadership and the department to establish and modify the charge description master (CDM) methodology and pricing models to ensure accuracy and regulatory compliance.
• Reports to the Manager, Provider Revenue Operations

What you will need:

• High school diploma or equivalent combination of education and experience
• Certified Professional Coder or Registered Health Information Technician accreditation required.
• Minimum of 2-5 years of professional coding experience with comprehensive knowledge of ICD-10, CPT, and HCPCs modifiers. Knowledge of Medicare, Medicaid, and other third-party billing rules and regulations.
• 3-6 years of professional coding experience; ability to code from operative reports; prior auditing experience.( Preferred)
• Effective verbal, written, and interpersonal communication skills with the ability to comfortably interact with erse populations.
• Ability to work collaboratively in a team-oriented environment with a strong customer-service orientation.
• Ability to handle patient and organizational information in a confidential manner.
• Ability to demonstrate competency with a standard desktop and Windows-based computer system, including a basic understanding of email, e-learning, intranet and computer navigation. Ability to use other software as required to perform the essential functions of the job.
• Demonstrated dependability and regular attendance.
• Solid understanding of ICD-10 and CPT coding and medical terminology, with knowledge of Medicare, Medicaid, Health Maintenance Organization and commercial insurance plans.
• Ability to exercise independent judgment as appropriate within standard practices and procedures..

About us:

Holy Cross Health is a Catholic, not-for-profit health system that serves more than 240,000 iniduals each year from Maryland’s two largest counties — Montgomery and Prince George’s counties. Holy Cross Health earns numerous national awards, clinical designations and accreditations across a wide range of specialties for providing innovative, high-quality health care services. We were named one of America’s 100 Best Hospitals for 2021.

Holy Cross Health is an Equal Employment Opportunity (EEO) employer. Qualified applicants are considered for employment without regard to Minority/Females/disabled/Veteran (M/F/D/V) status.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate ersity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A erse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Coding Supervisor

Remote – Nationwide

Full time

Thank you for considering a career at Ensemble Health Partners!

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

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

The Opportunity:

The Coding Supervisor is responsible for the day to day coding activities for the respective physician facilities within the company. This includes assisting the Manager and/or Director, and/or Coding Sr. Leader, with duties assigned to assure Accounts Receivable goals are met.

Job Responsibilities:

• The supervisor is responsible for the staffing, organizing and directing of coding activities within a given facility under the direction of the market Coding Manager. They will coach (SMART Responsibilities where applicable), develop, complete timely performance evaluations and discipline those staff members under their responsibility as needed.
• Assists with the creation and delivery of educational presentations/material related to coding.
• Monitors progress and achievement of coding goals and objectives and reports such information in a timely manner as requested by leadership.
• Monitors workflow, productivity and quality of coding and abstracting functions per system guidelines. Performs routine audits of work performed by all staff members.
• Maintains knowledge of all federal and state rules and associated coding guidelines.
• Assists in the development of policies and procedures and monitors staff compliance with policy and procedures.
• Acts as site resource person for coding related questions, to include assisting members of the medical staff and members of the management team.
• Completes staff schedules and timecards according to Company policy. Holds staff accountable for compliance with paid time off, (PTO) policies.
• Acts as a technical resource and assists with resolution of technical issues and/or works with appropriate staff/department to rectify technical issues impeding the functions of the coding team.
• If workload demands, accurately assigns codes to any medical record in conformance with American Hospital Association, (AHA) coding guidelines and/or financial payer requirements. Assigns appropriate modifiers and present on admission, (POA) indicators as necessary.

Experience We Love:

• 3+ years of general surgery, plastics and bariatrics coding experience
• 3+ years of leadership experience
• Ability to function independently with minimal supervision, as well as part of a team.
• Knowledge of medical record content to include electronic medical records, (EMRs.)
• Ability to function under continual deadlines.
• Ability to maintain accuracy during frequent interruptions.
• Proficiency in keyboarding skills and working knowledge of computers.
• Excellent communication skills.

Minimum Education:

• Bachelors Degree or Equivalent Experience

Licensure/Certification Required:

Candidates must have and keep current at least one of the following professional certifications:

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

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

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

REGISTERED NURSE – Personal Health Advocate

locations

US Remote

time type

Full time

job requisition id

R9672

Why is Health Advocate a great place to work? For starters, Health Advocate employees enjoy helping people every single day. Employees are given the training they need to do their jobs well, and they work with supervisors and staff who are supportive and friendly. Employees have room to grow, and many of Health Advocate’s supervisors are promoted from within the company. Join our award winning team!

2024:

• Excellence in Customer Service Awards: Organization of the Year (Small)
• Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner

As part of Teleperformance in the US, we were also named #95 in the 2024 ‘Fortune 100 Best Companies to Work For®’ in the USA by Great Places to Work (GPTW®)

Position Overview

At Health Advocate, we are committed to providing our customers with services that improve the health, well-being and productivity of their employees. The Personal Health Advocates are a dedicated team of Registered Nurses who assist our members in navigating the healthcare system by facilitating access to healthcare providers, health and benefit information, health services and resources and entitled benefits coverage.

Essential Job Functions

• Receive calls from members in regards to various healthcare issues (e.g., infertility, disease, medication, etc.) and determine best course of action/s to assist the members while adhering to established policies, procedures, and key performance indicators (KPIs) (e.g. case close targets, abandon rates, member follow up, all quality indicators, etc.)
• Build relationships with members in order to collaborate and develop plans of action by going above and beyond members’ initial requests, taking responsibility for members’ case records, and encouraging members to call back with future issues/ questions.
• Assist and educate members in understanding their medical conditions, associated health testing, test result interpretation, and health options available to them.
• Provide members choices in medical care providers and services based on the members’ clinical needs, geographic locations and available benefit offerings.
• Research providers through credentialing, education checks and affiliations with notable medical centers within the member’s plan
• Facilitate communication among members, treating physicians, and insurance carriers, which may include assisting members with asking necessary health questions to physicians or clarifying insurance plan provision
• Take appropriate steps on behalf of members by assisting with scheduling health appointments, re-scheduling health appointments, facilitating record and information transfers, and researching and resolving various problems as applicable
• Document cases in the department’s case management system using approved processes and procedures
• Escalate cases appropriately and on a timely basis to supervisor or internal resources for review as applicable
• Keep up-to-date on patient care procedures which include diagnosis, pre-certification, prior authorization, pre-service and post-service denials
• Continuously stay up to date on various health issues and medical procedures necessary to offer top of the line feedback to members
• Intercede for the member to obtain an earlier appointment.
• Help members obtain prescriptions
• Help members with pre-service fee negotiations
• Place outbound follow up calls for issues that cannot be resolved during the initial call
• Respond to member cases in delegate box, answers and after hours calls
• Mentor new team members

Team Interfaces/Customer Service

• Establish and maintain a professional relationship with internal/external customers, team members and department contacts
• Cooperate with team members to meet goals or complete tasks
• Provide customer service that exceeds customer expectation
• Treat all internal/external customers, team members and department contacts with dignity/respect
• Escalate work flow and communication issues to supervisor

Minimum Qualifications

• Education- BSN or RN degree from an accredited college or university required
• Minimum three to five years clinical and/or medical management experience
• Active and unrestricted State or Multi-State RN License
• Understanding of medical terminology to assist in locating appropriate care options

• Strong Communication skills and phone etiquette
• Strong ability to explain complex issues to employees/retirees
• Highly effective listening skills
• Strong problem solving/issues resolution skills
• Excellent customer service and customer resolution skills
• Organizational and administrative skills
• Experience with Microsoft Word and Excel
• Ability to work in a team environment

Mental and Physical Requirements-

• This position is a remote position. The employee will need to have a dedicated HIPPAA compliant work space. Have access to internet and router.
• The nature of the work in this position is sedentary and the incumbent will be sitting most of the time
• Essential physical functions of the job include fingering, grasping, pulling hand over hand, and repetitive motions to utilize general computer software/hardware continuously throughout the work day
• Essential mental functions of this position include concentrating on tasks, reading information, and verbal/written communication to others continuously throughout the work day

Related Duties as Assigned

• The job description documents the general nature and level of work but is not intended to be a comprehensive list of all activities, duties, and responsibilities required of job incumbents
• Consequently, job incumbents may be asked to perform other duties as required
• Also note, that reasonable accommodations may be made to enable iniduals with disabilities to perform the functions outlined above
• Please contact your local Employee Relations representative to request a review of any such accommodations

Company Overview

Health Advocate is the nation’s leading provider of health advocacy, navigation, well-being and integrated benefits programs. For 20 years, Health Advocate has provided expert support to help our members navigate the complexities of healthcare and achieve the best possible health and well-being. Our solutions leverage a unique combination of best-in-class, personalized support with powerful predictive data analytics and a proprietary technology platform to address nearly every clinical, administrative, wellness or behavioral health need. Whether facing common issues or an unprecedented challenge like COVID-19, our team of highly trained, compassionate experts work together to go above and beyond expectations, making healthcare easier for our members and ensuring they get the care they need.

