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Title: Payer Operations Specialist (Remote)

Location: US

Type: Contract

Job Description:

About Carda

Rehab is a pain. So much so that only 10% of qualifying Cardiac and Pulmonary patients attend. At Carda Health, we’ve reimagined rehab. Our program allows patients to complete inspiring, convenient, life-saving therapy remotely.

Who are we?

We are a team of clinicians, data scientists, mathematicians and repeat entrepreneurs. And a few recovering financiers. Our belief is that technology and data, when applied to the right problem, transforms people’s lives and changes even the most entrenched industries. Carda was founded by Harry and Andrew, two friends from Wharton who share a family history of heart disease and experience with poor access to care. We now work with some of America’s largest and top-ranked hospitals and most innovative insurers. We are fortunate to be backed by some of the best investors in the business who have also backed the likes of Livongo, Hinge, Calm, MDLive, and others.

Who are you?

You are motivated by the prospect of working at a fast-growing start-up. You are excited about the details but able to connect them back to bigger company goals. You are passionate about enabling others to do their jobs better and more efficiently – in this case expanding access to life-changing therapies. If you exhibit one characteristic above all others it is that of ownership. It personally bothers you when processes don’t work and you do everything in your power to prevent this from happening. You are a great collaborator and communicator who has experience both managing teams and working across teams to implement key initiatives. You are able to complete tasks and implement processes in ? of the time of a peer.

What will you do?

The Business Operations Analyst will have executional and strategic responsibilities. You will have the opportunity to gain exposure to a myriad of experiences working at a venture backed startup from an early stage. Your primary focus or driving goal will be ensuring that revenue (insurance claims and patient collections) is maintained as well as handling any compliance concerns related to revenue and business operations. The key driver of our revenue is insurance claims so experience in Revenue Cycle Management (RCM) and a willingness to learn are critical to succeeding in this role. This role requires collaboration across the Carda team including everyone from our C-suite executives to our clinicians.

In a little more detail:

• Communicate with patients daily to clarify insurance coverage and answer billing related questions
• Work with our billing company to complete tasks on claims that fail validation
• Work with Excel to manage reporting on claims and claims operations
• Work within our EMR and homegrown practice management system to correct patient data found to be inaccurate during the claim routing or adjudication process
• Assist with insurance verification/ eligibility determination questions
• Maintain updates in our billing system(s)
• Other duties as assigned

What we look for:

• A year of experience in an administrative medical setting working with patients
• Strong interpersonal skills
• Attention to detail
• Highly organized
• Knowledge of Medicare and Medicare Advantage Plans

Sr Admin – Medical Records (Remote)

General information

Job Posting Title

Sr Admin – Medical Records (Remote)

City

Remote

Country

United States

Working time

Full-time

Description & Requirements

Maximus is currently hiring a Sr. Admin – Medical Records to support the Independent Medical Review (IMR) program.

At Maximus, we are committed to cultivating a positive and inclusive work environment, and we are pleased to offer the following:

• Comprehensive Insurance Coverage – Medical, Dental, Vision, Life insurance, and enjoy discounts on Auto, Home, Renter’s, and Pet insurance.
• Future Planning – Prepare for retirement with our 401K Retirement Savings plan and Company Matching.
• Paid Time Off Package – Enjoy PTO, Holidays, and extended sick leave, along with Short and Long Term Disability coverage.
• Holistic Wellness Support – Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP).
• Recognition Platform – Acknowledge and appreciate outstanding employee contributions.
• Diversity, Equity, and Inclusion Initiatives – Join a workplace committed to fostering ersity and inclusion.
• Tuition Reimbursement – Invest in your ongoing education and development.
• Employee Perks and Discounts – Additional benefits and discounts exclusively for employees.
• Maximus Wellness Program and Resources – Access a range of wellness programs and resources tailored to your needs.
• Professional Development Opportunities: Participate in training programs, workshops, and conferences.

Essential Duties and Responsibilities:

– Correctly identify the party from which the medical records were submitted.

– Ensure correct documents are provided to the physician reviewer and submit assigned reports accurately and timely.

– Examine case file to ensure all relevant information has been submitted.

– Review documents to determine completeness and eligibility and report identified errors appropriately and timely.

– Correctly identify non-medical records and make appropriate decision on the need for further review of these documents.

– Index hundreds of pages of medical records completely, accurately, and efficiently.

– Perform other duties as may be assigned by management.

– Perform data entry tasks with accuracy.

Minimum Requirements

– High School Diploma or Equivalent required; Associate degree preferred.

– 4 to 6 years of related experience required.

– Medical-related experience preferred.

– 2- 4 years of relevant experience in healthcare administrative customer service experience.

– Strong analytical skills

– Detail and solution oriented

– Ability to work independently

– Excellent written and oral communication skills

– Proficiency in Microsoft Office suite

Preferred Requirements

-Experience in data entry and conducting reviews for data accuracy.

Home Office Requirements

– Maximus provides company-issued computer equipment

– Reliable high-speed internet service

– Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity

– Minimum 5 Mpbs upload speeds

#NYMC #LI-Remote

EEO Statement

Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and erse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate’s education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus’s total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant’s salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.

Minimum Salary

$22.00

Maximum Salary

$22.00

Centralized Coding Specialist – Remote-7410-7798

Pacific Medical Data Solutions

Description

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

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

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

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

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

The Centralized Coding Specialist will spend the bulk of their time making sure that their clients are fully supported from a charge entry, coding, and billing perspective. You will be responsible for reviewing a patients medical record after a visit and translating the information into codes that insurers use to process claims.

You will make sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations, complying with medical coding guidelines and policies. Following up and clarifying any information that is not clear.

Clearinghouse knowledge and working experience is also a plus You would be working in a team environment with guidance from the Manager Coding and Integrity. This position also works closely with the AR department for coding related issues.

Perform Evaluation and Management coding, procedure, ICD-10 and HCPC quality reviews as well as other projects related to physician coding compliance. Demonstrates a thorough understanding of complex coding, and reimbursement, as they relate to physician practices and clinic settings.

Keeps informed regarding current coding regulations, professional standards and company/department policies and procedures and effectively applies this knowledge.

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

Qualifications

ESSENTIAL FUNCTIONS

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

Other Functions

1. Maintains regular and predictable attendance.

2. Performs other essential duties as assigned.

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

Education:High school diploma or equivalent required.Bachelors Degree preferred or equivalent experience

Experience:3-5 years of medical coding experience

License or Certification:

This position requires credentialing through AHIMA, and/or AAPC

The following certifications are accepted:

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

Skills and Abilities:

• This position requires an understanding and knowledge of physician documentation requirements in a clinic setting to capture patients acute and chronic conditions
• Ability to create and follow written procedure.
• Ability to provide professional written communication and excellent customer service.
• Technical proficiency with computers, basic Microsoft software, and medical software systems (PM/EHR)
• Strong organizational skills
• Excellent communication skills and ability to work in a team environment.
• Strong technical and computer skills (PM/EHR Software, Excel, Outlook, MS Office, Web)
• Ability to learn new systems, software, and client specialties quickly.
• Self-starter with little to no supervision

Benefits

At Lifepoint, our Mission of Making Communities Healthier extends to our employees. We offer an excellent total compensation package, including a competitive salary and benefits. Some of our benefits include 401k, flexible PTO, generous Employee illness benefit (EIB), medical, dental, vision, tuition reimbursement, and an Employee Assistance Program.

We believe that happy, healthy people have a passionate engagement with life and work and have designed our package to enhance your wellbeing.

We also offer a flexible, remote work environment.

Pay range:$23-25/hour DOE Thefinal agreed upon compensation is based on inidual education, qualifications, experience, and work location. This position is bonus eligible.

Primary LocationColorado-Denver

ScheduleFull-time

Work ScheduleDay shift, 7-10 hr/shift, weekdays only

Clinical Nursing Coordinator

Fully Remote • Remote Worker – N/A

Description

From Intake to Outcomes, CareMetx is dedicated to supporting the patient journey by providing hub services, innovative technology, and decision-making data to pharmaceutical, biotechnology, and medical device innovators.

Clinical Nursing Coordinator: Job Description

POSITION SUMMARY:

The RN in this role is responsible for providing and documenting call center services for patients with rare or chronic disorders, on behalf of manufacturer clients. These clients, secured by CareMetx, provide specific guidelines for required nursing services. Nurse Educators do not provide medical advice or work clinically within this role, and do not interact directly with healthcare providers or offices. The nurse reports to the Sr. Director Operations.

PRIMARY DUTIES AND RESPONSIBILITIES:

1. Ability to work in call center environment, utilizing computer equipment, hardware and software, to successfully execute all job responsibilities
2. Executes assigned responsibilities as agreed upon by the manufacturer client and company leadership
3. Educates patients, physicians and families on prescribed, FDA approved therapies, according to manufacturer client needs and requirements
4. Utilizes reviewed and approved call scripts for communicating key messaging to patients?
5. Provides HIPAA compliant feedback and analysis to the manufacturer client as contractually required
6. Adheres to and is compliant with mandatory HIPAA requirements
7. Adheres to all company policies and procedures
8. Effectively communicates with patient, family, provider, manufacturer and team members
9. Responsible for maintaining required nursing licenses and relevant certifications?
10. Ability to manage time efficiently and prioritize job responsibilities?
11. Conveys a strong professional image and positive attitude at all times
12. Performs related duties as assigned.

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

1. Active RN licenses must be free of disciplinary actions and/or restrictions?
2. Minimum of 2 + years nursing experience
3. Consideration will be given to RN’s living in Nursing Licensure Compact ‘home states’
4. Bachelor’s degree preferred; Associate’s degree commensurate with experience
5. Prior call center or telehealth nursing experience preferred

MINIUMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

1. Knowledge and familiarity with call center and telehealth processes

Knowledge of biologic therapies, specialty pharmacy, and managed care processes

Proficient in Technology: Microsoft Office – particularly Word and Excel, Zoom, MS Teams, WebEx, Salesforce, Telephone systems)

1. Excellent interpersonal skills – demonstrates initiative, problem solving skills, acts as a team player
2. Excellent oral and written communication skills
3. Excellent organizational skills – ability to prioritize and adjust to shifting priorities
4. Excellent judgment/ decision Making skills
5. Compassionate and patient-focused
6. Ability to sit for extended periods of time
7. Ability to connect to the internet from remote location, as needed
8. Ability to perform all work duties from remote location, as needed
9. Ability to perform administrative responsibilities accurately and on time
10. Willingness to work multiple US time zones as needed
11. Ability to travel for national training meetings approximately 15%
12. Ability to work independently as well as with a team
    Ability to work flexible hours, as needed?
13. Ability to perform other program and company priorities, as needed

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.

• While performing the duties of this job, the employee is regularly required to sit.
• The employee must occasionally lift and/or move up to 10 pounds.

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. The noise level in the work environment is usually moderate.

Schedule

• Must be flexible on schedule and hours
• Some travel may be required

CareMetx considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply.

At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.

CareMetx is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.

Content and Curriculum Manager, Nursing

Job Description

For more than 80 years, Kaplan has been a trailblazer in education and professional advancement. We are a global company at the intersection of education and technology, focused on collaboration, innovation, and creativity to deliver a best-in-class educational experience and make Kaplan a great place to work.

The future of education is here and we are eager to work alongside those who want to make a positive impact and inspire change in the world around them.

The Nursing Content Manager leads key content and curriculum development projects in order to revise or develop new nursing products. She or he determines the appropriate team to recruit and manage for the execution of the project and works with implementation specialists to manage projects to ensure completion is timely, obstacles are removed, and any new processes are created and documented in order to achieve success. As a subject matter expert in nursing education, the content manager also ensures the quality of the product, alignment with customer expectations, and adherence to learning science principles.

Primary Responsibilities

• Content creation and development using multiple platforms on a project-by-project basis. This includes tracking, training, and metric reporting/presenting.
• Use of situational leadership and G.R.O.W. coaching to manage and develop content developers and content specialists.
• Collaborate with Kaplan teams to keep student success the focus of our delivery efforts. This includes customer service teams (NC, AM, Contact Center, Sales), academics, learning science, marketing, publishing, and technology.
• Actively pursue opportunities to continue to learn best practices in product development through research, professional development, and alternate learning opportunities. Sharing your learning with the team and broader KNA through thought leadership activities.

Education & Experience

• MSN in Nursing (required)
• 5+ years in nursing education and content development
• Considerable knowledge of current literature, trends, and developments in the design and development of nursing education/products.
• Excellent computer (Microsoft Office & Google Suites) and presentation skills.
• Open-minded team player with a positive attitude, sense of humor, energy, and dedication to collaborate and learn new systems/platforms/processes for authoring/reporting.
• Understanding and ability to provide training and assistance to internal team members with content development, platform/software usage, and navigation of Kaplan sites.
• Strong communication, public relations, and interpersonal skills for effective oral and written communication. Including the ability to develop/implement policy and procedures.
• Ability to provide leadership and supervise the planning, development, and establishment of new, modified, and/or improved projects. Including goal setting, research, data analysis, promotion, scoping, and independently prioritizing toward a deadline.

Preferred Qualifications

• DNP or PhD in Nursing or Education (preferred), Specialty/Certification (in nursing, instructional design, leadership, project management, and/or education).

We offer a competitive benefits package including:

Remote work provides a flexible work/life balance

Comprehensive Retirement Package automatically enrolled in The Company Contribution Plan (8-10% annual company contribution based on tenure)

Our Gift of Knowledge Program provides tuition assistance and substantial discounts for our employees and close family members

Competitive health benefits and new hire eligibility start on day 1 of employment

Generous Paid Time Off includes paid holidays, vacation, personal, and sick paid time-off, plus one (1) volunteer day and one (1) ersity and inclusion day to participate and give back to our local communities

And so much more!

For full-time positions, Kaplan has two Salary Grades, this position is a Salary Grade B: $64,000 – $202,600. Actual compensation for this role is determined by several factors including but not limited to job level, candidate’s skills, experience, and education, among other factors determined by the business.

