DHA Medical Coding Auditing Specialist

ID

65349

Recruiting Location : Location

US-

Category

Health/Medical

Position Type

Full-Time

Clearance Details

Ability to obtain and maintain a NACI clearance

Telework

Yes – May Consider Full Time Teleworking for this position

Position Description

Serco is excited to continue our support to the Defense Health Agency (DHA) Medical Coding Program Branch. The DHA is a joint, integrated Combat Support Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force to Combatant Commands in both peacetime and wartime. The essential mission of the DHA Medical Coding Program Branch (DHA-MCPB) is to improve the accuracy and quality of medical coding and documentation across DHA in support of the DHA mission. The work will encompass all 400 Military Treatment Facilities and Dental clinics assigned to DHA Markets. The work may include multiple conference calls, virtual meetings, and possible onsite visits to DHA organizational elements inside the continental United States (CONUS) and outside of the continental United States (OCONUS).

This position is 100% Remote.

Specifically, Medical coding auditing consists of a systematic, unbiased, independent examination of medical documentation and coding to validate that all codes entered into the Military Health System (MHS) systems are in conformity with official coding policies, regulations, requirements, and standards. The task involves developing or following a disciplined, systematic process that defines what is to be audited and why, how errors are defined and reported, what documentation and official guidance is required, and how results are reported. You will professionally interact with Medical Treatment Facility (MTF) staff physicians and other coders from different companies regarding coding and documentation rules, policies, procedures, and regulations. You will obtain clarification of conflicting, ambiguous, or non-specific documentation. Provide advice, assistance, and technical support to MTF staff, Medical Coders, reviewers, Medical Coding Compliance Specialists, and Medical Coding Trainers as appropriate regarding official coding guidance and regulatory provisions.

In this role, you will:

• Verify the accuracy of the diagnosis, procedure, supply codes, modifiers, and sequencing for the professional and institutional (facility) components of Inpatient, External Resource Sharing Agreement (ERSA), Ambulatory Procedure Visit (APV), Observation, Emergency Department (ED), and Outpatient encounters.
• Code audited include International Classification of Diseases, Clinical Modification (ICD-CM), International Classification of Diseases, Procedural Classification System (PCS), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and modifiers.
• Assign errors IAW the Defense Heath Agency policies, procedures, rules, and standards, and provides clear, concise, official coding guidance, rationale, and reasons for assigning specific errors.
• Ensure strict confidentiality of medical records and audit findings.
• Provide second-level review of coding assignment to ensure compliance with legal and procedural policies to ensure optimal reimbursements while adhering to regulation prohibiting unbundling and other questionable practices.
• Review encounters and/or record documentation to identify inconsistencies or discrepancies that may cause inaccurate coding, medico-legal repercussions or impacts quality patient care.
• Identify any problems with legibility, abbreviations, etc., and brings to the provider’s attention.
• Examine records for proper sequence of documents, presence of authorized signatures, and sufficient data is documented that supports diagnosis, treatment administered, and results obtained.
• Utilize medical computer software programs to abstract, analyze, and/or evaluate clinical documentation and enter/edit diagnosis and procedure codes.
• Write in a clear, concise, organized, and convincing manner for the intended audience; use correct English grammar, punctuation, and spelling; communicate information in a succinct and organized manner; and produce written information.

Qualifications

To be successful in this role, you will have:

• This position is contingent upon your ability to obtain and maintain a NACI clearance.
• A minimum of 8 years of medical coding and/or auditing experience in four or more medical, surgical, and ancillary specialties within the past 15 years.
• A minimum of one (1) year of performance in the specialty is required to be qualifying. Multiple specialties encompass different medical specialties (i.e. Family Practice, Pediatrics, Gastroenterology, OB/GYN, etc.) that utilize ICD, E&M, CPT, and HCPCS codes. Ancillary specialties (PT/OT, Radiology, Lab, Nutrition, etc.) that usually do NOT use E&M codes do not count as qualifying experience.
• Four (4) years of the 8 years of required coding experience must involve medical coding auditing functions. Auditing functions include development and execution of audit plan, conducting audit according to audit plan by reviewing required documentation.
  • Coding experience should include inpatient facility and ambulatory surgery areas. Additionally, coding, auditing and training exclusively for specialties such as home health, skilled nursing facilities, and rehabilitation care will not be considered as qualifying experience.
  • Coding experience limited to making codes conform to specific payer requirements for the business office (insurance billing, accounts receivable) is not a qualifying factor. Determining compliance with audit standards, communicating with stakeholders during all phases of audit, and reporting on audit findings.

• A minimum of one of the following:

• • An associate degree in health information management
    • Or a university certificate in medical coding; or
    • Or at least 30 semester Hours of university/college credit that includes relevant coursework such as anatomy/physiology, medical terminology, health information management, and/or pharmacology.
      • (Education must be from an accredited educational institution recognized by the American Health Information Management Association (AHIMA) and/or American Academy of Professional Coders (AAPC).)

• Coding Certifications – Medical Coding Auditors are required to possess a certification in good standing from each of the following categories:
  • Professional Services Coding Certifications: One of the following recognized professional certifications: Registered Health Information Technician (RHIT); or Registered Health Information Administrator (RHIA); or Certified Professional Coder (CPC); or Certified Outpatient Coder (COC); or Certified Coding Specialist – Physician (CCS-P).
  • Institutional (Facility) Coding Certifications: One of the following recognized Certified Inpatient Coder (CIC), or Certified Coding Specialist (CCS). Other institutional coding certifications will be considered by the DHA-MCPB on a case-by-case basis.
  • AAPC: Certified Professional Medical Coding Auditor (CPMA). Other medical coding auditing certifications will be considered by the DHA-MCPB on a case-by-case basis.
  • National Alliance of Medical Auditing Specialists’ (NAMAS) Certified Evaluation and Management Auditor (CEMA)
• Continuing Education Requirements: Medical coders shall maintain the required continuing education hours to maintain current and proper national certification(s) requirements for this position at no expense to the Government.
• Understand and interpret written material, including technical material, rules, regulations, instructions, reports, charts, graphs, or tables.
• Require attention to detail and completeness with a thorough understanding of government rules and regulations, medical coding and reimbursement guidelines, and potential areas of risk for fraud.
• Knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM), and Procedural Coding System (PCS); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT).
• Knowledge of reimbursement systems, including Prospective Payment System (PPS) and Diagnostic Related Groupings (DRGs); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS).
• Advanced knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes.
• Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to, Laboratory, Occupational Therapy, Physical Therapy, and Radiology).
• Thorough understanding of Government rules and regulations regarding medical coding, reimbursement guidelines, and healthcare fraud; commercial reimbursement guidelines and policies; coding audit principles and concepts, and potential areas of risk for fraud and abuse.
• Ability to travel up to 10%

Addtional Required experience and skills:

• A minimum of three (3) years of auditing, training, and/or compliance experience within the last six (6) years in a military coding environment.

If you are interested in supporting and working with our military and sailors and a passionate Serco team- then submit your application now for immediate consideration. It only takes a few minutes and could change your career!

In compliance with state and local laws regarding pay transparency, the salary range for this role is $62,037.42 to $93,056.69; however, Serco considers several factors when extending an offer, including but not limited to, the role and associated responsibilities, a candidate’s work experience, education/training, and key skills.

Company Overview

Serco Inc. (Serco) is the Americas ision of Serco Group, plc. In North America, Serco’s 9,000+ employees strive to make an impact every day across 100+ sites in the areas of Defense, Citizen Services, and Transportation. We help our clients deliver vital services more efficiently while increasing the satisfaction of their end customers. Serco serves every branch of the U.S. military, numerous U.S. Federal civilian agencies, the Intelligence Community, the Canadian government, state, provincial and local governments, and commercial clients. While your place may look a little different depending on your role, we know you will find yours here. Wherever you work and whatever you do, we invite you to discover your place in our world. Serco is a place you can count on and where you can make an impact because every contribution matters.

To review Serco benefits please visit: https://www.serco.com/na/careers/benefits-of-choosing-serco. If you require an accommodation with the application process please email: [email protected] or call the HR Service Desk at 800-628-6458, option 1. Please note, due to EEOC/OFCCP compliance, Serco is unable to accept resumes by email.

Candidates may be asked to present proof of identify during the selection process. If requested, this will require presentation of a government-issued I.D. (with photo) with name and address that match the information entered on the application. Serco will not take possession of or retain/store the information provided as proof of identity. For more information on how Serco uses your information, please see our Applicant Privacy Policy and Notice.

Serco does not accept unsolicited resumes through or from search firms or staffing agencies without being a contracted approved vendor. All unsolicited resumes will be considered the property of Serco and will not be obligated to pay a placement or contract fee. If you are interested in becoming an approved vendor at Serco, please email [email protected].

Serco is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.

Senior Coder-Anesthesia

Remote

Full time

35440

POSITION SUMMARY:

The Senior Coder-Anesthesia position is responsible for reviewing documentation in the outpatient/inpatient EHR. This position is responsible for assigning ICD-10-CM diagnosis codes and CPT, ASA, HCPCS II and appropriate modifiers to patient records from BMC Anesthesia Departments. The Senior Coder-Anesthesia position is a resource for the physicians and other health care providers in regard to coding and to review medical documentation to insure appropriate physician coding and billing.

Position: Senior Coder-Anesthesia

Department: FPF Prof. Billing Office

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Perform coding and related duties of moderate and high complexity anesthesia work using established guidelines in an accurate and timely manner.
• Review medical documentation and system generated charges or paper encounter forms. Appropriately assign CPT, ASA, ICD-10, HCPCS II, and modifiers based on documentation and payor requirements
• Research billing rules and regulations for moderately complex new and existing procedures
• Demonstrate a commitment to integrating coding compliance standards into daily coding practices. Identify, correct and report coding problems.
• Maintains knowledge of coding and professional skills, including maintaining yearly coding credentials through attendance at in-service programs, conferences, workshops, review of current literature and other educational programs.
• Resolves complex coding edits and denials in a timely manner. Identify opportunities to reduce denials and enhance revenue.
• Provide cross coverage of multiple specialties
• Function as a resource to external customers. Research and resolve complex coding inquiries. Make recommendations for coding policy changes.
• Perform peer to peer quality assurance reviews of all Physician Practice Coders in equal or lower complexity areas of expertise
• Functions as subject matter expert for assigned specialties
• Develop and maintain ision specific coding procedures and/or billing area instructions
• Complete special projects as assigned by manager.
• Participate in coding education for providers and co-workers upon request.
• Maintain coding certification.
• Sequences diagnoses, procedures and complications by following ICD-10-CM, Medicare, Medicaid, and other fiscal intermediary guidelines.
• Maintains productivity standards set forth in Departmental Policies and procedures.
• Review and respond to coding questions.
• Ensure billed service is being accurately coded.
• Perform random chart audits.
• Performs other duties as needed.

Must adhere to all of BMC’s RESPECT behavioral standards.

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

JOB REQUIREMENTS

EDUCATION:

Associates Degree (or direct work experience equivalent to at least 2 years)

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Certification may include CPC, COC, COC-A, CANPC, CGSC, CIC, CCA, CPC-A, CCS, CCS-P, RHIT, or RHIA

EXPERIENCE:

Minimum of 2 years experience conducting Anesthesia coding/auditing in a surgical/procedural environment to include compliance, and billing processes.

KNOWLEDGE, SKILLS & ABILITIES (KSA):

• Advanced Proficiency in ICD-10, CPT, ASA, HCPCS, and modifiers for coding of professional fee services.
• Advanced knowledge of anatomy and physiology, medical terminology and insurance reimbursement policies and regulations.
• Excellent written and verbal communication skills and the ability to prioritize and organize work to meet strict deadlines are required.
• Able to code moderate/high complexity work.
• Understands, retains, and is able to research coding billing rules, regulations, and requirements.
• Able to critically think through processes in coding to recognize errors and/or problems. Understands reasons for actions on edits.
• Able to share/transfer knowledge or train co-workers, peers, billing managers on coding – Able to provide education with physicians in small group or one-on-one sessions as needed or requested.
• Able to provide feedback to billing managers, physicians, staff, and others independently with occasional guidance from manager.
• Able to provide cross-coverage of multiple specialties.
• Able to perform peer to peer quality assurance reviews in equal or lower complexity areas of expertise.
• Proficient with computer applications (MS Office etc), Excellent data entry skills
• Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
• Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
• Ability to work with accuracy and attention to detail
• Ability to solve problems appropriately using job knowledge and current policies/procedures.
• Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.
• Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.

Equal Opportunity Employer/Disabled/Veterans

Value Based Care Coder

United States

Full-time – Remote

Remote

Accompany Health is on a mission to give low-income patients with complex needs the dignified, high-quality care they deserve but rarely receive. A primary, behavioral, and social care provider, Accompany Health walks alongside patients for their entire care journey, offering at-home and virtual care, as well as 24/7 support. Partnering with innovative payors, Accompany Health is powered by remarkable care teams, elegant technology, and a commitment to evidence-based practice.

We build long-term relationships with our patients so they know, without question, that our team is here for them day or night, year after year. We focus on the health outcomes most important to our patients to make it clear that they lead the way.

To achieve our mission, we collaborate with community-based organizations, local providers, and health plans. Led by our empathetic care teams, guided by proven care models, and powered by our own technology, we deliver a level of service that our communities rightfully deserve but rarely receive.

While our headquarters is in Bethesda, MD, our teams are distributed across the country. If you’re eager to make a tangible difference in people’s lives, to help correct long-standing disparities in health care, join us.

About the role:

As a Value Based Care (VBC) Coder for Accompany Health you will be:

-Pre-visit chart prep including review of medical records to identify diagnoses to be addressed by care teams in visits with patients.

-Concurrent and post-visit review to ensure care teams achieve accurate and specific clinical documentation.

-Identifying educational opportunities to improve clinical documentation in compliance with ICD-10 CM coding guidelines, internal protocols, and CMS and payer guidelines.

Responsibilities will include:

• • Prospective reviews of medical records to identify current conditions and suspect conditions
  • Concurrent review/real time education support and feedback during patient face-to-face visit to ensure coding and documentation accurately captures patient health status
  • Provide guidance to field staff and practices regarding general coding, documentation and risk adjustment best practices
  • Partner with internal stakeholders to improve reporting and analytics tools to drive improvements in the accuracy and completeness of clinical documentation and diagnosis coding
  • Reviews annual mapping of ICD-10 CM crosswalk from CMS Website
  • Other duties as assigned.
  • This role reports to the CDI Manager.

What makes you a fit for the team:

• • You are excited to work in a startup environment, with the ambiguity and shifting priorities that might come with it at times.
  • You are willing to go the extra mile no matter what.
  • You are passionate about our mission to improve the lives and healthcare outcomes of marginalized communities.

Desired skills and experience:

• • Required
  • Current certification as a Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent
  • 3+ years of recent, relevant work experience in medical coding, preferably in risk adjustment
  • Thorough understanding of medical coding guidelines and regulations including compliance, reimbursement, and the impact of diagnosis documentation on risk adjustment payment models
  • Subject matter expertise on the CMS HCC Risk Adjustment program, methodology, and impact to value-based contracts
  • Preferred
  • Experience in pre-visit planning and provider education
  • Experience with athenahealth
  • Experience with GSuite and Google applications

Customer Success Manager (CSM), Healthcare

United States (U.S.)

Company Overview

ID.me is a high-growth enterprise software company that simplifies how people prove and share their identity online. The company empowers people to control their data through a portable and trusted login, which means they don’t need to create a new password when visiting sites that have the ID.me button. ID.me’s digital identity network has over 117 million registered members, and is used by fourteen federal agencies, agencies in 30 states and over 600 corporations for secure identity proofing and verification.

ID.me’s technology meets the federal standards for consumer authentication set by the Commerce Department and is approved as a NIST 800-63-3 IAL2 / AAL2 credential service provider by the Kantara Initiative. In addition to helping people control their credentials and data, the company’s “No Identity Left Behind” initiative strives to expand digital access and inclusion for all people. The company offers multiple pathways to identity verification – online self-serve, live video chat agents, and in person. ID.me is passionate about building a robust identity network that does not compromise access for traditionally underserved groups.

ID.me has received numerous awards including Deloitte’s 2023 Technology Fast 500, Washington Business Journal’s Fastest Growing Companies, Entrepreneur Magazine’s 100 Brilliant Companies and Wall Street Journal’s Startup of the Year finalist. In recent quarters, ID.me announced it raised $132 million in Series D funding, led by Viking Global Investors with participation from CapitalG, Morgan Stanley Counterpoint, FTV Capital, PSP Growth, Auctus Investment Group, Moonshots Capital, and Scout Ventures. ID.me’s most recent round brings the total investment in ID.me to over $275 million since its founding in 2010.

About the job:

ID.me is looking for an experienced technical Customer Success Manager who has a passion for technology and the desire to e head-first into new challenges. The ideal candidate will thrive with a high level of ambiguity, collaborate cross-functionally, yet operate autonomously while maintaining an end-user centric approach. In this role, you become a consultative partner for our customers by leveraging your technical and relationship management skills. Additionally, this candidate should have strong business acumen and have the ability to influence key stakeholders. This role requires curiosity and a desire to acquire deep knowledge and expertise of our products and the identity space, and leverage that knowledge to develop strategies and deliver value to each customer.

What you will do:

• Work as a strategic advisor to your customers, influencing their technology strategy by positioning product features and ID.me best practices to accelerate adoption and growth.
• Act as a link between our customers and product by collecting feedback and identifying optimal implementation roadblocks.
• Foster deep relationships with customers, ensuring their and the end user’s satisfaction along the post sales journey.
• Analyze product performance data to identify usage trends or potential issues, de-escalating and resolving critical customer issues when necessary
• Lead in-person executive business reviews for strategic customers in your portfolio, interfacing with C-suite executives, business, and technical leaders to align to business objectives through a mutually agreed upon success plan.
• Build and execute success plans to mitigate risk and drive growth across the portfolio.
• Work with a balanced account team mindset, coordinating customer-related plays and motions with Sales and Solutions consulting.
• Work on strategic internal projects to help build the Customer Success program.
• Work proactively to ensure renewals are a non-event, forecasting expected churn and growth to leadership.
• Act as an owner and make things better every day.

Qualifications

• 5+ years of experience in Customer Success, Account Management, or Client Services, preferably at a SaaS cybersecurity or healthtech company.
• Detail, process, and systems orientation – the ability to synthesize, organize, and prioritize is critical to this role.
• A mind for technology – we will teach you about ID.me but our customers and product are inherently technical and you should have an aptitude for learning.
• Proven track record of success managing customers with Digital Wallet, IAM, or Identity Orchestration platforms
• Experience managing healthcare systems and / or healthcare tech customers.
• Strong analytical skills, leveraging a data-driven approach to influence.
• Strong communication skills with the ability to build consensus and de-escalate conflict.
• A team player mindset and a passion for collaboration.
• Travel expectations up to 25%

The annual base salary listed below for this role is based on experience, skills, education, relevant training and geographic location. Company bonus, incentive for sales roles, equity, and benefits are available depending on the role.

