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Remote Health Care Jobs

Essential Job Duties:

Respond promptly to each incoming call and assist patients by providing standardized care and benefits navigation, while quickly developing a friendly, yet professional rapport over the phone
Conduct a thorough clinical assessment of symptoms and confidently determine the appropriate level of care required to safely meet the patient’s medical need, and refer them using established guidelines
Follow standard procedures and protocols related to the triage service
Educate and communicate recommendations to patients thoroughly in patient-friendly language
Successfully route members to additional internal/external benefits and community resources, when needed
Provides care based upon the Included Health Core Values
Provides triage and support for urgent member prescription needs
Serves as a central point of contact for all Included Health member emergency escalations
Participate in team meetings and continuous quality improvement

Requirements:

Bachelor of Science in Nursing required
Registered Nurse, currently residing and licensed in a compact state with eligibility to obtain RN licensure in all 50 states
2+ years experience in a triage setting, preferably some of that experience being focused on phone triage, or 2+ years experience in an emergency room, or 4+ years experience in an ambulatory primary care role that included triage
Ability to work in PST Timezone
Expertise in advanced clinical decision making
Comfortable working with a wide variety of medical conditions for both pediatric and adult populations
Experience in engagement in complex decision making, including situations of uncertainty
Excellent written and verbal communication skills. The ability to gather a clinical history, answer questions at a patient level, and succinctly summarize findings is critical.
Strong competence and ability to use multiple computer/medical record systems, as well as Google suite
Must be able to work efficiently. We are a fast growing company and we are busy. Our team is expected to meet role specific metrics without sacrificing quality. Good judgment for balancing priorities is a must.
Maintain current nursing licensure by completing applications for renewal in a timely manner and by complying with all requirements for continuing education.

Other Skills/Abilities:

Self-disciplined, energetic, passionate, innovative and flexible
Must be able to work independently remotely and work well under stress
A team player that can follow a system and protocol to achieve a common goal
Demonstrates sound judgment, independent decision-making and problem-solving skills
Maintain current nursing licensure by completing applications for renewal in a timely manner and by complying with all requirements for continuing education.
Maintains professional demeanor and service-oriented patient focus to prioritize the patient experience
Possess the ability to multitask, and using best judgement when to seek additional input from leadership

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About Included Health

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

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

Credentialing Coordinator

GenesisCare Remote.co11 months ago

Apply Now11 months ago

location: remoteus

Apply Now

Credentialing Coordinator

locations

US-Remote

time type

Full time

job requisition id

R0017443

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

The Credentialing Coordinator is responsible for completing the Managed Care Credentialing/Recredentialing applications in a timely and accurate fashion. The Coordinator is responsible for follow-up to ensure that the physician is enrolled on the contracted managed care plans.

Your Key Responsibilities:

Responsible for creating Physician Reference Guides (PRG) in the department’s Access Credentialing Database for new physicians.
Responsible for CAQH on-line credentialing set up and maintenance efforts.
Accurate and timely submission of Managed Care Credentialing & Recredentialing applications for physicians and paraprofessionals.
Timely follow-up phone calls & documentation on a monthly basis to verify that credentialing applications have been received, until effective date is obtained.
Composing email notifications regarding participation effective dates for providers to appropriate market contacts, office & billing staff members.
Responsible for developing and updating Contract Summary Sheets with physician effective dates.
Responsible for requesting expired information for providers on a monthly basis to keep credentialing up to date.
Responsible for updating the Recredentialing portion of the database and auditing plans quarterly to ensure all recredentialing efforts are current.
Updating Managed Care Monthly (MCM) Updates with provider’s effective dates.
Notifying Managed Care plans regarding practice changes such as add/term locations & add/term providers and completing monthly follow up phone calls & documentation on open requests, until process is complete.
Assist other departments with credentialing and contracting issues as it pertains to claims.
Other duties as assigned.

Minimum Qualifications:

Must have a High School Diploma or equivalent.
Applicant must have credentialing experience in a physician office or health plan environment.
Advanced Excel Skills and proficient in MS Office.

Preferred Qualifications:

Experience working with Access.

About GenesisCare:

Across the world, we have more than 440 centers offering the latest treatments and technologies that have been proven to help patients achieve the best possible outcomes. For radiation therapy, that includes over 130 centers in the U.S. as well as 14 centers in the U.K., 21 in Spain and 36 in Australia. We also offer urology and pulmonology care in the U.S. in over 170 integrated medical offices. Every year our team sees more than 400,000 people globally.

Our purpose is to design care experiences that get the best possible life outcomes. Our goal is to deliver exceptional treatment and care in a way that enhances every aspect of a person’s cancer journey.

Joining the GenesisCare team means a commitment to seeing and doing things differently. People centricity is at the heart of what we dowhether that person is a patient, a referring doctor, a partner, or someone in our team. We aim to build a culture of care’ that is patient focused and performance driven.

GenesisCare is an Equal Opportunity Employer that is committed to ersity and inclusion.

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GenesisCare is an Equal Opportunity Employer.

Customer Contract Analyst

Syneos Health Remote.co11 months ago

Apply Now11 months ago

location: remoteus

Apply Now

Customer Contract Analyst

Updated: Yesterday

Location: United States-North America – US Home-Based

Job ID: 23003190

Description

Customer Contract Analyst

Syneos Health is the only fully integrated biopharmaceutical solutions organization purpose-built to accelerate customer success. We lead with a product development mindset, seamlessly connecting our capabilities to add high-value insights to speed therapies to patients and provide practical value to help our customers achieve their objectives.

Every day we perform better because of how we work together, as one team, each the best at what we do. We bring a wide range of talented experts together across a wide range of business-critical services that support our business. Every role within Corporate is vital to furthering our vision of Shortening the Distance from Lab to Life®.

Discover what our 29,000 employees, across 110 countries already know:

WORK HERE MATTERS EVERYWHERE

Why Syneos Health

We are passionate about developing our people, through career development and progression; supportive and engaged line management; technical and therapeutic area training; peer recognition and total rewards program.
We are committed to our Total Self culture – where you can authentically be yourself. Our Total Self culture is what unites us globally, and we are dedicated to taking care of our people.
We are continuously building the company we all want to work for and our customers want to work with. Why? Because when we bring together ersity of thoughts, backgrounds, cultures, and perspectives – we’re able to create a place where everyone feels like they belong.

Job responsibilities

Maintains ownership of and manages contract process to ensure timely delivery and execution consistent with standard cycle times, including but not limited to, the coordination and finalization of the contractual instrument and budget to align with defined scope of work.
Negotiates and prepares contracts, budgets and related documents for participation in clinical trials. Analyzes and validates contract and budgetary changes and provides appropriate commentary to Project Managers and Customer to support the overall budget value. Proactively communicates budgetary issues to internal parties, escalates deviations to department leadership and stays engaged in communications until issues are resolved.
Drives quarterly revenue targets through active workload management and prioritization and setting of plans for delivery and execution. Contributes to team effort and takes self-initiative to accomplish inidual targets that align with quarterly departmental goals.
Develops Customer relationships and works independently with Project Managers and Customer on assigned projects. Attends face-to-face meetings or calls with Project Managers and Customers as needed to ensure timely execution of contract.
Updates and maintains timely records in Customer Relationship Management (CRM) system and Contract Management System based on Global Deal and Contracts Management (GDCM) processes throughout the day on a daily basis.
Works consistently within the department’s metrics/timelines for completion of documents.
Follows all GDCM review processes and strives to consistently deliver a quality product to both internal and external Customers. Evaluates contracts for completeness and accuracy by comparing to department guidelines to determine adherence and ensures that corrections are appropriately made and documented to ensure the highest quality document is always delivered.
Maintains a high level of flexibility. Creates and resets priorities as the need arises. Identifies and raises issues before they become critical and adjusts quickly to the changes of a dynamic organization.
Perform all other duties as assigned. Minimal travel may be required (up to 25%).

Qualifications

What we’re looking for

BA/BS degree in a Business Administration or Finance with a minimum of 1-3 years’ experience, preferably in budgeting, finance, proposal development and/or contracts management within a clinical research/pharmaceutical environment; or equivalent combination of education, training and experience.
Must be customer-centric, self-motivated and proactive. Flexibility in responding to job demands.
Have excellent problem-solving skills and above average attention to detail.
Ability to perform several tasks simultaneously, to meet critical deadlines and possess strong analytical skills.
Knowledge of Microsoft Excel, Word and an understanding of costing models.
Ability to prepare and interpret budgets.
Ability to work successfully in a team environment and maintain effective working relationships with colleagues and manager.
Demonstrates effective time management skills.
Ability to prioritize multiple tasks with management guidance and oversight.
Excellent interpersonal, verbal and written communication skills.
Demonstrates a positive and flexible attitude toward new and/or unconventional work assignments.
Ability to consistently perform and deliver a high-quality work product. Excellent organizational skills. Ability to work well under pressure and adapt to changing priorities.
Knowledge of clinical trial proposal process and budget management.
Professional ability to interact with iniduals at all levels and different personalities.
Proficiency in mathematics and ability to work with budgets.
Good interpersonal skills and ability to work well with others.

Department Chair - Nursing

American Public University System - APUS Remote.co11 months ago

Apply Now11 months ago

location: remoteus

Apply Now

Department Chair – Nursing (Online/Remote)

Job Category: Academics

Requisition Number: DEPAR004695

Posting Details

Full-Time
Locations: Online / Remote

Job Details

Description

* When Applying: Upload a CV and a copy of unofficial transcripts, master’s degree and above. Student issued/unofficial copies are acceptable. Please do not send us official copies, unless specifically asked.

The Department Chair is a key leadership position within the University. The Department Chair provides the leadership for a quality learning experience for students by ensuring coherence in the discipline and relevance to the practice in support of the University Mission. This leadership position contributes to a range of activities that supports student learning outcomes, program quality, discipline integrity, and faculty growth, success, and belonging, all of which focus on student learning, teaching excellence, and faculty and student retention. The Department Chair collaborates with other departments including the Office of the Provost, Faculty Human Resources, Curriculum and Assessment, Instructional Design, Trefry Library, Electronic Course Materials, and the Center for Teaching and Learning, as well as operational departments such as Advising, Registrar, Marketing, Enterprise Data Office, Workforce Learning Solutions, and Military and Corporate Outreach. The Department Chair oversees the daily operations of one or more programs and faculty.