Awards:

2023:

• National Customer Service Association All–Stars Award: Service Organization of the Year.
• Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner

2022:

• Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner
• Excellence in Customer Service Awards: Organization of the Year (Small)
• Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver)

2021:

• Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Silver Winner
• Stevie® Awards for Sales & Customer Service: Most Valuable Response by a Customer Service Team (COVID-19). Bronze Winner
• Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver)

2020:

• National Customer Service Association All–Stars Award: Organizations of 100 or Greater, Runner-Up
• Communicator Award of Distinction: October 2019 Broker News
• MarCom Awards: Gold, COVID Staycation Ideas brochure
• MarCom Awards: Platinum, 2021 Well-being Calendar
• Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium category (Silver)

Health Advocate is an Equal Opportunity Employer that does not discriminate on the basis of race, color, sex, age, religion, national origin, citizenship status, military service and veteran status, physical or mental disability, or any other factor not related to job requirements. We respect and value ersity, and are committed to the principles of Equal Employment Opportunity.

VEVRAA Federal Contractor requesting appropriate employment service delivery systems, such as state workforce agencies and local employment delivery systems, to provide priority referrals of protected veterans.

PAY TRANSPARENCY NONDISCRIMINATION PROVISION

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to iniduals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)

Clinical Admin Coordinator

REMOTE

Contract

Healthcare

$18.00 USD Hourly – $20.50 USD Hourly

Our client is currently seeking a Clinical Admin Coordinator to join their team!

Scope of Role:

Location: Remote

Hours: 8:30am to 5:00pm M-F

Job Engagement: Contract

This job will have the following responsibilities:

• Telephonic outreach to new members and existing members to introduce or review care plans
• Providing/confirming the contact information for the APC, RN, and CN.
• Guiding members on utilization of plan benefits such as transportation and the OTC product catalog.
• Social Determinants of Health assessment and support.
• Completing RSA.
• Connecting members with team for care coordination needs.
• Other duties as assigned

Qualifications & Requirements:

• High School Diploma / GED Required
• 2+ years experience working in a physicians office, SNF, ALF, outpatient clinic with experience with patient and medical team communication and collaboration.
• Background as a Certified Nursing Assistant, Certified Medical Assistant, or LPN desirable

Title: Centralized Order Entry Pharmacist

Location: US

Job Description:

Do you have the career opportunities as a(an) Centralized Order Entry Pharmacist you want with your current employer? We have an exciting opportunity for you to join Work from Home which is part of the nation’s leading provider of healthcare services, HCA Healthcare.

SCHEDULE: NIGHT SHIFT

MUST BE LICENSED IN TEXAS

Benefits

Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Note: Eligibility for benefits may vary by location.

Our teams are a committed, caring group of colleagues. Do you want to work as a(an) Centralized Order Entry Pharmacist where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!

Job Summary and Qualifications

As the Centralized Order Entry (COE) Pharmacist, you will monitor, evaluate and make recommendations to assure the appropriate and effective use of pharmaceuticals for patient care. You will use the medication process to assess, plan, intervene, when necessary, implement and evaluate patient care in compliance with client hospital policies, protocols and procedures.

What you will do in this role:

• Provide patient care activities to ensure safe and effective drug therapy.
• Accurately enter orders in the computer in a timely manner.
• Follow facility procedures when non-formulary drugs, target drugs, restricted drugs and investigational drugs are ordered.
• Screen for drug interactions, allergies, order duplications, appropriate diagnosis, renal and liver function prior to order entry.
• Address facility queues in a timely manner.
• Investigate and report adverse drug events and medication incidents.
• Review and interpret all physician orders received, using the patient profile.
• Monitor for incompatibilities, concentration and rate on intravenous drugs.
• Document clinical interventions and follow-up when indicated.
• Assess orders for age-specific appropriateness from neonatal through geriatric.

What qualifications you will need:

• Bachelor’s degree from an accredited college of pharmacy is required.
• Pharm D is preferred.
• One (1) year of hospital experience is preferred
• Meditech experience is preferred.
• License – State Board of Pharmacy Required
• MUST BE LICENSED IN TEXAS

HealthTrust Supply Chain is a critical part of HCA Healthcare’s strategy. Our focus is to improve performance and reduce costs. We do this by joining non-clinical and administrative functions. HealthTrust Supply Chain best practice methodologies. We develop, apply and monitor cost-efficient initiatives and programs for HCA Healthcare. By improving facility efficiency, medical professionals can focus on our mission – patient care.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

“Bricks and mortar do not make a hospital. People do.”- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Centralized Order Entry Pharmacist opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

We are an equal opportunity employer and value ersity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Apply

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Details

United States

Pharmacy and Pharmacy Technician

Work from Home

schedule Full-time • Work From Home

About HCA Healthcare

What matters most to our erse and talented colleagues is giving people the absolute best healthcare in the most compassionate way possible.

Manager of Client Coding Integration

Remote – Nationwide

Full time

Thank you for considering a career at Ensemble Health Partners!

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

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

The Opportunity:

The Manager of Client Coding Integration is responsible for assisting in the development and evolution of the overall strategy for Ensemble Coding Operations. The Manager is responsible for assisting with all client coding customer service operational processes and workflow, including but not limited to, new client onboarding, provider clinical documentation improvement, support of operational coding processes, and customer coding relationship management. The Manager interprets client policies and procedures, recommends changes as appropriate, and provides relevant feedback. The Manager assists the Director of Coding Integration with the oversight and implementation of Coding Operations operational planning, service commitment, workflow processes and internal controls. As the Manager, this person serves as a key promoter of Ensemble PRC Coding Operations and is responsible for setting the tone of Coding Operations as a service organization, continuously seeking to understand, meet, and exceed customer expectations and needs.

Job Responsibilities:

• Sets clear goals and objectives for team members to drive operational excellence and problem-solving initiatives
• Ensures understanding and adherence to policies, practices, and procedures by direct reports, customers, and stakeholders
• Collaborates with practice Leadership teams to provide coding direction and guidance, fostering transparency and efficiency in coding processes
• Works closely with PRC Coding Operations to identify and resolve client issues promptly, maintaining alignment with organizational objectives
• Facilitates active engagement of client leadership in coding reporting with physicians, promoting transparency and collaboration.
• Collaborates with client leadership and physicians to ensure customer satisfaction and address coding accuracy concerns effectively
• Maintains effective working relationships with client leadership and providers, serving as a liaison between Ensemble PRC Coding Operations and practice management
• Supports strategic initiatives to enhance working relationships with clients, participating in committee meetings and strategic updates
• Proactively manages operational challenges within practice operations and coding teams, ensuring timely resolution and effective communication
• Contributes to innovation and knowledge sharing efforts within Coding Operations, identifying and implementing process improvements
• Participates in delivering coding training and education programs for physicians and client leadership, promoting continuous improvement
• Supports the performance review process for direct and indirect reports, fostering professional development and organizational success

Experience We Love:

• 5-7 years relevant experience
• 3-5 years of supervisory/management experience in Coding
• Experience working in large organizations, preferred.
• Consulting or proven work experience in areas of process reengineering and project management strongly preferred.
• Travel to client sites (estimate 20-40% travel)
• PC skills demonstrates proficiency in Excel, Power Point, and ability to work in multiple EMR systems (Meditech, AllScripts, Cerner, Power Chart, Epic)
• Tactical execution oversees the development, deployment and direction of complex programs and processes.
• Customer relationship establishes and maintains longterm customer relationships, building trust and respect by consistently meeting and exceeding expectations. Cultivating strategic customer relationships and ensuring that the customer perspective is the driving force behind all valueadded business activities.

Minimum Education:

• Bachelors Degree or Equivalent experience

Licensure/Certification Required:

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

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

Join an award-winning company

Three-time winner of “Best in KLAS” 2020-2022

2022 Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

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

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

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

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

Title: Centralized Coding Specialist – Remote PRN

Location: Denver, CO United States

Job Description:

The Physician Services Revenue Integrity team at Lifepoint Health is a nationwide revenue cycle management services provider that has been offering high quality medical billing services since 2004. We offer a rewarding work environment with career advancement opportunities while maintaining a small company, employee-focused atmosphere.

This is a fully remote position! You must live in the United States.

We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.

We are always looking for people inspired to help us in our mission. If you are someone who wants to change the lives of patients, drive success for our partners and be part of a team driven to improve care, we may have your next opportunity.

We are currently seeking a Centralized Coding Specialist. This remote-based position will spend the bulk of their time making sure that their clients are fully supported from a charge entry, coding, and billing perspective.