ID.me offers comprehensive medical, dental, vision, health savings account, flexible spending accounts (medical, limited purpose, dependent care, commuter benefit accounts), basic and voluntary life and AD&D insurance, 401(k) with company match, parental leave, ability to participate in unlimited paid time off subject to the terms and conditions of the PTO policy, including 8 company wide holidays, short and long-term disability insurance, accident and critical illness insurance, referral bonus policy, employee assistance program, pet insurance, travel assistant program, wellbeing and childcare discounts, benefit advocates, and a learning and development benefit.

The above represents the anticipated total rewards package for this job requisition. Final offers may vary from the amount listed based on qualifications, professional experiences, skills, education, relevant training, geographic location, and other job related factors.

U.S. Pay Range

$105,000 – $140,000 USD

Sunnyvale & Mountain View, CA Pay Range

$126,000 – $168,000 USD

ID.me maintains a work environment free from discrimination, where employees are treated with dignity and respect. All ID.me employees share in the responsibility for fulfilling our commitment to equal employment opportunity. ID.me does not discriminate against any employee or applicant on the basis of age, ancestry, color, family or medical care leave, gender identity or expression, genetic information, marital status, medical condition, national origin, physical or mental disability, political affiliation, protected veteran status, race, religion, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable laws, regulations and ordinances. ID.me adheres to these principles in all aspects of employment, including recruitment, hiring, training, compensation, promotion, benefits, social and recreational programs, and discipline. In addition, ID.me’s policy is to provide reasonable accommodation to qualified employees who have protected disabilities to the extent required by applicable laws, regulations and ordinances where a particular employee works. Upon request we will provide you with more information about such accommodations.

Please review our Privacy Policy, including our CCPA policy, at id.me/privacy. If you provide ID.me with any personally identifiable information you confirm that you have read and agree to be bound by the terms and conditions set out in our Privacy Policy.

General Surgery Coder

US – Remote (Any location)

Full time

21758

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Do:

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

What You Will Need:

• High School Diploma/GED or 3 years of relevant equivalent in lieu of diploma/GED
• 3 years of General Surgery Cases for Physician Billing
• 2-3 years of E/M experience
• CPC certification from AAPC

What Would Be Nice to Have:

• Multispecialty Surgical Coding experience
• Coding for an academic medical center

The annual salary range for this position is $49,800.00-$74,700.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

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

Benefits include:

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

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Manager Coding (QA)

US-Remote

Full-Time

Overview

The Coding Manager leads a team of coders, directly or indirectly, to deliver key components to the Cotiviti coding program. This role works with the Director of Coding, the Client team and other areas related to production, QA, and analytics for oversight of ongoing production and quality accuracy.

Responsibilities

• Work with the Director, Coding Services to oversee CMS-HCC and HHS- HCC coding production and quality including the management of staff, hiring, promoting, evaluating, and training, disciplining, and mentoring at the client team level.
• Facilitates all production meetings with Reporting, Data Capacity operations planning, and leadership to develop coding and abstraction production plans. Communicates production plans, quality goals and project priorities to internal Coding teams as well as external vendor partners in preparation for on-boarding and/or scheduling of all client projects, including on and offshore coding.
• Resolve issues that impact coding production and the full utilization of coding abstraction services for MRA, CRA and Medicaid. This will involve working closely with chart retrieval staff, IT, Production Analytics, HR, Trainers, and the QA team.
• Utilize Coding forecast and coding output data to monitor coding productivity and quality; address coders work performance concerns through meeting with the Coder and/or coding vendor leadership to develop an action plan as needed regarding production and quality accuracy standards. This includes the development of monitoring tools as needed to continually assess staff progress toward goal achievement.
• Constructs and communicates internal system reports for all coders (Coder I, Coder II, QA I and QA II and Team Leads) in the Clinical Coding Department. These reports cross production and quality accuracy. Reports are reviewed daily, weekly, monthly, quarterly, and yearly as needed.
• Ensures completion of various chart types (physician, hospital outpatient, hospital inpatient) from both a production and quality accuracy perspective.
• Frequently meets with clients to provide meaningful updates on project progress; works closely with client success and coding quality to ensure successful deliverables.
• Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that is able to assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction. Required
• Complete all responsibilities as outlined in the annual performance review and/or goal setting. Required
• Complete all special projects and other duties as assigned. Required
• Must be able to perform duties with or without reasonable accommodation. Required

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change. Required

Qualifications

• Bachelor’s degree, Coding certification; RHIA, RHIT, CRC, CCS, CCS-P, CPC, CPC-H (Nationally certified medical coder as certified by either AAPC or AHIMA) or 4 years equivalent work experience.
• 5+ years of HCC medical coding, record abstraction experience, including supervisory experience.
• Ability to establish, monitor and enforce staffing schedules and production schedules.
• Ability to analyze data to identify trends, outliers or areas that need attention from both a production and quality perspective, and implement changes as needed.
• Bachelor’s degree, Coding certification; RHIA, RHIT, CRC, CCS, CCS-P, CPC, CPC-H (Nationally certified medical coder as certified by either AAPC or AHIMA) or 4 years equivalent work experience.
• 5+ years of HCC medical coding, record abstraction experience, including supervisory experience.
• Ability to establish, monitor and enforce staffing schedules and production schedules.
• Ability to analyze data to identify trends, outliers or areas that need attention from both a production and quality perspective, and implement changes as needed.
• Ability to act as a coding resource or QA resource for Medicare Risk Adjustment, Commercial Risk Adjustment and Medicaid when production volume is required.
• Excellent written and verbal skills including coaching and interpersonal skills, and client interaction.
• Strong knowledge of medical terminology and anatomy and physiology.
• Analytical and critical thinking skills to understand data to influence decision making.
• Computer and technology literate.
• Manage multiple client deliverables and competing deadlines simultaneously.
• Awareness and adherence to HIPAA privacy and security regulations.
• Must remain flexible to provide assistance in any emergent situations and/or projects.
• Must be able to perform duties with or without reasonable accommodation.
• Work is performed in an office setting with some possible travel.

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• 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.
• No adverse environmental conditions expected.

Base compensation ranges from $78,000 to $90,000. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.

Title: ProFee Coding Lead

Location: Remote United States

Job Description:

Requisition ID 2024-37039

# of Openings 1

Category (Portal Searching) HIM / Coding

Position Type (Portal Searching) Employee Full-Time

Equal Pay Act Minimum Range $25.00 – $35.00 per hour

Overview

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.

Our coding team is growing and we’re in need of a Lead Coder with ProFee experience to join the 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!

Responsibilities

What you will do:

• Review medical record documentation to identify pertinent diagnoses/procedures requiring code assignment for profee charts and accurately code the diagnoses and procedures for reimbursement, research, and compliance with federal regulations.
• Query physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes.
• Keep abreast of coding guidelines and reimbursement reporting guidelines, bringing identified concerns to the manager for resolution.
• Mentor and train newly hired coders and providers, providing ongoing training for coding staff.
• Assist the coding manager with special coding assignments or coding tasks to resolve unbilled issues.
• Serve as a resource for all coding-related questions, responding promptly to requests and questions from coding staff.
• Promote inidual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
• Monitor and report all required performance measures, including the development of department goals and assistance in assessing goal attainment.
• Conduct and recommend training to improve team performance.
• Ensure management is informed of any employee personnel issues.
• Function as a resource to employees for questions and additional training.
• Assist management in monitoring staff’s KPIs, timekeeping, and schedules.

Qualifications

What you will bring to the table:

• 3+ years of Profee coding experience
• Previous supervisory/team lead experience
• Coding Certification from the American Association of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) required
• High School Diploma or GED required
• Associates Degree in Health Information Management or any Healthcare Related Field preferred
• Proficient knowledge of ICD-10 and Profee coding guidelines
• Strong billing/denial experience
• Effective oral and written communication skills
• Strong analytical skills to interpret data
• In-depth knowledge of human anatomy, medical terminology, and surgical terminology
• Strong critical thinking skills and decision-making abilities
• Comprehensive understanding of coding compliance policies, coding guidelines for multiple specialties, and insurance payor policies

Perks:

• Full Benefits including a 401k Savings Plan
• Access to 20-24 free CEUs per year, provided by Datavant, to support your continuous professional development
• Compensation for AAPC/AHIMA dues
• Company-provided equipment including computer, monitor, mouse, etc
• Comprehensive training led by a credentialed professional coding manager
• Exceptional service-style management and mentorship (we’re in this together!)

We are committed to building a erse team of Datavanters who are smart, nice, and get things done, where every Datavanter is empowered to bring their authentic self to their work. We are all responsible for stewarding a high-performance culture in which all Datavanters belong and thrive. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status.

Our compensation philosophy is to be externally competitive, internally fair, and not win or lose on compensation. Salary ranges for this position are developed with the support of benchmarks (competitive San Francisco rates for US-based roles) and industry best practices.

We’re building a high-growth, high-autonomy culture. We rely less on job titles and more on cultivating an environment where anyone can contribute, the best ideas win, and personal growth is driven by expanding impact. This means we default to simple job titles (e.g., Software Engineer) rather than complex ones (e.g., Senior Software Engineer). The range posted is for a given job title, which can include multiple levels. Inidual rates for the same job title may differ based on level, responsibilities, skills, and experience for a specific job. Pay ranges for this job title may differ based on location, responsibilities, skills, experience, and other requirements of the role. Pay range is between $25-35 an hour.

At the end of this application, you will find a set of voluntary demographic questions. If you choose to respond, your responses will be anonymous and used to help us identify areas of improvement in our recruitment process. (We can only see aggregate responses, not inidual responses. In fact, we aren’t even able to see if you’ve responded or not.) Responding is your choice and it will not be used in any way in our hiring process.

Equal Pay Act Minimum Range

$25.00 – $35.00 per hour

Senior Coder – Inpatient (Remote)

locations

Newark, DE

Full time

Job Details

Do you want to work at one of the Top 100 Hospitals in the nation? We are guided by our values of Love and Excellence and are passionate about delivering health, not just health care. Come join us at ChristianaCare!

ChristianaCare, with Hospitals in Wilmington and Newark, DE, as well as Elkton, MD, is one of the largest health care providers in the Mid-Atlantic Region. Named one of “America’s Best Hospitals” by U.S. News & World Report, we have an excess of 1,100 beds between our hospitals and are committed to providing the best patient care in the region. We are proud to that Christiana Hospital, Wilmington Hospital, our Ambulatory Services, and HomeHealth have all received ANCC Magnet Recognition®.

Scheduling Flexibility and Perks

• The schedule and hours for this position are very flexible and we will work with you on work/life balance to build a schedule that works for you
• This position is 100% remote and we encourage national candidates to apply
• We provide equipment, coding books, continuing education credits as well as professional organization memberships to AHIMA or APC

Primary Function:

ChristianaCare is currently seeking a full-time Senior Coder to be responsible for accurate and timely assignment of ICD 10 CM/PCS and HCPCS/CPT codes, payment group classification assignment and data abstraction for reimbursement purposes and statistical information reporting on all Inpatient, Outpatient, Emergency Medicine, Ancillary and Diagnostics records, and/or any other patient records for which HIMS Department performs coding services. Meets or exceeds productivity and accuracy standards outlined in the HIMS Coding Policies and Procedures.

Principal Duties and Responsibilities:

• Reviews and interprets Inpatient, Outpatient, Ancillary, Diagnostics and Emergency Medicine or other patient type records in order to assign appropriate ICD 10 CM/PCS diagnosis and procedure codes and/or HCPCS/CPT procedure codes as required based on record type and CCHS reporting practices.
• Performs coding and abstracting tasks to support accurate and timely billing, data quality and statistics, and calculation of severity of illness and risk of mortality reporting.
• Follows UHDDS definitions, CMS regulations, and Official and Internal Coding Guidelines.
• Utilizes information on diagnostic reports (i.e., radiology, pathology, EKG reports, laboratory values, doctors’ orders, and administrative medication forms) to accurately code patient charts in accordance with the Official Coding Guidelines.
• Completes daily work assignment as directed by Coding Support.
• Works within service line structure where applicable based on patient type.
• Serves as a mentor to newer coders in the Coder Position or coders who are being trained in a new coding discipline.
• Abstracts pertinent data, determines, and sequences codes for diagnoses and procedures, and enters all information into the coding and abstracting system.
• Utilizes coding and abstracting system as a communication tool, as outlined in the HIMS Coding DNFB Tagging procedures, including but not limited to placing accounts on hold in order to ask questions to management and initiate queries.
• Receives feedback and reviews charts with a member of the Coding Management Team for accurate code assignment.
• Provides all necessary coded and abstracted information required for final coding and billing of accounts within productivity expectations by work type in order to support department and organization goals for DNFB dollar amounts and bill hold days.
• Reviews prepopulated patient demographic information fed via HL7 from source system into coding system and makes necessary abstracted data changes in coding system as required for accurate posting to CCHS billing system.
• Utilizes coding system to calculate all inpatient encounters in both MS DRG and APR DRG groupers to support the accurate reporting of coded data for severity of illness and risk of mortality.
• Utilizes coding system to sequence CPT codes invoking the APC grouper methodology to arrive at the proper CPT code hierarchy.
• Submits timely, accurate, and concise daily productivity reports in accordance with department policy and practice.
• Attends and participates in coding section and department meetings, inservice training sessions, seminars and workshops.
• Reports errors as identified in patient identification, account or encounter information, documentation or other medical record discrepancies as they are noted during daily work performance.
• Supports the Coding Management team by working on special coding projects as assigned.
• Works with the HIMS Coding Systems Analyst under the direction of HIMS management to achieve the IT initiatives of the HIMS department. This may include systems testing and report reconciliation as needed in our coding and billing systems as well as other IT project support as deemed necessary by the coding management team.
• Works with the HIMS Coding Support Team under the direction of HIMS management to achieve the revenue cycle goals of the HIMS department. This may include working through aged coding accounts, accessing our billing system, and coding system reports and queues as deemed necessary by the coding management team.

Education and Experience Requirements:

• CCS credential required
• College Degree in Health Information Management, Completion of AHIMA Approved Certificate Program, or one-year coding experience in the acute care setting coding Inpatient, Observation, Emergency Medicine or Same Day Surgery is required.
• Associate or Bachelor Science degree in Health Information Technology preferred.
• An equivalent combination of education and experience may be substituted.

Christianacare Offers:

• Full Medical, Dental, Vision, Life Insurance, etc.
• 403(b) with company match.
• Generous paid time off.
• Incredible Work/Life benefits including annual membership to care.com, access to backup care services for dependents through Care@Work, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors for hotels, rental cars, theme parks, shows, sporting events, movie tickets and much more!

Medical Coder

Remote

Job Summary:

The CareBridge Medical Coder reviews all provider visit medical encounters for dual members and applies the most accurate diagnosis codes (ICD-10 codes). The Medical Coder serves as a resource and subject matter expert in the CMS Risk Adjustment Model. Additionally, the Medical Coder may identify missed opportunities to capture appropriate diagnosis codes.

Responsibilities:

• Runs a billing report in EMR for all providers to identify completed and signed notes
• Reviews all medical documentation for completed visit notes as well as patient profile information (problem list, medications, allergies, etc) in EMR for each member
• Assigns the appropriate ICD-10 code for each diagnosis
• Provides feedback to the provider on opportunities for improved documentation to support specific codes

Qualifications:

• Certification as a Medical Coder
• AAPC Certified Risk Adjustment Coder (CRC™) is preferred
• At least 2 years’ experience in applying appropriate diagnosis in the Medicare HCC model
• Expertise with the most current CMS Risk Adjustment Model

Those who thrive at CareBridge tend to possess these qualities:

• An entrepreneurial spirit. Must be a tenacious self-starter
• Flexible and adaptable to a constantly changing workload
• Must enjoy working in a fast-paced environment
• A sense of humor and a down-to-earth nature

Location: Remote

CareBridge is a provider of technology and services that assist payers and states in caring for patients receiving long-term support services. CareBridge’s services include electronic visit verification (EVV), data aggregation, 24/7-member support, and benefit management. CareBridge is led by a team of healthcare service and technology veterans and is headquartered in East Nashville.

Healthcare Customer Service Rep (Remote) | $15/hour

Job Location US

ID2024-4255

Category

Customer Service/Support

Position Type

Regular Full-Time

Overview

At Carenet, we foster collaboration, creativity and innovation. Our promises to our team members include empowering growth through trust, opportunity and accountability. We are looking for people who want to work with an entrepreneurial spirit and deliver market-leading performance!

If you are passionate about healthcare and supporting patients with their healthcare needs, empathetic, patient focused and enjoys interacting with patients, patient representatives, providers, pharmacies and more, then this may be the position for you.

$15.00/hour plus incentives!!

Responsibilities

Some of what you will be doing:

• Enjoy making outbound calls and reaching out to patients, members, and customers
• Strong sales aptitude, with the desire to earn a strong work ethic, highly motivated to achieve sales and productivity goals
• Demonstrate ability to explain/educate the benefits of In-Home Assessments and overcome objections to participate Have a passion for helping patients make decisions that will enhance their healthcare experience
• Ability to have Value Based Conversations including showing compassion, senior sensitivity, and ability to address member concerns
• Contacting members of various Medicare Advantage and Medicaid health plans by phone to offer, explain, and schedule a free in-home or virtual healthcare evaluation
• Adjust and reset appointments and schedules as required
• Ensures customer satisfaction by providing exceptional customer service, identifying customer needs, and assisting them with healthcare-related issues/concerns that are assessed through outreach programs
• Researches, identifies potential issues, and problem-solves
• The best part, you will be making a difference in someone’s life!

Why Carenet?

For more than 30 years, Carenet Health has pioneered advancements for an experience that touches all points across the healthcare consumer journey. In fact, we interact with 1 in 3 Americans every day, delivering positive healthcare experiences and improving outcomes. From best-in-class clinical expertise to personalized and automated solutions, we integrate the power of human touch with data-driven technology in our mission to make healthcare better for all.

By applying for this position, you understand and acknowledge the following: Our partnerships with our clients may require non-sensitive Personal Identifiable Information (Name, address, date of birth) to be shared for the purpose of system credentials and equipment. We have implemented strict security measures to keep your information confidential and secure.

Qualifications

We want you to be successful, so these are some of the qualifications required:

• High School Diploma or General Education Degree (GED) required
• Strong computer experience (data entry, screen navigation, keyboarding),
• Experience with Microsoft Outlook (email) and Word
• Excellent customer service skills
• Ability to adhere to daily schedules and duties
• Excellent oral and written communication skills
• Excellent demonstration of caring and compassion

Requisition number: 4255

Director of Coding

Remote

Become an Assembler! We are looking for a Director of Coding to join our Physician RCM Services ision. If you are looking for a company that is focused on being the best in the industry, love being challenged, and make a direct impact on our business, then look no further! We are adding to our motivated team that pride themselves on being client-focused, biased to action, improving together, and insistent on excellence and integrity.