Responsibilities:

Essential operations responsibilities include the ability to:

Articulate the department’s goals and needs to advance the department’s programs within the School, as well as outside the institution
Confer with internal and external stakeholders and advisory groups to obtain knowledge of student, curricular, occupational, discipline, or University needs
Collaborate with cross-functional departments and program stakeholders to develop, measure, and evaluate student learning outcomes, instructional efficacy, and student persistence and retention for continuous improvement
Contribute to and participate in the annual strategic planning and budgeting processes
Manage student conduct, appeals, and grievance processes

Essential teaching and learning culture activities include the ability to:

Hire, develop, support, and evaluate faculty
Document faculty successes and improvements in teaching, research, curriculum management, and service
Recognize faculty and colleagues for outstanding performance and accomplishments
Assign courses / credential faculty to teach
Assign appropriate amount of curriculum development to FTF
Regularly communicates with faculty
Convene regular faculty meetings

Essential leadership activities include the ability to:

Develop and support faculty to ensure discipline and program continuity, currency, and relevancy
Collaborate with faculty to ensure the program’s evolution reflects external changes in the discipline, external market, and internal changes within the University
Empower and support faculty to create student-centric, inclusive, welcoming learning environments in which all students can succeed
Model good engagement in the discipline
Demonstrate excellence in teaching and share effective practices within the University community
Uphold academic quality design by leading curriculum innovation, academic rigor, and teaching excellence

Effective leaders will possess these critical skills and professional characteristics:

Contribute and model professionalism as a thought-leader within the discipline, the School, and the University
Remain current on trends and developments within academic disciplines and leadership
Take initiative to address current challenges and opportunities with forward-thinking solutions
Show attention to detail and accountability for deliverables while managing competing priorities
Collaborate effectively, respectfully, and constructively with faculty and staff following the APEI employee handbook, APUS employee handbook and faculty handbook
Coach and develop others to improve performance and achieve professional goals
Practice emotional intelligence and coaching techniques, especially when managing stressful situations and difficult conversations
Value the ersity, equity, inclusion, belonging, strengths, and perspectives of others
Adapt quickly to changing priorities, strategic initiatives, and industry trends
Communicate effectively via written, oral, and visual media
Flexibility when need arises

Required Education and Experience:

Doctoral degree in nursing or a closely related field from a regionally accredited institution is required.
Five or more years of nursing experience is required
Five or more years of teaching experience is required.
Academic management and leadership experience is required.
Online teaching experience is required.
Proficient in Microsoft Office Suite programs required.
Experience with nursing specialty accreditation is strongly preferred.

Compensation and Benefits:

Full-time faculty are salaried employees. The starting salary for this position is $90,000 annually.
Information regarding our faculty benefits may be found here: https://www.apus.edu/about/careers/faculty.

*Please Note: Full-time faculty members and department chairs are to consider APUS their primary employer. Full-time salaried faculty and department chairs may not be full-time employees of any university, school, college, or institution of higher education outside of APUS; this includes administrative, staff, and teaching positions.

About Us:

American Public University System (APUS) is an Online University based in Charles Town, WV. Our company has over 100,000 students. Our emphasis is educating our nation’s military and public services communities with quality and affordable education. APUS provides partnership and commitment in helping students realize the dream of a higher education and the opportunities that brings. It is the policy of American Public University System (APUS) to afford equal opportunity to all qualified persons. We treat all qualified iniduals equally as to their recruitment, hiring, assignments, advancements, compensation, and all other terms and conditions of employment. of American Public University System (APUS) does not discriminate on the basis of race, color, religion, creed, sex, age, national origin, sexual orientation, or physical, mental, or sensory disability, or any other characteristic protected by law.

Sales Excellence Support Associate

eHealthInsurance Services Inc. Remote.co11 months ago

Apply Now11 months ago

location: remoteus

Apply Now

Sales Excellence Support Associate

locations

USA Remote

job requisition id

R3346

Get your career started at eHealth

eHealthInsurance has many exciting career opportunities in a number of locations, across various functions. Come join us today!

We are seeking a Sales Excellence Support Associates Full time and Seasonal to join the Sales Excellence team. The Sales Excellence Support Associate works directly with both sales supervisors and agents providing timely feedback with notes that will ensure inside sales agents adhere to pre-defined processes and company policies.

Attributes we are seeking:

We are seeking highly motivated self-starters comfortable being an inidual contributor as well as functioning within a group dynamic. As a Support associate at eHealth, you will be responsible for reviewing sales interactions for adherence to Sales Mastery University quality standards, while identifying areas in which to improve sales performance and increase reliability of the agent’s sales process.

Strong listener with exceptional attention to detail, able to perform daily call monitoring and evaluate call transcripts to ensure that processes are being followed.
Analytical thinker with the ability to analyze data and trends, and proactive in recommending opportunities to enhance the customer experience and sales performance.
Attend weekly calibration meetings with Sales leadership team, giving feedback and running meetings
An eye for efficiency, constantly looking for ways to streamline and improve quality assurance processes and procedures.
Effective collaborator, capable of working with different audiences such as sales leadership, analysts, and other quality assurance specialists.
Ability to execute in a fast-paced environment in which priorities may frequently change.
Self-starter that is results-oriented, able to get things done without constant direct supervision.
Team player, willing to share best practices and coach peers as necessary.
Willingness to participate in special projects as required.

Salary: $58,000 annually

Basic Qualifications:

Bachelor’s Degree, or the equivalent combination of education, professional training, and/or work experience
3+ years of relevant work experience
Excellent written and verbal communication skills
Good understanding of customer service industry standards

Preferred Qualifications:

2+ years of experience working in the Medicare industry
1+ year of Quality Assurance in a call center or related experience, preferably in the Medicare industry
Basic knowledge of quality assurance and continuous improvement concepts, procedures, and processes
Familiarity with NICE inContact or similar telephony tools
Outstanding time management skills, with a track record of making deadlines in a fast-paced environment
Exceptional organizational skills, with the ability to multitask and manage competing priorities

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The base pay range reflects the anticipated pay range for this position. The actual base pay offered will depend on various factors including inidual skills, experience, performance, qualifications, the department budget, and the location where work is performed. Base pay is one component of eHealth’s total rewards package, which also includes an annual performance bonus, plus an array of benefits designed to support employees’ personal and professional wellness. For more information on our total rewards offerings, please visit our career site.

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Base Pay Range -$47,500 – $59,400

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eHealth is an Equal Employment Opportunity employer. It is our policy to provide equal opportunity to all employees and applicants and to prohibit any discrimination because of race, color, religion, sex, national origin, age, marital status, sexual orientation, genetic information, disability, protected veteran status, or any other consideration made unlawful by applicable federal, state or local laws. The foundation of these policies is our commitment to treat everyone fairly and equally and to have a bias-free work environment.

Ethics and Compliance Specialist

iRhythm Technologies Remote.co11 months ago

Apply Now11 months ago

location: remoteus

Apply Now

Title: Ethics and Compliance Specialist

Location: Remote US

About iRhythm

iRhythm is a leading digital healthcare company focused on the way cardiac arrhythmias are clinically diagnosed by combining our wearable bio sensing technology with powerful cloud-based data analytics and Artificial Intelligence capabilities. Our goal is to be the leading provider of ambulatory ECG monitoring for patients at risk for arrhythmias. iRhythm’s continuous ambulatory monitoring has already put over 4 million patients and their doctors on a shorter path to what they both need answers.

About this role:

We are seeking an ethics and compliance professional with an aptitude for enabling compliant high-performing cultures. Our ideal teammate has a desire to grow professionally and a commitment to being a compliance business partner. This role will be a part of a fast-paced, results-driven environment that fosters employee growth and career development.

Responsibilities Include:

Deliver employee training, evaluate ethics and compliance activities, and act as a liaison between the Global Risk and Integrity (GRI) team and the organization
Conduct compliance research and develop presentations for leadership and the organization
Develop and provide employee training on compliance policies, practices, and reporting systems
Track compliance projects and ensure timely/effective follow up, as appropriate
Support policies and procedures development and associated communication, education, and follow up
Coordinate and conduct periodic monitoring and internal investigations and assessments
Develop and track compliance dashboard(s)
Serve as an internal and initial point of contact for compliance and privacy-related questions and concerns
Maintain compliance program documentation
Provide timely and effective communication with and data/reporting to the GRI team, Chief Compliance Officer, and the Chief Risk Officer
Develop engaging compliance communications and educational materials to reinforce awareness
Conduct work with integrity and compassion
Engage with all teammates in support of our positive and inclusive environment

Qualifications:

Bachelor’s degree required
3+ years professional experience, with 1-2 years of compliance experience required
Experience in health care compliance field including Federal Healthcare Regulations and International Healthcare Regulations
Experience utilizing project management methodologies
Ability to work in a fast-paced environment while maintaining a positive attitude
Self-motivated and self-disciplined with the willingness to exceed expectations, learn and grow
Demonstrated learning agility and growth mindedness; adaptable to new ideas and proactively applies new learnings
Exceptional written and verbal communication skills
Exceptional time management and ability to multi-task and prioritize
Ability to coordinate and work effectively across a geographically dispersed organization
Candidate should be very experienced in Microsoft Excel and PowerPoint

Preferred Qualifications

Life Sciences/Medical Device background is preferred, but not required
Ability to occasionally travel is preferred
Deep understanding of laws, regulations, standards, and risks relevant to medical device compliance is preferred

What’s in it for you:

This is a full-time position with a competitive compensation package and excellent benefits including medical, dental and vision insurance, paid holidays and paid time off.

iRhythm also provides additional benefits including 401K (w/ company match), employee stock purchase plan, annual organizational and cultural committee events and more!

FLSA Status: Exempt

As a part of our core values, we ensure a erse and inclusive workforce. We welcome and celebrate people of all backgrounds, experiences, skills and perspectives. iRhythm Technologies, Inc. is an Equal Opportunity Employer (M/F/V/D). Pursuant to San Francisco Fair Chance Ordinance, we will consider for employment all qualified applicants with arrest and conviction records.

