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Utilization Review Nurse- Full-Time (Days, Evenings & Nights)

locations

Remote – Other

time type

Full time

job requisition id

R011499

Do you perform admission and/or continued stay reviews in a hospital setting? Do you have five years of hospital acute care nursing experience? Are you looking for a remote opportunity?

We are seeking a candidate who has a proven record of conducting UR reviews in an acute hospital setting using InterQual. The ideal candidate must have at least 5 years of acute care experience in a hospital setting (OR, ER, ICU, MedSurg, Tele, NICU, Peds, Ortho) and at least 3 years of UR doing admission reviews and/or continued stay reviews in an acute hospital setting.

The Utilization Review RN requires a quick onboarding process to consult for our clients at the assigned facilities.

Responsibilities

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

Qualifications

Required

• Current RN licensure
• At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
• At least 3 years case management, concurrent review or utilization management experience
• Experience with InterQual
• Proficiency in medical record review

Preferred

• Case management/concurrent review/utilization management experience within the ED setting
• Bachelors of Science in Nursing

Expectations

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

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

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

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

Clinical Policy Coding Administrator

Locations: Telecommuter

Time Type: Full time

Job Requisition Id: R26325

Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership.

Forbes ranked Premera among America’s 2023 Best Midsize Employers because we are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!

This is a Work from Home Opportunity!!

As a Clinical Policy Coding Administrator for the Medical Policy and Clinical Coding team, you will work with a dynamic team of experts that pull together medical policy operations and clinical expertise to inform decisions that ensure members receive safe services and accurate payment for those services. The Clinical Policy Coding Administrator will focus on identifying and applying appropriate codes to support claim system edits that direct payment of medical services. You will be a liaison between the clinical and operations teams, working to bring the two aspects of the business together and making sure prior authorization applies to the appropriate services on the front end and that members claims are paid as expected once the service is performed.

Using your knowledge and expertise as a certified clinical coder, you will be the key contact for analyzing medical policies and identifying the appropriates codes to represent services, then collaborating with system configuration to ensure payment systems accurately process the member’s claims. Other work involves collaborating with benefits, preventive services, partnering with vendors on their coding requirements, reviewing provider appeals, assessing pricing determinations at claims level, managing the auto authorization process, supporting implementation of mandates, and many other special projects.

What you will do:

• Collect and analyze data to evaluate the effectiveness of medical policy implementation, identify and update appropriate procedure and diagnosis codes, and support business decisions regarding utilization management activities and guidelines.
• Support medical policy development and implementation by identifying and updating appropriate procedure and diagnosis codes for company medical policies and UM guidelines that reflect medical necessity, experimental/investigational or other code categories.
• Provide subject matter expertise for the Medical Policy Implementation Workgroup to ensure cross-functional collaboration within Healthcare Services, and other areas on coding edit decision-making related to medical policies and mitigate downstream impact.
• Perform analysis, research, and assessment in response to cross-functional requests to inform accuracy and consistency for claims processing, reimbursement, benefit, and product configuration issues.
• Develop and use data gathering tools to document and analyze patterns of code payments and denials, medical policy changes, and coding changes.
• Research and interpret medical claims utilization and program participation. Present findings to internal customers to assist them in managing healthcare costs and improved member satisfaction.
• Identify potential patterns and/or trends to confirm alignment of code payments, changes and denials, and medical policy changes.
• Provider appeal review determinations including assessment of appropriate coding, medical record review, and Correct Coding Initiative (CCI) bundling edits.
• Recommend pricing guidance for by report procedures at the claims level.
• Recommend action steps regarding code configuration issues, annual utilization, and review analysis to aid clinical review teams.
• Maintain current knowledge of coding application for current medical coding and other applicable coding systems that apply to medical documentation and claims.
• Provides subject matter expertise to a variety of internal committees as assigned.
• Completes special projects and other duties as assigned.

What you will bring:

• Bachelor’s degree or four (4) years’ relevant work experience. (Required)
• Current certification as a professional coder (RHIA, RHIT or CPC). (Required)
• Four (4) years of experience applying clinical coding expertise with two (2) of those years spent in a health plan or healthcare setting. (Required)
• Claims processing systems and product configuration experience including familiarity with supplemental tables and product configuration.
• Experience/knowledge of claims processing with a working knowledge of different claim types is desired.
• Current Washington State License: Registered Nurse (RN), Advanced Registered Nurse Practitioner (ARNP), or Physician’s Assistant (PA) (Bonus not required)

What we offer

• Medical, vision and dental coverage
• Life and disability insurance
• Retirement programs (401K employer match and pension plan)
• Wellness incentives, onsite services, a discount program and more
• Tuition assistance for undergraduate and graduate degrees
• Generous Paid Time Off to reenergize
• Free parking

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified iniduals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

National Salary Range: $68,400.00 – $116,300.00

National Plus Salary Range: $77,300.00 – $131,400.00 *National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

About Us

At Premera, we make healthcare work better. By focusing on improving our customers’ experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives.

As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from iniduals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services.

Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.

Remote Triage Nurse – Call Center

Nursing

United States

Company: Oak Street Health

Location: Various

Company Description

Oak Street Health is a rapidly growing company of primary care centers for adults on Medicare in medically-underserved communities where there is little to no quality healthcare. Oak Street’s care is based on an entirely new model that is based on value for its patients, not on volume of services. The company is accountable for its patients’ health, spending more than twice as long with its patients and taking on the risks and costs of their care. For more information, visit http://www.oakstreethealth.com.

Role Description:

At Oak Street Health, Nurses are an integral member of our Care Teams. The Clinical Call Center Triage RN effectively extends our care team outside of regular clinic hours, addressing patient’s medical, social, and psychological needs, via the phone and other future technologies such as telemedicine.

Together our teams are responsible for providing and coordinating care for an intimate panel of patients in our neighborhoods. While the typical primary care panel in the U.S. is around 2,500 patients for a single physician, our panels at Oak Street Health are around 500-750 for a team. This creates an opportunity to spend more time with patients, build deeper relationships, and to better execute/coordinate care plans.

We partner with a network of elite specialists and hospitals for specialty and acute care. As such, our Nurses, with our doctors, focus exclusively on care within the clinic: primary care, care coordination, and population health.

Core Responsibilities:

• Determine what kind of care and services the patient needs, direct them to the correct specialist, clinic, hospital, or other acute care setting, while providing clinical input up to the level of the role’s competency.
• Be on call with a licensed provider at all times, should consult that provider for input, and refer the patient to that provider in real time whenever appropriate
• Offer patient education when appropriate
• Coordinate care with other providers, specialists, testing facilities, agencies
• Population health approach, in coordination with the Care Team
• Participate in phone triage and outreach
• Participate in Oak Street Health promotional activities
• Other duties as assigned

What are we looking for?

We’re looking for motivated, nurses with:

• Excellent skills and care in giving advice, ensuring that they respond with the appropriate standard of care for a specific case and a warm, friendly approach
• Ability to accurately and succinctly document advice given and the patient’s response
• Active, non-probationary state Registered Nurse license
• Genuine passion for primary care
• Intrinsically motivated
• Embrace teamwork and the opportunity to collaborate with colleagues
• Want to be a part of an innovative model focused on empirically-guided population health
• Bilingual Spanish preferred
• Comfort with an evolving environment
• Some travel may be required
• US work authorization
• Someone who embodies being “Oaky”

What does being “Oaky” look like?

• Radiating positive energy
• Assuming good intentions
• Creating an unmatched patient experience
• Driving clinical excellence
• Taking ownership and delivering results
• Being scrappy

Why Oak Street?

Oak Street Health offers our coworkers the opportunity to be at the forefront of a revolution in healthcare, as well as:

• Collaborative and energetic culture
• Fast-paced and innovative environment
• Competitive benefits including paid vacation and sick time, generous 401K match with immediate vesting, and health benefits

Oak Street Health is an equal opportunity employer. We embrace ersity and encourage all interested readers to apply to oakstreethealth.com/careers.

Inpatient Coder II

Job ID: 975353

REMOTE

PERMANENT

HEALTHCARE

$60,000.00 USD ANNUALLY – $72,000.00 USD ANNUALLY

The Judge Group is looking for a full-time, 100% remote inpatient coder II!

The Inpatient Coder II is the coding and reimbursement expert for ICD-10-CM diagnosis coding and ICD-10-PCS procedure coding for complex inpatient acute care discharges. This person possesses a strong foundation in coding conventions, instructions, Official Guidelines for Coding and Reporting and Coding Clinics. The Inpatient Coder II has a deep understanding of disease process, anatomy/physiology, pharmacology, and medical terminology.

Responsibilities & Duties

• Utilizes technical coding expertise to assign appropriate ICD-10-CM and ICD-10-PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II’s typically see average CMI’s of 2.2609. This index score demonstrates higher patient complexity and acuity.
• Utilizes expertise in clinical disease process and documentation, to assign Present on Admission (POA) values to all secondary diagnoses for quality metrics and reporting.
• Thoroughly reviews the provider notes within the health record and the Findings from the Clinical Documentation Nurse in the Clinical Documentation Improvement (CDI) Department who concurrently reviewed the record and provide their clinical insight on the diagnoses.
• Utilizes resources within 3M 360 CAC (Computerized Assisted Coding) software to efficiently review documentation and select or assign ICD-10-CM/PCS codes using autosuggestion or annotation features.
• Reviews Discharge Planning and nursing documentation to validate and correct, when necessary, the Discharge Disposition which impacts reimbursement under Medicare’s Post-Acute Transfer Policy.
• Utilizes knowledge of MS-DRG’s, APR-DRG’s, AHRQ Elixhauser risk adjustment to sequence the appropriate ICD-10-CM codes within the top 24 fields to ensure correct reimbursement.
• Collaborate with CDI on approximately 45% of discharges regarding the final MS or APR DRG and comorbidity diagnoses.
• Educates CDI on regulatory guidelines, Coding Clinics and conventions to report appropriate ICD-10-CM diagnoses.
• Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, medical terminology to determine the Principal Diagnosis, secondary diagnoses and procedures.
• Follows the ICD-10-CM Official Guidelines for Coding and Reporting, ICD-10-PCS Official Guidelines for Coding and Reporting, Coding Clinic for ICD-10-CM and ICD-10-PCS, coding conventions and instructional notes to assign the appropriate diagnoses

Education & Experience

• A minimum of three years’ experience is required in an Academic Medical Center with Inpatient Coding experience.
• Current CCS, CIC, RHIA, or RHIT certification
• Position requires excellent computer/communication skills for provider and staff interactions.
• Candidate must have ability to handle multiple projects and appropriately prioritize tasks to meet deadlines.
• Candidate must have excellent organizational skills, able to understand and follow inidual client Standard Operating Procedures

Senior Billing Specialist, Pre-Access

Location: Remote – United States

About the Senior Billing Specialist, Pre-access at Headspace Health:

We’re looking for a Senior Billing Specialist who can combine their healthcare experience with a fast-paced and ever-changing environment. You will be working with the Billing team to ensure timely and accurate financial clearance resolution, research and review authorization, referral, and eligibility escalations from the billing team, perform productivity and quality reporting, and document and improve team processes to ensure insurance billing is handled correctly from start to finish.

How your skills and passion will come to life at Headspace Health:

• Serve as a team lead for the Pre-Access pod within the RCM Team
• Support the team in navigating payer-specific nuances including but not limited to: authorizations, referrals, carve-outs, and TPA plans while meeting production and quality targets
• Structure pod worklists distribution and monitor pod for quality
• Identify trending authorization and eligibility issues; making recommendations to RCM and Finance leadership on financial clearance remediation strategies
• Communicate with patients to obtain financial information and verify insurance coverage
• Calculate patient financial responsibility and provide accurate cost estimates
• Coordinate with billing and coding departments to ensure proper coding and billing of services
• Ensure compliance with all relevant regulations and guidelines
• Maintain accurate and complete patient records in the electronic medical record system
• Provide training and support to other revenue cycle staff as needed
• Work with RCM leadership on creating and maintaining a productive, collaborative, and rewarding work environment
• Uphold HIPAA compliance guidelines

What you’ve accomplished:

• 5+ years Revenue Cycle Management experience and knowledge of medical claims and health plan / EAP rules
• 2+ years of experience in Financial Clearance
• 1+ year experience in supervisory and managerial positions
• Self-starter with strong billing, coding, and claims follow-up skills
• Behavioral health / mental health service line and telehealth billing experience preferred
• Experience working with payer provider relations teams on trending payer issues, as well as working cross functionally with other teams (including credentialing, support, contracting, account management) to improve internal workflows
• Proficient in Excel and data analysis
• Technically savvy with claims billing software and Microsoft Office, with a desire to learn new software as well
• Strong root cause and problem solving skills
• Ability to navigate occasionally complex workflows
• Strong attention to detail
• Strong communication and interpersonal skills

Preferred Qualifications:

• Experience in behavioral health, telehealth, or digital health
• Experience in B2B2C healthcare

Pay & Benefits:

The base salary range for this role is determined by a number of factors, including but not limited to skills and scope required, relevant licensure and certifications, and unique relevant experience and job-related skills. The base salary range for this role is $67,230-$94,500.

At Headspace Health, cash salary is but one component of our Total Rewards package. We’re proud of our robust package inclusive of: base salary, stock awards, comprehensive healthcare coverage, monthly wellness stipend, retirement savings match, lifetime Headspace membership, unlimited, free mental health coaching, generous parental leave, and much more. Paid performance incentives are also included for those in eligible roles. Additional details about our Total Rewards package will be provided during the recruitment process.

*Applicants with disabilities may be entitled to reasonable accommodation under the terms of the Americans with Disabilities Act and certain state or local laws. A reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing undue hardship on Headspace Health. Please inform our Talent team by filling out this form if you need any assistance completing any forms or to otherwise participate in the application or interview process.

Surgical Coder II – Remote

Job ID 305011

• Rochester, MN
• Full Time
• Finance

Why Mayo Clinic

Mayo Clinic has been ranked the #1 hospital in the nation by U.S. News & World Report, as well as #1 in more specialties than any other care provider. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans – to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic. You’ll thrive in an environment that supports innovation, is committed to ending racism and supporting ersity, equity and inclusion, and provides the resources you need to succeed.

Responsibilities

The Surgical Coder reviews, analyzes, and codes professional/physician medical record documentation to include, but not limited to, medical diagnostic and procedural information for various practices. This coder works collaboratively with surgeons to ensure the accuracy of the code sets on the surgical case.

*This position is 100% remote work. Inidual may live anywhere in the US.

**This vacancy is not eligible for sponsorship / we will not sponsor or transfer visas for this position.

During the selection process, you may participate in an OnDemand (pre-recorded) interview that you can complete at your convenience. During the OnDemand interview, a question will appear on your screen, and you will have time to consider each question before responding. You will have the opportunity to re-record your answer to each question – Mayo Clinic will only see the final recording. The complete interview will be reviewed by a Mayo Clinic staff member and you will be notified of next steps.

Qualifications

High School diploma and 6 years of physician/professional/procedural/surgical coding experience OR Associate’s Degree and 4 years of physician/professional/procedural/surgical coding experience required; Bachelor’s Degree preferred.

Additional Qualifications:

• Knowledge of professional/physician coding rules for specialized surgical professionals. Experience with National Correct Coding Initiative edits (NCCI), National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Outpatient coding guidelines for official coding and reporting.
• In-depth knowledge of medical terminology, surgical procedures, disease processes, patient health record content and the medical record coding process.
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections.
• Knowledge of coding and billing requirements for services furnished in a teaching settings.
• Knowledge of coding and billing requirements for provider based billing facilities.
• Ability to work independently in a teleworking environment, to organize/prioritize work, exercise excellent communication skills, is attentive to detail, demonstrate follow through skills and maintain a positive attitude.

License or Certification:

Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist – Physician (CCS-P) or a coding credential of a Certified Professional Coder (CPC) required.

Exemption Status

Nonexempt

Compensation Detail

$27.41 – $37.01 / hour. Education, experience and tenure may be considered along with internal equity when job offers are extended.

Benefits Eligible

Yes

Schedule

Full Time

Hours/Pay Period

80

Schedule Details

Monday-Friday; 8:00am-5:00pm

Weekend Schedule

As Needed

International Assignment

No

Site Description

Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives. Learn more about what each unique Mayo Clinic campus has to offer, and where your best fit is.

Affirmative Action and Equal Opportunity Employer

As an Affirmative Action and Equal Opportunity Employer Mayo Clinic is committed to creating an inclusive environment that values the ersity of its employees and does not discriminate against any employee or candidate. Women, minorities, veterans, people from the LGBTQ communities and people with disabilities are strongly encouraged to apply to join our teams. Reasonable accommodations to access job openings or to apply for a job are available.

Title: Pro Fee Coder – Cardiology

Remote

Location: United States

Full-Time

Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).

The Pro Fee Coder will review clinical documentation to assign and sequence diagnostic and procedural codes for specific patient types to meet the requirements of hospital data or physician data retrieval for billing and reimbursement. Coder II may validate APC calculations to accurately capture the diagnoses/procedures documented in the clinical record for hospitals. The Coder II performs documentation review and assessment for accurate abstracting of clinical data to meet regulatory and compliance requirements. Coder II may interact with client staff and providers.

DUTIES AND RESPONSIBILITIES:

• Select and sequence ICD-10, and/or CPT/HCPCS codes for designated patient types which may include but not limited to: Ancillary (Diagnostic)/ Recurring; Hospital, Clinic; Physician Pro Fee; Technical Fee or Evaluation and Management, any associated chart capturing with any patient type.
• Review and analyze facility records to ensure that APC assignments and/or Evaluation and Management codes accurately reflect the diagnoses/procedures documented in the clinical record.
• Abstract clinical data from the record after documentation review to ensure that it is adequate and appropriate to support diagnoses, procedures and discharge disposition is selected.
• Complete assigned work functions utilizing appropriate resources. May act as a resource with client staff for data integrity, clarification and assistance in understanding and determining appropriate and compliant coding practices including provider queries.
• Maintain strict patient and provider confidentiality in compliance with all HIPPA Guidelines.
• Participate in client and Savista staff meetings, trainings, and conference calls as requested and/or required.
• Maintain current working knowledge of ICD-10 and/or CPT/HCPCS and coding guidelines, government regulations, protocols and third-party requirements regarding coding and/or bill.
• Participate in continuing education activities to enhance knowledge, skills, and maintain current credentials.