This is a full-time, non-exempt position reporting to the Vice President, and General Manager of Physician RCM.

‍

What you’ll do

• Oversee the daily operations of the coding department including workload and staffing; hiring, disciplining, and performance appraisals; training; and monitoring quality of work.
• Develop long-range and short-term goals, objectives, plans, and programs and ensure they are implemented.
• Assist in planning, developing, and controlling the budget, including staffing costs, and operations of the coding unit.
• Evaluate the impact of innovations and changes in programs, policies, and procedures for the coding department. Design and implement systems and methods to improve data accessibility.
• Identify, assess, and resolve problems. Prepares administrative reports.
• Conduct and oversee coding audit efforts and coordinate monitoring of coding accuracy and documentation adequacy. Ensure timely submission of claims and communicate with account managers on escalations.
• Detect non-compliant issues through thorough auditing and monitoring processes. Outline the nature of corrective action plans to address these issues. Conduct follow-up audits to ensure compliance and report the outcomes. Present findings and corrective measures to the Directors and the Compliance Officer.
• Conduct trend analyses to identify patterns and variations in coding practices and case-mix-index.
• When necessary, review claim denials and rejections pertaining to coding and medical necessity issues and implement corrective action plans (such as educational programs) to prevent similar denials and rejections from recurring.
• Provide strategic leadership to enhance the effectiveness of the coding and compliance program, serving as a facilitator, liaison, and motivator to drive success.
• Stay updated on changes in coding regulations and implement necessary changes.
• Prepare and release weekly reporting on issues pending clinic review.
• Host training sessions with coding staff and AR staff.
• Serve as main point of contact for coding questions for management staff.
• Effectively present data, trends, and performance metrics to clients and internal Leadership as required.
• Other tasks and projects as needed and required.

What we’re looking for

• Knowledge and understanding of coding for multiple specialties including but not limited to Family Medicine, Internal Medicine, Pediatrics, Podiatry, Physical Therapy, Chiropractic, General Surgery, Orthopedic Surgery, Cardiology, Urgent Care, Pain Management, Neurosurgery, Neurology, Anesthesiology, ENT Surgery, Ophthalmology, Behavioral Health, Radiology, and Oncology etc.
• AAPC Certified (or equivalent with AHIMA)
• 5+ years of experience with professional fee coding/ambulatory care coding
• Proven executive/client presence; the ability to present to executive-level leaders is needed.
• Experience and background in Physician Professional Billing highly preferred.
• Candidates must have experience in supervising staff and overseeing workflow functions.
• Experience with Microsoft Office products such as Outlook, Word, and Excel are required.
• Some limited travel may be required.
• Qualified candidates must have a professional working environment in their home including phone and internet access.
• Ability to function well in a fast-paced and at times stressful environment.
• Prolonged periods of sitting at a desk and working at a computer. Ability to lift and carry items weighing up to 10pounds at times.

Why join the team?

• Be part of something special! We are growing both organically and through acquisitions.
• Career growth – your next role with Assembly might not be created yet and we are waiting for your help to chart the way!
• Ongoing training and development programs.
• An environment that values transparency
• Competitive Benefit Packages available, Paid Holidays, and Paid Time Off to enjoy your time away from the office.

Medical Coding Auditor

Remote Nationwide

Full time

job requisition id R-341796

Become a part of our caring community and help us put health first

The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor’s work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Where you Come In

The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor’s work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

As a Medical Coding Auditor for the Hospital Outpatient/APC Coding Team you will:

• Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered
• Review medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines specific to Ambulatory Payment Classification (APC) and Hospital Outpatient Facility coding

• Utilize encoders and various coding resources
• Perform CPT/HCPCS Procedure reviews
• Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed
• Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information
• Maintain current working knowledge of ICD-10 and CPT coding guidelines, government regulation and protocols
• Complete appropriate system(s) entry regarding claim/encounter information
• Support and participate in process and quality improvement initiatives

What Humana Offers

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

Use your skills to make an impact

Required Qualifications – What it takes to Succeed

• CPC, CCS, ROCC, RHIA, or RHIT Certification with a minimum of 3 years post-certification experience
• Minimum of 3 years post certification experience Outpatient Specialty Surgeries and Procedures
• Minimum of 3 years post certification experience reading and interpreting claims
• Strong knowledge of CPT/HCPS coding
• Experience reading & coding from operative reports
• Chemotherapy Infusion experience
• Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information
• Strong attention to detail, can work independently and determine appropriate course of action, & ability to handle multiple priorities
• Comfortable working in a production-based work environment
• Demonstrated ability to exercise solid judgement and discretion in handling and disseminating information
• Ability to work independently and manage work load
• Strong written and verbal communication skills; strong analytical, organizational and time management skills
• Working knowledge of Microsoft Office Programs (Word, Excel)

Preferred Qualifications

• Outpatient facility auditing experience
• Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology
• Ambulatory Payment Classification (APC) coding experience
• Radiation Oncology coding experience
• Experience in prospective payment methodologies
• Experience with the Claims Life Cycle including Accounts Receivable
• 3M Coder software experience
• Prior coding experience

Additional Information – How we Value You

• Benefits starting day 1 of employment
• Competitive 401k match
• Generous Paid Time Off accrual
• Tuition Reimbursement
• Parent Leave

Work at Home Requirements

• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Scheduled Weekly Hours 40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and inidual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$57,700 – $79,500 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or inidual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, iniduals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Title: SME Nurse

Location: Remote, USA

Type: Contract

Workplace: remote

Category: Sales

Job Description:

For more than 20 years, PointClickCare has been the backbone of senior care. We’ve amassed the richest senior care dataset making our market density untouchable and our connections to the healthcare ecosystem exponentially more powerful than those of any other platform.

With Collective Medical & Audacious Inquiry, we’ve become the most expansive, full-continuum care colaboration network, offering care teams immediate, point-of-care access to deep, real-time insights at every stage of a patient’s journey.

For more information on PointClickCare, please connect with us on Glassdoor and LinkedIn.

What you’ll be doing day to day:

Provide PointClickCare subject matter expertise as a clinician who has documented within the electronic medical record, understands nursing process and documentation guidelines.

Assist and complete labeling of clinical notes into defined categories for data input and standardized information gathering.

Provide feedback and clinical expertise on workflows within the electronic medical record and documentation requirements as an end-user.

Provide Clinical expertise to the Product organization to support the development of the new PCC offerings

Work with a team of subject matter experts, ensuring that each is consistently adding value to the team and garnering feedback about process and work expectations.

Serve as industry expert that can support industry insight to influence the specific process identified for work related needs with the assigned project Be able to research data sources and verify the validity of the information

Work with team to analyze, collect, and create testable electronic data for information systems

Collaborate and consult with others who utilize the data in the assigned projects to seek feedback and follow quality assurance guidelines

Complete the required training as defined by security, clinical director and HR.

Requirements

• Clinical background (LPN/LVN, RN, NP) – at least 5 years’ acute or LTPAC clinical experience, clinical software experience and predictive intelligence with an EHR preferred
• Clinical degree required; bachelor’s degree preferred with proof of clinical license verification
• Strong organizational and project management skills
• Must be a self-starter and work independently
• Must be a multitasker with excellent communication skills who is energized by working in a complex, dynamic, and fast-paced environment Experience in data labeling, supporting and servicing customers using a clinical software application is preferred Technical acumen or familiarity with the PointClickCare EHR is preferred but not required
• Passion for transforming healthcare Must have a working computer and internet and be willing to comply with technical requirements as outlined by our security and technical teams
• Specifics Include:
• Physical security requirements while working within the job, including a private space, a properly secured Wi-Fi connection, no shared access to the computer used for labeling
• Install the approved and assigned VPN and use a particular internet browser as defined by the project
• Possess strong proficiency in written and spoken English with professional communication skills and the ability to understand medical terminology Must be able to complete the required background check, contract period and follow HR policies while representing PCC and the period that follows based on policy.
• #LI-AV1
• #LI-remote

This is a contract role ending 10/31/2024

It is the policy of PointClickCare to ensure equal employment opportunity without discrimination or harassment on the basis of race, religion, national origin, status, age, sex, sexual orientation, gender identity or expression, marital or domestic/civil partnership status, disability, veteran status, genetic information, or any other basis protected by law. PointClickCare welcomes and encourages applications from people with disabilities. Accommodations are available upon request for candidates taking part in all aspects of the selection process. Please contact [email protected] should you require any accommodations.

When you apply for a position, your information is processed and stored with Lever, in accordance with Lever’s Privacy Policy. We use this information to evaluate your candidacy for the posted position. We also store this information, and may use it in relation to future positions to which you apply, or which we believe may be relevant to you given your background. When we have no ongoing legitimate business need to process your information, we will either delete or anonymize it. If you have any questions about how PointClickCare uses or processes your information, or if you would like to ask to access, correct, or delete your information, please contact PointClickCare’s human resources team: [email protected]

PointClickCare is committed to Information Security. By applying to this position, if hired, you commit to following our information security policies and procedures and making every effort to secure confidential and/or sensitive information.

Title: Nurse, Health Screener— Peoria, IL

Category Per Diem and On Call

Location Peoria, Illinois

Job function Operations

Job family Per Diem Examiner

Shift Day

Employee type On Call

Work mode Remote

Job Description:

The primary responsibility of the Health Screener is to provide coverage in the field ensuring that health screenings are completed accurately and on time.Maintain a safe and professional environment for clients and employees; perform with confidence all aspects of a health screening, including specimen collection and processing duties following established practices and procedures.

This is an independent contractor (1099) position with the possibility of converting to a W2 per diem employee after meeting certain criteria.

• Perform biometric screening at client sites including finger stick blood collection, BMI, Blood Pressure and other health screening services based on service package
• Performs basic waived testing technical procedures on blood samples and completes required quality control.
• Provide exceptional customer service at all health screenings.
• Maintains accurate, complete, and legible records.
• Participates in training/retraining and continuing education programs as necessary.
• Complies with all designated safety policies and procedures in the work area, including the use of applicable protective equipment when necessary to prevent exposure to potentially infectious agents.
• Understands and complies with applicable federal, state and local laws. Adheres to quality assurance procedures and good manufacturing practices.
• Maintain all HIPAA and OSHA standards while on events.
• Performs other related duties as necessary.

QUALIFICATIONS

Required Work Experience:

N/A

Preferred Work Experience:

At least 1 year of healthcare experience in a professional setting preferred.

Physical and Mental Requirements:

• Lift light to moderately heavy objects. The normal performance of duties may require lifting and carrying objects. Objects in the weight range of 1 to 15 pounds are lifted and carried frequently; objects in the weight range of 16 to 40 pounds may be lifted and carried occasionally. Objects exceeding 41 pounds are not to be lifted or carried without assistance
• Requires use of phone and PC
• Fine dexterity with hands/steadiness
• Handling stress & emotions
• Concentrating on tasks
• Making decisions
• Adjusting to change
• Examining/observing details
• Sitting or standing for long periods at a time
• Position requires travel

Knowledge:

Must be knowledgeable of required regulations and comply with them

Skills:

• Proficient with finger sticks and manual blood pressure.
• Ability to understand and perform complex procedures and techniques and work with complex instrumentation (Cholestech and/ or Cardio Check experience preferred).
• Skills required for proper specimen and reagent handling, labeling, processing, preparation, transportation, and storage necessary.
• Excellent customer service internally and externally
• Possess good written and verbal communication skills
• Ability to read, understand and follow detailed procedures
• Basic computer skills necessary including access to internet / email
• Strong communication skills both written and verbal
• Proficient in Microsoft Office Suite, specifically Word, Outlook, and Excel

EDUCATION

Some College Courses(Required)

LICENSECERTIFICATIONS

Meet state licensure requirements, if applicable. (Required)

Bilingual Family Nurse Practitioner (CA Licensed, Spanish Speaking)

Remote, United States

About the Opportunity

Pair Team is building a team of deeply passionate iniduals ready to change primary care operations for those who need it most. We are looking for a highly motivated full-time Bilingual Family Nurse Practitioner who is willing to think creatively and empathically to help our team change the way people access healthcare.

We are excited to partner with Federally Qualified, Non-Profit Health Centers in California to enable their participation in CalAIM’s new Enhanced Care Management Medi-Cal benefit program, which provides long-term, whole-person care coordination, inclusive of behavioral health and social needs supports.

We seek a full-time Bilingual Family Nurse Practitioner to play a critical role in our whole-person, interdisciplinary care model. This person would be responsible for directly engaging and caring for iniduals living with Serious Mental Illness/ Substance Use Disorder, experiencing homelessness, and/or those who have high medical needs. We believe in the power of trust and relationships to successfully engage those who may have never received the kind of whole-health care that Pair Team can provide. Focused on building relationships with and providing support to iniduals whose quality of life can be improved with the Enhanced Care Management benefit, the Lead Care Manager has lived experience working with these populations, is an empathetic problem-solver, and works closely with our partner clinics, community organizations, and Pair Team’s Lead Care Managers and Clinical Team.

You’re excited about this opportunity because you will…

• Provide best-in-class virtual preventive care for underserved patients using our internal care delivery technology and your excellent clinical judgment
• Develop and refine clinical programs to support our patients holistically and address barriers / gaps in their care
• Work with our product team and provide feedback to improve our platform for our growing care team
• Collaborate and grow with a erse and inclusive team
• Work from home with laptop and workstation provided
• Be part of a high-energy, growth-oriented and erse team
• Facilitate Systematic Case Reviews with our care management and clinical teams

What You’ll Need

• 2+ years of clinical experience in serving patients with complex social and healthcare needs and passionate about building a more equitable healthcare system
• 1+ year of clinical Case Management experience
• Experience and desire to work closely with a multidisciplinary team
• Technology-savvy and experienced in digital-first healthcare (e.g. telemedicine) and comfortable working in a variety of different tech platforms
• Board certification or eligibility in Family Medicine
• Comfortable and able to work with patients across the lifespan, from pediatrics to geriatrics
• Experience working with and in Medicaid/FQHC clinics that are often underfunded / underserved
• Bilingual, Spanish and English speaking
• NP license in CA
• Active DEA license
• Startup experience is a plus!

Because We Value You:

• Competitive salary: $115,000 – $125,000 (depending on experience)
• Comprehensive health, vision & dental insurance
• 401k and Equity compensation package
• 100% Remote – Monthly $100 work from home expense stipend
• Flexible vacation policy – take the time you need to recharge

Title: OP Coding Edit Auditor – Remote

Location: Frisco United States

Facility: Conifer Revenue Cycle Solutions

JOB SUMMARY

Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment is in compliance with the official coding guidelines as supported by clinical documentation in health record. Validates abstracted data elements that are integral to appropriate payment methodology.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Consulting: Consults facility leaders and staff on best practices, methodology, and tools for accurately coding.
• Chart Analysis IP, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or MS-DRG assignment. Adheres to Standards of Ethical Coding (AHIMA).Reviews medical records to determine accurate required abstracting elements (facility/client/payer specific elements) including appropriate discharge disposition
• IP, OP Coding: Reviews medical records for the determination of accurate assignment of all documented ICD-9-CM codes for diagnoses and procedures. Abstracts accurate required data elements (facility/client specific elements) including appropriate discharge disposition.
• Coding: Uses discretion and specialized coding training and experience to accurately assign ICD-9, CPT-4 codes to patient medical records.
• Abstracting: Reviews medical records to determine accurate required abstracting elements (client specific elements) including appropriate discharge disposition.
• Coding Quality: Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC & CC) and procedures. Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by SOW.
• CDI: Identifies and communicates documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.) to appropriate personnel for follow-up and resolution.
• Professional Development: Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-9-CM and CPT coding. Attends mandatory coding seminars on annual basis (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient and outpatient coding. Quarterly review of AHA Coding Clinic. Attends Quarterly Coding Updates and all coding conference calls

KNOWLEDGE, SKILLS, ABILITIES

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

• Ability to consistently code at 95% accuracy and quality while maintaining client specified production standards
• Must successfully pass coding test
• Knowledge of medical terminology, ICD-9-CM and CPT-4 codes
• Must be detail oriented and have the ability to work independently
• Computer knowledge of MS Office
• Must display excellent interpersonal skills
• The coder should demonstrate initiative and discipline in time management and assignment completion
• The coder must be able to work in a virtual setting under minimal supervision
• Intermediate knowledge of disease pathophysiology and drug utilization
• Intermediate knowledge of MSDRG classification and reimbursement structures
• Intermediate knowledge of APC, OCE, NCCI classification and reimbursement structures

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

EDUCATION / EXPERIENCE

• Associates degree in relevant field preferred or combination of equivalent of education and experience
• Three years coding experience including hospital and consulting background

CERTIFICATES, LICENSES, REGISTRATIONS

• AHIMA Credentials, and or AAPC

PHYSICAL DEMANDS

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

• Duties may require bending, twisting and lifting of materials up to 25 lbs.
• Duties may require driving an automobile to off- site locations.
• Duties may require travel via, plane, care, train, bus, and taxi-cab.
• Ability to sit for extended periods of time.
• Must be able to efficiently use computer keyboard and mouse to perform coding assignments.

WORK ENVIRONMENT

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

• Floats between clients as requested.
• Capacity to work independently in a virtual office setting or at hospital setting if required to travel for assignment.

OTHER

• Regular travel may be required

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

Compensation and Benefit Information

Compensation

• Pay: $30.85-$46.28 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.
• Conifer observed holidays receive time and a half.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 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, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

Physician Practice Coding Specialist Remote, Cardiology Support Services, FT, 08A-4:30P-143930

Job Description – Physician Practice Coding Specialist Remote, Cardiology Support Services, FT, 08A-4:30P (143930)

Baptist Health South Florida is the region’s largest not-for-profit healthcare organization with 12 hospitals, more than 27,000 employees, 4,000 physicians, and 200 outpatient centers, urgent care facilities, and physician practices spanning across Miami-Dade, Monroe, Broward, and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. Baptist Health is supported by philanthropy and committed to its faith-based charitable mission of medical excellence.

Our mission, vision, and values make us who we are at Baptist Health and are at the center of everything we do. At Baptist Health, we positively impact the human experience for patients, employees, and physicians. Our success comes from a culture of quality and dedication that is instilled into every member of the Baptist Health family.

This year, and for 24 years, we’ve been named one of Fortune’s 100 Best Companies to Work For, based on employee feedback. We’ve also been recognized as one of America’s Most Innovative Companies and People Magazine included us in 50 Companies That Care. Based on the U.S. News & World Report 2023-2024 Best Hospital Rankings, Baptist Health is the most awarded healthcare system in South Florida, with its hospitals and institutes earning 45 high-performing honors.