Make iRhythm your path forward.

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Outpatient Complex Coder

Banner Health Remote.co11 months ago

Apply Now11 months ago

location: remoteus

Apply Now

Outpatient Complex Coder Remote

locations

Remote US

time type

Full time

job requisition id

R4339032

Primary City/State:

Phoenix, Arizona

Department Name:

Coding-Acute Care Hospital

Work Shift:

8 hours

Job Category:

Revenue Cycle

Primary Location Salary Range:

$23.84 – $35.77 / hour, based on education & experience

In accordance with State Pay Transparency Rules.

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

Ideal Acute Care/Facility Same Day Surgery Outpatient Complex Coder | Medical Coder will have experience coding Acute Care Same Day Surgeries (multiple specialties – and have wide variety), Observation visits, solid CPT skills in a variety of encounters/surgery types, working knowledge of PCS coding fundamentals, and experience addressing NCCI edits and applying appropriate modifiers. They would be able to work effectively with common office software and coding software and abstracting systems. In most of our Coding roles, there is a Coding Assessment given after each successful interview. Banner Health provides your equipment when hired.

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

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

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

POSITION SUMMARY

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

CORE FUNCTIONS

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

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

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

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

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

MINIMUM QUALIFICATIONS

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

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

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

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

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

PREFERRED QUALIFICATIONS

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

Previous experience in large, multi-system healthcare organization.

Additional related education and/or experience preferred.

Licensed Nurse Practitioner

Vesta Healthcare Remote.co11 months ago

Apply Now11 months ago

location: remoteus

Apply Now

Title: Full Time New York (NY) Licensed Nurse Practitioner (NP)

Remote

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

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

Our program monitors in real-time, identifying issues before they become health events, and helping connect those in need with those who can help via technologies such as video, chat, and telephone. Our technology platform includes home-based mobile applications, a clinical dashboard, and data analytics on data not previously available to health professionals. We are disrupting a $109 billion industry and have recently closed our latest funding round with a blue-chip list of investors.

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

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

The ideal teammate would be…

A person who’s passionate about working closely with a clinical team to ensure the best clinical outcomes for those we serve. A person who enjoys a fast paced clinical environment, performing telephonic and virtual visits related to proactive chronic care management, remote patient monitoring, and/or resolving more urgent clinical issues quickly. Lastly, someone who aspires to work with a company who is on the leading edge of community health working with partners to allow our elderly to remain at home and free of avoidable hospitalizations.

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 in the state of New York (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)
Experience working in home care and/or family medicine, geriatrics (preferred)
Experience working within a clinical team environment
The ability to work remotely and has a private area with a computer in their home/workspace (required)
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

Pay range is $120K – $125K annually based on experience.

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

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

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

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

Coordinator - Appeals

Maximus Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Coordinator Appeals

Job Locations: USRemote

Requisition ID: 202389528

# of Openings: 1

Job Function: Clinical

Job Schedule: Regular FullTime

Job Summary

Essential Duties and Responsibilities:

Function as a Subject Matter Expert in one or more process areas.
Analyze data submitted for Independent Medical Review.
Conduct fact finding and analyses on those cases deemed complex in nature or requiring adjudication; apply established procedures where the nature of the system, feasibility, computer equipment and reporting tools have not already been decided.
Track and meet required deadlines for complex cases or other assigned tasks.
Assist leadership through research of data and/or authoring reports.
Analyze data using all applicable state law, state regulations, process documents, and other sources as defined by the client contract.
Work independently on specific situations or on a team to resolve problems and deviations according to current established practices; and obtains advice where precedents are unclear or not available from the client.
Answer and respond to phone calls/emails from participants in the Independent Medical Review process.
This position may assist others or provide onthejob training or act as a mentor to production staff.

Minimum Requirements:

High School diploma or equivalent with 0-2 years of experience.

MAXIMUS Introduction

Since 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of governmentsponsored programs. With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.

EEO Statement

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

Pay Transparency

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

Posted Max

USD $24.04/Hr.

Posted Min

USD $9.62/Hr.

Professional Coder

Mayo Clinic Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Professional Coder – Remote

Job ID 306596

Rochester, MN

Full Time

Finance

Why Mayo Clinic

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

Responsibilities

The Professional Coder reviews, analyzes, and codes professional/physician medical record documentation to include, but not limited to, medical diagnostic, lab, pathology and E/M coding information for various practices in the hospital outpatient, hospital inpatient and clinic settings.

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

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

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

Qualifications

–Associate’s Degree required; Bachelor’s Degree preferred.

-Minimum of 2 years of physician/professional coding experience with E/M services.

License of Certification:

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

Exemption Status

Nonexempt

Compensation Detail

$24.85 – $33.57 / hour. Education, experience and tenure may be considered along with internal equity when job offers are extended.

Benefits Eligible

Yes

Schedule Full Time

Hours/Pay Period 80

Schedule Details Monday – Friday with typical business hours between 8:00 am – 4:30 pm CST.

Weekend Schedule Based on business needs.

International Assignment No

Site Description

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

Affirmative Action and Equal Opportunity Employer

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

Pro Fee Coder - Radiology

Savista Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Pro Fee Coder – Radiology

Remote – USA
Full time

R2508

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

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

DUTIES AND RESPONSIBILITIES:

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

SKILLS AND QUALIFICATIONS:

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

PREFERRED SKILLS:

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

Note: Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $22.08 – $34.69 an hour. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.

SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.

Clinical Content Specialist - Nursing

Wolters Kluwer Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Clinical Content Specialist – Nursing

Apply

locations

USA-MN-Remote

USA-AZ-Work from Home

USA-IL-Work from Home

USA-IN-Work from Home

USA-GA-Work from Home

View All 7 Locations

time type

Full time

posted on

Posted 2 Days Ago

job requisition id

R0035833

R0035833

Clinical Content Specialist Nursing

MN – Remote, U.S.

We are looking for a Clinical Content Specialist – Nursing to facilitate our mission to provide both faculty and students with best-in-class educational tools. We are known as innovators in the Nursing Education market and are constantly looking for new and inventive ways to prepare students for entry-level practice. If you’re an analytical thinker passionate about enabling the next generation of nurses, we want to hear from you!

The Clinical Content Specialist – Nursing will work closely with the Content Management Consultant to integrate our products within an institution through their curriculum. Together they will also plan and deliver high quality NCLEX Review and Consultation services by identifying and assessing client needs and developing evidence-based, best practice, content for faculty and students to assist in preparation for the NCLEX.

The Clinical Content Specialist – Nursing will work cross-functionally with internal and external stakeholders to provide updates to assessment products and coordinate efforts with the nursing education team. The ideal candidate will be passionate about Nursing Education, pedagogy, analysis, and student success as well versed on the New Generation NCLEX. The person will be able to work collaboratively in a team-based approach to achieve goals and have a bias toward action. This candidate should be ready to e in and understand the current market of Nursing Education and the importance of student success to prepare future nurses for the innovative and dynamic world of nursing.

ESSENTIAL DUTIES & RESPONSIBILITIES

The Senior Content Management Analyst’s primary responsibilities include:

Develop and maintain data analysis procedures to help provide clients with the best information possible when promoting student retention and success.
Teach faculty how to maximize the use of their adopted resources using evidence-based practice in nursing education.
Develop program and product-centered communications via multiple media platforms for Wolters Kluwer.
Provide information about other Wolters Kluwer products and services that may be relevant based on conversation with the client.
Follow up with clients responding to questions/concerns from decision makers.
Assist in effectively integrating our products throughout a client’s curriculum.
The ability to fully understand strengths and weaknesses as a whole or inidually per program within an institution.
Provide top quality customer service to current and future customers.
Facilitate PreView, ReViews, Mentoring and Consultations to current and future long-standing customers.
Assist on creating learning tools to be used by faculty from our product line.
Provide faculty education through conferences, webinars, recorded sessions, and in-person training.
Utilize multiple modalities in teaching faculty and students.
Ability to stay up to date on Nursing practice and Nursing Education fields of studies.

Other Duties:

Travel up to 40 – 50% as needed for NCLEX reviews, conferences, consultations, and training.
Trend information discussed with clients that may be the platform for new products.
Collaborate with the nurse educator team to evaluate practices and processes in place.
Flexible to work on other product development as needed.

QUALIFICATIONS

Education: Education: Master’s Degree in Nursing required. Doctoral degree in nursing (PhD or DNS (DNP) preferred)

Required Experience:

5+ years teaching in academic nursing programs.
5+ years’ experience as a RN.
Experience in NCLEX Review for nursing students.
Experience leveraging data to meet customer needs.
Experience interfacing with customers
Teaching experience in an academic nursing program.
Active RN licensure (unencumbered).
Proficient in Microsoft Office.

Other Knowledge, Skills, Abilities or Certifications:

Strong oral and written communication skills, including presentation skills.
Ability to manage and handle difficult scenarios.
Ability to prioritize and manage complex tasks simultaneously.
Organization, analytical, and planning skills.
Strong cross-functional collaboration skills.
Attention to detail; ability to meet deadlines.
Persistence.
Ability and willingness to travel to meet business goals and objectives.
Professionalism and integrity.
Flexible and Agile to changing environment.

Travel: up to 40 – 50%

Veterinary Nurse

Fuzzy Pet Health Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Veterinary Nurse

REMOTE

DIGITAL HEALTH

FULL-TIME

The Company

Fuzzy is your pet health partner. On a mission to make pet care more accessible, Fuzzy is a subscription-based service offering members 24/7 Live Vet Chat support, virtual vet consultations, and on-demand answers from a team of licensed, on-staff pet health experts. Fuzzy also offers pet parents vet-tested and recommended products and personalized programs for nutrition, training, and obedience.

Through technology, we’re creating a different type of relationship between pet parents and their veterinary caregivers one that’s personal, empowering, and focused on improving the lives of animals.