#LI-DK1

#LI-Remote

Location

Remote/Nationwide, USA

Additional Locations

Employee Type

Employee

Job Functional Area

Content/Material Creation

Business Unit

00092 Kaplan Health

At Kaplan, we recognize the importance of attracting and retaining top talent to drive our success in a competitive market. Our salary structure and compensation philosophy reflect the value we place on the experience, education, and skills that our employees bring to the organization, taking into consideration labor market trends and total rewards. All positions with Kaplan are paid at least $15 per hour or $31,200 per year for full-time positions. Additionally, certain positions are bonus or commission-eligible. And we have a comprehensive benefits package, learn more about our benefits here.

Diversity & Inclusion Statement:

Kaplan is committed to cultivating an inclusive workplace that values ersity, promotes equity, and integrates inclusivity into all aspects of our operations. We are an equal opportunity employer and all qualified applicants will receive consideration for employment regardless of age, race, creed, color, national origin, ancestry, marital status, sexual orientation, gender identity or expression, disability, veteran status, nationality, or sex. We believe that ersity strengthens our organization, fuels innovation, and improves our ability to serve our students, customers, and communities. Learn more about our culture here.

Kaplan considers qualified applicants for employment even if applicants have an arrest or conviction in their background check records. Kaplan complies with related background check regulations, including but not limited to, the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. There are various positions where certain convictions may disqualify applicants, such as those positions requiring interaction with minors, financial records, or other sensitive and/or confidential information.

Kaplan is a drug-free workplace and complies with applicable laws.

Title: Medicare Nurse Reviewer

Location: United States

Job Description:

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

Under limited supervision, the Medicare Nurse Reviewer applies medical necessity guidelines in making authorization determinations for inpatient admissions, concurrent, and retrospective reviews in collaboration with physician reviewers. Applies evidence-based discharge planning so that patients have a safe and timely transition to next appropriate level of care.

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

Responsibilities

• Evaluates clinical information using established national decision support criteria, company policies, and inidual patient considerations to ensure the provisions of safe, timely, and appropriate covered healthcare services.
• Independently conducts basic to complex post-acute care admissions, concurrent, and retrospective reviews, including skilled nursing facility, acute physical rehabilitation, and long-term acute care hospitals, to ensure compliance with criteria guidelines, member eligibility, benefits and contracts.
• Plans, implements, and documents, discharge planning activities based on the members’ specific clinical condition, health plan benefits, and optimal care delivery. Acts as a resource to the provider community, explaining processes for accessing the Company’s website to identify network providers for next level of care and post-discharge follow-up care
• Promotes effective resource management by directing member care to accessible cost-effective post-acute network providers and services at appropriate level of care. Coordinates with other Pharmacy and Care Management departments to facilitate the timely provision of covered health care services.
• Participates with designated external vendors and Assistant Medical Directors, social workers and case managers to determine potential high dollar member costs, discharge planning interventions that ensure delivery of consistent and quality health care services.
• Keeps up to date on utilization management regulations, policies and practices.
• If assigned to Preceptor/Trainer task: Orients, trains and provides guidance to more junior or less experienced staff. Supports implementation of new procedures, processes or clinical systems.
• Performs other duties as assigned.

Qualifications

• Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor’s degree preferred.
• 3 years as a Registered Nurse with a combination of clinical and or utilization/case management experience, preferably in the health insurance industry.
• Acute inpatient level of care in Medical/Surgical/Critical Care/ ambulatory care experience preferred.
• Registered Nurse with current State of Ohio unrestricted license.
• Intermediate Microsoft Office skills and proficiency navigating windows and web-based systems.
• Knowledge of, and the ability to apply fundamental concepts related to HIPAA compliance and related regulations.
• Knowledge of clinical practices and efficient care delivery processes.
• Ability to occasionally travel offsite for on-going training.
• Ability to occasionally work weekends and extended hours as needed.

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

A Great Place to Work:

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

Excellent Benefits and Compensation:

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

An Investment in You:

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

About Medical Mutual:

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

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

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

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

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

#LI-REMOTE

Healthcare Revenue Cycle SNF Billing Consultant II

Job Locations: US

Job ID

2024-6404

Category

Consulting

Remote

Yes

At Wipfli, people count.

At Wipfli, our people are core to everything we do—the catalyst behind our ability to create exceptional impact and extraordinary results.

We believe in flexibility. We focus on relationships. We encourage each inidual to follow their own path.

People truly matter and they feel it. For those looking to make a difference and find a professional home, Wipfli offers a career-defining opportunity.

Join Wipfli as a Healthcare Revenue Cycle SNF Billing Consultant II, guiding clients through the complexities of optimizing financial performance. By collaborating with cross-functional teams, this role supports Skilled Nursing and Senior Living clients in streamlining their revenue processes and enhancing operational efficiencies, making an impact on financial strategies and solutions.

Responsibilities:

• Conduct revenue cycle assessments and provide actionable insights for enhancement.
• Research, analyze, and resolve complex cases and problem accounts.
• Develop good working relationships with clients to maintain and provide ongoing service to them.
• Lead a small group of associates on day to day outsourced billing engagements.
• Assists in developing strategies to improve overall revenue performance.
• Ability to balance projects simultaneously.
• Ability to work under pressure and time deadlines.
• Ability to analyze data and recommend solutions.
• Ability to travel to client sites as needed.

Qualifications:

• Bachelor’s Degree
• Two to three years of years’ work experience in a professional services firm or three+ years of private industry experience focused on healthcare.
• Healthcare revenue cycle and denial management experience required.
• Experience with SNFs and senior living facilities required.
• Experience with home health and hospice preferred.
• Working knowledge of UB-04 and HCFA-1500 required.
• Experience with multiple EHR systems; PCC, Matrix, and/or ECS preferred.
• Proficient in Word, Excel, and Outlook.

Cheyenne Lee, from our recruiting team, will be guiding you through this process. Visit her LinkedIn page to connect!

Wipfli is an equal opportunity/affirmative action employer. All candidates will receive consideration for employment without regards to race, creed, color, religion, national origin, sex, age, marital status, sexual orientation, gender identify, citizenship status, veteran status, disability, or any other characteristics protected by federal, state, or local laws.

Wipfli is committed to providing reasonable accommodations for people with disabilities. If you require a reasonable accommodation to complete an application, interview, or participate in our recruiting process, please send us an email at [email protected].

Wipfli supports equal pay for equal work and values each candidate’s unique experiences and skill sets. The estimated pay range for this position is: $54,000.00 to $90,000.00. Compensation within the range is determined by a variety of factors including, but not limited to, location, iniduals’ skills, experience, training, licensure and certifications, business needs and applicable employment laws.

Iniduals may be eligible for an annual discretionary bonus, subject to participation rules and based on a variety of factors including, but not limited to, inidual and Firm performance. Wipfli cares about our associates and offers a variety of benefits to support their well-being. Highlights include 8 health plan options (both HMO & PPO plans), dental and vision coverage, opportunity to enroll in HSA with potential Firm contribution and an Employee Assistance Program. Other benefits include firm-sponsored basic life and short and long-term disability coverage, a 401(k) savings plan & profit share as well as Firm matching contribution, well-being incentive, education & certification assistance, flexible time off, family care leave, parental leave, family formation benefits, cell phone reimbursement, and travel rewards. Voluntary benefit offerings include critical illness & accident insurance, hospital indemnity insurance, legal, long-term care, pet insurance, ID theft protection, and supplemental life/AD&D. Eligibility for all benefits programs is dependent on annual hours expectation, position status/level and location. Wipfli offers flexibility for many positions to be performed remotely; please discuss your work preferences with your recruiter during the interview process.

#LI-CL2 #LI-remote

Part Time Case Manager RN

Job Locations: US-Remote

Job ID

2024-3583

Category

Care Management

Type

Regular Part-Time

Overview

Now is the time to join us!

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

Responsibilities

Who are you?

We are seeking Case Manager RN to join our team on a part-time basis, working up to 29 hours per week. In this role, you will provide telephonic case management between providers, patients and caregivers to help ensure cost-effective, high-quality healthcare for health insurance plan participants. This position offers flexibility and is ideal for candidates looking for reduced hours while making an impact within the team.

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

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

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

Qualifications

What you bring to the Personify Health team:

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

• Graduation from an accredited RN program and possession of a current California RN license.
• Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience.
• Prefer case management experience, emergency room, critical care background or some other area of clinical care that is pertinent to case management.

You also take pride in offering the following Core Skills, Competencies, and Characteristics:

• Knowledge of medical claims and ICD-10, CPT, HCPCS coding.
• Ability to critically evaluate claims data and determine treatment plan; discharge planning experience.
• Ability to work independently making decisions and problem solving
• Knowledge of community resources and alternate funding programs.
• Computer proficiency or working knowledge of Microsoft Office Suite.
• Excellent interpersonal, communication and negotiation skills.
• Strong customer orientation.
• Good time management skills and highly organized.

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

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

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $32.00 to $38.00. Note that compensation may vary based on location, skills, and experience.

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

#LIRemote

#WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded

Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to [email protected]. All of our legitimate openings can be found on the Personify Health Career Site.

Application Deadline: Open until position is filled.

Remote Multispecialty Surgery Coder III

locations

US – Remote (Any location)

Full time

Job Family:

Health

Travel Required:

None

Clearance Required:

Ability to Obtain NACI

The Multispecialty Surgery Coder III will Code for Multispecialty Surgery physicians primarily Single Path Coding. Multi-specialty surgical coding experience, any Trauma, Urology, ENT, Plastics, GenSurg, OB/GYN, Cardiovascular, Interventional Radiology, etc. Ability 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 as and 100% remote.

Responsibilities:

• Demonstrates the ability to perform quality surgical coding and multispecialty chart types as assigned.

• Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing. • Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards. • Achieves and maintains 95% accuracy in coding while maintaining a high level of productivity. Accuracy will be monitored during monthly reviews either within the facility. • Ability to maintain average productivity standards as follows • Works the review queue daily to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary. • Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process. See re-bill policy in facility guidelines. • Coder downtime must be reported immediately to the administrative staff to ensure turnaround is met. • Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility. • Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request. • Responsible for coding or pending every chart placed in their queue within 24 hours. • It is the responsibility of the coder to notify administrative staff in the event they cannot meet the twenty-four hour turn around standard. • Coders are responsible for checking the Guidehouse email system at least every two hours during coding session. • Coders must maintain their current professional credentials while working for Guidehouse. • Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility. • Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy) • It is the responsibility of each coder to review and adhere to the coding ision policy and procedure manual content. • Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services. • Communicates problems or coding principle discrepancies to their supervisor immediately. • Communication in emails should always be professional

What You Will Do:

Demonstrates the ability to perform quality E/M coding and surgical as appropriate on assigned Hospitalist encounters.

• Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing. • Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards. • Achieves and maintains 95% accuracy in coding while maintaining a high level of productivity. Accuracy will be monitored during monthly reviews either within the facility. • Ability to maintain average productivity standards as follows • Works the review queue daily to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary. • Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process. See re-bill policy in facility guidelines. • Coder downtime must be reported immediately to the administrative staff to ensure turnaround is met. • Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility. • Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request. • Responsible for coding or pending every chart placed in their queue within 24 hours. • It is the responsibility of the coder to notify administrative staff in the event they cannot meet the twenty-four hour turn around standard. • Coders are responsible for checking the Guidehouse email system at least every two hours during coding session. • Coders must maintain their current professional credentials while working for Guidehouse. • Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility. • Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy) • It is the responsibility of each coder to review and adhere to the coding ision policy and procedure manual content. • Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services. • Communicates problems or coding principle discrepancies to their supervisor immediately. • Communication in emails should always be professional (reference e-mail policy).

What You Will Need:

• High School Diploma/GED or 3 years of relevant equivalent experience in lieu of diploma/GED, or post-high school education through a university or technical school program resulting in completion of ONE of the following:
  • Successful completion of an American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) coding certification preparation course for professional services or facility coding that includes medical terminology, anatomy and physiology, health information management concepts, and pharmacology
  • Successful completion of a training course beyond apprentice level for medical technicians, hospital corpsmen, medical service specialists, or hospital training, obtained in a training program given by the Armed Forces or the U.S. Maritime Service under close medical and professional supervision.
• One of the following recognized professional coding certifications: Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist – Physician (CCS-P)
• 3 years Multi-Specialty Surgery Coding experience, both IP and OP coding for physician claims.
• EMR experience
• Must maintain credential throughout employment.

ONE of the following recognized professional coding certifications:

• Certified Professional Coder (CPC)
• Registered Health Information Technician (RHIT)
• Registered Health Information Administrator (RHIA)
• Certified Coding Specialist – Physician (CCS-P)
• 3 years Multi-Specialty Surgery Coding experience, both IP and OP coding for physician claims.
• EMR experience
• Must maintain credential throughout employment.

What Would Be Nice To Have:

• Certified Inpatient Coder (CIC)
• Registered Health Information Technician (RHIT)
• Registered Health Information Administrator (RHIA)
• Certified Coding Specialist (CCS)
• Recognized E&M coding certifications: Certified Evaluation and Management Coder (CEMC), or National Alliance of Medical Auditing Specialists’ (NAMAS) Certified Evaluation and Management Auditor (CEMA)
• Must be able to work independently, multi-task well and interface with all levels of personnel as well as clients
• Knowledge & experience with Federal & State Coding regulations and Guidelines to include DHA or Military Health Coding experience
• Multiple EMR and/or Practice Management systems experience
• Single path coding experience

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

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.

Title: Inpatient Coder

Location: Phoenix United States

time type: Full time

job requisition id: R4392719

Job Description:

Department Name:

Work Shift: Day

Job Category: Revenue Cycle

A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you’re looking to leverage your abilities – you belong at Banner Health.

As part of the Banner Health Revenue Cycle Team, there are opportunities within that team. We specialize in Inpatient coding on the facility side. We do not do pro-fee coding. We are a team of 4 Inpatient Coding Managers who cover for each other and report to the Director of Acute Care Coding. These positions offer opportunities for growth both within the coding department, including roles such as Coding Educator, Coding Quality Analyst and supervisory/management opportunities. Additionally, as part of the Revenue Cycle team, there are opportunities within that team as well.