But really, the reason we’re excited to come to work is the people.

Working together, we form personal connections with our colleagues that are stronger than most of us have experienced at other jobs. We develop caring relationships with our patients and their families that go beyond just delivering healthcare. After all, we know what it’s like to be in their shoes. Many of us have been patients here and have had family members as patients here. We’re committed to delivering quality care in the most compassionate way possible because we feel a personal stake in the outcomes. When it comes to caring for people, we’re all in.

Description

The Coding Specialist is responsible for the assignment of appropriate ICD-10-CM/CPT/HCPCS/ Level I & II modifiers) codes to services, diagnosis and procedures to obtain accurate timely and accurate production for proper reimbursement and data collection through evaluating and interpreting medical record documentation. Adheres to official coding guidelines and regulations, AMA, CMS and National Correct Coding Initiatives (NCCI). Collaborates with Coding Education team for identified trends and provider educational coding opportunities. Ensure timely charge review/processing of daily submissions. Routinely monitoring annual coding and regulation changes. Communicate to clinical providers all discrepancies in coding based on the medical record reviewed and provides feedback related to documentation issues and/or revenue opportunities. Review coding claim denials from Revenue Management for coding resolutions. Participates in audit, education and coding team meetings to discuss solutions to coding guidance. Meet or exceed required departmental expectations on a consistent basis. Performs a variety of other Coding Compliance duties as needed. Presents a positive, professional appearance and conveys a professional demeanor in the performance of assigned duties. Estimated pay range for this position is $22.87 – $29.73 / hour depending on experience.

Qualifications

High School Diploma, Certificate of Attendance, Certificate of Completion, GED or equivalent training or experience required.

Licenses & Certifications: AAPC Certified Professional Coder AHIMA Certified Coding Specialist AHIMA Certified Coding Specialist-Physician-based Additional Qualifications: Certified Professional Coder (CPC), Certified Coding Specialist or Physician (CCS-P) designation required with current active status. Required completion of an accredited certified coding specialist program. Minimum of one (1) to two (2) years coding experience in a physician practice setting. Must pass pre-employment coding assessment test with before hire. Proficient in ICD-10CM/PCS, HCPCS/CPT coding conventions and guidelines, National and Local Coverage Determinations. Ability to define problems, collect data, establish facts, and draw valid conclusions. Comprehensive knowledge of coding guidelines in collaboration with federal and national regulations (CMS, AHIMA, NCCI etc.). Attention to detail and completeness with a thorough understanding of government rules and regulations, medical coding and reimbursement guidelines. Ability to identify/trend/summarize potential compliance, coding, billing concerns and bring forth a potential resolution. Competency in computer applications. Ability to function independently and as a team player in a fast-paced environment required. Ability to communicate effectively with physicians and co-workers.

Minimum Required Experience: 2 years

Job

Coding

Primary Location

Remote

Organization

Baptist Health Medical Group

Schedule

Full-time

Unposting Date

Ongoing

EOE

Title: Senior Clinical Data Manager/Principal Clinical Data Manager

Location: Remote, United States

Job Description:

*This position is 100% remote, but the preference is to have someone on the east coast*

Position Summary:

The Senior Clinical Data Manager/Principal Clinical Data Manager is responsible and manages all aspects of the clinical trial data management process from study start up to post database lock for assigned projects. Standard Operating Procedures / Work Instructions (SOPs/WIs); regulatory directives; study specific plans and guidelines will be followed. This position will also oversee and/or perform database development and testing.

Essential functions of the job include but are not limited to:

• • Primary Data Management (DM) contact (Lead DM role) for assigned clinical project(s) / program(s), ensuring that there is back-up, continuity, responsiveness, and that tasks are performed in a timely manner. May support another Lead DM as a back-up and/or team member. May include DM oversight of sponsor programs.

• • Oversee project data entry process including development of data entry guidelines, training, data entry quality and resourcing

• • May perform quality control of data entry

• • Provide input, assesses and manage timelines. Ensure that clinical data management deadlines are met with quality. Assess resource needs for assigned projects, as needed.

• • Develop CRF specifications from the clinical study protocol and coordinate the review/feedback from all stakeholders

• • May assist in building clinical databases

• • Conduct database build UAT and maintain quality controlled database build documentation. Oversee overall quality of the clinical database.

• • May specify requirements for all edit check types e.g. electronic, manual data review, edit checks, etc. Oversee development of the edit check specifications and manual data review specifications

• • Responsible for creating, revising, appropriate versioning and maintaining data management documentation. Oversee completeness of data management documentation for the Trial Master File.

• • Train clinical research personnel on the study specific CRF, EDC, and other project related items as needed.

• • Review and query clinical trial data according to the Data Management Plan

• • Perform line listing data review based on the guidance provided by the sponsor and/or Lead DM

• • Run patient and study level status and metric reporting

• • Perform medical coding of medical terms relative to each other in order to ensure medical logic and consistency

• • Coordinate SAE/AE reconciliation

• • Liaises with third-party vendors such as external data and EDC vendors in a project-manager capacity in support of timelines and data-related deliverables

• • May assist with SAS programming and quality control of SAS programs used in the Data Management department

• • Identify and troubleshoot operational problems, issues, obstacles, and barriers for studies based on metrics data, audit reports, and input from project team members and other stakeholders

• • May assist in reviewing and providing feedback on protocols, Statistical Analysis Plans (SAP) and Clinical Study Reports (CSRs), if required by the project

• • Participate in the development and maintenance of Standard Operating Procedures (SOPs) and corresponding process documentation related to data management and database management activities

• • May attend strategy meetings, bid defense prep meetings, bid defenses, capability presentations, potential client engagement meetings

• • May review Request for Proposals (RFP), proposals, provide project estimates

• • Provide leadership for cross-functional and organization-wide initiatives, where applicable

• • Trains and ensures that all data management project team members have been sufficiently trained

• • Communicate with study sponsors, vendors and project teams as needed regarding data, database or other relevant project issues

• • May present software demonstrations/trainings, department/company training sessions, present at project meetings

• • May require some travel

• • Perform other duties as assigned

Qualifications:

Minimum Required:

• • Bachelors and/or a combination of related experience

Other Required:

• • 8+ years’ experience for a Sr. Clinical Data Manager and 10+ years for a Principal Clinical Data Manager

• • Proficiency in Microsoft Office: Word, Excel, PowerPoint, Outlook

• • Able to handle a variety of clinical research tasks

• • Excellent organizational and communication skills

• • Professional use of the English language; both written and oral

• • Experience in utilizing various clinical database management systems

• • Broad knowledge of drug, device and/or biologic development and effective data management practices

• • Strong representational skills, ability to communicate effectively orally and in writing

• • Strong leadership and interpersonal skills

• • Ability to undertake occasional travel

Preferred:

• • Experience in a clinical, scientific or healthcare discipline

• • Dictionary medical coding (MedDRA and WHODrug)

• • Understanding of CDISC standards (CDASH, SDTM, ADaM, etc..)

• • Oncology and/or Orphan Drug therapeutic experience

Precision is required by law in some states or cities to include a reasonable estimate of the compensation range for this role. This compensation range takes into account the wide range of factors that are considered in making compensation decisions including but not limited to: skill sets, experience and training, licensure and certifications, and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Precision, it is not typical for an inidual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. This role is also eligible for a discretionary annual bonus, health insurance, retirement savings benefits, life insurance and disability benefits, parental leave, and paid time off for sick leave and vacation, among other benefits.

Reasonable estimate of the current range $113,000—$180,000 USD

Any data provided as a part of this application will be stored in accordance with our Privacy Policy. For CA applicants, please also refer to our CA Privacy Notice.

Precision Medicine Group is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status or other characteristics protected by law. 2020 Precision Medicine Group, LLC

If you are an inidual with a disability and require a reasonable accommodation to complete any part of the application process or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact Precision Medicine Group at [email protected].

It has come to our attention that some iniduals or organizations are reaching out to job seekers and posing as potential employers presenting enticing employment offers. We want to emphasize that these offers are not associated with our company and may be fraudulent in nature. Please note that our organization will not extend a job offer without prior communication with our recruiting team, hiring managers and a formal interview process.

Surgical Coding Educator, CPC

• Remote, USA, United States
• temprop=”jobLocation” itemscope=”” itemtype=”http://schema.org/Place”>Employees can work remotely
• temprop=”employmentType”>Full-time
• Department: 953 – Virtual Products – Scribe and Coder

Company Description

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

Job Description

The Coding Educator will be accountable for provider satisfaction related to CODER+ services provided by Privia Health. The Educator will serve as an integral member of the CODER+ program team, responsible for partnering with providers and staff to ensure smooth delivery of CODER+ surgical services and to maintain provider satisfaction. This person will collaborate with the Providers, CODER+ Program Manager and Clinic Managers as needed to resolve any CODER+ issues that may arise. The ideal candidate will draw on existing expertise in surgical specialty medical coding, provider education, billing and compliance with government and commercial payers and act as a coding resource for Providers to reach out to. The ideal candidate is a self-starter, comfortable with managing multiple priorities, and a creative problem solver.

This role requires 20% travel

Primary Job Duties:

• Serve as a surgical coding resource for providers and clinic staff when they have questions.
• Proactively reach out to providers and develop positive working relationships to ensure their coding needs are met.
• Conduct provider and clinic staff documentation education as needed.
• Research and answer coding and coding workflow related questions for providers and clinic staff.
• Possess a working knowledge of the EMR and Billing Platform and assist providers and staff as needed.
• Coordinate with internal Privia teams including CODER+, Compliance, and Risk Adjustment to answer questions.
• Collaborate with providers
• Manage all escalations through resolution.
• Follow coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies.

Qualifications

• 5+ years of provider medical coding experience across medical and surgical specialties
• 3+ years of provider auditing experience across medical and surgical specialties
• Active and in good standing AAPC Certified Professional Coder (CPC) certification required
• Active and in good standing AAPC Certified Professional Medical Auditor (CPMA) certification preferred
• Experience working in a physician practice setting strongly preferred
• Ability to work effectively with physicians, advanced practice providers (APP), practice staff, health plan/other external parties and Privia multidisciplinary team
• Ability to travel to multiple locations nationwide to meet with providers.
• Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
• Must comply with HIPAA rules and regulations

Interpersonal Skills and Attributes:

• Able to have honest, difficult conversations with providers and office managers
• Passion for efficiency and a drive to reduce redundancy and waste
• Ability to work in a fast-paced environment with all levels of management
• Able to work through periods of ambiguity
• Strategic and tactical; able to help scale operations for growth
• Clear and concise oral and written communication
• Knack for prioritizing efficiently and multi-tasking
• Self-directed with the ability to take initiative
• Competent in maintaining confidential information
• Enthusiastic with the ability to thrive in an atmosphere of constant change
• Strong team player with ability to manage up members of team to encourage partnership and cooperation with clinic staff

The salary range for this role is $72,000.00-$80,000.00 in base pay and exclusive of any bonuses or benefits. This role is also eligible for an annual bonus targeted at 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Title: Coding Manager Profee/FHQC

Location: Remote, USA

Job Description:

As our Profee/FQHC Coding Manager you will supervise multiple teams of remote-based and on-site medical coding associates. Every day you are responsible for managing their performance, productivity and quality. In addition to the managerial responsibilities, the Site Coding Manager works directly with R1’s customers to communicate coding performance, collaboratively identify and solve problems, assist in managing projects and help to deliver on financial and operational commitments related to coding. To thrive in this role, you must have proficiency in professional coding, strong leadership skills, and excellent interpersonal and teamwork attributes.

Your day-to-day role will include:

• Ensures managed coders meet or exceed productivity standards (measured in charts per hour and downtime) and quality standards.
• Supervises and directs daily coder work schedules and work assignments.
• Assists with assessment, training and onboarding of new-hires; creates 30/60/90 day ramp-up plans for new associates.
• Creates and manages inidual growth and development plans for coders related to quality, productivity and employee development.
• Provides training as needed on reimbursement and trending issues in particular service line areas
• Administers annual (or more frequent as needed) evaluations of coder performance and competence.
• Plans, assigns and directs coding workflow to exceed system-wide targets and consistently maintains a zero-backlog
• Assists various process improvement projects associated with coding and other reimbursement activity workflows.
• Identifies and solves moderate to complex problems related to coding and other reimbursement activity workflows.
• Optimizes staffing efficiency by minimizing production downtime and slowness to meet specific cost targets.
• Implements findings from Regional Coding Manager to meet or exceed team coding quality standards.
• Identifies, tracks and reports key barriers and process defects to the customer and leadership teams on weekly basis.
• Reviews and obtains medical records and other documentation to verify accuracy and completeness to assist in payment for services

You Have:

• CCS-P or CPC required
• FQHC Coding experience
• Professional Fee Coding Experience

For this US-based position, the base pay range is $45,409.55 – $87,948.00 per year . Inidual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.

R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.

Sr. Clinical Coding Quality Auditor

locations

Remote

Full time

Position: Senior Clinical Coding Quality Auditor

Department: FPF Prof. Billing Office

Schedule: Full Time

POSITION SUMMARY:

The Senior Clinical Coding Quality Auditor conducts independent audits of Emergency/Observation and Outpatient professional fee services. Assures appropriate and accurate coding assignments in accordance with federal coding regulations and guidelines. Prepares written reports of findings and leads meetings with providers to review the audit findings and recommend ways to improve when indicated. Also responsible for providing assistance with coding inquiries from providers, coding, staff, etc. This position requires knowledge of applicable regulations for Medicaid and Medicare, as well as the principles of physician documentation, coding, and billing in a variety of settings and specialties. Also required is advanced knowledge of CPT, ICD-10-CM, and HCPCS coding systems. Responsibilities also include providing ICD-10-CM and EMR documentation training to physicians.

JOB REQUIREMENTS

EDUCATION:

Associates Degree (or direct work experience equivalent to at least 2 years)

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Certification may include CPC, COC, COC-A, CIC, CCA, CPC-A, CCS, CCS-P, RHIT, or RHIA

EXPERIENCE:

Minimum of 2 years experience conducting high complexity Emergency, Observation and Outpatient coding/auditing to include compliance, and billing processes.

KNOWLEDGE AND SKILLS:

• Advanced Proficiency in ICD-10, CPT, HCPCS, and modifiers for coding of professional fee services.
• Advanced knowledge of anatomy and physiology, medical terminology and insurance reimbursement policies and regulations.
• Excellent written and verbal communication skills and the ability to prioritize and organize work to meet strict deadlines are required.
• Able to code moderate/high complexity work.
• Understands, retains, and is able to research coding billing rules, regulations, and requirements.
• Able to critically think through processes in coding to recognize errors and/or problems. Understands reasons for actions on edits.
• Able to share/transfer knowledge or train co-workers, peers, billing managers on coding – Able to provide education with physicians in small group or one-on-one sessions as needed or requested.
• Able to provide feedback to billing managers, physicians, staff, and others independently with occasional guidance from manager.
• Able to provide cross-coverage of multiple specialties.
• Able to perform peer to peer quality assurance reviews in equal or lower complexity areas of expertise.
• Proficient with computer applications (MS Office etc.), Excellent data entry skills
• Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Performs Pro Fee and Outpatient Coding/charging Audits
• Independently conduct reviews/audits on the adequacy of medical record documentation to support the codes selected by clinicians, coders and coding vendors in accordance with professional standards, organizational policies and procedures, laws, and regulations.
• Creates and communicates clear and accurate audit findings to physicians, departments and vendors which include references for authoritative guidance.
• Performs research related to compliance and coding issues.
• Schedules meetings with Stakeholders.
• Ensure compliance with coding guidelines
• Assist in creating and updating coding reference materials and presentations as needed.
• Pursues education and training opportunities to assure compliance with current laws, rules and regulations by participating in professional education activities and obtaining and maintaining relevant certifications.
• Communicate with Management regarding trends, issues or assistance needed.
• Maintains an accurate record of time spent on all assignments.
• Maintain coding certification.
• Sequences diagnoses, procedures and complications by following ICD-10-CM, Medicare, Medicaid, and other fiscal intermediary guidelines.
• Maintains productivity standards set forth in Departmental Policies and procedures.
• Review and respond to coding questions.
• Ensure billed service is being accurately coded.
• Performs other duties as needed. IND123

Must adhere to all of BMC’s RESPECT behavioral standards.

Title: Nurse Practitioner

Location: CA-Long Beach

Job Description:

We are seeking a highly skilled and compassionate Telehealth Nurse Practitioner to join our health team in Long Beach, CA!

Typical hours 8/9a-4p

This is a Remote Role primarily. Up to $120,000/annually based on experience!

Education:

• Certified and registered as a nurse practitioner (NP) by the State Education Department to practice as an NP in CA. • Must have Medicare license numbers and State Medicaid license numbers. • Board certification: AANP or ANCC REQUIRED

Job Responsibilities

• In this role, you will conduct patient assessments via telehealth, order medically necessary diagnostics, and perform patient follow-ups • Conduct virtual consultations to assess healthcare needs, provide diagnoses, and develop treatment plans • Collaborate with a multidisciplinary team of healthcare professionals to ensure comprehensive care coordination • Maintain accurate and up-to-date patient records in accordance with regulatory standards and company policies • Provide education and support to patients regarding their health conditions, medications, and self-care strategies

Benefits:

Medical, Dental, Vision, 401k. plus more.

Pay Details: $100,000.00 to $120,000.00 per year

Equal Opportunity Employer/Veterans/Disabled

To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.adecco.com/en-us/candidate-privacy

The Company will consider qualified applicants with arrest and conviction records subject to federal contractor requirements and/or security clearance requirements.

Title: Bilingual Registered Nurse (Remote)

Location: Remote

Job Description:

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these iniduals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center.

Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others’ needs ahead of her own, keeping the hearth warm so the home and family can function.

We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta Healthcare comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. It’s an insurance covered benefit, so it’s available to most adults with Caregivers free of charge to them.

The ideal candidate would be able to:

• Plan and conduct intervention opportunity evaluations, respond to urgent alerts and remote patient monitoring alerts as needed to help drive high quality care at a lower cost
• Have the ability and skill to recognize clinical scenarios that require escalation to the internal team nurse practitioner
• Work directly with the member, via various forms of communication, texting, virtual visits, and telephone, to develop and achieve patient centered chronic care management goals
• Develop and update care plans for members while keeping a close eye on caregiver and/or family support
• Apply clinical experience and judgment to the utilization management/care management activities
• Be responsible for day to day work with patients related to interventions needed for quality outcomes to reduce avoidable admissions, readmissions and ED utilization.
• Collaborate with engagement and product teams to promote quality outcomes, optimize service experience, and promote effective use of resources for complex or elevated medical issues

Would you describe yourself as someone who has:

• Current RN license in New York and Compact or Massachusetts (required)
• Fluency in English and Spanish in writing, reading, and speaking (preferred)
• Graduated from an accredited nursing program (required)
• At least 2 years of nursing experience providing care to adult and geriatric patient populations (required)
• Confidence with clinical skills and knowledge of chronic conditions (required)
• The ability to work remotely and has a private area in their home/workspace (required)
• A genuine, compassionate desire to serve others and help those in need
• High speed home WiFi/data connection to support company provided IT equipment

In addition to amazing teammates, we also offer:

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

Pay range is $85,000 -$101,000 per year based on experience and location. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level.)