The Role

We are looking for full time Veterinary Nurses to provide Fuzzy Pet Health customers with a compassionate, thorough, and a medically excellent tele-health experience. Our customers subscribe to the Fuzzy Pet Health digital health experience to get professional, point of need advice about all manner of issues they are having with their pets. You’ll be responsible for using an evolving diagnostic framework to evaluate, consult, and advise pet owners, and following up with customers to ensure successful outcomes.

You’ll use your expertise and training to triage inbound emails and chats, ranging from counseling customers who are experiencing urgent and emergency issues, needing to stabilize their pet and get them to an urgent care facility, to talking owners through minor issues and providing general advice on issues like food allergies, nutrition, dermatology, and parasites.

What We’re Looking For

- At least 5 years of clinical experience
- You love pets and are passionate about helping owners be awesome pet parents
- Excited about the potential for digital transformation in veterinary medicine and you want to make a BIG impact on pet health
- Enthusiasm, collegiality, and integrity are at the core of who you are and how you work
- Reliable, accountable, and find joy in your chosen profession.
- Flexible to work one weekend day per week and some holidays.
- Actively enrolled DVM students are also welcome to apply

Responsibilities

- Provide Fuzzy’s pet parents with a compassionate, thorough, and a medically excellent telehealth experience
- Use your expertise and training to triage inbound emails and chats to mitigate a variety of situations
- Provide counsel to customers experiencing urgent, emergency issues and needing to stabilize their pet in order to get them to a proper care facility
- Talk owners through minor issues and provide general advice on matters related to mild food allergies, nutrition, dermatology, and parasites

We know that great work comes from great, and inclusive teams. At Fuzzy, we specifically look for iniduals of varying strengths, skills, backgrounds, and ideas. We believe this gives us a competitive advantage to better serve our members and helps us all grow as Fuzzyrs and iniduals.

We hire candidates of any race, color, ancestry, religion, sex, national origin, sexual orientation, gender identity, age, marital or family status, disability, veteran status, and any other status. Fuzzy is proud to be an Equal Opportunity Employer and will consider qualified applicants with criminal histories in a manner consistent with the San Francisco Fair Chance Ordinance. If you have a disability or special need that requires accommodation, please let us know.

Nurse Specialist

Labcorp Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Nurse Specialist

Remote_United States

Full time

The Nurse Specialist is responsible for supporting the operations of Labcorp Peri-approval and Commercialization patient support and access programs. This inidual interacts primarily with patients and care partners who are receiving clinical support services from a program. Examples of this type of support may include contact center based-services, such as advising patients on dosing, guiding patients through product administration, providing approved recommendations to patients on managing side effects, discussing medication adherence with patients, or field-based services, such as on-site patient injection training

Additionally, this inidual may be responsie for preparing monthly and ad hoc project-specific reports. The Nurse Specialist also serves as a subject matter expert on programs and is first point of contact for clinical care program calls.

The Nurse Specialist may be either contact-center based or field-based.

Essential Duties

Makes scheduled outbound calls and responds to inbound calls from patients and other customers regarding clinical aspects of a product, product administration, and adherence to medical therapies or treatments or for other related issues. Conducts follow up calls or sends follow up correspondence as necessary according to the program’s guidelines.
Reviews approved therapy or treatment-related information with callers and identifies potential barriers to treatment. Within guidelines approved by the program’s sponsor, helps identify solutions to improve access and to help patients remain on prescribed treatment. Provides approved information to patients and their caregivers in a clear, caring way so that they may make informed choices.
Keep case notes and tracks cases effectively using proprietary computer system. Establishes appropriate activity plans to trigger next call, correspondence, or intervention.
May provide pre-approved medical information or literature to customers based on the guidelines of the specific program.
May conduct /behavioral interviewing and motivational coaching calls with patients to encourage them to be adherent to their medication as prescribed.
Documents adverse events and provides reporting per Labcorp and client policies and procedures
Other duties, as assigned

Experience

Minimum Required:

Minimum of two years customer service and contact center experience strongly desired. Experience with field-based work is also desired.
2 years clinical experience

Education/Qualifications/Certifications and Licenses

Minimum Required:

The Nurse Specialist will have a current RN license in good standing in the state of practice. In addition, will ideally hold a Bachelor’s degree or evidence of continual work toward a degree is strongly preferred. The Nurse Specialist without a Bachelor’s Degree must have an Associate’s Degree and ideally should have four or more years of healthcare or customer service work experience.

Additional required skills include:

Strong written and oral communication skills.
Customer service focus.
Ability to work effectively through influence and collaboration.
Good judgment in managing and escalating client or project issues. Must be able to manage multiple projects and understand contact center processes.
Excellent interpersonal skills.
Ability to identify problems, take initiative, and be solution oriented.

As a leading global contract research organization (CRO) with a passion for scientific rigor and decades of clinical development experience, Fortrea provides pharmaceutical, biotechnology, and medical device customers a wide range of clinical development, patient access and technology solutions across more than 20 therapeutic areas. With over 19,000 staff conducting operations in more than 90 countries, Fortrea is transforming drug and device development for partners and patients across the globe.

Pay Range: $32.00 – $46.00 an hour

Benefits: All job offers will bebased on a candidate’s skills and prior relevant experience, applicabledegrees/certifications,as well as internal equity and market data.Regular, full-time or part-time employees working 20 or more hours per week are eligible for comprehensive benefits including: Medical, Dental, Vision, Life, STD/LTD, 401(K), ESPP, Paid time off (PTO) or Flexible time off (FTO), Company bonus where applicable. For more detailed information, please click here.

Did you know?

Labcorp’s Clinical Development and Commercialization Services business is now Fortrea in connection with its planned spin-off from Labcorp, which is expected in mid-2023. Fortrea’s spin-off from Labcorp is subject to satisfaction of certain customary conditions. This spin-off will position both organizations for accelerated growth and allow each to focus resources on distinct strategic priorities, customer and employee needs and value creation opportunities.As a provider of phase I-IV clinical trial management, regulatory guidance, patient access solutions and market access consulting, Fortrea will partner with both emerging and large pharmaceutical, biotechnology, device and diagnostic companies to drive healthcare innovation and improve the lives of patients worldwide.

Fortrea is looking for problem-solvers and creative thinkers who are passionate about breaking down barriers faced by sponsors of clinical trials, and who are committed to helping transform the development process to get promising life-changing ideas and therapies to patients faster. Join us as we cultivate a workspace where all employees have the opportunity to grow and make impacts on a global scale. For more information and questions related to Fortrea, please visit www.fortrea.com.

Labcorp is proud to be an Equal Opportunity Employer:

As an EOE/AA employer, Labcorp strives for ersity and inclusion in the workforce and does not tolerate harassment or discrimination of any kind. We make employment decisions based on the needs of our business and the qualifications of the inidual and do not discriminate based upon race, religion, color, national origin, gender (including pregnancy or other medical conditions/needs), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic. We encourage all to apply.

Behavioral Health Inpatient Medical Coder

AQuity Solutions Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Remote Behavioral Health Inpatient Medical Coder

Job Category: Coder

Requisition Number: REMOT001376

Part-Time

Locations

Showing 1 location

Virtual, USA

Job Details

Description

About Aquity: Headquartered in Cary, NC, a suburb of Raleigh, Aquity Solutions employs more than 7,000 clinical documentation production staff throughout the U.S., India, Canada, and Australia. With over 40 years of experience and recognized by both KLAS and Black Book as the top outsourced transcription service vendor, Aquity Solutions is focused on delivering superior business results. Aquity Solutions provides healthcare professionals with key services including: Medical Scribing, Interim HIM Services, Medical Coding and Medical Transcription.

Position Summary: As an experienced inpatient coder, you will be responsible for providing coding and abstracting for Inpatient services using ICD-10 CM/PCS coding systems. You will use established coding principles, software and your knowledge and experience to assign diagnostic and procedural codes after a thorough review of the medical record to obtain the appropriate DRG. As a coding professional, we may ask you to mentor new hires by providing education and training. We may need for you to perform other responsibilities when production requirements allow.

Essential Functions:

Reviews Medical Records to identify pertinent diagnoses and procedures relative to the patients’ healthcare encounter
Selects the principal diagnosis and principal procedure, along with other diagnoses and procedures using UHDDS definition. Ensures appropriate DRG assignment.
Abstracts appropriate information from the medical record based on the guidelines provided by the client and after a thorough review of the medical record.
Solicits clarification from the physician regarding ambiguous or conflicting documentation in the medical record using guidelines provided by the client.
May act as a mentor to training coders and/or new hires by providing education and training.
Maintains current knowledge of the information contained in the Coding Clinic and the Official Inpatient Guidelines for Coding and Reporting.
Ability to meet productivity standards while maintaining a 95% accuracy rate.
Assists with other responsibilities when requested.
Maintains effective and professional communication skills.
Contributes to a positive company image by exhibiting professionalism, adaptability and mutual respect.

Requirements:

Licenses/Certifications; CCS, RHIT, RHIA preferred.
Must have a minimum of 1-year Inpatient coding experience.
Extensive knowledge of ICD-10 CM/PCS coding principles and guidelines, DRG Assignment, MCC/CC capture, federal, state and payor-specific regulations and policies pertaining to documentation, coding and billing
Understands medical terminology, anatomy, physiology, surgical technology, pharmacology and disease processes
A high-level of coding accuracy, critical thinking skills and attention to detail
Excellent oral and written communication skills, must be detailed and articulate
Strong knowledge of Microsoft Word, Excel, PowerPoint and Outlook

We have a wide array of customers providing our coders the opportunity to work with different environments and specialty areas- so every day is something new and exciting. The best thing- you can do this from the comfort of your own home. Our coders have an opportunity to work remotely and can work flexible hours contingent on client’s needs.

Senior Manager of Community and Wellness

Plume Hormone Therapy Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Sr Manager of Community and Wellness (Remote)

Remote

Member Success

Remote / Full Time Employee

Remote

At Plume, we’re on a mission to radically transform healthcare access for the transgender and gender-nonconforming communities. As a trans-founded company, we’re proud to be building a virtual care home that makes a difference in countless lives. This work is deeply personal and heart-driven, and we want teammates who, above all else, care. We offer an affirming, trans/queer-friendly, culturally inclusive work environment filled with purpose and camaraderie. Are you ready to be part of our growing team in the healthtech industry?

