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Remote Health Care Jobs

Description

Firefly Health is building a revolutionary new type of comprehensive health “care and coverage, powered by a relationship-driven care team, a trusted virtual and in-person clinical network, and our proprietary technology platform.

Founded by experienced clinicians and technology leaders, Firefly Health is on a mission to deliver clinical and financial health through joyful, always there care. We are flipping the script on what it means to be a health plan and actually providing a true health benefit to members.

We are intensely focused on optimizing the physical + mental + financial wellbeing of those who want (and deserve) something better than the status quo. If you are ready to roll up your sleeves and take on our audacious mission, we would love to hear from you.

Contract Position:

We are looking for a Certified Professional Coder to join our team in a contract role through the end of the year, working approximately 30 hours per week. As a Certified Professional Coder, you will ensure the accuracy and integrity of medical coding for billing and reimbursement.

Contract Role and Responsibilities:

Assign accurate medical codes to diagnoses, procedures, and services in accordance with coding guidelines and regulations
Ensure compliance with insurance eligibility requirements, fee for service and capitated coding standards, and billing regulations
Perform risk adjustment coding to optimize reimbursement and accurately reflect patient acuity
Collaborate with healthcare providers to improve clinical documentation to support accurate coding and billing
Conduct regular audits to ensure coding accuracy and compliance with regulatory requirements
Provide education and training to healthcare providers and staff on coding best practices and documentation improvement strategies
Stay current with updates to coding guidelines, regulations, and industry trends

Contractor Requirements:

Certified Professional Coder (CPC), Certified Coding Specialist (CCS) credential or Certified Coding Specialist- Physician-based (CCS-P) required
Minimum of 2 years of experience in medical coding and billing
Minimum of 1 years of experience in risk adjustment coding
Proficiency in ICD-10-CM, CPT, HCPCS
Strong understanding of medical terminology, anatomy, physiology, and disease processes
Excellent analytical and problem-solving skills
Detail-oriented with a high level of accuracy in coding and documentation
Effective communication and interpersonal skills
Ability to work independently and as part of a team in a fast-paced healthcare environment
Commitment to maintaining confidentiality and adhering to ethical standards

Contractor Preferred Qualifications:

You thrive in a multidisciplinary environment and are skilled at collaborating with professionals from various sectors within healthcare to enhance the coding process and overall patient care
You are proficient with the latest healthcare technology platforms and have a knack for leveraging digital tools to streamline coding processes and improve accuracy
You are committed to continuous professional development and are always looking for opportunities to learn more about the latest coding standards, healthcare regulations, and industry best practices
You have exceptional communication skills, capable of explaining complex coding guidelines to iniduals with non-technical backgrounds, facilitating clear and effective information exchange across the organization
You are a proactive problem solver who anticipates and addresses issues before they escalate

Firefly is an equal-opportunity employer. We value erse backgrounds and perspectives. We’re committed to building and sustaining an inclusive workplace culture where iniduals are treated with dignity and respect. All employment is decided on the basis of qualifications, merit, and business need. Firefly is an E-Verify employer.

Registered Nurse Clinical Specialist

Transcarent Remote.co6 days ago

Apply Now6 days ago

location: remoteus

Apply Now

Registered Nurse Clinical Specialist

at Transcarent

US – Remote

Who we are

Transcarent is the One Place for health and care. We cut through the complexity, making it easy for people to access high-quality, affordable care. With a personalized app tailored for each Member, an on-demand care team, and a connected ecosystem of high-quality, in-person care and virtual point solutions, Transcarent eliminates the guesswork to confidently guide Members to the right level of care. We take accountability for results offering at-risk pricing models and transparent impact reporting to align incentives towards measurably better experience, better health, and lower costs. At Transcarent, you will be part of a world-class team, supported by top tier investors like 7wireVentures and General Catalyst, and founded by amission-driven teamcommitted to transforming the health and care experience for all. We closed on our Series C funding in January 2022, raising our total funding to $298 million and enabling us to respond to the demand for our offering.

Transcarent is committed to growing and empowering a erse and inclusive community within our company. We believe that a team with erse lived experiences, working together will strengthen our organization, and our ability to deliver “not just better but different” experiences for our members.

We are looking for teammates to join us in building our company, culture, and Member experience who:

Put people first, and make decisions with the Members best interests in mind
Are active learners, constantly looking to improve and grow
Are driven by our mission to measurably improve health and care each day
Bring the energy needed to transform health and care, and move and adapt rapidly
Are laser focused on delivering results for Members, and proactively problem solving to get there

About this role

The Registered Nurse Clinical Specialist reports to the Director, Clinical Operations of Care Support Services and is responsible for guiding members through their Transcarent experience in partnership with Transcarents Care Coordinators. This role also supports quality assurance and improvement efforts and operations related to our Centers of Excellence (COE) program in accordance with the Transcarent Quality Tenets. The Registered Nurse Clinical Specialist will reflect the mission, vision, and value statements of Transcarent to internal departments and external plan sponsors, providers, and partners.

What youll do

Support the Care Support Services team with clinical subject matter expertise and guidance relating to inidual cases and in broader strategy and processes. This includes direct support to Plan Members.

Partner with the Care Support Services Team to manage a caseload efficiently and effectively across a variety of clients and all clinical categories.
Supports members to introduce, coordinate, and guide members through their Transcarent experience.
Work effectively with other supporting operational roles and internal departments, to coordinate the member’s case.
Effectively address and resolve Member barriers to utilizing the benefit including addressing program questions and collecting medical records in a timely and accurate manner to ensure an expedited process.
Work with cross functional teams to develop new or update existing quality measures, protocols, processes, and policies to minimize risk and ensure compliance.
Work collaboratively with our COE facility and provider partners in support of achieving the highest quality experience for our Members.
Support the Provider Relations team with guidance relating to COE facilities and providers for targeting and participation.
Support the operational needs of the COE program from a clinical perspective including monitoring and support for member complications.
Lead a cohort of Care Coordinators to ensure cases are effectively progressing through to completion accurately.
Other duties as assigned.

What were looking for

Registered Nurse and current licensure, BSN required.
A minimum of 5 years clinical acute care experience as a practicing RN preferred.
Compact licensure
Experience in surgery preferred.

Nice to have

Flexibility – Openness and understanding that dynamic environments include change, and welcoming that change with a positive attitude.
Problem Solving – Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
Customer Service – Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
Oral Communication – Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
Written Communication – Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
Teamwork – Balances team and inidual responsibilities; Exhibits objectivity and openness to others’ views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone’s efforts to succeed.

Total Rewards

Inidual compensation packages are based on a few different factors unique to each candidate, including primary work location and an evaluation of a candidates skills, experience, market demands, and internal equity.

Salary is just one component of Transcarent’s total package. All regular employees are also eligible for the corporate bonus program or a sales incentive (target included in OTE) as well as stock options.

Our benefits and perks programs include, but are not limited to:

Competitive medical, dental, and vision coverage
Competitive 401(k) Plan with a generous company match
Flexible Time Off/Paid Time Off, 12 paid holidays
Protection Plans including Life Insurance, Disability Insurance, and Supplemental Insurance
Mental Health and Wellness benefits

Location

You must be authorized to work in the United States. Depending on the position we may have a preference to a specific location, but are generally open to remote work anywhere in the US.

Transcarent is an equal opportunity employer. We celebrate ersity and are committed to creating an inclusive environment for all employees. If you are a person with a disability and require assistance during the application process, please dont hesitate to reach out!

Research shows that candidates from underrepresented backgrounds often dont apply unless they meet 100% of the job criteria. While we have worked to consolidate the minimum qualifications for each role, we arent looking for someone who checks each box on a page; were looking for active learners and people who care about disrupting the current health and care with their unique experiences.

Coding Operations & Execution

Datavant Remote.co7 days ago

Apply Now7 days ago

location: remoteus

Apply Now

Title: Coding Operations & Execution

Location: Remote, United States

JobDescription:

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

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

The Vice President of HCC Risk Adjustment is responsible for the oversight of risk adjustment and coding, and establishing and managing company coding guidelines, policy and procedures. The VP plays a critical role in the development and execution of business strategy and compliance, overseeing the development, implementation and execution of Medicare advantage and Managed Medicaid risk adjustment strategy.

You will:

Strategy, planning and execution of the Risk adjustment coding business including ACA/Exchange, Medicare Advantage, and Medicaid plans.
Demonstrate and pass on expert knowledge in HCC risk adjustment methodologies and industry-leading solutions and strategies to drive optimized results.
Partner with Analytics to develop new predictive, analytic and reporting tools to glean actionable insights into current performance and new opportunities and leverage a network of experts – internal and external – to enhance Risk
Adjustment innovation and performance. Integrate NLP (Natural Language Processing) technology with human coding expertise to delivery highest accuracy to clients.
Monitor risk adjustment submissions as compared to expected revenue and proactively address gaps in data submissions and impacts to forecasting and budgets.
Improve monitoring and auditing protocols to ensure internal and vendor compliance with all applicable regulations and risk adjustment data validation audits (RADV).
Leverage market insights to monitor trends and external landscape, and to inform capability strategies and customer use case scenarios.
Consult with and support Payer Client Services team with all Risk Adjustment programs and initiatives.
Ensure operational integration of contractual requirements resulting in adherence to quality standards and performance expectations as required and strive to exceed established service level agreements.
Oversight of the Coding management team and staff in all departmental functions including implementing best practices in talent acquisition for HCC coders, overseeing onboarding, staffing plans and staff performance to ensure optimal talent management and utilization.
Develop and manage a multi-million dollar department budget.
Negotiate, direct and oversee the administration of contracts, select and performance manage key vendor partners, and foster new relationships and partnerships with cutting edge service providers.
Direct oversight of team/department and responsibilities around managing, developing, and handling employment actions of direct staff and manager
Provide training sessions and educational resources to our client success team on the use of our coding software, coding guidelines, industry update and best practices on how to sell and discuss coding offerings with clients.
Offer ongoing support and troubleshooting assistance to address client inquiries, issues, and challenges related to coding processes or system usage.
Conduct regular check-ins and meetings with account managers and coding clients to understand their evolving needs, address concerns, and provide proactive support.

Client Relationship Management:
- Serve as the Coding Subject Matter Expert for our client success team, fostering strong relationships and acting as a trusted advisor.
- Conduct regular check-ins and meetings with account managers and coding clients to understand their evolving needs, address concerns, and provide proactive support.

Training and Support:
- Provide training sessions and educational resources to our client success team on the use of our coding software, coding guidelines, industry update and best practices on how to sell and discuss coding offerings with clients.
- Offer ongoing support and troubleshooting assistance to address client inquiries, issues, and challenges related to coding processes or system usage.

What you will bring to the table:

Minimum of a Bachelor’s degree in business, finance, analytics, healthcare delivery, public policy or a related field is required. A Master’s degree in a related field of study is preferred.
Seven (7) or more years’ experience in health plan, health technology for health plans, risk & quality at a plan or vendor, or a consultant in one or more of those areas.
Five years experience with HCC coding leadership
Four years experience in a in a client success / client facing role
AAPC or AHIMA certification preferred.
Strong analytical skills needed to prepare and analyze data to drive KPIs and process improvements within the department.
Strong leadership and management skills to directly manage a team/department.
Strong communication skills; ability to present information in a concise manner to multiple organizational levels including Board of Directors
Must be able to travel a minimum of 50% of the time (more travel may be required at times)

Bonus points if:

MBA or similar degree
Familiarity with NLP, AI and LLM business models related to coding productivity and product differentiation
Product experience

We are committed to building a erse team of Datavanters who are all responsible for stewarding a high-performance culture in which all Datavanters belong and thrive. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status.

Our compensation philosophy is to be externally competitive, internally fair, and not win or lose on compensation. Salary ranges for this position are developed with the support of benchmarks and industry best practices.

We’re building a high-growth, high-autonomy culture. We rely less on job titles and more on cultivating an environment where anyone can contribute, the best ideas win, and personal growth is driven by expanding impact. The range posted is for a given job title, which can include multiple levels. Inidual rates for the same job title may differ based on their level, responsibilities, skills, and experience for a specific job. The estimated salary range for this role is $208k-290k.

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

Clinical Data Coder/Specialist-Temp

Natera Remote.co8 days ago

Apply Now8 days ago

location: remoteus

Apply Now

Clinical Data Coder/Specialist-Temp

Remote

Position Summary:

The Clinical Data Coder/Specialist – Pre Claims is responsible for the accurate and timely work to effect filing of Insurance claims. Qualified inidual will demonstrate clinical claims detailed knowledge, coding and delivering resolutions to missing/ incomplete order data. This person will identify invalid clinical values to help drive clean claims and revenue pull through on all products and services.

This position will support the Revenue Cycle function and report to the Front End Manager of Revenue Cycle.

Note: This is a temp position.

Essential Duties and Responsibilities:

– Identify order and reimbursement deficiencies – both clinical and code related

– Investigate and correct, where appropriate, deficient clinical claim information

-Identify and escalate missing, and sometimes invalid, clinical order data for timely contact resolution with supporting cross functional teams

– Partner with multiple internal cross-functional teams and successfully manage multiple product projects simultaneously.

-Research claim and account information using various systems and portals internal and external

-Stay current with relevant medical billing regulations, rules and guidelines

-Complete position responsibilities within the appropriate time frame while adhering to quality standards

-Ability to interact with various insurances/ third party payors accurately and timely to ensure that authorizations are obtained and necessary documents are available for claim support based on internal and external policies and regulations

– Participate in clinical data management activities including leading clinical data initiatives, analysis and optimization of our clinical data capture workflows

– Translate data into meaningful information and knowledge that supports decision making or determining action that drives performance improvement and quality

– Identifies and uses internal and external sources of information for benchmarking and comparative performance, which includes networking with clinical communities, researching literature and agencies, and staying current on new indicators and other requirements

-Act as SME for multiple purposes where coding and clinical operations data is relevant

– Support and comply with the companys policies and procedures.

-Maintains strictest confidentiality, and adheres to all HIPAA guidelines/regulations

– Regular and reliable attendance.

– Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.

-Perform analytical and special projects, prepare ad hoc reports/data queries as may be assigned/requested, working with leadership

Qualifications:

Minimum Qualifications:

– Bachelor degree in relevant field is preferred

– 3+ years professional coding experience with current certification including International Classification of Diseases (ICD-10) and Coding Procedure Terminology (CPT) and HCPCS coding.

– Authorization to work in the United States without sponsorship.

– Certified coder designation/certification by AHIMA or AAPC required

– Superior organization skills, detail oriented, and ability to be persistent and follow through

– Problem-solving, ability to adapt, flexibility in approaches to accomplishing tasks, and ability to independently arrive at creative solutions to problems

– Excellent communication skills, both verbal and written, particularly the ability to convey technical information in an accessible and understandable manner

– Ability to work both independently and in collaboration with iniduals from various disciplines

Preferred Qualifications:

– 5+ years of experience coding in the medical/healthcare billing area- Lab a plus

– Any years of experience in the revenue cycle function to include third party payer experience.

– Thorough understanding of professional coding, documentation, medical billing processes.

– Deep familiarity with payer/insurance Medical policy, Prior Auth, claims, appeals and reimbursement processes.

– Knowledge and familiarization with Medicare billing regulations and reimbursement methodologies for Laboratory

The pay range is listed and actual compensation packages are based on a wide array of factors unique to each candidate, including but not limited to skill set, years & depth of experience, certifications and specific office location. This may differ in other locations due to cost of labor considerations.

Remote USA

$18$25 USD

OUR OPPORTUNITY

Natera is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, womens health, and organ health. Our aim is to make personalized genetic testing and diagnostics part of the standard of care to protect health and enable earlier and more targeted interventions that lead to longer, healthier lives.