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

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

Title: Registered Nurse

Location: Remote

Job Description:

The Role

KMG in partnership with Thirty Madison is on a mission to change the way healthcare is delivered. We expand access to specialist-level healthcare through a simple and transparent experience. Our integrated platform — combining specialized telemedicine, highly personalized treatment plans, and ongoing care management — ensures better outcomes for our patients across a breadth of chronic conditions and needs. We are building a core clinical team driven by our mission to put the healthcare system back to work for patients and are looking for registered nurses eager to be at the forefront of a new model of care delivery and ready to push the envelope of telemedicine care just a little bit.

In this role, you will work closely with our providers and patients through many stages of their Thirty Madison journey. The role is both patient and provider-facing, from helping patients receive medical records, to assisting providers in coordinating treatment plans. You’ll partner with and support the Customer Experience team, our medical network, and patients across all of our brands. You must be comfortable speaking with others across various channels (primarily email/message) compassionately and professionally.

Patients are ready for healthcare delivery that matches the innovation and accessibility they’ve come to expect from other service sectors, and Thirty Madison is putting that capability in their hands. Above all, you embody the Thirty Madison mission of providing access to healthcare for all who suffer from chronic conditions.

Comp | Perks | Benefits

• The base pay range for this position is: $42.30 per hour**
• Annual Incentive Plan
• Generous PTO
• Robust and affordable Health, Dental, and Vision plan options
• 401k with match
• $750 vacation stipend and $500 happiness stipend per year
• Paid vacation, holidays and sick pay

**Base pay offered may vary depending on job-related knowledge, skills, experience and in some cases licensure. An annual incentive plan and stock options differentials may be provided as part of the compensation package, in addition to a full range of medical, financial, and/or other benefits, dependent on the position offered.

What you bring to the role

• Review medical history with patients in preparation for prescriber review
• Provide patient counseling on the use, safety, and side effects of medications prescribed through our platform

Other responsibilities will include:

• Counseling and treatment disposition for patients
• Complete and submit required public health reporting
• Collaborates in establishing the plan of care, coordinates and implements care delivery while anticipating patient care needs across the continuum of our platform
• Analyzes comprehensive information pertinent to the patient’s care and management to determine nursing diagnosis
• Continually utilizes the nursing process to evaluate a patient’s progress towards goals and applies appropriate interventions to ensure effective outcomes
• The registered nurse may also contribute to other areas of the business related to clinical care, such as development of counseling resources for patients, process improvement, and audits of clinical quality and operations
• Attending weekly RN meetings; Staying up to date with process improvement or workflow change implementations
• Other duties as assigned

Minimum Qualifications

• Registered Nurse in good standing with a compact license; compact license a must
• Primary care experience preferred
• Must be able to work at least one (1) weekend shift
• Additional non-compact/inidual state license(s) a plus
• Must be willing and eligible to apply for licensure in all 50 states
• Comfort in counseling on side effect management, drug interactions, adverse events, medication-specific guidelines for the different conditions and treatments that we currently offer, and any conditions we expand into (ex. Birth control, STI, UTI, migraine, dermatology, mental health)
• Exceptional written and verbal communication skills – Spanish speaking a plus
• Availability to train during scheduled orientation period
• Regular and reliable attendance
• Adherence to the assigned work schedule

You may be a great fit if you are

• Enthusiastic about providing unparalleled patient experience through the delivery of prompt and empathetic care to our patients driven by a culture of excellence.
• Self-motivated and thrive in environments that offer a high degree of autonomy
• Skilled at using online tools and technology to deliver care and communicate with patients

WFH/IT Requirements:

• Reliable at home internet with a download speed of at least 25 Mbps and an upload speed of at least 5 Mbps
• A quiet place in your home to receive inbound and place outbound calls

Physical Requirements:

• Manual dexterity, arm and upper body range of motion sufficient for use of a keyboard, mouse and telephone 7-8 hours per day
• Speech and hearing sufficient for in-person communication 7-8 hours per day
• Vision sufficient for use of a computer monitor
• Ability to sit or stand at a desk for 7-8 hours per day

All Company policies and procedures are subject to change without notice based on business needs. This includes, but is not limited to, the locations where we hire remote, hybrid, or onsite employees.

U.S. Applicants Only

Don’t meet every single requirement? Studies have shown that women and people of color are less likely to apply to jobs unless they meet every single qualification. At Thirty Madison we are dedicated to building a erse, inclusive and authentic workplace, so if you’re excited about this role but your past experience doesn’t align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.

We are proud to be an equal opportunity workplace committed to building a team culture that celebrates ersity and inclusion.

We will ensure that iniduals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions. Contact us at [email protected] to request accommodation.

About Thirty Madison

Thirty Madison is a family of specialized healthcare brands devoted to creating exceptional outcomes for all. Each of its specialized brands is focused on a specific ongoing condition, and thoughtfully designed to support the unique needs of its community with personalized treatments and care; with Keeps for men’s hair loss, Cove for migraine, Facet for skin conditions, and NURX for sexual health. With empathy at the heart of its innovation, its proprietary care model empowers hundreds of thousands of people with ongoing conditions with the accessible, effective treatments across a lifetime of care. In just four years, we’ve built a number of brands and are continuing to grow rapidly, recently raised a $140m Series C, and are backed by some of the best healthcare and consumer investors, including HealthQuest Capital, Mousse Partners, Bracket Capital, Polaris Partners, Johnson & Johnson, Maveron, Northzone, among others.

We are honored to become Great Place to Work certified and be included on BuiltIn’s 2021 list of Best Places To Work in New York City, and Best Midsize Companies To Work For. We’ve also been recognized by Forbes’ Best Startup Employers, being named as one of America’s Best Places to Work 2022. This recognition is a true testament to our hardworking team and company culture. As we continue to grow, we pride ourselves on finding passionate iniduals who truly embody our core values and mission each and every day. Learn more at ThirtyMadison.com.

*This employer participates in E-Verify and will provide the federal government with your I-9 Form information to confirm that you are authorized to work in the U.S.*

*Please be aware that there are fraudulent entities who are falsely claiming to be or represent Thirty Madison in order to solicit sensitive personal information or payment. Thirty Madison is not in any way associated with these entities or practices. The safety and integrity of those seeking employment with us is of the utmost importance and we actively work with our legal and security teams to prevent future incidents.

Thirty Madison will never ask for sensitive information or payment when engaging with job seekers. The entities use many methods to perpetuate these scams, including but not limited to: participating in a text-only interview, using Thirty Madison’s trademarks on their correspondence, or providing you with a seemingly legitimate offer letter. If you suspect you are a victim of this scamming, we encourage you to cease further contact and report the crime to The Federal Trade Commission.

Title: Bilingual Healthcare Customer Service Representative – Remote

Location: US remote

Requisition ID: 2024-52253

Category: Customer Service/Support

Country: United States

Job Description:

About TP

Teleperformance is a global, digital business services company. We deliver the most advanced, digitally powered business services to help the world’s best brands streamline their business in meaningful and sustainable ways.

With more than 500,000 inspired and passionate people speaking more than 300 languages, our global scale and local presence allow us to be a force of good in supporting our communities, our clients, and the environment.

Benefits of working with TP include:

• Paid Training
• Competitive Wages
• Full Benefits (Medical, Dental, Vision, 401k and more)
• Paid Time Off
• Employee wellness and engagement programs

Teleperformance and You

Through a balanced high-tech and high-touch approach blended with deep industry and geographic expertise, we make people’s lives simpler, faster, and safer. We help companies adapt quickly to changing needs, and are inspired to deliver only the best in all that we do. You will become a key contributor in making that happen.

As the eyes and ears for our team fielding customer inquiries and finding innovative ways to respond, you will work in a collaborative and engaging environment. You will have the chance to interact with people from all walks of life, and no two days will be the same. As you continue to grow and challenge yourself, you will discover your potential can take you anywhere you want to go.

Did you know that our Chief Client Officer started her career at Teleperformance as an agent and advanced to the pinnacle of the company? At Teleperformance, the sky is the limit!

At this time, Teleperformance can only offer employment to iniduals located in the following states: AL, AR, AZ, CT, DE, FL, GA, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, PA, RI, SC, SD, TN, TX, UT, VA, VT, WI, WV, WY

Responsibilities

Your Responsibilities

Healthcare Customer Service Representatives field customer inquiries by finding innovative ways to respond to varying questions, issues, and concerns.

• Connect with customers via phone/email/chat/and or social media to resolve their questions or concerns
• Calmly attempt to resolve and de-escalate any issues
• Escalate interactions when necessary and appropriate
• Respond to requests for assistance and/or possible processing payments
• Track all call related information for auditing and reporting purposes
• Provide feedback on call issues
• Upsell if required

Qualifications

We’re looking for fearless people – people who are inspired to deliver only the best in all that we do.

• Must be fluent in English and Spanish
• Ability to work remotely in a virtual team environment
• 6 months Customer service experience preferred
• Over 18 years of age
• Ability to type 30 wpm
• High School Graduate or GED
• Comfort with desktop computer system
• Proven oral & written communication skills
• Logical problem-solving skills
• Ability to navigate Windows operating systems
• Organization and work prioritization skills

Work from Home Requirements:

• Internet Connection Requirements:
  • Minimum subscribed download rate equal or exceeds 50.0 Mbps
  • Minimum subscribed upload rate equal or exceeds 10.0 Mbps
  • ISP must have no packet loss and ping under 50ms
  • Proof of internet speed required
• Clean and quiet workspace

Be Part of Our TP Family

It is our mission to always provide an environment where our employees feel valued, inspired, and supported, so that they can bring their best selves to work every day. We believe that when employees are happy and healthy, they are more productive, creative, and engaged. We are committed to providing a workplace that is conducive to happiness and a healthy work-life balance. We also believe that to be our best selves, we need to be surrounded by people who are positive, supportive, and challenging. We are committed to creating a culture of inclusion and ersity, where everyone feels welcome and valued.

Teleperformance is an Equal Opportunity Employer

Bilingual Medical Assistant Care Coordinator

Job details

Salary:$18 – $19 per hour

Location:Illinois

Job type:Permanent

Discipline:Care Management

Reference:231733_1722028330

Work Location:Remote

Job description

**Applicants can be located anywhere in the United States and must be able to work Pacific Time Zone or Eastern Time Zone schedule, must have MA Certification and being Bilingual is required**

**Training will be completed in Central Time Zone for 6 weeks**

Responsibilities:

• Conducting monthly phone calls with patients, practices, pharmacies, etc. to ensure that your patients are getting what they need between office visits. You will be spending 7-8 hours on the phone daily.
• Creating and/or revising a personalized care plan for each patient you call on, in coordination with the practices and providers you support.
• Working to identify social determinants of health, gaps in care, and eligibility for assistance or other referral services for each of your patients. You will coordinate and collaborate with the office staff, other community programs and resources to address all of these effectively.
• Empower patients to take charge of their own wellness and goals in the context of their care plan.
• Making approximately 30-50 phone calls a day to yield the 15 patient interactions necessary to complete 20 minutes of CC service for the month.
• Maintaining your patients’ privacy, confidentiality and safety, and adhering to ethical, legal, and accreditation/regulatory standards at all times.

Requirements:

• • Exceptional verbal and writing skills in English and Spanish, including accurate spelling and grammar. Not only will you speak with patients on the phone, you’ll communicate with patients and doctors in writing as well.
  • At least 1 year experience as an MA with active accreditation required
  • Technology experience – preferably with multiple EMR/EHR systems, familiar with Microsoft Office, GoogleSuite products and comfortable learning new softwares quickly.
  • Call Center and/or Triage experience is a plus
  • Experience serving a geriatric population is a plus
  • Case management or care coordination experience is a plus

Schedule:

• M-F (EST or PST)
• Fully remote

Pay: $18-19/hr

Title: Remote Colorectal Surgery Coder (Profee)

Location: TX-Dallas

Job Type: Contract-to-perm

Category: Medical Coder

Pay Rate: $22 – $28 (hourly estimate)

Job Description:

o 7am-8:30am CST flex start time

o Flex as long as it’s day shift (40 hours) o Fully remote o Open to hire out of state but not in CA, WA, OR, NV

Start day in PMD (surgeon charge rounding tool)

o Code o Communicate back and forth with physicians (doing a lot of this), code cases and work edits, review submitted charges o Surgeons want to sign off on everything o Billing practices for bundling o Once they charge and hit the billing systems, they will review and move all edits so claims can drop o Looking at outstanding holds and charges (missing slips) and update reports accordingly o Updating reports o Track using production sheet o Weekly huddle with supervisor, bi-weekly huddle with entire team o Reports to supervisor who will report to coding manager (everyone reports to coding director: Crisleyla Sliman)

Systems: IDX (provider billing), Athena1, IomedG2 (McKesson proprietary system), PMD (rounding tool)

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

o CPC or CCS or CCSP or CGIC certification

o 2 years SURGERY CODING EXPERIENCE o Colorectal or General Surgery coding experience o Experience working in a profee setting coding for providers

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: REMOTE Full Time Massachusetts Spanish Bilingual Licensed Nurse Practitioner (NP)

Location: Remote

Job Description:

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these iniduals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center.

Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others’ needs ahead of her own, keeping the hearth warm so the home and family can function.

We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta Healthcare comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. It’s an insurance covered benefit, so it’s available to most adults with Caregivers free of charge to them.

We seek team members who are passionate about making home the best place it can be for people with home care needs and see the important role Caregivers play. Our team members are collaborative data-driven optimists who always focus on doing what’s best for patients and their caregivers. We see ourselves as being here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids).

The ideal teammate would be able to:

• • Conduct video visits for chronic care management and remote patient monitoring to create an appropriate care plan for the member

• • Conduct care coordination and recommend/identify cost effective research based treatment and intervention

• • Utilize strong clinical skills in physical assessment and chronic disease management for at risk adults and apply member specific Care Management and inidualized care planning

• • Be comfortable with advanced care planning discussions with caregivers and members

• • Serve as a consulting resource on care management practice as needed

• • Attend meetings, training sessions and participates on committees as needed

• • Possess a strong knowledge of clinical procedures, standards and quality control checks

• • Possess a strong knowledge of medical conditions, interventions and treatment

• • Provide members, caregivers and facility education

• • Monitor the quality of member’s care and updates plan of care

Would you describe yourself as someone who has:

• • Fluency (reading, writing, speaking) in Spanish AND English (required)

• • Certified and licensed as a Nurse Practitioner in good standing in at least the state of Massachusetts (required)

• • Master’s or doctoral degree from an accredited institution for nurse practitioners (required)

• • Medicare participation and ability to have the company bill for services on your behalf (required)

• • Certification from ANCC (or equivalent) as an Adult, Family, Geriatric, and/or Acute Nurse practitioner (required)

• • 1+ years of Nurse Practitioner Experience (required), qualified for independent practice in your licensed jurisdiction (preferred)

• • 1+ years of telephonic triage or equivalent experience (required)

• • 2+ years of clinical experience working with complex adult populations (required)

• • Ability to practice independently with little clinical support (required)

• • Comfort using technology like Google Suite, multiple EMRs, Slack (required)

• • The ability to work remotely and has a private area with a computer in their home/workspace (required)

• • Experience working in home care and/or family medicine, geriatrics (preferred)

• • Experience working within a clinical team environment

• • Strong organizational skills, including the ability to prioritize

• • Passionate about our mission to improve people’s lives

• • Comfortable in a dynamic and always evolving startup environment

In addition to amazing teammates, we also offer:

• • Health, dental, and vision insurance with a choice of many different plans/costs partially subsidized by us

• • Paid vacation

• • Paid Sick/personal days

• • ~12 paid holidays

• • One time reimbursement to set up your home office

• • Monthly reimbursement for internet or other home office expenses

• • Monthly gym reimbursement to be used for gyms membership and classes

• • Basic Life & AD&D, Short-term and Long-term Disability Benefits paid fully by us

• • Accident insurance, hospital insurance, and critical insurance

• • Pre-tax Flex Spending/Dependent Care/Transit accounts

• • 401k with up to 4% match

Pay range is $125K – $130K annually. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

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

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

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

Nursing Educator Expert (Contract)

United States – Contracted

What Were Looking For in a Nursing Educator Expert

Study.com is looking for nurses and nursing educators who are passionate about helping others prepare for their certification exams, including the Next Gen NCLEX RN and PN. Were looking for experts to contribute to our library of test preparation materials by creating a variety of resources and learning content to help students prepare for exams. Our projects include work such as writing learning content, developing case studies, writing practice questions, reviewing and designing course curriculum, and more!The projects you work on will vary, depending on company priorities and are paid per piece.

Our ideal candidate:

• Has a strong academic background in nursing (BSN, MSN, DNC)
• Holds a professional nursing license (RN, PN, etc.)
• Has experience as a nursing educator
• Is an expert in nursing topics and knows what it takes for nursing students to pass their licensing exams, including the Next Gen NCLEX
• Has strong writing skills

As a Nursing Educator Expert, you’ll receive the following

• Payment:Timely, reliable payments twice a month via PayPal. All work is paid per piece. Per piece rates may vary based on complexity of the work.
• Support:Access to asuper supportive in-house team to answer your questions and lend a hand.
• Satisfaction:You’ll be helpingpeople pass the tests they need to achieve their dreams.

Utilization Review Nurse- FT Weekends

remote type

Fully Remote

locations

Remote – Other

time type

Full time

job requisition id

R013017

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

Responsibilities

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

Qualifications

Required

• Current RN licensure
• At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
• At least 2 years utilization management experience in acute admission and concurrent reviews
• Intermediate level experience with InterQual and/or MCG criteria within the last two years
• Proficiency in medical record review in an electronic medical record (EMR)
• Experience in MS Office and basic Excel
• Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs
• Passing score(s) on job-related pre-employment assessment(s)

Preferred

• 3+ years utilization management experience within the hospital setting
• Bachelors of Science in Nursing
• Proficient in InterQual/MCG criteria
• Case Management Certification (CCM, ACM, CMCN, or CMGT-BC

Expectations

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

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

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

If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please use this form to request details which you may be legally entitled.