SKILLS AND QUALIFICATIONS:

• Candidates must successfully pass pre-employment skills assessment. Required:
• An active AHIMA (American Health Information Association) credential including but not limited to RHIA, RHIT, CCS, CCA, or an active AAPC (American Academy of Professional Coders) credentials COC (formerly CPC-H), CCS-P, or CPC or related specialty credential.
• Two years of recent and relevant hands-on coding experience
• Knowledge of medical terminology, anatomy and physiology, pharmacology, pathophysiology, as well as ICD-10 and CPT/HCPCS code sets
• Ability to consistently code at 95% threshold for quality while maintaining client-specific and/or Savista production and/or quality standards
• Proficient computer knowledge including MS Office including the ability to enter data, sort and filter excel files, (Outlook, Word, Excel)
• Must display excellent interpersonal and problem-solving skills with all levels of internal and external customers

PREFFERED SKILLS:

• Recent and relevant experience in an active production coding environment strongly preferred
• Associates degree in HIM or healthcare-related field, or combination of equivalent education and experience
• Experience using Rcx, Cerner, Optum (a plus)

Coding Quality Specialist (Outpatient) (Remote)

Job Type

Full time Day – 08 Hour

Day – 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview

The Coding Quality Specialist evaluates the adequacy and effectiveness of internal and operational controls designed to ensure that coding processes and practices lead to appropriate execution of regulatory requirements and guidelines related to facility coding including federal and state regulations and guidelines, CMS (Centers for Medicare and Medicaid Services) and OIG (Office of Inspector General) compliance standards. Applies standardized scoring methodology to consistently evaluate coding accuracy and standardizes review findings and methodology to report monitoring results. Communicates review results to department management, coders and other appropriate staff. Makes recommendations to management for corrective action. Serve as a subject matter expert and authoritative resource on interpretation and application of coding rules and regulations and conducts risk assessments of potential and detected compliance deficiencies.

Locations

Stanford Health Care

What you will do

• Adheres to the defined review timeline and coding review protocol standards; assists with development of the monitoring schedule; identifies areas to be reviewed.
• Applies consistent and standardized compliance monitoring methodology for sample selection, scoring and benchmarking, development and reporting of findings.
• Conducts risk assessments to define monitoring priorities by evaluating previous findings.
• Conducts routine retrospective and prospective facility and technical coding reviews, specialized and focused reviews, and other reviews as directed by the Manager and Director of HIMS Coding and Compliance Department.
• Evaluates the appropriateness of ICD-10(International Classification of Diseases), HCPCS (Healthcare Common Procedure Coding System) and CPT (Current Procedural Terminology) codes; evaluates the appropriateness of DRG (Diagnosis-related Group) and admission assignments; evaluates appropriateness of modifier usage; and performs other related analysis and evaluations.
• Prepares written reports of review findings and recommendations and presents to management and maintains monitoring records.
• Researches, abstracts and communicates federal, state, and payor documentation, and coding rules and regulations; stays current with Medicare, Medi-Cal and other third party rules and regulations, ICD and CPT coding updates, Coding Clinic guidelines; serves as subject matter expert and authoritative resource for the department.

Education Qualifications

• High School Diploma or GED equivalent

Experience Qualifications

• Three (3) years of progressively responsible and directly related work experience

Required Knowledge, Skills and Abilities

• Ability to analyze and develop solutions to complex problems
• Ability to communicate effective in written and verbal formats including summarizing data, presenting results
• Ability to comply with the American Health Information Management Associate’s Code of Ethic and Standards
• and applicable Uniform Hospital Discharge Data Set (UHDDS) standards
• Ability to establish and maintain effective working relationships
• Ability to judgment and make informed decisions
• Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
• Ability to use computer to accomplish data input, manipulation and output
• Ability to work effectively both as a team player and leader
• Knowledge of DRG/APC reimbursement
• Knowledge of health information systems for computer application to medical records
• Knowledge of ICD-10-CM & CPT-4 coding conventions to code medical record entries; abstract information
• from medical records; read medical record notes and reports; set accurate Diagnostic Related Groups
• Knowledge of standards and regulations pertaining to the maintenance of patient medical records; medical records coding systems; medical terminology; anatomy and physiology and study of disease

Licenses and Certifications

• CCS – Certified Coding Specialist or
• RHIT – Registered Health Information Technician or
• RHIA – Registered Health Information Administrator or
• CPC and/or CCSP – Certified Professional Coder

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care
• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
• Coordinate for Me: Own the complexity of my care through coordination

#LI-RL1

Equal Opportunity Employer Stanford Health Care (SHC) strongly values ersity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an inidualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $55.99 – $63.06 per hour

Complex Care Manager RN

Remote

Full time

POSITION SUMMARY:

This is a full time, mon-Friday, 40 hour FTE position. No weekends or holidays observed by BMC Health Systems. This is a hybrid role, which will consist of work from home, home visits and community visits for patient care, as well as spending 1-2 days per week working from the Primary care site.

The RN Complex Care Manager in this role will be stationed at the Signature Health Care Raynham, MA embedded site. The RN will be expected to complete home and community visits for patient care in the town of Raynham and the surrounding communities. This is a hands off clinical care role, providing care coordination and intensive case management services to high risk Medicaid patients.

Candidates must have a car and the ability to travel for patient care and on site presence at the embedded PCP site.

The Complex Care Manager works with relevant stakeholders to identify and engage patients in care management with a focus on patient experience, improving health and reducing cost. The inidual is responsible for working with patients to identify strengths and barriers and to develop an inidualized, patient-centered care plan. Excellent interpersonal skills, clinical expertise in conditions prevalent in the Medicaid population (Substance Use Disorder, Serious Mental Illness, Congestive Heart Failure [CHF, etc.), patient engagement skills and the ability to work independently and collaboratively are key requirements of the job.

• Primary Care-based Complex Care Management: The CCM team will be embedded in local primary care practices. The nurse will partner closely with the community wellness advocate, PCPs, Integrated Behavioral Health Professionals, Pharmacists, and other local resources in the Primary Care Practice to develop multi-disciplinary care plans. Nurses will proactively seek out opportunities to care for patients, including during PC visits, during ED or IP visits, out in the community, or on the phone. Nurses will be paired with Community Wellness Advocates who will partner with nurses on a shared patient panel, and will focus on social determinants of health.

Compensation will be based on a salary/incentive plan.

Position: Complex Care Manager RN

Department: Pop-Health Care Management

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

Key Functions/Responsibilities:

• Identify and recruit appropriate patients for care management from lists and referrals, in collaboration with supervisors and local clinical site leaders
• Ability to execute core care management duties:
  • Comprehensive assessment: bio-psycho-social-spiritual
  • Collaboration with patient and care team to develop patient-centered care plan, with particular focus on chronic disease management, social determinants, transitions of care and advanced care planning (HCP, MOLST)
  • Implementation of care plan;
  • Collaboration with community partners, such as VNA agencies, caregiver programs (PCA, ADH, AFC), DME providers and social service agencies; 5) assessment of goal completion, with transition of patient to inactive or graduated status as appropriate.
• Uses reflective, empathetic language and open-ended questions to understand what the patient truly wants for him/herself beyond being healthy and staying out of the hospital
• Meet the patient where he/she is; observe the patient without intervention or judgment
• Has knowledge of common chronic medical conditions presented in the population served and is able to:
  • Educate the patient on their medication conditions and medications, and build their self-management skills;
  • Use motivational interviewing to promote behavioral change;
  • Assess, triage, and rapidly respond to clinical changes that could lead to the need for emergency services if not intervened upon.
• Meets regularly with leaders at the local clinical site (Primary Care, ED, inpatient), and care management supervisor, to triage program issues appropriately.
• Participates in local site operations, including team meetings, curbsides with care team members, etc.
• Actively participates in planning and growth of program with relevant stakeholders as needed, to respond to evolving needs of MassHealth ACO.
• Facilitates interdisciplinary consultation on patient’s behalf through participation in rounds, team meetings and clinical reviews
• Complies with established metrics for performance and adheres to documentation and work flow standards
• Maintains HIPAA standards and confidentiality of protected health information.
• Adheres to departmental/organizational policies and procedures.
• Care Manager will work full-time at the clinical site of care

Metrics:

• ED and inpatient visits
• Total medical expense
• Patient satisfaction
• Clinical outcomes
• Provider satisfaction
• Avoidable admissions

Other duties as assigned

JOB REQUIREMENTS

EDUCATION:

• AD or BS in Nursing

Preferred/Desirable:

• BS or Masters in Nursing

EXPERIENCE:

• A minimum of two years of clinical experience is preferred, with care management experience preferred

Preferred experience:

• Experience working with vulnerable patient populations
• Home care or clinic
• Motivational interviewing
• Clinical experience working with patients with multiple complex health issues
• Care management

CERTIFICATION OR CONDITIONS OF EMPLOYMENT:

• Licensed to practice professional nursing as a Registered Nurse in the Commonwealth of Massachusetts. AND/OR Completed an accredited educational program for Nurse Practitioners

COMPETENCIES, SKILLS, AND ATTRIBUTES:

• Excellent interpersonal skills and ability to work collaboratively
• Self-management skills, including ability to prioritize and set patient-centered goals
• Excellent written and verbal communication
• Able to maintain professional boundaries
• Ability to work with erse, safety-net population
• Skilled at engaging difficult to engage patientsbuild rapport, trust
• Creative problem solver
• Ability to adapt to changes in healthcare delivery at local and systems level
• Extensive knowledge of healthcare systems and community resources
• Ability to leverage systems and resources for improved patient outcomes
• Strong organizational and time management skills

Neurosurgery – Coder (brain/spine)

Job ID2023-3055

# of Openings 2

Category Medical Coding

Minimum Hours Varies

Type Regular Part-Time

Overview

Neurosurgery Specialty Coder – Part Time

GeBBS is looking for a Neurosurgery E/M and surgery coder (brain and spine) with at least 3 years’ experience in neurosurgery coding. This is a long-term, remote coding position with a flexible schedule and a collaborative and supportive team working 10 hours per week.

If you have experience in other specialties, we may be able to offer additional hours.

Responsibilities

• The neurosurgery/spine/brain coder is responsible for ensuring timely, accurate and compliant coding.
• Coder must be able to abstract all CPT, ICD-10-CM, modifiers, and units from the medical record documentation.
• This position provides daily, weekly and monthly reports to executive team and clients/physicians, as well as provider education related to coding and documentation.
• Other responsibilities include accurately entering data into coding software and/or Excel reports. Performing accurate coding using applicable guidelines and client protocols and communicating with clients and/or providers as needed.
• Provide written feedback of coding results as needed in the form of comments, summary findings and recommendations.
• Ensure compliance with federal and state laws, regulations, and standards related to health information and coding principles.
• Communicate with Project Manager as needed (i.e., schedule changes, daily assignments/work volume, coding questions, etc.).

Qualifications

• This is a W2 position for a long-term project
• Current certification through AAPC or AHIMA required
• 3+ years’ experience required abstracting neurosurgery coding CPT, E&M, HCPCS and ICD-10-CM codes from medical records.
  • Experience must include coding POS 11, 21, 22
• 3+ years’ experience with neurosurgery procedure coding (spine)
  • Cervical, thoracic, lumbar spinal fusions/discectomies/laminectomies/decompressions via open and neurointerventional approaches
  • Not required: Craniotomies for injuries/mass removals/aneurysms via open and neurointerventional approaches
• Requires advanced technical knowledge in spinal Neurosurgery.
• Experience in researching and applying coding rules and regulations.
• Must have experience with data entry of codes into a database and/or software tool.
• 95% accuracy rate
• US-Based Candidates Only

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

Renal Service Coordinator – Supervisor (Bilingual)

Remote, U.S. 

Healthcare Operations Patient Engagement

Full Time

Remote

Interwell Health is a kidney care management company that partners with physicians on its mission to reimagine healthcarewith 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!

The Renal Service Coordinator Supervisor will be responsible for direct supervision of staff by providing guidance, mentorship and support, and will act as a Subject Matter Expert for our bilingual Renal Service Coordinators working in a remote environment. The Renal Service Coordinators work in collaboration with our team of nurses, telephonically supporting members and connecting them to resources that slow the progression of kidney disease and improve their overall wellbeing. The supervisor will collaborate with direct reports, internal stakeholders, and the region’s Clinical Director to ensure we deliver high quality care and an optimal patient experience.

The work you will do:

• Responsible for supervising and coordinating the Renal Service Coordinator Team in their day-to-day work, and problem solving as issues and process gaps arise.
• Collaborate with other supervisors and senior leadership to develop team policies, procedures, goals, and objectives. Track and report results
• Provide leadership and coaching for all direct reports to maintain an engaged, productive and high-performing team. Support hiring to grow our team with top talent
• Become a Subject Matter Expert on the tools Renal Service Coordinators rely on, guiding team members on using them to achieve their goals, and partnering with other teams on necessary workflow or technological changes.
• Monitor key performance metrics, such as quality, task completion, appropriate prioritization, and workload balance. Provide regular feedback and insights
• Assure team compliance through regular audits and chart reviews. Lead issue resolution in team’s development areas
• Assess departmental needs and recommend necessary changes to upper leadership.
• Assist with various projects as assigned by the manager.
• Partner with Clinical team leadership in delivering strong health outcomes and a positive patient experience

The skills and qualifications you need:

• Must be bilingual – Spanish – written and verbal professional proficiency required.
• 3 or more years of Renal Service Coordinator experience or 2- 3 years of Supervisory experience, preferably in a healthcare setting
• Previous successful remote team leadership experience preferred.
• Excellent communication and problem-solving skills.
• Strong computer skills with demonstrated proficiency in word processing, spreadsheet, presentation, and email applications.
• Must be organized and detail-oriented, with a strong bias for follow-up and problem resolution.

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 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!

Meeting & Events Manager

Remote

About SpringWorks Therapeutics

SpringWorks is a clinical-stage biopharmaceutical company applying a precision medicine approach to acquiring, developing and commercializing life-changing medicines for patients living with severe rare diseases and cancer. SpringWorks has a differentiated targeted oncology pipeline spanning solid tumors and hematological cancers, including two late-stage clinical trials in rare tumor types as well as several programs addressing highly prevalent, genetically defined cancers. SpringWorks’ strategic approach and operational excellence in clinical development have enabled it to rapidly advance its two lead product candidates into late-stage clinical trials while simultaneously entering into multiple shared-value partnerships with innovators in industry and academia to unlock the full potential for its portfolio and create more solutions for patients with cancer.

We give it our all every day because we believe in the power of targeted oncology to help people with cancer. If you recognize yourself in us, then we’d like to meet you. The answers are waiting and we need your help finding them.

About the Role:

The Meeting & Events Manager reports to the Director of Commercial Operations and serves as the operational lead for all meetings and events in the Commercial Organization. This inidual is accountable to establish operational objectives, plan and execute operations, and manage all third-party suppliers for meeting & events operations and logistics for: advisory boards, plan of action (POA) meetings, national sales meetings, training meetings, speaker programs, and conferences. This inidual also holds accountability for handling end to end exhibit development and operations for conferences and plays an important part in the curation of the employee and customer experience.

Duties & Responsibilities:

• Handle end to end venue sourcing (e.g., conduct site visits, source venues according to specification, negotiate contracts, plan menus, prepare banquet event orders, plan AV/Production needs)
• Manage the development and production of all meeting-related content (e.g., timeline creation, development of agenda and logistics communications, print/distribution of invitations, confirmations, meeting packets, onsite materials)
• Plan and manage all registration and travel demand associated with the meetings & events (e.g., flights, housing selection, ground transportation, registration, tracking)
• Manage exhibit development, including oversight of exhibit suppliers, coordination of committee & functional reviews and approvals
• Oversee on-demand/supplemental suppliers for meeting planning, coordination, and on-site support, speaker bureau logistics, and others as required
• Build, monitor, and maintain accurate meeting and events KPIs & budgets, including accrual tracking & reporting; consistently thinking creatively to contain costs
• Manage all compliance reporting pre and post meeting as required (e.g., FCPA, Meal Caps, State Laws and TOV reporting)
• Travel on-site to manage staff and execution of plan when required
• Constantly strive for continuous improvement of M&E processes, procedures, and tools
• Provide unparalleled consultative service to meeting owners and attendees

Qualifications:

Education:

• Bachelor’s Degree preferred

Experience:

• 3+ years relevant experience managing operations (preference in biotech/pharma company)
• 1+ years meeting planning and organization, pharmaceutical/biotech meetings preferred

Skills:

Technical:

• Organized and possesses superior attention to detail
• Ability to multi-task, prioritize workload and meet deadlines
• Exceptional problem-solving skills
• Strong administrative and computer skills (e.g., database management, phone support, email)
• Moderate to Advanced User of Microsoft Office Suite, CVENT, ContractSafe, and DocuSign

Leadership:

• Consultative and service-oriented approach when engaging with colleagues

Communication:

• Excellent written and verbal communication
• Objective and partner-oriented communication style when engaging with service providers

Other:

• Calm under pressure
• Work well in a collaborative environment
• Moderate to extensive travel is required and may involve weekends from time to time
• In-office days prior to live meeting dates for shipping/meeting material preparation
• Some lifting (e.g., boxes of meeting materials)

Actual pay will be determined based on experience, qualifications, and other job-related factors permitted by law. A discretionary annual bonus may be available based on inidual and Company performance.

We also offer a comprehensive benefits package for our team of SpringWorkers and their families, including competitive compensation, annual cash bonuses and equity grants, 401K matching, fully covered medical, dental, and vision plans, and a full week of holiday break at year end. It’s the right thing to do and helps us be healthy, happy, and at our best for the people who need us.

At SpringWorks, we believe in fostering a culture of belonging. Our Employee Resource Group’s (ERG) mission is to boldly live the SpringWorks values, provide resources, and deeply engage SpringWorkers and the communities we serve to foster a culture of belonging. Ensuring ersity, equity, and inclusion are integral to our organization’s DNA.

SpringWorks is an equal employment opportunity employer that is strongly committed to equal employment opportunities for all iniduals. The Company does not discriminate in employment opportunities or practices on the basis of actual or perceived sex (including pregnancy, childbirth, breast feeding or related medical conditions), gender, gender identity or gender expression, sexual orientation, partnership status, marital status, familial status, pregnancy status, race, color, national origin, ancestry, religion, religious creed, age, alienage or citizenship status, veteran status, military status, physical or mental disability, past or present history of mental disorder, medical condition, AIDS/HIV status, sickle cell or hemoglobin C trait, genetic predisposition, genetic information, protected medical leaves, domestic violence victim status, sex offense or stalking victim status, political affiliation and any and all other characteristics or categories protected by applicable federal, state or local laws.

This Equal Employment Opportunity Policy applies to all aspects of employment, including, without limitation, recruitment, hiring, placement, job assignment, promotion, termination, transfer, leaves of absence, compensation, discipline, and access to benefits and training. Any violation of this Policy will result in disciplinary action up to and including termination of employment.

Medical Coder II

Apply

locations

US-Remote

time type

Full time

posted on

Posted 8 Days Ago

job requisition id

R0016336

At GenesisCare we want to hear from people who are as passionate as we are about innovation and working together to drive better life outcomes for patients around the world.

PURPOSE: This position, under limited supervision, reviews, analyzes and assures the final diagnosis and procedures as stated by the practicing providers are valid and complete. Accurately codes office and hospital procedures for providers to ensure proper reimbursement. Responsible for coding, chart compliance, auditing and collections support. The ideal candidate will have 2+ years coding experience in a hospital or medical office setting.