The Centralized Coding Specialist will spend the bulk of their time making sure that their clients are fully supported from a charge entry, coding, and billing perspective. You will be responsible for reviewing a patient’s medical record after a visit and translating the information into codes that insurers use to process claims. You will make sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations, complying with medical coding guidelines and policies. Following up and clarifying any information that is not clear. Clearinghouse knowledge and working experience is also a plus You would be working in a team environment with guidance from the Manager – Coding and Integrity. This position also works closely with the AR department for coding related issues.

Perform Evaluation and Management coding, procedure, ICD-10 and HCPC quality reviews as well as other projects related to physician coding compliance. Demonstrates a thorough understanding of complex coding, and reimbursement, as they relate to physician practices and clinic settings. Keeps informed regarding current coding regulations, professional standards and company/department policies and procedures and effectively applies this knowledge.

This Position is 100% Remote; can work from anywhere within the US.

ESSENTIAL FUNCTIONS

• Seeking Certified Pro-Fee with a minimum of 3-5 years’ coding experience.
• Experience with Provider Based and Rural Health preferred.
• Apply appropriate coding classification standards and guidelines to medical record documentation for accurate coding.
• Resolve medical record documentation deficiencies through healthcare provider query and provide routine feedback to correct deficiencies.
• Perform quality assessment of records, including verification of medical record documentation (both electronic and handwritten).
• Responsible for researching errors or missing documentation from medical record in order to provide accurate coding processes.
• Abstract and assign the appropriate ICD-10, HCPCS/CPT codes; including Level I & Level II modifiers as appropriate for all diagnosis and procedures performed in outpatient and inpatient settings.
• Assist in the development and ongoing maintenance of processes and procedures for each assigned client revolving around system use, billing/coding rules, and client specific guidelines.
• Manage time effectively to meet all required deadlines and timeframes for client and department needs.
• Collaborate in a team environment with the Department Manager and other staff on a regular basis.
• Ensure compliance with all relevant regulations, standards, and laws.

Other Functions

1. Maintains regular and predictable attendance.

2. Performs other essential duties as assigned.

KNOWLEDGE, SKILLS & ABILITIES: The requirements listed below are representative of the knowledge, skills and/or abilities required.

Education: High school diploma or equivalent required. Bachelor’s Degree preferred or equivalent experience

Experience: 3-5 years of medical coding experience

License or Certification:

This position requires credentialing through AHIMA, and/or AAPC

The following certifications are accepted:

• CPC
• CEMC
• CPMA
• CRC
• CPB
• Specialty certification
• CCS-P
• RHIT

Skills and Abilities:

• Ability to create and follow written procedure.
• Ability to provide professional written communication and excellent customer service.
• Technical proficiency with computers, basic Microsoft software, and medical software systems (PM/EHR)
• Strong organizational skills
• Excellent communication skills and ability to work in a team environment.
• Strong technical and computer skills (PM/EHR Software, Excel, Outlook, MS Office, Web)
• Ability to learn new systems, software, and client specialties quickly.
• Self-starter with little to no supervision

PHYSICAL AND MENTAL DEMANDS:

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

While performing the duties of this job, the employee is occasionally required to stand; walk; sit for extended periods of time; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, bend, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 20 pounds. Repetitive motion of upper body required for extended use of computer. Required specific vision abilities include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

WORK ENVIRONMENT AND TRAVEL REQUIREMENTS:

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

Benefits

At Lifepoint, our Mission of Making Communities Healthier extends to our employees. We offer an excellent total compensation package, including a competitive salary and benefits. Some of our benefits include 401k, flexible PTO, generous Employee illness benefit (EIB), medical, dental, vision, tuition reimbursement, and an Employee Assistance Program. We believe that happy, healthy people have a passionate engagement with life and work and have designed our package to enhance your wellbeing.

Pay range: $25-31/hour DOE The final agreed upon compensation is based on inidual education, qualifications, experience, and work location. This position is bonus eligible.

Lifepoint Health is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans’ status or any other basis protected by applicable federal, state or local law.

Nurse Practitioner (Telehealth) – Colorado

locations

Remote USA

Full time

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, erse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology – to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we’ve grown fast and now serve members across the United States. And we’ve just started. So join us on this mission!

Job Description

This role is a fully remote position to care for our current members in Colorado.

A bit about this role:

This position represents an amazing opportunity for a caring nurse practitioner (APRN). Your primary focus will be delivering world class comprehensive care to our members. One of Devoted Medical’s missions is to bring care to where our members live – meaning your visits will be predominantly virtual telehealth.

Required skills and experience:

• APRN with 3 or more years working in outpatient clinical practice.
• An active and clear RN and APRN license in one of the following states: Colorado
• Active BLS is required at time of hire and must be maintained while employed at Devoted Medical.

Desired skills and experience:

• Experience in primary care, family medicine, geriatrics and/or palliative care.
• Experience performing Medicare annual wellness visits or in-home comprehensive visits with elderly patients or Medicare patients.
• Experience performing visits over telehealth video platforms.
• An understanding of managed care is a plus, including how to appropriately assess STARS/HEDIS measures, code clinical comorbidities, and identify clinical care gaps.

Your Responsibilities will include:

• Conduct primarily telehealth video visits to members with the opportunity for a small volume of home based visits (drive to member’s home). In some instances when appropriate and compliant with licensure, you may also provide telehealth visits to members located in other geographies.
• Primarily perform comprehensive assessment visits (CAVs) including comprehensive diagnosis/disease review, medication review, and assessment for quality of care (STARS/HEDIS) interventions as well as social and home health/DME needs.
• Work closely with other members of the member’s care team including their PCP, specialists, and other Devoted team members including pharmacy, clinical nursing, and social work as well as interfacing with family members and caregivers in order to coordinate care for the member and deliver a collaborative care plan.

Salary Range: $115,000 – $122,000 / year

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the inidual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more….

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Title: Nurse/APC Fellow- Medical Standards Implementation

Location: Telecommuter

Type: Fellow

Workplace: remote

Category: Medical Services

Job Description:

Planned Parenthood is the nation’s leading provider and advocate of high-quality, affordable sexual and reproductive health care for all people, as well as the nation’s largest provider of sex education. With more than 600 health centers across the country, Planned Parenthood organizations serve all patients with care and compassion, with respect, and without judgment, striving to create equitable access to health care. Through health centers, programs in schools and communities, and online resources, Planned Parenthood is a trusted source of reliable education and information that allows people to make informed health decisions. We do all this because we care passionately about helping people lead healthier lives.

Planned Parenthood Federation of America (PPFA) is a 501(c)(3) charitable organization that supports the independently incorporated Planned Parenthood affiliates operating health centers across the U.S. Planned Parenthood Action Fund is an independent, nonpartisan, not-for-profit membership organization formed as the advocacy and political arm of Planned Parenthood Federation of America. The Action Fund engages in educational, advocacy, and electoral activity, including grassroots organizing, legislative advocacy, and voter education.

Planned Parenthood Federation of America (PPFA) and Planned Parenthood Action Fund (PPAF) seek a Nurse Fellow – Medical Standards Implementation for January 2025 through December 2025. This job reports to the Director of Medical Standards Implementation in the Medical Services Team in the Care and Access Division of PPFA. The Medical Services Team is dedicated to supporting Planned Parenthood affiliates in the delivery of high-quality health care.

We invite you to explore the PPFA Medical Services Student Nurse/APC Fellowship, an employment and learning experience for students in an undergraduate nursing program or graduate nursing/APC students. During this telecommuter opportunity, you’ll be a member of an interdisciplinary healthcare team and work alongside clinicians, RNs, and administrative professionals at PPFA. You will also have access to clinical resources, and to PPFA-sponsored continuing education activities, professional development activities, and networking opportunities.

The PPFA Medical Services Student Nurse/APC Fellowship is a paid 12-month part-time program from January through December 2025, providing opportunities to gain valuable clinical support skills and experience. The fellow will typically work 15 hours per week, with scheduling flexibility based on student needs, including the ability to work evening and weekend hours. Weekday daytime hours will occasionally be required, which will be discussed and arranged with the supervisor. We understand that you are a student first and that your schedule will change throughout the program.

Purpose:

• Provide support to the Medical Services Team to increase quality, safety, equity and consistency of affiliate clinical care by enhancing implementation and training programs related to PPFA Medical Standards & Guidelines (MS&Gs).
• Learn about and contribute to clinical support and administrative activities necessary to help support frontline Planned Parenthood affiliate staff in their delivery of patient care.