The Natera team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions, who care deeply for our work and each other. When you join Natera, youll work hard and grow quickly. Working alongside the elite of the industry, youll be stretched and challenged, and take pride in being part of a company that is changing the landscape of genetic disease management.

WHAT WE OFFER

Competitive Benefits – Employee benefits include comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents. Additionally, Natera employees and their immediate families receive free testing in addition to fertility care benefits. Other benefits include pregnancy and baby bonding leave, 401k benefits, commuter benefits and much more. We also offer a generous employee referral program!

For more information, visit www.natera.com.

Natera is proud to be an Equal Opportunity Employer. We are committed to ensuring a erse and inclusive workplace environment, and welcome people of different backgrounds, experiences, abilities and perspectives. Inclusive collaboration benefits our employees, our community and our patients, and is critical to our mission of changing the management of disease worldwide.

All qualified applicants are encouraged to apply, and will be considered without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, age, veteran status, disability or any other legally protected status. We also consider qualified applicants regardless of criminal histories, consistent with applicable laws.

If you are based in California, we encourage you to read this important information for California residents.

Link: https://www.natera.com/notice-of-data-collection-california-residents/

Please be advised that Natera will reach out to candidates with a @natera.comemail domain ONLY. Email communications from all other domain names are not from Natera or its employees and are fraudulent. Natera does not request interviews via text messages and does not ask for personal information until a candidate has engaged with the company and has spoken to a recruiter and the hiring team. Natera takes cyber crimes seriously, and will collaborate with law enforcement authorities to prosecute any related cyber crimes.

Clinical Appeals Nurse (RN) Remote

Molina Healthcare Remote.co8 days ago

Apply Now8 days ago

location: remoteus

Apply Now

Clinical Appeals Nurse (RN) Remote

Molina Healthcare Job ID 2025531

JOB DESCRIPTION

Job Summary

Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance standards.

We are seeking a Registered Nurse with previous Inpatient/outpatient appeals knowledge/experience. The candidate should have MCG criteria knowledge, critical thinking skills, and strong organizational skills. Experience with Medicare review UM/Appeals and skilled computer skills highly preferred. Must be able to work independently in a high-volume environment. Further details to be discussed during our interview process.

Remote position.

Work schedule M-F 8:30 AM to 5:00 PM, weekend overtime eligibility. There is weekend and holiday rotation in the appeals department.

KNOWLEDGE/SKILLS/ABILITIES

The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request by another Molina department to reduce the likelihood of a formal appeal being submitted.
Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and inidual judgment and experience to assess the appropriateness of service provided, length of stay and level of care.
Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) cases and with Marketplace EOCs (Evidence of Coverage).
Reviews medically appropriate clinical guidelines and other appropriate criteria with Chief Medical Officer on denial decisions.
Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues.
Identifies and reports quality of care issues.
Prepares and presents cases in conjunction with the Chief Medical Officer for Administrative Law Judge pre-hearings, State Insurance Commission, and Meet and Confers.
Represents Molina and presents cases effectively to Judicial Fair Hearing Officer during Fair Hearings as may be required.
Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals.
Provides training, leadership and mentoring for less experienced appeal LVN, RN and administrative staff.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred.

Required Experience

3-5 years clinical nursing experience, with 1-3 years Managed Care Experience in the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as needed or equivalent experience (such as specialties in: surgical, Ob/Gyn, home health, pharmacy, etc.).
Experience demonstrating knowledge of ICD-9, CPT coding and HCPC.
Experience demonstrating knowledge of CMS Guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare, CHIP and Marketplace, applicable State regulatory requirements, including the ability to easily access and interpret these guidelines.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN) license in good standing.

Preferred Education

Bachelor’s Degree in Nursing

Preferred Experience

5+ years Clinical Nursing experience, including hospital acute care/medical experience.

MCG criteria knowledge

Critical thinking skills

Strong organizational skills

Medicare review UM/Appeals experience

Skilled computer skills

Preferred License, Certification, Association

Any one or more of the following:

Active and unrestricted Certified Clinical Coder
Certified Medical Audit Specialist
Certified Case Manager
Certified Professional Healthcare Management
Certified Professional in Healthcare Quality
other healthcare certification

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $54,373.27 – $117,808.76 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time

Behavioral Health Crisis Coordinator

Grow Therapy Remote.co10 days ago

Apply Now10 days ago

location: remoteus

Apply Now

Title: Behavioral Health Crisis Coordinator

Location: Remote

JobDescription:

About us:

Grow Therapy is on a mission to serve as the trusted partner for therapists growing their practice, and patients accessing high-quality care. Powered by technology, we are a three-sided marketplace that empowers providers, augments insurance payors, and serves patients. Following the mass increase in depression and anxiety, the need for accessibility is more important than ever. To make our vision for mental healthcare a reality, were building a team of entrepreneurs and mission-driven go-getters. Since launching in February 2021, weve empowered more than ten thousand therapists and hundreds of thousands of clients across the country and insurance landscape. Weve raised more than $178mm of funding from Sequoia Capital, Transformation Capital, TCV, SignalFire, and others.

What Youll Be Doing:

We are looking for a Behavioral Health Crisis Coordinator to provide support to mental health practitioners contracted with Grow Therapy. Youll help us expand the Clinical vertical at Grow Therapy by launching workflows for HLOC coordination (step up and step down) and clinical case consultation for providers who have a client in crisis. This role will serve as a clinical SME to assist our internal, non-clinical Escalation team to problem solve using best practices for crisis risk management. This is a fully remote position reporting directly to our Grievance Coordinator as part of the Clinical Excellence Team. Your responsibilities will include:

Conduct real-time case consultations with providers related to their clients who are experiencing a crisis
Meet SLAs to coordinate resources for IOP level of care and FUH appointments upon receipt of a provider or payor referral
Partner with our Escalation team to provide asynchronous clinical guidance to address acute behavioral health needs of clients
Review and respond to billing exceptions due to crisis care needs
Serve as an internal SME with non-clinical teams on topics related to risk management and crisis intervention

Salary range: $90,843 – $118,750

Youll Be a Good Fit If:

You have 5+ years of experience providing crisis intervention as a licensed clinician (LCSW, LMFT, LPC/LMHC, Licensed Psychologist in any state)
Youre highly competent working in a fast-paced remote environment using asynchronous communication and a range of software tools
You have experience working in a high volume telehealth environment and understand the nuances and challenges of being an independent telehealth provider
Youre known as someone who is a problem solver, kind, patient and able to remain calm amidst a crisis
Youre able to commit to working 9am-6pm or 10am-7pm MT Monday-Fridays

If you dont meet every single requirement, but are still interested in the job, please apply. Nobody checks every box, and Grow believes the perfect candidate is more than just a resume.

Note: Please upload your resume in PDF format

Benefits

The chance to drive impact within the mental healthcare landscape from day one
Comprehensive health insurance plans, including dental and vision
Our dedication to mental health guides our culture. Wellness benefits include (but are not limited to):
- Flexible working hours and location (remote OR in-office, your choice!)
- Generous PTO
- Company-wide winter break
- Mental health mornings (2 hours each week)
- Team meditation
- Wellness Stipend
- In-office lunch and biweekly remote lunch on us!
Continuous learning opportunities
Competitive salary
The opportunity to help build a rapidly scaling start-up organization by taking strong ownership of your work, mentorship, and our unbounded leadership opportunities

#LI-REMOTE

Grow Therapy is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements.

Comprehensive Medication Review Medical Assistant

Vesta Healthcare Remote.co10 days ago

Apply Now10 days ago

location: remoteus

Apply Now

Title: Comprehensive Medication Review Medical Assistant

Location: Remote

Job Description:

Nice to meet you, we’re Vesta Healthcare.

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

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

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

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

The ideal teammate would be…

A customer focused inidual who is responsible for assisting the team in coordinating the care of members enrolled in Medicare’s chronic care management program during each calendar month. This will primarily entail periodic telephonic outreach calls to members, caregivers, and other care team members as directed with documentation in the appropriate platform to ensure compliance. The Medical Assistant will collaborate with the supervising provider and staff to conduct outreach, assessment and service planning to coordinate care for the CCM patients.

The ideal teammate would be able to:

Conduct patient interviews and create accurate, comprehensive medication lists
Coordinate clinical service visits between pharmacists and members and/or caretakers
Provide practice support including: contacting members, caregivers, and care team members as directed, work closely with the clinical team to improve the health and care of our members
Coordinate care for members of the program
Enter data within operating dashboards, reporting and workflow platforms
Ensure call resolution by discussing purpose of call, effectively address all concerns, and escalate calls as necessary according to protocol
Manage challenging member and/or caretaker situations and be able to respond promptly to member needs and service requests
Embrace a continuous quality improvement approach by proactively identifying areas of improvement and communicating those ideas to the clinical services team
Participate in other activities as assigned

Would you describe yourself as someone who has:

A current Medical Assistant (CMA) certification (required)
Fluency in English and Spanish (writing, reading and speaking) (required)
At least two years of experience as a medical assistant with at least 1 year experience as a medication reconciliation medical assistant (required)
The ability to work Monday – Friday, 9:00 am – 6:00 pm EST and rotating holiday shifts (required)
Knowledge and understanding of chronic care management processes (required)
Comfort using technology like Google Workspace, multiple EMRs, Slack (required)
Worked with multiple platforms to provide a seamless experience for the patient (required)
The ability to be focused and productive while working from home with a private area in their home/workspace with a reliable internet connection (required)
A positive attitude and genuinely enjoys talking to patients
Demonstrated ability to work effectively as a member of an interdisciplinary team, displaying good judgment and decision-making skills
The ability to perform duties as assigned or requested

In addition to amazing teammates, we also offer:

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

Pay rate is $22-23 hourly. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

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

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

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

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

Orthopaedic Medical Coding Specialist II

Surgical Notes Remote.co10 days ago

Apply Now10 days ago

location: remoteus

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Orthopaedic Medical Coding Specialist II

at Surgical Notes

Remote, United States

Surgical Notes is hiring for aOrthopaedicMedical Coding Specialist IIto provide accurate and timely coding for our ambulatory surgical clients. The ideal candidate has excellent organizational skills, communication skills, with the desire and ability to learn quickly. Working as a part of the team to meet deadlines, but also being able to work independently is crucial to the success in this position. Our organization prides itself on being built upon a set of strong core values. We are looking for candidate who will actively exhibit these core values: Service Excellence, Transparency, Teamwork, Accountability, Hardwork, and Positive Attitude.

External Title:ASC Medical Coding Specialist II

Internal Title:US Coding Inidual Contributor II

Reports to:Manager, Coding

Responsibilities:

Review operative reports to abstract information and apply CPT, HCPCS, and ICD-10-CM codes
Provide coding for all Level 2 and some Level 3 procedures (ASC) as well as Level 1 as needed
Perform coding for pro fee surgical encounters
Verify LCD/NCD information as appropriate
Utilize NCCI edits, AMA CPT Assistant, AHA Coding Clinic, and other resources as needed
Initiate physician queries as needed
Escalate coding/documentation problems when appropriate
Participate in ongoing coding education
Perform other related duties as required/assigned

Role Information:

Full-Time or Part-Time
Hourly
Non-Exempt
Eligible for Benefitsif Full-Time
Quarterly Bonus (based on quality and productivity)
Remote: The minimum bandwidth requirements are 10 Mbps upload and 50 Mbps download speeds. The recommended bandwidth requirements are 20 Mbps upload and 100 Mbps download speeds.

Job Requirements:

Required Knowledge, Skills, Abilities & Education:

High School Diploma or equivalent
Coding certification through AAPC or AHIMA (CPC, COC, RHIT, CCS, etc., no apprentice designation)
2 years outpatient surgical coding
2 years of Ambulatory Surgical Center coding experience
Extensive knowledge of medical terminology, anatomy and physiology
Ability to work independently and as part of a team
Flexibility to assume new tasks or assignments as needed
Strong attention to detail and speed while working within tight deadlines
Exceptional ability to follow oral and written instructions
A high degree of flexibility and professionalism
Excellent organizational skills
Outstanding communications skills; both verbal and written

Preferred Knowledge, Skills, Abilities & Education:

Associate Degree in healthcare related field
Experience working in an/Ambulatory Surgery Center (ASC)
Strong Microsoft Office skills in Excel, Outlook, and Teams

Physical Demands:

Sitting and typing for an extended period of time
Reading from a computer screen for an extended period of time
Speaking and listening on a telephone
Working independently
Frequent use of a computer and other office equipment
Work environment of a traditional fast-paced and deadline-oriented office

Key Competencies:

Job Knowledge/Technical Knowledge
Productivity
Initiative/Execution
Flexibility
Quality Control

US Pay Ranges

$21$28 USD

About Surgical Notes

Surgical Notes is the premier ASC revenue cycle management and billing services partner. Our expert teams with ASC-specific experience provide scalable billing, transcription, coding, and document management services and solutions that fully integrate with all leading ASC practice management systems. The largest management companies and hundreds of ASCs that partner with Surgical Notes experience and benefit from immediate operational and financial improvements that exceed industry performance levels.

Surgical Notes is an equal opportunity employer. We celebrate ersity and are committed to creating an inclusive environment for all employees.

Clinical Administrative Coordinator

ApolloMed Remote.co11 days ago

Apply Now11 days ago

californialocation: remoteus monterey park

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Clinical Administrative Coordinator

QualityRemote, United States

Description

Job Title: Clinical Administrative Coordinator (REMOTE)

Department: Quality Clinical Operations

About the Role:

We are looking for a Clinical Administrative Coordinator to join a team that is passionate about the health of our patients. As part of the Quality Department, the Clinical Operations team leads the effort to improve health outcomes by coordinating and delivering key clinical care. Through outreach and education, we inspire patients to take a preventive approach to maintaining their health and to be active in their management of chronic diseases. Together, we strive to achieve healthy living for all through all stages of life.

As a Clinical Administrative Coordinator, you will support the operations of the Quality Clinical Operations team. Your role helps carry out the clerical duties of our various programs. Your assignments help us to not only better serve our members, but also provide Primary Care Providers with timely updates regarding the services their patients have received. You may also be asked to carry out other duties in support of department programs and goals.

What Youll Do:

Send reports and notes to providers, and confirm receipt
Upload and download medical records
Receive incoming calls, emails, and faxes
Input patient information accurately into electronic health record system
Call patients to remind them of their appointment date and time
Follow up with patients who missed their appointments
Assist patients with health questionnaires
Prepare screening kits
Oversee inventory of office and medical supplies
If applicable, provide translation assistance in department programs
Uses, protects, and discloses our companys patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Other duties may be assigned

Qualifications:

Associates Degree
At least one year of experience in a clerical or administrative role
Experience using Microsoft applications such as Word, Excel, and Outlook
Must have respect for confidentiality
Must have ability to plan, prioritize, and complete tasks

Youre great for the role if:

Experience in clinical/medical settings
Experience using EHR systems
Basic understanding of medical conditions and specialties
Speak Chinese and/or Spanish and/or Vietnamese (not required)

Who We Are:

Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

Our platform currently empowers over 10,000 physicians to provide care for ~1 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

Our Values:

Put Patients First
Empower Entrepreneurial Provider and Care Teams
Operate with Integrity & Excellence
Be Innovative
Work As One Team

Environmental Job Requirements and Working Conditions:

This is a REMOTE position with occasional requirement to report to the office as needed. The office is located at 568 W. Garvey Ave, Monterey Park, CA 91754.
The total compensation target pay range for this role is: $17-20 per hour. The salary range represents our national target range for this role.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an inidual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us [email protected] request an accommodation.

Additional Information:

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Psychiatric Mental Health Nurse Practitioner

Cerebral Care Remote.co11 days ago

Apply Now11 days ago

location: remoteus

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Title: Psychiatric Mental Health Nurse Practitioner (1099 Contractor) – Illinois

Location: Remote (United States)

Job Description:

Our Company:

82% of clientsreport an improvement in their anxiety symptoms after using Cerebral.
75% of clientswho report improvement in their depression see improvement within 60 days.
50% of clientswho initially report suicidal ideation no longer harbor suicidal thoughts after treatment with Cerebral.