Available to over 1 million transgender iniduals across 45 states, we’re growing fast and need passionate, talented iniduals like you to join our journey and help us to increase access to life-saving Gender Affirming Hormone Therapy and improve the lives of trans folks. If you have a heart-forward approach and resonate with our values, we’d love to hear from you!

Our Core Values:

We Are Authentic: We opt for honest and direct conversations. We strive to be vulnerable and connect authentically.

We Are Accountable: We follow up and commit to each other within the community and to ourselves.

We Are Growth-Oriented: We take the initiative, we’re proactive learners, and we tackle new challenges.

We Are Inclusive: We’re considerate of working across erse experiences. Every voice is valuable in serving our vision. We have an unusual bias for seeking input.

We Are Collaborative: We put we before I, we stay engaged and communicative when we disagree, and we can commit even if we’re not in complete agreement.

We Are Trans-Informed: We ask why? and distrust the status quo. We honor awkwardness & experimentation over polish and how things have always been done.

If our mission and values speak to you, you’re an experienced Community & Wellness Manager in healthcare, you have a passion for serving marginalized and underrepresented communities, and you have a deep understanding of the trans experience, we can’t wait to meet you!

About the Role:

At Plume, we envision a member experience that provides thoughtful, expert, timely, and gender-affirming care that celebrates and enhances the quality of life for every trans person. Reporting directly to our Sr Director of Member Services, our next Sr Manager of Community and Wellness will oversee our Community and Wellness team as well as the strategic development and implementation of new wellness initiatives, and promote and ensure quality community engagement through a robust engagement platform, including the creation and monitoring of community events, peer support groups, bulletin boards, etc. Your duties will span team leadership & management, program development & evaluation, community engagement, the design/delivery of persuasive presentations, and more! You’ll work cross-functionally with our Director of Strategic Partnerships to evaluate member retention and satisfaction metrics, and build/nurture relationships with external mission-aligned organizations to enhance our offerings and promote our members’ wellness.

Responsibilities:

Provide leadership, guidance, and mentorship to our Community and Wellness team, supporting professional development, assessing performance, and conducting regular stand-up meetings and 1:1s to discuss progress, challenges, and future plans
Represent Community Wellness needs and priorities on the Member Services management team, and manage communications and relationships with partners to ensure effective collaboration and alignment with Plume’s mission, values, and goals
Design, manage, evaluate, and ensure the effectiveness of our overall Community Wellness program, including creating new programs to address the wellness needs of our members and incorporating input from the community and external partners
Establish partnerships with mission-aligned organizations to enhance our member wellness initiatives, and evaluate these programs/initiatives to ensure their success and impact, adjusting to ensure effectiveness when appropriate
Prepare reports on community engagement and program evaluation to assess the effectiveness of initiatives
Contribute quarterly to strategic planning and goal-setting for the Community Wellness program and Member Services team, helping to identify, measure, and KPIs and OKRs
Accountable for the success of relevant cross-functional projects
Supervise community engagement activities, which encompass guiding Plume support groups and community events, managing resources for members, and both leading and taking part in public speaking opportunities
Collaborate cross-functionally to launch and manage a care navigation and peer coaching program that supports members in their wellness journey
Provide escalation support, effectively addressing community issues and safety concerns
Due to the nature of startups, this role is expected to be dynamic and may evolve to encompass additional duties and ad hoc projects as needed

About you:

A strong appreciation for the trans experience and a desire to increase access to gender-affirming care
Adept at multitasking, prioritizing, and working quickly. Even in a remote, fast-paced startup setting, you hold yourself and others accountable to meet deadlines and complete tasks
Excellent in cultivating and maintaining relationships, working collaboratively with both internal and external stakeholders, and ensuring alignment with Plume’s mission, values, and goals
Excellent at planning, organizing, and focusing on the important tasks
Innovative problem-solver with a knack for generating unique and effective solutions
Proficient in fostering professional growth and development in others
Strategic thinker with the ability to visualize the big picture and anticipate future trends
An exceptional communicator who excels in clear and concise speaking, writing, listening, and presenting
Analytically minded, adept at preparing reports and evaluating the effectiveness of initiatives

Qualifications:

7+ years of experience in healthcare (10+ years preferred)
6+ years of experience directly managing people & teams, ideally within healthcare
Strong experience or demonstrated focus on working with marginalized or underrepresented communities
Prior experience in telehealth, digital-health, or health-tech startups is a plus!
Extensive experience in program management, design, and evaluation, particularly related to wellness initiatives and community engagement
Proven ability in strategic planning, establishing KPIs and OKRs, and preparing reports to assess program effectiveness
Proven ability to establish and nurture partnerships with organizations that align with our mission & values
Direct experience in managing crisis situations, effectively addressing community issues and safety concerns preferred
Familiarity with or experience in care navigation and peer coaching programs preferred

Compensation & Perks:

Competitive Annual Salary DOE
Ground-Floor Equity
Medical, Dental, Vision, 401(k)
Free Plume and Mental Health Subscriptions

Plume is an equal-opportunity employer. Trans and gender-nonconforming iniduals are strongly encouraged to apply, particularly those who identify as people of color, and we also encourage applications from suitably qualified and eligible candidates regardless of age, color, disability, national origin, ancestry, race, religion, gender, sexual orientation, gender identity and/or expression, veteran status, genetic information, or any other status protected by applicable law. We will provide reasonable accommodations to iniduals with disabilities upon request. Please let us know if you require any accommodations to apply or interview for this position.

Discover more about Plume at www.getplume.co and become part of our award-winning journey towards transforming healthcare for every trans life. Join us today in shaping the future of healthtech and LGBTQ+ care!

Bilingual Registered Nurse

Vesta Healthcare Remote.co11 months ago

Apply Now11 months ago

location: remoteus new york

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Title: Full-Time Bilingual Registered Nurse (Remote)

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

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

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

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

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

The ideal teammate would be

As a Registered Nurse, you will be a valued member of the team. We are looking for an RN who recommends resources and creates Personalized Home Intervention Plans for high-risk, high-utilizer iniduals to facilitate quality inidualized treatment interventions and outcomes. This position will collaborate with the clinical team in maintaining a successful program which may include helping develop workflows, reporting, staff recruitment and training. They will be responsible for the day-to-day work with patients related to in-home insights & interventions needed for quality outcomes to reduce avoidable admissions, readmissions, and ED utilization. This is a remote/work from home position.

The ideal teammate 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
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 support
Apply clinical experience and judgment to the utilization management/care management activities
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
Participate in quality management/performance improvement activities

Would you describe yourself as someone who has:

Graduated from an accredited nursing program (required)
Current NY RN License in good standing? (required)
2+ years of experience in a fast-paced health services organization providing community care services ideally including care management, home care, remote telephonic triage, palliative care, and/or other related services (required)
Bilingual in English and Spanish, Russian, Mandarin and/or Cantonese (required)
Experience providing care to adult and geriatric patient populations (required)
Experience with Chronic Care Management and Advanced Care Planning workflow (preferred)
Ability to identify social determinants of health and develop goals associated with overcoming barriers (preferred)
Strong analytical, written and verbal communication skills; demonstrated ability to think critically and make decisions based on data
Very strong computer skills with ability to toggle between multiple systems simultaneously
Metrics and process-driven, passionate about numbers as well as people
Motivated self-starter and creative problem-solver who is comfortable working in a fast-paced, dynamic environment
A genuine, compassionate desire to serve others and help those in need

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, home equipment, 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 + match

Pay range is $82K – $87K based on experience. (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).

We look forward to speaking with you!

Medical Coding Specialist

pMD Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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(Contract) Medical Coding Specialist

REMOTE, US

OPERATIONS

CONTRACT

REMOTE

We hold ourselves to exceptionally high standards in order to provide unparalleled service to healthcare professionals, their staff and patients. We strive to end each workday knowing that we’ve made someone’s life better.

Our team is comprised of courageous and caring healthcare warriors. We’re here to solve the impossible problems, such as reducing medical errors, saving patient lives, and empowering physicians to stay financially independent. We care deeply about making a big impact and we are relentless.

Inspired to grow the company and our careers, we remain committed to daily discipline, self improvement, and a ceaseless search for solutions.

We equally value our work and our life apart from work. We’re compelled to work with urgency, decisiveness, and efficiency in everything we do. This affords us freedom and time for things that matter most.

Leaders at pMD are developed through our mentorship program. Investing in the success of each inidual strengthens our team and builds loyalty. We believe in leading by example. Everything one does ripples outward. Therefore, we need each inidual at pMD to embody our leadership principles to thrive as an enduring great company.

(Contract) Medical Coding Specialist

(Contract) The Medical Coder role at pMD helps our team and our customers reach our business goals through thoroughly scrubbing claims for coding and billing accuracy. This is an important role that focuses on the front-end revenue cycle. This includes identifying and preventing claim errors that would result in a denial to support timely payment and exceed industry standard benchmarks.

Responsibilities include:

perform claim scrubbing review to support coding and billing accuracy and clean claim submission
apply accurate modifiers and ensure that the correct provider, place of service, insurance, filing type, and referrals/auths are included
verify claims against NCCI edits to facilitate compliance and prevent coding denials
review National Coverage Determinations (if necessary) when scrubbing the charge to adhere to payer policies
maintain confidentiality of all patient records

Requirements include:

Post-Secondary Certificate in Medical Billing and Coding
must be proficient with CPT/ICD-10, NCCI edits, and abreast of the latest coding guidelines issued by the AMA and CMS
must be able to work independently in a fast-paced environment
exceptional attention to detail
must be willing to comply with independent contractor guidelines
reside in the U.S.

We are only accepting applications through our online job portal, Lever. We aren’t able to consider and respond to other types of applications, including those sent via email to pMD support, at this time. Please direct application status questions to [email protected].