Delivery:

Under the direction of the Director of Medical Standards Implementation:

• Participates in the planning, designing, delivery, and evaluation of trainings to enhance implementation of the PPFA MS&Gs, which may include federation-wide virtual and live activities.
• Participates in continuing education (CME/CE) application processes.
• Reviews, edits, and creates implementation and training resources to enhance affiliate implementation of the PPFA MS&Gs.
• Reviews, edits, and creates patient education resources.
• Assists in supporting the PPFA Clinical Advisory Committee (CAC), including planning for and participating in the quarterly CAC meetings and supporting the CAC membership process.
• Reviews, uploads, removes and edits Medical Services intranet resources.
• Participates in the planning and evaluation of the annual meeting of the National Medical Committee.
• Completes other duties as assigned.

Engagement:

• Regularly collaborates with all staff within the Medical Services Team at PPFA.
• May interact with staff of all levels in other departments and isions, as well as at affiliates and a wide variety of professionals and professional organizations external to Planned Parenthood.

Knowledge, Skills and Abilities (KSAs):

• Education/Credentials: Currently enrolled in an accredited undergraduate nursing program through at least November or December 2025 or currently enrolled in an accredited graduate clinician program through at least November or December 2025. Preferred: enrollment in a nursing education program.
• Experience: at least two years of employment experience.
• Comfort with technology and with learning new technologies.
• Excellent computer skills, as this position will require the use of Google Suite, Microsoft Office Suite, Adobe Pro, Asana, Smartsheet, and webinar platforms, among others.
• Knowledge of communicating with erse groups, working with a multicultural workforce, and exhibiting sensitivity and appreciation of cultural differences is required.
• Must be a self-starter with the ability to work with remote supervision.
• Must have good oral and written communication skills.
• Must be able to perform literature searches.
• Must be detail-oriented.
• Must be flexible.
• Must have excellent interpersonal and customer service skills.
• Must be comfortable working with telecommuters.
• Must recognize the value of ersity and maintain relationships with staff and external audiences that respect inidual dignity.

Travel: None required, though optional travel to 1 meeting may be possible

• Total offer package to include generous vacation + sick leave + paid holidays, inidual/family provided medical, dental and vision benefits effective day 1, life insurance, short/long term disability, paid family leave and 401k. We also offer voluntary opt-in for Flexible Spending Account (FSA) and Transportation/Commuter accounts.

We value a truly erse workforce and a culture of inclusivity and belonging. Our goal is to attract qualified candidates and encourage applications from all iniduals without regard to race, color, religion, sex, national origin, age, disability, veteran status, marital status, sexual orientation, gender identity, or any other characteristic protected by applicable law. We’re committed to creating a dynamic work environment that values ersity and inclusion, respect and integrity, customer focus, and innovation.

PPFA participates in the E-Verify program and is an Equal Opportunity Employer.

#LI-SY1

*PDN-HR

Roles that are denoted as NYC, DC, or both will work a hybrid schedule, requiring 2-3 days per week in the office unless the role is denoted as onsite, which requires working onsite full time or 5 days per week.

Billing Specialist

Job LocationsUS-WA-VANCOUVER

ID

2024-151418

Line of Business

PharMerica

Position Type

Full-Time

Pay Min

USD $21.00/Hr.

Pay Max

USD $21.00/Hr.

Our Company

PharMerica

Overview

Remote

Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for iniduals who are looking for career progression!

This is a remote position. Applicants can live anywhere within the continental USA.

Must be able to effectivley work in the Pacific Time Zone

40 hours per week: 9:30am-6:00pm, Days will vary. Pacific Time Zone

This is an excellent opportunity for a Pharmacy Technician to move from a retail to office environment for those who are willing to learn claims, billing and insurance processing.

Pharmacy Technician experience and/or knowledge of pharmaceuticals is a strong preference.

We offer:

DailyPay

Flexible schedules

Competitive pay

Shift differential

Health, dental, vision and life insurance benefits

Company paid STD and LTD

Tuition Assistance

Employee Discount Program

401k

Paid-time off

Tuition reimbursement

Non-retail/Closed-door environment

Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. If your passion is service excellence and top-quality care come join our team and apply today!

*Position will be posted for a minimum of 7 business days

Responsibilities

The Client Billing Associate will:

• Interpret contract documents to ensure billing is performed in compliance with all contract terms
• Processes changes in information systems to support accurate and efficient billing process and financial close
• Facilitates and ensures accurately and timely billing of services and fees to facility clients
• Completes interim statement review to ensure charges are accurate
• Participate in month-end closing and audits as necessary
• Provides customer support via phone or electronic communications
• Supports other departments, such as Census, when volumes or needs dictate
• Works under general supervision
• Performs other tasks as assigned
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
• To perform this job successfully, an inidual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Each essential function is required, although reasonable accommodations may be made to enable iniduals with disabilities to perform the essential functions.

Qualifications

• High School graduate, GED or equivalent experience is required; 2 year degree is preferred
• Customer Service, Financial Service, Accounting, Technical, or other experience in which the ability to problem solve, work under strict deadlines, and produce quality outputs are displayed is required
• Third Party Billing or collections/billing experience in the healthcare industry; AS400 computer experience is preferred
• Flexibility, decisiveness, tenacity, problem solving, practical learning, detail conscious, communicates effectively, dependability, responsible, builds trust, resolves conflicts constructively is required
• Ability to be inventive and analytical are preferred competencies

About our Line of Business

PharMerica is a full-service pharmacy solution providing value beyond medication. PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations. PharMerica is one of the nation’s largest pharmacy companies. PharMerica offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades. For more information about PharMerica, please visit www.pharmerica.com. Follow us on Facebook, Twitter, and LinkedIn.

Salary Range

USD $21.00 / Hour

ALERT: We are aware of a scam whereby imposters are posing as employees from our company. Beware of anyone requesting financial or personal information.

We take pride in creating a best-in-class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card, driver’s license, bank information, or payment for work equipment, etc.) from you via text or email. If you are suspicious of a job posting or job-related email mentioning our company, please contact us at [email protected].

Click here for additional FAQ information.

Title: Family Nurse Practitioner (EST)

Location: Remote – USA

Type: Full-Time

Workplace: remote

Category: Medical

About Equip

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

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

About the role:

The Family Nurse Practitioner or Physician Assistant will be responsible for caring for children and adults with eating disorders via Equip’s 100% virtual Telehealth platform. Family Nurse Practitioners and Physician Assistants are essential members of Equip’s 5-person virtual treatment team, working alongside a therapist, dietitian, peer mentor, and family mentor to help people recover from eating disorders.

Responsibilities:

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

Qualifications:

• Board Certification as a Family Practice Nurse Practitioner or Physician Assistant.
• Ability to maintain active NP or PA licenses and pursue cross licensing as applicable (cost of licenses to be covered by Equip).
• 3+ years of experience treating pediatric, adolescent, and adult patients in an outpatient setting.
• Demonstrate a commitment to providing excellent evidence-based care, advancing clinical skills, and a passion for professional development.
• Communicate effectively with patients and patient’s carers, and respond to messages within a timely manner.
• Be curious, enjoy learning, and participate enthusiastically and collaboratively in a multidisciplinary team.

Schedule

• Monday – Friday. 40 Hours.

The pay range for this position in the US is $110,000 – $130,000/yr.

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

Physical Demands

Work is performed 100% from home with no requirement to travel. This is a stationary position that requires the ability to operate standard office equipment and keyboards as well as to talk or hear by telephone. Sit or stand as needed.

At Equip, ersity, equity, inclusion and belonging are woven into everything we do. At the heart of Equip’s mission is a relentless dedication to making sure that everyone with an eating disorder has access to care that works regardless of race, gender, sexuality, ability, weight, socio-economic status, and any marginalized identity.

As an equal opportunity employer, we provide equal opportunity in all aspects of employment, including recruiting, hiring, compensation, training and promotion, termination, and any other terms and conditions of employment without regard to race, ethnicity, color, religion, sex, sexual orientation, gender identity, gender expression, familial status, age, disability, and/or any other legally protected classification protected by federal, state, or local law.

Auditor Clinical Validation OPSP Coding

Job Locations US-Remote

ID 2024-13397

Category

Audit – Healthcare

Position Type

Full-Time

Overview

This auditing role will focus on Coding & Clinical Chart Validation for our Outpatient and Specialty audits. The ideal candidate for this position needs to have both a clinical (nurse) and a coding / auditing background focused on one of the following disciplines from a coding and billing perspective: SNF, IRF, Home Health, APC, ER, Diagnostics and Professional Service. This position is responsible for auditing outpatient/specialty claims and documenting the results of those audits. with a focus on clinical review, coding accuracy, medical necessity, and the appropriateness of treatment setting, and services delivered.