ESSENTIAL DUTIES:

• Confirm patient demographic, insurance and referring physician information is accurately entered into practice management system.
• Confirm insurance verifications and authorizations, as required.
• Communicate with Financial Counselors regarding insurance authorizations and referrals.
• Review daily physician schedules and evaluate Evaluation & Management (E&M) levels for appropriate complexity assigning the correct CPT code.
• Enter all CPT and ICD-10 coding into practice management system timely and accurately for code capture.
• Accurately follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies.
• Enter all word codes into practice management system per company policy and procedures.
• Follow established check and balance systems to ensure complete and accurate code capture.
• Respond to audit findings and make applicable coding additions or corrections.
• Review Medicare Local Coverage Determinations (LCDs) and Medicare bulletin updates and Medicare NCCI.
• Update practice management system patient’s account notes with any changes made to patient information or as otherwise dictated by company policy and procedure.
• Confirm all documentation required for coding is complete and meets required regulations.
• Attends seminars and in-services as required to remain current on coding issues.

RESPONSIBILITIES/QUALIFICATIONS:

• Perform coding work requiring independent judgment with speed and accuracy.
• Examining and verifying coding errors through audits.
• Required In-services.
• Communicating clearly and concisely, orally and in writing.
• Confidentiality.
• Ability to use the computer.
• Understanding and carrying out verbal and written directions.
• Follow GenesisCare’s policies and procedures.
• Work independently in the absence of supervision.

EDUCATION AND/OR EXPERIENCE:

• Medical Billing/Coding Diploma or Certificate Required (CPC)
• Oncology coding experience (preferred)
• 2 or more years of coding experience in hospital or medical office setting required.
• Proficient knowledge of medical terminology, ICD-10 and CPT coding.
• Excellent computer skills including Microsoft Office especially Word and Excel.
• High school graduate or equivalent.

Telephonic Complex Nurse Case Manager

Job LocationsUS-United States

Requisition ID

2023-15249

Category

Managed Care

Position Type

Regular Full-Time

Overview

AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Complex Care Case Manager, RN for Workers Compensation.

PRIMARY PURPOSE: The Complex Care Case Manager will provide comprehensive and quality telephonic case management for our injured employees with complex diagnoses and often catastrophic injuries. Our nurses will be responsible for proactively applying clinical expertise ensuring our injured employees receive medically appropriate healthcare to achieve a safe return to work or best optimal level of function through engagement with the injured employee, provider and employer. Our nurses will be empathetic informative medical resources for our injured employees, and they will partner with our adjusters to develop a personalized holistic approach for each claim. These responsibilities may include utilization review, pharmacy oversight and care coordination.

Responsibilities

• Uses clinical/nursing expertise to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered.
• Improve the quality of life with the overall goal of return to pre-injury status. Assist the injured employee and family to secure optimal care and achieve full recovery.
• Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional guidelines.
• Coordination of medically appropriate care where multiple services may be needed such as discharge planning for hospitalizations, pain and symptom management, home health, provider home visits, home based palliative care or assistance with daily living activities.
• Responsible for accurate comprehensive documentation of case management activities in case management system. This includes documenting medical and disability case management strategies for claim resolution, based on clinical expertise. Adheres to confidentiality policy. Includes written correspondence as needed to prescribing physician(s) and refers to physician advisor as necessary
• Uses clinical/nursing skills to help coordinate the inidual’s treatment program while maximizing quality and cost-effectiveness of care including direction of care to preferred provider networks where applicable.
• Establishes effective return to work plans with employer, injured employee, provider and other parties as needed. Addresses need for job description and appropriately discusses with employer, injured employee and/or provider. Works with employers on modifications to job duties based on medical limitations and the employee’s functional assessment.
• Responsible for helping to ensure injured employees receive appropriate level and intensity of care through use of medical and disability duration guidelines, directly related to the compensable injury and/or assist adjusters in managing medical treatment to drive resolution.
• Communicates effectively both verbal and written with medical professionals, claims adjuster, client, vendor, supervisor and other parties as needed to negotiate, coordinate appropriate medical care and effective return to work plans utilizing critical thinking skills, clinical expertise and other resources needed to achieve an optimal case outcome.
• Performs clinical assessment via information in medical/pharmacy reports and case files; assesses client’s situation to include psychosocial needs, cultural implications and support systems in place
• Objectively and critically assesses all information related to the current treatment plan to identify barriers, clarify or determine realistic goals and objectives, and seek potential alternatives.
• Partners with the adjuster to develop medical resolution strategies to achieve maximal medical improvement or the appropriate outcome
• Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
• Engage specialty resources as needed to achieve optimal resolution (behavioral health program, physician advisor, peer reviews, medical director).
• Partner with adjuster to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves
• Maintains client’s privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.
• May assist in training/orientation of new staff as requested
• Other duties may be assigned.
• Supports the organization’s quality program(s).

Qualifications

Education & Licensing

Active unrestricted RN license in a state or territory of the United States required. Bachelor’s degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. National Certification in case management OR the ability to obtain certification within 24 months of employment is required. (CCM, COHN, CRRN, etc). Active unrestricted RN license in a state or territory of the United States with eligibility to get and/or renew a multistate license is required. Written and verbal fluency in Spanish and English preferred

Experience

• Minimum Five (5) years of related experience required to include two (2) years of direct clinical care AND three (3) years of combination of either case management/managed care setting/discharge planning/utilization management required.
• Preferred previous clinical experience emergency room, critical care, home care or rehab experience.

Skills & Knowledge:

• Knowledge of workers’ compensation laws and regulations
• Knowledge of case management practice
• Knowledge of the nature and extent of injuries, periods of disability, and treatment needed
• Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines
• Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitation
• Knowledge of behavioral health
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Leadership/management/motivational skills
• Analytic and interpretive skills
• Strong organizational skills
• Excellent interpersonal and negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

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

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

Physical: Computer keyboarding

Auditory/Visual: Hearing, vision and talking

What We Offer

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

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

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

Coding Supervisor

Remote – Nationwide

Full time

R008895

Thank you for considering a career at Ensemble Health Partners!

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

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

The Opportunity:

Responsibilities:

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

Minimum Education Requirement:

• 2 Year/Associate’s Degree

Preferred Education:

• 4 Year/Bachelor’s Degree

License/ Certification Requirement:

• Certified Coding Specialist, (CCS,) or CIC (for Inpatient) or COC for Outpatient, Registered Health Information Technician, (RHIT,) or Registered Health Information Administrator, (RHIA)

Preferred Certifications:

• ICD-10 Credentialed Trainer certification, Certified Revenue Cycle Representative (CRCR)

Join an award-winning company

• Three-time winner of Best in KLAS 2020-2022
• 2022 Top Workplaces Healthcare Industry Award
• 2022 Top Workplaces USA Award
• 2022 Top Workplaces Culture Excellence Awards
  • Innovation
  • Work-Life Flexibility
  • Leadership
  • Purpose + Values

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

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

Operations Associate, Clinical Pharmacy Operations

locations Remote USA

time type Full time

job requisition id R1134

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 more about this role:

Devoted Medical is building clinical programs to manage and coordinate care in a manner consistent with Devoted’s values of treating every member like family. Medication plays a crucial role in helping people manage chronic conditions, but in many cases effective medication management is limited by barriers to access, uncoordinated prescribing, or a failure to use the most effective evidence-based medication therapies. Devoted’s clinical pharmacy team aims to support improved therapeutics for Devoted members.

It supports this work in three ways:

• Conducting medication reviews (via direct member engagement and via pharmacist consult support for other clinicians)
• Virtual pharmacist-led care via telemedicine to close therapy gaps
• Coordinating care for changes in therapy by counseling members and engaging prescribers and pharmacies

This work is done in service of a number of goals. The clinical pharmacy team drives Devoted’s quality and Medicare Stars performance on medication adherence, blood pressure control, statin use, and other quality measures, and also plays a critical role in care teams for other clinical programs (such as our Intensive Home Care program, our Diabetes and CHF programs, and our Transition of Care program). Pharmacist consults help our clinical teams reduce polypharmacy issues and improve evidence-driven medical therapy.

Examples of these interventions include:

• Conducting comprehensive and targeted medication reviews
• Identifying and closing statin therapy gaps via a pharmacist-led telemedicine intervention
• Driving medication adherence for diabetes, hypertension, and cholesterol management
• Performing consults for complex care teams to help address polypharmacy issues
• Coordinating appropriate screening and testing for therapeutic drug monitoring and detection/prevention of future bad outcomes

As an Operations Associate in this role, you will partner with our Clinical Pharmacy and Operations teams to assist in coordination, tracking and monitoring, outreach, and follow-up to ensure that we are assisting the team and providing best in class care to our members. You will be part of a mission-driven, team-oriented, joyful culture amongst the broader pharmacy team who care for our members.

Responsibilities will include:

• Assists with assignment and distribution of daily tasks to ensure optimizing productivity
• Ensure that all team members are working at their top of their license, works in conjunction with stakeholders to develop tools and oversight to ensure distribution of pharmacist & pharmacy technician work
• Ensure programs are developed to run as automated as possible, with clear success metrics
• Ability to develop workflows and supporting documentation for all program processes
• Engages with cross-functional team members in designing, implementing, and maintaining new or changes to existing programs.
• Consistently identifying areas of opportunity for process improvement and finding ways to streamline processes
• Assists with pharmacy related questions and concerns and provides triage to the appropriate escalation pathway
• Communicate frequently with team members and leadership; ensure all required follow-up tasks are completed in a timely manner
• Assists with special projects as needed/required
• Working hours 8:00am – 5:30pm EST

The Operations Associate, Clinical Pharmacy Operations will report to the Director, Clinical Pharmacy Operations at Devoted Medical. The Director will work in conjunction to support all operational activities associated with the Clinical Pharmacy team.

Attributes to success:

• Highly organized and detail-driven
• Adaptable and flexible, willing to roll your sleeves up and shift priorities
• Collaborative and enjoys working as part of a team
• You thrive in a fast-paced, dynamic environment and are a self-starter
• You excel at solving complex problems but you’re also very happy to make a “to do” list, roll up your sleeves, and get these tasks done
• You are a transparent communicator about your work, what’s going well, and what’s not; and thoughtful about adapting and finding new and innovative ways for improving processes
• You have a passion for making healthcare better; supporting the delivery of care that we would want for your own family members

Desired Skills and experience:

• Ability to work in a startup, fast-paced environment
• Bachelor’s degree strongly preferred
• 2+ years professional experience in operations, workflow management and/or process management, in a medical setting strongly preferred
• Bilingual in Spanish a plus

Salary Range: $57,700 – $78,800 annually

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 or commission eligibility for all 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.

The salary and/or hourly range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member’s base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, years of relevant experience, education, credentials, budget and internal equity).

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.

Medical Review Coding QA Auditor (Outpatient)

Job Code:2023-53-R-014

Location:United States – Remote

Status:Regular Full Time

Pay Range:70550.00-95450.00

Responsibilities:

The Medical Review Coding QA Auditor (Outpatient) is responsible for conducting Quality Assurance (“QA”) reviews of medical review audit work completed by the medical review coding audit team members to ensure the accuracy of claim findings and applicable documentation for our clients. Communicates and supports the identification of potential training opportunities or enhancements to training and/or concept review guideline materials and tools. Responsible for performing some audit activity and consistently achieves or exceeds productivity goals and quality standards. Serves as subject matter expert, provides supplemental escalation support, and may perform special project activity as needed.

Duties

• Performs limited volume of outpatient coding reviews on medical records to maintain subject matter expertise, and additionally as needed to support business needs.
• Conducts quality assurance reviews on medical review audit work completed by the medical review coding audit team members, maintaining productivity and quality standards as defined by department policy.
• Objectively and accurately documents quality review results in accordance with department quality policies and procedures, scoring and reporting all QA results in an approved QA tracking system and routes record appropriately within audit platform based upon how QA review resulted in concurrence with audit finding or identified corrections required.
• Reviews audit documentation and conducts research, analyzes claims data, applies knowledge of client SOW, applicable concept guidelines, policies, and regulations as necessary to determine if audit result is accurate and includes complete details to support findings.
• Provides correction to narrative rationale to correspond with audit determination and flags patterns of concern to audit leadership for real-time intervention, preventing an accumulation of improper findings
• Contributes to the continuous improvement feedback process and suggests or makes any edits, documentation, next steps, and reporting as may be necessary in accordance with department process and audit leadership direction.
• May support findings during the appeals process, if needed.
• May perform primary audit activity as assigned by management
• Monitors, tracks, and reports on all work conducted in accordance with QA process and management direction.
• May prepare QA reports for management that includes a variety of data and trends at the inidual, department, and client program level, as well as date range or concept based/trended, or other characteristic that will provide valuable business insights.
• Consults with internal resources as necessary.
• Become subject matter expert for assigned business segment(s).
• Maintain current knowledge and changes that affect our industry and clients as it pertains to medical practice, technology, regulations, legislation, and business trends.
• Participates in and contributes to applicable department meetings.
• Successfully completes, retains, applies, and adheres to content in required training as assigned that includes but not limited to information security, anti-harassment and other compliance and policy/procedures training applicable for position.
• Proactively contributes to continuous improvement of activities and sets positive example
• Contributes collaboratively to identifying opportunities for improvement of audit results and continuous improvement initiatives.
• May support training material/tools and best practices development.
• May identify/make recommendations to management for supplemental team/concept type training.
• May support training activities for new audit staff or provide supplemental training for existing staff as needed.
• Contributes to positive team environment that fosters open communication, sharing of information, continuous improvement, and optimized business results.
• Receives feedback and adjusts work priority as necessary.
• Serves as positive role model and example for other audit staff and conducts work in accordance with company policies, government regulations and law.
• Performs job duties with high level of professionalism and maintains confidentiality
• Perform other incidental and related duties as required and assigned to meet business needs.

*Note – All employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Performant’s policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Required Skills and Knowledge:

• Demonstrated ability to perform claim payment audits with high quality and production results, as well as successful application of skills to conduct quality assurance review of audit work completed by others.
• Must be able to manage multiple assignments effectively, create documentation outlining findings, QA review results and/or documenting suggestions, organize and prioritize workload, problem solve, work independently and with team members.
• Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10/MS-DRG coding.
• Proficiency with MCS 1500/UB 04 forms
• Strong knowledge of medical documentation requirements and an understanding CMS, Medicaid and/or Commercial insurance programs, particularly the coverage and payment rules and regulations.
• Working knowledge of encoder
• Proven ability to review, analyze, and research coding issues
• Reimbursement policy and/or claims software analyst experience
• Familiarity with interpreting electronic medical records (EHR)
• Basic understanding of accounting principles for accounts payable and receivable as it relates to medical billi ng.
• Independent, out-of-the-box thinker; Performs successfully against work given in the form of objectives and projects; leads by example.
• Understands processes, procedures, and workflow; and demonstrated ability to identify areas of opportunity
• Demonstrated ability to consistently apply sound judgment and good effective decision making.
• Understands Medical Review Audit and Quality Assurance objectives, activities, and key drivers in achieving operational goals.
• Ability to efficiently and effectively run reports, analyze information, identify meaningful trends, and identify potential solutions.
• Strong communication skills, both verbal and written; ability to communicate effectively and professionally at all levels within the organization, both internal external.
• Demonstrated ability to collaborate effectively in a variety of settings and topics.
• Excellent editing and proofreading skills.
• Ability to independently organization, prioritize and plan work activities effectively for self and others; develops realistic action plans with the ability to multi-task effectively.
• Excellent time management and delivers results balancing multiple priorities.
• Strong analytical skills; synthesizes complex or erse information; collects and researches data; uses experience to compliment data.
• Leverages strong critical thinking, questioning, and listening skills to research and effectively resolve complex issues.
• Demonstrated ability to identify areas of opportunity and create efficiencies in workflows and procedures.
• Demonstrated ability to be proactive; identifies and resolves problems in a timely manner; develops alternative solutions.
• Ability to create documentation outlining findings and/or documenting suggestions.
• Strong general computer skills, including, but not limited to Desktop and MS Office applications (Intermediate Excel Skills), application reporting tools, and case management system/tools to review and document findings.
• Solid technical aptitude with demonstrated ability to quickly learn and adapt to new systems and tools.
• Ability to be flexible and thrive in a high pace environment with changing priorities.
• Adaptable to applying skills to erse operational activities to support business needs.
• Self-starter with the ability to work independently in remote setting with minimum supervision and direction in the form of objectives.
• Serves as a positive role model; and demonstrates characteristics that align and contribute to a collaborative culture of continuous improvement and high performing teams.
• Capability of working in a fast-paced environment, flexibility with assignments and the ability to adapt in a changing environment
• Ability to obtain and maintain client required clearances, if applicable, as well as pass company regular background and/or drug screening.

Additional Requirements:

• Ability to obtain and maintain client required clearancesas well as pass company regular background and/or drug screening.
• Completion of Teleworker Agreement upon hire, andadherence to the Agreement (and related policies and procedures) including, butnot limited to: able to navigate computer and phone systems as a user to workremote independently using on-line resources, must have high-speed internetconnectivity, appropriate workspace able to be compliant with HIPAA, safety& ergonomics, confidentiality, and dedicated work focus without distractionsduring work hours.

Physical Requirements:

**NOTE: Must be able to meet requirements for andperform work assignments in accordance with Company policies and expectationson a home remote basis (and must meet Performant remote-worker requirements)until at which time staff may be notified and required to work from aPerformant office location on an ad-hoc or periodic basis.

• Basic office equipment required to perform remote workis provided by the company.
• Job is performed in a standard busy office environmentwith moderate noise level (or may be home-office setting subject to Companyapproval and Teleworker Agreement), sits at a desk during scheduled shift, usesoffice phone or headset provided by the Company for calls, making outboundcalls and answering inbound return calls using an office phone system; views acomputer monitor, types on a keyboard, and uses a mouse.
• Reads and comprehends information in electronic(computer) or paper form (written/printed).
• Sit/stand 8 or more hours per day; has the option tostand as needed while on calls; reach as needed to use office equipment.
• Consistently viewing a computer screen and typesfrequently, but not constantly, using a keyboard to update accounts.
• Consistently communicates on the phone as requiredprimarily within the department and company and may include client contacts orother third-party depending on assignment with account holders, may dialmanually when need or use dialer system; headset is also provided.
• Occasionally lift/carry/push/pull up to 10lbs.

Education and Experience:

• Current certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P
• Not currently sanctioned or excluded from the Medicare program by OIG
• 3+ years of direct experience in medical chart review for all provider/claim types for outpatient
• 5+ years relevant auditing experience in a provider or payer environment demonstrating breadth and depth of knowledge/skills for the position. (less than 5 yrs. may be considered for internal candidates based upon demonstrated skills and results).
• Prior experience in role with responsibility for conducting primary audit, utilization or prior-authorization work, or quality review of audit work performed by others (QA function, appeals function, lead, supervisory role, etc.)
• Prior experience in payer edit development and/or reimbursement policy a plus.
• Prior experience working in remote setting preferred.

Other Requirements:

Performant is a Government contractor and subject tocompliance with client contractual and regulatory requirements, including butnot limited to, Drug Free Workplace, background requirements, and clearances(as applicable).