The Role:

We are looking for clinicians with state licenses from the following states: California and/or Illinois

This is a 1099 contract position offering up to 25 hours per week based on availability. Full practice and full prescriptive authority is required for Illinois.

Who you are:

You are PMHNP licensed and in good standing
Board certification (AANP or ANCC)
Minimum of a Master’s degree in nursing, specializing in psychiatric mental health
Comfortable assessing and formulating evidence-based treatment plans for clients with mental illness
Maintain a strong evidence-based clinical skill set while practicing & implementing outcome-focused care within the clinical coverage team
Empathetic and intuitive listening
Strong verbal and written communication
Knowledgeable in crisis response
Comfortable working autonomously in a telemedicine environment
Tech-savvy with the ability to navigate various systems & tools with ease (this includes, but is not limited to Google Workspace, proprietary EMR, etc.)
Passionate about our mission of improving access to high-quality mental health care
An entrepreneurial spirit or previous experience within a startup or fast-paced environment is preferred

How your skills and passion will come to life at Cerebral:

Hold thoughtful and engaged sessions with clients; 30 minute initial sessions and 15 minute follow up sessions
Maintain and provide direct care to a panel of clients
You will work collaboratively with other mental health care partners at Cerebral to ensure the most beneficial level of evidence-based treatment plans for our clients
Work alongside other like-minded clinicians that have a common goal to positively impact the lives of others, and create an environment that leads to favorable outcomes for clients

What we offer:

Mission-driven impact:
- Shape the future of the #1 largest and fastest growing online mental health care company in the world
- Build a platform that is improving the lives and well-being of hundreds of thousands of people
- Join a community of high achievers who have a passion for promoting mental health
Path to develop & grow:
- Readily available psychiatrists and clinician leadership for case consultations to ensure you always receive the support you need
- Access to innovative technology to support you in delivering the highest quality of care to your clients
- Access to UpToDate for continued education (free CEU offering)
Remote-first model:
- Flexibility to choose the hours and schedule that work best for you
- Work virtually from anywhere in the United States
Culture & connectivity:
- Highly-responsive and supportive team of clinical and operational management
- Decreased administrative time for clinicians through ongoing technology improvements and automations
- Fully integrated, data-enabled EMR with embedded clinical decision support, monthly prescriber metric reports, and task management system
- Opportunity to participate in strategic development initiatives to improve our clinical quality and safety and/or clinical processes across the organization

Who we are (our company values):

Client-first Focus– relentless focus on advancing the quality of care, clinical experience, and patient safety
Ethics & Integrity– do what is right and demonstrate ethical principles, even when no one is watching
Commitment– accountable for fully delivering on commitments to our clients and each other
Impact & Quality– make a positive impact and deliver high quality outcomes, based on data and evidence
Empathy– act compassionately, listen to seek understanding, and cultivate psychological safety with clients and colleagues
Collaboration– achieve our goals together as a united team, strengthened by mutual openness, trust, and ersity of thought
Thoughtful Innovation– continuously evolve our ability to deliver on our mission, prioritizing long-term, strategic bets over short-term gains

ENT/Plastics Physician Coder

Guidehouse Remote.co13 days ago

Apply Now13 days ago

location: remoteus

Apply Now

ENT/Plastics Physician Coder

locations

US – Remote (Any location)

time type

Full time

job requisition id

17351

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Do:

Responsible for the management of health information systems consistent with the medical, administrative, ethical and legal requirements of the health care delivery system. Which may also include monitoring data imports, providing basic system maintenance, documentation of workflow, training and data research. Oversees the maintenance of medical records and the coding of data from medical records.
Participates in the preparation of reports, provides information and prepares correspondence regarding patient admissions, treatment, discharges and deaths in accordance with departmental policies and legal requirements governing the release of medical information.
Works collaboratively with providers, other health care professionals and coding team to ensure that clinical information in the medical record is present and accurate so that the appropriate utilization, clinical severity, outcomes and quality is captured for the level of service rendered to each patient, as well as ensuring compliant reimbursement of patient care services.

What You Will Need:

High school diploma and 1-3 years of ENT with Plastics experience in surgical coding
AAPC Certification CPC

What Would Be Nice To Have:

Multi-specialty Surgical Coding experience

The annual salary range for this position is $32,600.00-$48,800.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

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

Benefits include:

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

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Faculty Nursing (FNP) Online

Herzing University Remote.co13 days ago

Apply Now13 days ago

location: remoteus

Apply Now

Faculty Nursing (FNP) Online

Job Category: Academics

Requisition Number: FACUL002338

Posting Details

Full-Time
Locations
Showing 1 location

Remote

Job Details

Description

If you are a current employee, faculty or adjunct instructor at Herzing University (not a Contractor or temporary employee through a staffing agency), please click here to log in to UKG and then navigate to Menu > Myself > My Company > View Opportunities to apply using the internal application process.

Herzing University is currently accepting applications forFull-Time Nursing Faculty(FNP)opportunities for ourOnlineProgram. Nursing Faculty will teach primarily for the FNP program with other nursing undergraduate and graduate teaching responsibilities as needed.

These career focused programs strive to bridge the gap between the theory and practice. Your role will be to prepare your students for a career in nursing by leading them through classes, labs, and real-life clinical settings. For this reason, we are looking for professional nurses who can translate their background, education, and rich experience into an engaging learning environment.

To participate in a remote work arrangement, employees must reside in the United States. No remote work arrangement will be considered for working from outside the United States.

Qualified applicants will be able to demonstrate the following:

Currently hold WI or Compact RN license
Master of Science in Nursing, with a PhD, DNP, or Doctorate in Education or related Healthcare field
Hold an FNP certification
Minimum of 2 years of experience in online nursing education

Preferred:

Minimum of 2 years of experience teaching in a graduate nursing program
Experience with Canvas as a learning management system a plus

Summary of Primary Responsibilities

A full job description will be provided during the interview process when you can discuss what this specific role will be, but the position’s responsibilities fall into eight basic areas.

Subject Matter Expertise
Effective Communication
Pedagogical Mastery
Operational Excellence
Appreciation and Promotion of Diversity
Assessment of Student Learning
Utilization of Technology to Enhance Teaching and Learning
Continuous Improvement

These competencies, as identified by the Universitys academic community encompass the knowledge, skills, and behaviors essential to a faculty members success in the classroom and provide the basis for the faculty hiring, evaluation and development process.

To learn more about Herzing University and our values, visit us at:https://www.youtube.com/watch?v=FusbVnks_YQ

We offer a comprehensive benefits package including outstanding education assistance programs.

Herzing University is committed to providing a erse environment and is dedicated to fostering a culture and atmosphere of mutual respect.It provides an inclusive and collegial community where iniduals are valued, heard and empowered to contribute to the effectiveness of the institution.

It is the universitys practice to recruit and hire without discrimination because of skin color, gender, religion, LGBTQi2+ status, disability status, age, national origin, veteran status, or any other status protected by law.

Director, Professional Coding & Education

Boston Medical Center Remote.co15 days ago

Apply Now15 days ago

location: remoteus

Apply Now

Director, Professional Coding & Education

Remote

Full time

job requisition id 34503

The Director of Professional Coding and Education is responsible for the direction and leadership of operational, financial, programmatic, educational, workforce management, for Professional Coding. This includes establishing, meeting and continuously monitoring the goals and objectives while maintaining alignment with the strategic goals and objectives for BMCHS. While the range of duties and responsibilities is broad and varied, the position includes directing the day-to-day operations, budgeting, financial management, and human resource management. The Director works closely with a variety of stakeholders, coordinating the activities of Professional Coding across the enterprise.

Position: Director, Professional Coding Operations & Education

Department: HIM/ Revenue Cycle

Schedule: Full Time

POSITION SUMMARY:

The Director of Professional Coding and Education is responsible for providing coding oversight and creating standards to ensure coding accuracy, compliance and appropriate reimbursement across BUMG, along with managing operational execution of these standards in areas reporting to Revenue Cycle. The Director has responsibility for managing coding operations and overall success of an effective program, including oversight for coding training across BUMG. The Director manages coding staff to ensure compliance with coding guidelines, regulatory agencies and that appropriate reimbursement is received for the level of service rendered. The Director is responsible for a erse, growing department, requiring skills in data-driven decision-making, project and portfolio management, system redesign, process improvement/lean management, and customer relationship management. This position requires a deep knowledge of industry best practices in technology and workflow. The Director will use these skills and experience to partner with physicians, department chairs, department administrators, and other clinical and non-clinical operational stakeholders in a highly complex and decentralized professional coding model, to develop an organization-level roadmap of process and technology improvements to maximize patient and provider experience from a coding perspective, while increasing efficiency.

JOB REQUIREMENTS

EDUCATION:

Minimum: Bachelors Degree in a health-related field. Four (4) years of relevant experience may be considered in lieu of degree in addition to the experience below.

Preferred: Bachelors Degree in Health Information Management

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

Minimum: Certified Professional Coder (CPC) or Certified Coding Specialist Professional CCS-P)

Preferred: RHIT, RHIA

EXPERIENCE:

Minimum: of 4 years related experience in professional coding with ICD-9/ICD-10, E/M and CPT. 3 years management experience in Medical Coding medium or large health care facility.

Preferred: 3 years management experience with an academic medical center

KNOWLEDGE AND SKILLS:

Expertise knowledge of ICD-9/ICD-10, CPT and E&M coding principals and guidelines
Knowledge of MS, AP, and APR DRG systems APG, EAPGs
Knowledge of payer reimbursement methodologies, federal, state and payer specific regulations, policies and compliance standards
Excellent written verbal and communication skills
Excellent critical thinking skills
Excellent skill in providing hands-on education to providers including audit finding and improvement opportunities.
Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
Ability to work cooperatively with members of the healthcare delivery team and staff,
Ability to adapt to changes in workload and priorities, responding quickly to urgent requests.
Ability to mentor, guide and motivate direct reports through demonstration of best practices and leading by example.
Excellent communication and interpersonal skills to include the ability to negotiate and resolve conflicts and build teams.
Demonstrated creativity and flexibility.
Ability to operate in high-pressure situations.
Excellent organizational skills.
Demonstrated innovative approach to problem resolution.
Ability to work collaboratively across BMCHS entities and disciplines.
Demonstrated commitment to patient- and family centered care.
Broad knowledge of modern health care administration practices and principles within a managed care environment and/or an academic medical center.
Effective analytical ability in order to develop and analyze options, recommend solutions to and solve complex problems and issues.
Demonstrated effective managerial and administrative leadership of clinical operations
Knowledge of principles and techniques used in negotiation as applied to service contracts and equipment purchasing.
Effective organizational, planning and project management abilities.
Experience in financial and programmatic presentations.
Ability to function independently and deal with multiple, simultaneous projects.

ESSENTIAL RESPONSIBILITIES / DUTIES:

Administrative Leader

Contribute to the success of BMCHS by providing leadership, direction and coordination of operations, finances, and human resources for Professional Coding
Manage and direct all Professional Coding activities within areas of responsibility.
Continually assesses all services, identifies problems, utilizes data to analyze and propose innovative approaches for solutions.
Maintain records related to operations and services that are complete, accurate, available, and in compliance with all legal, regulatory, and policy requirements.
Engages staff and other stakeholders in continuous improvement of systems and processes; manages resources for staff participation in improvement work activities.
Ensures effective facilitation of improvement teams and development of leadership skills to ensure overall effectiveness of the meetings.
Organizes and prioritizes time and resources to manage efficiency and appropriately delegates.
Remains current of new trends and best practices and incorporates into Professional Coding practices and programs.
Articulates and enforces standards for quality/productivity
Identify trends in documentation and coding concerns and collaborate with Leadership and Compliance to assess and implement corrective action
Demonstrates achievable and measurable results and develop action plans for improvement
Initiates, monitors, and enforces regulatory requirements
Holds self and others accountable to policy, standards and commitments and provides timely follow through on questions and concerns.
Ensures development Professional Coding initiatives to improve patient satisfaction and family centered care.
Develops and implements clinical outcome measures for quality improvement Incorporates the use of evidence-based practice and appreciative enquiry into program development and improvement activities
Actively listens to staff ideas and concerns, assesses others communication styles and adapts to them.
Effectively facilitates meetings within Coding, CDI, and Revenue Cycle Operations and organizational level.
Creates bi-directional systems that effectively communicate information and data, utilizing multiple methods.
Articulates and presents data, information, and ideas in a clear and concise manner.
Participate in rejections, denials and claims review process with billing team to ensure compliance and accurate reimbursement
Communicates with physicians, academic department leaders, and senior administrators to maintain coordination with BMCHS programs.
Demonstrates empathy and concern while ensuring goals are met.
Manages the complex interdepartmental and interdisciplinary relationships to assure collaboration and effective/efficient operations within Coding and Revenue Cycle.
Creates an environment that encourages erse opinion, recognizes differences, and incorporates into process and services.
Exhibits awareness of personal attitudes and beliefs, recognizing its effect on response to others.
Creates a culture and systems for recognizing and rewarding staff

Resource Manager

Creates and maintains a satisfying workplace that fosters professional growth and job satisfaction for all members of the healthcare team.
Interviews to select top talent, matching Professional Coding Operations needs with appropriate skill sets.
Develops and implements recruitment and retention strategies that support a culture of leadership.
Identifies and addresses own professional growth needs.
Assesses manager and staff development needs, identifies goals and provides resources.
Identifies lack of competency in performance and establishes a plan which includes goals, interventions, and measures.
Maintains membership in professional organization(s) to develop knowledge and resources through networking, continuing education, and participation in national, regional, and/or local activities.
Ensures integration of ethical standards and core values into everyday work activities.

Educator/Research Facilitator

Facilitate accurate representation ofprofessional coding and clinical documentation through interaction with physicians, coders and practice staff by providing ongoing education
Contributes to a learning environment by providing educational opportunities to staff, cross-functional departments, students, residents, fellows, and faculty.

Critical Interfaces

Leads and/or serves on a variety of appropriate internal and external committees to represent the Professional Coding

Departmental Leader

Must adhere to all of BMCs RESPECT behavioral standards.
Interprets impact of broad scope organizational change for staff and develops change strategies for successful implementation.
Models Respect for People commitments through all interactions.
Leverages Leadership Competencies to develop themselves and others
Develops and manages operational initiatives with measurable outcomes.
Formulates objectives, goals and strategies collaboratively with other stakeholders.
Prepares and delivers reports to operational leadership outlining progress toward meeting annual goals and objectives, to include performance related to finance, clinical activity, quality, and human resources. IND123

Equal Opportunity Employer/Disabled/Veterans

PAC Nurse

CareCentrix Remote.co15 days ago

Apply Now15 days ago

location: remoteus

Apply Now

PAC Nurse

Remote

Min

USD $28.85/Hr.

Max

USD $38.46/Hr.

Overview

ThePAC Nurseis a telephonic position responsible for managing the length of stay (LOS) for Long Term Acute Hospital (LTACH), Skilled Nursing Facility (SNF), and Institutional Rehab Facility (IRF) for their assigned post-acute care facilities through collaborationPAC Nursewill also collaborate with key facility personnel as well as with CareCentrix internal Medical Directors, Market Engagement Directors and Nurse Managers to develop and maintain a timely discharge plan.