Oncology Pathology Assistant

Natera Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Oncology Pathology Assistant

Remote

PRIMARY RESPONSIBILITIES:

Assist the medical and customer service teams with the interpretation of oncology pathology reports to identify optimal samples to request when initial FFPE blocks or slides are inadequate for testing.
Read and ensure accurate curation of clinical history, diagnosis, progress notes, and specimen information is entered into the Signatera sample database.
Assist with devising strategies to stratify data for retrieval from the Signatera sample database and other databases as necessary.
Maintain proficiency with and help organize diagnostic data according to pertinent WHO guidelines.
Serve as subject matter expert to the Laboratory Director, Genetic Counseling, Customer Experience, Sales, and Clinical Trial teams for pathology reports.
Assist in the identification and alert the Laboratory Director when samples may have been collected at suboptimal timepoints and/or fixative conditions.
Assist Genetic Counseling and Customer Experience teams in identification and procurement of optimal additional samples, as necessary.
Provide professional support for the Clinical Trial team through accurate and organized data transfer.
Performs other duties as assigned.

QUALIFICATIONS:

Bachelor’s degree, or higher, with certification as a Histology Technologist by the American Society of Clinical Pathology (ASCP), or equivalent board, is required.
Minimum of 5 years of experience in anatomic pathology including extensive knowledge of solid tumor pathology.

KNOWLEDGE, SKILLS, AND ABILITIES:

Ability to accurately understand and convey information found in anatomic pathology reports to team members for a wide variety of solid tumors, including but not limited to lung, colon, and breast cancer.
Ability to identify potential diagnostic sample(s) that will ensure successful testing.
Ability to communicate effectively with team members and referring pathology laboratories.
Ability to build relationships with referring pathology laboratories.
Detail oriented. Ability to think broadly about the importance of clinical information and to work independently.

#LI-REMOTE

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.

Colorado

$75,700—$113,500 USD

OUR OPPORTUNITY

Natera™ is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s 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, you’ll work hard and grow quickly. Working alongside the elite of the industry, you’ll 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.

Specialist II, Customer Education

Boston Scientific Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Specialist II, Customer Education

Remote Eligible: Remote in Country

Location: Maple Grove, MN, US, 55311

Additional Location(s): Remote

Diversity – Innovation – Caring – Global Collaboration – Winning Spirit – High Performance

At Boston Scientific, we’ll give you the opportunity to harness all that’s within you by working in teams of erse and high-performing employees, tackling some of the most important health industry challenges. With access to the latest tools, information and training, we’ll help you in advancing your skills and career. Here, you’ll be supported in progressing – whatever your ambitions.

About the role:

Initiates, develops, administers and executes meetings and SHV events that are aligned with the SHV Clinical Education objectives. Supports departmental budgeting, planning and report outs.

Your responsibilities will include:

Participates in the planning, execution and finalization of projects according to strict deadlines, within budget and by following organized and repeatable procedures
Coordinates the efforts of team members in order to deliver projects according to objectives
Acts as a liaison with stakeholders and effectively communicates expectations to team members and stakeholders in a timely and clear fashion.
Serves as an ambassador for Boston Scientific by providing thorough and professional communication, visit oversight and management, across stakeholders within the organization
Build and maintain relationships with marketing, engineering, sales reps, and executives to ensure the execution of successful and customized customer interactions
Works with various teams and stakeholders to support business objectives
Metrics & Continuous Improvement: Evaluates the effectiveness of programs by soliciting participant feedback, summarizing results, and formulating recommendations to determine successes and areas of improvement, which will be used to improve subsequent program effectiveness
Process & System Activation & Improvement: Represents function as an expert, initiating, guiding and/or participating in various process and system activation and improvement efforts (e.g. Cvent, salesforce.com, etc.)
In all actions, demonstrates a primary commitment to patient safety and product quality by maintaining compliance to the Quality Policy and all other documented quality processes and procedures
Manage digital content and access portals in collaboration with technical experts
Work collaboratively within the team and with other business functions

Required qualifications:

5+ years of Structural Heart or Interventional Catheter Based therapy experience
Ability to execute on multiple projects simultaneously and meet deadlines in a fast-paced environment
Ability to prioritize projects based on business need
Fully remote based, but travel to Maple Grove HQ and training sites required
Approximately 20% overnight travel required, with multiple consecutive days
Basic competency on Microsoft Office 365 products (Word, Excel, PowerPoint, Teams)

Preferred qualifications:

Good time management skills
Great interpersonal and communication skills
Self-starter with clear focus
Continuous improvement mindset; ability to identify existing gaps/needs
Comfortable learning new/unfamiliar process’

Requisition ID: 563863

As a leader in medical science for more than 40 years, we are committed to solving the challenges that matter most – united by a deep caring for human life. Our mission to advance science for life is about transforming lives through innovative medical solutions that improve patient lives, create value for our customers, and support our employees and the communities in which we operate. Now more than ever, we have a responsibility to apply those values to everything we do – as a global business and as a global corporate citizen.

So, choosing a career with Boston Scientific (NYSE: BSX) isn’t just business, it’s personal. And if you’re a natural problem-solver with the imagination, determination, and spirit to make a meaningful difference to people worldwide, we encourage you to apply and look forward to connecting with you!

At Boston Scientific, we recognize that nurturing a erse and inclusive workplace helps us be more innovative and it is important in our work of advancing science for life and improving patient health. That is why we stand for inclusion, equality, and opportunity for all. By embracing the richness of our unique backgrounds and perspectives, we create a better, more rewarding place for our employees to work and reflect the patients, customers, and communities we serve. Boston Scientific is proud to be an equal opportunity and affirmative action employer.

Boston Scientific maintains a drug-free workplace. Pursuant to Va. Code § 2.2-4312 (2000), Boston Scientific is providing notification that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the workplace and that violations will result in disciplinary action up to and including termination.

Please be advised that certain US based positions, including without limitation field sales and service positions that call on hospitals and/or health care centers, require acceptable proof of COVID-19 vaccination status. Candidates will be notified during the interview and selection process if the role(s) for which they have applied require proof of vaccination as a condition of employment. Boston Scientific continues to evaluate its policies and protocols regarding the COVID-19 vaccine and will comply with all applicable state and federal law and healthcare credentialing requirements. As employees of the Company, you will be expected to meet the ongoing requirements for your roles, including any new requirements, should the Company’s policies or protocols change with regard to COVID-19 vaccination.

Client Coordinator

Abarca Health Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Title: Client Coordinator

(US)

Location: Remote

What you’ll do

In a few words

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

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

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

The fundamentals for the job

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

What we expect of you:

The bold requirements

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

Nice to haves

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

Physical requirements

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

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

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

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

#LI-JD1 #LI-REMOTE

Patient Billing Support Specialist

WebPT Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Patient Billing Support Specialist

Job Category: Billing

Requisition Number: PATIE004138

Posting Details

Full-Time
Locations

United States

Job Details

Description

Who We Are Looking For

As a WebPT Patient Billing Support Specialist, you will be a part of our patient billing customer service team, delivering exceptional customer service to our members’ patients. You will be responsible to perform both inbound and outbound self pay collections efforts to resolve a patient balance.

What You’ll Be Doing As A Part of Our Team

Manage high volume inbound and outbound calls in a timely manner while providing exceptional customer service.
Follow call center scripts and member requirements when handling patient calls.
Identify patient needs, clarify information, research every issue and provide solutions.
Complete assigned work as directed in a timely manner.
Meet personal and team production and performance targets.
Work closely with management team in reporting any patient complaints and provide thoughtful feedback on areas needing improvement.
Interact with others in a positive, respectful and considerate manner.
Maintain a positive attitude and be a team player.
Other duties as assigned
Reliable and punctual in reporting for work and taking designated breaks.

What You Should Have to Qualify

Demonstrate core customer service competencies, such as active listening, empathy and other de-escalation tactics.
Ability to multitask in a fast paced call center environment.
Adapt to an ever changing environment.
Be organized, ahead of schedule, communicative, and accountable.
1 year of customer service call center experience.

Ideally, You Would Also Have These

1 year of experience in hospital or physician billing.
Prior experience in a fast paced call center environment.
Knowledge of the Fair Credit Report Act (FCRA) and Fair Debt Collections Practices Act (FDCPA).
Bilingual

Culture is at our Core

Service: Create Raving Fans
Accountability: F Up; Own Up
Attitude: Possess True Grit
Personality: Be Minty
Work Ethic: Be Rock Solid
Community Outreach: Give Back
Health and Wellness: Live Better
Resource Efficiency: Do Ms With Menos

About Us

Here, we work hardbut we have lots of fun doing it. We believe in equal opportunity for all, autonomy, trailblazing, and always doing right by our Members. Most importantly, though, we believe in empowering rehab therapy professionals to achieve greatness in practice. So, if you’re a can-do kinda person who loves to help Members win and enjoys working from just about anywherethen you’ll fit right in. We’ve got big plans, but we can’t achieve them without you. Join us, and let’s achieve greatness.

Company Perks

Ample Time Off for fun and rest
Work from nearly anywhere in the US
WFH supply budget
Time Off to make an impact through volunteering
Multiple Employee Resource Groups (ERGs)
Health, Dental, Vision, 401k, HSA, any many other benefits
Authenticity and Acceptance

#LI-CB1

#LI-Remote

Qualifications

Skills

Required

Customer Service

Intermediate

Preferred

Medical Billing

Intermediate

Experience

Required

1 year: Customer service call center experience

Technical Assistance Specialist

ZERO TO THREE Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Technical Assistance Specialist

Remote

Part Time

Mid Level

ABOUT ZERO TO THREE

Founded in 1977, ZERO TO THREE works to ensure that babies and toddlers benefit from the early connections that are critical to their well-being and development. Our mission is to ensure that all babies and toddlers have a strong start in life. At ZERO TO THREE, we envision a society with the knowledge and will to support all infants and toddlers in reaching their full potential. Our Core Values Statement: We believe that how we do our work is as important as what we do. To learn more about ZERO TO THREE, please visit our website at zerotothree.org.

OUR COMMITMENT TO DIVERSITY

ZERO TO THREE is proud to be an equal opportunity employer committed to inclusive hiring, advancement, and professional development. It is dedicated to ersity in its work, its staff, and with community partners. This is an exceptional opportunity for a professional who shares our commitment to ersity, equity, and inclusion and supports our mission to enhance outcomes for all children.