Looking for a motivated, experienced Inpatient Facility | Acute Care | HIMS Coder -Remote | Medical Coder, with CPC or CCS and/or RHIT or RHIA Certifications, to join our talented Acute Care HIMS Coding Team. Candidate should have experience coding all service lines including, but not limited to; Trauma, ICU, Cardiac, Transplant, Orthopedics, High-Risk OB, NICU, and more. Must have ICD-10-PCS coding experience. Ideally 1 or more years of experience coding in a facility coding setting (physician or pro-fee coding for IP is not considered part of the required experience coding facility inpatient accounts). We use the number of accounts for specific patient types and specialties in combination with the Case Mix Index and case financial information to formulate Banner productivity standards, which are currently more stringent than most national standards identified. Quality standards are set at a DRG accuracy rate of 95% or higher among other quality measures. Meeting Accounts Receivable goals supports Banner Financial goals. In all of our Inpatient Coding roles, there is a Coding Assessment given after each successful interview. Banner Health provides your equipment when hired. You will be fully supported in during initial training by both the Banner Coding Education team and your hiring manager, with continued support throughout your career here!

This is a fully remote position and available if you live in the following states only: AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, MD,MI, MN, MO, MS, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WV, WA, WI & WY.

The hours are flexible as we have remote Coders across the Nation. Generally any 8 hour period between 7am – 7pm can work, with production being the greatest emphasis.

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

POSITION SUMMARY

This position provides coding and abstracting for lower tiered complexity range of acute care services at all Banner hospitals. Reviews diagnosis and diagnostic information and codes and abstracts diagnoses and/or procedures on inpatient records using ICD CM and PCS coding classification systems. Completes MS-DRG and APR-DRG assignments on inpatient records as appropriate. Ensures ethical and accurate coding in accordance with all regulatory requirements and AHIMA Standards of Ethical Coding.

CORE FUNCTIONS

1. Analyzes medical information from medical records. Accurately codes diagnostic and procedural information in accordance with national coding guidelines and appropriate reimbursement requirements. Consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes. Provides timely and accurate coding in accordance to department specific productivity and quality standards thorough assignment of ICD CM and PCS codes, MS-DRGs, APR-DRGs and POAs for lower tiered complexity range of acute care services at all Banner hospitals.
2. Abstracts clinical diagnoses, procedure codes and documents other pertinent information obtained from the patient encounter. Seeks out missing information and creates complete records, including items such as disease and procedure codes, discharge disposition, date of surgery, attending physician, consulting physicians, surgeons and anesthesiologists. Refers inconsistent patient treatment information or documentation to coding support tech, coding quality analyst or coding manager for clarification/additional information for accurate code assignment.
3. Provides quality assurance for medical records. For all assigned records and/or areas assures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards.
4. Works under general supervision. Uses specialized knowledge for accurate assignment of ICD-CM and PCS and MS-DRG or APR-DRG codes according to national guidelines.

MINIMUM QUALIFICATIONS

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

Requires Certified Coding Specialist (CCS) or Certified Outpatient Coder (COC) or Certified Professional Coder (CPC) or Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) or other appropriate coding certification in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).

Requires one year of coding experience in Acute Care inpatient facility or healthcare system.

Must demonstrate a level of knowledge and understanding of ICD-CM and PCS coding principles as recommended by the American Health Information Management Association coding competencies.

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

PREFERRED QUALIFICATIONS

Associates degree in a job-related field or experience equivalent to same.

Previous experience in large, multi-system healthcare organization.

Additional related education and/or experience preferred.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

PRN Corporate Coder

Location: Dallas United States

Job ID: 2403035697-0

Facility: Other Staff

Job Description:

Tenet Healthcare has immediate needs for remote, home-based Corporate Coders to support the hospital business. Corporate Coders can be based anywhere in the country with home internet access.

The Corporate Coder (“CC”) functions under the direction of the Health Information Corporate Coding Manager. The CC is responsible for accurate coding and abstracting of clinical information from the medical record. The CC is responsible for maintaining standards for coding data quality and integrity, as well as productivity within established guidelines. The CC is responsible for coding of Tenet facilities as assigned, assisting with productive coding to maintain DNFC, assisting with quality chart reviews, assisting with the training of new CC’s and/or other projects where indicated.

• Accurately and productively code/abstract patient health documentation for Tenet facilities.
• Utilize coding abilities to review flagged cases, in CARDS and RevInt for coding accuracy.
• Assisting in coding quality reviews/audits and second level reviews as needed.
• Attends Tenet coding educations and maintains coding credentials.

Required:

• Associates or higher-level degree in a Health Information Management discipline.
• 1-3 years inpatient coding experience.
• Skilled and working knowledge of MS Office suite.
• Strong technical background and electronic medical record experience.
• Successful completion of at least one AHIMA (American Health Information Management Association) certified program with achievement of the correlating professional credential preferred (RHIA, RHIT, and / or CCS, etc.).

Preferred:

• Bachelor’s or higher-level degree in a Health Information Management discipline.
• 3+ years of inpatient coding experience.
• Coding experience in a large, complex health system.

A pre-employment coding proficiency assessment will be administered.

Compensation

• Pay: $26.40 to $39.00 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Observed holidays receive time and a half.

Benefits

The following benefits are available, subject to employment status:

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

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

#LI-DM4

2403035697

Registered Nurse Care Manager

Remote, United States

Interwell Health is a kidney care management company that partners with physicians on its mission to reimagine healthcare—with the expertise, scale, compassion, and vision to set the standard for the industry and help patients live their best lives. We are on a mission to help people and we know the work we do changes their lives. If there is a better way, we will create it. So, if our mission speaks to you, join us!

Are you passionate about making a real difference in the lives of patients with chronic kidney disease? As an RN Care Manager, you’ll empower members to manage their health, offering personalized support that helps slow disease progression and minimize the need for costly interventions. In this role, you’ll collaborate with healthcare providers, dialysis teams, and other professionals to create inidualized care plans, educate patients, and coordinate their transitions to dialysis. Your work will primarily be telephonic, using motivational interviewing to engage patients in their care and reduce hospitalization risks. We’re looking for empathetic, proactive problem-solvers with strong communication skills and the ability to adapt in a fast-paced environment. Join us in delivering high-quality care while contributing to program improvements and impactful initiatives.

Note: This position is 100% remote, with multiple openings available! Candidates outside the Eastern Time zone must be willing to work Eastern Time hours.

What you will do: 

• Collaborate with clinical and non-clinical staff and other members of the patient’s health care team to develop inidualized interventions to meet the member’s current needs.
• Communicate and coordinate with the member and appropriate members of the patient’s health care team in developing, executing, and reviewing results of care coordination efforts.
• Utilize motivational interviewing techniques to influence members to engage in their own care.
• Collaborate with providers and members to ensure an optimal and successful transition from chronic kidney disease to dialysis.
• Partner closely with providers and dialysis clinics to identify and mitigate hospitalization and mortality risk for members.
• Participate in quality improvement activities and project-based work including practice, clinic, and community-based education initiatives.
• Evaluate program processes and make recommendations to management that will improve the effectiveness and efficiency of the program.

What you will need: 

• Registered Nurse (RN) required with active unrestricted licensure in practicing state, with a willingness to obtain additional state licensures as needed; a clear and active Nurse Licensure Compact (NLC) is also required
• Associate Degree in Nursing (ADN) required; Bachelor of Science in Nursing (BSN) preferred.
• 2 to 5+ years of Nephrology Nursing and/or Case Management experience, with experience in a role related to patient education and/or case management preferred.
• Must have knowledge of teaching-learning process, principles, and methods of adult education.
• Proven understanding of renal and diabetes disease process and current management practices.
• Familiarity with telehealth platforms and electronic health records (EHRs).
• Demonstrated knowledge of healthcare regulations, including HIPAA, with a strong commitment to patient confidentiality and ethical care.
• Excellent communication and interpersonal skills, with the ability to establish rapport and convey empathy over the phone, as well as proficiency with explaining complex medical information in simple terms
• Empathetic and culturally competent, able to quickly build trust and maintain a patient-centered approach with erse populations.
• Ability to prioritize tasks, manage workload, and adapt to rapidly changing situations and patient needs.

Our mission is to reinvent healthcare to help patients live their best lives, and we proudly live our mission-driven values:

– We care deeply about the people we serve.

– We are better when we work together. – Humility is a source of our strength. – We bring joy to our work. – We deliver on our promises.

We are committed to ersity, equity, and inclusion throughout our recruiting practices. Everyone is welcome and included. We value our differences and learn from each other. Our team members come in all shapes, colors, and sizes. No matter how you identify your lifestyle, creed, or fandom, we value everyone’s unique journey.

Oh, and one more thing … a recent study shows that men apply for a job or promotion when they meet only 60% of the qualifications, but women and other marginalized groups apply only if they meet 100% of them. So, if you think you’d be a great fit, but don’t necessarily meet every single requirement on one of our job openings, please still apply. We’d love to consider your application!

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.

Title: Inpatient Coder Senior Associate

Location: Remote – USA

Job Description:

Clover is reinventing health insurance by working to keep people healthier.

The Payment Integrity team is a group of innovative thinkers sitting at the intersection of Clover’s provider Network, Claims, and Tech teams. The Payment Integrity team ensures that Clover pays claims in an accurate manner, with a particular focus on reducing inappropriate medical spend.

As a Senior Associate – Inpatient Coder for Payment Integrity at Clover Health, you will play a key role ensuring that Clover is able to continue to build and scale a compliant, efficient and profitable program. You will work to ensure quality assurance standards and regulatory policy are reflected in claims processing practices. You will help drive value for every member by ensuring that Clover’s medical claims are paid accurately and recovering overpayments when they are identified. The Senior Associate – Inpatient Coder monitors and coordinates the identification of provider DRG denials and upcoding.

As an Inpatient Coder Senior Associate, you will:

• • Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues on a prospective and retrospective basis that drive inaccurate payments to providers.

• • Proactively identify overpayments to ensure accurate claims payments on all inpatient services.

• • Prepare response letters to deliver our decisions to members and/or providers within the regulatory timeframes set forth by the Centers for Medicare & Medicaid Services (CMS).

• • Act as a subject-matter expert for cross-functional clinical reviews: digest complex concepts and regulations and communicate them effectively to different stakeholders, including senior-level leadership.

• • Research and respond to external auditor concerns/questions regarding the completeness and accuracy of data creation and integration.

• • Work closely with data scientists, engineers and operational teams to create sustainable and scalable solutions.

• • Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams.

• • Identify and review potential program efficiencies and opportunities.

• • Continue to analyze existing policies to ensure accuracy and proper execution.

• • Communicate effectively both internally and externally to ensure accurate claims adjudication and proper provider notification.

You will love this job if:

• • You want to make an impact. You thrive off of helping others, and want your work to make a difference in our members’ lives.

• • You are a team player. You enjoy partnering with others, and want to work collaboratively to find new solutions.

• • You are a strong communicator. You have strong verbal and written communication skills that foster trust, knowledge sharing, and progress.

• • You are detail-oriented. You pay attention to the small things, while understanding how they fit into the bigger picture.

• • You are motivated to learn. There is no shortage of technical, clinical, and operational skills to learn at Clover.

You should get in touch if:

• • You hold a CCS certification or similar inpatient coding certification; required

• • You have a deep knowledge and understanding of DRG pricing methodology; required.

• • You have current or previous nursing or firsthand clinical experience; preferred.

• • You have 5+ years of experience in clinical coding; preferred

• • You have Medicare or Medicare Advantage payment integrity or claims operations experience; preferred

• • You are technologically savvy with strong computer skills in Excel and PowerPoint.

• • You have knowledge of statistical methods used in the evaluation of healthcare claims data and SQL a plus.

Benefits Overview:

• • Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.

• • Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.

• • Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, company holidays, access to mental health resources, and a generous flexible time-off policy.

• • Professional Development: We are committed to developing our internal talent. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.

Additional Perks:

• • Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities

• • Reimbursement for office setup expenses

• • Monthly cell phone & internet stipend

• • Remote-first culture, enabling collaboration with global teams

• • Paid parental leave for all new parents

• • And much more!

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we’ve created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven iniduals with erse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people’s lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone’s responsibility.

#LI-Remote

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

For California, Colorado, New Jersey, New York, or Washington residents, a reasonable estimate of the base salary range for this role can be found below. For candidates residing in other geographic areas, the range will be adjusted based on location. Final pay is based on several factors including but not limited to internal equity, market data, and the applicant’s education, work experience, certifications, etc.

Colorado/Washington Pay Range

$64,000 – $89,000 USD

California/New Jersey/New York Pay Range

$64,000 – $99,000 USD

Title: CODING SPECIALIST II – Remote – FT Days

Location: United States

Category: Health Information Management

Job Id: 00548737

Job Description:

Employment Type: Full time

Shift: Day Shift

If you are looking for a remote Coding Speicalist position, this could be your opportunity. Here at St. Peter’s Health Partner’s, we care for more people in more places.

Position Highlights:

Quality of Life: Where career opportunities and quality of life converge

Advancement: Strong orientation program, generous tuition allowance and career development

Work/Life: M-F 8am – 4:30pm with the option to flex time.

What you will do:

The Coding Specialist II analyzes physician/provider documentation contained in health records (electronic, paper or hybrid) to determine the principal diagnosis, secondary diagnoses, principal procedure and secondary procedures.

Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of Internal Classification of Diseases, Clinical Modification diagnosis and procedure codes, and Current Procedural Terminology / Healthcare Common Procedure Coding System (HCPCS) procedure codes and all required modifiers

What you will need:

Two years of current E&M Coding Experience

Completion of an AHIMA-approved coding program or an AAPC-approved coding program, or

Associate’s degree in Health Information Management or a related field or an equivalent combination of years of education and experience is required.

Certified Coding Specialist (CCS), Certified Procedural Coder (CPC), Registered Health Information

Technologist (RHIT), or Registered Health Information Administrator (RHIA) is required.

Current experience utilizing encoding/grouping software is preferred. Ability to utilize both manual and automated versions of the ICD and CPT coding classification systems is preferred.

Ability to use a standard desktop and windows based computer system, including a basic understanding of e-mail, internet, and computer navigation. Ability to use other software as required to perform the essential functions on the job. Familiarity with distance learning or using web-based training tools desirable.

Well-developed written and oral communication skills that may be used either on-site or in virtual working environments. Ability to communicate effectively with iniduals and groups representing erse perspectives.

Ability to work with minimal supervision and exercise independent judgment.

Ability to research, analyze and assimilate information from various on-site or virtual sources based on technical and experience-based knowledge. Must exhibit critical thinking skills and possess the ability to prioritize workload.