• Must submit to and pass pre-hire background check, aswell as additional checks throughout employment.
• Must be able to pass a criminal background check; mustnot have any felony convictions or specific misdemeanors, nor on state/federaldebarment or exclusion lists.
• Must submit to and pass drug screen pre-employment (andthroughout employment).
• Performant is a government contractor. Certain clientassignments for this position requires submission to and successful outcome ofadditional background and/or clearances throughout employment with the Company.

Employment VISA Sponsorship is not available for thisposition

Job Profile is subject to change at any time.

EEO

Performant Financial Corporation is an Equal OpportunityEmployer.

Performant Financial Corporation is committed tocreating a erse environment and is proud to be an equal opportunityemployer. All qualified applicants will receive consideration for employmentwithout regard to race, color, national origin, ancestry, age, religion,gender, gender identity, sexual orientation, pregnancy, age, physical or mentaldisability, genetic characteristics, medical condition, marital status,citizenship status, military service status, political belief status, or anyother consideration made unlawful by law.

NO AGENCY SUBMISSIONS WITHOUT PERFORMANT AUTHORIZEDAGENCY AGREEMENT AND APPROVED PERFORMANT JOB ORDER5.

Utilization Management Coordinator

Remote

Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.

SCOPE OF ROLE

The role of the Referral Coordinator is to facilitate consistency of information shared across practices to promote care coordination and effective member co-management for behavioral and non-behavioral practitioners. The Referral Coordinator collaborates with clinical team members to evaluate the potential over and underutilization of specialty services based on clinical protocols.

ROLE RESPONSIBILITIES

• Prioritizes assigned patient cohorts to ensure specialty referral completion and ensures stat and expedited referrals are completed based on timeliness standards
• Schedules patients (Preferred Providers List of Specialists) and notifies them of appointment information, including, date, time, location, etc.
• Ensures missed specialty appointments are rescheduled and communicated to the physician/clinician.
• Ensures specialist notifications of referral status
• Completes exchange of information by retrieving and ensuring upload of specialty consultation and follow-up notes
• Completes documentation based on standardized documentation; to include, but not limited to location, notification of specialist, notification of patient, the status of appropriateness reviews
• Enters all Inpatient and Outpatient elective procedures in EMR and contacts specialist for post-procedure referral needs
• Follows up on all Home Health and DME orders to ensure the patient receives the services ordered.
• Completes appropriateness review based on clinical protocols and appropriately refers to Nurse or Medical Director Addresses referral-based phone calls for Primary Care Physicians panel and completed phone messages timely
• Facilitates escalation of denied referrals to the clinical team for appeal reviews.
• Adheres to the Policies and Procedures set forth by the Quality Management Committee.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• High School Diploma
• Minimum 2 years of experience in medical management.
• Capacity to interpret health plan benefit decisions

LICENSURES AND CERTIFICATIONS

• Certification as a Medical Assistant preferred

WORK ENVIRONMENT

• The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
• Some travel may be required.

Clinical Care Reviewer, Utilization Management Review, Registered Nurse, REMOTE

Location: Remote, United States/US

C: 2.02

Location Remote, United States

Primary Job Function Medical Management

Job Brief

Current unrestricted North Carolina or compact Registered Nurse license required. While this is a remote role, the selected candidate will be required to work during Eastern Standard Time or Central Standard time.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate iniduals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

The Clinical Care Reviewer will be scheduled to CORE or FLEX hours to provide access to medical necessity determinations for urgent and contractually required coverage requests on a 24/7, 365 basis.

Under the direction of the supervisor, the Clinical Care Reviewer UM is responsible for completing medical necessity reviews. Using clinical knowledge and experience, the Clinical Care Reviewer UM reviews the provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. It is within Clinical Care Reviewer UM discretion to pend requests for additional information and/or request clarification.

The Clinical Care Reviewer UM will use his/her professional judgment to evaluate the request and ensure that services are appropriately approved, recognize care coordination opportunities and refer those cases to Population Health as needed. The Clinical Care Reviewer UM will apply independent medical judgment to medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when indicated. The Clinical Care Reviewer UM will ensure that treatment delivered is appropriate and meets the Member’s needs in the least restrictive, least intrusive manner possible. The Clinical Care Reviewer UM will maintain current knowledge and understanding of and regularly apply the laws, regulations, and policies that pertain to the organizational business units and uses clinical judgment in their application.

This description provides a general overview of the position, recognizing that day to day duties of each inidual in the position may vary based on personal experience, skills, supervision, cases and other factors.

Education/Experience:

• While this is a remote role, the selected candidate will be required to work during Eastern Standard Time or Central Standard time.
• Associate’s Degree required; Bachelor’s Degree preferred.
• Current unrestricted North Carolina or compact Registered Nurse license required.
• 3 or more years of experience in a related clinical setting as a Registered Nurse.
• Experience performing utilization management reviews (prior authorization and concurrent reviews) in a managed care organization.
• Proficiency utilizing MS Office and electronic medical record and documentation programs.
• Experience utilizing Interqual desired.
• Strong written and verbal communication skills.
• Ability to think critically to resolve problems.
• Valid Driver’s License and reliable automobile transportation for on-site assignments and off-site work related activities (based on business needs).

Inpatient Coder

Location Omaha, Nebraska, USA

76960 USD – 83200 USD/Year

Daily Duties:

The Inpatient Coder II is the coding and reimbursement expert for ICD-10-CM diagnosis coding and ICD-10-PCS procedure coding for complex inpatient acute care discharges. This person possesses a strong foundation in coding conventions, instructions, Official Guidelines for Coding and Reporting, and Coding Clinics.

• Utilizes technical coding expertise to assign appropriate ICD-10-CM and ICD-10-PCS codes to complex inpatient visit types.
• Thoroughly reviews the provider notes within the health record and clinical documentation.
• Efficiently review documentation and select or assign ICD-10-CM/PCS codes using autosuggestion or annotation features.
• Review Discharge Planning and nursing documentation to validate and correct when necessary.
• Utilizes knowledge of MS-DRGs, APR-DRGs, and AHRQ Elixhauser risk adjustment to sequence the appropriate ICD-10-CM codes within the top 24 fields to ensure correct reimbursement and NM’s ranking in US News and World Report.
• Collaborate with CDI on discharges regarding the final MS or APR DRG and comorbidity diagnoses.
• Educates CDI on regulatory guidelines, Coding Clinics, and conventions to report appropriate ICD-10-CM diagnoses.
• Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to determine the Principal Diagnosis, secondary diagnoses, and procedures.
• Utilizes coding expertise and knowledge to write appeal letters in response to payor DRG downgrade notices.
• Meets established coding productivity and quality standards.

Additional Skills & Qualifications:

• 3+ years of inpatient coding experience in an academic facility or teaching hospitality.
• RHIA, RHIT or CCS credential
• AHIMA membership
• Ability to work from home with hard-wired internet and designated office space

Work Environment:

• 100% remote opportunity; all equipment will be provided.

Shift:

• 8-hour shift between 6 am-6 pm in the candidate’s local time zone.

Title: Nurse Practitioner – Care OnDemand – Acute Care Visits – Remote

Location: United States

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 more about this role:

This position represents 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, amazing practice administrators, and our close social work and clinical nurse partners at Devoted Health Plan.

Responsibilities will include:

• Primarily perform 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 other members of the member’s care team including their PCP, specialists, and other Devoted team members including pharmacy, clinical nursing, and social work as well as interfacing with family members and caregivers in order to coordinate care for the member and deliver a collaborative care plan.
• 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.

Attributes to success:

• Skilled nurse practitioner with comprehensive knowledge of acute conditions, diagnostics, and treatments.
• Adept ordering of appropriate diagnostic testing, quality of care interventions, and completing a comprehensive diagnosis review.
• You have great clinical and non-clinical judgment.
• You are thorough and take the time to address the needs of your patients.
• You are deeply empathetic and humanistic, and want to go the last mile for your patients.
• You enjoy a fast-paced, high-energy, organization. Agility and collaboration are key as we will change and improve quickly.
• You welcome learning and using new technologies that are being developed in parallel. You thrive on knowing your work can help make these technologies better for you and your patients.
• You learn from every experience and are not afraid to fail – that’s how you’re wired.
• Finally and most importantly, you have a passion for making healthcare better, solving complex problems, and supporting the delivery of healthcare that we would want for our own family members.

Desired skills and experience:

• Role licensure and certification in good standing is required in Arizona, Illinois, Ohio, Texas, or Florida 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
• 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.

#LI-REMOTE

Salary range: $110 – 125K annually

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 or commission eligibility for all roles
• Parental leave program
• 401K program
• And more….

The salary and/or hourly range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member’s base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, years of relevant experience, education, credentials, budget and internal equity).

Nurse Talent Advocate

at Incredible Health

Remote

Do you love customer service and the idea of helping healthcare workers find their dream permanent job? Do you want to be in a working environment surrounded by amazing fellow nurses and operations experts who are just as passionate and excited as you are? Do you want to make a difference to the careers of nurses across the country?

Incredible Health is hiring a highly motivated and energetic Talent Advocate to engage with fellow nurses to find their next dream job through our platform. As a Talent Advocate, you will play an important role in helping nurses find their next jobs by providing Talent with a direct contact as they navigate the job search and interview process.

Incredible Health is a fast-growing, venture-backed career marketplace for healthcare workers.

The typical day-to-day in this role will involve:

• Speak with our platform’s nurses to help them evaluate potential hospital employers.
• Coach and support our platform’s nurses through their interview process.
• Work in a super energetic and collaborative environment with a team of nurses and operations experts dedicated to helping Incredible Health growth and expansion.

You might be the one we’re looking for if:

• You get energized by interacting with fellow nurses to help them find the next step of their careers.
• Obstacles don’t stop you. You think critically and creatively to solve problems.
• You love picking up the phone. You have strong communication skills with the ability to clearly articulate ideas and build relationships.
• You have a collaborative, team-oriented working style with the ability to work independently.
• You have the ability to prioritize and organize a dashboard of candidates.
• You are committed and self-motivated to driving strong results for our talent users, employers users, your team, and yourself
• You have a willingness and desire to learn.
• You’re available to work 40 hours per week and are authorized to work in the US.
• You are open to a 2-month 1099 trial period. The 1099 trial period is to make sure this is a transition you would like to make.
• RN license is preferred but not required.

Success in your first 6 months will look like:

• You are confident when speaking with our candidates and can clearly articulate job opportunities, the hiring process with our Employer Groups, and navigating the Offer stage.
• You have built strong relationships with your fellow Talent Advocates, Recruiter Advocates, and other cross-functional stakeholders.
• You have successfully helped nurses find their next dream permanent job!

And now a little bit about us…

Incredible Health is the fastest-growing venture-backed career marketplace for healthcare workers. Our software and service help healthcare workers like nurses find and do their best work. We’re using technology to give healthcare recruiting a much-needed speed and quality boost while solving the number one problem of our hospital partners – how to get the staff they need. Our vision is to help healthcare workers live better lives. We’re backed by top venture firms like Andreessen Horowitz and we’re growing and moving fast.

Working here is awesome because:

• We’re moving quickly so things never get stale.
• We get to make a difference in the lives of healthcare workers who are truly amazing people.
• We are a fully remote team!
• We are a very high-caliber team of medical doctors, nurses, software engineers, designers, sales leaders, account managers, and more.
• We pay a competitive salary, and we’ve got you covered when it comes to your health (medical, vision, dental) and future (401k).
• We offer 2 weeks of vacation plus sick, bereavement and holidays
• We welcome candidates with backgrounds that are commonly underrepresented in our industries.
• We deeply value culture, community, and camaraderie amongst our team – we strive to create a work environment that lets you have fun and celebrate (team events and trivia galore!).

Member Advocate I

locations

US Remote

time type

Full time

job requisition id

R0006347

Member Advocate I

What will you be doing:

The Member Advocate position will function as the primary resource for nonclinical patient support for the Centers of Excellence and nontraditional TPA lines of business, patients and services.

• Patient Support
• Customer Service
• Data Entry

What we’re looking for:

Required Qualifications

Work Experience:

Years of Applicable Experience – 2 or more years

Skills & Experience:

Customer Service, Data Entry, Patient Support

Education:

High School Diploma or GED

In order to comply with applicable legal obligations, Premier requires employees to provide proof of full vaccination against COVID-19. We will consider requests for disability or religious accommodations during the recruiting process as needed. Premier will also observe state laws related to vaccination, as applicable.

Preferred Qualifications

Relevant Experience to include (3 bullets maximum):

• Medical or Health Industry experience
• Fluent in Spanish

Education:

Associate’s or technical degree

Premier’s compensation philosophy is to ensure that compensation is reasonable, equitable, and competitive in order to attract and retain talented and highly skilled employees. Premier’s internal salary range for this role is $34,000 – $64,000. Final salary is dependent upon several market factors including, but not limited to, departmental budgets, internal equity, education, unique skills/experience, and geographic location. Premier utilizes a wide-range salary structure to allow base salary flexibility within our ranges.

Employees also receive access to the following benefits:

· Health, dental, vision, life and disability insurance

· 401k retirement program

· Paid time off

· Participation in Premier’s employee incentive plans

· Tuition reimbursement and professional development opportunities

Inpatient Coder

• Department: Health Information Management
• Usual Schedule: M-F 8-5
• Regions: Carle Foundation
• On Call Requirements: none
• Job Category: Clerical/Admin
• Work Location: Working from Home
• Employment Type: Full – Time
• Nursing Specialty:
• Job Post ID: 32760
• Secondary Job Category: Clerical/Admin
• Experience Requirements: 1 – 3 Years
• Weekend Requirements: none
• Education Requirements: Not Indicated
• Shift: Day
• Location: Remote
• Holiday Requirements: none

Job Description

JOB SUMMARY:

The HIM Certified Coder is responsible for accurate and timely coding of hospital inpatient, hospital outpatient and/or professional fee encounters using appropriate ICD10/ICDPCS, CPT, or HCPCs codes and appropriate coding software such as computer assisted coding and encoders as a means to ensure compliant billing of Carle claims. HIM Certified Coder is responsible for understanding and applying all regulatory coding guidelines, such as National and Local Coverage Determinations and application of CPT modifiers. HIM Certified Coder is also responsible for understanding and applying coding knowledge to resolve billing edits related to coding. HIM coder uses Carle electronic medical record systems to review clinical encounters.

EDUCATIONAL REQUIREMENTS

None Required

CERTIFICATION & LICENSURE REQUIREMENTS

Registered Health Information Admin (AHIMA) upon hire or Registered Health Information Tech (AHIMA) upon hire or Certified Coding Specialist (AHIMA) upon hire or Certified Coding Specialist Physician Based upon hire or Certified Professional Coder (AAPC) upon hire or Certified Inpatient Coder (AAPC) upon hire or Certified Outpatient Coder (AAPC) upon hire.

EXPERIENCE REQUIREMENTS

One year coding experience preferred

SKILLS AND KNOWLEDGE

Knowledge of ICD-10-CM, CPT, and HCPC coding rules and guidelines for code application, ability to work with others collaboratively and communicate efficiently, both orally and in writing. Knowledge of medical science, anatomy and physiology required. Ability to perform computer data entry. Experience with encoders or other coding software packages preferred.

ESSENTIAL FUNCTIONS:

• Responsible for accurately coding all records according to the appropriate coding classification (ICD-10 and/or CPT and/or HCPCs and modifiers) system. The assignment of codes will accurately reflect the diagnoses and procedures pertinent to the patient.
• Provides interdepartmental coding assistance, as needed, to determine accurate coding assignment.
• Develops methodology to provide a coding process that is compliant with regulatory agencies including the utilization of reference materials such as, but not limited to, Center for Medicare Services (CMS) publications, Coding Clinic, CPT Assistant, etc.
• Facilitates optimization of revenue while maintaining compliance standards for the organization through varied venues and tasks (auditing/monitoring, training, facilitation of charges through the claim scrubber system, assisting with various patient or payor related charge/account inquiries, research on various coding/billing related topics as requested by various sources internal and external to the organization, etc.).
• Serves as an expert resource regarding CPT, HCPCS, ICD-10-CM, all other necessary coding systems, and regulatory guidelines for all internal and external parties.
• Serve as liaison for coding and billing staff to ensure accurate charge capture.
• Reports any documentation and coding improvement needs based upon review findings.
• Responsible for maintaining coding certification, knowledge and skills to successfuly perform job duties
• Provides initial and ongoing provider and staff training regarding appropriate code assignment
• Performs provider and peer coding audits as requested
• Assist with monitoring of internal controls for coding and billing.
• Facilitates external audit activities and reporting of such activities to the appropriate administrative personnel.

Medical Coding Specialist

Remote – USA

Full timedeg

JR14642

Teladoc Health is a global, whole person care company made up of a erse community of people dedicated to transforming the healthcare experience. As an employee, you’re empowered to show up every day as your most authentic self and be a part of something bigger – thriving both personally and professionally. Together, let’s empower people everywhere to live their healthiest lives.

The Opportunity

This role will be responsible for reviewing medical record documentation for accurately assigning diagnostic and procedural coding relative to revenue and reimbursement for all encounters associated with Teladoc Health. This will also include translating patient information into alpha-numeric medical codes using patient treatment, health history, diagnosis, and related information. ICD-10-CM and CPT code assignments must be consistent with CMS’ Official Guidelines, any regulatory agency and payer guidelines.

We will look to your knowledge of CPT, ICD-10 coding guidelines, compliance, and professional billing practices; including knowledge of Evaluation and Management Guidelines to coordinate with Coding Leadership to identify provider education and revenue opportunities.

Responsibilities

• Complete accountable work related to pended charges in work queue review to ensure timely billing in conjunction with billing and compliance guidelines
• Select correct code assignment by proficient analysis and translation of diagnostic statements, physician’s orders, and other pertinent documentation
• Responsible for keeping abreast of current ICD-10 and CPT coding guidelines and regulatory guidance; including responsibility for maintaining current coding certification status
• Participates in process improvement assignments and other duties as assigned in coordination with billing for documentation review as needed for rebill and appeals

Candidate Profile

• 4+ years professional coding experience, billing for professional services, and related experience
• Associate degree in related field or equivalent experience may be substituted
• Current AAPC Certified Professional Coder (CPC) certification
• Expertise of Coding and Billing Guidelines for multiple specialties
• Technical knowledge and skills of electronic medical records

The base salary range for this position is $50,000.00-60,000.00. In addition to a base salary, this position is eligible for a performance bonus and benefits (subject to eligibility requirements) listed here: Teladoc Health Benefits 2023. Total compensation is based on several factors including, but not limited to, type of position, location, education level, work experience, and certifications. This information is applicable for all full-time positions.

Why Join Teladoc Health?