Responsibilities

In this role, you will:

For assigned post-acute facilities:
- Establish scheduled telephonic touch points with each facility point person to review each member within that facility and confirm appropriateness for continued stay.
- Authorize continued stay at SNF, IRF, LTACH and Home Health care (if delegated) using approved medical care guidelines and collaboration with key facility personnel within the healthcare setting.
- Use clinical expertise, review clinical information and clinical criteria to determine if the service/device meets medical necessity for the member.
- Ensure case review and elevation to complete the determination is rendered within the contractual and regulatory turnaround time standards to meet both contractual and regulatory requirements.
Interact with the PAC Medical Director as needed to ensure proper medical necessity decisions are being rendered. Partner closely with the PAC Medical Director in care planning and goal setting, reviewing discharge plans and length of stay status to ensure optimal outcomes.
Act as a clinical resource for unlicensed Post-Acute Care Coordinators, providing clinical expertise and helping to clarify referral source directives. Receive/respond to requests from unlicensed staff regarding scripted clinical questions and issues.
Act as the primary contact to the post-acute facility or facilities to which they are assigned to obtain all clinical information required and to proactively obtain patient status updates.
Through the Supervisor, work closely with Market Engagement Directors to efficiently address potential facility concerns, pushback or gaps in process.
Communicate customer service/provider issues to supervisor for logging and resolution.

Support the following additional duties as requested:

- - - - Participate in performance and operational improvement activities.
      - Participate in and contribute to ongoing quality assessment/improvement activities, ensures the collection of data for improvement analysis and prepares reports as requested.
      - Assist team in implementing and maintaining standardized operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.
      - Participate in special projects and performs other duties as assigned.
      - Participate in an annual Inter-rater reliability Testing Process.
      - Schedule options vary with this role based on business needs, currently we need nurses willing to work weekend schedules.

Qualifications

You should reach out if:

You hold a current and unrestricted license as a Licensed Practical Nurse or Registered Nurse
You have Associate’s Degree or Diploma in Nursing/Practical Nursing or the equivalent
You possess a minimum of 2 years clinical experience in a clinical setting
You are an expert in Utilization Management and knowledge of URAC & NCQA standards
You have a broad knowledge of health care delivery/managed care regulations and experience with evidence based care guidelines (i.e. MCG/Milliman, InterQual)
You have excellent negotiation, influencing, problem solving and decision making skills required
You possess organizational skills and are able to effectively manage and prioritize tasks
You can work independently, utilizing sound clinical judgment and critical thinking skills under minimal supervision
You must have a strong commitment to quality and standards

What we offer:

Salary Range: $32.00 – $36.00 / hour plus Annual Corporate Bonus incentive
Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match
Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more
Advancement Opportunities, professional skills training, and tuition /exam reimbursement
PayActiv – access earned income in between pay checks
Walgreens Discount – receive up to 25% off eligible items
Great culture with a sense of community

CareCentrix maintains a drug-free workplace

Risk Adjustment Coder

Cityblock Health Remote.co18 days ago

Apply Now18 days ago

location: remoteus

Apply Now

(TEMP) Risk Adjustment Coder

at Cityblock Health

Remote, USA

#communityhealth #healthcare

About Us:

Cityblock Health is the first tech-driven provider for communities with complex needsbringing better care to where its needed most, block by block. Founded in 2017 on the premise that health is local and based in Brooklyn, we are backed by Alphabets Sidewalk Labs along with some of the top healthcare investors in the country.

Our mission is to improve the health of underserved communities. Importantly, our solutions are designed specifically for Medicaid and lower-income Medicare beneficiaries, and we meet our members where they are, bringing care into the home and neighborhoods through our community-based care teams and Virtual Care offerings.

In close collaboration with community-based organizations, local providers, and leading health plans, we are reorganizing the health system to focus on what matters to our members. Equipped with world-class, custom care delivery technology, we deliver personalized primary care, behavioral health, and social services to deliver a radically better experience of care for every member and community we serve.

Over the next year, well grow quickly to bring better care to many more members and their communities. To do this, we need people who, like us, believe thateveryoneshould have good care for what matters to them, in their community.

Our work is grounded in a belief in the power of a erse community. To close gaps in care and advance equity in the communities we serve, we have to start with making our own team erse and inclusive. Our ways of working are characterized by creativity, collaboration, and mutual learning that comes from bringing together a community from erse backgrounds and perspectives. We strive to ensure that every person on the Cityblock team, and every Cityblock member, feels supported and included as a part of our community.

Our Values:

Aim for Understanding
Be All In
Bring Your Whole Self
Lean Into Discomfort
Put Members First

About the Role:

As the Risk Adjustment Coding Specialist, you will play a critical role in creating a culture of best-in-class clinical documentation accuracy in support of building a model of care focused on quality and health outcomes. You will work closely with our Value Services, Clinical, and Compliance teams to leverage your clinical, coding, and documentation expertise to foster improvements in the overall quality, completeness, and compliance of clinical documentation.The role is a temporary role lasting approximately 4-5 months.

Serve as the subject matter expert on Medicare HCC documentation requirements and ICD-10-CM coding guidelines
Maintain professional communication with provider teams
Ensure adherence to Cityblocks coding guidelines and any necessary updates are shared across the teams.
Develop a foundational understanding of the coding tool and processes to assign proper Risk Adjustment codes.
Comply with all legal requirements regarding coding procedures and practices

Requirements for the Role:

2+ years of Risk Adjustment (HCC) coding experience required
AAPC or AHIMA certified coder a must (i.e. CPC, CCS, etc.)
Strong knowledge of medical terminology, physiology, pharmacology, and disease processes and related procedures
Ability to follow ICD-10 CM, Coding Clinic, internal coding guidelines and documentation for CBH aligned beneficiaries
Knowledge of risk adjustment (HCCs), guiding principles, and reimbursement methodology
Ability to flourish in fast-paced environments, work independently, and can identify inidual opportunities for success
Excellent attention to detail, data-driven, and tech-savvy
Demonstrates excellent written and verbal communication and critical thinking skills
Strong ability to effectively build relationships and collaborate with coworkers and clinicians
Strong technical skills using Google Workspace including Google Meets, Google Sheets, Google Docs as well as Slack communication platform

What Wed Like From You:

A resume and/or LinkedIn profile

Cityblock values ersity as a core tenet of the work we do and the populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

We do not accept unsolicited resumes from outside recruiters/placement agencies. Cityblock will not pay fees associated with resumes presented through unsolicited means.

We take into account an iniduals qualifications, skillset, and experience in determining final salary.This role is eligible for sick leave.The expected salary range for this position is$31.88/hr to$37.88/hr. The actual offer will be at the companys sole discretion and determined by relevant business considerations, including the final candidates qualifications, years of experience, skillset, and geographic location.

Medical Clearance (for Member-Facing Roles):

You must complete Cityblocks medical clearance requirements, which include, but may not be limited to, evidence of immunity to MMR, Hepatitis B, Varicella, and a TB screen, or have an approved medical or religious accommodation that precludes you from being vaccinated against these diseases.

Covid 19 Update – Please Read:

Cityblock requires those hired into this position to provide proof that they have received the COVID-19 vaccine. Any iniduals subject to this requirement may submit for consideration a request to be exempted from the requirement (based on a valid religious or medical reason) on forms to be provided by Cityblock. Such requests will be subject to review and approval by the Company, and exemptions will be granted only if the Company can provide a reasonable accommodation in relation to the requested exemption. Note that approvals for reasonable accommodations are reviewed and approved on a case-by-case basis and availability of a reasonable accommodation is not guaranteed. This vaccination requirement is based, in part, on recently established government requirements. The requirement is also based on the safety and effectiveness of the vaccine in protecting against COVID-19, and our shared responsibility for the health and safety of members, colleagues, and community.

The COVID-19 pandemic has severely impacted the health and lives of people around the world, including the vulnerable populations Cityblock serves. As a healthcare provider, Cityblock holds ourselves to the highest standards when promoting the health and safety of those who we serve. Given that the COVID-19 vaccines are one of the most powerful tools to fight this disease and save lives, Cityblock is implementing a COVID-19 booster mandate for Washington, D.C. employees under the guidance of local/state mandates.

Nurse Case Manager - RN

Acentra Health Remote.co18 days ago

Apply Now18 days ago

location: remoteus

Apply Now

Title: Nurse Case Manager – RN (Remote U.S.)

Location: Remote Remote US

JobDescription:

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

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

Acentra seeks a Nurse Case Manager RN (Remote U.S.) to join our growing team.

** Contractually Required Work Hours: Monday – Friday 8:00 AM to 5:00 PM Pacific. **

** This is a full-time, direct hire, exempt (salary), remote-based opportunity with Benefits. **

Job Summary:

The Nurse Case Manager RN:

Utilizes clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and decision-making skills to determine medical appropriateness while maintaining production goals and QA standards.
Ensures day-to-day processes are conducted in accordance with NCQA, URAC, and other regulatory standards.

Job Responsibilities:

Contacts and performs initial interviews with patients who need health coaching programs.
Provides necessary coaching to reduce or eliminate behaviors that are considered high-risk.
Identifies the required goals that each patient must fulfill and advises of feasible options for achieving the goals.
Educates members on health issues/concerns and the way in which one could combat them.
Utilizes appropriate motivational interviewing techniques necessary for coaching and assisting the patient to complete a self-management goal/action plan.
Maintains current knowledge regarding CHF, HTN, COPD, asthma, and diabetes, as well as related treatments and complex medications.
Performs ongoing reassessment of the review process to offer opportunities for improvement and/or change.
Conducts clinic one-on-one visits with Disease Management Chronic Care Program participants, utilizing the Chronic Care Model, to assess patient needs for DME, home health, value-added services, and any other necessary resources.
Fosters positive and professional relationships and acts as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
Always maintains medical records confidentiality through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies.
Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following Acentra Health policies, procedures, and guidelines.
Actively cross-trains to perform duties of other contracts within the Acentra Health network to provide a flexible workforce to meet client/consumer needs.

The above list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

Requirements

Required Qualifications/Experience:

Active unrestricted RN Oregon State clinical license per contract requirements.
Graduation from an accredited Bachelors Degree Nursing Program.
1+ years of clinical experience in an acute or med-surgical environment.
1+ years of case management and/or disease management experience.
Medical record abstracting skills.
Knowledge of the organization of medical records, medical terminology, and disease process.
Excellent communication, problem-solving, and decision-making skills.
Ability to effectively manage and prioritize tasks.
Ability to work in a team environment.
Flexibility and strong organizational skills.
Must be proficient in Microsoft Office and Internet/web navigation.

Preferred Qualifications/Experience:

Case Management Certification (CCM).
Knowledge of current National Committee for Quality Assurance (NCQA)/Utilization Review Accreditation Commission (URAC) standards.
Utilization Review (UR) and/or Prior Authorization or related experience.
Knowledge of InterQual criteria.
Familiarity with ancillary services, including HHC, SNF, Hospice, etc.
Experience in managing complex or catastrophic health cases.
Experience helping iniduals change health behaviors.
Working toward or completion of CCM/CCP/CDE certification or Advanced degree.

Why us?

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

We do this through our people.

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

Thank You!

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

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra.com/careers/

EOE AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.

Benefits

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

Compensation

The pay range for this position is $80,000-90,000 annually.

Based on our compensation philosophy, an applicants placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.

Supv, Ins Billing Order Entry

Natera Remote.co19 days ago

Apply Now19 days ago

location: remoteus

Apply Now

Supv, Ins Billing Order Entry

Remote

Position Summary:

Supervising Prior Authorization Specialists in a high production and quality environment.

Job Responsibilities:

Supervise PA Coordinators.

Train, develop, and coach Prior Authorization specialists

Provide daily operational work planning and organization to ensure operational efficiency and effectiveness of the department .

Demonstrate expertise in researching and trouble-shooting issues that arise and provides assistance to prior authorization specialists to resolve issues.

Ensure staff handle submissions per specified payor guidelines and follow up with payors for timely and accurate processing.

Evaluate performance and address performance issues of prior authorization specialists.

Participate in the identification and execution of operational performance improvement opportunities and activities.

Assist in developing reports and conduct analysis to help improve processes to meet provider and regulatory requirements.

Collaborate with our Quality team to improve process and insure compliance of company and regulatory requirements;

San Carlos, CA

$63,800$7,970,000 USD

OUR OPPORTUNITY

WHAT WE OFFER

For more information, visitwww.natera.com.

If you are based in California, we encourage you to read this important information for California residents.

Link:https://www.natera.com/notice-of-data-collection-california-residents/

For more information:

-BBB announcement on job scams

-FBI Cyber Crime resource page

Lead Coding Specialist

Baptist Health South Florida Remote.co20 days ago

Apply Now20 days ago

location: remoteus

Apply Now

Lead Coding Specialist, Health Information Management, FT, 08A-4:30P-141254

Baptist Health South Florida is the largest healthcare organization in the region, with 12 hospitals, more than 24,000 employees, 4,000 physicians and 100 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties. Baptist Healthhasinternationally renowned centers of excellencein cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. A not-for-profit organization supported by philanthropy and committed to its faith-based charitable mission of medical excellence,Baptist Health has been recognized by Fortune as one of the 100 Best Companies to Work For in America and by Ethisphere as one of the Worlds Most Ethical Companies.

Everything we do at Baptist Health, we do to the best of our ability. That includes supporting our team with extensive training programs, millions of dollars in tuition assistance, comprehensive benefits and more. Working within our award-winning culture means getting the respect and support you need to do your best work ever. Find out why were all in for helping you be your best.

Description

The position will serve as the primary support to the Coding Supervisor. Assist in the supervision of coding, abstracting and reimbursement supporting billing ensuring compliance along with efficient operations for all Baptist Health facilities. Ensures established goals and ICD-10-CM/PCS guidelines, CPT, and coding conventions are adhered to. Assist with monitoring reports and workflows identifying opportunities for improvement, work volume and distribution, reviewing and reconciling reports, providing coding training within the Coding Department and performing research on coding issues. Monitors coding personnel activities ensuring accurate and timely processing in accordance with state and federal regulations. Assist with monitoring reports and workflows identifying opportunities for improvement.

Qualifications

Degrees: Associate’s
Licenses & Certifications: AHIMA Certified Coding Specialist
Additional Qualifications: Prefer RHIA or RHIT or equivalent experience.
At least five years Inpatient or Outpatient Surgery, Ancillary and Emergency Room coding experience in a large healthcare institution required.
Excellent verbal and written communication skills with ability to communicate clearly with both internal and external customers, problem-solving and personnel management skills.
Knowledgeable in health information systems, database management, spreadsheet design, and computer technology.
Strong computer proficiency (MS Office Word, Excel and Outlook).
Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service.
Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices.

Job

Corporate

Primary Location

Remote

Organization

Corporate

Schedule

Full-time

EOE

Licensed Nurse Practitioner (NP)

Vesta Healthcare Remote.co20 days ago

Apply Now20 days ago

location: remoteus

Apply Now

Title: REMOTE Afternoon/Nights Licensed Nurse Practitioner (NP) – 3pm-11pm ET

Location: Remote

Job Description:

Nice to meet you, we’re Vesta Healthcare.

The ideal teammate would be able to:

Conduct video visits for chronic care management and remote patient monitoring to create an appropriate care plan for the member
Conduct care coordination and recommend/identify cost effective research based treatment and intervention
Utilize strong clinical skills in physical assessment and chronic disease management for at risk adults and apply member specific Care Management and inidualized care planning
Be comfortable with advanced care planning discussions with caregivers and members
Serve as a consulting resource on care management practice as needed
Attend meetings, training sessions and participates on committees as needed
Possess a strong knowledge of clinical procedures, standards and quality control checks
Possess a strong knowledge of medical conditions, interventions and treatment
Provide members, caregivers and facility education
Monitor the quality of member’s care and updates plan of care

Would you describe yourself as someone who has:

Certified and licensed as a Nurse Practitioner in good standing (required)
The ability to work Monday-Friday, 3pm-11pm ET (required)
Master’s or doctoral degree from an accredited institution for nurse practitioners (required)
Medicare participation and ability to have the company bill for services on your behalf (required)
Certification from ANCC (or equivalent) as an Adult, Family, Geriatric, and/or Acute Nurse practitioner (required)
1+ years of Nurse Practitioner Experience (required), qualified for independent practice in your licensed jurisdiction (preferred)
1+ years of telephonic triage or equivalent experience (required)
2+ years of clinical experience working with complex adult populations (required)
Ability to practice independently with little clinical support (required)
Comfort using technology like Google Suite, multiple EMRs, Slack (required)
The ability to work remotely and has a private area with a computer in their home/workspace (required)
Experience working in home care and/or family medicine, geriatrics (preferred)
Experience working within a clinical team environment
Strong organizational skills, including the ability to prioritize
Passionate about our mission to improve people’s lives
Comfortable in a dynamic and always evolving startup environment

In addition to amazing teammates, we also offer:

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

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

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

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.