Excellent organizational skills. Ability to perform multiple duties and functions related to daily operations and maintain excellent customer service skills. Ability to perform frequent detailed tasks and provide immediate service with frequent interruptions. Ability to change and be flexible with work priorities. Strong problem-solving skills.

Must be comfortable functioning in a virtual, collaborative, shared leadership environment.

Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of CHE Trinity Health.

Pay Range:$21.20 – $29.15

Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.

Our Commitment to Diversity and Inclusion

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

Title: Remote Psychiatric Mental Health Nurse Practitioner (W2, Full-Time)

Location: Orlando United States

Job Description:

Job description

Brave Health is on a mission to expand access to high-quality, affordable care for behavioral health conditions. We utilize the power of technology to eliminate barriers and expand access to high quality mental health and substance use disorder treatment. Through telehealth services we are able to reach those in need, when and where they need it. As a community based start-up, our goal is to make quality mental health services accessible for all.

We are looking for full-time Psychiatric Mental Health Nurse Practitioners to join our team and provide outpatient services through our telehealth program!

Benefits: Our team works 100% remotely from their own homes!

Compensation range – $125,000 to $130,000 plus quarterly bonuses ($1,000 to $10,000)

• W2 full-time positions
• Compensation package includes a base plus bonus!
• Monday – Friday schedule; No weekends!
• Liability insurance coverage and annual stipend for growth and education opportunities
• We not only partner with commercial health plans, but are also a licensed Medicaid and Medicare provider and see patients across the lifespan

Requirements: Brave PMHNP’s may be based anywhere in the US, but must have an active Florida license to get started.

• 2 years experience practicing as a Nurse Practitioner
• Experience in Addiction and Mental Health
• Currently holds a Psychiatric Mental Health certification (PMHNP) in Florida
• Eligibility to work in the United States. We are not able to provide or assist with visas or attaining work eligibility
• Open to obtaining additional state licesnure
• Fluency in English; Spanish preferred, proficiency in other languages a plus

Skills:

• Willingness to work in partnership with the client to achieve goals
• Experience working with adults in need of mental health and/or substance abuse treatment.
• Knowledge of mental health and/or substance abuse diagnosis. Diagnostic skills.
• Treatment planning
• Ability to utilize comprehensive assessments.
• Timely and quality documentation; experience with EHRs.
• Adaptable to technology, including telehealth software or comfortable with video communication. Experience utilizing telehealth platforms preferred.
• Awareness of and compliance with HIPAA and 42 CFR Part 2

Brave Health is very proud of the erse team we have that cares for our erse population of patients. We are an equal opportunity employer and encourage all applicants from every background and life experience without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Location: Remote, US

Type: Full Time – Regular

Workplace: remote

Category: Clinical Delivery

Job Description:

Registered Nurse

Department: Global Delivery

Level: Inidual Contributor

Work Location: Remote

______________________________________________________________________________________

What We Do

Care Access is a unique, multi-specialty network of research sites which operates as one connected team of physician investigators, nurse coordinators, and operations managers. Our goal is to engage every healthcare professional in clinical research and to make clinical trials a care option for every patient. By removing this bottleneck, Care Access is helping accelerate the approval and delivery of critical and life-saving therapies.

Who We Are

We care. Our people are the engines behind our mission: to revolutionize access to clinical trials for the benefit of patients everywhere. We care for one another, find new ideas to accelerate medicine, and seed a long-term impact for generations.

Position Overview

The Registered Nurse (RN) in this role will manage the communication of abnormal lab results to patients, ensuring compliance with state licensure requirements. This includes contacting patients, documenting communications, following up on lab escalations, and collaborating with providers to ensure all patient interactions are appropriately managed and documented. This role is critical in ensuring timely patient communication and maintaining compliance with clinical and legal standards.

What You’ll Be Working On

Duties include but not limited to:

Lab Results Management:

Receive and Review Results: Receive flagged abnormal, urgent, or critical lab results and ensure they are ready for patient communication.

Patient Communication: Contact patients to communicate abnormal lab results, ensuring focused, uninterrupted time for calls due to potential challenges in reaching patients. Follow protocols and scripts to ensure compliance. RNs must provide only legally permissible information, avoiding diagnosis or prescribing advice, as per scope of practice.

Documentation: Accurately document all communications in patient progress notes, including abnormal results, patient concerns, and follow-up actions. Ensure compliance with part-11 signature requirements and submit completed notes to the Clinical Conduct Team.

Escalation to Providers: For questions beyond the RN’s scope, escalate to a licensed, on call provider (NP/PA/MD/DO) and ensure they review and sign off on progress notes.

Retention Team Escalations: Address lab-related escalations from the Retention Team, such as result clarifications, data discrepancies, or additional test requests, and communicate resolutions back to the patient, documenting the outcome.

Physical and Travel Requirements

This is a remote position with less than 10% travel requirements. Occasional planned travel may be required as part of the role.

? PTO and On-Call Coordination: Work within a structured on-call system to ensure coverage when team members are on leave.

What You Bring

Knowledge, Skills, and Abilities:

Skills:

Excellent communication and patient interaction skills.

Strong attention to detail and ability to manage multiple patients efficiently.

Ability to work independently while collaborating with a larger clinical team.

Certifications/Licenses, Education, and Experience:

Education:

Active RN license in an NLC or non-compact state.

BSN or equivalent degree preferred.

Experience:

Minimum of 2 years of experience in clinical research, patient communication, or related field.

Proficiency in Salesforce or other EMR systems for documenting patient interactions.

Licensure Requirement: Compact licensure required, non-compact state license preferred. Willingness to maintain and obtain additional state licenses as needed. Must hold all licenses in good standing.

Compact States [42]: RNs with compact licenses can practice in all 42 states in the compact, including Alabama, Arizona, Arkansas, Colorado, Florida, Texas, and more.

Non-Compact States [8]: California, Nevada, Illinois, Hawaii, Alaska, Oregon, Minnesota, New York.

Benefits (US Full-Time Employees Only)

PTO/vacation days, sick days, holidays.

100% paid medical, dental, and vision Insurance. 75% for dependents.

HSA plan

Short-term disability, long-term disability, and life Insurance.

Culture of growth and equality

401k retirement plan

Diversity & Inclusion

We serve patients and researchers from erse cultures and communities around the world. We are stronger and better when we build a team representing the people we aim to support. We maintain an inclusive culture where people from a broad range of backgrounds feel valued and respected as they contribute to our mission. We value ersity and believe that unique contributions drive our success.

At Care Access, every day, we are advancing medical breakthroughs. We’re uniting standard patient care with cutting-edge treatments and research. Our work brings life-changing therapies to those in need and paves the way for newer and greater treatments to reach the world. We’re proud to advance these breakthroughs and work with the big players while engaging with the physicians and caring for patients.

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

Care Access is unable to sponsor work visas at this time.

Production Coding Specialist I – REMOTE

Job ID 2024-15406

Function

Revenue Cycle Management

Location

US-Remote

Employment Status

Full Time

Overview

The incumbent of this role abstracts data from the anesthesia record into the MD Cloud Practice Solutions platform, and may also work with other charge capture platforms, including Medaxion, PC7, and multiple facility EMR’s based on assigned location. This role possesses a high-level competency in ICD10 coding and coding guidelines. Coder I codes for physicians, CRNA, CAA, NP, SRNA, and residents. Coder I has familiarity with LCD/NCD and experience with CMS guidelines for coding.

At this time, US Anesthesia Partners does not hire candidates residing in New York, California, Hawaii, or Alaska.

Job Highlights

ESSENTIAL DUTIES AND RESPONSIBILITIES (include but not limited to):

• Reviews anesthesia documentation, and other forms of documentation for appropriate required elements, such as attestations, signatures, dates etc.
• Abstracts and codes surgical procedures from all sections of CPT and cross walk surgical codes to ASA.
• Comprehensive understanding of applicable
• Proficient in ICD10 coding
• Abstracts anesthesia times and
• Identifies and assigns care team
• Reviews for medical
• Meet team KPIs including, including daily production and quarterly coding audit score
• Performs other duties as
• Adheres to all company policies and procedures – especially HIPAA and

Qualifications

Knowledge/Skills/Abilities (KSAs):

• Highschool graduate or equivalent.
• CPC with 2+ years of experience in surgical coding minimum, anesthesia a plus.
• Experience with multiple EMR’s and documentation types and templates, including handwritten paper documentation, and electronic medical records.
• Basic charge capture platform experience.
• Intermediate knowledge and working experience with Microsoft Word, Excel, and Adobe PDF.
• Intermediate Outlook skills.
• Communicate well with all levels of USAP employees.
• Excellent organizational and time management skills required to complete daily assignments in a timely manner.
• Ability read, write, and speak English.
• Excellent computer skills.
• Ability to work independently.

*The physical demands described here are representative of those that may need to 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.

• Occasional Standing
• Occasional Walking
• Frequent Sitting
• Frequent hand, finger movement
• Use office equipment (in office or remote)
• Communicate verbally and in writing

DISCLAIMER: The above job description has been written to indicate the general nature and level of work performed by employees within this classification. It is not written to be inclusive of all duties, responsibilities and qualifications required of employees assigned to this job.

US Anesthesia Partners, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability (physical or mental), family medical history or genetic information, political affiliation, military service, or other non-merit based factors.

Title: Clinical Care Coordinator – Remote

Location: Mooresville United States

Position Type: Part-Time

Category: Operations

Company: Gentiva

Job Description:

Our Company

Gentiva is an industry leader in hospice, palliative, home health, and personal home care. Our place is by the side of those who need us, offering physical, spiritual and emotional support to patients and their families so they may make the most of every moment. We believe that better care for caregivers and clinicians means better care for everyone, so we offer ongoing professional training, lower nurse-to-patient ratios, and comprehensive benefits for eligible employees. Here, you’ll join gifted colleagues who make a lasting difference in people’s lives every day.

Overview

We are looking for a Remote C linical Care Coordinator to join our team. This position will directly report to the Director Contact Centerand is responsible for being highly knowledgeable regarding post-acute levels of care, and an expert regarding Gentiva services including home health, hospice, and palliative care.

The shift is

Monday 8am – 6:30pm

Tuesday 10am – 8:30pm

Thursday 10am – 8:30pm

• Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data.
• Utilize a variety of tools and methods to quickly provide patient options and education including but not limited to sites of service, specialty offerings, post-acute care, and other related questions.
• Able to navigate healthcare options, care services post-acute offerings, Medicare coverage, billing issues, as well as accessing healthcare resources.

About You

• Associate degree required. Bachelor’s degree preferred
• Registered Nurse / RN or LPN with professional licensure in a compact state preferred. May be required to obtain licensure in additional states as dictated by business needs.
• Minimum of 3 years’ post-acute experience. Home Care and hospice experience preferred
• Nursing background working across multiple areas of post-acute care.
• INTERNET REQUIREMENT: High-speed Internet connection (minimum 10 Mb/s download speed and minimum 2 Mb/s upload speed, recommended 5 Mb/s upload). Satellite based internet services are not acceptable.
• Excellent analytical and problem-solving skills.
• Ability to learn and master information related to locations and services of client.
• Outstanding computer skills.
• Good time management skills
• Good working knowledge of home health, hospice and palliative care services
• Ability to communicate effectively with empathy over the phone and while interacting with others; excellent interpersonal skills.

RN, LPN, Registered Nurse, Remote Nursing Job, Remote RN

We Offer

• Comprehensive Benefits Package: Health Insurance, 401k Plan, Tuition Reimbursement, PTO
• Competitive Salaries
• Mileage Reimbursement
• Professional growth and development opportunities

Legalese

• This is a safety-sensitive position
• Employee must meet minimum requirements to be eligible for benefits
• Where applicable, employee must meet state specific requirements
• We are proud to be an EEO employer
• We maintain a drug-free workplace

ReqID: 2024-104505 Category: Operations Position Type: Part-Time Company: Gentiva Type of Service: Hospice Only

Care Coordinator, Care Management

WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Inidual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, no matter their circumstances.

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Care Management Coordinator provides administrative and clerical support for the Care Management Department. In this role, the inidual must be able to plan, organize, and prioritize work to ensure accurate and timely completion. The Care Management Coordinator performs complex administrative functions to support a multidisciplinary team of clinicians, community-based agencies and staff, and members and caregivers. The Care Management Coordinator is a key contact and department representative and must have excellent written and verbal communication skills. This skill is critical in facilitating communication among team members as well as providers regarding referrals, authorizations, scheduling appointments, and obtaining and documenting information. Assessment scheduling, data entry and tracking are other key functions. Perform other duties as requested.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Generates and/or distributes member documents and files
• Data entry of confidential member information into multiple databases
• Generates simple reports for care management team
• Initiates and follows up on requests for provider information
• Assists in scheduling Primary Care Team meetings and exchanging information, facilitating communication among team members as needed
• Assists in managing and tracking required assessments and informing appropriate care management staff
• Schedules assessments, home visits, and other appointments as requested by the care management staff
• Data entry of assessments into member records and into State system that is timely and accurate
• Prepares materials for mailing upon request
• Answers telephone calls for department staff and takes accurate messages
• Knows when to escalate issues with staff, supervisors, providers, contracted vendors, etc. for resolution
• Performs general office duties including sorting mail, faxing, filing, photocopying, researching addresses and contact information
• Prioritizes tasks and ensures deadlines are met
• Provides excellent customer service skills
• Participates in group meetings to ensure policies, procedures and workflows are up to date and makes recommendations for process improvement
• Maintains and assists with filing systems.
• Assists in special projects and prepares materials, binders, presentations as needed
• Attends scheduled meetings and required training
• Assists with new staff training
• Regular and reliable attendance is an essential function of this position
• Maintains HIPAA standards and confidentiality of protected health information
• Other tasks as requested

Qualifications:

Experience:

• 2 years office/administrative experience particularly in a high volume office with data entry and customer service call centers

Education:

• Associate’s degree in Healthcare or business administration, or a related area or equivalent relevant work experience

Preferred/Desirable:

• Knowledge of medical terminology a plus
• Knowledge of care management software systems, claims systems (preferably Facets) for recording and obtaining information a plus
• Experience with health care databases
• Health plan/health care experience
• Bilingual skills, fluency in Spanish

Competencies, Skills, and Attributes:

• Ability to work as part of a team
• Highly organized and able to prioritize tasks with ability to meet deadlines
• Has excellent data entry skills and knowledge of Microsoft Office, in particular Word and Excel
• Excellent communication skills both oral and written
• Strong interpersonal skills and ability to work with consumers as well as professionals
• Attention to detail
• Knowledge of administrative functions and scheduling experience
• Able to work in fast-paced environment and take independent initiative

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Inidual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the ersity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Pre-Screening Coordinator

Remote, US

Full time – Temporary

Remote

What We Do

Care Access is a unique, multi-specialty network of research sites which operates as one connected team of physician investigators, nurse coordinators, and operations managers. Our goal is to engage every healthcare professional in clinical research and to make clinical trials a care option for every patient. By removing this bottleneck, Care Access is helping accelerate the approval and delivery of critical and life-saving therapies.