A New Category in Healthcare: Teladoc Health is transforming the healthcare experience and empowering people everywhere to live healthier lives. Our Work Truly Matters: Recognized as the world leader in whole-person virtual care, Teladoc Health uses proprietary health signals and personalized interactions to drive better health outcomes across the full continuum of care, at every stage in a person’s health journey. Make an Impact: In more than 175 countries and ranked Best in KLAS for Virtual Care Platforms in 2020, Teladoc Health leverages more than a decade of expertise and data-driven insights to meet the growing virtual care needs of consumers and healthcare professionals. Focus on PEOPLE: Teladoc Health has been recognized as a top employerby numerous media and professional organizations. Talented, passionate iniduals make the difference, in this fast-moving, collaborative, and inspiring environment. Diversity and Inclusion:At Teladoc Health we believe that personal and professional ersity is the key to innovation. We hire based solely on your strengths and qualifications, and the way in which those strengths can directly contribute to your success in your new position. Growth and Innovation: We’ve already made healthcare yet remain on the threshold of very big things. Come grow with us and support our mission to make a tangible difference in the lives of our Members.

As an Equal Opportunity Employer, we never have and never will discriminate against any job candidate or employee due to age, race, religion, color, ethnicity, national origin, gender, gender identity/expression, sexual orientation, membership in an employee organization, medical condition, family history, genetic information, veteran status, marital status, parental status or pregnancy.

Teladoc Health respects your privacy and is committed to maintaining the confidentiality and security of your personal information. In furtherance of your employment relationship with Teladoc Health, we collect personal information responsibly and in accordance with applicable data privacy laws, including but not limited to, the California Consumer Privacy Act (CCPA). Personal information is defined as: Any information or set of information relating to you, including (a) all information that identifies you or could reasonably be used to identify you, and (b) all information that any applicable law treats as personal information. Teladoc Health’s Notice of Privacy Practices for U.S. Employees’ Personal information is available at this link.

ER Registered Nurse RN

Per Diem Triage / $38/hour (Remote)

Remote

Nice to meet you, we’re Vesta Healthcare.

Vesta Healthcare is a startup with a simple mission: Delivering extraordinary outcomes by unlocking the power of caregivers. We enable people with personal assistance to thrive at home, in their community by assuring their caregivers have the resources, data, and support they need. We achieve this through a combination of analytics, technology, services, and deep healthcare expertise.

At Vesta Healthcare, we enable people with personal assistance to thrive at home, in their community by assuring the people they rely on, their caregivers, have the resources, data, and support they need. We achieve this through a combination of analytics, technology, services, and deep healthcare expertise. Our analytics help identify and target the right people and populations. Our technology creates real-time connectivity and actionable data out of observations. Our services connect to real people who can help when needs arise, and our healthcare expertise helps us understand how we create value for both payers and providers.

Vesta Healthcare partners with physician groups and home care agencies to help implement and deliver these services; providing administrative support, and helping to find committed and capable staff for the physician group.

We’re looking to add to our team of experts who care deeply about our mission.

Our team is passionate, driven, collaborative, intellectually curious, and excited about the opportunity to transform our healthcare system. We’re inspired by caregivers and seek to create a platform that recognizes, utilizes and supports the vital role they play. We strive to continuously learn, explore, experiment and achieve results. We are here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids)

The ideal teammate would be…

A Registered Nurse with availability to work a minimum of 24 DAYTIME hours a week either Monday through Friday or Friday through Sunday from the comfort of their own home. The RN must be experienced in triaging older adults and the elderly population and is conducted telephonically in a model with nurse practitioners for collaboration. You will play an integral role in reducing unnecessary utilization of the Emergency Room and maintain the patients’ independence and safety at home.

The ideal candidate would be able to:

• Triage by speaking with the member, family or caregiver
• Have confidence in the ability to recognize clinical scenarios that require escalation to the internal team nurse practitioner
• Have excellent customer service
• Have the ability to educate members, family or other caregivers on chronic conditions, diet changes, and medications.
• Utilize technology for documentation
• Have the confidence to work in a fast paced environment
• Have a quiet work environment in your home with high speed internet
• Coordinate care appropriately and timely with members of the care

Would you describe yourself as someone who has:

• Graduated from an accredited nursing program (required)
• Current RN License (required)
• A Registered Nurse license with at least 2+ years of emergency department, urgent care, and/or triage experience (required)
• The ability to work a minimum of 24 hours a week (required)
• A Registered Nurse with experience providing care to adult and geriatric patient populations (required)
• Confidence with clinical skills in performance of telephonic triage (required)
• The ability to work remotely and has a private area with a computer in their home/workspace (required)
• A genuine, compassionate desire to serve others and help those in need

Pay range is $35 per hour.

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

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

At Vesta, we are constantly searching for the most dynamic and best talent to join our team with a mission of empowering caregivers in the home!

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

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

Ortho Surgery and E/M Coder

Job ID

2023-3043

# of Openings

1

Category

Medical Coding

Minimum Hours

Varies

Type

Per Diem

Overview

Ortho Surgery and E/M Coding Specialist

Here is your opportunity to be part of this exciting team. We are hiring now and have an immediate need for an Ortho Surgery and E/M Coder. Remote-work from home 10-15 hours per week.

Responsibilities

This position will provide high quality E/M, procedure and surgery for Ortho Surgery and E/M.

Qualifications

• Current CPC, CCS, or equivalent through the AAPC or AHIMA required
• Must have at least two years of active E/M coding experience for multiple specialties. This experience must include coding POS 11, 21, 22, coding of in-office procedures across multiple specialties and must be able to code all types of E/M visits (ED, CC, home health, prolonged services, etc.)
• Must have at least two years of active surgery coding experience
• Must be able to maintain a 95% accuracy rate
• Inpatient and outpatient E/M pro-fee coding experience is required
• Coders for this role must provide their own computer with a Windows Based Operating System (MAC is not compatible) and dual monitors
• Must be able to commit to working 10-15 hours per week

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

Life and Wellness Coach

Part-time [Contract]

at Spring Health

Remote

Our mission: to eliminate every barrier to mental health.

Spring Health is a comprehensive mental health solution for employers and health plans. Unlike any other solution, we use clinically validated technology called Precision Mental Healthcare to pinpoint and deliver exactly what will work for each person — whether that’s meditation, coaching, therapy, medication, and beyond.

Today, Spring Health equips over 800 companies, from start-ups to multinational Fortune 500 corporations, as a leading and preferred mental health service. Companies like General Mills, Guardian, Bain, and Instacart use the Spring Health platform to provide mental health services to thousands of their team members globally. We have raised over $300 million from prominent investors including Kinnevik, Tiger Global, Northzone, RRE Ventures, Rethink Impact, Work-Bench, William K Warren Foundation, SemperVirens, Able Partners, True Capital Ventures, and a strategic investor, Guardian Life Insurance. Thanks to their partnership, our current valuation has reached $2 billion.

We are seeking qualified, part-time [Contract] Coaches to join our Care Operations team. Care Operations mission is to create member delight by providing high-touch support, goal-driven coaching programs, and access to the most erse, high-quality provider care. Coaches will be responsible for delivering tele-coaching sessions to help our members progress towards reaching their goals. This role will be a 1099 contract role.

What you will be doing:

• Provide structured wellness and/or life coaching sessions to clients via video or phone.
• Support adults with setting goals, developing action plans, and encouraging action to achieve their goals for common life challenges like stress, work issues, home problems, or growth areas.
• Maintain a calendar displaying your availability and keep track of your session notes in a timely manner.
• Collaborate with our dedicated support team whenever you need assistance to ensure coordinated care.
• Provide culturally competent and empathetic care, upholding our values of ersity and inclusion for all races, ethnicities, and genders.

Who you are

• ICF-credentialed coach (ACC, MCC, PCC) or NBC-HWC accreditation
• Minimum of 100 hours of post-training coaching experience
• You’re comfortable with technology and are telehealth competent.
• You are committed to quality care, want to expand your capabilities, and increase your effectiveness by being informed of client progress or challenges.
• You like working independently, but would also enjoy having the support of a team and opportunities for connections and collaboration with others

The compensation for this position is $30 per 30 minute session and $45 per 45 minute session.

Why Spring Health:

• You’ll set your own schedule to fit your professional and personal needs.
• Work from anywhere, as long as you have a confidential, quiet, and private location with stable internet.
• No need to spend time marketing your practice or collecting fees – we take care of the administrative work so that you can focus on coaching.
• Grow your ability to provide effective coaching through feedback that helps you identify what is working with your clients.
• Join a dynamic community where you will be supported, your work appreciated, and you’ll have the opportunity to help us shape the future of mental health care!

In addition to finding people who are truly excellent at what they do, we take our values at Spring Health seriously:

• Members Come First We are genuine member advocates.
• Move Fast to Change Lives We build with urgency and intention.
• Take Ownership We extend trust and hold ourselves accountable.
• Embrace Diverse Teams & Perspectives We find strength in the ersity of cultural backgrounds, ideas, and experiences.
• Science Will Win We will achieve impact by innovation and evidence based frameworks.
• Candor with Care We are open, honest and empathetic.

The target salary range for this position is $30 – $45 per session. Inidual pay may vary from the target range and is determined by a number of factors including experience, location, internal pay equity, and other relevant business considerations. We review all employee pay and compensation programs annually at minimum to ensure competitive and fair pay.

Our privacy policy: https://springhealth.com/privacy-policy/

Spring Health is proud to be an equal opportunity employer. We do not discriminate in hiring or any employment decision based on race, color, religion, national origin, age, sex, marital status, ancestry, disability, genetic information, veteran status, gender identity or expression, sexual orientation, or other applicable legally protected characteristic. We also consider qualified applicants regardless of criminal histories, consistent with applicable legal requirements. Spring Health is also committed to providing reasonable accommodations for qualified iniduals with disabilities and disabled veterans. If you have a disability or special need that requires accommodation, please let us know.

Nursing Standardized Test Question Writer (Contract)

Multiple Countries – Contracted

As a Nursing Standardized Test Question Writer, you’ll be:

• Creating practice questions to aid students in preparing for professional nursing exams, such as the NCLEX-RN exam
• Choosing from a wide range of skills to create well-written questions
• Creating viable alternate answer choices for the practice problems
• Writing explanations to practice problems

As a Nursing Standardized Test Question Writer, you’ll receive the following:

• Reliable payment: Timely, reliable payments twice a month via Paypal. All work is paid per piece. Per-piece rates vary based on complexity and length of content.
• Flexibility: Remote work according to your own schedule with no waiting, no assignments, and productivity/hourly requirements
• Support: Access to an incredibly supportive in-house team to answer your questions

• Work satisfaction: The knowledge that you’re helping millions of students achieve their academic goals!

What we’re looking for:

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

Do you think you can be a Nursing Standardized Test Question Writer for Study.com? Click Apply Now at the bottom to fill out an application and submit your resume!

CODING SPECIALIST

(REMOTE)

Fully Remote • Remote • OCHIN Billing Services

Full-time

Description

MAKE A DIFFERENCE OCHIN

OCHIN is a rapidly growing national nonprofit health IT organization with two decades of experience transforming health care delivery to drive health equity. We are hiring for a number of new positions to meet increasing demand. When you choose to join OCHIN, you have the opportunity to continuously grow your skills and do meaningful work to help fulfill our mission.

OCHIN provides leading-edge technology, data analytics, research, and support services to nearly 1,000 community health care sites, reaching nearly 6 million patients nationally. We believe that every inidual, no matter their race, ethnicity, background, or zip code, should have fair opportunity to achieve their full health potential. Our work addresses differences in health that are systemic, avoidable, and unjust. We partner, learn, innovate, and advocate, in order to close the gap in health for iniduals and communities negatively impacted by racism or other structural inequities.

At OCHIN, we value the unique perspectives and experiences of every inidual and work hard to maintain a culture of belonging.

Founded in Oregon in 2000, OCHIN employs a growing virtual workforce of more than 900 erse professionals, working remotely across 49 states. We offer a generous compensation package and are committed to supporting our employees’ entire well-being by fostering a healthy work-life balance and equitable opportunity for professional advancement. We are curious, collaborative learners who strive to live our values everyday: leadership, collaboration, excellence, innovation, inclusion, and stewardship. OCHIN is excited to support our continued national expansion and the increasing demand for our innovative tools and services by welcoming new talent to our growing team.

Position Overview

The Coding Specialist is responsible for providing high quality healthcare coding services to one of more OCHIN Billing Services member clinics and/or OCHIN consortium member clinics. The Coder will recognize potential high-risk trends and develop techniques to optimize revenue, improve coding accuracy, and streamline the revenue cycle. Our team member will escalate difficult or unique coding problems with the Billing Supervisor assigned to the clinic, resolve issues, apply new information to future issues, and make suggestions to enhance our efficiency and effectiveness through process improvement with the assistance of their immediate supervisor This position will enhance the billing department’s reputation by accepting ownership for accomplishing new and different requests and exploring opportunities to add value to job accomplishments.

Essential Duties

• Provide efficient and effective coding services on behalf of our member clients in accordance with
• Payer requirements and organizational policies, while ensuring compliance to all coding guidelines.
• Abstract clinical data (diagnoses and procedures) from patient medical records and on-line patient data.
• Review and interpret patient encounters for accurate code assignment of all relevant diagnoses and procedures.
• Help fulfill the reimbursement needs of the member through review and recommendation or correct assignment of diagnosis and procedure codes which are critical to third party reimbursement.
• Research and obtain necessary information from provider/office via Epic in-basket when necessary per agreement.
• Assist with research for denied claims.
• Meet assigned productivity goals.
• Establish and maintain positive working relationships with patients, payers, team members, clients and other stakeholders.
• Maintain confidentiality of patient information, organization data and information, and in compliance with HIPAA regulations
• Perform other specific projects related to billing, data entry and computer operations as required.
• Other duties as assigned.

Requirements

• Required is a minimum of a high school diploma or GED, or a combination of relevant experience and some higher education.
• Preferred is an Associate’s or Bachelor’s degree in Business or applicable area of study.
• Previous FQHC/RHC experience preferred.
• Knowledge of Medical Terminology is required for this role.
• Prior experience using Epic practice management system preferred.
• Working knowledge of Medicare, Medicaid, MVA, Workers Comp and private insurance billing and reimbursement processes, legal requirements knowledge.
• Dual language skills, specifically in Spanish is a plus.
• Required certifications include:
• Medical coding from AAPC (CPC Certificate) or AHIMA (CCS Certificate, and
• Current certification from ADCA (CDC certificate).
• Maintain Certifications by completing any necessary training and obtain required CEU’s.

Base Pay Overview

The typical offer range for this role is minimum to midpoint, ($24.01 – $28.21) with the midpoint representing the average pay in a national market scope for this position. Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will consider a wide range of factors directly relevant to this position, including, but not limited to, skills, knowledge, training, responsibility, and experience, as well as internal equity and alignment with market data.

Work Location and Travel Requirements

OCHIN is 100% remote organization. Work from home requirements are:

• Ability to work independently and efficiently from a home office environment
• High Speed Internet Service
• It is a requirement that employees work in a distraction free workplace
• Travel may be required to support our member organizations on-site based on business requirements for OCHIN

We offer a comprehensive range of benefits. See our website for details: https://ochin.org/employment-openings

COVID-19 Vaccination Requirement

To keep our colleagues, members, and communities safe, OCHIN requires all employees—including remote employees, contractors, interns, and new hires—to be vaccinated with a COVID-19 vaccine, as supported by state and federal public health officials, as a condition of employment. All new hires are required to provide proof of full vaccination or receive approval for a medical or religious exemption before their hire date.

Equal Opportunity Statement

OCHIN is proud to be an equal opportunity employer. We are committed to building a team that represents a variety of backgrounds, perspectives, and skills for the benefit of our staff, our mission, and the communities we serve. As an Equal Opportunity and Affirmative Action employer, OCHIN, Inc. does not discriminate on the basis of race, ethnicity, sex, gender identity, sexual orientation, religion, marital or civil union status, age, disability status, veteran status, or any other protected characteristics. All aspects of employment are based on merit, performance, and business needs.

#LI-Remote

Salary Description

Min -$24.01 Mid- $28.81 Max- $33.61

Title: Nurse Care Manager

Location: Remote

Company Description

This is an exciting opportunity in a fast-paced, growing digital health startup. The Clinic by Cleveland Clinic, a joint venture between Cleveland Clinic and Amwell, was launched in 2019 to unlock access to the world’s best healthcare expertise so no one is left behind. This startup company’s initial focus is transforming the $5 billion global second opinion market, with additional digital health solutions in development. The Clinic offers virtual care from Cleveland Clinic’s highly-specialized experts through Amwell’s leading-edge digital health technology platform. Learn more at www.theclinic.io.

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey.

Amwell is a leading telehealth platform in the U.S. and globally, connecting and enabling providers, insurers, patients, and innovators to deliver greater access to more affordable, higher quality care. Amwell solutions are used by 240 health systems and 55 health plan partners, covering over 150 million lives.

The position is remote. The role reports to the Director, Clinical Operations.

Brief Overview:

We are looking for an experienced and dynamic nurse committed to delivering empathetic, concierge services to our consumers of the Virtual Second Opinion Services. You will be responsible for establishing a relationship with patients via online/telephone intake through active listening and questioning process, documenting these encounters and providing instruction and creating an opinion timeline based on established protocol.

A strong background in an ambulatory, hospital or telehealth with the ability to function independently in an organized fashion managing a portfoaccdddclio of patients through the virtual second opinion process is essential to success in this position.

Core Responsibilities:

• Responsible for establishing a relationship with patients and effectively triaging and providing care guidance and resolution to all contacts and patients.
• Assesses patient needs, determines and initiates appropriate action or response to meet identified needs.
• Assesses patient and physician needs, provides requested information and/or guidance or service as appropriate or forwards to the appropriate person on the clinical management team.
• Initiates and independently implements appropriate clinical activities, including communication with patient/caregiver, physician (as applicable) and complete documentation of events.
• Maintains consistent communication with patients.
• Assists, reviews, researches, and resolves active patient and referral concerns and complaints and records outcomes accordingly to meet regulatory compliance standards.
• Other duties as assigned.

Qualifications:

• Graduate of an accredited school of professional nursing. BSN preferred or other allied health professional degree.
• Current Ohio RN and/or multistate compact license
• Other Allied Health license
• Good clinical judgment, careful listening, critical thinking skills and assessment skills.
• Strong customer service skills, including both verbal and written communication skills.
• Strong computer skills
• Ability to be self-directed, excel in critical thinking and problem solving skills.
• Minimum of 2 years nursing or clinical experience (preferred in ambulatory, hospital, med/surg, long term care, home care, hospice or palliative care setting)
• Prior phone triage or telehealth services.
• Manual dexterity to operate office equipment. May require periods of sitting or standing for long periods of time.
• Requires good visual acuity through normal or corrected vision. Must be able to hear normal conversation. Must be able to lift at least 20 pounds.

Additional information

Working at The Clinic

This Clinic is a partnership between American Well and Cleveland Clinic, where the two parent organizations founded the company on the mission of To make it easier for patients to get the best care by aligning world-class clinical expertise with innovative digital technology.’ The vision for The Clinic is to unlock access to the world’s best healthcare expertise so no one is left behind. We are a group of visionaries defining and realizing the global possibilities of digital health. We believe in: patient centricity; being bold, daring, and decisive; having a passion to win; teamwork and collaboration; transparency and trust. The pace is fast, the work rewarding and the outcomes, deeply satisfying.