Data Analyst, Risk Adjustment Coding

Datavant Remote.co22 days ago

Apply Now22 days ago

location: remoteus

Apply Now

Title: Data Analyst, Risk Adjustment Coding

Location: Remote, United States

JobDescription:

The Payer Solutions team is actively looking for a detail-oriented and passionate data scientist to become a valuable part of our expanding team. Our focus involves identifying and creating opportunities to expand risk adjustment and quality digital use cases while also assessing and quantifying our programs’ comprehensive efforts and effects on patient health status and revenue. If you are an experienced data analyst with deep understanding of Risk Adjustment data modeling, please consider applying for this role!

You will:

Analyze large datasets to identify trends, patterns, and insights about Coding reporting needs to enhance productivity and quality, and turn those needs into actionable reporting.
Provide real-time data insights to business on demand through ad-hoc queries
Collect, interpret, and aggregate data from multiple data sources for supporting risk adjustment medical record coding and quality processes
Design, develop, test, and deploy reporting to support risk adjustment business users needs
Look to automate a vast majority of reporting.
Identify trends in the reporting and work to partner with the teams to improve productivity and quality.
Run various risk adjustment models for Medicare Advantage, Medicaid or ACA to forecast patient risk scores and return on investment based on historical data and project variables.
Work closely with cross-functional teams, including clients, to understand business needs, and determine the right methodology for analysis and assumptions to provide data-driven insights into program performance and partnerships.
Create clear and concise reports to communicate findings and insights to both technical and non-technical stakeholders.
Stay abreast of industry trends, new technologies, and methodologies to enhance the team’s analytical capabilities.

What You Will Bring to the Table:

Experienced (3+ years or more) in data analysis, database technologies (Oracle/MS SQL Server), SQL queries, and MS Excel
Experience in risk adjustment (MA, ACA and MD) data analysis
Thorough understanding of risk models including HCC, RxHCC, HHS-HCC and CDPS
System architectural experience building end-to-end risk adjustment solutions and reporting packages
Experience analyzing risk adjustment data for trends, disease/diagnosis prevalence and hierachy
System architectural experience building end-to-end risk adjustment solutions and reporting packages
Experience managing data flows for chart retrieval, RA coding, Hedis abstraction and quality
Ability to build, architect and deliver robust customer facing reports and internal reports
Experience in building queries to collect and interpret raw data from databases to support risk adjustment coding and medical record
Ability to support major transformational program changes such as building new databases, supporting data governance in a cloud-based structure etc.
Experience in using business intelligence, data visualization, query, analytic and statistical software to build solutions, perform analysis and interpret data (SSRS, Power BI, Tableau)
Strong problem-solving skills with the ability to think critically and provide data-driven solutions.
Expertise in the data cleaning, preprocessing, manipulation, integration, processing and interrogation of large datasets.
Strong understanding of statistical probability distributions, bias, error, and power as well as sampling and resampling methods.
Exceptional initiative and ability to solve problems independently, seek help when needed, and take ownership when navigating ambiguity.
Excellent communication skills.
Well-developed time management skills and demonstrable experience of prioritizing work to meet tight deadlines for client deliverables.

Bonus points if:

An appreciation of the need for effective data privacy and security methods and an awareness of the relevant legislation.
Experience with cloud services for storage and computing.
Experience with machine learning algorithms.
Knowledgeable in health plan operations and reporting.

Nurse Practitioner - Telemedicine

Curai Health Remote.co22 days ago

Apply Now22 days ago

location: remoteus

Apply Now

Title: Nurse Practitioner – Telemedicine (W2, full time)

Location: Remote

Type: Full-Time

Workplace: remote

Category: Nurse Practioners

JobDescription:

Curai Health is an AI-powered virtual clinic on a mission to improve access to care at scale. As the pioneer in deploying machine learning into clinical workflows, Curai Health enables its dedicated, specially trained clinicians to deliver primary care to more people at a fraction of the cost. Easy-to-use and convenient, Curai Health partners with insurers and health systems to keep patients engaged in their care over time, improving health outcomes and reducing costs.

Our company is remote-first, and we consider candidates across the United States. Our corporate office is located in San Francisco. We will consider any candidates that are fully licensed Nurse Practitioners to practice in the United States and carry the required state licenses.

Clinical Operations at Curai

The clinical team at Curai uses Artificial intelligence-empowered electronic records to deliver urgent care and primary care to our patients. Currently, we are searching for Nurse Practitioners who can see both adult & pediatric patients. We operate 24/7 and seek flexible clinicians to meet our patients’ needs. We have day, night, and weekend shift opportunities available.

Who You Are

• Have worked remotely before, or have a strong feeling that you’d work well with a 100% remote team, spread across multiple time zones

• Value a team-based collaborative approach as it relates to providing healthcare

• Passionate about providing empathetic personalized patient care at the scale

• Have informed opinions that you hold lightly but are flexible to meet the needs of patients and the business

• Understand that flexibility and adaptability are key traits to being successful in a start up environment and change is inevitable

What You’ll Do

A day in the life of a Curai Nurse Practitioner is spent doing things like:

• Seeing acute/urgent care patients in our live text-based chat clinic including straightforward chronic care cases requiring refills.

• 90% clinical and 10% administrative tasks. Administrative time is broken down between clinical meetings, EHR/automation product feedback projects, and clinical operations quality improvement projects.

• Being responsible for accurately diagnosing patients using detailed patient history-taking and providing evidence-based treatment recommendations.

• Writing efficient encounter visit notes in a clear fashion that demonstrates strong medical decision-making skills, differential diagnoses, and a well-written and relevant care plan. Closing all notes optimally by the end of the encounter, and the latest by the last shift of the day.

• Providing feedback to the AI/ML and product teams on features that improve provider efficiency and accuracy.

• Staying abreast of EHR feature updates by continuously training and remaining current on the platform.

• Working closely with physicians in collaborative agreements for states that require it.

What You’ll Need

• Board certified in Family Nurse Practitioner (FNP)

• Prior telemedicine experience

• NP License in a compact state or you currently hold multiple state licenses (we will assist in licensing you up to all 50 states)

• You must also have a clear medical history (no nursing board actions or complaints).

• Completed an accredited Nurse Practitioner program in the United States.

• 5 years post NP training

• Digital savviness, excellent typing skills, excellent grammatical construction, and excellent command of English.

• Proficiency in English. Spanish fluency is an added plus.

• Start-up experience in healthcare is a plus.

• Pacific or Mountain Time zone is a plus

Salary is dependent on a scale based on years of experience, coverage of licenses, and work location. Thus, our annual base range is large at $110 – $180k.

Multi-State Full Time Nurse Practitioner

Vesta Healthcare Remote.co26 days ago

Apply Now26 days ago

location: remoteus

Apply Now

Title: Multi-State Full Time Nurse Practitioner

(NP)

Location: Remote

JobDescription:

Nice to meet you, we’re Vesta Healthcare.

The ideal teammate would be able to:

Conduct video visits for chronic care management and remote patient monitoring to create an appropriate care plan for the member
Conduct care coordination and recommend/identify cost effective research based treatment and intervention
Utilize strong clinical skills in physical assessment and chronic disease management for at risk adults and apply member specific Care Management and inidualized care planning
Be comfortable with advanced care planning discussions with caregivers and members
Serve as a consulting resource on care management practice as needed
Attend meetings, training sessions and participates on committees as needed
Possess a strong knowledge of clinical procedures, standards and quality control checks
Possess a strong knowledge of medical conditions, interventions and treatment
Provide members, caregivers and facility education
Monitor the quality of member’s care and updates plan of care

Would you describe yourself as someone who has:

Fluency in reading, writing, and speaking English AND Mandarin OR Cantonese
Certified and licensed as a Nurse Practitioner in good standing (required)
Master’s or doctoral degree from an accredited institution for nurse practitioners (required)
Medicare participation and ability to have the company bill for services on your behalf (required)
Certification from ANCC (or equivalent) as an Adult, Family, Geriatric, and/or Acute Nurse practitioner (required)
1+ years of Nurse Practitioner Experience (required), qualified for independent practice in your licensed jurisdiction (preferred)
1+ years of telephonic triage or equivalent experience (required)
2+ years of clinical experience working with complex adult populations (required)
Ability to practice independently with little clinical support (required)
Comfort using technology like Google Suite, multiple EMRs, Slack (required)
The ability to work remotely and has a private area with a computer in their home/workspace (required)
Experience working in home care and/or family medicine, geriatrics (preferred)
Experience working within a clinical team environment
Strong organizational skills, including the ability to prioritize
Passionate about our mission to improve people’s lives
Comfortable in a dynamic and always evolving startup environment

In addition to amazing teammates, we also offer:

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

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

Virtual Medical Assistant

Eden Health Remote.co26 days ago

Apply Now26 days ago

location: remoteus

Apply Now

Title: Virtual Medical Assistant

Location: Remote

Type: Full-time

Workplace: remote

Category: Virtual Care Operations

JobDescription:

About Eden Health Eden Health provides simple, tech-enabled primary care sold directly to employers. Our users enjoy immediate access to care over the Eden Health app, in our private clinics, and directly in their offices. We have transformed healthcare from an unpleasant necessity to a delightful experience focused on improving the lives of patients. The proof is in the outcomes; when companies work with us they have healthier workforces, increased productivity, and reduced healthcare costs. What you will do As a full-time Virtual Medical Assistant, you will play an essential role in our virtual day-to-day operations for our national virtual primary care practice. You will work closely with the clinical and operations teams, contributing to a meaningful workplace and clinical experience. Excellent candidates will exemplify a passion for delivering exceptional patient experiences, building trust, and having a “no task is too big or small” attitude. Our Virtual Care Team consists of Medical Assistants, Medical Providers, and Operational Leads. As a member of that Care Team, you will assist with virtual intake and rooming, care coordination, patient outreach, insurance navigation, and eligibility checks. This is a virtual only role based out of the East Coast with expected hours of availability being between 6am – 8pm EST. In this position you will report to the Director of Virtual Care Operations and work collaboratively with Medical Providers, virtual care teams, and other Medical Assistants. Be ready to adapt to and thrive in a fast-paced, innovative, tech forward environment that always puts the patient first!

What success looks like

Master the Eden Health care model and ecosystem, fostering strong and lasting patient relationships.
Adhere to and uphold Eden Health and Clinical Care standard operating procedures, workflows, and service philosophy. Maintain clinical etiquette, acumen, and professionalism.
Work collaboratively with peers, clinicians, and operations leadership to provide exceptional clinical, operational, and administrative longitudinal primary care
Maintain an interactive relationship with key stakeholders on the virtual clinical careteam
Creating a 5-star patient experience by conducting pre-, post-, peri-patient outreach, facilitating referrals, retrieving external medical records, following up with labs and patients on results, and maintaining an accurate and up-to-date EMR.
Consistently adhere to and demonstrate knowledge of HIPAA, OSHA policy, and AAMA regulations and guidelines.

Essential Responsibilities

Collect vital patient health history and assist in completing charts using various data sources and clinical tools
Assist patients with scheduling appointments, updating insurance records, check-in/out processes, and completion of consents and intake forms
Perform standard Medical Assistant clinical competencies, including:
Supporting patients virtually to obtain, document, and report accurate vital signs
Obtaining, documenting, and reporting basic medical, social, and family history
Providing patient education on topics such as blood pressure monitoring and glucometer usage
Manage and maintain medical records and insurance reports
Liaise with external facilities to arrange hospital admissions, laboratory services, and support the patient’s overall care plan as needed
Produce and distribute correspondence memos, letters, faxes and forms
Perform other related duties as required

What you will bring

Desire to be part of a fast-paced startup environment, utilizing technology to deliver exceptional clinical experiences and collaborate with providers, virtual dyads, and other medical assistants as part of a cohesive team.
2+ years of in-person or virtual (preferred) medical office experience, operations associate, or other clinical-related experiences.
2+ years of customer-facing service experience within a medical clinic or similar setting, including clinical and administrative support.
Experience in maintaining patient records and documentation.
State-mandated medical assistant certifications required at the time of hire
Practical understanding of medical, insurance, and medication terminology, HIPAA policies, medical malpractice, and informed consent
Enthusiasm for delivering excellent customer service and providing five-star patient experiences.
Excellent verbal and written communication (chat, email, and verbal-based), attention to detail, and sense of urgency
Proficiency with modern EMRs (Athena is a bonus), apple and iOS hardware and operating systems, and familiarity with google suite
Ability to work shifts between the hours of 6am – 8pm EST, Monday – Friday
Multi-lingual (preferred)

Why Eden Health

Remote first company and culture: Featured in Built Ins 2023 100 Best Hybrid Places to Work
Featured in Forbes list of America’s Best Startup Employers for 2023
Series C Healthtech startup with a mission-driven team that’s passionate about helping every person have a relationship with a trusted healthcare provider
Competitive salary and equity compensation package
Medical, dental, and vision insurance and commuter benefits
Dedicated Culture Committee led by CEO
Positive, inclusive, supportive culture cheering you on your journey
Strong and quickly growing client base of Americas leading employers

The base salary range for this role is $49,600 to $54,560 and is determined based on experience, geography, and qualifications. The base salary is one component of the total compensation package, which includes equity, PTO, and other benefits. This position is salaried, non-exempt with overtime pay eligibility. While the majority of Eden Health positions are remote-first, we are a company that values building trusted relationships. To achieve this we have programming and events which require us to be in person, including team and company-wide meetings. To ensure everyone’s safety, we require all employees to be fully vaccinated against COVID -19, subject to reasonable accommodations for medical conditions or sincerely held religious beliefs. If you have additional questions, your Talent Partner will be able to answer them. Eden Health is an equal opportunity employer and encourages all applicants from every background and life experience without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Please note: Eden Health interview requests and job offers only originate fromedenhealth.comemail addresses (e.g.jsmith@edenhealth.com).All Eden Health interviews are conducted via Zoom or Google Meet meetings.Eden Health will never ask for bank information (e.g. account and routing number), social security numbers, passwords, or other sensitive information to be delivered via email. If you receive a scam email or wish to report a security issue involving Eden Health, please notify us at:security@edenhealth.com. #LI-Remote #BI-Remote

Surgical Coding Educator, CPC

Privia Health Remote.co27 days ago

Apply Now27 days ago

location: remoteus

Apply Now

Surgical Coding Educator, CPC

Employees can work remotely
Remote, USA, United States
Full-time
Department: 953 – Virtual Products – Scribe and Coder

Company Description

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

Job Description

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

This role requires 20% travel

Primary Job Duties:

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

Qualifications

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

Interpersonal Skills and Attributes:

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

The salary range for this role is $77,000.00-$82,000.00 in base pay and exclusive of any bonuses or benefits. This role is also eligible for an annual bonus targeted at 10%.The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

All your information will be kept confidential according to EEO guidelines.

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

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

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

Spanish Bilingual Registered Nurse

Vesta Healthcare Remote.co29 days ago

Apply Now29 days ago

location: remoteus

Apply Now

Spanish Bilingual Registered Nurse (Remote)

Location: Remote

Job Description:

Nice to meet you, were Vesta Healthcare.