Who We Are

We care. Our people are the engines behind our mission: to revolutionize access to clinical trials for the benefit of patients everywhere. We care for one another, find new ideas to accelerate medicine, and seed a long-term impact for generations.

Position Overview

The Pre-Screening Lab Process Coordinator will serve as an integral part of the organization by helping to facilitate oversight of lab result process for Care Access’s Pre-Screening Program. This role will ensure that labs have resulted, reported, filed, and escalated with appropriate medical oversight.

What You’ll Be Working On (Duties include but are not limited to):

Lab Management:

· Coordinate with clinical and administrative staff, and management to ensure that all necessary labs are returned to the proper party.

· Ensure that all lab results are accurately recorded, filed in the appropriate participant’s medical record, and communicated with the Retention Team.

· Escalate abnormal lab results to the appropriate medical personnel and ensure proper medical oversight is maintained.

· Communicate with Care Access and vendor laboratories to ensure samples have properly resulted.

· Perform checks of participant data in tech systems to ensure accurate lab reporting.

· Effectively perform quality checks of teammates’ work to ensure the highest level of data quality.

· Maintain a call schedule with lab process manager for communicating needs such as medical oversight and cross functional collaboration.

· Perform duties of the role in compliance with state specific guidelines, legal, regulatory, and organizational policies.

Physical and Travel Requirements

• • This is a remote position with less than 10% travel requirements. Occasional planned travel may be required as part of the role.

What You Bring (Knowledge, Skills, and Abilities):

• • Successfully able to manage multiple sites/projects.
  • Strong organizational skills: Able to prioritize, support, and follow through on assignments.
  • Thorough knowledge of company SOPs and Care Access Project Specific process flows/ expectations
  • Good working knowledge of federal regulations, good clinical practices (GCP) especially as it relates to research laboratory processes.
  • Communication Skills: Strong verbal and written communication skills as evidenced by positive interactions with coworkers, management, clients, and vendors.
  • Team Collaboration Skills: Work effectively and collaboratively with other team members to accomplish mutual goals. Bring a positive and supportive attitude to achieving these goals.
  • Strong computer skills with demonstrated abilities using clinical trials databases and Microsoft systems.
  • Maintain a positive attitude under pressure.
  • High level of self-motivation and energy
  • Must have a client-service mentality.

Certifications/Licenses, Education, and Experience:

• • Fluent reading and writing in Portuguese
  • Will be required to work in Brazil operating hours.
  • 1 year of Clinical Research experience, clinical research laboratory experience is a plus.
  • Strong knowledge of GCP-ICH requirements and data collection in a research setting
  • Proficient in research terminology and medical (basic) terminology
  • Strength in communication, planning, and time management skills
  • Strong People Skills
  • Office/business skills and computer skills

Benefits (US Full-Time Employees Only)

• • PTO/vacation days, sick days, holidays.
  • 100% paid medical, dental, and vision Insurance. 75% for dependents
  • HSA plan
  • Short-term disability, long-term disability, and life Insurance
  • Culture of growth and equality
  • 401k retirement plan

Title: Senior Post-Award Grants Administrator

Location: Boston United States

Job Description:

This is a remote role that can be done from most US states.

The Post-Award Senior Grant Administrator (Senior GA) is an active member of the Mass General Brigham (MGB) central research management office and is a primary point of contact for Principal Investigators (PIs) and Department Administrators at Brigham and Women’s Hospital, Massachusetts General Hospital, and other institutions within the Mass General Brigham System. The Post-Award Senior GA is committed to identifying and adhering to best practices in grants and contract administration while upholding the highest standards of integrity and fiduciary responsibility. The Post-Award Senior GA will proactively address the demands of research grant administration by providing exceptional customer service to Mass General Brigham’s distinguished research community and collaborators in their pioneering efforts in science and medicine.

The Post-Award Senior GA actively and independently manages the grant-related activity of an assigned portfolio of research departments. As the primary contact for these departments, the Post-Award Senior GA provides guidance and resolves issues regarding project management once an award has been granted. Included in these responsibilities are account activation and setup, sponsor outreach and negotiation, financial analysis, and employee salary allocations. The Post-Award Senior GA will be expected to hold Institutional Signing Authority, will handle the more complex hospital departments, and will be expected to show a high level of professionalism, and the ability to represent the office both internally and externally. The Post-Award Senior GA will act both independently and as a member of a dynamic group to achieve the goals of the Post-Award team and of MGB Research Management overall. The volume and complexity of the work is commensurate with experience; and the opportunity exists to take on a greater and more in-depth workload with successful performance.

Principal Duties and Responsibilities:

• Take ownership of managing an assigned portfolio of research departments and serve as the primary Post-Award resource for department administrators and PIs.
• Field inquiries from Department Administrators and PIs, and communicates institutional policy, procedure, and documentation requirements.
• Conduct a thorough review of all award terms and conditions for all new and renewal grants and contracts for assigned workload or as triaged by the manager.
• Under the supervision of managers, assist as needed to ensure MGB compliance with terms.
• Verify compliance approvals (Human Subjects, Cost Share, Animal Use, etc.), as part of the award acceptance process.
• Upon receipt of an award, complete the system database for all new awards being funded, and continue the account setup and corresponding data entry of award information into the Insight system.
• Maintain electronic Insight records in compliance with institutional and sponsor policies.
• After award information has been entered into Insight, activate the account. Notify PI and Department Administrator once approved and activated.
• Review incoming agreement modifications to confirm that proposed changes are appropriate. Negotiate, with guidance from the manager as necessary, with sponsors.
• Draft and issue outgoing agreement modifications to collaborators with directives from PI and department.
• Communicate with department and PIs throughout the grant lifecycle and assist in the development and submission of all requests for a change of PI, change in scope of work, extension requests, and re-budgeting requests.
• Review and approve salary allocations for personnel with salaries that are directly charged to sponsored research agreements. Check to make sure all accounts are active and that the proposed changes are appropriate and allowable per the terms of the award.
• Work with assigned departments and other MGB offices, as needed, on all PI transfers.
• Conduct financial analysis for all active accounts on the assigned department portfolio.
• Work with Post-Award Manager on complex transactions.
• Use Insight, MicroStrategy, or PeopleSoft queries and reports to measure and manage workflow effectively and efficiently.
• Expected to obtain Institutional Signing Authority within six months of start date subject to manager discretion
• Assist the Manager, as delegated, in the orientation, training, and mentoring of GA I and GA II staff.
• Assist the Manager, as delegated, in the review of GA I and GA II work and the QC review of all data entered.
• Expected to handle special projects such as training new hospital administrators, giving presentations on Post-Award processes to new investigators, giving presentations at NCURA and similar meetings, Insight system improvements, etc.
• Effectively work with demanding clientele and be able to identify potential risks to the institution and escalate issues appropriately in a timely manner.
• Assist the Manager and Director, or lead, in the development and implementation of both internal and external training modules.
• Cover for Manager as needed – run and/or attend meetings, compile tracking reports, etc.
• Assume additional responsibilities as assigned.

Qualifications

• At least 3-6 years of experience in professional research administration in an academic setting (hospital, non-profit organization, or university) is preferred.
• Bachelor’s Degree in a related field is preferred.

Skills/Abilities/Competencies

• Must possess the ability to thrive in a busy, high-volume, and deadline-driven team environment that requires coordination of multiple activities and the judgment and flexibility to reprioritize tasks as needed.
• Extensive knowledge of program administration guidelines of Federal and non-federal funding agencies supporting biomedical research.
• Familiarity/experience with all types of award mechanisms, including grants, contracts, subcontracts, and cooperative agreements.
• Proficiency in Microsoft Office Suite.
• Excellent problem-solving skills.
• Excellent verbal and written communication skills.
• Requires strong organization and communication skills with a focus on customer service.

About Us:

As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We’re focused on a people-first culture for our system’s patients and our professional family. That’s why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees’ personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step.

Our employees use the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

Primary Location

MA-Boston-MGB Remote See Posting for Details

Work Locations

MGB Remote See Posting for Details

399 Revolution Drive

Somerville 02145

Job

Research Finance

Organization

Mass General Brigham

Schedule

Full-time

Standard Hours 40

Shift

Day Job

Employee Status

Regular

Recruiting Department MGB Research Management

Job Title: Survey Coder

Location: us

Job Description:

Time type: Full time

job requisition id: REQ1299

Location: Evansville IN or Remote

About this Role: As a Survey Coder, you will be part of a dynamic group tasked to maintain the best practices and quality execution of survey verbatim coding.

What You’ll Do:

· Perform verbatim review to identify adverse events

· Perform coding on verbatim comments from survey responses

· Code advertising content elements on media associated with a survey

· Create Storyboards and scripting for media associated with a survey

· Finalize and release code sheet

· Create and maintain documentation on processes, automation

· Seek ways to enhance productivity and finds efficiencies

· Communicate and build strong day-to-day working relationships clients

What You’ll Need:

· Bachelor’s Degree in Business, Social Sciences, or quantitative field or 2+ years’ experience in relevant work experience (coding of open-ended survey comments preferred)

· Working knowledge of MS Office Suite

· Strong verbal and written communication skills

· Ability to be creative in troubleshooting issues and solving problems

· Strong project management and time management skills

· Good eye for detail. Compensation: $20.00/hr

About Comscore

At Comscore, we’re pioneering the future of cross-platform media measurement, arming organizations with the insights they need to make decisions with confidence. Central to this aim are our people who work together to simplify the complex on behalf of our clients & partners. Though our roles and skills are varied, we’re united by our commitment to five underlying values: Integrity, Velocity, Accountability, Teamwork, and Servant Leadership. If you’re motivated by big challenges and interested in helping some of the largest and most important media properties and brands navigate the future of media, we’d love to hear from you.

Comscore (NASDAQ: SCOR) is a trusted partner for planning, transacting and evaluating media across platforms. With a data footprint that combines digital, linear TV, over-the-top and theatrical viewership intelligence with advanced audience insights, Comscore allows media buyers and sellers to quantify their multiscreen behavior and make business decisions with confidence. A proven leader in measuring digital and set-top box audiences and advertising at scale, Comscore is the industry’s emerging, third-party source for reliable and comprehensive cross-platform measurement. To learn more about Comscore, please visit Comscore.com.

EEO Statement: We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, disability status, sexual orientation, gender identity, age, protected veteran status or any other characteristic protected by law.

Title: Complex Coder Outpatient

Location: CO-Colorado

Job Description: **Primary City/State:**

Arizona, Arizona

**Department Name:**

Coding-Acute Care Hospital

**Work Shift:**

Day

**Job Category:**

Revenue Cycle

**Primary Location Salary Range:**

$25.54 – $38.30 / hour, based on education & experience

In accordance with State Pay Transparency Rules.

A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you’re looking to leverage your abilities – you belong at Banner Health.

Looking for a motivated, experienced **Outpatient | Acute Care | HIMS Complex Coder -Remote | Medical Coder, with CPS or CCS and/or RHIT or RHIA Certifications,** to join our talented Acute Care HIMS Coding Team. Candidate should have experience coding all service lines including, but not limited to; **Cath Lab, Interventional Radiology, and more** . Must have ICD-10CM and ICD-10-PCS coding experience. **Ideally 2 or more years of experience coding in a facility coding setting** . Our outpatient coding expectation is 1-2 charts per h while maintaining a accuracy rate of 95% or higher. We use the number of accounts for specific patient types and specialties in combination with the Case Mix Index and case financial information to formulate performance to Banner standards, which are currently more stringent than most national standards identified. Meeting Accounts Receivable goals supports Banner Financial goals. In most of our Coding roles, there is a **Coding Assessment given after each successful interview. Banner Health provides your equipment when hired.** You will be fully supported in training for anywhere from 1 month+ according to inidual need, with continued support throughout your career here!

**This is a fully remote position and available if you live in the following states only: AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, MD,MI, MN, MO, MS, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WV, WA, WI & WY.**

**The hours are flexible** as we have remote Coders across the Nation. Generally any 8 hour period between 7am – 7pm can work, with production being the greatest emphasis.

**A Coding Assessment will be given after a successful interview to be completed within 48 hours.**

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

POSITION SUMMARY

This position provides coding and abstracting for a full range of outpatient complex surgical and observation acute care services at all Banner hospitals. This includes highest level of complexity of accounts encountered in Banner’s Academic, Trauma and high acuity facilities. Reviews health record documentation and assigns diagnoses and/or surgical procedure codes on all outpatient complex records using ICD CM/PCS and CPT4 coding classification systems. Completes APC assignment on outpatient complex records as appropriate. Ensures ethical and accurate coding in accordance with all regulatory requirements and nationally recognized coding guidelines.

CORE FUNCTIONS

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

2. Abstracts clinical diagnoses, procedure codes and other pertinent information obtained from the patient encounter. Place account in the appropriate status for required missing documentation to complete assignment of disease and procedure codes, and any pertinent abstract elements.

3. Provides quality coding by ensuring compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as Banner specific policy and procedures and applicable professional standards for a full range of outpatient complex surgical and observation acute care services at all Banner hospitals. This includes highest level of complexity of accounts encountered in Banner’s Academic, Trauma and high acuity facilities.

4. May provide mentoring for less experienced staff members. May act as a subject matter expert for complex coding.

5. Works under general supervision using specialized expertise in the subject matter. Works within a set of defined rules. Ability to address complex coding matters independently with regard to interpretation of coding guidelines, NCCI edits, and LCDs (Local Coverage Determinations) prior to referral to coding analyst, coding educator, or coding manager/supervisor.