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

Title: Remote – Licensed Practical Nurse (LPN) – Nevada Licensure

Location: Las Vegas NV US

Job Description:

CareHarmony’s Care Coordinators (LPN) (LVN) work comprehensively with providers to deliver value-based care management initiatives for their patients.

CareHarmony is seeking an experienced Licensed Practical Nurse – LPN Nurse (LPN) (LVN) with at least 3 years of direct patient-facing work experience; that thrives in a fast-paced environment, is self-motivated, has impeccable attention to detail, and values the impact they can have on a patient’s healthcare journey.

You will have experience identifying resources and coordinating needs for chronic care management patients.

What’s in it for you?

• Fully remote position – Work from the comfort of your own home in cozy clothes without a commute. Score!
• Consistent schedule – Full-Time Monday – Friday, no weekends, rotational on-call-once per year on average.
• Career growth – Many of our team members move up in the company at a faster-than-average rate. We love to see our people succeed!

Requirements

Responsibilities:

• Manage patient census with a resolution-driven approach to close gaps in clinical and non-clinical patient care.
• Identify and coordinate community resources with patients that would benefit their care.
• Provide patient education and health literacy on the management of chronic conditions.
• Perform medication management, including identifying potential medication concerns, reconciliation, adherence, and coordinating refills.
• Assist in ensuring timely delivery of services to your patients; Home Health, DME, Home Infusion, and other critical needs.
• Resolve patients’ questions and create an open dialogue to understand needs.
• Assist/Manage referrals and appointment scheduling.

Additional Requirements:

• Active Nevada License (LPN)
• Technical aptitude – Microsoft Office Suite
• Excellent written and verbal communication skills

Plusses:

• Epic Experience
• Bilingual
• California License (LPN)

Remote Requirements:

• Must have active high-speed Wi-Fi
• Must have a home office or HIPAA-compliant workspace

Physical Requirements

• This position is sedentary and will require sitting for long periods of time
• This position will require the ability to speak clearly and listen attentively, often by telephone, for an extended period of time
• The position will require the ability to understand, process, and take thorough notes in real-time on telephone conversations

Benefits:

• Health Benefits (core medical, dental, vision)
• Paid Holidays
• Paid Time Off (PTO)
• Sick Time Off (STO)

Pay:

• $22/hr-$28/hr
• Opportunities to pick up OT to increase earnings

Medical Coding Coordinator 2

time type

Full time

job requisition id

R-344002

Become a part of our caring community and help us put health first

The Medical Coding Coordinator 2 extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records.

The Medical Coding Coordinator 2

• Maintains required standards of performance in both coding accuracy and productivity to meet client turnaround and satisfaction.
• Stays current with most recent coding changes and guidance from CMS, AHA Coding Clinics, AHIMA, Official Inpatient Coding Guidelines, as well as internal education from Physicians, CDI and Coding leadership.
• Completes required Continuing Education hours to maintain credential requirements.
• Maintains a collegial working relationship with other departments.
• Performs Root Cause analysis and pursues opportunities to mitigate claim overpayments
• Basic Reporting
• Works with other departments such as Claims, Finance, Provider Services, and Provider Configuration and Load
• Create Financial Recovery Overpayment Letters

Use your skills to make an impact

Required Qualifications

• 2 or more years of Medical claim processing experience
• 2 or more years of experience as a certified medical coder (AAPC Coding Certified)

Preferred Qualifications

• Financial Recovery or Quality Audit experience or working within a similar environment(s)- (Pre and Post Pay)
• Medical claims experience (Institutional and professional claims)
• Proficiency in Microsoft Office applications Word and Excel
• Ability to quickly learn new systems
• Ability to manage and prioritize tasks based on business need

Additional Information

• Schedule: Monday to Friday from 8 am to 5 pm EST. with flexibility, Overtime as needed based on business needs
• Training: 100% Virtual

Additional Information

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/yammer and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

#LI-BB1

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and inidual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$37,200 – $51,200 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, iniduals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Physician Coding AR Specialist – Remote

locations

Remote

time type

Full time

job requisition id

R111745

Department:

10417 Revenue Cycle – Coding & HIM Support Professional

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

This is a remote position Monday through Friday, 40 hours week required. Prefer Cardio experience.

Major Responsibilities:

• In collaboration with Customer Service, analyze and resolve professional coding complaints in a timely manner using correct coding and payer guidelines to ensure patient satisfaction.
• Identifies and analyzes coding denials for a specific population of charges and works in collaboration with the Production Coding team. Coordinates coding rejection data collection activities used for reporting and accountability tracking. Identifies potential trends or knowledge concerns and opportunities for improvement and prevention.
• Researches and documents applicable regulatory, coding and billing rules. Develops standardized processes and tools for the coding production team to utilize when dealing with insurance rejections and recommendations to avoid future denials.
• Works with Professional Coding Leadership to develop monthly coding update reports to continually educate and communicate coding related recommendations based on monthly findings. Maintains up-to-date information regarding coding denials and rejections and communicates the changes accordingly.
• Identifies and problem solves trends and issues. Collaborates with department leadership clinic operations managers, system contracting team to determine preventative measures, follow-up and resolve these issues. Communicates with and acts as a resource for others regarding coding and appeal issues.
• Provides regular statistical reports to leadership regarding rejection/denial volumes, response timeliness, success rates, identified trends, and recommendations to prevent future coding rejections/denials.
• Maintains up-to-date knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally and locally (i.e., NCD, LCD) accepted coding policies and standards. Develops expertise in coding for assigned specialties. Communicates and reinforces changes in CPT, ICD-10-CM/PCS, HCPCS and other requirements and coordinates necessary modifications and updates appropriately.
• Responsible for retrospective chart and claim coding review. Identifies coding errors and recommends correct coding based on CPT, ICD-10 CM/PCS, HCPCS in accordance with coding and payer guidelines.

Licensure, Registration, and/or Certification Required:

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

Education Required:

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

Experience Required:

• Typically requires 5 years of professional coding and at least 3 years of payer background experience in physician revenue cycle processes, health information workflows and reimbursement in a large, complex clinic or medical group.

Knowledge, Skills & Abilities Required:

• Advanced knowledge of ICD, CPT and HCPCS coding guidelines.
• Advanced of medical terminology, anatomy, and physiology.
• Advanced ability to identify coding discrepancies and provide recommendations for improvement
• Advanced ability to analyze trends and data and display them in a statistical reporting format.
• Advanced knowledge of care delivery documentation systems and related medical record documents. Advanced knowledge of Medicare, Medicaid, and commercial payer coding guidelines.
• Advanced computer skills including the use of Microsoft Office, email and exposure or experience with electronic coding systems or applications.
• Proficient interpersonal and communication (oral and written) skills, including the ability to effectively collaborate with multiple departments.
• Excellent organization and prioritization skills; ability to manage multiple priorities in a stressful, fast-paced work environment.
• Excellent analytical skills, with a great attention to detail.
• Ability to work independently and exercise independent judgment and decision making. Ability to meet deadlines while working in a fast-paced environment.

Physical Requirements and Working Conditions:

• Exposed to normal office environment.
• Position requires travel which will result in exposure to road and weather hazards.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

Senior Medical Intelligence Representative

locations

U.S. Employees (Remote)

Hartford, Connecticut

Baltimore, Maryland

Portland, ME

Kansas City, Missouri

time type

Full time

job requisition id

JR00097722

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You’ll work with dynamic colleagues – experts in their fields – who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you’ll have new and exciting opportunities to make life brighter for our Clients – who are at the heart of everything we do. Discover how you can make a difference in the lives of iniduals, families and communities around the world.

Job Description:

At Sun Life, we look for optimistic people who want to make life brighter for ourClients.We understand the value of erse cultures, perspectives, and identities, and want you to bring your full and authentic self to work.Every day,you’ll be empowered and challengedbyworking withdynamic colleaguesto find new and innovative ways to make Sun Life the best benefits company in America.

The opportunity: The Sr. Medical Intelligence Representative is responsible for researching and profiling a variety of healthcare providers or facilities based on specific clinical criteria and creating a personalized report to guide a client in their decision-making for provider selection. This role involves collaboration with Medical Intelligence Team Leads and Advisory teams, for research guidance, as well as managing the task delegation to Medical Intelligence Associates who will collaborate with you to find qualified providers. The Sr. Medical Intelligence Representative will also complete special projects as assigned to support the operations of the Medical Intelligence team.

How you will contribute:

• Conduct research on qualified healthcare providers by utilizing erse and authoritative sources
• Collaborate with the Medical Intelligence and Advisory teams to creatively and strategically solve client requests
• Perform interviews with provider offices to obtain key information that will be used to prepare written reports for clients
• Utilize organizational tools and database resources to manage client and team needs
• Prepare written reports with information obtained from the Medical Intelligence Associate
• Assist Team Leads with special research or administrative projects

What you will bring with you:

• Ability to work with a erse range of people
• Experience in the medical or behavioral health field
• Excellent verbal and written communication skills
• Strong PC skills; MS Office and Internet research experience required
• Excellent organizational and prioritization skills, with an interest in improving efficiency
• Ability to work within a team environment and communicate effectively with team members
• Ability to adapt to workflow changes and business growth in fast-paced environment
• Demonstrated ability to work well in a deadline driven environment
• Ability to think quickly and respond to urgent requests and changing circumstances

Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents ersity in all forms. If you think you might thrive in this setting, we would love to hear from you.

Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!

Life is brighter when you work at Sun Life

• Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more
• Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account
• A flexible work environment with a friendly, caring, collaborative and inclusive culture
• Great Place to Work® Certified in Canada and the U.S.
• Named as a “Top 10” employer by the Boston Globe’s “Top Places to Work” two years running

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.

If you are a California resident, the salary range for this position is:

• Southern California region: $49,700-$67,100 annually
• Central California region: $52,400-$70,700 annually
• Northern California region: $56,000-$75,700 annually

If you are a Colorado or Nevada resident, the salary range for this position is $47,500-$64,100 annually

If you are a Connecticut or Maryland resident, the salary range for this position is $49,700-$67,100 annually

If you are Washington or Rhode Island resident, the salary range for this position is $52,400-$70,700 annually

If you are a New York resident, the salary range for this position is $56,000-$75,700 annually

We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on inidual and business performance as well as a broad range of competitive benefits.

Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, erse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and inidual needs.

#LI-remote

Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified iniduals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email [email protected] to request an accommodation.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and inidual needs.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

Job Category:

Customer Service / Operations

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.

Title: Psychiatric Mental Health Nurse Practitioner (PMHNP)

Location: Rhode Island

Type: Contract-1099

Workplace: remote

Category: Nurse Practitioners

Job Description:

We are seeking a Compassionate and Adult ADHD Experienced Provider to Join our Team at Done. Done. is a digital health company that is making high-quality psychiatric chronic care management more accessible and affordable for patients.

Our mission is to empower everyone living with ADHD to reach their fullest potential. We meet that mission by providing a patient-first, technology-powered ADHD treatment platform that keeps costs down and reduces patient wait times. With guidance from the most advanced clinical leadership and board-certified psychiatrists, we have created a platform that provides a patient-first healthcare experience and the highest quality of ADHD care for our patients.

Perks:

• • Flexible and Sustainable Work Schedule : Set your own Schedule, anywhere from 7am – 10pm, Monday – Sunday, the Flexibility is one of the many perks here at Done.
  • Dedicated Clinical Admin Team Just for You : Your Assigned Care Team will be responsible for Non-Clinical Support from Patient Scheduling to Pharmacy Communications and more to allow you to focus on the most important thing – providing care to the patients.
  • Comfortable & Fun Remote Work Environment: Work from anywhere you like alongside our enthusiastic, tight-knit team of medical doctors, other clinicians, engineers, and care team staff.
  • On-Site Training : Get medical guidance and advice for complex patient cases from our expert psychiatrists and mental health clinicians.
  • Internal Opportunities to Cross-License
  • Full-time Hiring Option : After working with us for a while, you will have the opportunity to convert to full-time hours and earn additional compensation and benefits.
  • Malpractice Liability Insurance Provided
  • Collaborating Physician Provided (If Applicable)
  • Physical Office (If Applicable)

What we are looking for:

• • A Provider who is Passionate about our Mission and Recognition of the impact on the Healthcare Industry
  • Comfort working independently as well as with the Done team
  • Comfort operating in a fast-moving, high-growth environment
  • Experience diagnosing and treating patients with ADHD

Role:

• • Conduct ADHD Evaluations
  • On-Going Patient Management

Requirements:

• • PMHNP
  • Board Certified
  • Applicable Valid DEA / License
  • Computer Proficiency
  • Excellent Written and Verbal communication skills

$90 – $120 an hour

Title: Senior Clinical Admin Nurse – Remote

Location: Phoenix AZ US

Full Time

The Senior Clinical Admin Nurse will be responsible for providing inidualized attention to UMR membership and covered families and serves to assist with navigation of the health care system. The purpose of the clinical liaison nurse is to help iniduals live their lives to the fullest by supporting coordination and collaboration with multiple and external partners including consumers and their families/caregivers, medical, and other clinical teams.

Primary Responsibilities:

• • Provide members with tools and educational support needed to navigate the health care system and manage their health concerns effectively and cost efficiently

• • Assist members with adverse determinations, including the appeal process

• • Teach members how to navigate UMR internet-based wellness tools and resources

• • Outreach to membership providing pre-admission counseling to membership

• • Outreach to membership providing discharge planning to membership and caretakers

• • Track all activities and provide complete documentation to generate customer reporting

• • Accept referrals via designated processes, collaborate in evaluating available services, and coordinate necessary medical care and community referrals as needed

• • Comply with all policies, procedures and documentation standards in appropriate systems, tracking mechanisms and databases

• • Contribute to treatment plan discussions

• • Other duties as assigned

Candidate must be willing to work Monday – Friday 8:00 am – 5:00 pm

Required Qualifications:

• • Current and unrestricted RN compact license

• • 2+ years of acute nursing experience

• • Basic computer proficiency (ie MS Word, Outlook)

• Proven ability to function independently and responsibly with minimal supervision

Preferred Qualifications:

• • Bachelor’s degree in nursing

• • CCM

• • 2+ years managed care experience

• • Critical care, pediatric, med-surg and/or telemetry experience

• • Utilization management experience

• • Adverse Determination experience

• • Telecommute experience

Soft Skills:

• • Demonstrated excellent verbal and written communication skills

• • Excellent customer service orientation

• • Proven team player and team building skills

• Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Title: Registered Nurse Caseload Coverage Specialist

Location: Orlando FL US

Job Description:

Description

CircleLink Health is seeking passionate, tech-savvy registered nurses to work remotely and serve patients enrolled in Medicare’s Chronic Care Management Program.

In this part-time role (20-25 hours per week), the Remote RN Caseload Coverage Specialist will manage their own small caseload of patients at the start of each month and assist fellow nurses with their caseloads during the latter half of the month in an effort to consistently exceed our company-wide goal of serving 95% of our patient population.

• Utilize our specialized care management software to call Medicare patients with 2 or more chronic conditions (Diabetes, CHF, Chronic Pain, COPD, etc.) on a monthly basis.
• Promote positive patient heath outcomes and ensure continuity of care by managing patient contact in cases where patient’s primary nurses are unavailable.
• Build and maintain rapport with patients to help coach them to improved health through SMART goals and education on self-management strategies.
• Implement and improve the Plan of Care by updating medications, appointments due, biometrics, symptoms, and interventions made.
• Connect patients with community resources as needed, including transportation, personal care needs, prescription/DME assistance, social services, etc.
• Conduct Transitional Care Management activities for high-risk patients discharged from the hospital and the ER to reduce unnecessary readmissions.
• Close care gaps by encouraging and assisting with preventive care measures, i.e., annual well visits, vaccines, cancer screens, follow-up/specialist appointments, etc.
• Provide flexible support to fellow nurses by assisting with their caseloads during the second half of the month.

Requirements

Requirements:

• Fluent in English.
  • Spanish-speaking is a plus!
• Self-directed, able to work independently with little supervision while meeting performance metrics.
• Flexible, adaptable, and available to provide immediate assistance nurse peers throughout the month
• Thrive in a dynamic setting, embracing the unique and varied experiences that come with each workday, where no two days are the same.
• Willingness to take on additional tasks and responsibilities as needed to support the team.
• Passion for nursing and improving patient outcomes.
• Good with technology and eager to learn and use new software.
• Excellent organizational and time management skills.
• Strong communication and telephonic skills.
• Strong critical thinking and problem-solving skills.

Education and Experience:

• Current COMPACT nursing license
• Proficiency with electronic health records and web-based applications.
• 3+ years experience as a Registered Nurse.

Preferred Education and Experience, but not required:

• Case Management or Chronic Disease Management experience.
• Certified Diabetes Educator.
• Experience with Motivational Interviewing or other behavior change communication techniques.
• Scheduling and Other Requirements:
• RN needs a STRONG internet-connected computer.
• Minimum of 20-25 hours of availability per week required.
• Ability to manage a small caseload at the beginning of each month.
• Open availability during the second half of the month to assist fellow nurses.
• You will commit to your own schedule using our software.
• Work must be completed on weekdays between 9am-6pm.
• This is a 1099 contract position with no end date. Care coaches are responsible for their own taxes and insurance.

Benefits

Compensation:

Care Coaches can earn up to $45.00 per hour. Compensation is paid at the rate of $15.00 per initial Clinical Encounter per patient per month. A clinical encounter occurs after two criteria are met: a patient has a successful clinical call and the patient has 20 minutes or more of time in their chart timer.

Ex: If in one hour you called and spoke 3 patients and spent 20 minutes with each of them, your pay for that hour would be $45.00 per hour ($15.00/pt reached x 3)

Ex: If in one hour you called and spoke with 2 patients and spent 30 minutes with each of them, your pay for that hour would be $30.00 ($15.00/pt reached x 2).

Pay Timing:

Monthly via direct deposit, 40 days after the last day of the month of service. This is due to the time it takes Medicare to process reimbursements, but your monthly pay is guaranteed after the month is over.

Billing Specialist

locations

Remote – Nationwide

time type

Full time

job requisition id

R020657

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 Billing Specialist performs daily billing tasks such as: Works daily failed bill, failed claims on host system and failed claims within billing vendor. Works late charges, re-bill’s, & any additional assigned reports. Updates to Excel reports capturing status of accounts billed/not billed. Pulls documents for audits updating tracking sheets of the audit status. Prints and mails hardcopy claims along with any additional documentation need with the claims. Ensures the Company is meeting regulatory compliance requirements.