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

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

The ideal candidate would be able to:

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

Would you describe yourself as someone who has:

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

In addition to amazing teammates, we also offer:

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

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

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

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!

Plastic Surgery Coder

Guidehouse Remote.co29 days ago

Apply Now29 days ago

location: remoteus

Apply Now

Plastic Surgery Coder

US –Remote(Any location)

Full time

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Do:

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

What You Will Need:

High school diploma and 5+ years of prior coding experience
Minimum of 3 years coding experience related directly to Plastic Surgery coding
CPC

What Would Be Nice To Have:

Multispecialty Surgical coding experience

The annual salary range for this position is $49,400.00-$74,200.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

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

Benefits include:

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

Psychiatric Mental Health Nurse Practitioner

Done. - Done Health P.C. Remote.co30 days ago

Apply Now30 days ago

location: remotework from anywhere

Apply Now

Title: Mandarin Speaking Psychiatric Mental Health Nurse Practitioner (PMHNP)

Location: California

Type: Contract-1099

Workplace: remote

Category: Nurse Practitioners

JobDescription:

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

Perks:

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

What we are looking for:

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

What you’ll do:

Conduct psychiatric evaluations
Manage your patients medication regimens you prescribe and adjust medication and dosages as needed
Respond to EHR messages, refill requests, and conduct occasional remote follow-up appointments with your patient panel

Role:

Conduct ADHD Evaluations
On-Going Patient Management

Requirements:

PMHNP
Board Certified
Applicable Valid DEA / License
Computer Proficiency
Excellent Written and Verbal communication skills
Bilingual in Mandarin/English

Done. does not discriminate on the basis of race, sex, color, religion, age, national origin, marital status, disability, veteran status, genetic information, sexual orientation, gender identity or any other reason prohibited by law in provision of employment opportunities and benefits.

LPN/RN Quality Review and Audit Lead Representative

Express Scripts Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

LPN/RN Quality Review and Audit Lead Representative, Work from Home , Anywhere, USA in Nashville, Tennessee

Job Summary:

The HEDIS Abstraction Lead Representative works under the direction of the HEDIS Abstraction Lead within the Cigna Medicare Quality Department. These home-based positions are responsible for working independently to review and abstract pertinent medical record information in accordance with multiple study criteria and in alignment with the HEDIS specifications. The information to be abstracted will be obtained from medical records copied from physician offices/healthcare facilities and sent to CIGNA.

These personnel abstract clinical data into HEDIS nonstandard supplemental sources for HEDIS year round working in partnership with Medicare Quality, Stars, Network Operations. They are also responsible for identifying gaps in documentation to share back to providers and market staff for future improvement of HEDIS rates. During the annual HEDIS Medical Record Review (MRR) project (January-May), they also serve as a member of the HEDIS MRR abstraction/over-read team. Must possess proven ability and prior experience using HEDIS software, abstraction and identifying medical chart opportunities for providers. Demonstrates understanding of HEDIS technical Specifications and ability to apply knowledge in a fast-paced environment.

Additionally, the HEDIS Abstraction Specialist may collaborate with non-clinical personnel regarding collection of medical records from physician offices for additional medical record pursuits or may collect the information themselves. All medical records that are copied or received in the Cigna offices must be kept confidential, in accordance with federal and local requirements, and maintained at the Cigna office. Other duties as assigned to improve HEDIS rates including: gleaning records for additional information, utilization research applying measure probability logic to create additional HEDIS chase pursuits, and HEDIS MRR measure team lead.

Minimum Requirements:

Current active RN or LPN/LVN license preferred
Three years’ experience with HEDIS MRR or HEDIS abstraction/over-read preferred.
Experience with data entry and audit.
Experience with electronic medical records
Intermediate Level experience working with Microsoft Office Products. (Outlook, Word, Excel,and PowerPoint).

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

About Cigna Healthcare

Cigna Healthcare, a ision of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

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

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

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

Coding Specialist

Ensemble Health Partners Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Coding Specialist

locations

Remote – Nationwide

time type

Full time

job requisition id

R020554

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:

Advanced outpatient coding position that reviews medical record documentation and accurately assign ICD-10-CM, ICD-10-PCS, as well as CPT IV codes based on the specific record type and abstract specific data elements for each case in compliance with federal regulations. This position codes all types of outpatient visits to include ancillary, urgent care, emergency department, observation, same day surgery, and interventional procedures. Follows the Official Guidelines for Coding and Reporting, the American Health Information Management Association, (AHIMA,) Coding Ethics, as well as the American Hospital Association, (AHA) Coding Clinics, CMS directives and Bulletins, Fiscal Intermediary communications. Utilizing Coding Applications in accordance with established workflow. . Follows Policies and Procedures and maintains required quality and productivity standards.

Job Responsibilities:

Reviews medical record documentation and accurately assigns appropriate ICD-9-CM, ICD-10, CPT IV, and HCPCS codes utilizing the 3M software tools for all OP Work Types (Ancillary, ED Charge/Code, Same Day Surgery, and Observation. . The assigned codes must support the reason for the visit and the medical necessity that is documented by the provider to support the care provided. When applicable, apply the appropriate charges such as the Evaluation & Management, (E&M) level and injections and infusions, and/or other necessary requirements for Observation cases, using a third party software systems such as LYNX.

Correctly abstract required data per facility specifications.

Perform “medical necessity checks” for Medicare and other payers as required per payment guidelines.

Responsible for monitoring and working of accounts that are Discharged Not Final Billed, failed claims, stop bills, and epremis as a team, ensure timely, compliant processing of outpatient claims in the billing system.

Responsible to maintain established productivity requirements, key performance indicators established for 3M 360 CAC for CRS & Direct Code as well as ensure accuracy to maintain established quality standards.

Remain abreast of current requirements of the Centers for Medicare & Medicaid Services, (CMS,) to include National Coverage Determinations, (NCD) and Local Coverage Determinations, (LCD) guidelines, related to the assignment of modifiers, to ensure the submission of a clean claim the first time through.

Maintains competency and accuracy while utilizing tools of the trade, such as the 3M encoder, Computerized Assisted Coding, (CAC,) Medical Necessity software, abstracting system, code books, and all reference materials. Reports inaccuracies found in Coding Software to HIM Management/Supervisor, reports any potential unethical and/or fraudulent activity per compliance policy

Follows all established Mercy Health policies and procedures to include abiding by paid time off, (PTO) requirements.

Attends required system, hospital and departmental meetings and educational sessions as established by leadership, as well as completion of required annual learning programs, to ensure continued education and growth.

Assist in the mentoring and training of Coders as required.

Experience We Love:

1 year of previous of coding experience
Current coding certification
Experience in cardiovascular coding, preferred
CRCR Certification required, or willingness to obtain within 9 months of hire

#LI-HB1

#LI-REMOTE

Join an award-winning company

Three-time winner of Best in KLAS 2020-2022

2022Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

Innovation
Work-Life Flexibility
Leadership
Purpose + Values

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

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

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

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

EEOC Know Your Rights

FMLA Rights – English

La FMLA Espaol

Utilization Management Nurse Reviewer

Dane Street Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Job Title: Utilization Management Nurse Reviewer

Location: West Palm Beach FL US

JobDescription:

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

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

Shift Times:

9 am start time
11:00am start time
weekend shift 10 hours (Thurs- Sun) Start time 8 am.

MAJOR DUTIES & RESPONSIBILITIES

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

Requirements

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

Additional Duties

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

EDUCATION/CREDENTIALS:

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

JOB RELEVANT EXPERIENCE:

2 yrs minimum clinical nursing experience is required. One year of previous experience in Utilization Management is preferred.

JOB RELATED SKILLS/COMPETENCIES:

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

WORKING CONDITIONS/PHYSICAL DEMANDS:

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

WORK FROM HOME TECHNICAL REQUIREMENTS:

Supply and support their own internet services.

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

Benefits

We offer generous Paid Time Off, excellent benefits package and a competitive salary. Apple equipment and media stipend is provided for remote work space. Come up to speed quickly with our strong training program! If you want to work in an exciting, fast-paced environment where you can provide meaningful contributions, then we encourage you to apply.

ABOUT DANE STREET:

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

Outpatient Coder

Guidehouse Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Outpatient Coder

Location:US -Remote(Any location)

Full time

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Do:

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

What You Will Need:

High school diploma and 3-5 years of prior relevant experience
CCS or CPC

What Would Be Nice To Have:

CPC

The annual salary range for this position is $43,400.00-$65,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Benefits include:

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

About Guidehouse

Bilingual Front Office Medical Assistant

Vesta Healthcare Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Bilingual Front Office Medical Assistant (Remote)

Remote

Nice to meet you, were Vesta Healthcare.

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

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

The ideal teammate would be

A customer focused inidual who responsible for assisting the team in coordinating the care of members enrolled in Medicare’s chronic care management program during each calendar month. This will primarily entail periodic telephonic outreach calls to members, caregivers, and other care team members as directed with documentation in the appropriate platform to ensure compliance. The Care Coordinator will collaborate with the supervising provider and staff to conduct outreach, assessment and service planning to coordinate care for the CCM patients.

The ideal teammate would be able to:

Provide practice support including: contacting members, caregivers, and care team members as directed, work closely with the clinical team to improve the health and care of our members
Coordinating care for members of the program
Data entry within operating dashboards, reporting and workflow platforms
Ensure Data Quality and Accuracy
Other administrative support

Would you describe yourself as someone who has:

Fluency in English and Spanish/Mandarin/Cantonese/Russian (writing, reading and speaking) (required)
A minimum of 2 years of experience working in a healthcare setting (required)
The ability to work alternating weekends – 10H Sat/Sun with flex hours on the week days OR 9-6pm rotating on Sat/Sun(required)
Knowledge and understanding of medical terminology (required)
2+ years working in a medical practice with front office experience and/or medical receptionist experience (required)
Knowledge and understanding of chronic care management processes (required)
A customer service mindset for both internal and external customers (required)
Medical Assistant and or Medical Scribe Certification (required)
A strong proficiency in computer software navigation; data entry and data cleansing
A fundamental knowledge of Google Docs, Sheets, Slides or similar
A demonstrated ability to work effectively as a member of an interdisciplinary team, displaying good judgment and decision-making skills
Ability to perform duties as assigned or requested

In addition to amazing teammates, we also offer:

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

Pay rate is $20.00 hourly.(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).

Nurse Practitioner

Midi Health Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

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Clinical Documentation Integrity Coder

Vytalize Health Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Title: Clinical Documentation Integrity Coder (remote)

Location: Remote

JobDescription:

About Our Company

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

About our Growth

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

Why you will love working here

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

Your opportunity

The CDI Specialist supports clinical documentation to ensure complete, accurate, and compliant coding for Medicare and Medicare Advantage beneficiaries. Proficient in ICD-10-CM coding and risk adjustment methodologies, you optimize coding integrity, conducting chart reviews specifically addressing the CMS-HCC model. This role emphasizes production coding with a focus on enhancing clinical documentation through compliant risk adjustment chart review programs (minimum 30 charts per day).

As a CDI Specialist, you significantly contribute to ensuring accurate and compliant documentation, aligning beneficiaries health burden with risk scores for appropriate Medicare reimbursement. Your expertise in precision and excellence supports the organization’s commitment to providing high-quality healthcare services.

What you will do

Clinical Documentation Enhancement:

Validate and ensure the completeness, accuracy, and integrity of coded data.
Support and enhance clinical documentation to ensure comprehensive, accurate, and compliant coding for Medicare and Medicare Advantage beneficiaries.

Coding Proficiency:

Demonstrate proficiency in ICD-10-CM coding, CPT codes, HCPCS codes, and risk adjustment methodologies to optimize coding integrity.
Comply with HIPAA laws and regulations.

Chart Reviews:

Review and accurately code medical records and encounters for ICD-10 diagnoses and procedures codes related to Risk Adjustment and HCC coding guidelines.

Production Coding:

Oriented towards production coding, with a primary emphasis on improving clinical documentation through effective risk adjustment coding.
Maintain productivity standards averaging 30 charts per day.

Documentation Alignment:

Ensure documentation aligns with regulatory guidelines and standards, emphasizing precision in risk adjustment processes.
Stay up to date with the latest coding guidelines, rules, and regulations related to Risk Adjustment and HCC coding.

Contribution to Accuracy:

Contribute significantly to accurate and compliant documentation, aligning beneficiaries health burden with risk scores for appropriate Medicare reimbursement.

Quality Assurance:

Ensure exemplary attention to detail and completeness, ensuring coding is consistent with ICD-10-CM, CMS-HCC, and other relevant coding guidelines.
Uphold a commitment to precision and excellence, maintaining at least a 95% coding accuracy rate.

EHR Knowledge and Proficiency:

Demonstrate knowledge and expertise in various Electronic Health Record (EHR) systems to optimize chart reviews across multiple platforms.

What will make you successful in this role

Minimum of 2 years HCC/Risk Adjustment coding experience required, 3+ years preferred.
Strong communication skills, including clear verbal and written communication, effective collaboration, and the ability to convey complex coding concepts.
Knowledge of medical records coding procedures and ICD-10/CPT Coding Systems required.
Must hold a Certified Risk Adjustment Coder (CRC) and Certified Professional Coder (CPC) certification.

Perks/Benefits

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

Salary $60,000-65,000 DOE + 10% annual bonus potential + benefits (see above)

We are interested in every qualified candidate who is eligible to work in the United States. However, we are not able to sponsor visas.

Please note at no time during our screening, interview, or selection process do we ask for additional personal information (beyond your resume) or account/financial information. We will also never ask for you to purchase anything; nor will we ever interview you via text message. Any communication received from a Vytalize Health recruiter during your screening, interviewing, or selection process will come from an email ending in @vytalizehealth.com

Nurse Case Manager

Valenz Health Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Nurse Case Manager

Fully Remote

Job Type

Full-time

Description

Valenz Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity, and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan, and member. By establishing true transparency and offering data-driven solutions that improve cost, quality, and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare.

About Our Opportunity

As a Nurse Case Manager, you will play a critical role in coordinating and managing healthcare services for patients, ensuring optimal care delivery and facilitating effective communication among various healthcare providers. With your nursing expertise and case management skills, youll provide comprehensive care coordination and support to patients throughout their healthcare journey.

The Nurse Case Manager collaborates with patients, families, physicians, and other healthcare professionals to develop and implement personalized care plans, monitor patient progress, and advocate for the best possible outcomes.

Things Youll Do Here:

Coordinate and manage healthcare services for patients, ensuring comprehensive care delivery and effective communication among healthcare providers.
Assess patients’ healthcare needs and develop personalized care plans based on their conditions and goals.
Advocate for patients’ rights, preferences, and needs, and help them navigate the healthcare system.
Monitor patients’ progress, adherence to treatment plans, and evaluate the effectiveness of interventions.
Maintain accurate documentation of patient assessments, care plans, and outcomes.
Generate reports on patient progress, outcomes, and utilization of healthcare resources.
Provide patient education on medication administration, and self-care techniques.
Offer emotional support and counseling to patients and their families, addressing their concerns and fears.
Promote health and wellness by encouraging preventive measures and healthy lifestyle choices.
Adhere to the applicable URAC Standards, CMSAs Standards of Practice, state, local, and federal laws and Valenzs policies and procedures.
Partner with internal teams to identify health plan coverage savings as appropriate.

Reasonable accommodation may be made to enable iniduals with disabilities to perform essential duties.

Where Youll Work

This role is a fully remote role.

Why You Will Love Working Here

We offer employee perks that go beyond standard benefits and compensation packages see below!

At Valenz, our team is committed to delivering on our promise toengage early and often for smarter, better, faster healthcare. We want everyone engaged within our ecosystem to bestrong, vigorous, and healthy.Youll find limitless growth opportunities as we grow together. If you’re ready to utilize your skills and passion to make a significant impact in the healthcare self-funded space, Valenz might be the perfect place for you!