MINIMUM QUALIFICATIONS

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

Requires Certified Coding Specialist (CCS) or Certified Outpatient Coder (COC) or Certified Professional Coder (CPC) or Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) or other appropriate coding certificaion in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).

Requires two or more years of outpatient complex experience in an acute care inpatient facility or healthcare system.

Must demonstrate a level of knowledge and understanding of ICD CM/PCS, CPT4 coding principles and coding competencies as demonstrated by certification through the American Health Information Management Association or by the American Academy of Professional Coders.

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

PREFERRED QUALIFICATIONS

Associates degree in a job-related field or experience equivalent to same.

Previous experience in large, multi-system healthcare organization.

Additional related education and/or experience preferred.

**Anticipated Closing Window (actual close date may be sooner):**

2025-02-18

**EEO Statement:**

Our organization supports a drug-free work environment.

**Privacy Policy:**

EOE/Female/Minority/Disability/Veterans

Banner Health supports a drug-free work environment.

Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability

Nurse Care Manager, Infertility-Maternity

Location: Remote

Type: Contractor

Workplace: remote

Category: Clinical Strategy and Services

Job Description:

We are looking for an Infertility/Maternity Nurse Care Manager for our Care and Case Management team. Interested nurse care managers must be passionate about holistic and patient-centered care to support members through their healthcare journey and ensure needs are met with industry-leading interventions.

The telephonic Nurse Care Manager will specialize in guiding members through both routine and complex infertility and maternity clinical scenarios, partnering with a multidisciplinary clinical team that includes providers, care coordinators, and other supporting team members to deliver integrated remote care and case management. The Nurse Care Manager should enjoy spending time on the phone, listening to members’ needs, answering questions, and serving as a member advocate. They should excel at creating personalized care plans and possess the clinical acumen to guide members through infertility and maternity journeys, while effectively navigating available benefits and resources. Nurse Care Managers will support members with education, advocacy, and care management through family building/fertility journeys and prenatal/postpartum care, ensuring they receive comprehensive care that results in positive health outcomes for both the inidual and their families.

Responsibilities

• Deliver coordinated, patient-centered virtual Care Management by telephone and/or messaging that improves members’ health outcomes
• Generate impactful care plans together with members and our multidisciplinary care team, and help members achieve their desired goals
• Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.
• Partner with the members’ local providers to ensure coordinated care.
• Provide compassionate, longitudinal follow-up care, building supportive relationships.

Qualifications:

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

Schedule

M-F 9a-6p PST

About Included Health

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

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

Clinical Coding Appeals Nurse

Remote, USA

Full time

R240000002599

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.

As our Clinical Coding Appeals Nurse, you will help review and interpret medical records to draft appeals of denied and underpaid claims. Every day you will review medical records to ensure appropriate coding of removed or revised diagnosis and procedure codes. Then you will draft appeal letters based on clinical judgment and knowledge and make coding change suggestions to our clients based on ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance. To thrive in this role, you must have experience identifying different types of hospital documentation including, but not limited to, medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters. Proficiency in basic computer skills is essential for excelling in this remote production-drive position.

Here’s what you will experience working as a Clinical Coding Appeals Nurse:

• Review and interpret medical records to appeal denied and underpaid claims.
• Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer or third-party auditor.
• Draft appeal letters that are well-written, logically structured, and persuasive, utilizing ICD-9/10 CM & PCS, CPT, HCPCS, NCCI guidance.
• Ensure that all appeals are completed timely to ensure internal and external compliance deadlines are met.

Required Skills:

• Active Registered Nurse license
• Active AHIMA or AAPC Coding Certification including CCS, RHIA, RHIT, CCA, CPC-A, CPC-H (COC), CPMA, CIC, CDI, or CDIP

For this US-based position, the base pay range is $71,930.00 – $109,236.00 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.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent

Sr Director, Clinical Operations

Work at Home

Full time

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they’re supported to live their best lives, and when they feel welcome to bring their whole selves to work. That’s one reason why ersity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What You’ll Be Doing:

The Senior Director, Strategic Partner Programs is responsible for overseeing operational performance and improvement initiatives for dedicated customers.

Key responsibilities include:

• Leading operational planning, implementation, and evaluation of clinical programs

• Coordinating with key stakeholders internally and externally

• Serving as a trusted advisor to clients and providing thought leadership

• Creating and monitoring metrics for clinical, operational, and economic performance

• Planning, prioritizing, and scheduling projects to meet timelines

• Acting as a liaison between Clinical Operations and Partner Operations

• Monitoring performance metrics and driving initiatives to optimize performance

• Ensuring compliance with service level agreements

• Collaborating with Finance, Analytics, and Operations to manage key performance indicators

• Coordinating service delivery across a matrixed operational model

Additional duties:

• Providing technical guidance on problem definition and resolution

• Establishing client quality objectives and benchmarks

• Identifying and resolving operational deficiencies for dedicated clients

• Adhering to company policies, procedures, and standards

• Addressing and resolving user issues and understanding user terminology

• Providing customer support to both internal and external customers

• Offering guidance on conflict resolution

• Developing and ensuring compliance with policies and procedures

• Promoting professional growth and development through education and skills competency

The Experience You’ll Need (Required):

• Bachelor’s degree or 10 years of related experience

• Five (5) to Seven (7) years of healthcare experience

• Experience in working directly with Health Plan customers is required

• Demonstrates strong analytical, organizational and critical thinking skills.

• Ability to travel 25% for internal and external meetings

Technical requirements:

This role is a remote position. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router.

Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

Technical Requirements:

We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

The expected base salary/wage range for this position is $140,000-150,000. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected iniduals, which may vary above and below the stated amounts.

Physician Practice Coder

locations

Remote

time type

Full time

job requisition id

37114

Position: Physician Practice Coder

Department: Coding & Education

Schedule: Full Time, Remote

POSITION SUMMARY:

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:

CPC – Certified Professional Coder

CPC-A – Certified Professional Coder Apprentice

EXPERIENCE:

2-5 years experience required in a multi-specialty physician coding environment to include coding, compliance, and billing processes.

KNOWLEDGE AND SKILLS:

• Work requires in-depth knowledge of medical terminology, ICD-10-CM and CPT-4 Work also requires basic concepts of human anatomy, physiology and pathology.
• 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:

Coding support

• Reviews patient medical records and abstracts medical data that identifies all diagnoses and procedures.  Codes diagnoses, procedures, and appropriate modifiers from the medical record documentation using ICD-10-CM, CPT4/HCPCS classification systems.  Refers to a computerized encoding system, written coding aids and other reference materials to ensure accurate coding for billing.
• Sequences diagnoses, procedures and complications by following ICD-10-CM, CPT-4, and the Uniform Hospital Discharge Data Set (UHDDS); adheres to the Official Guidelines for Coding and Reporting, Coding Clinic guidelines and other regulatory guidelines as appropriate. Consults with the CDCI team to request appropriate physician or appropriate medical staff to clarify medical record information.
• Maintains productivity standards set forth in Departmental Policies and procedures.
• 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.
• Utilizes hospital’s cultural values as the basis for decision making and to facilitate the hospital’s goals and mission.
• Follows established Hospital infection control and safety procedures.

• Review and respond to coding questions.
• Ensure billed service is being accurately coded.
• Perform random chart audits.
• Provide continual coding updates.
• Research coding issues that arise.
• Codes diagnoses and procedures from the medical record using ICD-10-CM and CPT-4/HCPCS classification systems.
• Sequences diagnoses, procedures and complications by following ICD-10-CM, Medicare, Medicaid, and other fiscal intermediary guidelines.
• Reviews charts for documentation and signature.
• 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). IND123

Equal Opportunity Employer/Disabled/Veterans

Manager Coding

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.
• 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.

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.

Medical Coder – Hospital Outpatient

Location:Remote, United States

Full time

job requisition id: 23567

Job Description:

Job Family:

Health

Travel Required:

None

Clearance Required:

Ability to Obtain NACI

Join Guidehouse’s Best in KLAS medical coding team!

Guidehouse is partnering with the DHA as part of a large-scale project in support of our military healthcare facilities and hospitals. This is an exciting opportunity to join a mission drive project and contribute to a best in KLAS medical coding team. We are proud to be recognized as a Military Friendly Employer for the fifth consecutive year, listed among the 2024 Military Spouse-Friendly Employers and we’re Great Places to Work certified. These roles are 100% remote and offer a flexible schedule.

We offer:

• Competitive compensation and comprehensive benefits
• A flexible, remote work arrangement
• The opportunity to work the #1 ranked Best in KLAS medical coding team, and a rapidly growing global professional services firm
• A collaborative, erse, and supportive workplace
• Corporate membership to AAPC and the AAPC webinar subscription for our full-time team coders who are AAPC members
• Encoder Pro as a resource tool for our full-time team members
• Monthly education newsletter and education opportunities provided through our education department
• AAPC approver instructor who helps coordinate your CEU’s or expanded CPC specialty certifications

If you are a skilled Medical Coder looking to make a difference for a mission driven project, apply today!

What You Will Do:

• Oversees the maintenance of medical records and the coding of data from medical records.
• Participates in the preparation of reports, provides information and prepares correspondence regarding patient admissions, treatment, discharges and deaths in accordance with departmental policies and legal requirements governing the release of medical information.
• Works collaboratively with providers, other health care professionals and coding team to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes and quality is captured for the level of service rendered to each patient, as well as ensuring compliant reimbursement of patient care services.
• Infusion and Injection Charging
• E/M Leveling

What You Will Need:

• High School Diploma or equivalent
• 3 years of prior relevant medical coding experience
• CCS, CPC-H, RHIT or RHIA Certification
• Must be a US Citizen and willing to undergo a federal background check as part of the onboarding process

What Would Be Nice To Have:

• Federal or Military medical coding experience
• Experience working in any of the following systems: EPIC, Cerner, Next Gen, Allscripts or any other EHR.
• Knowledge of Anatomy, Physiology and Medical Terminology.
• Experience with Government and other Payer guidelines as they relate to compliant coding.
• Willingness to maintain professional credentials at all times.
• Associates Degree

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.

Title: Hospital Coding Specialist II (Remote)

locations

Marshfield, WI

time type

Full time

job requisition id

R-0040187

Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!

Job Title:

Hospital Coding Specialist II (Remote)

Cost Center:

101651098 HIM-Facility Coding

Scheduled Weekly Hours:

40

Employee Type:

Regular

Work Shift:

Mon-Fri; day shifts (United States of America)

Job Description:

JOB SUMMARY

Hospital Outpatient Coding:

The Hospital Coding Specialist ll reviews clinical documentation and diagnostic results as appropriate to extract data and apply appropriate International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes for billing, internal and external reporting, research and regulatory compliance activities. This inidual accurately codes outpatient conditions and procedures as documented in the medical record and applying the ICD Official Guidelines for Coding and Reporting. The Hospital Coding Specialist II provides charge validation and capture processes for various patient types. This inidual assigns codes for diagnoses, treatment, and procedures according to the appropriate classification system for outpatient encounters. The Hospital Coding Specialist II utilizes technical coding principles and APC reimbursement expertise to assign appropriate ICD diagnoses, ICD CPT/HCPCS codes including modifier assignment. This inidual validates and/or identifies chargeable items for various patient types (i.e., OBS, SDS) and enters them into the billing system to include the following outpatient visit types:

• Ambulatory surgery (same day surgery), may include charge capture
• Observation service encounters
• Other hospital outpatient types in accordance with Coder II job descriptions, as assigned

Hospital Inpatient Coding:

The Hospital Coding Specialist II accurately codes inpatient conditions and procedures as documented in the International Classification of Diseases (ICD) Official Guidelines for Coding and Reporting and in the Uniform Hospital Discharge Data Set (UHDDS) and assignment of the appropriate MS-DRG (Medicare Severity-Diagnosis Related Group) or APR-DRG (All Patients Refined Diagnosis Related Groups) for complex, multi-specialty inpatient services. This inidual understands and applies applicable medical terminology, anatomy and physiology, surgical technology, pharmacology and disease processes. The Hospital Coding Specialist II reviews professional and hospital inpatient medical record documentation and properly identifies and assigns:

• ICD CM and PCS codes for all reportable diagnoses and procedures. This includes determining the correct principal diagnosis, co-morbidities and complications, secondary conditions, surgical procedures and/or other procedures.
• MS-DRG /APR-DRG
• Present on admission indicators
• HAC (Hospital Acquired conditions) and when required, report through established procedures
• PSI conditions and report through established procedures
• Discharge Disposition code
• Works collaboratively with the Clinical Documentation Improvement Specialists to address documentation concerns and DRG assignments
• Assists in the preparation of responses to DRG validation requests and other third party payer inquiries related to coding and DRG assignments as requested

JOB QUALIFICATIONS

EDUCATION

The inidual applying must meet the minimum qualifications in all three required sections below to be considered a candidate for interview. Please consider when listing minimum qualifications.

Minimum Required: Medical Coding Diploma or American Health Information Management Association (AHIMA) approved Health Information Management Degree or related program.

Preferred/Optional: None

EXPERIENCE

Minimum Required: Two years coding and reimbursement experience in a multi-specialty setting clinic/hospital or completion of coding degree or diploma will be considered in addition to the following:

• Knowledge of medical terminology, anatomy and physiology, pharmacology, disease process, and surgical procedures
• Knowledge of accepted medical abbreviations and their meanings
• Knowledge in the use of specialized references such as the ICD and CPT-4 books, medical dictionaries and texts, and medical journals
• Must have extensive knowledge of Coding Clinic, CPT Assistant and all official coding guidelines
• Advanced knowledge of hospital information systems, encoders and other technology to facilitate a successful work environment while maintaining maximum communication and adhering to HIPAA security standards
• Advanced knowledge Microsoft Outlook, Excel and Word functions
• Technical skills required to learn and navigate a variety of software systems and trouble shoot computer problems
• Strong written and verbal communication skills
• Ability to think and work independently, yet interact positively with team
• Advanced problem solving skills
• Attention to detail is crucial to this position

Preferred/Optional: Experience with electronic health record systems.

CERTIFICATIONS/LICENSES

The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position

Minimum Required: AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management) credential (i.e. CCS, CCS-P, RHIT, RHIA, CCA, CPC, CPC-H, COC) within one year of hire.