Responsibilities

Audits Outpatient and Specialty Claims:

• Utilizes medical chart coding principles and client specific guidelines in performance of medical audit activities with Outpatient (APC, PNPP), Pharmacy and/or Inpatient DRG claims.
• Draws on advanced coding expertise and industry knowledge to substantiate conclusions.
• Performs work independently, reviews and interprets medical records and applies in-depth knowledge of coding principles to determine potential billing/coding issues.
• Effectively Utilizes Audit Tools
• Utilizes advanced proficiency, Cotiviti encoder and audit tools required to perform duties.
• Enters claim into Cotiviti system accurately and in accordance with standard procedures.
• Meets or Exceeds Standards/Guidelines for Productivity Maintains production goals, accuracy and quality standards set by the audit for the auditing concept.
• Meets or Exceeds Standards/Guidelines for Quality
• Achieves the expected level of quality set by the audit for the auditing concept, for valid claim identification and documentation.
• Identifies New Claim Types
• Identifies potential claims outside of the concept where additional recoveries may be available.
• Suggests and develops high quality, high value concepts and/or processes improvement, tools, etc.
• Recommends New Concepts and Processes
• Has broad in-depth knowledge of client, contract terms and complex claim types gained from extensive healthcare auditing experience.
• Suggests, develops and implements new ideas, approaches and/or technological improvements that will support and enhance audit production, communication and client satisfaction.
• Evaluates information and draws logical conclusions.
• Complete all responsibilities as outlined on annual Performance Plan.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

Qualifications

Education (required)

• Associate or bachelor’s degree Health Information Management (RHIA or RHIT)
• Or equivalent combination of relative work experience.

Certifications/Licenses (required)

• Coding Certification required and maintained i.e. CPC, CIC, CCS, CCS-P, RHIA or RHIT

Experience

• 5 to 7 years of experience with clinical medical record coding or auditing and a working knowledge of HIPAA Privacy and Security Rules and CMS security requirements.
• Working knowledge of HIPAA Privacy and Security Rules, CMS security requirements and clinical medical record coding or auditing.
• A broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology.
• Ability and desire to utilize base coding and clinical auditing knowledge to learn and become proficient in a variety of outpatient and specialty review types.
• Adherence to official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge – DRG, ICD-10, CPT, HCPCS codes.
• Excellent verbal and written communication skills.
• Ability to work well in an inidual and team environment

Working Conditions and Physical Requirements:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Communicating with others to exchange information.
• Repeating motions that may include the wrists, hands and/or fingers.
• Assessing the accuracy, neatness and thoroughness of the work assigned.
• No adverse environmental conditions expected.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access / connectivity and office setup and maintenance.

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

Pay Transparency Nondiscrimination Provision

Cotiviti will not discharge or in any manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as part of their essential job functions cannot disclose the pay of other employees or applicants to iniduals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)

Title: UM Nurse

time type

Full time

job requisition id

R-5281

Utilization Management Nurse

Work from home within Oregon, Washington, Idaho or Utah

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia’s dedicated team of Nurses are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Utilization Management Nurses provide utilization management (such as prospective concurrent and retrospective review) to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes and appropriate payment for services – all in service of making our members’ health journeys easier.

Are you a Nurse who has a passion for healthcare? Are you a Nurse who is ready to take your career to the next level and make a real difference in the lives of our members? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• Associate or Bachelor’s Degree in Nursing or related field
• 3 years of case management, utilization management, disease management, auditing or retrospective review experience
• Equivalent combination of education and experience
• Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical care.
• May need to have licensure in all four states served by Cambia: Idaho, Oregon, Utah, Washington.
• Must have at least one of the following: Bachelor’s degree (or higher) in a health or human services-related field (psychiatric RN or Masters’ degree in Behavioral Health preferred for behavioral health); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management)

Skills and Attributes:

• Knowledge of health insurance industry trends, technology and contractual arrangements.
• General computer skills (including use of Microsoft Office, Outlook, internet search). Familiarity with health care documentation systems.
• Strong verbal, written and interpersonal communication and customer service skills.
• Ability to interpret policies and procedures and communicate complex topics effectively.
• Strong organizational and time management skills with the ability to manage workload independently.
• Ability to think critically and make decisions within inidual role and responsibility.

What You Will Do at Cambia:

• Conducts utilization management reviews (prospective, concurrent, and retrospective) to ensure medical necessity and compliance with policy and standards of care.
• Applies clinical expertise and evidence-based criteria to make determinations and consults with physician advisors as needed.
• Collaborates with interdisciplinary teams, case management, and other departments to facilitate transitions of care and resolve issues.
• Serves as a resource to internal and external customers, providing accurate and timely responses to inquiries.
• Identifies opportunities for improvement and participates in quality improvement efforts.
• Maintains accurate and consistent documentation and prioritizes assignments to meet performance standards and corporate goals.
• Protects confidentiality of sensitive documents and issues while communicating professionally with members, providers, and regulatory organizations.

#LI-Remote

The expected hiring range for a Utilization Management Nurse is $38.00 – $41.50 an hour depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 10%. The current full salary range for this role is $33.80 – $55.00 an hour.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we’re helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

• Work alongside erse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce ersity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

Senior Coder

Remote – Nationwide

Full time

Thank you for considering a career at Ensemble Health Partners!

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

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

The Opportunity:

* We are seeking candidates with experience in General Surgery, ED and Vascular *

The Senior Coder is a certified coder with expert knowledge in front and back end coding. This position is responsible for root cause analysis of trending front and/or back end identified coding opportunities; internal and external coding/documentation education; supporting and at times leading coding opportunity improvement projects. This position will also perform and/or assist with special coding projects as determined by leadership.

Job Responsibilities:

• Complete root cause analysis of identified front and/or back end coding opportunities as assigned.
• Support/lead opportunity improvement projects as assigned.
• Research and provide coding guidance for new client service lines/services.
• Maintains compliance with established corporate and departmental policies and procedures, quality improvement program, customer service and productivity expectations.
• Maintain workflow/process knowledge of each functional area of coding.
• Provide and/or assist with provider education, as well as the development educational tools. Communicates professionally with physicians, management, and peers.
• Participates in all educational activities including coding meetings/calls necessary to provide information relating to coding and compliance. Remains abreast of changes to current payer guidelines, Correct Coding Initiative edits, and Local/National Coverage Determinations for accuracy in Coding and mentors team members regarding coding guidelines and accuracy. Assists with training of other coders.
• Takes initiative for learning new skills and willingness to participate and share expertise on projects, committees and other activities as deemed appropriate. Demonstrates personal responsibility for job performance.
• Other duties as assigned by Manager/Supervisor.
• Possible travel for education sessions, CME events, etc. as defined by Physician Revenue Cycle Leadership.
• Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.
• Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient’s status and interprets the appropriate information needed to identify each patient’s requirements relative to his or her age, specific needs and to provide the care needed as described in departmental policies and procedures.

Experience We Love:

• AAPC or AHIMA Coding Certification (i.e. CPC, CCS-P) required
• Minimum of 4 years coding experience required, 5 years preferred
• Extensive knowledge/experience in physician front end and back end coding with expert knowledge in a multiple coding specialties and the ability to provide education/support to coding team and providers as well as strong analytic skills.
• Knowledge of Medical Terminology, IDC-10, CPT, and HCPCS.
• PC and Computer application knowledge and experience. Navigational and basic functional expertise in Microsoft business software (Excel, Word, PowerPoint).
• Excellent skills of organization, communication, time management, financial analysis, written policy, trouble shooting and problem solving.
• Ability to multi-task and prioritize needs to meet short and long term timelines. Mobile phone access with adequate data to handle business needs is required.
• Experience with EPIC and previous use of coding software tools. Dual Certification.

Join an award-winning company

Three-time winner of Best in KLAS 2020-2022

2022Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

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

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

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

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

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

This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the roles range.

Title: Clinical Operations Coordinator

Location: United States

Job Description:

At Morgan & Morgan, the work we do matters. For millions of Americans, we’re their last line of defense against insurance companies, large corporations or defective goods. From attorneys to client support staff, creative marketing to operations teams, every member of our firm has a key role to play in the winning fight for consumer rights. Our over 3,000 employees are all united by one mission: For the People.

Summary

Our Medical Operations team is looking to add a Clinical Operations Coordinator to help support our medical team! Successful candidates will have a clinical background and be able to work with and assist in reviewing medical records and capturing all medical and treatment aspects of a client’s treatment plan. As an essential part of our growing team, you will track metrics for all cases that come through and have an opportunity to grow as business needs change.

This is a full-time remote position that requires RN clinical experience with Emergency Medicine, Neurology, or Orthopedic patients.

Responsibilities

• Working with several teams and initiatives.

• Reviewing and auditing legal files.

• Responsible for quality clinical evaluations and team performance.

• Interacting with both internal and external stakeholders.

• KPI driven and process improvement heavy.

Qualifications

• Required: Registered Nurse, Active License.

• Required Clinical Experience: Emergency Medicine, Neurology, Neurosurgery, Utilization Review, or Stroke experience.