Benefits

• The Clinic offers a competitive benefits package that includes health, dental, and vision insurance, paid holidays, and paid vacation.

Coder III – Day

Schedule & Location:

Full-Time: 80 hours, biweekly

Monday-Friday: Day shift

Remote work opportunity

Job Description:

Under general supervision, collects, reviews, retrieves and codes Evaluation & Management codes, and major procedures (surgical procedures, anesthesia reports, radiology reports/procedures) and other services for Medicine/Surgical practices, based on data from medical records and reports for quality assessment, audit and billing purposes.

Duties and Responsibilities:

1. Performs chart audits, reviewing for accuracy and compliance.
2. Reviews operative reports and other documentation and assigns appropriate diagnosis (ICD-10), procedure codes (CPT-4), and other services (HCPCS) for final billing.
3. Research and process invoice corrections.
4. Reviews and analyzes coding/billing procedures.
5. Presents training and feedback concerning medical coding, compliance, and reimbursement to physicians/providers.
6. Coordinates and implements reimbursement improvement activities with staff and providers.
7. Meets WellSpan Coding Compliance Guidelines.

Qualifications:

Minimum Experience:

• 3 years

Minimum Education:

• High School or GED

Required Certification:

• Certified Procedural Coder (CPC), Certified Coding Specialist-Physician (CCS-P) or Certified Medical Coder (CMC) AND a Specialty Coding Certification, Certified Anesthesia and Pain Management Coder (CANPC), must be obtained within one year

Skills:

• Knowledge of ICD-10-CM, CPT-4, and HCPCS coding; basic computer skills

Physician Coding Liaison II -Remote- Hematology and Oncology

locations

Aurora Medical Center Summit – 36500 Aurora Dr

time type

Full time

job requisition id

R65460

Department:

10395 Revenue Cycle – Coding & HIM Clinician Support

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

First Shift

This is a REMOTE opportunity

Major Responsibilities:

• Provides service line/specialty specific coding/documentation education and feedback related to coding changes (CPT including E&M, modifiers, ICD-10-CM, and HCPCS), annual code updates, payer requirements, and payer rejection resolution to assigned Physicians/APCs. Partners with CMOs to standardize coding processes across a specific specialty. Shares and/or presents coding/documentation education presentations to Chief Medical Officers (CMOs), Physicians/APCs, Senior Director Administrators across the organization. Coordinates with PSA Liaisons to provide adequate Physician/APC and/or clinical team member support.
• Conducts orientations for all Physicians/APCs, residents/students and clinical team members on specialty specific coding and documentation related education. Performs new clinician documentation reviews for specialty specific coding, and documentation feedback, as requested.
• Coordinates responses to Physicians/APCs, Locum Tenens, residents/student’s questions and feedback from various sources and partners, including Senior director administrators, CMOs, Medical Group Compliance, Internal Audit, Physician Compensation, Clinical Informatics/Clinical Informatics Educators, Quality Improvement Coordinators, and/or other external partners.
• Queries Physician/APC, Locum Tenens, residents/students when prompted by Professional Coding Department production coders to assist in resolving coding and documentation questions. Relays any coding changes, feedback, and education to Physician/APC, Locum Tenens, residents/students and/or clinic leadership, as appropriate.
• Monitors and works to resolve charge sessions requiring additional information for assigned clinicians and/or service line/specialty in the Epic work queues and/or other transfer work queues to ensure Clinicians are completing work timely to ensure proper supporting documentation for billing and timely filing.
• Attends and provides service line/specialty specific coding and documentation information, as requested, to CMOs, Physicians/APCs and/or Clinic/Site Department meetings. These may be virtually and/or in-person. Virtually attends Physician/APC education that include coding and/or documentation topics, such as Documentation Specialist clinician low risk review meetings, Risk Adjustment/HCC meetings, and/or Medical Group Compliance reviews/meetings.
• Collaborates with Physician Coding Liaison to review and provide coding/documentation guidance on Epic order entry, diagnosis, and charge capture preference lists as well as SmartSets and templates.
• Develops Physician/APC monthly service line/specialty newsletters to continually educate and communicate updates from various coding resources including specialty society organizations. Communicates new services performed by Physician/APCs to Professional Coding department leadership.
• Identifies service line/specialty specific trending data and opportunities to capture revenue through documentation improvement. Attends service line/specialty specific coding and/or society conferences, as requested, to gain further knowledge that is uniquely relevant to that specialty and how coding, documentation, and billing are affected. Maintains expert knowledge of Medicare, Medicaid, and other regulatory requirements pertaining to nationally accepted coding policies and standards.

Licensure, Registration, and/or Certification Required:

• Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), or
• Coding Specialist – Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), or
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or
• Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), or
• Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC), and
• Specialty Medical Coding Certification issued by the American Academy of Professional Coders (AAPC) needs to be obtained within 1 year.

Education Required:

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

Experience Required:

• Typically requires 5 years of experience in expert-level professional coding and least 3 years educating/training licensed clinicians.

Knowledge, Skills & Abilities Required:

• Specialty Medical Coding Certification must be held in the area(s) you will support.
• Excellent communication (oral and written), adult education, and interpersonal skills. Ability to develop rapport and maintain positive, professional partnerships primarily with employed Physicians, APCs, CMOs, Senior director administrators, Medical Group Operations, and physician coding team members.
• Advanced computer skills including the use of Microsoft office products, electronic mail, video/web conferencing, including exposure or experience with electronic coding and EHR systems or applications.
• Excellent/comprehensive skills in organization, prioritization, problem solving, facilitation skills as well as the ability to have meaningful, albeit, difficult conversations with CMOs/Physicians/APCs and/or Senior Director Administrators.
• Highly proficient in critical thinking and analytical skills with an extensive attention to detail.
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment.
• Ability to work in multiple work environments (ie virtual, office, clinic/hospital, other).

Physical Requirements and Working Conditions:

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

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

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

Title: Medical Billing and Collections Specialist

Location: United States

Performs designated collection activities for assigned agencies to ensure receivables are reimbursed in an accurate and timely manner. Works directly with the payer and internal and external customers towards efficient and effective collection results. Works under moderate supervision.

Job Location: Anywhere in the United States. This role is eligible for work-from-home status. The majority of current Corridor staff work remotely, from their homes.

Essential Duties and Responsibilities: To perform this job successfully, an inidual must be able to perform the following satisfactorily; other duties may be assigned.

• Ensures the coordination of collection activities for designated accounts, leading to the timely reimbursement of receivables using available resources including internal/external databases, payer portals/websites, and telephone.
• Determines and initiates appropriate action to resolve denied/rejected invoices and prepares payer corrections and/or appeals in accordance with payer plan requirements using electronic and paper processes.
• Review EOPs/EOBs/RAs/EOMBs for accuracy of patient responsibility.
• Analyzes and clears payment variances. May prepare adjusted and corrected bills, adjust accounts receivable entries, or prepare refunds in accordance with existing operating procedures.
• Participates in payer webinars and conference calls covering a wide range of topics that enables the RCM team to effectively collect accounts receivable.
• Prepares special handling and/or reconciliation spreadsheets for payers and/or clients.
• Participates in special projects and performs other duties as assigned.

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. Must have home health care collections experience.

Education/Experience:

High school diploma or general education degree (GED); or two-three years related experience and/or training; or equivalent combination of education and experience. Focus on Collections experience in the healthcare industry, emphasis on home health and hospice a plus.

Computer Skills:

Microsoft Office Applications – intermediate skill required.

Title: Clinical Documentation Specialist

Location: United States

Remote – Nationwide

Full time

Thank you for considering a career at Ensemble Health Partners!

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

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

The Opportunity:

Facilitates and obtains appropriate physician documentation for any patient clinical condition or procedure to support the appropriate severity of illness, expected risk of mortality, and complexity of care as documented in patient medical records. Extensive medical record review and interaction with physicians, nursing staff, other patient care givers and HIM coding professionals is done to ensure the documentation is complete and accurate.

Responsibilities:

• Completes initial patient medical record review within 24-48 hours of patient’s admission; completes subsequent reviews of patient’s medical record reviews every 24-48 hours and enters review findings in CDE software system
• Assigns Principal diagnosis, CC/MCC (complication and comorbidity/major complication and comorbidity), evaluate for Severity of Illness (SOI) and Risk of Mortality (ROM) on all patients while in-house. Assigns working ICD-10-CM and PCS codes and DRG (Diagnosis Related Group) using encoder in CDE software.
• Clarifies with physicians regarding missing, unclear, unsupported or conflicting health record documentation by requesting and obtaining additional documentation from physicians when needed. Face to face physician interaction and written clarifications are used.
• Educates key healthcare providers such as physicians, nurse practitioners, allied health professionals, nursing and care coordination regarding clinical documentation improvement, documentation guidelines and the need for accurate and complete documentation in the health record.
• Partners with coding professionals to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine the working and final DRG assignment. Reviews DRG denial letters and writes denial appeal letters.
• Collaborates with care coordination, nursing staff and other ancillary staff regarding interaction with physicians on documentation and to resolve physician clarifications prior to patient discharge.
• Maintains and upholds all clinical documentation regulatory guidelines
• Formulates and submits timely, well prepared appeals for reconsideration by third party administrators (payors). Including supporting documented clinical evidence, Coding/CDE Guidelines and other regulatory standards/guidelines as appropriate. Works collaboratively with co-works and management to effectively resolve root cause issues that impact payor contracts, hospital operations, or departmental to maintain reimbursement and minimize appeal requests and/or denials.

Requirements:

• 4 year/ Bachelors Degree in Nursing
• Current RN Licensure
• Minimum of five years acute care nursing experience with specific medical/surgical, Intensive Care, or Emergency Department experience
• Excellent interpersonal skills including excellent verbal and written communication skills; proficient in and demonstrate excellent physician relations
• Ability to organize and present information clearly and concisely; excellent computer and keyboarding skills; high degree of prioritization skills
• CCDS (Certified Clinical Documentation Specialist) certification, preferred

Join an award-winning company

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

2022 Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

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

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

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

Title: Client Coordinator (US)

Location: Remote

What you’ll do

In a few words

Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning

The Client Success team oversees the implementation of new clients, products, and services. The team manages client relationships for all our accounts, looking for ways to satisfy every single client need and delivering excellence in all matters relating to client support and relationships. They provide guidance, attend to daily needs and identify new pathways for business expansions.

As our Client Coordinator, you are the face representing Abarca and the foundation of Client Success operational support. Your job is to identify and respond proactively and quickly to any situation pertaining to clients. You will identify, respond, and triage any situation our clients bring up, ensuring that excellent service is delivered to our pharmacies, payers, health plans, and unions. Your strategic and enthusiastic solution-driven mind will put our clients at the core of everything to maintain and guarantee the best experience for them, ensuring a positive relationship between client and organization.

The fundamentals for the job

• Follow up on pending topics and reach out to other business areas to provide timely resolutions.
• Support and identify special projects and process improvement opportunities to enhance organizational processes and service deliveries. Manage and document project tasks.
• Be the first-tier support for Darwin Users; this requires a good understanding of Darwin Platform logics and functionality as well as client business requirements and benefit rules.
• Service Level Agreement oversight, including understanding and ensuring change requests from clients are submitted through CRM and confirmed to client within the agreed times.
• Maintenance and tracking of customer relationship management systems deliverables per areas/clients assigned. Use of dashboards and reports to track client or internal agreed upon service level agreements, at-risk projects, or timelines and escalate appropriately within Client Success.
• Prepare and/or request client reports from other operational departments within Abarca.
• Generate and analyze reports to make recommendations internally and to clients as well as identify proactively any issues with output content.
• Manage client communication on Darwin global alerts as well as Darwin development release notes.

What we expect of you:

The bold requirements

• Bachelor’s Degree in, Business, Science or a related field. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 1+ year of experience within Client Management or related position.
• Project coordination experience.
• Experience in handling client relations with attention to detail and customer service skills.
• Excellent time management and prioritization skills.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)

Nice to haves

• Knowledge of pharmacy benefit manager, health care, and/ or health insurance.

Physical requirements

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate ersity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify. Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time

All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of gender, race/ethnicity, gender identity, sexual orientation, protected veteran status, disability, or other protected group status.

#LI-NO1 #LI-REMOTE

Title: Bilingual Health & Wellness Advisor

Location: Remote, United States

Who We Are:

Calm is the leading mental health brand, on a mission to support everyone on every step of their mental health journey. With the #1 app for sleep, meditation and relaxation, Calm’s transformational mindfulness content supports users across seven languages in more than 190 countries.

What We Do:

Calm is the world’s #1 brand for mental fitness and our Calm Business team is furthering our mission to make the world happier and healthier by bringing our offering into the employee benefits space. Calm Business is helping companies build a more resilient organization by promoting better sleep, reducing stress and anxiety, and developing consistent mindfulness practices. We offer accessible and effective content to meet the needs of any erse workforce. With our proven launch strategy and marketing resources, plus ongoing engagement programs and account support, we take the stress out of employee benefits.

What You’ll Do:

As a member of our team, you will help create and deliver workshops to our customers virtually and occasionally in person. You’ll partner with our clients to uphold their wellness and DEIB strategies through education and training utilizing adult learning techniques and coaching skills.

• Develop and deliver engaging and interactive workshops and trainings from our catalog of sessions to our B2B partners virtually and occasionally in-person
• Assist the development of existing workshops into Spanish
• Project manage workshop initiatives. This includes but is not limited to preparing materials, providing frequent updates, utilizing our project management system, and other administrative tasks
• Provide outstanding customer service during clients calls, scheduling, and feedback sessions
• Manage and lead projects independently providing timely updates to the team and cross-functional peers
• Create internal trainings using our LMS system
• Focus on continued growth by training and qualifying on new sessions and attend external training programs
• Maintain the buildout of new services under our services umbrella
• Create and build new trainings focused on the learner through methods such as ADDIE as well as coaching skills such as motivational interviewing and strengths identification

Who You Are:

• A go-getter who is comfortable working in a startup environment
• Comfortable with delivering trainings based on a specific curriculum
• Can create engaging and interactive workshops with a focus on the learner
• A team player who can collaborate and share information with others while also being able to work independently
• Excel with time management and can produce deliverables based on internal roadmaps
• Know the difference between presenting, facilitation, and coaching
• You love technology and can learn new systems and processes quickly
• Available to occasionally work until 8:00 PM Pacific

Nice to Haves:

• Experienced with ZenDesk, Salesforce, gSuite, Prezi, Slack, Zoom, Microsoft Teams, WebEx, or Workramp
• Master’s degree or higher
• More than one certification or designation listed below

Minimum Requirements:

• Bilingual (Native Spanish and English)
• 4+ years in adult group facilitation or coaching experience
• Have one of the following certifications or trainings: NBC-HWC or ICF ACC designation, Certified Diversity Practitioners, MBSR, MBCT or MSC Certification (Level 1 Teacher Certification or higher), or a Health Education with at least 4 years of professional experience

The anticipated salary range for this position is $102,300 – $143,200. The base salary range represents the low and high end of Calm’s salary range for this position. Not all candidates will be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate’s skills, experience and other qualifications. This role is also eligible for equity + comprehensive benefits + 401k + flexible time off.

We believe that mental health is health, and every person should be considered in the discussion. That’s why we’re proud to be an equal opportunity workplace, committed to providing equal employment opportunities to all applicants and employees regardless of race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, medical condition, genetic information, military or veteran status, gender identity or expression, sexual orientation, or any other characteristic protected by applicable federal, state or local law.

Calm is deeply committed to ersity, equity and inclusion. We strive to create a mindful and respectful environment where everyone can bring their authentic self to work, and experience a culture that is free of harassment, racism, and discrimination.

Calm is also committed to providing reasonable accommodations for qualified iniduals with disabilities, including disabled veterans. Please contact Calm’s Recruiting team if you need a reasonable accommodation or any assistance completing any forms or to otherwise participate in the application process.

Professional Fee Coder II (Fully Remote)

Location: US National

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

Remote Location

Shift Days

Schedule 7:00am-4:00am

Job Summary

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as the No. 4 hospital in the nation, according to the U.S. News & World Report. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

As a Remote Professional Fee Coder II, you will monitor, review, and apply correct coding principles to clinical information received from ambulatory areas for the purpose of reimbursement, research, and compliance. You will identify and apply diagnosis codes, cot codes, and modifiers as appropriately supported by the medical record in accordance with federal regulations. Lastly, you will ensure that billing discrepancies are held and corrected.

The ideal future caregiver is someone who:

• Has a minimum of 2 years of coding experience in a multi-specialty facility.
• Has critical thinking and analytical skills.
• Can work under pressure.
• Demonstrates a strong work ethic.

This opportunity offers up the possibility to advance into Coder III, Senior Coder or Supervisor positions.

Cleveland Clinic provides what matters most: career growth, delivering world-class care to our patients, continuous learning, exceptional benefits and working for an organization that offers many long-term career paths. Join us and experience a culture where opportunities to advance and the support to get there go hand-in-hand.

Job Details

Responsibilities:

• Compares and reconciles daily patient schedules, census, and registration to billing and medical records documentation for accurate charge submission, which includes processing of professional charges, facility charges, manual data entry. Investigates and resolves charge errors.
• Meets coding deadlines to expedite the billing process and to facilitate data availability for CCF providers to ensure appropriate continuity of care.
• Works held claims and claim edits in the CCF claims processing system.
• Maintains proficiency in related CCF billing systems, productivity standards, and records to be used for reconciliation and charge follow up. Utilize ICD#9, ICD#10 and CPT-4 coding systems and materials.
• Maintains current knowledge and skills through reading and utilizing coding resources. Attends and participates in coding education systems.
• Other duties as assigned.

Education:

• High School Diploma / GED or equivalent required.
• Specific training related to CPC procedural coding and ICD9, ICD10 diagnostic coding through continuing education programs/seminars and/or community college.
• Working knowledge of human anatomy and physiology, disease processes and demonstrated knowledge of medical terminology.

Certifications:

• Certified Professional Coder (CPC), Certified Coding Specialist Physician (CCS-P), Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Associate (CCA) by American Health Information Management Certification (AHIMA) or Certified Outpatient Coder (COC) by American Academy of Professional Coders is required and must be maintained.
• Existing CCF employees credentialed with CMC may be required to obtain CPC (or CCS-P, RHIT, or CCA) within 12 months.

Complexity of Work:

• Coding assessment relevant to the work may be required.
• Requires critical thinking and analytical skills, decisive judgment and work with minimal supervision.
• Applicant must be able to work under pressure to meet imposed deadlines and take appropriate actions.

Work Experience:

• Minimum of 2 years of coding experience in a health care environment and or medical office setting required.
• Internal candidate must currently be employed as a Professional Fee Coder I at the Cleveland Clinic or have met all the training, quality and productivity benchmarks of Professional Fee Coder I for six months to apply for a Professional Fee Coder II position.