Perks and Benefits

Generously subsidized company-sponsored Medical, Dental, and Vision insurance.
Spending account options: HSA, FSA, and DCFSA
401K with company match and immediate vesting.
Flexible working environment.
Generous Paid Time Off to include Vacation, Sick, and Paid Holidays.
Paid maternity and paternity leave.
Community giveback opportunities, including paid time off for philanthropic endeavors.

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and inidual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.

Requirements

What Youll Bring to the Team:

3+ years of direct case management experience, with a demonstrated ability to develop, implement, and monitor personalized care plans, coordinate healthcare services, and collaborate with multidisciplinary teams for optimal patient outcomes.
RN License with an active and unrestricted license to practice in the state of primary residence – compact license preferred.
Experience in a deadline driven environment with a knack for organization and detail.
Ability to comprehend the consequences of various problem situations and to refer such problems to the appropriate inidual (or supervisor) for decision-making.
Excellent communication skills to liaise between patients, families, and healthcare professionals.
Patience and resilience, especially when faced with challenging situations.

A plus if you have:

Additional state licensures
Certified Case Manager (CCM), Chronic Care Professional (CCP), etc. or willingness to obtain CCM in 18 months of hire.

Medical Video Content Creator

Rupa Health Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Title: Medical Video Content Creator (Contract Position)

Location: Remote

Type: Contract

Workplace: remote

Category: Growth, Sales, and Marketing

JobDescription:

Overview

Hey there, health gurus! Are you a licensed MD, ND, or PhD with a knack for the camera and a passion for functional medicine? Rupa Health is on the hunt for a Medical Content Creator who can turn complex medical jargon into engaging, informative videos. Join us in our mission to educate millions on the harmony of conventional and functional medicine, and let’s spread the word about root cause medicine together!

A little about Rupa – The future is personalized, root-cause healthcare.

Rupa makes lab testing simple. We turn an archaic 15 hour-a-week process into a delightful 15 min task for practitioners ordering lab testing for their patients.

Lab testing is the key to a more personalized and holistic approach to medicine, and Rupa is paving the way with critical infrastructure for this next generation of healthcare. Through Rupa, practitioners can order specialty testing, such as DNA testing, microbiome testing, advanced fertility and hormone testing, blood labs, and more.

This comprehensive and personalized approach to healthcare is the missing piece for the millions of people suffering from complex, chronic health conditions. Rather than band-aid solutions, practitioners utilize our platform to understand, diagnose, and treat the root cause of people’s health issues through testing. At Rupa, we are building the infrastructure to make this root-cause approach the standard of care for every person on the planet.

Starting with lab testing, Rupa is bringing tools and resources to trailblazing practitioners who are practicing medicine in a way that truly helps people get well.

What This Role Will Own

As our Medical Content Creator, you’ll be the maestro of our video content, orchestrating everything from content ideation to the final cut. Here’s what you’ll own:

Video Wizardry: Script, propose, and record at least two stellar videos per month that will captivate our audience.

Idea Generator: Unleash your creativity to regularly propose fresh and engaging content ideas to the Rupa Health Team.

Collaborative Spirit: Be the friendly face that works well with others, embraces feedback, and upholds integrity in every action.

Communication Pro: Keep in touch with our team through Slack and Email, ensuring your messages are as clear as your video content.

Quality Champion: Deliver videos with world-class video and audio quality – don’t worry, we’ve got the gear you need!

Hard Requirements

Licensed Professional: You must be a licensed MD, ND, or PhD.

Functional Medicine Fanatic: A deep passion and understanding of functional medicine is non-negotiable.

Editorial Expertise: You’ve got a solid grasp of the editorial process and can craft content that educates and engages.

Communication Skills: Your communication skills are top-notch, both on and off camera.

Nice To Have Requirements

Social Savvy: Experience with social media and a knack for engaging with a digital audience.

Tech-Friendly: Comfortable with using video editing software and equipment.

Innovative Thinker: Always thinking of new ways to present content that sets us apart from the rest.

Quick Note

We’re all about embracing ersity and fostering an inclusive environment here at Rupa Health. We’re proud to be an equal opportunity employer. We celebrate our differences and are committed to creating an inclusive environment for all employees, regardless of race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Heads up, folks! Rupa Health will always reach out from our official rupahealth.com domain. We won’t slide into your DMs on messaging apps or ask for bank details or purchases during the hiring process. If something seems off, hit us up at [email protected] to confirm you’re chatting with our legit team.

Requirements:

[Record Videos] Able to script, propose, and record at least two videos per month
[Licensed Professional] You must be a licensed MD, ND, or PhD.
[Propose Content Ideas] Create content on the topics of your choice and propose content ideas regularly to the Rupa Health Team
[Team Player] A friendly human who is pleasant to work with, gives & takes feedback well, is responsible (does what they say they will), and performs their job with integrity
[Communication] Able to communicate with our team promptly on Slack and Email
[Quality of Work] The videos you submit will be world class video and audio quality – we will provide equipment if necessary

Senior Account Support Coordinator

Prime Therapeutics Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Senior Account Support Coordinator

locations

Home

time type

Full time

job requisition id

R-11505

Our work matters. We help people get the medicine they need to feel better and live well. We do notlose sight of that. It fuels our passion and drives every decision we make.

Job Description Summary

Supports a variety of administrative and project tasks for the account management team, including tracking client projects and assigned tasks.

Job Description

Managesprojectand reporting for the client management process to ensure that due dates and deliverables are tracked and on schedule for all client activities as assigned by manager and team.
Attends client conference calls and onsite meetings to document client deliverables, client summary notes and follow up items.
Prepares and develops client presentations.
Assists in the development, coordination and materials necessary for site visits/client meetings.
Exercises independent judgment and discretion responding to requests, arranging meetings and interacting with key contacts.
Independently handles the setting up and maintenance of client project tracking reports and processes.
Coordinates or independently completes special projects according to manager’s general instructions.
Assists manager or other staff members with more complex and detailed client projects.
Participates in additional client support related activities at the direction manager, and interacts with team to meet internal reporting requirements and deliverables

Responsibilities

Knowledge of Pharmacy and Medical Claims.
Strong working knowledge of Microsoft Office Suite and Adobe software.
5+ years’ related experience in healthcare setting in customer service or account management, training or education.

Work Experience

Work Experience – Required:

Marketing

Education

Education – Required:

A Combination of Education and Work Experience May Be Considered., Associates

Education – Preferred:

Bachelors

Potential pay for this position ranges from $52,250.00 – $78,390.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the “Benefits at a glance” button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage erse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.

Positions will be posted for a minimum of five consecutive workdays.

Coding Specialist

Iodine Software Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Coding Specialist

Remote

Join us. Lets make a direct impact in healthcare.

Being an Iodine employee means becoming part of something bigger: using clinical AI technology to drive smarter healthcare processes and positively impact patient care.

Who we are:

Iodine is an enterprise AI company that is championing a radical rethink of how to create value for healthcare professionals, leaders, and their organizations: automating complex clinical tasks, generating insights and empowering intelligent care. Powered by one of the largest sets of clinical data and use cases available, our groundbreaking clinical machine-learning engine, Cognitive ML, constantly ingests the patient record to generate real-time, highly focused, predictive insights that clinicians and hospital administrators can leverage to dramatically augment the management of care delivery.

What were looking for:

Reporting to the Chief Clinical Strategist, the Coding Specialist is a member of the Customer Success organization who will provide coding subject matter expertise, insight and an active role to our clinical and business goals including product innovation and development.

What youll do:

Coding

Research and develop inpatient coding criteria that identifies common areas of coding error or discrepancy
Conduct coding and documentation audits to assess product compliance with coding guidelines and regulations.
Identify areas for product improvement and provide recommendations for enhancing accuracy.
Stay informed about industry updates on coding guidelines and materials to ensure product compliance and competitiveness.
Collaborate with internal teams to understand the implications of coding and clinical documentation requirements on product development.
Engage with client partners to assess coding practices and responsibilities that would impact product development.
Research healthcare technology changes and trends affecting documentation and coding, guiding product development accordingly.
Evaluate coding processes, systems, and documentation practices, implementing strategies to optimize product performance and efficiency.
Design workflow processes to ensure efficiency and quality for users.
Collaborate with cross-functional teams, especially the clinical team, to ensure clinical and coding compliance and support organizational initiatives.
Stay up-to-date with changes in coding regulations, guidelines, and industry trends.
Prepare coding-related reports, analyses, and recommendations for product development and strategic decision-making.

Product

Collaborate with cross-functional teams, serving as the coding subject matter expert
Collaborate with Data Science to improve inputs to models
Conduct and coordinate audits and quality checks of product capabilities

What wed love to see:

Bachelor’s degree in Health Information Management (RHIA) or Bachelor degree in related field with appropriate coding certification
Certification: PCC and/or CIC required, CPC preferred
Experience in monitoring and assessing coding accuracy
Experience managing a second level review process that identifies coding error or discrepancies
Experience in developing new technology highly preferred
5+ years of inpatient coding experience required
Experience in coding consulting role preferred
Ability to travel 15-20% of the time

Please note this position is not restricted solely to the responsibilities listed above and that the job scope and responsibilities are subject to change.

RN Clinical Documentation Specialist

Ensemble Health Partners Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

RN Clinical Documentation Specialist

locations

Remote – Nationwide

time type

Full time

job requisition id

R018291

Thank you for considering a career at Ensemble Health Partners!

The Opportunity:

The CDI Specialist 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.

Job 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.

Experience We Love:

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

Minimum Education

Current RN Licensure

Certifications:

CRCR Required within 9 months of hire

#LI-LS1

#LI-REMOTE

Join an award-winning company

Three-time winner of Best in KLAS 2020-2022

2022Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

Innovation
Work-Life Flexibility
Leadership
Purpose + Values

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

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

Benefits Verification Specialist

Cencora Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Benefits Verification Specialist

locations

Remote, USA

time type

Full time

job requisition id

R245157

Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthier futures, and every person here is essential to us being able to deliver on that purpose. If you want to make a difference at the center of health, come join our innovative company and help us improve the lives of people and animals everywhere.

What you will be doing

Location: Remote, USA

Hours: 8:30am to 5:30pm EST, Monday through Friday

PRIMARY DUTIES AND RESPONSIBILITIES:

Reviews all patient insurance information needed to complete the benefit verification process.

Triages cases with missing information to appropriate program associate.

Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options.

Identifies any restrictions and details on how to expedite patient access.

Could include documenting and initiating prior authorization process, claims appeals, etc.

Completes quality review of work as part of finalizing product.

Reports any reimbursement trends/delays to management.

Performs related duties and special projects as assigned.

Applies company policies and procedures to resolve a variety of issues.

What your background should look like

PRIMARY DUTIES AND RESPONSIBILITIES:

Reviews all patient insurance information needed to complete the benefit verification process.

Triages cases with missing information to appropriate program associate.

Verifies patient specific benefits and precisely documents specifics for various payer plans including patient coverage, cost share, and access/provider options.

Identifies any restrictions and details on how to expedite patient access.

Could include documenting and initiating prior authorization process, claims appeals, etc.

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

High school diploma or GED required.

Requires minimum of two (2) years directly related and progressively responsible. experience in customer service, medical billing and coding, benefits verification, healthcare, business administration or similar vocations.

A bachelors degree is preferred.

An equivalent combination of education and experience will be considered.

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

Advanced customer service experience.

Proficient Windows-based experience including fundamentals of data entry/typing.

Proficient with Microsoft Outlook, Word, and Excel.

Strong interpersonal skills and professionalism.

Independent problem solver and ability to make , good decisions.

Robust analytical skills.

Strong attention to detail.

Effective written and verbal communication.

Familiarity with verification of insurance benefits preferred.

Attention to detail, flexibility, and the ability to adapt to changing work situations.

What Cencora offers

We provide compensation, benefits, and resources that enable a highly inclusive culture and support our team members ability to live with purpose every day. In addition to traditional offerings like medical, dental, and vision care, we also provide a comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness. This encompasses support for working families, which may include backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, and paid caregiver leave.

To encourage your personal growth, we also offer a variety of training programs, professional development resources, and opportunities to participate in mentorship programs, employee resource groups, volunteer activities, and much more.

For details, visit https://www.virtualfairhub.com/amerisourcebergen

Schedule

Full time

Salary Range*

$31,500 – 46,530

*This Salary Range reflects a National Average for this job. The actual range may vary based on your locale. Ranges in Colorado/California/Washington/New York State-specific locations may be up to 10% lower than the minimum salary range, and 12% higher than the maximum salary range.

Affiliated Companies:

Affiliated Companies: Lash Group, LLC

Equal Employment Opportunity

Cencora is committed to providing equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, disability, veteran status or membership in any other class protected by federal, state or local law.

The companys continued success depends on the full and effective utilization of qualified iniduals. Therefore, harassment is prohibited and all matters related to recruiting, training, compensation, benefits, promotions and transfers comply with equal opportunity principles and are non-discriminatory.

Cencora is committed to providing reasonable accommodations to iniduals with disabilities during the employment process which are consistent with legal requirements. If you wish to request an accommodation while seeking employment, please call 888.692.2272 or email [email protected]. We will make accommodation determinations on a request-by-request basis. Messages and emails regarding anything other than accommodations requests will not be returned

Inpatient Medical Records Coder

Northwell Health Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Title: Inpatient Medical Records Coder (Certified)

Location: Lake Success, NY

Job Responsibility:

Analyzes and interprets the medical record in its entirety to ensure accurate, complete and consistent selection of diagnoses and procedures to assure the production of quality healthcare data and accurate facility payment.
Applies understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable codes.
Utilizes resources and reference materials (e.g., on-line sources, manuals) to identify appropriate codes and reference code applicability, rules and guidelines.
Applies the Uniform Hospital Discharge Data Set (UHDDS) definitions as well as any additional regulatory guidelines and/ or coding references to select the principal diagnosis, secondary diagnoses, all significant procedures, indicating the patient’s acuity, severity of illness and risk of mortality (if applicable), as documented in the medical record.
Codes and reports diagnoses and their associated present on Admission (POA) Indicator and procedures in accordance with the established International Classification of Diseases 10th Revision Procedure Classification System (ICD-10-PCS) Official Guidelines for Coding and Reporting.
Accurately assigns discharge disposition for all records as required and in accordance with the Centers for Medicare and Medicaid Services (CMS) rules and regulations.
Make determinations on medical coding and takes initiative to complete reviews and coding independently, to avoid delays in the workflow process
Manages multiple work demands simultaneously to maintain relevant efficiency and turnaround time standards for completing coding/DRG assignment
Assigns and reports all other data elements required for Statewide Planning and Research Cooperative System (SPARCS) data collection, Congenital Malformations and Expirations.
For outpatient encounters, applies coding conventions and official coding guidelines approved by the Current Procedural Terminology (CPT) rules established by the American Medical Association (AMA), and any other official rules and guidelines established for use with the mandated outpatient procedure code sets.
Assigns appropriate discharge physician in the system.
Generates compliant physician queries to clarify any incomplete/ambiguous or conflicting documentation and applies post-query responses to make final coding determinations.
Demonstrates basic knowledge of the impact of coding decisions on revenue cycle.
Assists in the education of physicians and other clinicians by advocating proper documentation practices, further specificity, resequencing and inclusion of diagnoses or procedures when needed to more accurately reflect the acuity, severity of illness and risk of mortality as indicated..
Attends and participates in required hospital education programs in order to maintain and enhance their coding skills and stay abreast of changes in codes, coding guidelines and regulations.
Maintains the minimum data standards for accuracy and efficiency as defined by the facility.
Maintains certified coding credentials in accordance with the certified coding requirements and demonstrates annual compliance.
Performs related duties, as required.