• Ability to interact with people at all levels of the corporate structure, prioritize and handle numerous competing demands in a high-volume, fast paced working environment.

• Highly organized, details oriented with exceptional interpersonal skills.

• Excellent written and verbal communication skills with spoken and written fluency in English.

• Strong analytical and problem-solving skills required.

• Must be able to multitask and handle high-stress, sensitive situations with a high degree of confidentiality.

• Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint, and Outlook, plus a variety of other word-processing, spreadsheet, database, email, and case management software.

The anticipated salary range of $60,000.00-$75,000.00 will be contingent upon various factors, including but not limited to, relevant experience, internal equity, market data, job location, and other job-related factors permitted by law.

#LI-CB1

Benefits

Morgan & Morgan is a leading personal injury law firm dedicated to protecting the people, not the powerful. This success starts with our staff. For full-time employees, we offer an excellent benefits package including medical and dental insurance, 401(k) plan, paid time off and paid holidays.

Equal Opportunity Statement

Morgan & Morgan provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

E-Verify

This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the I-9 Form.

Privacy Policy

Here is a link to Morgan & Morgan’s privacy policy.

Credentialing Coordinator – Remote

ID

2024-54858

Job Family

Billing

NOW HIRING: FULLY REMOTE CREDENTIALING COORDINATOR

Our Passion:

We exist to Lead Care With Light. We need passionate, talented people working together who share our desire to provide the best quality care to our patients and lead the fight against the opioid epidemic. We are prepared to treat the entire disease, not just a piece of it.

Our Team:

Acadia Healthcare’s Comprehensive Treatment Centers (CTC) ision operates 160+ outpatient addiction recovery centers nationwide, serving patients undergoing treatment for opioid use disorder. As the leading provider of medication-assisted treatment in the nation, we care for more than 70,000 patients daily. Our mission is to deliver comprehensive care, combining therapies with safe and effective medications. Our team stands at the forefront of the battle against the opioid epidemic.

Our Benefits:

• Medical, dental, and vision insurance
• Acadia Healthcare 401(k) plan
• Paid vacation and sick time
• Flexible start time
• Opportunityfor growth that is second to none in the industry

Your Job as a Credentialing Coordinator:

The Credentialing Coordinator manages the credentialing portion of the contract process. You will partner with facilities to prepare the proper documentation for initial and re-credentialing application submissions to meet required deadlines, assist in the completion of Medicaid enrollments, and be responsible for completing POAs. The Credentialing Coordinator maintains the department work flow to ensure accuracy and completion of tasks in a timely manner.

Job Responsibilities:

• Request and review key credentialing file documentation for each provider/clinician.
• Review and complete Primary Source Verification for all vital credentialing file documentation.
• Prepare and submit initial and re-credentialing documentation for each payor as needed.
• Track and monitor incoming and outgoing credentialing requests, including maintenance of credentialing files.
• Maintain various database systems.
• Prepare and submit state Medicaid and other payor enrollments and re-validations.
• Work directly with payers, the CBOs, and Contracting Departments to resolve disputes.
• Prepare and administer routine correspondence, memoranda, and notifications.
• Work closely with the CBOs and Contracting Departments to ensure efficiency of processes and create new workflow tools as needed.
• Update and maintain in-house documents.

Qualifications

Your Education and Qualifications:

• BA/BS degree preferred.
• Minimum of 2 years experience in credentialing in a healthcare setting required
• Must have experience with multi-state payor enrollment and require minimal assistance/training for the position
• Experience with state Medicaid and MCO payor enrollment for initial and recredentialing applications required
• Communicates effectively with healthcare provider and payors for any needed information to complete enrollment
• Experience with behavioral health credentialing a plus, but not necessary.
• Knowledge of CredentialingStream/Verity a plus, but not necessary.

Your Skills:

• Strong organizational and analytical skills, with attention to detail.
• Excellent verbal and written communication skills.
• Ability to prioritize task and to work independently.
• Also, the ability to work within a team environment.
• Should be able to multitask and work well under pressure.
• Ability to meet weekly goals.
• Comfortable working in a fast-paced healthcare environment.
• Willing to assist other team members and departments as needed to complete tasks
• Willing to assist and work on additional projects as needed.

We are committed toproviding equal employment opportunities to all applicants for employment regardless of an iniduals characteristics protected by applicable state, federal and local laws.

Title: Clinical Review Nurse

Location: United States United States

Job Description:

AmTrust Financial Services, a fast-growing commercial insurance company, has a need for Clinical Review Nurse remote or in an office location.

PRIMARY PURPOSE: The Clinical Review nurse has the responsibility of reviewing the medical necessity, appropriateness, quality and efficiency of services in the appropriate setting for Workers’ Compensation claimants. This position assesses the medical appropriateness of proposed treatments and medications for our injured employees, and partners with the AmTrust Claims Adjuster team to expedite medically necessary treatment for each claim. They also review pharmacy authorizations to determine appropriateness of pharmaceutical treatment. Maintains a solid understanding of AmTrust’s mission, vision, and values. Upholds the standards of the AmTrust organization.

Responsibilities

• Perform Utilization Review activities prospectively, concurrently, or retrospectively in accordance with the appropriate jurisdictional guidelines.
• Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered.
• Responsible for helping to ensure injured employees receive appropriate level and intensity of care directly related to the compensable injury using industry standard and/or state specific medical treatment guidelines and formularies.
• Objectively and critically assesses all information related to the current treatment request to make the appropriate medical necessity determination.
• Sends determination letters as needed to requesting physician(s) and refers to physician advisors for second level reviews as necessary.
• Responsible for accurate comprehensive documentation of Utilization Review activities in the case management and pharmacy benefit management systems.
• Responsible for completing timely reviews according to state’s requirements and communicating the UR determination to all parties.
• Uses clinical/nursing skills to help coordinate the inidual’s treatment program while maximizing quality and cost-effectiveness of care.
• Communicates effectively with providers, claims adjuster, client, and other parties as needed to expedite appropriate medical care
• Keeps current with market trends and demands.
• Performs other functionally related duties as assigned

Qualifications

Active unrestricted RN license in a state or territory of the United States with eligibility to get and/or renew a multistate license.

• 5+ years of related experience or equivalent combination of education and experience required to include 2+ years of direct clinical care OR2+ years of utilization management required.

Education & Licensing

• Bachelor’s degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred.
• Acquisition and maintenance of Insurance License(s) may be required to comply with state requirements. Preferred for license(s) to be obtained within three – six months of starting the job.

Skills & Knowledge

• Proficiency in all Microsoft Office products including Project, Word, Excel, PowerPoint, Visio, and SharePoint
• Knowledge of workers’ compensation laws and regulations, behavioral health, case management practice, URAC standards, ODG, Utilization review, pharmaceuticals to treat pain, pain management process, drug rehabilitation, state workers compensation guidelines, periods of disability, and treatment needed
• Excellent oral and written communication, including presentation skills

• Ability to interact collaboratively and work effectively with a multi-functional team and throughout the organization; fosters an environment of shared responsibility and accountability
• Strong organizational, communication and analytical skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding Auditory/Visual: Hearing, vision and talking

What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a erse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the erse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see ersity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

Bilingual Telehealth Nurse Practitioner

Remote USA

Full time

job requisition id

R2160

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, erse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology – to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we’ve grown fast and now serve members across the United States. And we’ve just started. So join us on this mission!

Job Description

This role is a fully remote position.

A bit about this role:

This position represents an amazing opportunity for a caring nurse practitioner (APRN). Your primary focus will be delivering world class comprehensive care to our members. One of Devoted Medical’s missions is to bring care to where our members live – meaning your visits will be predominantly virtual telehealth.

Required skills and experience:

• APRN with 3 or more years working in outpatient clinical practice.
• An active and clear RN and APRN license.
• Active BLS is required at time of hire and must be maintained while employed at Devoted Medical.

Desired skills and experience:

• Experience in primary care, family medicine, geriatrics and/or palliative care.
• Experience performing Medicare annual wellness visits or in-home comprehensive visits with elderly patients or Medicare patients.
• Experience performing visits over telehealth video platforms.
• An understanding of managed care is a plus, including how to appropriately assess STARS/HEDIS measures, code clinical comorbidities, and identify clinical care gaps.

Your Responsibilities will include:

• Conduct primarily telehealth video visits to members with the opportunity for a small volume of home based visits (drive to member’s home). In some instances when appropriate and compliant with licensure, you may also provide telehealth visits to members located in other geographies.
• Primarily perform comprehensive assessment visits (CAVs) including comprehensive diagnosis/disease review, medication review, and assessment for quality of care (STARS/HEDIS) interventions as well as social and home health/DME needs.
• Work closely with other members of the member’s care team including their PCP, specialists, and other Devoted team members including pharmacy, clinical nursing, and social work as well as interfacing with family members and caregivers in order to coordinate care for the member and deliver a collaborative care plan.