Preferred/Optional: AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management) credential (i.e. CCS, CCS-P, RHIT, RHIA, CCA, CPC, CPC-H, COC) at time of hire.

Given employment and/or payroll requirements of inidual states, Marshfield Clinic Health System supports remote work in the following states:

Alabama

Alaska

Arkansas

Florida

Georgia

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Michigan

Minnesota

Mississippi

Missouri

Nebraska

North Carolina

North Dakota

Ohio

Oklahoma

South Carolina

South Dakota

Tennessee

Texas

Utah

West Virginia

Wisconsin

Wyoming

Marshfield Clinic Health System will not employ iniduals living in states not listed above.

Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.

At Marshfield Clinic Health System, we are fully committed to addressing health equity, ersity and inclusion for our employees and providers, our patients, and the communities we serve. We believe that every inidual should have the opportunity to attain their highest level of health. We embrace ersity and welcome differences in who we are and how we think. We believe that any inidual or group should feel welcomed, respected and valued. View our Equity and Inclusion Statement here.

Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.

Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

Inpatient Medical Coder

Location: Remote United States

Requisition ID

2024-37576

Category (Portal Searching)

HIM / Coding

Position Type (Portal Searching)

Employee Full-Time

Equal Pay Act Minimum Range

$30.00 – $40.00 per hour

Job Description:

Overview

Datavant is a data platform company for healthcare whose products and solutions enable organizations to move and connect data securely. Datavant has a network of networks consisting of thousands of organizations, more than 70,000 hospitals and clinics, 70% of the 100 largest health systems, and an ecosystem of 500+ real-world data partners.

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

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

Responsibilities

You will:

• Reviews medical records and assigns accurate codes for diagnoses and procedures.
• Assigns and sequences codes accurately based on medical record documentation.
• Assigns the appropriate discharge disposition to medical records.
• Abstracts and enters the coded data for hospital statistical and reporting requirements.
• Communicates documentation improvement opportunities and coding issues to appropriate personnel for follow up and resolution.
• Maintains 95% coding accuracy rate and 95% accuracy rate for MS-DRG assignment and maintains site designated productivity standards.
• Maintains minimum production of 1 charts per hour or site specific productivity standards.
• Demonstrates excellent written and verbal communications skills.
• Communicates professionally with co-workers, management, and hospital staff regarding clinical and reimbursement issues.

Qualifications

What you will bring to the table:

• A minimum of 2 years of inpatient coding facility experience
• CCS, RHIT, or RHIA preferred
• Strong verbal and written communication skills

Bonus points if:

• Associate or Bachelor’s degree from an AHIMA-certified HIM or Nursing Program, or completion of a certificate program from AAPC with a preference for CCS
• Level 1 trauma facility experience
• Experience in computerized encoding and abstracting software

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!)

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

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. The estimated salary range for this role is $30.00 – $40.00.

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.

This job is not eligible for employment sponsorship.

Equal Pay Act Minimum Range

$30.00 – $40.00 per hour

Title: Bilingual (Spanish) Virtual Acute Care/Emergency Medicine Nurse Practitioner

Remote USA

Full time

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

Job Description

A bit about this role:

• This position is an amazing opportunity for a caring Nurse Practitioner (APRN) to help build and staff our growing telehealth medical group called Devoted Medical.
• Your primary focus will be delivering world class acute care to our members with emergent/critical illness. The Care OnDemand Nurse Practitioner will diagnose complex medical conditions, order and interpret diagnostic tests, and work with patients, families, and Care OnDemand team to establish care plans.
• One of Devoted Medical’s missions is to bring care to where our members live meaning your visits will be virtual telehealth care. On a day-to-day basis you will work closely with co-clinicians at Devoted Medical including physicians and APRNs as well as medical assistants, documentation experts, practice administrators, and our close social work and clinical nurse partners at Devoted Health Plan.

Required skills and experience:

• Role licensure and certification in good standing is required and the ability to get licensed in requested states within 90 days of hire date. You will be required to get licensed in additional states as needed.
• RN and APRN licenses are active and in good standing.
• Active BLS certification.
• Must be bilingual in Spanish/English.

Desired skills and experience:

• Experience in primary care, internal medicine, urgent care, emergency room, and/or geriatrics.
• Experience performing visits over telehealth video platforms.
• Experience in managing acute/chronic disease exacerbations including CHF exacerbations, diabetic emergencies, COPD exacerbations and hypertensive emergencies.
• A strong desire to continue practicing acute care – you believe in the mission of bringing care to where the patient lives.

Your Responsibilities and Impact will include:

• Performing Care OnDemand (acute care) visits including evaluating and diagnosing acute illnesses, ordering/interpreting diagnostic testing, establishing care plans including prescribing appropriate medications, and assessment for quality of care (STARS/HEDIS) interventions as well as social and home health/DME needs.
• Work closely with the member’s care team including their PCP, specialists, and other Devoted team members including pharmacy, clinical nursing, and social work as well as interfacing with family members and caregivers in order to coordinate care for the member and deliver a collaborative care plan.
• Utilize our home grown electronic health information system for visits while also providing feedback on how to improve the interface.
• In certain geographies, there will be a weekend on-call component to support our clinical nurses who triage calls from our members during the weekend.

Salary range: $125,000 – $135,000 / year

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

Our Total Rewards package includes:

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

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

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

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

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

Bilingual Nurse (RN) Case Management Lead Analyst

Remote, US

CategoryMedical & Pharmacy

Job Id24012216

Hours: Monday-Friday. Day shift with one evening shift per week required.

Bilingual in English/Spanish

​

• Position Scope

  Hours for the Position: Must be able to work 9a.m.-5:30p.m. with one evening shift required per week. Monday-Friday. 

  Nurse Case managers are healthcare professionals, who serve as customer advocates to coordinate, support, and guide care for our customers, families, and caregivers to assist with navigating through the healthcare journey. 

  Additionally, the candidate will be responsible for the adoption and demonstration of the Care Solutions cultural beliefs. They will be responsible for role modeling the six cultural beliefs to drive personal accountability and organizational results.

  • Customer Strong: I deliver world-class experiences for all my customers.

  • Me to We: I take accountability to trust, partner, and deliver.

  • Own It: I see a need and deliver value because I care.

  • Evolve and Adapt: I learn and adapt to meet evolving business needs.

  • Be Bold: I pioneer and think broadly to solve challenges.

  • Take Care: I prioritize self-care and act with compassion toward colleague.

  Day in the Life Responsibilities

  • Collaborates with customer in creation of care plan and documents plan in medical management system.

  • Partners with each customer to establish goals and interventions to meet the customer’s needs.

  • Establishes plan of care in conjunction with the customer and provider then document into a medical management system.

  • Utilizes motivational interviewing, behavior change, and shared decision making to help customers achieve optimal health and well-being.

  • Empowers customers with skills to enhance interaction with their providers.

  • Interfaces with the customer, family members/caregivers, providers, and internal partners to coordinate the needs of the customer through telephonic, email, text, and chat interactions.

  • Collaborates with nutritionist, pharmacist, behavioral clinician, Medical Director and customer’s provider and other Cigna Medical Management programs to provide whole-person health support.

  • Tracks daily activities to trend volume and outcomes.

  • Follows standard operating procedures.

  • Toggles between multiple systems and applications.

  • Research relevant topics in health promotion and disease prevention, as required for specific customers.

  • Prioritizes work to meet commitments aligned with organizational goals.

  • Understands and adheres to Case Management performance measures to deliver on key results.

  • Completes training within the communicated time limit as required per role.

  • Demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate.

  Minimum requirements

  • Active unrestricted Registered Nurse (RN) license in state or territory of the United States.

  • Minimum of two years full-time direct patient care setting as an RN required.

  • Bilingual in English and Spanish (Fluency Speaking/Writing)

  • Must be flexible to work days or evenings based on business needs

  Preferred requirements

  • For non-standard shift positions/State License Requirements: Available to work (Evenings after 11:30 a.m.) with a 12% shift differential.

  • Must have an active and unencumbered RN License in the State of Residence

  • Within four (4) years of hire as a case manager will possess a URAC-recognized certification in case management.

  • Excellent communication skills including telephonic (verbal) and digital (messaging, emails).

  • Skilled in clinical acumen to form a judgement and act.

  • Strong computer skills in Microsoft word, Excel, Outlook, and ability to perform thorough internet research.

  • Ability to recognize, address and resolve conflicts in a professional, collaborative manner.

  • Demonstrates sensitivity to culturally erse situations, participants, and customers.

  • Demonstrates effective organizational skills and flexibility to meet the business needs.

  • Adapts approach and demeanor in real time to match the shifting demands of different situations.

  • Ability to manage multiple, complex situations in a fast-paced environment collaborating with clinical and other business partners.

  • Some roles may require on-site meetings or audits twice a year require

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 75,300 – 125,500 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] an update on your application or to provide your resume as you will not receive a response.

Qualified applicants with criminal histories will be considered for employment in a manner

consistent with all federal, state and local ordinances.

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.

Care Advice Line Registered Nurse 1

CAL RN 1

• Remote, USA, United States
• Part-time
• Department: 340 – Care Advice line

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

We are always seeking top talent for the After Hours Care Manager position and are currently reviewing resumes. If you meet the qualifications and are interested in future opportunities, we encourage you to appl

We are actively recruiting for an After Hours Care Manager to join our rapidly growing Population Health team.  The primary role of the Care Manager will be to provide our patients with on-demand telephone-based care management services through a 24/7 Nurse Advice Line (i.e. telephone triage).   Care Managers will assess symptoms/concerns of callers to determine the urgency and type of care needed, refer to or schedule appointments with providers as appropriate, and give health information and advice to callers.  The goal of the Nurse Advice Line is to reduce unnecessary visits to the clinic and emergency department, provide information for self-care and symptom management, and to coordinate care across the healthcare delivery system.  Care Managers operate in a team-based model, acting as an extension of the primary care provider.

Primary Job Duties:

• Handles inbound communications from patients who are seeking information about symptoms or care concerns
• Conduct outbound communications for follow-up and care coordination
• Consult and coordinate with internal and external team members to assess, plan, implement and evaluate patient care plans, make appropriate referrals, and provide follow-up
• Assist with finding appropriate providers, community resources, care solutions and coordinate priority appointments
• Record member data in Privia’s web-based medical record system and associated EMRs, or health portals.
• Research information online and in Privia’s internal knowledge databases
• Provide health information, coaching, and critical thinking skills to assist our members with medical and wellness related issues
• Other care management activities as needed (e.g. close “gaps in care,” complex care plans, etc.)
• Must comply with HIPAA rules and regulations

Qualifications

• This part-time role is primarily available for Nights, Weeknights and Holidays (9pm-9am EDT) , with flexible and alternating shifts (2, 4, 8, 6, 10 & 12 hours).
  •  Must maintain “on average” at least 16 hours of nights and/or weekend coverage)/week or 64 hours/month.   Weekend times span from Friday, 9p EDT – Monday, 9a EDT.  Flexible time off as needed.
• Privia will help set up the home office setting with computers, high speed internet access and other equipment needed for the role.
• Registered Nurse (RN) with current resident compact licensure in assigned state(s).
• Bachelor’s degree, required
• Experience in a call center, triage position, consulting environment or like environment.
• Minimum 3+ years of recent clinical experience, with problem-solving and critical-thinking skills
• Disease Management, Case Management, Utilization Review or Wellness experience
• Without question, ‘Exceptional Customer Service’
• Strong computer skills.  Internet savvy
• Clear, confident communication and listening skills
• Self -motivated and self-disciplined a must
• Willingness to do what it takes to get the job done and make patients the number one priority
• Able to thrive in a quiet, secure home office environment
• Detailed-oriented, organized with the ability to work well in fast-paced work environment
• Bilingual – Spanish, Korean, Vietnamese, or Farsi preferred

The hourly range for this role is $24 to $31hr in base pay. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

Technical Requirements (for remote workers):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment.This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Technical Requirements (for remote workers only, not applicable for onsite/in office work):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.

Nurse Care Manager – Telehealth

• USA
• per hour Hourly pay with bonus opportunities
• Hourly
• Full Time

Join Signallamp Health: Empower Patients from the Comfort of Your Home

We’re on a mission to redefine the healthcare experience for chronically ill patients, and we need passionate Nurses to join our journey.

Imagine this: Most people only see their doctors when they’re unwell, face the stress of booking appointments, and endure lengthy waits in crowded waiting rooms. But what happens in those critical moments between visits? Who’s there when they grapple with medication side effects, need assistance with transportation, or are torn between a trip to the ER or waiting it out?

At Signallamp, we’ve transformed remote care management to ensure that these vulnerable iniduals are never alone. As a part of our team, you’ll work comfortably from your home, maintaining consistent connections with patients, offering them the guidance they need to navigate their health challenges, and ultimately bridging the gaps that traditional healthcare often overlooks.

Join us, and be at the forefront of compassionate, innovative care as one of our Registered Nurse Chronic Care Managers or Licensed Practical Nurse Chronic Care Managers.

Nursing on Your Terms: Home-Based, Tailored Schedules, Meaningful Relationships

As a Chronic Care Manager with Signallamp, you’ll deliver the compassionate care and patient education you’re renowned for, but with the added benefit of working from home. Skip the daily commute, save on gas, be there for your family when they need you, and enjoy the simple pleasures, like your pet’s company or flexibility for personal appointments.

Work schedule M-F 8-430pm EST or 11-730pm EST

After your first 6 months, choose a schedule that fits YOU:

4 days x 8 hours

4 days x 9 hours

4 days x 10 hours

Pick the rhythm that suits your life. And guess what? Your benefits stay the same!

Our nursing team is the backbone of long-lasting patient relationships. Engaging with the same iniduals monthly, our nurses offer the consistent, personalized support that is often missing in busy doctor’s offices. This level of attention not only makes patients feel valued but also empowers them to take better care of themselves, ensuring a longer, active, and safer life.

Benefits

• Medical, dental, vision, short term disability, long term disability, life insurance
• PTO, sick and holiday pay (including Black Friday, Christmas Eve and your birthday!)
• Continuing Education Credits (CEU) paid for
• Additional State licensure paid for
• Employee Assistance Program (EAP) – free and confidential
• 401k with company match
• Potential to flex time
• Retention, referral and productivity bonus payments

A Day in the Life of a Chronic Care Manager

– Engage in regular check-ins with patients: Discuss changes since the last conversation, follow up on appointments, and understand any new instructions from their doctor.