Physical Requirements:

• Typical physical demands involve prolonged sitting and/or traveling through various locations in the hospital and dexterity to accurately operate a data entry/PC keyboard.
• Manual dexterity required to locate and lift medical charts.
• Ability to work under stress and to meet imposed deadlines.

Personal Protective Equipment:

• Follows Standard Precautions using personal protective equipment as required for procedures.

Keywords: Pro Fee, CPC, CPT, CCA, CCS, RHIT, RHIA, health information management, medical billing and coding, outpatient

Cleveland Clinic Health System administers an influenza prevention program as well as a COVID-19 vaccine program. You will be required to comply with both programs, which will include obtaining an influenza vaccination on an annual basis, and being fully vaccinated against COVID-19, or obtaining an approved exemption.

Senior IRF Coder

locations

Remote – Other

time type

Full time

job requisition id

R011430

Responsible for daily coding, auditing and DRG validation of assigned encounters is accurate and compliant.

Do you perform coding audits of medical records for Inpatient Medical Rehabilitation ?

We are seeking a candidate who has a proven record for accuracy in IRF coding and thorough understanding of ICD-10 codes and related IRF coding PPS regulations. Responsibilities include conducting IRF PPS Coding audits inclusive of IRF-PAI and UB-04 review, maintaining expertise in ICD-10 coding and credentials and meeting daily accuracy and productivity standards. in accordance with established department policies. The ideal candidate has a highly developed ability to review medical records to identify the etiologic diagnosis , current comorbid conditions, tiers, and complications recorded on the IRF-PAI relative to the patient’s inpatient rehabilitation stay. The candidate must have ability to review the coding on the UB-04 claim form and determine the accuracy of the principal diagnosis and secondary diagnoses as determined by physician documentation. Essential is the ability to identify incomplete or missing diagnosis codes on the IRF-PAI and UB-04 claim form and also identify codes that impact CMG tier and compliance.

Come join this amazing team of experts that provides inpatient rehab healthcare facilities the clinical and technical expertise that enables them to adhere to the complex regulations for care and payment. Collaborate with our IRF clinicians who in conjunction with coders perform full coding only and coding /clinical audits in adherence with up-to-date ICD-10 coding guidelines. Also perform coding only audits in adherence with up to date ICD-10 coding guidelines.

Knowledge and skills:

• Associate’s degree in medical coding or equivalent training acquired through at least five years of progressive on-the-job experience; health related BS degree a plus.
• Experience in IRF coding is required
• A minimum of 3-5 years of ICD-10-CM coding experience directly applying codes for inpatient rehabilitation prospective payment systems is required. CCS Certified AHIMA Coding Specialist, CIC, Certified Inpatient Coder, CPC credential from AAPC a plus. * CCS, Certified Coding Specialist, AHIMA; CPC, Certified Professional Coder, AAPC a plus.

• Experience answering complex IRF coding questions
• Experience conducting IRF coding chart audits
• Experience writing and reviewing IRF coding reports
• Experience with coding productivity standards
• Experience coding for 20+ bed-sized IRF facilities

Our erse team of highly motivated leaders, innovators, and healthcare experts are the secret to our 30 plus years of success. If you are a professional who collaborates with their team to deliver the best and most reliable network system then apply today!

Expectations

• Normal office environment including but not limited to long periods of sitting, typing, analyzing data, telephone communication, use of standard office equipment and daily personal interaction. Normal office environment including but not limited to long periods of sitting, typing, analyzing data, telephone communication, use of standard office equipment and daily personal interaction.

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

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the inidual can provide proof of valid prescription to Netsmart’s third party screening provider. Additionally, a positive result for marijuana will not automatically disqualify a candidate from employment if the inidual can provide a valid prescription for medicinal use issued in his or her state of residence. A prescription is required even in states where recreational use has been legalized.

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

Senior Hospital Coder – Remote

• Full Time
• Finance

Why Mayo Clinic

Mayo Clinic has been ranked the #1 hospital in the nation by U.S. News & World Report, as well as #1 in more specialties than any other care provider. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans – to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic. You’ll thrive in an environment that supports innovation, is committed to ending racism and supporting ersity, equity and inclusion, and provides the resources you need to succeed.

Responsibilities

The Quality Senior Coder is responsible for working collaboratively with various team members such as Coding Operations, Revenue Integrity, Provider Education, Billing and Accounts Receivable and Denials. This position coordinates with others as needed to ensure comprehensive and inclusive education, training and auditing as it relates to all professional and hospital coding processes. This position will mentor, instruct and/or train other Professional and Hospital Coders in compliant coding standards (ICD-10 coding conventions, Official ICD-10 Reporting Guidelines, Coding Clinic, etc.). The Quality Senior Coder educates, trains and audits Coders based on their review, interpretation, and translation of provider medical diagnostic and procedural information documentation into appropriate codes following professional and hospital inpatient and/or outpatient claims and reporting requirements.

*This position is 100% remote work. Inidual may live anywhere in the US.

**Visa sponsorship is not available for this position. Also, Mayo Clinic DOES NOT participate in the F-1 STEM OPT extension program.

During the selection process, you may participate in an OnDemand (pre-recorded) interview that you can complete at your convenience. During the OnDemand interview, a question will appear on your screen, and you will have time to consider each question before responding. You will have the opportunity to re-record your answer to each question – Mayo Clinic will only see the final recording. The complete interview will be reviewed by a Mayo Clinic staff member and you will be notified of next steps.

Qualifications

High School diploma and 7 years hospital inpatient coding and/or hospital outpatient coding experience OR Associate’s Degree and 5 years hospital inpatient coding and/or hospital outpatient coding experience required; Bachelor’s Degree preferred.

Additional Qualifications:

• Experience with inpatient or outpatient coding guidelines and facility claim rules along with appropriate coding skills: ICD-10-CM diagnosis assignment, ICD-10-PCS procedure assignment, DRG assignment (e.g., MS-DRG and APR-DRG) for SOI and ROM.
• Experience with hospital outpatient coding guidelines and claims reporting rules with appropriate coding skill set of CPT/HCPCS.
• Experience with applications or applying National Correct Coding Initiative (CCI) edits, National Coverage Determinations (NCD), Local Coverage Determinations (LCD), Coding Clinic, Coding Clinics for HCPCS, Current Procedural Terminology (CPT) Assistant coding guidelines, and official ICD-10 guidelines for Coding and Reporting.
• In-depth knowledge of medical terminology, anatomy and physiology, simple to complex disease processes, pathophysiology, and pharmacology.
• Knowledge of principles, methods, and techniques related to compliant healthcare hospital billing.
• Knowledge of coding and billing requirements for provider based (PBB) facilities and critical access hospital (CAH).
• Ability to work independently in a teleworking environment, to organize/prioritize work, exercise excellent communication skills, is attentive to detail, demonstrate follow through skills and maintain a positive attitude.

License or Certification:

Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or coding credential of a Certified Coding Specialist (CCS) Certified Inpatient Coder (CIC) or Certified Professional Coder (CPC) required.

Exemption Status

Nonexempt

Compensation Detail

$27.95 – $37.74 / hour. Education, experience and tenure may be considered along with internal equity when job offers are extended.

Benefits Eligible

Yes

Schedule

Full Time

Hours/Pay Period

80

Schedule Details

Monday – Friday, normal business hours.

Weekend Schedule

N/A

International Assignment

No

Site Description

Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives. Learn more about what each unique Mayo Clinic campus has to offer, and where your best fit is.

Affirmative Action and Equal Opportunity Employer

As an Affirmative Action and Equal Opportunity Employer Mayo Clinic is committed to creating an inclusive environment that values the ersity of its employees and does not discriminate against any employee or candidate. Women, minorities, veterans, people from the LGBTQ communities and people with disabilities are strongly encouraged to apply to join our teams. Reasonable accommodations to access job openings or to apply for a job are available.

Title: Customer Service Representative

Location: United States

JOB DESCRIPTION

Responsibilities

• Responsible for coordinating testing services for patients by:
• Reviewing test request forms and additional documentation submitted with a patient specimen to ensure accurate and timely testing.
• Working with healthcare providers to complete the required documentation and sample submission.
• Working with insurance companies to secure the highest possible coverage for patients.
• Communicating with patients to explain insurance coverage benefits and test information including process and turnaround time.
• Employee will be on the phone approximately 60-80% of the time.
• Participate in the Quality Assurance plan.
• Comply with applicable CLIA and HIPAA regulations.

Pay: $18.46/hr

Qualifications

• High School Diploma or GED
• Bachelor’s degree and more than one year of customer service and reimbursement experience preferred
• Excellent interpersonal and communication skills
• Accurate typing skills of at least 65 words per minute
• Excellent listening, transcribing, and self-review skills PC experience, including familiarity with Excel, Word, Internet, and e-mail
• Able to manage several tasks simultaneously, often under pressure.

Physical and Mental Job Requirements

• 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.
• While performing the duties of this job, the employee is frequently required to sit; talk; or hear.
• The employee is occasionally required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; and stoop; kneel; or crouch
• The employee must occasionally lift and/or move up to 25 pounds.
• Specific vision abilities required by this job include close vision, distance vision and depth perception.

#LI-REMOTE

Biostatistician

We are seeking a trained Biostatistician to assist with data management and monitoring for UNITAID-funded project. The goal of the grant is to conduct studies aimed at reducing TB incidence and deaths among people living with HIV(PLHIV) (15-49) and child contacts through sustainable implementation of affordable TB preventive therapies, as well as assess risks associated with these therapies among pregnant women living with HIV. The incumbent will have a primary appointment in the Johns Hopkins School of Medicine and will work in a multidisciplinary environment collaborating with investigators based at the Bloomberg School of Public Health, as well as our international partners based in Sub-Saharan Africa. The types of studies conducted under this grant include inidual- and cluster-randomized clinical trials, as well as observational studies.

Primary responsibility will be implementing best practices of data management, providing study design and analytic support for various studies and secondary analyses for publications, presentations and grant submissions. This position will routinely interact with a multidisciplinary team. Must have ability to manage multi-project workload, both development and maintenance. Depending on the task and project involved the position may be expected to lead, work as part of a team, or work inidually to complete the work as necessary.

Specific Duties & Responsibilities

• Across ongoing studies, as well as the two newly initiating studies, the successful candidate will be required to work with the project Lead Statistician to provide the following support.
• For ongoing studies, the databases will be developed and access to these will be provided. For new studies, responsibilities may include developing the study databases on a platform described in the protocol, and this may include using the Research Electronic Data Capture (REDcap) system, for which training will be available.
• Conduct data monitoring and regular summaries of the data as described in the protocols.
• Assist the study statistician will interim data analyses if specified in the protocols this may entail assembling the analytic data sets, conducting analyses and generating associated figures and tables.
• Assemble analytic datasets with input from the study statistician for the primary outcomes analysis and any sub-analyses deemed necessary for the study.
• Attend study-related meetings and provide data updates as needed. The frequency of these will be determined by the investigative teams.
• Contribute to manuscript drafting and other results dissemination activities.

Minimum Qualifications

• Master’s Degree in biostatistics, epidemiology, or related quantitative field.
• Minimum of one-year related experience.

Preferred Qualifications

Classified Title: Biostatistician

Role/Level/Range: ACRP/04/MD Starting Salary Range: $54,080-$74,390-$94,710 Annually (Commensurate with experience) Employee group: Full Time Schedule: Monday-Friday, 8:30am-5:00pm Exempt Status: Exempt Location: Remote Department name: SOM DOM Infectious Disease Personnel area: School of Medicine

Total Rewards

The referenced salary range is based on Johns Hopkins University’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level. Johns Hopkins offers a total rewards package that supports our employees’ health, life, career and retirement. More information can be found here: https://hr.jhu.edu/benefits-worklife/

Claims Support Coordinator (Remote)

REMOTE 

MEMBER CARE – MEMBER CARE

FULL-TIME

REMOTE

The Role:

As a Claims Support Coordinator, you will be part of a vibrant team of high performing and highly engaged professionals that work to ensure a quality patient experience within our service level agreements. The Claims Support Coordinator role serves as a liaison between plan members, providers and health insurance companies to get claims issues resolved. The Claims Support handles all communication, paperwork, and negotiations with a health insurance carrier or provider on the behalf of the plan member.

Responsibilities:

• Your primary objective is to provide effective and timely customer service for members, providers, insurer and clients regarding health care claims
• Ensure timely follow-up on requests for accounts to be reviewed
• Organize health insurance paperwork and medical record documentation
• Demonstrate knowledge of proprietary software and other required technology (Google apps, etc)
• Negotiate with providers on plan member balances
• Challenge denials of claims by the insurance company
• Communicate with medical offices, hospitals, laboratories, etc… in an effort to obtain relevant records for the patient’s case
• Contact providers and insurance companies to resolve claim concerns
• Assist with understanding of explanation of benefits (EOBs)
• Enabling members to get the errors fixed and recoup or lower their expenses by resolving their: medical bills, denied medical claims, medical letters of appeal
• Analyze and identify trends and patterns related to member billing complaints
• Collaborate with peers and management across functions
• Understand the evolving business requirements and adapt the operational processes to meet those requirements
• Speak clearly, confidently and have a friendly phone demeanor while demonstrating persuasion in overcoming objections
• Be able to handle a fast-paced dynamic environment with competing priorities
• Model a culture reflective of our Core Company Values; gain and maintain a thorough understanding of the Patient Care Team policies, processes, software, etc.

Qualifications:

• Minimum 3 years Claims experience strongly preferred
• Hospital Claims experience strongly preferred
• Highly effective communication, problem resolution and organizational skills
• Demonstrated ability to meet goals in a rapidly changing environment
• Excellent data and overall analytical skills
• Proven track record of driving measurable efficiency results
• Knowledge of medical terminology, ICD-9/ICD-10, CPT and DRG coding a plus.
• College degree preferred (additional experience in lieu of college degree will be considered)

#LI-CH1

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.

Insurance Follow Up Specialist

Location Tampa, Florida, USA

22 USD – 22 USD/Hour

REMOTE Hospital Biller

A top healthcare revenue cycle management company is excited to welcome applicants for an

opportunity as an Insurance Representative that will join their team Coralville, IA. Within this role, you will follow up with payers, file appeals, when necessary, perform insurance billing, and adjust identification to ensure proper account resolution.

Further explore this exclusive opportunity below

What’s in it for you:

• Flexibility Ability to work remotely from anywhere in the U.S.
• Training Extensive training program based on the employee’s needs
• Growth Openings due to increase in business needs
• Strong Culture Inclusive workplace focused on professional and personal development

In this role you will

• Effectively handling each form of insurance follow-up
• Handle insurance billing and adjustment identification to ensure proper account resolution
• Make 40-60 outbound calls per day with insurance companies and customers
• Research if/why claims were denied and file and work to file an appeal when necessary

Required Experience:

• High School Diploma or Equivalent
• 3+ Years Insurance Follow-Up (for hospital claims) or 2 Years of Hospital Billing experience
• Past Work with 1500 and UB04 Forms
• Understanding of HIPPA, PCI protocols, and insurance follow-up processes
• Knowledge of inpatient/outpatient denials follow up
• Ability to make 40-60 outbound calls per day

Title: Clinical Enablement Specialist

Location: Remote

Virta is the first company with a clinically-proven treatment to safely and sustainably reverse type-2 diabetes without the use of medications or surgery. Our innovations in nutritional biochemistry, data science and digital tools combined with our clinical expertise are shifting the diabetes treatment paradigm from management to reversal.

Our mission: reverse type 2 diabetes in 100 million people.

Virta is available to 100% of the U.S population, and we are expanding our capabilities to bring our groundbreaking online type 2 diabetes reversal treatment to even more patients.

We’re looking for a motivated inidual to join our Clinical Enablement team at Virta. As a Clinical Enablement Specialist, you will support the clinical operations of our provider team as we guide patients through diabetes reversal. Your primary responsibilities in this role will include working with internal and external teams to improve provider efficiency by executing on clinical support tasks in order to achieve positive patient health outcomes.

The Clinical Enablement Specialist will be part of a team who is accountable for metrics such as patients under management per provider and overall provider satisfaction. We’re looking for someone who is passionate about clinical operations and who is willing to jump in and make an impact. This role will work cross-functionally with our coaches, providers, CS, enrollment, and engineering teams to ensure our providers and patients are receiving resolutions for clinical issues which will help Virta transform more and more patients’ lives!

Responsibilities

• Execute on tier 1 and 2 provider and coach requests via the ZenDesk ticketing system. This includes cueing up prescriptions in our electronic prescribing software, handling prior-authorization requests, and ordering patient labs.
• Communicating with outside healthcare facilities (i.e. Insurance companies, pharmacies, labs, clinics) to fulfill clinical requests from Virta’s providers
• Utilize our EHR Spark in order to review and transcribe incoming patient labs, and appropriately cue them up for our providers to review
• Continually find ways to improve our processes and support our clinical teams, while maintaining high patient safety and quality standards

90 Day Plan

Within your first 90 days at Virta, we expect you will do the following:

• Become familiar with the Virta treatment and be able to answer all different types of provider tickets autonomously
• Become familiar with our provider databases and how to appropriately pull information from them to answer both internal and external questions
• Develop a consistent and efficient daily workflow with the team to ensure all tickets and requests are resolved in a timely manner (usually within 24 hours)

Must-Haves

• Experience working in a healthcare clinical setting
• Passion for clinical operations and working closely with healthcare providers
• Ability to think critically and be data-driven in solving patient problems
• Operational experience- especially in a fast-growing, rapidly changing environment
• Knowledge of technology tools and ability to quickly pick up new technologies
• Strong and effective communication skills, with the ability to listen to understand an issue and problem solve
• Keen attention to detail in order to effectively solve tickets the first time around
• Strong time management skills and the ability to work efficiently while multitasking

Nice-to-haves

• Clinical Experience working alongside doctors and nurses to deliver patient care
• Customer facing experience
• Prior experience using technology tools including GSuite, ZenDesk, SalesForce, and JIRA
• Healthcare and diabetes knowledge

Values-driven culture

Virta’s company values drive our culture, so you’ll do well if:

• You put people first and take care of yourself, your peers, and our patients equally
• You have a strong sense of ownership and take initiative while empowering others to do the same
• You prioritize positive impact over busy work
• You have no ego and understand that everyone has something to bring to the table regardless of experience
• You appreciate transparency and promote trust and empowerment through open access of information
• You are evidence-based and prioritize data and science over seniority or dogma
• You take risks and rapidly iterate

As part of your duties at Virta, you may come in contact with sensitive patient information that is governed by HIPAA. Throughout your career at Virta, you will be expected to follow Virta’s security and privacy procedures to ensure our patients’ information remains strictly confidential. Security and privacy training will be provided.

Virta has a location based compensation structure. Starting pay will be based on a number of factors and commensurate with qualifications & experience. For this role, the compensation range is $47,954 – $62,286. Information about Virta’s benefits is on our Careers page at: https://www.virtahealth.com/careers.