Salary Range: $115,000 – $125,000 / year

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the inidual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more….

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a erse and vibrant workforce.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value ersity and collaboration. Iniduals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

Title: RN Case Manager

Location: Remote

Job Description:

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

About our Growth

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

Visit www.vytalizehealth.com for more information.

Why you will love working here

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

Your opportunity

The RN Case Manager (Remote) works with the clinical department and acts as a liaison between our physician practices and their patients. The RN Case Manager advocates for personalized treatment options that address a patient’s unique care needs. The RN Care Manager uses a patient-centric approach that supports the value-based care model, offers education and guidance for navigating complex medical decisions, and coordinates care for patients when they need support the most, including post discharge and when social needs are not met. This RN Case Manager will support special clinical programs and initiatives to support VBC and shared savings goals.

What You Will Do

• You will be responsible for using your assessment and communication skills to engage with patients in need of clinical support to determine and prioritize their needs. You will deliver patient-centered care, provide exceptional customer service, and work within your scope of practice to provide evidence-based education, assessment, and care navigation
• Identify patient/caregiver education needs through telephonic assessment/engagement and ensure that patient/caregiver have adequate information to participate in the successful transition back to their home setting from an inpatient or post-acute facility stay
• Conduct timely telephonic clinical outreach to identified patients
• Collaborate with PCP, NP, and other members of the healthcare team to coordinate care for patientsand actively help keep them stable at home
• Serve as the point of contact and informational resource for patients, care team, family/caregiver(s), payers, and community resources.
• Implement interventions that improve health outcomes, lower costs, and improve the experience for the patient.
• Work collaboratively with provider offices, SNFs, hospitals, and other teams in Clinical Services to support each patient’s needs most efficiently and effectively.
• Assist in the coordination across the continuum of care while maintaining confidentiality.
• Guide patients through the health care system and help them overcome barriers.
• Coordinate treatment and services for patients
• Schedule medical appointments as needed
• Communicate about a patient’s health condition with the patient and their family
• Provides community resources to patientsas needed and to support resolution of SDoH
• Maintain a comprehensive working knowledge of community resources.
• Assume accountability for the quality of care.
• Continually seek new knowledge and learning that supports clinical care coordination.
• Support non-RN team members in their contributions to care coordination by educating and providing clinical guidance as needed
• May be asked to support the Director in day-to-day supervision of team members as needed.

What will make you successful here

• Bachelor’s Degree in Nursing
• 5 years experience as an RN or RN Care Manager
• Post Acute Care experience strongly preferred
• Transitions of Care experience strongly preferred
• Startup experience preferred
• Unencumbered RN license, compact nursing license preferred
• Accredited Case Manager (ACM) preferred
• Comfortable and able to adapt to rapid changes
• Excellent verbal and written communication skills
• Excellent organizational skills and attention to detail
• Entrepreneurial spirit, a sense of ownership and comfortable operating in ambiguity
• Solution oriented with the ability to think strategically and creatively in decision-making
• Able to work independently
• Coachable and able to take direction and feedback well, yet being forward-thinking to challenge the status quo
• Proficient with Microsoft Office Suite or related software.
• Demonstrate a positive attitude and respectful, professional customer service
• Acknowledge patient’s rights on confidentiality issues and follow HIPAA guidelines and regulations
• Passionate about patient experience
• Confident managing change, goal-oriented and has a growth mindset
• Comfortable with digital technology (including tools like MS Office, Google, various EMRs, etc.) and able to troubleshoot technology issues
• Compassionate and good at listening to patient or staff concerns
• Organized, efficient, and adaptable: able to carry out a variety of administrative and clinical duties
• Ability to critically think, solve problems, and bring professionalism to all situations
• Able to contribute to quality improvement and process improvement initiatives
• Maintain a professional and HIPAA compliant workspace
• Excellent written and verbal communication skills
• Strong clinical and problem-solving skills
• Strong attention to detail
• Proficiency in Microsoft Office Suite

Perks/Benefits

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

Title: Inpatient Coder

Location: Savannah United States

Job Description:

Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as an Inpatient Coder today with Work from Home.

Benefits

Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues

Note: Eligibility for benefits may vary by location.

Come join our team as an Inpatient Coder. We care for our community! Just last year, HCA Healthcare and our colleagues donated $13.8 million dollars to charitable organizations. Apply Today!

Job Summary and Qualifications

As an Inpatient Coding Specialist, you will be responsible for working inpatient coding related alerts/edits, predominately post initial/final coding. You will also perform the alert/edit resolution activities in the applicable systems. The alerts/edits shall be worked according to the established procedures and thresholds and communicated as appropriate.

What you will do in this role:

• Compiles daily work list from eRequest, CRT and/or other alert/edit systems
• Takes action and resolves alerts/edits daily following established procedures and thresholds
• Enters detailed notes to update eRequest to provide details if the alert/edit cannot be resolved or must be rerouted to another responsible party for research/resolution
• Escalates alert/edit resolution issues as appropriate to minimize final billing delays
• Monitors the aging of accounts held by an alert/edit, prioritizes aged accounts first, and reports to leadership
• Works with team members in billing, revenue integrity and/or the Medicare Service Center to resolve alerts/edits
• Assigns interim DRGs for in-house patients at month end
• Completes MOCK abstracts as necessary (e.g., combining the codes for outpatient and inpatient claims subject to the payment window)
• Assists the Coding Leads and/or Coding Managers in resolving unbilled reason codes (URC)/Hold Reasons
• Communicates coding revisions to the applicable party (e.g., CIS, lead, manager, international log) 2 Job Description
• Periodically works with their manager to review inidual work accomplishments, discuss work problems/barriers, discuss progress in mastering tasks and work processes, and discusses inidual training needs and career progression

What qualifications you will need:

• Undergraduate (associate or bachelors) degree in HIM/HIT preferred.
• RHIA, RHIT, and or CCS preferred
• 1-year acute care inpatient coding experience required with 3 years’ experience preferred.
• RHIA, RHIT and/or CCS preferred

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Inpatient Coder opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

We are an equal opportunity employer and value ersity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Title: Medical Coder Auditor- Physician Rev Cycle Coding

Location: NC-Chapel Hill

Job Description:

Become part of an inclusive organization with over 40,000 erse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

Serves as a lead employee who audits coded records for multiple specialties. Analyzes coded records for compliance with federal, state and third party insurer rules and regulations. Establishes a collaborative relationship with stakeholders to ensure quality standards are met.

Responsibilities:

1. Accurately assigns International Classification of Diseases 10-CM (ICD-10) diagnostic and Current Procedural Terminology (CPT) codes with modifiers, and other applicable codes. Analyzes information for optimal and proper reimbursement, including coding denial resolution. Ensures compliance with all appropriate coding, billing and data collection regulations and procedures. Uses appropriate software to validate information. 2. Provides information to physicians and other health care staff regarding current coding practices and changes in 3rd party, state and federal regulations and guidelines. 3. Reviews, analyzes and abstracts provider documentation for diagnoses, procedures, ancillary testing, medications, laboratory and other services provided. Obtains missing information and/or clarifies existing documentation. 4. Performs pre-bill and/or post-bill audits for assigned coding teams. 5. Adheres to departmental quality and production standards. 6. Reviews work of staff, researches and resolves problems referred by coders or departmental leadership. Provides information on performance of coders to supervisor regarding performance. 7. Provides training and serves as a general resource to assist other coders and members of department staff. 8. Collaborates with team leadership to address coding trends. 9. Acquires continuing education via UNC Physicians approved programs and vendors. 10. Maintains required professional certification.