Essential Job Functions

• Reviews/Updates failed bills & claims on host system and within billing vendor. Works daily electronic 277’s resolving claim issue’s.
• Works daily late charges & rebills.
• Bills hardcopy claims attaching any needed documentation for payment.
• Pulls EOB’s and Medical Records as needed attaching to claims and mailing.
• Contact patients, insurance, any third party for insurance information or any additional billing data.
• Contact patient and third parties for needed billing information.
• Performs rebill projects and additional daily reports.
• Assists with creation/up keep of training documents

Other Preferred Knowledge, Skills and Abilities

Minimum Years and Type of Experience:

• Accredited degree or equal experience in hospital billing.
• Must have billing experience on multiple payers or a SME for one payer.
• Must demonstrate basic computer knowledge and demonstrate proficiency in Microsoft Excel.
• Must pass typing test of 35 words per minute (error adjusted).

Minimum Education:

• High School Diploma or GED. Combination of post-secondary education and experience will be considered in lieu of degree.

Certifications:

• CRCR within 9 months of hire (Company Paid)

Join an award-winning company

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

2022 Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

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

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

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

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

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

Remote Pro-Fee Coder – Anesthesiology

locations

US – Remote (Any location)

time type

Full time

job requisition id

20752

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

The Anesthesia Coder, codes anesthesia documents and/or charge tickets as assigned. If requested by supervisor, provides technical guidance and training on medical coding to physicians and/or other department staff. Maintains knowledge of AMA guidelines and billing compliance and performs all other duties as required.

Must be self-directed and self-motivated; must have good communication and interpersonal skills. Must be detail oriented, accept responsibility for the direction, control and planning of one’s own work; recognize the rights and responsibilities of patient and employee confidentiality; adaptable to change and improvement; relate to others in a manner which creates a sense of teamwork and cooperation; show exemplary attitude in levels of maturity, responsibility, judgment and conduct exhibit flexibility and cope effectively in an ever-changing, fast-paced healthcare environment; perform effectively when confronted with emergency, critical, unusual or dangerous situations; and demonstrate the quality work ethic of doing the right thing the right way. This position is full time and 100% remote.

What You Will Do:

• Assigns case numbers to special billing charges if applicable or sends to research as needed.
• Assigns required CPT/ICD/ASA/HCPCS codes and/or modifiers as needed per documentation.
• Identifies missing information and gives to appropriate party for follow up.
• Resolves TES edits as required.
• Has specific job knowledge to perform assigned job functions, including all applicable computer programs?
• Attends required in-service training, various committees, department, and other appropriate meetings related to medical coding issues.

Quality Assurance:

• Meets or exceeds quality assurance standards as defined by management for work assigned.
• Admits mistakes, makes corrections, and works to prevent future occurrences.
• Maintains all coding certifications.

Productivity:

• Meets or exceeds productivity standards as defined by management for work assigned.
• Meets assigned deadlines/turnaround time.
• Performs tasks efficiently and assumes more work when possible.
• Works with management to ensure workflow is maintained and effective.

Communication:

• Openly exchanges information with co-workers in a timely manner.
• Respects the confidentiality of information in the workplace.
• Provides coding/technical guidance to physicians and other departmental staff in identifying and resolving issues or errors, such as incomplete or missing records and documentation, ambiguous or non-specified documentation, or codes that do not conform to approve coding principles/guidelines.
• Informs others as needed in a clear, concise manner; selects the proper mode of communication and includes appropriate parties.
• Notifies supervisor promptly when problems arise with equipment, programs, etc.

Ethics and Compliance:

Employee performs within the prescribed limits of the company’s Ethics and Compliance program and is responsible to detect, observe and report compliance variances to their immediate supervisor, or upward through the chain of command, the Compliance Officer or the compliance hotline. Employee completes all required annual compliance education.

What You Will Need:

• High School Diploma/GED or 3 years of relevant equivalent in lieu of diploma/GED
• 1-3 years Anesthesia Coding Experience
• Certified Professional Coder Certification (CPC) or a comparable coding certification (e.g., AHIMA CCS-P)

What Would Be Nice to Have:

• 4 years Anesthesia Coding Experience
• AAPC Anesthesia and Pain Management Coder Certification (CANPC)

Additional Requirements

• The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.

The annual salary range for this position is $43,400.00-$65,000.00. 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.

Utilization Review Nurse- FT (9a-9p EST)- 8HR Shift

remote type

Fully Remote

locations

Remote – Other

time type

Full time

job requisition id

R012857

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

Responsibilities

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

Qualifications

Required

• Current RN licensure
• At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
• At least 2 years utilization management experience in acute admission and concurrent reviews
• Intermediate level experience with InterQual and/or MCG criteria within the last two years
• Proficiency in medical record review in an electronic medical record (EMR)
• Experience in MS Office and basic Excel
• Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs
• Passing score(s) on job-related pre-employment assessment(s)

Preferred

• 3+ years utilization management experience within the hospital setting
• Bachelors of Science in Nursing
• Proficient in InterQual/MCG criteria
• Case Management Certification (CCM, ACM, CMCN, or CMGT-BC

Expectations

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

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

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

If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please use this form to request details which you may be legally entitled.

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

Netsmart’s Job Applicant Privacy Notice may be found here.

Billing & Administrative Specialist

FULL TIME • FULLY REMOTE – US

Benefits:

• 401(k)
• Competitive salary
• Health insurance
• Home office stipend
• Paid time off

Billing & Administrative Specialist

We are seeking an experienced Billing and Administrative Specialist to oversee the financial and administrative operations of our mental health clinic. The ideal candidate will have a strong background in medical billing and coding, along with excellent organizational and communication skills to effectively manage client interactions and administration.

Responsibilities:

• Manage all aspects of billing and collections for services provided, including insurance claims processing, payment posting, and follow-up on outstanding accounts.
• Ensure accurate coding of services rendered and adherence to billing regulations and guidelines.
• Handle inquiries and resolve issues related to billing, insurance coverage, and payments from clients and insurance companies.
• Maintain up-to-date knowledge of insurance policies, billing procedures, and coding updates to optimize reimbursement and minimize billing errors.
• Oversee the day-to-day administrative operations of the clinic, including scheduling appointments and managing client records
• Coordinate with clinicians and clinical director to streamline workflow processes and ensure efficient delivery of services.
• Collaborate with external vendors, such as billing software providers and insurance companies, to resolve technical issues and improve billing efficiency.
• Assist with preparing financial reports and analyses to monitor clinic revenue, expenses, and performance metrics.
• Assist with other administrative tasks and projects as needed to support the overall functioning of the clinic.

Qualifications:

• Minimum of 2-3 years of experience in medical billing and coding, preferably in a mental health setting.
• Proficiency in medical billing software and electronic health record (EHR) systems. Experience with Valant EHR a plus.
• Strong understanding of insurance claims processing, billing regulations, and coding standards (e.g., CPT, ICD-10).
• Excellent attention to detail and accuracy in data entry and record-keeping.
• Effective communication skills, both written and verbal, with the ability to interact professionally with clients, staff, and external stakeholders.
• Some understanding of client scheduling in a clinical setting.
• Proficient in the use of typical office technology (computers, e-mail, etc.). Experience with Microsoft 365 a plus.
• Proven ability to multitask, prioritize tasks, and meet deadlines.
• Strong leadership and interpersonal skills.
• Ability to maintain confidentiality and handle sensitive information with discretion.
• Commitment to providing exceptional customer service and promoting a positive clinic environment.
• Desire to work in a collaborative atmosphere that embodies Ellie’s values (creativity, authenticity, humor, compassion, acceptance, determination);

What we have to offer:

• Competitive salary, excellent benefits and paid time-off
• Flexible scheduling

What else you should know:

• Ellie Mental Health is a highly successful multi-clinic mental health organization originally based in Minnesota; however, Ellie in Boise is locally owned and operated. The owner and Director are lifelong Idahoans committed to expanding mental health services in our community. Our vision is to operate a small but mighty clinic with a dedicated team of kickass therapists and staff who support one another in providing excellent services to our clients and the larger community.

This is a remote position.

Compensation: $45,000.00 – $48,000.00 per year

Title: Customer Liaison Nurse

Location: Any state, US

Company: New York Life Insurance Co

Location Designation: Fully Remote

Job Description:

When you join New York Life, you’re joining a company that values career development, collaboration, innovation, and inclusiveness. We want employees to feel proud about being part of a company that is committed to doing the right thing. You’ll have the opportunity to grow your career while developing personally and professionally through various resources and programs. New York Life is a relationship-based company and appreciates how both virtual and in-person interactions support our culture.

GBS

A career at New York Life offers many opportunities. To be part of a growing and successful business. To reach your full potential, whatever your specialty. Above all, to make a difference in the world by helping people achieve financial security. It’s a career journey you can be proud of, and you’ll find plenty of support along the way. Our development programs range from skill-building to management training, and we value our erse and inclusive workplace where all voices can be heard. Recognized as one of Fortune’s World’s Most Admired Companies, New York Life is committed to improving local communities through a culture of employee giving and service, supported by our Foundation. It all adds up to a rewarding career at a company where doing right by our customers is part of who we are, as a mutual company without outside shareholders. We invite you to bring your talents to New York Life, so we can continue to help families and businesses “Be Good At Life.” To learn more, please visit LinkedIn, our Newsroom and the Careers page of www.NewYorkLife.com.

Role Summary:

The LPN is a professional that works with a multidisciplinary team of other Nurses, Behavioral Health Specialists, Physicians, Claim Managers and/or Vocational Coaches. The LPN is relied upon to assist with telephonic assessment of a customer’s functionality from a holistic point of view, build a rapport with the customer, as well as gather pertinent information from the customer and /or treating providers. The ideal candidate will possess the desire to grow within the organization, as the LPN role provides the opportunity for employees to be exposed to and acquire skills to do so.

QUALIFICATIONS

• Licensed Practical Nurse with current unencumbered LPN licensure in the U.S.
• Minimum of 3 years clinical experience with strong clinical background in at least one or more of the following: Medical/Surgical, Occupational Health, Rehabilitation, Psychiatric, Critical Care, or Public Health Nursing
• Ability to function in a team environment
• Proficient computer skills to include the ability to navigate independently and knowledge in Microsoft Outlook, Windows, Excel, and Word
• The ability to multitask such as talking while typing and working on variety of applications and/or computer monitors simultaneously
• Strong written and verbal communication skills
• Timely, clear, concise documentation and communication
• Attention to fine detail
• Excellent organizational and time management skills
• Strong critical thinker
• The ability to diffuse difficult or challenging situations
• Comfortable giving and receiving feedback
• Flexible to an ever changing environment
• Ability to work independently with a sense of urgency and customer-focus mindset

Training & Development:

The LPN will undergo a comprehensive paid training program. Coaching and feedback is provided to help gain the necessary skills to be successful.

Schedule information:

This is a full-time work from home position Monday through Friday. Candidates must be available to work 8 hour shifts from 8am-430pm or 830am-5pm.

Salary:

Competitive full-time base salary

Benefits:

Paid Vacation, Health Care, 401K match, Tuition Assistance, Flexible Spending Accounts

Career Opportunities:

New York Life offers a variety of career opportunities

It is recommended that all qualified candidates apply to this posting as soon as possible. Residents of Colorado are hereby notified that the deadline to apply is 2 weeks from the Posting Date listed above.

Salary range: $45,000-$60,000

Overtime eligible: Nonexempt

Discretionary bonus eligible: Yes

Sales bonus eligible: No

Click here to learn more about our benefits. Starting salary is dependent upon several factors including previous work experience, specific industry experience, and/or skills required.

Recognized as one of Fortune’s World’s Most Admired Companies, New York Life is committed to improving local communities through a culture of employee giving and volunteerism, supported by the Foundation. We’re proud that due to our mutuality, we operate in the best interests of our policy owners. We invite you to bring your talents to New York Life, so we can continue to help families and businesses “Be Good At Life.” To learn more, please visit LinkedIn, our Newsroom and the Careers page of www.NewYorkLife.com.

Job Requisition ID: 90184

Title: Utilization Management Nurse Reviewer

(Remote, LPN Required)

Location: Remote Remote US

Job Description:

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of medical procedures, tests, and treatments.

Utilization Management Nurse Reviewers collaborate with healthcare providers, insurance companies, and patients to optimize healthcare delivery, control costs, and maintain quality care. Their responsibilities include assessing medical necessity, coordinating care, conducting utilization reviews, providing recommendations for care plans, and ensuring adherence to regulations and guidelines. This role requires strong clinical knowledge, critical thinking skills, communication abilities, and the ability to make informed decisions regarding patient care pathways.

MAJOR DUTIES & RESPONSIBILITIES

• Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria).
• Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services.
• Offer clinical expertise and serve as a clinical reference for non-clinical staff members.
• Input and manage essential clinical details within various medical management platforms.
• Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review.
• Apply clinical reasoning to determine the suitable evidence-based guidelines.
• Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director.

Requirements

• Proficient in both written and spoken communication.
• Capable of maintaining professional communication with physicians and clients.
• Skilled at handling multiple tasks and adjusting swiftly in a dynamic office setting.
• Possesses a keen organizational sense and pays close attention to details.
• Adept at resolving intricate and multifaceted problems.
• Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook.
• Background in medical or clinical practice through education, training, or professional engagement.
• Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a nursing degree from an accredited college (for RNs).

Additional Duties

• May provide oversight to the work of the team members.
• Continuously improves processes that help to facilitate better turnaround time, peer to peer success rates and lessens returned reports by clients for clarification purposes, ultimately resulting in higher client satisfaction.
• Responsible for the final approval on cases for release to the client.
• Will act as a liaison and coordinate quality issue reports along with all new reviewer reports with the VP of Clinical Operations.

EDUCATION/CREDENTIALS:

Licensed Practical/Vocational Nurse with an active and unrestricted license to practice.

JOB RELEVANT EXPERIENCE:

2 yrs minimum clinical nursing experience is required.

One year of previous experience in Utilization Management is required.

JOB RELATED SKILLS/COMPETENCIES:

Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills. Possess a proficient understanding of computer operations, particularly the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows. Show the capability to acquire new skills and competencies to address the evolving requirements of systems, software, and hardware.

WORKING CONDITIONS/PHYSICAL DEMANDS:

Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.

WORK FROM HOME TECHNICAL REQUIREMENTS:

Supply and support their own internet services.

Maintaining an uninterrupted internet connection is a requirement of all work from home position.

Requirements

Beginning compensation will depend on several factors including the candidate’s experience, education, and specific skills. In addition to the base salary, we offer a comprehensive benefits package including health insurance, retirement plans, and performance bonuses.

Our Commitment:

We are committed to providing fair and competitive compensation that reflects each employee’s contributions and performance. We value ersity and strive to create an inclusive environment for all employees.

Salary: $45,000 – $70,000 USD

Benefits

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

Title: Utilization Management (UM) Nurse Clinical Reviewer – LPN/RN (Remote U.S.)

Location: Indianapolis IN US

Job Description:

CNSI and Kepro are now Acentra Health! Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the company’s mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate iniduals dedicated to being a vital partner for health solutions in the public sector.

Acentra seeks a Utilization Management (UM) Nurse Clinical Reviewer – LPN/RN (Remote U.S.) to join our growing team.

Job Summary:

The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and decision- making skills to determine medical appropriateness.

Job Responsibilities:

• Performs all applicable review types as workload indicates accurately and timely. These may include both inpatient and outpatient review types.
• Utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical thinking and decision-making skills to determine medical appropriateness.
• Performs all applicable review types as workload indicates, accurately and timely. These may include both inpatient and outpatient review types.
• Determines approval or initiates a referral to the physician consultant and processes physician consultant decisions ensuring reason for the denial is described in sufficient detail on correspondence.
• Assures accuracy and timeliness of all applicable review type cases within contract requirements.
• Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.
• In collaboration with Supervisor, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.
• Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.
• Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution.
• Performs all applicable review types as workload indicates.
• Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
• Attends training and scheduled meetings and for maintenance and use of current/updated information for review.
• Cross trains and perform duties of other contracts to provide a flexible workforce to meet client/customer needs.

Requirements

Required Qualifications/Experience:

• Active unrestricted Indiana Licensed Practical Nurse (LPN) OR Registered Nurse (RN) OR other applicable State and/or Compact State clinical license per contract requirements.
• Graduate of an accredited Diploma, Associate, or Bachelor’s Degree Nursing Program.
• 2+ years of Utilization Management (UM) experience from the State, Hospital, or Health Plan.
• Knowledge of InterQual or MCG (Milliman) criteria.
• Knowledge of current NCQA/URAC standards.
• 2+ years of relevant clinical experience.
• Knowledge of the organization of medical records, medical terminology, and disease process.
• Strong clinical assessment and critical thinking skills required. Medical record abstracting skills required.
• Must be proficient in MS Office and internet/web navigation.

Preferred Qualifications/Experience

• Experience with State Medicaid programs.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people’s lives nationwide. Our company cares about our employees, giving you the tools and encouragement you need to achieve the finest work of your career.

Benefits are a key component of your rewards package. Our benefits are designed to provide additional protection, security, and support for your career and life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay range for this position is $58,240-$74,880 annually.

“Based on our compensation program, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”

Thank You!

We know your time is valuable, and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may interest you. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra.com/careers/

EOE AA M/F/Vet/Disability

Acentra 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 applicable Federal, State, or Local law.https://acentra.com/careers

Title: Nurse Care Navigator

Location: Remote

Type: Full-time

Category: Operations

Job Description:

Sana’s vision is to make healthcare easy.

All of us can agree healthcare is simply too hard in the US. And our members feel that pain day in and day out. We aim to create an experience that simply feels easy when you need to access our healthcare system. If you need something, you know where to go to get it with care that is a click (or as few clicks as possible!) away.

What’s beautiful about a vision oriented toward “easy” is how it imparts a singular feeling. We instinctively know as humans when something is easy versus hard, even if we can’t explain why. We fight as a company to make an easy pathway available to all our members at every stage of their healthcare journey. If you feel passionate about delivering better healthcare to small businesses through a seamless care experience and affordable benefits, join us!

We are looking for a hard-working, empathetic person to join our Case Management team. We’re building a team of nurses to guide our members with complex and chronic care needs through the complicated healthcare system to ensure they receive the right care, in the right setting, at the right time. This is a remote position, but we do require that you have unencumbered licensure as a Registered Nurse in Texas, and are eligible for licensure in any US state.

What you will do

• • Provide clinical navigation support for our internal health plan team to include but not limited to: condition education, care options, and planning, care compliance, medication adherence, shared decision support, and care coordination
  • Proactive outreach engagement of high-risk, rising-risk, and gap-in-care members to help them best navigate their healthcare journey
  • Manage the partnership with our external UM and RN Case Managers to ensure high quality, prompt utilization review, successful case management engagement, and high-value care navigation
  • Act in the best interest of the member by being a health advocate and supporter in the member’s healthcare journey
  • Build relationships with clinical contacts at Sana’s partners to provide streamlined referral pathways for care navigation
  • Assist with all post-op coordination of care and member support for patients who utilize our surgical care partners
  • Help identify provider contracting opportunities for network development to improve member access
  • Monitor and evaluate the effectiveness of care navigation and adjust as necessary utilizing clinical knowledge, evidence-based guidelines, and operational key performance indicators.
  • Collaborate cross-functionally with Underwriting and Claims Operations to offer a clinical perspective on certain high-cost claimants.