SUMMARY

The Technical Assistance (TA) Specialist provides support to Tribal Maternal, Infant, and Early Childhood Home Visiting (TMIECHV) grantees in implementing the goals of the Tribal MIECHV program, including the following:

Supporting the development of happy, healthy, and successful American Indian and Alaska Native (AIAN) children and families through a coordinated home visiting strategy that addresses critical maternal and child health, development, early learning, family support, and child abuse and neglect prevention needs
Implementing high-quality, culturally relevant, evidence-based home visiting programs in AIAN communities
Expanding the evidence base around home visiting interventions with Native populations
Supporting and strengthening cooperation and coordination and promoting linkages among various early childhood programs, resulting in coordinated, comprehensive early childhood systems

ESSENTIAL RESPONSIBILITIES

Assist Project Director, other TA staff, ACF staff, and consultants to plan and deliver all levels of technical assistance activities to grantees
Maintain an ongoing and responsive relationship with a portfolio of 4 – 6 assigned grantees, including development of inidualized TA plans and provision of intensive, relationship-based technical assistance
Implement grantee communication strategies as directed by ACF including participating and notetaking on grantee monthly calls
Actively participate in the development and implementation of an annual, national grantee meeting, and regional grantee meetings as assigned.
Participate in the implementation of targeted TA activities including Communities of Learning and webinars.
Identify best practices and disseminate lessons learned to promote the adoption of tribal home visiting core strategies to a broad audience through written products, presentations and other dissemination mechanisms
Utilize electronic media, virtual communication technology and other technology resources to plan, deliver and track all technical assistance activities within time frame defined
Contribute to the evaluation of Tribal Home Visiting Programmatic TA, including tracking TA performance data, sharing observations of lessons learned in the planning and delivery of TA, and participating in quality improvement efforts
Coordinate with the MIECHV Tribal Evaluation TA provider, the MIECHV Technical Assistance Resource Center and other TA providers, as appropriate
Make in-person TA visits to grantees as assigned
Performs other duties as assigned to ensure the efficient and effective functioning of the project

ESSENTIAL SKILLS & EXPERIENCE

A minimum of six years of experience in home visiting, early childhood, mental health, public health or related field
Expertise in effectively communicating with, training, and providing technical assistance in the above domains to professionals and paraprofessionals in American Indian-Native Alaskan communities
Strong knowledge of home visiting, child development, early learning, family support, and the prevention of child abuse and neglect
Experience planning, coordinating and providing inidualized technical assistance to states, communities and/or programs
Ability to work collaboratively with iniduals representing a range of backgrounds, ersities and skill levels
Experience in facilitating groups, including decision-making and managing conflict
Ability to be flexible and adaptable to dynamic changes in the work environment
Excellent writing and verbal skills with a proven ability to publish articles, develop materials, and communicate issues around home visiting, child development, early learning, family support, and the prevention of child abuse and neglect
Ability to work with a team as well as independently
Strong interpersonal skills
Ability to read, analyze and interpret complex documents
Ability to manage multiple tasks
Travel, including overnight stays, required

ESSENTIAL QUALITIES

Encourages and practices critical thinking
Is self-reflective and empathic
Recognizes the influence of workplace relationships on outcomes and results
Maintains a respectful and accepting approach to others
Awareness of the influence of the larger context on inidual behavior
Collaboratively and creatively supports the work efforts of colleagues at all levels and in all areas of the organization

EDUCATION

Master’s degree in early childhood, mental health, public health or related field recommended.

PHYSICAL REQUIREMENTS

While performing the responsibilities of the job, the employee is frequently required to use finger dexterity and sufficient hand dexterity to use a computer keyboard and be capable of reading a computer screen. Also, they may need to remain seated for extended periods, can perform repetitive motions, and reach for objects. An employee is frequently required to hold a writing instrument, communicate verbally, and hear well enough to detect nuances and receive detailed information. They may be required to grasp objects, push, and pull objects, bend, stand, walk, squat, or kneel. Vision abilities required by this job include close vision for data preparation or analysis, and expansive reading. May need to lift up to 30 pounds.

WORKING CONDITIONS

The work conditions described here are representative of those an employee encounter while performing this job. Depending on work location, the incumbent will typically work indoors in a heated and air-conditioned office, with a mixture of natural, incandescent, and fluorescent light with low to moderate noise levels or be subject to working conditions conducive to a home environment. When travel is expected, the incumbent will be exposed to outside environmental conditions during those times

Credentialing Associate

SonderMind Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Credentialing Associate

Location: Denver, CO or Remote

At SonderMind, we know that therapy works. SonderMind provides accessible, personalized mental health care that produces high-quality outcomes for iniduals. SonderMind’s inidualized approach to care starts with using innovative technology to help people not just find a therapist, but find the right, in-network therapist for them.

How you’ll make an impact

The Credentialing Associate is responsible for managing the credentialing activities for providers that join our network, and ensuring that providers submit proper documentation and adhere to our outlined processes and deadlines. You will be focused on shortening the amount of time it takes to get providers credentialed with SonderMind and our contracted payor partners.

Success looks like

Within one week, fully understand each step of the credentialing process.
Within one month, reach a level of efficiency across your duties, including serving as the point of contact for onboarding providers.
Within two months, ramp up to the prescribed service level agreements while maintaining accuracy
Within three months, generate and implement at least one process improvement across all Credentialing activities.

What you’ll do

Serve as the Credentialing point of contact for providers as they move through the onboarding process. This communication will take place via text, email, and sometimes video conferencing.
Continuous outreach and follow-ups to providers to ensure they complete their application (judged by completion of CAQH)
Proactively obtain the necessary documents, updates and actions from providers during the onboarding process
Reduce the time it takes to get a signed provider to a maximally credentialed’ provider
Be able to quickly manage multiple priorities within established deadlines and metrics

What you’ll bring with you

Required Experience

Previous experience and knowledge of credentialing activities
Attention to detail and the ability to organize workflow effectively to meet deadlines and metrics
Ability to work collaboratively with internal and external stakeholders.
Excellent written and verbal communication skills
Comfortable corresponding live with clinicians

Preferred Experience

Experience using CAQH
Experience with a CRM software (Salesforce preferred)
Experience working as a liaison between customers and partners
Experience working with healthcare insurance companies in some capacity

What we value

Curious: Seek to understand and pull the thread
Courageous: Takes action, even when uncomfortable
Lightful: Assume positive intent in others
Authentic: Say what you mean, mean what you say, act accordingly
Bucketworthy: Don’t let your bucket leak

Our Benefits

The anticipated salary range for this role is $21.64/ hour. Actual compensation is based commensurate with qualifications and experience.

As a leader in redesigning behavioral health we are walking the walk with our employee benefits package. We focus on meeting SonderMinders wherever they are and supporting them in all facets of their life with both mental and physical aspects in mind.

Our benefits include:

Medical, Dental, and Vision coverage effective on your first day with plans to meet your needs including HSA and FSA options.
Therapy coverage benefits to enable our employees to get the care they need
Generous PTO increasing based on years of service, company paid holidays
Employer-paid disability & AD&D to cover life’s unexpected – not only that, we cover the difference in salary for up to eight weeks of short-term disability leave
Eight weeks of paid parental leave
Competitive market salary, up-to 4% salary company match on 401K
Pet insurance through ASPCA

Mental wellness impacts people of every community. At SonderMind, building and supporting a erse workforce is foundational to our goal to redesign behavioral healthcare to be more approachable and accessible. SonderMind is a committed equal opportunity employer and provides a workplace that will not tolerate discrimination or harassment on the basis of race, religion, national origin, gender identity or expression, sexual orientation, age, or marital, veteran, or disability status.

Medication Coordinator

Cerebral Care Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Title: Medication Coordinator (1099 Contract)

Location: Remote (United States)

Our Company:

At Cerebral, we’re on a mission to democratize access to high-quality mental health care for all. We believe that everyone everywhere deserves to get the care they need, and are striving to make care convenient and accessible, while tackling the stigmas that surround mental illness.

Since launching in January of 2020, Cerebral has scaled to provide mental health services to more than 700,000 people in all fifty US states. With support from investors like SoftBank, Silver Lake, Access Industries, Bill Ackman, WestCap, and others, and impactful leaders like you, we’ll continue to democratize mental health care and double down on clinical quality and deliver exceptional client outcomes for years to come. With a heavy focus on clinical quality and safety in all that we do, we’ve accomplished excellent outcomes for hundreds of thousands of clients:

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

This is just the beginning for Cerebral, and we won’t stop building, growing, and iterating until everyone, everywhere can access high-quality, evidence-based mental health care without high costs and/or long wait times. We’re looking for mission-driven leaders who share these values, and we need your help as we transform access to high-quality mental health care in the United States and beyond.

The Role:

As a Medication Coordinator at Cerebral, you will support the successful administration of our Medication Management program. The right inidual for the role should feel comfortable operating independently and remotely, and working alongside medical providers to ensure timely and accurate medication delivery. As the bridge between the medical teams, support teams, and counseling teams, this inidual should feel empowered to request updates from key stakeholders or elevate any concerns. We are looking for a sharp inidual with a keen eye for detail. If you can spot a different size font while copyediting, or get agitated when people do not capitalize their names on forms – This is the role for you!