Other Information

Other information:

Education Requirements: High School diploma or GED Successful completion of the UNC HCS SS Rev Cycle Physician Coder Auditor Proficiency Test. Licensure/Certification Requirements: Must have one of the following: – AAPC (American Academy of Professional Coders) certification-AHIMA (American Health Information Management Association) CCSP Certification-Must obtain CPMA certification within 1 year of hire date. Professional Experience Requirements: If Associates Degree or Higher: Five (5) years of experience in physician medical coding. If High School Diploma: Seven (7) years of experience in physician medical coding. Knowledge/Skills/and Abilities Requirements:

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Physician Rev Cycle Coding

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $27.89 – $40.09 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Supervisor of Coding

Location: United States

Remote Worker

Salary: 36.12 – 50.56

Biweekly Hours: 80

Job Description:

This position is responsible for the organizational and functional integrity of the coding sections, ensuring staff compliance, development, and education. The incumbent is well-versed in Facility or Professional coding concepts, coordinates HIM initiatives to ensure accurate reimbursement in the Revenue Cycle, monitors productivity, and performs retrospective reviews for coding accuracy and educational opportunities. Focus is specific to hospital inpatient, outpatient, transitional care services or professional services.

temprop=”description”>Nature and Scope

temprop=”description”>Incumbent is responsible for the day-to-day operations of their coding team, ensuring adequate staffing, fair work distribution, and timely and accurate completion of coding tasks. They are responsible for coordinating work schedules, maintaining a calendar of scheduled time off for all employed coding staff and liaising with contract services when applicable to provide adequate coverage based on work volumes and required staffing plan adjustments.

temprop=”description”> The incumbent reviews and analyzes health records to identify relevant diagnoses and procedures for distinct patient encounters, translating diagnostic and therapeutic phrases utilized by healthcare providers into coded form. The translation process may require interaction with the healthcare provider to ensure that the terms have been translated correctly. The coded information that is a product of the coding process is then utilized for reimbursement purposes, in the assessment of clinical care, to support medical research activity, and to support the identification of healthcare concerns critical to the public at large.

temprop=”description”>Incumbent must have a thorough understanding of the content of the medical record in order to be able to locate information to support or provide specificity for coding. Incumbent must be trained in the anatomy and physiology of the human body and disease processes in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures to be coded and to provide direction and mentoring of staff to ensure their understanding of coding principles and correct coding initiatives.

temprop=”description”>This position is challenged to be aware of the continual changes in Federal and State regulations for prospective payment, respond appropriately to observed fraud or abuse and keep informed of changes in treatment modalities and new procedures, and to perform appropriate queries when physician documentation is vague or missing. The Supervisor is expected to share pertinent changes with staff and to assist subordinates in interpretation and application of these changes.

temprop=”description”>The incumbent will be familiar with computer operations, encoder software, and electronic health record (HER) software. They must be capable of training others in data entry and abstracting. Incumbent will audit/approve time and attendance bi-weekly and monitor staff compliance with Renown Health policies. Incumbent will also monitor staff productivity weekly. Completes employee evaluations and 90 and 180-day progress reports timely, offering developmental plans pertinent to the position and employee growth.

temprop=”description”>Supervisor of Coding (Professional Services Focus): The incumbent that oversees Professional Services coders should demonstrate experience with ICD-10-CM, CPT, HCPCS, E/M and HCC capture. This incumbent will be responsible for monitoring work queue volumes, productivity and quality of coding for Professional Services coders. They will provide reporting on provider education results for multiple audiences, and develop the Professional Coding staff. This person assesses and maintains impact of current compliance activities and evaluates risk factors of coding and documentation practices. In addition to supervising staff and provider/physician CPT coding, they are expected to have a close working relationship with the Medical Directors and Operations Mangers to support provider coding accuracy that is consistent with industry standards and in compliance coding guidelines.

temprop=”description”>This position does not provide patient care.

temprop=”description”>Disclaimer

temprop=”description”>The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

temprop=”description”>Minimum Qualifications

temprop=”description”>Requirements – Required and/or Preferred

temprop=”description”>Education:

temprop=”description”>Must have working-level knowledge of the English language, including reading, writing and speaking English. An Associate’s or Bachelor’s Degree is preferred.

temprop=”description”>Experience:

temprop=”description”>Experience in a managerial capacity in health information management for 3-5 years preferred. Two to four years of facility or professional coding experience required.

temprop=”description”>Certification(s):

temprop=”description”>Ability to obtain and maintain a credential recognized by AHIMA or AAPC is required, this excludes apprenticeship credentials (i.e. CCA or CPC-A)

temprop=”description”>Computer / Typing:

temprop=”description”>Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

Actual salary offered may vary based on multiple factors, including but not limited to, an inidual’s location and their knowledge, skills, and experience as well as internal equity.

Remote Pro Fee Coder – Plastic Surgery

locations

US – Remote (Any location)

time type

Full time

job requisition id

21186

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Do:

• Code Complex Plastic Surgery cases including facial trauma
• Works collaboratively with providers, other health care professionals and coding team to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes and quality is captured for the level of service rendered to each patient, as well as ensuring compliant reimbursement of patient care services.

What You Will Need:

• High School Diploma/GED or 3 years of relevant equivalent experience in lieu of diploma/GED
• 5+ years of prior coding experience
• 3 years coding experience related directly to Plastic Surgery coding
• CPC

What Would Be Nice To Have:

• Multispecialty Surgical coding experience

#IndeedSponsored

The annual salary range for this position is $57,300.00-$85,900.00. 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.

Director, Coding Outsource

locations

Remote – USA

time type

Full time

job requisition id

R3874

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 Director, Coding Outsource delivers operational performance outcomes as established in Savista’s annual financial packages and by contractual obligations to clients managed.

More specifically, this role requires talent that can:

• Institute and then continuously assess protocols for how client engagements are launched, managed, and monitored on an ongoing basis, including operationalizing contractual obligations, measuring performance, and sustaining expected levels of talent deployed.

• Oversee the staffing and performance management of the management team assigned to Coding Outsource.

• Analyze P&L outcomes and take action when necessary.

• Collaborate with Client Relationship Development team members to create pathways on how client satisfaction will be initially obtained and sustained thereafter.

• Support services growth.

• Seek ways and means to continuously improve service delivery.

• Maintain familiarity of pertinent and innovative healthcare related issues and regulations.

Minimum Qualifications:

• Bachelor’s in business or health information administration with an active RHIA

• 7 years of healthcare revenue cycle services management experience

Note: Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $135,000 to $150,000. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.

Preferred Qualification:

• Post-implementation Epic systems experience that demonstrates the capability to refine Owning Area edits queuing to each coding team

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.

Coding Supervisor

US – Remote (Any location)

Full time

22408

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Do:

The Physician Coding Team Supervisor must be proficient in Surgical Coding and have experience overseeing physician coding teams. The Supervisor will perform training and initial QA review for coders who are direct reports. Supervisors must have the ability to review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting, research as required, and regulatory compliance. Under the direction of the Coding Manager—Supervisors should be proficient in communicating with coding teams, Client contacts and Providers regarding the coding of conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. The Supervisor scope may involve oversight of teams working coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines. Supervisors should be proficient in Excel and create reports as requested and must communicate professionally with all levels of personnel both internally and externally. Travel may be necessary to client sites at times. This position is full time and is 100% remote.

Duties and Responsibilities:

• Demonstrates the ability to perform oversight, training, and response to internal and external requests regarding quality and production.
• Respond to provider and client questions
• Host client-facing calls and create reports for leadership regarding assigned projects in a timely manner.
• Maintain team goals to promote coder accuracy and efficiency for assigned projects.
• Work with internal education resources to promote skillsets of assigned coding team both domestic and global as assigned.
• Maintain a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing.
• Ensure all services documented in the patient’s chart are properly coded with appropriate ICD-10 and CPT codes when reviewing coding work or responding to coder and client queries.
• Work with coders/client to attain proper documentation in a timely manner according to facility standards when services/diagnoses are not documented appropriately.
• Ensure assigned coding team maintains 95% accuracy in coding while maintaining a high level of productivity.
• Supervisors will work with coders one-on-one during monthly reviews to cover educational opportunities and accuracy.
• Ability to maintain average productivity standards as follows per internal and client coding contracts.
• Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process.
• Coder downtime must be reported immediately to the administrative staff to ensure turnaround is met.
• Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility.
• Provides accurate coding and/or billing questions within eight hours of request.
• Responsible for coding or pending every chart placed in their queue within 24 hours.
• It is the responsibility of the Supervisor to coordinate with coding management in the event the 24 hour turn around standards cannot be met.
• Supervisors must maintain their current professional credentials while working for Guidehouse.
• Supervisors are responsible for becoming familiar with the Guidehouse coding website and using the information contained on the website as a daily tool to correctly code and abstract for each facility.
• Supervisors are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy).
• It is the responsibility of the supervisor to review and adhere to the coding ision policy and procedure manual content.
• Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services.
• Communicates problems or coding discrepancies to Coding Leadership immediately.
• Communication in emails should always be professional (reference e-mail policy).

What You Will Need:

• Requires a University Degree and a minimum of 5 years of prior relevant experience (Relevant experience may be substituted for formal education)
• 3 years of pro fee ortho, trauma or surgical coding
• CPC certification from AAPC
• Must maintain credential throughout employment.
• Strong working knowledge & experience with Federal & State Coding Regulations and Guidelines.

What Would Be Nice to Have:

• Must be able to work independently, multi-task, and interface with all levels of personnel and clientele.
• Excellent verbal, written, and interpersonal communication skills.
• Experience in multiple EMR and/or practice management systems (EPIC, Cerner, Next Gen, Allscripts, IDX, etc.).
• Coding Supervisory experience preferred

#IndeedSponsored

The annual salary range for this position is $57,000.00-$85,400.00. 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.