Title: Implementation Manager-Enterprise Healthcare

Location: US, Remote

WE’RE LUMA HEALTH.

Needing healthcare can be hard getting care shouldn’t be.

We built Luma Health because we are all patients. We believe it should be easy to see and connect with our doctor. To get the care we need, when we need it.

So, we’ve created solutions to fix this problem. Our technology makes messaging easier, scheduling appointments more efficient, and it modernizes care delivery from beginning to end.

The Role:

We are looking for a highly driven and empathetic Implementation Manager to be responsible for all customer implementations and training from go-live through fully implemented and expansion.

The Implementation Manager will be responsible for ensuring our customer implementations stay on track and are delivered on time and with high quality. This role will work closely with our Customer Success Managers and our Engineering team to customize and configure the product, solve issues, keep the project on track, report on progress, and address obstacles to ensure successful on-time launches. The Implementation Manager will also be responsible for developing new processes to reduce the time and effort involved in customer implementations.

You will provide expert guidance to clients that enable them to adopt and use the product, and make informed decisions about future product selection based on client inquiries during implementation. You will proactively engage with and train users at each account to help them get the most out of Luma.

The successful candidate will be a self-starter, experienced IM who has a track record of successfully implementing complex, multi-stakeholder, or small, contained deployments. This person is passionate about tackling difficult problems in healthcare and is excited by the ambiguity and opportunity that comes with working in a dynamic, fast-growing technology company.

What you’ll do:

• Become an expert on the Luma Health platform and products
• Manage implementation of customers from contract through launch
• Work with the CSM to understand client pain points and success metrics
• Document data requirements and process workflows
• Develop product customization based on client requests
• Develop project plans, track progress and monitor roadblocks during implementation phases
• Partner internally with our technical team to optimize client implementations and resolve technical challenges, and with the product team to design ideal offering/features. Ensure on-time delivery of Luma implementations
• Keep clients and internal tech teams on track and communicate and nudge (politely!) as necessary to meet deadlines
• Regularly report on status of implementations and potential issues
• Help our clients learn and navigate our product and the process change it can bring; proactively ensure new clients are getting value from Luma Health
• Identify weaknesses and failure points in current project implementation plans and spearhead process improvements
• Contribute to the development of scalable content resources for Luma clients (e.g., user guides, presentations, best practice recommendations, and other tools for the client)
• Be creative; be willing to build out new approaches that help define a playbook for ongoing customer engagement and success

Qualifications:

• Minimum 3 years of software implementation experience. SaaS experience is preferred. Direct healthcare experience is strongly preferred
• Excellent project management skills and ability to collaborate across multiple internal and external stakeholders
• Excellent written and verbal communication skills
• Detail oriented
• Strong analytical and critical thinking skills; strong problem solving skills
• You have proven success in building trust and driving results for a broad range of stakeholders: C-Suite, senior executives, developers, and day-to-day users of the software.
• Ability to quickly identify underlying drivers of problems, quickly develop hypotheses, and execute on a path to solve
• Proven record of unblocking relationships, turning detractors into advocates, and driving issues to resolution with great client satisfaction
• A natural tendency to be customer first and a willingness to go the extra mile
• Team-oriented, doer mentality (i.e. no task is too small)
• Growth company DNA — ability to thrive in a dynamic, fast-paced startup environment
• Degree from a nationally-recognized and well-regarded four-year institution
• Ability to travel to client sites as necessary

We Take Care of You!

• Competitive Health Benefits: Luma Health covers 99% of the employee and 85% of the dependent premium costs.
• Work Life Balance
• Flexible Time Off
• Wellness Programs
• Discounted Perks
• 401(k) and Company Equity

Don’t meet every single requirement? At Luma Health we are dedicated to building an inclusive workplace so if you’re excited about this role but your past experience doesn’t align with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles.

Luma Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We believe in order to thrive, businesses need a erse team and leadership. We welcome every race, religion, color, national origin, sex, sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an inidual with a disability, genetic information, or other applicable legally protected characteristics. Everyone is welcome here.

Come join us if you want to make a difference in health care.

Note: we have been made aware of iniduals fraudulently claiming to represent Luma Health recruiting. Please note that you will never be asked to submit payment or share financial information to participate in our interview process. All emails from Luma Health will come from “@lumahealth.io” email addresses. Any emails from other email addresses are scams. If you suspect that you’ve been contacted by a scammer, we recommend you cease all communication with the scammer and contact the FBI Internet Crime Complaint Center. If you’d like to verify the legitimacy of an email you’ve received from Luma Health recruiting, forward it to [email protected].

ProFee/Facility Medical Coder

Job LocationsUS

Job ID 2023-5235

Category Other

Remote Yes

The way you think makes you different. At Wipfli, we embrace that.

Our inclusive culture provides a space for everyone to have a voice. Our growing number of DEI resource groups celebrate ersity and champion awareness throughout Wipfli.

We’re also focused on helping you achieve success with balance. From hybrid schedules and flexible time off to training programs and mental wellness initiatives, we take care of our team.

If you want to be in an environment where you can grow, feed your curiosity and make a difference, Wipfli is the place for you.

Responsibilities

• Reviews patient charts, documents for verification and review code assignment in accordance with official coding guidelines.
• Ensures codes are sequenced according to government and insurance regulations.
• Assigns or validates discharge disposition and POA indicators.
• Abstracts and enters the coded data for hospital statistical and reporting requirements.
• Researches and analyzes data needs for reimbursement.
• Researches, analyzes and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
• Maintains 95% coding accuracy rate and maintains site designated productivity standards.

Qualifications

• Recognized coding credential from AHIMA or AAPC; and RHIA or RHIT may also be considered.
• Coding Certifications; preferred (CPC and/or CCS).
• 3-5+ years of work experience as a Medical Coder in both facility and professional coding setting required.
• Preferred setting experience in coding for Acute Care Hospitals, Critical Access Hospitals, Clinics, Rural Health Clinics, Federally Qualified Healthcare Centers.
• Excels at organizing and prioritizing workload and deadlines with high quality and accuracy.
• Proficient computer skills and working with coding software.
• Excellent written and verbal communication skills.

Title: Quality RN

Location: Remote

Company Description

Amwell is a leading telehealth platform in the United States and globally, connecting and enabling providers, insurers, patients, and innovators to deliver greater access to more affordable, higher quality care. Amwell believes that digital care delivery will transform healthcare. We offer a single, comprehensive platform to support all telehealth needs from urgent to acute and post-acute care, as well as chronic care management and healthy living. With over a decade of experience, Amwell powers telehealth solutions for over 150 health systems comprised of 2,000 hospitals and 55 health plan partners with over 36,000 employers, covering over 80 million lives.

Brief Overview:

This position provides quality review and support to the Amwell Medical Group (AMG). The RN candidate will be employed by Amwell providing review and support to the Amwell Medical Group Practice. The Amwell Medical Group is comprised of board-certified, credentialed, qualified physicians and other allied providers and is built to provide online healthcare services for Amwell’s Online Care clients.

The Amwell Medical Group currently provides acute care services in approximately 44 states, with the expectation of expanding to providing other medical services (e.g., chronic care management, specialty care, behavioral health) in all 50 states in the future. Care is delivered utilizing Amwell’s Online Care system. Online Care allows patients and consumers to connect with physicians immediately, whenever they have a health need, from their homes or offices. The innovation uses advanced Web-based technologies and telephony to remove traditional barriers to healthcare access, including insurance coverage, geography, mobility and time constraints.

Core Responsibilities:

• Participate in monthly Ongoing Professional Provider Evaluation (OPPE)- in-depth provider case reviews.
• Identify provider trends and deficits in clinical and documentation standards.
• Participation in Provider coaching/training
• Participate in monthly client meetings to understand and support client expectations.
• Initiation and management of Prior Authorizations.
• Participation in workflow design and QA improvements.
• Participation in risk management planning.
• Participation in ongoing policy and procedure design and editing- including, but not limited to clinical matters, intake, emergency preparation, referral planning, and documentation.
• Participation in regulatory assessment and compliance planning.
• Interface with providers as needed.
• Provide clinical support to other departments as needed to support organizational initiatives.
• Participation in department and committee meetings.
• Participation in the development of a process that measures outcomes.
• Participation in the quality management program, including investigation of red flag cases and adverse events.
• Participate in root cause analysis.

Qualifications:

• Registered nurse with a broad range of clinical experience; minimum of 10 years in practice
• Experience managing clinical outcomes based on a variety of acute and chronic illnesses.
• Strong communication skills: the ability to build professional relationships with providers to provide ongoing feedback/coaching.
• Strong analytical skills, review, and analysis of metrics to identify provider issues.
• Strong technical and application skills to support providers/patients.
• Interpretation and manipulation of clinical data via excel spreadsheets.
• Experience providing remote care/support is a plus.
• Desire to be a part of the telehealth innovation.

Additional information

Working at Amwell:

Amwell is changing how care is delivered through online and mobile technology. We strive to make the hard work of healthcare look easy. In order to make this a reality, we look for people with a fast-paced, mission-driven mentality. We’re a culture that prides itself on quality, efficiency, smarts, initiative, creative thinking, and a strong work ethic.

Our Core Values include One Team, Customer First, and Deliver Awesome. Customer First and Deliver Awesome are all about our product and services and how we strive to serve. As part of One Team, we operate the Amwell Cares program, which brings needed assistance to our communities, whether that be free healthcare for the underserved or for people affected by natural disasters, support for equality, honoring doctors and nurses, or annual Amwell-matched donations to food banks. Amwell aims to be a force for good for our employees, our clients, and our communities.

Amwell cares deeply about and supports Diversity, Equity and Inclusion. These initiatives are highlighted and reflected within our Three DE&I Pillars – our Workplace, our Workforce and our Community.

Amwell is a “virtual first” workplace, which means you can work from anywhere, coming together physically for ideation, collaboration and client meetings. We enable our employees with the tools, resources and opportunities to do their jobs effectively wherever they are!

The typical base salary range for this position is $91,200-$125,400. The actual salary offer will ultimately depend on multiple factors including, but not limited to, knowledge, skills, relevant education, experience, complexity or specialization of talent, and other objective factors. In addition to base salary, this role may be eligible for an annual bonus based on a combination of company performance and employee performance. Long-term incentive and short-term variable compensation may be offered as part of the compensation package dependent on the role. Some roles may be commission based, in which case the total compensation will be based on a commission and the above range may not be an accurate representation of total compensation.

Further, the above range is subject to change based on market demands and operational needs and does not constitute a promise of a particular wage or a guarantee of employment. Your recruiter can share more during the hiring process about the specific salary range based on the above factors listed.

Additional Benefits

• Unlimited Personal Time Off (Vacation time)
• 401K match
• Competitive healthcare, dental and vision insurance plans
• Paid Parental Leave (Maternity and Paternity leave)
• Employee Stock Purchase Program
• Free access to Amwell’s Telehealth Services, SilverCloud and The Clinic by Cleveland Clinic’s second opinion program
• Free Subscription to the Calm App
• Tuition Assistance Program
• Pet Insurance

Community Wellness Advocate

locations Remote

time type Full time

job requisition id 28661

POSITION SUMMARY:

A Community Wellness Advocate (CWA) is a trusted member of the community who helps high risk patients maintain stable health and wellness along a continuum, through integrating and connecting hospital, home-based, and community-based services. CWAs are responsible for providing advocacy and case management services; developing an interdisciplinary care plan based on identified patient needs; facilitating access to social service resources and other internal and external resources; monitoring the patient’s progress; and problem-solving with patients to both accelerate and enhance access to concrete supports.

CWAs provide in-home or community-based one-on-one, family, and/or interdisciplinary group support to high risk care patients and collaborates with the Patient Care Manager, PCP, and other members of the care team to conduct needs assessments to identify and respond to barriers to the patient’s health and wellness.

Position: Community Wellness Advocate

Department: Pop Health – Care Management

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Initiates face to face contact with eligible patients to describe role, explain participation benefits and begin screening process.
• Schedules and completes initial hospital, clinic, or community-based (homes, shelters, housing agencies, substance use treatment programs, etc.) visit screening, care plan, and follow up visits and phone calls for enrolled patients within specified timeframes.
• Teaches key educational messages using a variety of culturally, linguistically and educationally appropriate strategies, in a variety of settings.
• Clearly documents all activities in the patient’s record and care management system.
• Participates with other staff in activities that include community outreach, presentations to community organizations, development of materials, and phone calls.
• Works with patients and providers to set goals for patient’s care and provides guidance for patient to achieve those goals.
• Reinforces educational messages regarding disease self-management by linking clients with supportive community services and programs.
• Presents patients at case review meetings succinctly and logically.
• Consults with Patient Care Manager, primary clinical staff, behavioral health teams and / or PCP regarding complex patient situations, demonstrating an understanding of how to solicit and incorporate provider feedback in order to continuously develop the most optimal plan for care.
• Demonstrates the ability to function within an inter-disciplinary team (nurse care coordinators, social workers, behavioral health clinicians, physicians, resource specialists, clinical support staff, etc.), connecting the patient with resources as needed.
• Records and monitors the participants’ progress toward goals within specific timeframes.
• Documents assessments and key patient updates in Epic system; documents relevant day-to-day activities and patient data.
• Prepares reports and documents as needed or requested.
• Assists patients with organizing their records, making follow-up appointments, attending follow-up appointments, and filling their prescriptions.
• Helps patients fill out applications, for example for Medical Assistance, Housing, and SNAP (Supplemental Nutrition Assistance Program).
• Provides advocacy, patient education and successful warm hand offs in accessing community-based and hospital-based programs.
• Assists patient in addressing and overcoming barriers with a range of concrete supports, including but not limited to: healthcare support services, behavioral health, financial assistance, child-care and caregiver support, housing, support with utility bills, food, financial entitlements, clothing, transportation, food pantries, violence prevention, social isolation and any other appropriate community resources.
• Coordinates with community-based long-term services and supports.
• Provide intensive home and community-based outreach, motivational interviewing and goal setting, resource connection and accompaniment to medical appointments as needed to help patients appropriately utilize healthcare.
• CWAs may visit patients in hospital and ER settings to facilitate with transitions of care.
• Establishes culturally appropriate and trusting relationships with patients and their families.
• Participates in all training activities as designated by Community Wellness Manager (CWM) and the Nurse Practitioner.
• Attends regularly scheduled supervision and other program assigned meetings.
• Develops and maintains strong relationships with the community and community resources to ensure patient access.

NOTE: The CWA will not provide hands on care or other services noted as home health services, including but not limited to: performance assessments, provision of care, treatment, or counseling; and/or monitoring of patient’s health status.

JOB REQUIREMENTS

EDUCATION:

• HS Diploma with community experiences or Bachelor’s degree

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

• Driver’s license required

EXPERIENCE:

• Minimum of 2 years prior healthcare, public health, or community-based experience in community setting.

KNOWLEDGE AND SKILLS:

• Basic knowledge of healthcare system.
• Outstanding interpersonal skills of foremost importance to interact with families and patients.
• Interest in community health and outreach.
• Exceptional organizational skills; ability to multi-task and work independently and as part of a team.
• Demonstrated oral and written English communication skills.
• Fluency in Haitian Creole or Spanish preferable.
• Understanding of how language, culture and socioeconomic circumstances affect health.
• Desire to work with erse, multi-cultural and multi-lingual populations.
• Proficiency with Microsoft Office applications (i.e. MS Word, Excel, Access, Outlook) and web browsers. Proficiency with data entry and data tracking.

Nurse Clinical Lead

at Signify Health

Remote

Position Overview:

The Nurse Clinical Lead is a role within the Network Oversight team responsible for leadership and generalized oversight of Signify Health’s provider network conducting in-home and virtual health evaluations.

Diversity and Inclusion are core values at Signify Health, and fostering a workplace culture reflective of that is critical to our continued success as an organization.

In this role, the Spirometry Nurse Clinical Lead serves as a lead within Network Oversight and is responsible for the oversight of ensuring the provider network is meeting quality standards for Spirometry testing. The Nurse Clinical Lead will serve as the clinical resource for the Diagnostic and Preventive Services department, including spirometry testing, pilot projects, and escalations related to the quality of testing and completions. The Nurse Clinical Lead will be responsible for answering clinical questions regarding spirometry testing, device, workflow, and troubleshooting errors for spirometry testing. The Nurse Clinical Lead will also be responsible for the completion management of spirometry testing. The Nurse Clinical Lead will be required to follow all Signify Health policy and protocols related to spirometry testing and diagnostic and preventive services and escalate to other departments as appropriate if additional leadership is needed.

Spirometry RN Clinical Lead:

• Generalized oversight of ensuring the provider network is meeting quality standards
• Serve as the clinical resource for the Diagnostic and Preventive Services department, pilot projects, and escalations related to the provider network
• Responsible for Spirometry testing provider escalations, recommendations and will be required to follow all Signify Health policy and protocols and escalate to a Regional Clinical Lead if additional leadership is needed
• Point of contact for spirometry clinical leadership to the provider network as needed
• Provide diagnostic preventative service training to clinicians
• Provides general support to the senior nurse clinical manager and departmental leaders

Additional Job Responsibilities:

• Participate in staff meetings, conference calls, and other meetings as needed
• Attend training sessions to acquire/enhance skills related to programs offered
• Complete reports/projects/tasks as requested by the Sr. Nurse Clinical Manager
• Daily troubleshooting of program/processes as indicated
• Ability to travel 30-40% of the time air/land travel, may include some overnights and weekends
• Perform other incidental and related duties as required

Essential Characteristics:

• Strategic thinker
• Results driven
• Detail-oriented
• Self-directed and organized
• Sound judgment in handling/escalating difficult situations
• Sense of urgency
• Good interpersonal and conflict resolution skills
• Discrete (i.e., ability to maintain confidentiality)
• Team player
• Ability to work under pressure
• Ability to take direction

Working Conditions:

• Fast-paced environment
• Requires working at a desk to use a phone and computer
• Use office equipment and machinery effectively
• Work effectively with frequent interruptions
• Ability to bend, stoop
• Lifting requirements of 20 pounds occasionally unassisted
• May require additional hours to meet project deadlines

About Us:

Signify Health is helping build the healthcare system we all want to experience by transforming the home into the healthcare hub. We coordinate care holistically across iniduals’ clinical, social, and behavioral needs so they can enjoy more healthy days at home. By building strong connections to primary care providers and community resources, we’re able to close critical care and social gaps, as well as manage risk for iniduals who need help the most. This leads to better outcomes and a better experience for everyone involved. Our high-performance networks are powered by more than 9,000 mobile doctors and nurses covering

every county in the U.S., 3,500 healthcare providers and facilities in value-based arrangements, and hundreds of community-based organizations. Signify’s intelligent technology and decision-support services enable these resources to radically simplify care coordination for more than 1.5 million iniduals each year while helping payers and providers more effectively implement value-based care programs.

To learn more about how we’re driving outcomes and making healthcare work better, please visit us at www.signifyhealth.com

We are committed to equal employment opportunities for employees and job applicants in compliance with applicable law and to an environment where employees are valued for their differences.