About you

• • Bachelor’s degree in a health-related field with at least 3 years of clinical experience. Case management or clinical care navigation experience preferred
  • Active and unencumbered licensure as a Registered Nurse in Texas. A compact license is preferred. Eligibility for licensure in any US state.
  • Experienced in remote work
  • Excellent clinical, organizational and communication skills
  • Entrepreneurial. Self-directed. Excited to build something from scratch
  • Values-oriented. You care about making our healthcare system work better for people and business owners
  • Gritty. You aren’t worried about getting your hands dirty and working hard when you need to
  • Comfortable with change. We are a startup and need people who are ok doing things outside of their traditional job description
  • Comfortable with modern web applications. We are building all of our software in-house and you will be a key constituent in its development

$80,000 – $85,000 a year

Our cash compensation amount for this role is targeted at $80,000 – $85,000 per year for all US-based remote locations. Final offer amounts are determined by multiple factors including candidate experience and expertise and may vary from the amounts listed above.

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

Title: Sr. Supervisor, Infusion Nursing – Accredo – Kent, WA

Location: OR-Salem

Job Description: Candidates for this position should reside in Washington or Oregon, and will supervise nurses working throughout Washington, Oregon, western Idaho & Alaska.

**This is a hybrid role between Work at Home, field visits and possibly in-office requirement based on location.**

**What You’ll Do** **:**

+ Provide specialized infusion therapies and clinically excellent professional nursing services to patients and caregivers at home or in alternate settings.

+ Supervise daily nursing activities and ensure quality patient care, as directed by the Nurse Manager.

+ Ensure RNs are knowledgeable of the patient’s disease state, trained/educated on the medication and have demonstrated competency in use of ancillary supplies/pump/access devices.

+ Conduct skills return demonstration and supervisory visits for all RN staff announced and unannounced to assess delivery of quality patient care in a clinical setting.

+ Supervise receipt, evaluation, acceptance and execution for the initial patient intake process to ensure that patient verification, assessment, teaching and the ongoing scheduling of nursing service occurs in a timely appropriate manner.

+ Monitor the daily nurse scheduler application to ensure nursing team is compliant with nursing note submission, availability and completion of plans of treatment.

+ Supervise the completion of all patient-related documentation to ensure accuracy, timeliness, and regulatory compliance.

+ Identify operational opportunities and areas for process development, improvement and administration applicable to clinical product offerings and present recommendations to leadership.

**What You’ll Need** **:**

+ Registered Nurse (RN) license in good standing in the state of residence

+ BSN degree, plus 2+ years of relevant RN experience; or

+ ASN degree, plus 5+ years of relevant RN experience; or

+ Nursing Diploma, plus 8+ years of relevant RN experience

+ 1+ years of experience in critical care, acute care, or home care/home infusion environment

+ 2-3 years supervisory experience is required

+ Strong IV insertion skills

+ Previous home infusion / home healthcare experience strongly preferred

+ Solid understanding of the health insurance industry

+ Ability to navigate and support both public and private insurance/plan requirements

+ Managed care exposure

+ Understanding or ability to implement utilization management principles

+ Excellent verbal and written communication and presentation skills

+ Proficient use/navigation of Microsoft and Apple technology

+ Ability to work Monday-Friday, but also have evening and weekend flexibility, as needed

+ Ability to travel up to 10%

**Your Benefits as an Accredo Home Infusion Sr. Supervisor** **:**

+ Medical, Prescription Drug, Dental, Vision, and Life Insurance

+ 401K with Company Match

+ Paid Time Off and Paid Holidays

+ Bonus Eligibility

+ Mileage reimbursement

+ Internal Career Training Resources

+ Tuition Assistance

Accredo, Evernorth Health Services’ specialty pharmacy, serves patients with complex and chronic health conditions, including Pulmonary Arterial Hypertension, cancer, hepatitis C, HIV, bleeding disorders, and multiple sclerosis.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 78,300 – 130,500 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

**About Evernorth Health Services**

Evernorth Health Services, a ision of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._

_If you require reasonable accommodation in completing the online application process, please email:_ [email protected]_ _for support. Do not email_ [email protected]_ _for an update on your application or to provide your resume as you will not receive a response._

_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._

Psychiatric Mental Health Nurse Practitioner – California Licensed (Remote)

Location

Remote – United States

Type

Full time

Department

Clinical

We believe that mental health is just as important as physical health. We recognize that mental health issues can be complex and multifaceted, and we are dedicated to treating the whole person, not just the symptoms.

We aim to create a world where mental health is no longer stigmatized or marginalized, but rather is embraced as an integral part of one’s overall well-being.

We believe that by providing quality care that is both evidence-based and compassionate, we can empower iniduals to take charge of their mental health and achieve their full potential. We are passionate about making a positive impact on the lives of those struggling with mental health issues and we strive to be a force for positive change in the field of mental healthcare.

We’re looking for high-quality board-certified Psychiatric Mental Health Nurse Practitioners (PMHNP) to join our telehealth practice.

Salary range: $160,000 to $280,000k*

*Our target compensation is $187,000 for clinicians that are billing 33 clinical hours a week and taking their generous paid time off. The range is a function of how many weekly visits are done, documentation and billing practices reflecting complexity and services provided.

Our Telehealth Practice

We’re committed to building a comprehensive, modern psychiatric clinic delivering patient care at the highest quality standards.

What sets us apart

• Comprehensive support: Our team of virtual care associates, nurses, and care coordinators take on all non-clinical tasks so you can focus on providing quality patient care.
• Flexibility: Our clinic hours allow you to see patients at times that fit your schedule. We offer 8 and 10 hour shifts M-F from 7am to 7pm PST. Additional clinic hours coming soon!
• Work/life balance: Clinicians have time to see your patients AND provide quality care. Your schedule includes admin time, assistive charting technology, daily new patient maximums and a thoughtful provider ramping schedule.
• Clinical Leadership: Our psych services leaders understand what it is like to be a clinician because they are providers, too!
• Innovation: We utilize measurement based care practices to ensure that you and your patients are able to see the results of the care you are providing. We are are building the technology and tools to empower clinicians and patients across every step of their journey.

You’ll get:

• Administrative support: We find patients, get them scheduled, and handle everything related to insurance and billing. Plus, our support team is on hand to answer any questions you or your patients have.
• Technology for efficient documentation: Every PMHNP gets a subscription to a medical autoscribe to aid in note-taking. With this tool, our team sees up to an 80% reduction in documentation time.
• Coordinated care: Our in-house team connects your patients with the help they need, whether that’s a higher level of care escalation or a rematch to another clinician.
• Investments in your development: In addition to an annual stipend for continuing education, our team collaborates to share best practice guidelines and insights to ensure high quality of care for Rula patients.

You Will:

• Provide clinical consultations with clients seeking mental health care including diagnostic assessments, psychiatric workup, treatment planning including medication management
• Work with iniduals who are struggling with mental health issues such as depression, anxiety, ADHD, trauma, and addiction
• Have access to our EHR & telehealth platform

• Have adequate time to engage with patients — half-hour sessions for follow-ups and 1 hour for initial consultations.

• Engage in collaborative case conferences and clinical team culture as well as collaborative TRAVEL”>TRAVEL”>meetings with an MD
• Abide by our policies and procedures, including timely completion of documentation/charge slips, participation in quality audits, and using measurement-informed care as part of the treatment of your patients

Minimum Qualifications:

• 2+ years experience as a psychiatric Nurse Practitioner
• Experience with mental health assessment, diagnosis, triage, managing common psychiatric medication and treatment plans, and managing crisis situations
• Certified by the ANCC as a PMHNP
• Looking for a full-time job that requires 33 bookable hours per working week
• A valid nurse practitioner furnishing license issued by the California BRN.
• Master’s or doctoral degree from an accredited university or graduate program in psychiatric mental health nursing
• Valid/active DEA (any state) with the ability to prescribe schedule II-V medications
• Willing and able to explore 103B independent practice in California
• Comfortable working independently and proficient with technology, EHR, and telehealth best practices
• Experience and ability to work with adult or adolescent(13y-17y) populations (with appropriate experience)
• Deeply empathetic and skilled at building a rapport with your clients
• No suspension/exclusion/debarment from participation in federal healthcare programs (e.g., Medicare, Medicaid, SCHIP)
• No adverse actions by any nursing board, hospital, or other credentialing body in the past 2 years

We’re serious about your well-being! As Part Of Our Team, Full-Time Employees Receive

• 100% remote work environment from anywhere in the US
• Competitive pay and benefits that don’t change based on location
• Health benefits: medical, dental, vision, life, disability, and FSA/HSA
• Access to our 401(k) plan
• Generous time off policies, including 2 company-wide shutdown weeks each year (for most employees) to focus on self-care
• Paid parental leave
• Employee Assistance Program (EAP)
• Stipend to ensure your home office sets you up for success
• Quarterly department stipend for team building or in-person TRAVEL”>gatherings
• Wellness events and lunch & learns spanning many topics

TeleHealth Diabetes Nurse Manager

Location

Remote

Type

Full time

Department

Science & MedicineClinical Care

Compensation

• Estimated base salary$87K $96K

Virta is an online specialty medical clinic that reverses type 2 diabetes, pre-diabetes, and obesity safely and sustainably without the risks, costs, or side effects of medications or surgery. Our innovations in the application of nutritional biochemistry, data science, and digital tools–combined with our clinical expertise–are shifting the diabetes treatment paradigm from management to reversal.

Virta has developed a novel, team-based care model that delivers the Virta treatment exclusively through a telemedicine platform, with no brick-and-mortar clinics. Our clinical trial, which has already producedsix peer-reviewed publications, shows that the Virta treatment has lowered hemoglobin A1c values under the diabetes threshold while discontinuing diabetes medications.

The American Diabetes Association has endorsed the core component of the Virta treatment, personalized carbohydrate restriction, as a first-line nutritional therapy for people with type 2 diabetes.

Weve been reversing diabetes for the last seven years, we see patients in all 50 states, and we are expanding our reach to patients with pre-diabetes and obesity. Our mission: Reverse type 2 diabetes in 100 million people.

To achieve that mission, Virta is looking for an experienced leader to help build and manage this new Team of RN CDE’s as a player-coach.

Calling out two key requirements of the role:

1. You must hold an active RN license in a Nursing Compact state.
2. In your application you must demonstrate that as a manager, you have helped your direct reports improve their skills and develop their careers, hired for quality and counseled people out, and built team cohesion and rapport.

Responsibilities:

• Build and manage a team of 10-15 outstandingpart-timenurses, including managing QA/QI, supervision, scheduling, and working with our administrative team to manage licensure of team members.
• Be a player coach: spend approximately half your time seeing patients and half your time managing the team.
• Conduct 20-minute clinical intake visits with prospective patients via video and/or phone. Intakes include verifying and documenting a clinical history, verifying medications, answering basic questions about Virta treatment, and identifying and flagging concerning history or labs for provider review.
• Educate patients about Virta and Virtas treatment and helping them prepare for their nutritional and behavioral journey with Virta, setting them up for clinical success.
• Management activities will include, but are not limited to:
  • Daily Schedule hygiene for assigned nursing team to enhance applicant throughput.
  • Monitoring and assigning provider support requests and initiatives.
  • Providing updates to clinical intake workflow
  • Delivery of just in time feedback as needed
  • Weekly POD meeting with team
  • Working with Head of Nursing and Clinical leads on developing

and implementing quality initiatives.

• Commitment to providing care of the highest quality that delivers an exceptional experience for the patient

Requirements

• Minimum of 2 experience working with diabetes patients in a clinical setting
• Interest and knowledge of diabetes care, diabetes prevention, and low carbohydrate nutrition.
• 3+ years experience managing nurses ideally in an ambulatory,virtualpractice, or in a clinical diabetes setting.
• Active RN license with at least one year of clinical experience working with patients with type 2 diabetes. CDE licensure preferred but not required
• Active RN license in, and resident of, a Nursing Licensure Compact state
• Associate orBachelor’sRN Nursingdegreefrom an accredited school or university
• Eligible for licensure in every U.S. state.
• Interest and aptitude for working with a growth stage, tech-enabled healthcare organization
• Occasional (2-3x/yr)travelto team and company events.
• An outstanding bedside manner: patients trust you and feel supported and empowered by your presence on the phone/video and your communication.
• Team player: You work well with others, put your team first, and contribute toward the betterment of the Virta clinical team.

Senior Coder – Anesthesia

Remote

Full time

34528

Position: Senior Coder-Anesthesia

Department: FPF Prof. Billing Office

Schedule: Full Time

POSITION SUMMARY:

The Physician Practice Coder II-Anesthesia position is responsible for reviewing documentation in the outpatient/inpatient EHR. This position is responsible for assigning ICD-10-CM diagnosis codes and CPT, ASA, HCPCS II and appropriate modifiers to patient records from BMC Anesthesia Departments. The Physician Practice Coder II Anesthesia position is a resource for the physicians and other health care providers in regard to coding and to review medical documentation to insure appropriate physician coding and billing.

Conducts CPT and ICD-10 coding reviews by detailed examination of each line item in the physician medical record and charge session. Performs chart audits to ensure correct coding and charge capture have been applied appropriately. Works closely with key revenue cycle stakeholders to understand reasons for denials, root cause analysis, and feedback to providers.

JOB REQUIREMENTS

EDUCATION:

Associates Degree (or direct work experience equivalent to at least 2 years).

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Certification may include CPC, COC, COC-A, CANPC, CGSC, CIC, CCA, CPC-A, CCS, CCS-P, RHIT, or RHIA

EXPERIENCE:

Minimum of 2 years experience conducting Anesthesia coding/auditing in a surgical/procedural environment to include compliance, and billing processes.

KNOWLEDGE AND SKILLS:

• Advanced Proficiency in ICD-10, CPT, ASA, HCPCS, and modifiers for coding of professional fee services.
• Advanced knowledge of anatomy and physiology, medical terminology and insurance reimbursement policies and regulations.
• Excellent written and verbal communication skills and the ability to prioritize and organize work to meet strict deadlines are required.
• Able to code moderate/high complexity work.
• Understands, retains, and is able to research coding billing rules, regulations, and requirements.
• Able to critically think through processes in coding to recognize errors and/or problems. Understands reasons for actions on edits.
• Able to share/transfer knowledge or train co-workers, peers, billing managers on coding – Able to provide education with physicians in small group or one-on-one sessions as needed or requested.
• Able to provide feedback to billing managers, physicians, staff, and others independently with occasional guidance from manager.
• Able to provide cross-coverage of multiple specialties.
• Able to perform peer to peer quality assurance reviews in equal or lower complexity areas of expertise.
• Proficient with computer applications (MS Office etc), Excellent data entry skills
• Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
• Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
• Ability to work with accuracy and attention to detail
• Ability to solve problems appropriately using job knowledge and current policies/procedures.
• Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.
• Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Perform coding and related duties of moderate and high complexity anesthesia work using established guidelines in an accurate and timely manner.
• Review medical documentation and system generated charges or paper encounter forms. Appropriately assign CPT, ASA, ICD-10, HCPCS II, and modifiers based on documentation and payor requirements
• Research billing rules and regulations for moderately complex new and existing procedures
• Demonstrate a commitment to integrating coding compliance standards into daily coding practices. Identify, correct and report coding problems.
• Maintains knowledge of coding and professional skills, including maintaining yearly coding credentials through attendance at in-service programs, conferences, workshops, review of current literature and other educational programs.
• Resolves complex coding edits and denials in a timely manner. Identify opportunities to reduce denials and enhance revenue.
• Provide cross coverage of multiple specialties
• Function as a resource to external customers. Research and resolve complex coding inquiries. Make recommendations for coding policy changes.
• Perform peer to peer quality assurance reviews of all Physician Practice Coders in equal or lower complexity areas of expertise
• Functions as subject matter expert for assigned specialties
• Develop and maintain ision specific coding procedures and/or billing area instructions
• Complete special projects as assigned by manager.
• Participate in coding education for providers and co-workers upon request.
• Maintain coding certification.
• Sequences diagnoses, procedures and complications by following ICD-10-CM, Medicare, Medicaid, and other fiscal intermediary guidelines.
• Maintains productivity standards set forth in Departmental Policies and procedures.
• Review and respond to coding questions.
• Ensure billed service is being accurately coded.
• Perform random chart audits.
• Performs other duties as needed. IND12

Must adhere to all of BMC’s RESPECT behavioral standards.

Equal Opportunity Employer/Disabled/Veterans

Sr Medical Coder – Part-Time

Location: United States

Status (FT/PT): Part-Time Shift: Day shift Req ID: 59947

**Part-time, 20 hours/week; Day shift, Monday-Friday

Find more than your next job. Find your community.

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

Why work as a Sr Medical Coder at Munson Healthcare?

• Remote work schedule
• Our dynamic work environment includes many opportunities for growth and development
• Our efforts directly impact patient satisfaction and outcomes
• Our employees work in positive, supportive, and compassionate environments built on our organizational values.

Summary:

The facility Senior Coder/Abstractor is a critical member of the Revenue Cycle Team and is responsible for coding and abstracting inpatient and complex outpatient medical records for performance improvement, statistical research, administrative, and facility reimbursement purposes.

Coding is performed using utilizing ICD10-CM, ICD10-PCS and CPT-4 classification systems and is subject to the Official Guidelines for Coding and Reporting, AHIMA Code of Ethics “Standards of Ethical Coding”, AHA Coding Clinic and technical rules outlined by hospital guidelines.

The Senior Coder/Abstractor works closely with the Coding Analyst, Clinical Documentation Integrity Specialists, and the Regional Coding Operations Coordinator. Required qualities include teamwork, ability to code various patient types for a variety of Munson facilities, and flexibility in handling work assignments while maintaining productivity and quality standards. This position supports the timely and accurate submission of facility claims and works to achieve or exceed the established Accounts Receivable goals for the department.

What’s Required:

• Associate or Bachelor Degree in Health Information. CCS certification with a minimum of 2 years coding experience will be considered.
• Certification as a Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS) is required. New graduates must obtain certification as Registered Health Information Technologist (RHIT), or Registered Health Information Administrator (RHIA) within 12 months of hire date.
• One to three years’ previous experience using ICD10-CM, ICD10 PCS and CPT-4 coding systems is required.
• Demonstrated ability to meet productivity and quality standards is required.
• Keyboard entry skills are required.

The Benefits of Working at Munson:

• Eligible for a $2,500 Sign on Bonus
• Competitive salaries
• Full benefits, paid holidays, and paid time off (up to 19 days your first year)
• Tuition reimbursement and ongoing educational opportunities
• Retirement savings plan with employer match and personal consulting
• Wellness plans, an employee assistance program and employee discounts