Who you are:

MA or Pharmacy Technician Certification or licensure is not required, but is preferred
Experience working in a fast-paced or startup environment a plus
Former professional experience in an administrative or clinical function
Preferable to working weekends on a rotating schedule, but is not required
Always acts first in consideration of client safety and wellbeing
Detail-oriented and likes to follow a process
Clear written communicator
Advanced proficiency using a computer and ability to learn how to use new computer programs quickly (e.g. Slack, Dosespot)
Feels comfortable making judgment calls or seeking support from others
Basic knowledge or understanding of common medications for mental health management

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

Triage incoming client request for refills of medication; escalating to RN’s or Prescribers as needed
Utilize problem-solving skills to troubleshoot medication related issues at client’s preferred local pharmacy, or through in-house delivery pharmacy to ensure no medication gaps.
Complete insurance related task; i.e. Prior Authorizations

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 (and counting)
- Join a community of high achievers who have a passion for promoting mental health
Path to develop & grow:
- Bi-annual performance reviews & opportunities for promotions – as Cerebral grows, so should you. We build your goals together and forge a career path that is right for you
Remote-first model: Work virtually from anywhere in the US
Competitive compensation & benefits:
- Total compensation includes equity/stock options
- Medical, Dental, Vision, Life Insurance, and 401k with employer match to all employees
- Unlimited PTO – we encourage taking the time you need to relax and recharge
- Top-tier wellness benefits and perks, including bi-quarterly mental health days (8 per year), No-Meeting-Wednesdays, holistic monthly wellness stipend, and access to on-demand health & wellness content
  - $200 WFH reimbursement
Culture & connectivity:
- Virtual social events (e.g., happy hours) enable us to build a sense of community and connect on a more personal level
- Monthly peer-to-peer recognition allowance via Bonusly allows team members to reward one another for values-aligned contributions
- Optional in-person company retreats provide an opportunity to augment team-building and celebrate our successes together

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

Utilization Review Nurse

Netsmart Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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

locations

Remote – Other

time type

Full time

job requisition id

R011499

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

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

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

Responsibilities

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

Qualifications

Required

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

Preferred

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

Expectations

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

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

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

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

Clinical Policy Coding Administrator

Blue Cross Blue Shield - BCBS Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Clinical Policy Coding Administrator

Locations: Telecommuter
Time Type: Full time

Job Requisition Id: R26325

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

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

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

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

This is a Work from Home Opportunity!!

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

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

What you will do:

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

What you will bring:

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

What we offer

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

Equal employment opportunity/affirmative action:

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

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

National Salary Range: $68,400.00 – $116,300.00
National Plus Salary Range: $77,300.00 – $131,400.00

*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

About Us

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

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

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

Triage Nurse - Call Center

Oak Street Health Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Remote Triage Nurse – Call Center

Nursing

United States

Company: Oak Street Health

Location: Various

Company Description

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

Role Description:

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

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

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

Core Responsibilities:

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

What are we looking for?

We’re looking for motivated, nurses with:

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

What does being “Oaky” look like?

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

Why Oak Street?

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

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

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

Inpatient Coder II

Judge Group Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Inpatient Coder II

Job ID: 975353

REMOTE

PERMANENT

HEALTHCARE

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

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

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

Responsibilities & Duties

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

Education & Experience

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

Senior Billing Specialist, Pre-Access

Headspace Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Senior Billing Specialist, Pre-Access

Location: Remote – United States

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

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

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

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

What you’ve accomplished:

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

Preferred Qualifications:

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

Pay & Benefits:

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

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

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

Surgical Coder II

Mayo Clinic Remote.co11 months ago

Apply Now11 months ago

location: remoteus

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Surgical Coder II – Remote

Job ID 305011

Rochester, MN
Full Time
Finance

Why Mayo Clinic

Responsibilities

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

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

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

Qualifications

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

Additional Qualifications:

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

License or Certification:

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

Exemption Status

Nonexempt

Compensation Detail

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

Benefits Eligible

Yes

Schedule

Full Time

Hours/Pay Period

Schedule Details

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

Weekend Schedule

As Needed

International Assignment

Site Description

Affirmative Action and Equal Opportunity Employer

Pro Fee Coder - Cardiology

Savista Remote.co12 months ago

Apply Now12 months ago

location: remoteus

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Title: Pro Fee Coder – Cardiology

Remote

Location: United States

Full-Time

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

DUTIES AND RESPONSIBILITIES:

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

SKILLS AND QUALIFICATIONS:

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

PREFFERED SKILLS:

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

Coding Quality Specialist - Outpatient

Stanford Medicine Remote.co12 months ago

Apply Now12 months ago

location: remoteus

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Coding Quality Specialist (Outpatient) (Remote)

Job Type

Full time Day – 08 Hour

Day – 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview

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

Locations

Stanford Health Care

What you will do

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

Education Qualifications

High School Diploma or GED equivalent

Experience Qualifications

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

Required Knowledge, Skills and Abilities

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

Licenses and Certifications

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

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

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

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

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

#LI-RL1

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

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

Complex Care Manager Registered Nurse

Boston Medical Center Remote.co12 months ago

Apply Now12 months ago

location: remoteus

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Complex Care Manager RN

Remote

Full time

POSITION SUMMARY:

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

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

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

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

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

Compensation will be based on a salary/incentive plan.

Position: Complex Care Manager RN

Department: Pop-Health Care Management

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

Key Functions/Responsibilities:

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

Metrics:

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

Other duties as assigned

JOB REQUIREMENTS

EDUCATION:

AD or BS in Nursing

Preferred/Desirable:

BS or Masters in Nursing

EXPERIENCE:

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

Preferred experience:

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

CERTIFICATION OR CONDITIONS OF EMPLOYMENT:

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

COMPETENCIES, SKILLS, AND ATTRIBUTES:

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

Neurosurgery - Coder - brain, spine

GeBBS Healthcare Solutions Remote.co12 months ago

Apply Now12 months ago

location: remoteus

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Neurosurgery – Coder (brain/spine)

Job ID2023-3055

# of Openings 2

Category Medical Coding

Minimum Hours Varies

Type Regular Part-Time

Overview

Neurosurgery Specialty Coder – Part Time

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

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

Responsibilities

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

Qualifications

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

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

Renal Service Coordinator - Supervisor, Bilingual

InterWell Health Remote.co12 months ago

Apply Now12 months ago

location: remoteus

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Renal Service Coordinator – Supervisor (Bilingual)

Remote, U.S.

Healthcare Operations Patient Engagement

Full Time

Remote

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

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

The work you will do:

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

The skills and qualifications you need:

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

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

– We care deeply about the people we serve.

– We are better when we work together.

– Humility is a source of our strength.

– We bring joy to our work.

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

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

Meeting and Events Manager

SpringWorks Therapeutics Remote.co12 months ago

Apply Now12 months ago

location: remoteus

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Meeting & Events Manager

Remote

About SpringWorks Therapeutics

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

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

About the Role:

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

Duties & Responsibilities:

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

Qualifications:

Education:

Bachelor’s Degree preferred

Experience:

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

Skills:

Technical:

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

Leadership:

Consultative and service-oriented approach when engaging with colleagues

Communication:

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

Other:

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

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

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

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

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

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

Medical Coder II

GenesisCare Remote.co12 months ago

Apply Now12 months ago

location: remoteus

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Medical Coder II

Apply

locations

US-Remote

time type

Full time

posted on

Posted 8 Days Ago

job requisition id

R0016336

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

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

ESSENTIAL DUTIES:

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

RESPONSIBILITIES/QUALIFICATIONS:

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

EDUCATION AND/OR EXPERIENCE:

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

Telephonic Complex Nurse Case Manager

AmTrust Financial Services Remote.co12 months ago

Apply Now12 months ago

location: remoteus

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Telephonic Complex Nurse Case Manager

Job LocationsUS-United States

Requisition ID

2023-15249

Overview

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

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

Responsibilities

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

Qualifications

Education & Licensing

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

Experience

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

Skills & Knowledge:

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

WORK ENVIRONMENT

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

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

Physical: Computer keyboarding

Auditory/Visual: Hearing, vision and talking

What We Offer

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

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

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

Coding Supervisor

Ensemble Health Partners Remote.co12 months ago

Apply Now12 months ago

location: remoteus

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Coding Supervisor

Remote – Nationwide

Full time

R008895

Thank you for considering a career at Ensemble Health Partners!

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

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

The Opportunity:

Responsibilities:

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

Minimum Education Requirement:

2 Year/Associate’s Degree

Preferred Education:

4 Year/Bachelor’s Degree

License/ Certification Requirement:

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

Preferred Certifications:

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

Join an award-winning company

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

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

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

Operations Associate, Clinical Pharmacy Operations

Devoted Health Remote.co12 months ago

Apply Now12 months ago

location: remoteus

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Operations Associate, Clinical Pharmacy Operations

locations Remote USA

time type Full time

job requisition id R1134

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

Job Description

A bit more about this role:

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

It supports this work in three ways:

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

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

Examples of these interventions include:

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

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

Responsibilities will include:

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

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

Attributes to success:

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

Desired Skills and experience:

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

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

Our Total Rewards package includes:

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

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

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

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

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

Medical Review Coding QA Auditor - Outpatient

Performant Financial Corporation Remote.co12 months ago

Apply Now12 months ago

location: remoteus

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Medical Review Coding QA Auditor (Outpatient)

Job Code:2023-53-R-014

Location:United States – Remote

Status:Regular Full Time

Pay Range:70550.00-95450.00

Responsibilities:

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

Duties

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

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

Required Skills and Knowledge:

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

Additional Requirements:

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

Physical Requirements:

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

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

Education and Experience:

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

Other Requirements:

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

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

Employment VISA Sponsorship is not available for thisposition

Job Profile is subject to change at any time.

EEO

Performant Financial Corporation is an Equal OpportunityEmployer.

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

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

Utilization Management Coordinator

Bright HealthCare Remote.co12 months ago

Apply Now12 months ago

location: remoteus

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Utilization Management Coordinator

Remote

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

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

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

SCOPE OF ROLE

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

ROLE RESPONSIBILITIES

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

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

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

LICENSURES AND CERTIFICATIONS

Certification as a Medical Assistant preferred

WORK ENVIRONMENT

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

Clinical Care Reviewer, Utilization Management Review, Registered Nurse

AmeriHealth Caritas Remote.co12 months ago

Apply Now12 months ago

location: remoteus

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

Location: Remote, United States/US

C: 2.02

Location Remote, United States

Primary Job Function Medical Management

Job Brief

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

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

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

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

Responsibilities:

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

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

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

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

Education/Experience:

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

Inpatient Coder

Aston Carter Remote.co12 months ago

Apply Now12 months ago

location: remoteus

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Inpatient Coder

Location Omaha, Nebraska, USA

76960 USD – 83200 USD/Year

Daily Duties:

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

Additional Skills & Qualifications:

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

Work Environment:

100% remote opportunity; all equipment will be provided.

Shift:

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