– Delve into rich conversations and bond with patients, understanding their unique personalities and challenges.

– Establish and nurture trust with new patients and their families.

– Act as a vital link within the patient’s care team: Communicate seamlessly with providers and in-office staff.

– Harness your expertise to:

– Guide patients in prioritizing their health and understanding their conditions.

– Advocate for patients, providing answers and addressing medical concerns promptly.

– Use technology to manage and coordinate care, from gathering resources to setting care goals.

Utilize Electronic Medical Record (EMR) systems to:

– Review recent office visits.

– Liaise with the care team.

– Accurately document all actions taken for patients.

Hear more about working at Signallamp https://signallamphealth.com/learnaboutus/

You’re a Great Fit If Your Qualifications include:

Compassion: At the heart of everything, you provide heartfelt care to patients.

Licensing: You’re an RN/LPN licensed in any U.S. state. If your role involves caring for out-of-state patients, we’ll cover your licensing fees.

Experience:

– Minimum of 4 years in nursing care for chronically ill patients.

– Background in home health or primary care settings is a plus.

– Proficiency in using Electronic Medical Records (EMR).

Tech-savvy: Confidence in learning and adapting to new technology tools.

Time Management: Proven skills in managing your time effectively, especially when remote working.

Communication: Exceptional active listening skills, along with clear written and verbal communication.

Adjunct Faculty – Nursing

Location: Virtual United States

Job Description:

Instructional faculty report to the Department Chair overseeing the course/content area they are teaching. This is a remote online part-time faculty position based within the continental United States.

Excelsior University provides fully developed courses with materials and activities to allow the faculty to focus on the students. Part-time faculty should expect to provide prompt and substantive responses to student needs, hold virtual office hours, assist in proctoring if applicable, offer timely formative feedback on student work, and demonstrate their subject matter expertise through constructive involvement with student discussions and learning activities. In addition, Excelsior looks for our instructional faculty to demonstrate a commitment to student success by supporting college engagement and retention initiatives, reaching out to struggling students and collaborating with faculty and support staff to ensure students have access to all available resources that impact success.

Duties and Responsibilities:

• Implementing courses as designed by the University.
• Bring inidual knowledge and expertise on the subject matter in the engagement of students.
• Engage regularly and substantively with students via email, announcements, and online discussion boards.
• Provide timely, high-quality feedback on student work.
• Hold regular virtual office hours, weekly.
• Participate in ATI proctoring if applicable.
• Keep the department chair apprised of any student or course issues.
• Follow University policies.
• Complete University-required training and attending required pre-term meetings.
• Respond to all messages from students and the University within 48 hours.
• Utilize provided rubrics to grade all assignments timely and provide narrative feedback that summarizes the strengths and areas in need of improvement.
• Cultivate a caring environment that supports open dialogue, collaboration, and opportunities for scholarly growth.
• Enforce all University policies listed in the Faculty Handbook.
• Submit final grades timely, within 3 days after the end of the term.

Qualifications: 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.

• Earned doctoral or terminal degree in Nursing or related field from a regionally accredited institution.
• New York Registered Nurse licensure or the willingness to apply for New York state licensure.
• Strong verbal and written communication skills, with ability to present information clearly, concisely, and accurately; friendly, persuasive speaking and writing style.
• Experience in Nursing Education in areas such as teaching-learning strategies, educational technologies, writing course and module outcomes, curriculum design, assessment and evaluation strategies, and research, etc.

Rate of Pay:

• A flat rate of $1000 per credit for a section of at least 10 undergraduate students or 8 graduate students. Courses that fall under these student headcounts are considered low enrolled courses.
• Low enrolled courses will be paid on a directed study rate ($250/student for undergraduate courses and $300/student for graduate courses) based on the number of students enrolled in the course section at the close of late registration.

Remote applicants please be aware that the University is required to withhold New York state income taxes from your wages, as well as the state income tax, if applicable, in the state where you perform services. This is because of New York’s “convenience of the employer” rule, which requires the University, as a New York employer, to withhold New York income tax from the wages of its employees working outside of New York if the employee’s work is performed outside of New York for the convenience of the employee, rather than out of a business necessity of the University.

Senior Clinical Data Science Lead

1. Multiple US Locations

JR118622

1. Clinical Data Management, Data Science
2. ICON Full Service & Corporate Support
3. Hybrid: Office/Remote

About the role

Sr. Clinical Data Science Lead-US, Remote

ICON plc is a world-leading healthcare intelligence and clinical research organization. We’re proud to foster an inclusive environment driving innovation and excellence, and we welcome you to join us on our mission to shape the future of clinical development.

We are seeking a Senior Clinical Data Science Lead to join our erse and growing team within our Biotech Government and Public Health ision.  You will be joining the world’s largest & most comprehensive clinical research organization, powered by healthcare intelligence. The Senior Clinical Data Science Lead (Senior CDSL) serves as the primary contact for internal and external team members regarding clinical data science data review activities and leads these review activities to ensure delivery of data fit for analysis. They are accountable for achieving clinical data science deliverables on-time, with high-quality, and to agreed financial metrics.

What you Will be Doing:

• Develop and oversee timeliness of clinical data science activities during the life cycle of studies as it relates to data review and data delivery milestones
• Provide input into clinical system development activities and clinical risk management activities
• Track and keep functional management and those responsible for project management informed of any issues that might affect project target dates, scope or budget and escalates potential problems effectively and in a timely manner
• Forecast budget, hours, and resourcing for clinical data review activities
• Perform analytic review as defined in the scope of work and functional plans focusing on errors that matter or have a meaningful impact on the safety of the subject or interpretation of the final analysis
• Accountable for the development of planning documents related to data review, data analytics, and data deliverables.
• Participate in Sponsor and/or third-party audits.
• Negotiate timelines and key deliverables with clients and/or external customers, vendors, and departments as needed
• Travel (approximately 15%) domestic and/or international

Your Profile

• 5+ years of clinical data management experience in clinical research
• 2+ years of experience working in a clinical research organization (CRO)
• Experience as a functional lead of multiple low and moderately complex studies, whilst acting as a resource for less experienced colleagues
• Experience with all steps within the data science lifecycle and most major data science study tasks with proficiency in at least one Clinical Data Management system required (e.g., Medidata Rave, Crucial Data Solutions TrialKit, Inform, Oracle Clinical, Veeva)
• Excellent communication skills
• Budget and timeline management experience
• Data Analytic and Data Validation experience
• Bachelor’s degree or local equivalent

#LI-Remote

#LI-TG2

What ICON can offer you:

Our success depends on the quality of our people. That’s why we’ve made it a priority to build a erse culture that rewards high performance and nurtures talent.

In addition to your competitive salary, ICON offers a range of additional benefits. Our benefits are designed to be competitive within each country and are focused on well-being and work life balance opportunities for you and your family.

Our benefits examples include:

• Various annual leave entitlements
• A range of health insurance offerings to suit you and your family’s needs.
• Competitive retirement planning offerings to maximize savings and plan with confidence for the years ahead.
• Global Employee Assistance Programme, LifeWorks, offering 24-hour access to a global network of over 80,000 independent specialized professionals who are there to support you and your family’s well-being.
• Life assurance
• Flexible country-specific optional benefits, including childcare vouchers, bike purchase schemes, discounted gym memberships, subsidized travel passes, health assessments, among others.

ICON, including subsidiaries, is an equal opportunity and inclusive employer and is committed to providing a workplace free of discrimination and harassment. All qualified applicants will receive equal consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Paralegal

United States

GENERAL PURPOSE OF JOB

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

KEY RESPONSIBILITIES

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

JOB REQUIREMENTS

Education: 

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

Experience: 

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

Certificates, Licenses, Registrations:  

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

Knowledge, Skills & Abilities:  

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

Title: Coding Specialist 4 – Integrated procedures

Location: Seattle United States

Req #:239439

Department:UW MEDICINE ENTERPRISE RECORDS & HEALTH INFO

Job Location: Remote/Hybrid

Salary:$5,749 – $8,228 per month

Other Compensation:

Union Position:Yes

Shift:First Shift

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

Job Description:

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

WORK SCHEDULE

100% FTE, Days

100% Remote

POSITION HIGHLIGHTS</p>

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

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

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

DEPARTMENT DESCRIPTION

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

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

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

PRIMARY JOB RESPONSIBILITIES

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

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

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

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

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

REQUIRED POSITION QUALIFICATIONS

High school diploma or equivalent

Three years of coding experience or equivalent education/experience.

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

UW Medicine – Where your Impact Goes Further

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

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

Certified Coder

Category

Professional & Business Support

Job Family

Remote / Work from Home / Virtual

Department

Revenue Cycle-Physician Billng

Schedule

Full-time

Facility

Castleway / Castleton Office Park

Castleway Drive

Indianapolis, IN 46250 United States

Shift

Day Job

Hours

Works remotely

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

Job Description:

Join Community

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

Make a Difference

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

Exceptional Skills and Qualifications

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

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

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

Why Community?

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

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

Location: Fountain Valley, CA (Predominantly Remote)

Job Description:

MEM008343

Department: Document Improvement

Status: Full-Time

Shift: Days (8hr)

Pay Range*: $31.25/hr – $45.32/hr

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

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

Position Summary

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

Essential Functions and Responsibilities of the Job

1. Proficient in Microsoft Office suite

2. Proficient in Epic software

3. Possess analytical skills

4. Possess critical thinking and problem-solving skills

5. Solid understanding of the health care revenue cycle

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

7. Provide excellent customer service

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

9. Detail oriented

10. Strong work ethic, honest, and dependable

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

12. Professional demeanor at all times

13. Maintain patient confidentiality

14. Maintain a safe and orderly work area

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

16. Be at work and be on time

17. Follow company policies, procedures and directives

18. Interact in a positive and constructive manner

19. Prioritize and multitask

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

Qualifications

Minimum Requirements

Qualifications/Work Experience:

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

·Expert knowledge of ICD10, CPT and HCPCS

·Strong knowledge of medical terminology, anatomy and physiology

·Epic software experience highly desired

·Proficient Microsoft skills

Education/Licensure/Certification:

·High School diploma or GED required;

·CPC, CCS, or equivalent certification required

Primary Location: United States-California-Fountain Valley

Job: Coder

Organization: MemorialCare Medical Foundation

Schedule: Full-time

Employee Status: Regular

Job Level: Staff

Work Schedule: 8/40 work shift hours

Shift: Day Job

Department Name: Document Improvement

Title: HIM Clinical Inpatient Coder II – (Remote)

Location: United States

Status: Full-Time

Standard Hours per Week: 40

Job Category: Finance

Regular, Temporary, Per Diem: Regular

Remote Eligibility: Full-Time Remote

Job Description:

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

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

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

To qualify, you must have:

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

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

#LI-Remote

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

Location: Remote

Type: Contractor

Workplace: remote

Category: Clinical Strategy and Services

Job Description:

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

Responsibilities:

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

Qualifications:

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

Schedule: M-F 9a-6p PST

About Included Health

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

—–

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

Registered Nurse

Title: RN Daytime Triage – Remote

Location: Minneapolis United States

Job Description:

Number of Job Openings Available:

1

Date Posted:

October 04, 2024

Department:

62000635 Allina Health Group Daytime RN Triage

Shift:

Day (United States of America)

Shift Length:

8 hour shift

Hours Per Week:

32

Union Contract:

Non-Union

Weekend Rotation:

Every 3rd

Job Summary:

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

Key Position Details:

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

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

Job Description:

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

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

Principle Responsibilities

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

Required Qualifications

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

Preferred Qualifications

• Experience in triage, anticoagulation, or remote nursing support

Licenses/Certifications

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

Physical Demands

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

Registered Nurse

Location: United States

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

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

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

Additional Details:

• • Malpractice coverage provided by employer

• • Weekdays plus possible weekend hours required

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

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

KEY RESPONSIBILITIES

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

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

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

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

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

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

BACKGROUND AND EXPERIENCE

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

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

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

• • At least one year of health tech experience required

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

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

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

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

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

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

• • Self starter, solutions-oriented mentality

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

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

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

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

BENEFITS

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

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

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

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

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

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

• • Remote-first team

• Competitive Paid Parental Leave for parents

Health Services Coordinator -Sales Account Coordination

Remote

Full Time

Entry Level

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

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

What you’ll do:

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

What you’ll need to be successful:

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

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

Nurse Case Manager – Workers’ Compensation

Job Number: 234727

Join Forbes’ 2024 Best Employer for Diversity!

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

Must-have qualifications

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

Preferred skills

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

Compensation

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

Benefits

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

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

Equal Opportunity Employer

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

#LI-Remote

Job: Claims

Primary Location: United States

Schedule: Full-time

Employee Status: Regular

Work From Home: Yes

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

Location: United States

Job Description:

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

Essential Duties and Responsibilities:

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

Knowledge, Skills, Abilities:

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

Education / Experience

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

Compensation:

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

Benefits:

The following benefits are available, subject to employment status:

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

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

#LI-DM4

2403029636

Title: Profee – Facility Surgery Coder

Location: Irving United States

Job Description:

Who we are.

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

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

Profee – Facility Surgery Coder

Location: Remote (US Wide)

Requirements:

3+ years coding experience

2+ years of Oncology coding experience.

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

HCPCS – EPIC/ 3M 360 CAC experience required.

Experience in multi-specialty Oncology coding.

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

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

Rewards and benefits:

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

Future career path:

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

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

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

Join our phenomenal team to grow together!

#LI-US #LI-REMOTE

Learn more about us

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

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

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

Location: Remote United States

Requisition ID

2024-37522

# of Openings

1

Category (Portal Searching)

HIM / Coding

Position Type (Portal Searching)

PRN

Equal Pay Act Minimum Range

$20.00 – $30.00 per hour

Job Description:

Overview

Full Time & PRN Opportunities

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

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

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

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

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

Responsibilities

What you will do:

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

Qualifications

What you will bring to the table:

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

Bonus points if:

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

Perks:

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

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

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

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

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

This job is not eligble for employment sponsorship.

Equal Pay Act Minimum Range

$20.00 – $30.00 per hour