ADA Essential Functions

Job Qualifications:

Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Specialist-Physician (CCSP), Certified Inpatient Coder (CIC), or Certified Outpatient Coder (COC), required.
Successful completion of a medical coding course, required.

AND

Minimum of two (2) year experience as an ICD-10 Outpatient/Inpatient medical records coder, in an acute care facility, required.

Competent in the utilization of an electronic medical record, and computerized coding/abstracting systems, required.

Experience with Computer Assisted Coding preferred.

Additional Salary Detail:

The salary range and/or hourly rate 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, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity

The salary range for this position is $39.68-$46.26/hour

Revenue Integrity / RN Senior Consultant

Craneware Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

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Revenue Integrity / RN Senior Consultant

Office Location:Homebased – US

Introduction to Craneware

Lets transform the business of healthcare! At The Craneware Group, we are dedicated to empowering our customers with industry-defining insights that pave the way for a brighter future.

If you are an energetic, forward-thinking inidual with a passion for innovation, we invite you to join our thriving team of more than 750 dedicated professionals. Together, we’ll fuel the expansion of our SaaS platform and develop cutting-edge applications that redefine the healthcare landscape.

The Team

At The Craneware Group, we have a talented mix of employees from erse backgrounds, which brings a high level of innovation and collaboration to deliver excellent customer service. We are currently seeking an experiencedRevenue Integrity/Registered Nurse Senior Consultantto join our team. We are seeking an RN with Revenue Integrity Experience who is AAPC certified, with 3 5 years of experience in claims auditing and appeals writing.

Come join a seasoned team of Clinical Revenue Integrity industry experts. If you are looking for a fast-paced position where you can apply your clinical and revenue integrity skills, while driving project from end to end, this may be the perfect position for you. This position allows you to be innovative along with your colleagues to support Customers from a Clinical Revenue Integrity perspective.

You Will Be

Assessing andanalyzingServices offerings provided by Consulting; Document Best Practice;DriveContinuous Process Improvement.
Acting as a resource/go-to person for TCG key stakeholders (i.e., Product Management, Development, Sales, Customer facing teams).
Providingmastery level consulting to hospitals seeking insights and guidance to ensure best practices.
Servingas a Project Manager to oversee the daily operations of the specific services provided to ensure best practices.
Completingrevenue cycle assessments by reviewing current operations and conducting key interviews to identify opportunities for improvement.
Performing comprehensive assessments of charge capture and reconciliation procedures to ensure all services provided are charged.
Assessing charge ticket and interface mappings to the CDM to identify discrepancies.
Testing claim logic within billing and scrubber systems to ensure accurate flow of coded data to the bill and to the payor.
Conducting CDM reviews to assure all lines are coded correctly and all services rendered are available to charge.
Conducting audits to assess the accuracy and completeness of the bills, coding, medical record documentation, and/or level of care assignment to ensure regulatory compliance and maximize revenue opportunities.
Reviewing medical records and utilize clinical knowledge and regulatory guidance as well as knowledge of payer requirements to determine reasons for denial and whether an appeal is warranted.

You Will Bring

Educated toBachelorDegreelevel
RN, BSN, CPC, COC or CCS certification
7+ years experience in specific services provided and healthcare operations
5 years experience managing project teams
In-depth knowledge and understanding of healthcare services, health information technology, regulatory requirements, clinical data management, project management
Exceptional communication skills both written and verbal
Dedication to staying current with industry changes and advances
5+ years experience working with commonly used financial systems and transaction processing systems such as EPIC, McKesson, Cerner, Meditech, Paragon, CPSI, GE, and Siemens
Proficiency with Microsoft Office and associated TCG products
Research and analysis skills
Demonstrates a high level of commitment to superior customer satisfaction through the entire duration of the customer relationship.
Highly accountable and results oriented, burning desire to get things done and a sense of urgency, resourceful with excellent planning skills
AAPCCertification with 3-5 yearsexperiencein claims auditingand appealswriting

AAPC Certification with 3-5 years experience

Utilization Management Nurse Reviewer

Dane Street Remote.coabout 1 month ago

Apply Nowabout 1 month ago

location: remoteus

Apply Now

Utilization Management Nurse Reviewer

RemoteUnited States

Description

Shift Times:

9 am start time
11:00am start time
weekend shift 10 hours (Thurs- Sun) Start time 8 am.

MAJOR DUTIES & RESPONSIBILITIES

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

Requirements

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

Additional Duties

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

EDUCATION/CREDENTIALS:

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

JOB RELEVANT EXPERIENCE:

2 yrs minimum clinical nursing experience is required. One year of previous experience in Utilization Management is preferred.

JOB RELATED SKILLS/COMPETENCIES:

WORKING CONDITIONS/PHYSICAL DEMANDS:

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

WORK FROM HOME TECHNICAL REQUIREMENTS:

Supply and support their own internet services.

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

Benefits

Executive Editor

McGraw-Hill Education Remote.coabout 2 months ago

Apply Nowabout 2 months ago

location: remoteus

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Executive Editor

Location:Remote, United States

Product Development
Professional
Remote

Overview

Build the Future

When was the last time you experienced the impact of your work? Our ProfessionalEducationproduct team thrives on building meaningful relationships with innovative medical authors and Educators.

How can you make an impact?

As TheExecutive Editoryou will be reporting to the Senior Publisher of Medical Content and will be responsible for managing the revision and acquisition of titles across the allied health markets managing a large number of author teams and will also directly supervise Editors working within allied health and nursing practice.This is aremoteposition open to applicants within the United States

What you will be doing:

Work with the Global Publisher set strategy for the main products in the MHP allied health lists.
Propose 5-10 new and revised book contracts per year and publish 5-10 books per year.
Manage MHPs publishing lines in physical therapy and pharmacy and establish productive working relationships with author teams.
Work with the Global Publisher and platform team to identify desirable content for the AccessPharmacy and AccessPhysiotherapy subscription platforms, and acquire such content from credible sources.
Represent the allied health lists to MHP sales, marketing, and user services teams.
Manage 2-3 editors and provide guidance and direction for print and digital strategy and execution in those lists
Align closely with internal platform and Product Management teams to produce product roadmaps and priorities for execution

You should apply if:

5 Years+ experience in editorial acquisitions and content development in medical publishing.
Proven experience in strategic planning for an allied health market list.
Knowledge of digital platforms and digital product development and maintenance a plus.
Strong analysis, product development, management, and communication skills.
Demonstrated successfulcontractnegotiation and implementation skills.
Digital content development
Working knowledge of digital platform and content workflows
Roadmap planning and execution
Strong project management skills, including the ability to manage collaboration across internal departments.
Outstanding writing and presentation skills.
BA/BSdegreerequired.

Why work for us?

The work you do at McGraw Hill will be work that matters. We are collectively designing content that will build the future ofeducation. Play your part and experience a sense of fulfilment that will inspire you to even greater heights. If you are curious, open to new ideas and ready to make a difference, we want to talk to you.

The pay range for this position is between $100,000 – $130,000 annually; however, base pay offered may vary depending on job-related knowledge, skills, experience and location.An annual bonus plan may be provided as part of the compensation package, in addition to a full range of medical and/or other benefits, depending on the position offered.

Manager, HCC Risk Adjustment Coding

Datavant Remote.coabout 2 months ago

Apply Nowabout 2 months ago

location: remoteus

Apply Now

Manager, HCC Risk Adjustment Coding

Remote, United States

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

What we need

Manager, HCC Codingis responsible forthe oversight and management of coding production, quality, and vendor management. This roleis responsible forensuring adherence to departmental goals, quality standards, metrics, policies, etc. They will provide leadership and guidanceregardingactivity, status, trends, coaching/feedback methods and coordination ofadditionalresources to support coding production and quality.

You Will:

Create and manage teams daily, weekly and monthly production and quality goals to ensure that department objectives are met.
Cross functional collaboration to ensure that QA, trends and education is provided timely and accurately to team members.
Maintain internal coding policies and procedures to ensure compliance, coding consistency and up to date coding practices.
Oversee onboarding, staffing plans and staff performance to ensure optimal talent management and utilization.
Effective team management and utilization to achieve coding operational KPIs.
Accountability and mentoring of supervisors and staff to business values and coding operations KPIs
Reporting to coding leadership on business trends and project coding patterns as well as an obstacles to achieving KPIs or deadline.
Collaboration with the Training/Education Department with a focus on content development/design, training coordination and facilitation
Manage all aspects of the Auditing and Quality Department for remote coding teams as well as field teams as necessary.
Monitor and report effectiveness of training programs from research, benchmark, propose training and development opportunities to drive continuous improvement.
Approve team members PTO and manage staffs time out of office while continuing to meet department Auditing and Quality goals.
Knowledge and expertise in use of NLP and AI technology in coding business.
Collaboration with coding production to achieve 95% coding quality accuracy at project level.
Accountability and mentoring of quality and audit supervisors and audit staff to business values and coding operations KPIs.
Vendor oversight performing production and quality oversight for both onshore and offshore vendors.
Facilitate communication in regards to production and quality KPI metrics with vendors.
Monthly reconciliation of vendor performance metrics to assist with billing and SLA penalties if applicable.
Provide operational assistance to vendors regarding training, project assignment and system support.
Business related travel up to 20%.

What You Will Bring to the Table:

Bachelors Degree or a minimum of five years of equivalent experience in quality and/or coding management role(s) with increasing level of responsibility.
A minimum of 5 years of experience in risk adjustment coding and/or auditing experience.
Experience with adult learning methodologies and distance learning preferred
Excellent written and oral communication skills.
Strong managerial, leadership, and interpersonal skills.
Outstanding organizational skills.
Ability to communicate effectively with all levels of the organization.
Ability to work effectively in a remote, team environment.
Flexibility in work schedule to meet departmental needs.
Strong analytical and problem-solving skills to grasp the key points from complicated details and provide direction/ coaching to members of the team.
A strongknowledge base of medical terminology, medical abbreviations, pharmacology and disease processes.
Ability to analyze data to determine the root cause of identified quality/production concerns.
Must be able to follow instructions, meet deadlines and work independently.
Intermediate Excel skills and the ability to use other Microsoft applications
Working knowledge of the business use of computer hardware and software to ensure effectiveness and quality of the processing and security of the data.
AHIMA certified credentials (RHIA, RHIT, CCS) or AAPC certified credentials (CPC, CPC-H, COC, CIC, or CRC)

Nurse Clinical Reviewer - RN

Acentra Health Remote.coabout 2 months ago

Apply Nowabout 2 months ago

location: remoteus

Apply Now

Nurse Clinical Reviewer – RN (Remote U.S.)

Remote

United States

Operations

Full time

ZNE

Job Description:

Acentra seeks a Nurse Clinical Reviewer RN (Remote U.S.) to join our growing team.

Job Summary:

Our Nurse Clinical Reviewer RN will use clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and decision-making skills to determine medical appropriateness while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with NCQA, URAC, and other regulatory standards.

Job Responsibilities:

Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care.
Determines if the medical record documentation supports the need for services.
Determines approval or initiates a referral to the physician consultant and processes physician consultant decisions ensuring the reason for the denial is described in sufficient detail on correspondence.
Fosters positive and professional relationships and acts as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for review.
Always maintains medical records confidentiality through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies.
Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following Acentra policies, procedures, and guidelines.
Actively cross-trains to perform duties of other contracts within the Acentra network to provide a flexible workforce to meet client/consumer needs.
Other duties as assigned.

Requirements

Required Qualifications/Experience:

Active unrestricted RN license in the State of North Dakota or a compact state license.
Utilization Review (UR) and/or Prior Authorization or related experience.
Direct experience in a clinical setting or other applicable State and/or Compact State clinical experience.
Strong clinical assessment and critical thinking skills.
Knowledge of InterQual OR American Society of Addiction Medicine (ASAM) guidelines.
Ability to prioritize, assign, and follow up on work.
Ability to problem solve.
Ability to provide technical consultation and policy interpretation.
Excellent customer service.
Excellent written and verbal communication skills.
Microsoft Office basic skills.

Preferred Qualifications/Experience:

Knowledge of InterQual OR American Society of Addiction Medicine (ASAM) criteria.
Knowledge of current National Committee for Quality Assurance (NCQA)/Utilization Review Accreditation Commission (URAC) standards.

Why us?

We do this through our people.

Thank You!

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

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra.com/careers/

EOE AA M/F/Vet/Disability

Benefits

Compensation

The pay range for this position is $36.06 – 38.47 / hour.

Based on our compensation philosophy, an applicants placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.

Customer Care Nurse

The Hartford Remote.coabout 2 months ago

Apply Nowabout 2 months ago

location: remoteus

Apply Now

Customer Care Nurse

Location:United States -Remote

100%Remote

Full time

Customer Care Nurse – CQ09CN

Were determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals and to help others accomplish theirs, too. Join our team as we help shape the future.

Our team is committed to driving profitability by delivering exceptional customer service, great claim outcomes and returning people to work! We have some of the best claims leaders and handlers in the industry!As a Customer Care Nurse, you will work in a fast-paced incoming call environment where you play a pivotal role in the claim intake process for an injured claimant! This dynamic and experienced team of medical professionals work remotely across the United States to facilitate Short-Term (STD) and Long-Term Disability (LTD) case files. The successful Customer Care Nurse typically handles 35-40 calls per day which allow them to obtain critical medical information relevant to the disability claim file. During these short 15 minute intake calls, the Customer Care Nurses use their keen clinical skillset to assess, document and review the medical acuity of a claimants condition. Our exceptional team of clinical professionals model empathy and compassion as they walk the claimant thru the intake process.

RESPONSIBILITIES:

Provide the claimant with the explanation of intake and subsequent claims process expectations
Effectively assess, evaluate and document a claimants medical information to initiate the claim process while simultaneously reviewing functional limitations or work accommodations
Gather medically diagnosed restrictions and/or limitations for Return To Work expectations
Determine the medical complexity and appropriate assignment duration and/or a medical milestone for the assigned claim
Accurately enter employee/employer/physician intake information into our claim technology platform for the appropriate tracking of all clinical impressions which enables a Claims Ability Analyst to facilitate a claimdecision based on a claimants functional condition
Effectively communicate complex medical information to a claimant in a clear, simple and concise manner
Demonstrate sound medical knowledge and clinical assessment in a time-sensitive claim intake

QUALIFICATIONS:

Prefer candidates in either the West or Central time zones
An active LPN/LVN license is required, RN licenses will be considered
Minimum of 12 months of practicing clinical experience with broad spectrum knowledge about anatomy and physiology
Clinical Case Management experience preferred
Excellent communication skills (oral/written)
Excellent keyboard/automation skills
Working proficiency of MS Office (Word, Excel, Outlook & PowerPoint)

ADDITIONAL INFORMATION:

Start date: Monday, June 3rd, 2024
Location: This is a 100% remote, work from home opportunity
Training hours: 10:00 AM – 6:30 PM EST, Monday thru Friday for the first 8 weeks of employment. Time off during training is not accommodated
Post training: 11:30 AM – 8:00 PM EST, Monday thru Friday
Internet Connectivity Requirement/Remote Positions: For 100% remote positions, we require that (1) you have high speed broadband cable internet service with minimum upload/download speeds of 10Mbps/100Mbps and (2) your Internet provider supplied device is to be hardwired to the Hartford issued router and/or computer. To confirm whether your Internet system has sufficient speeds, please visit http://www.speedtest.net from your personal computer.

Compensation

The listed annualized base pay range is primarily based on analysis of similar positions in the external market. Actual base pay could vary and may be above or below the listed range based on factors including but not limited to performance, proficiency and demonstration of competencies required for the role. The base pay is just one component of The Hartfords total compensation package for employees. Other rewards may include short-term or annual bonuses, long-term incentives, and on-the-spot recognition. The annualized base pay range for this role is:

$63,760 – $95,640