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Title: Coding Manager, Pro Fee & FQHC

locations

Remote, USA

time type

Full time

job requisition id

R240000009540

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

As our Coding Manager, Pro Fee & FQHC, you will supervise remote-based, pro fee coding associates. Every day you are responsible for managing your team’s performance, productivity, and quality. In addition to the managerial responsibilities, the Site Coding Manager works directly with R1’s clients to communicate coding performance, collaboratively identify and solve problems, assist in managing projects, and help to deliver on coding-related financial and operational commitments. To thrive in this role, you must have demonstrated experience managing a team of coders and multiple client accounts as well as proficiency in professional fee coding.

Here’s what you will experience working as a Coding Site Manager:

• Ensure managed coders meet or exceed productivity and quality standards.
• Supervises and directs daily coder work schedules and work assignments.
• Assists with assessment, training and onboarding of new-hires; creates 30/60/90-day ramp-up plans for new associates.
• Creates and manages inidual growth and development plans for coders related to quality, productivity and employee development.
• Provides ongoing training and coaching to domestic and international teams.
• Assists various process improvement projects associated with coding and other reimbursement activity workflows.
• Identifies and solves moderate to complex problems related to coding and other reimbursement activity workflows.
• Optimizes staffing efficiency by minimizing production downtime to meet specific targets.
• Implements findings from Regional Coding Manager to meet or exceed team coding quality standards.
• Identifies, tracks and reports key barriers and process defects to the client and leadership teams on weekly basis.

Required Skills:

• AAPC or AHIMA Certified coding professional: CPC, CCS
• Demonstrated leadership experience including managing direct reports
• Client management experience including preparing and presenting various reports and presentation slide decks in PowerPoint
• Ability to manipulate and analyze data in Excel using pivot tables
• Strong communication skills including the ability to vocalize and document complex coding scenarios and prepare slide decks for internal and external stakeholders

For this US-based position, the base pay range is $64,657.00 – $80,821.00 per year . Inidual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

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

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

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

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

Coding Supervisor

Remote – Nationwide

Full time

Thank you for considering a career at Ensemble Health Partners!

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

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

The Opportunity:

CAREER OPPORTUNITY OFFERING:

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement
• This position pays between $51,700 – $99,000 based on experience

Responsible for the day to day coding activities for the respective physician facilities within the company. This includes assisting the Manager and/or Director, and/or Coding Sr. Leader, with duties assigned to assure Accounts Receivable goals are met.

Job 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. They will coach (SMART Responsibilities where applicable), develop, complete timely performance evaluations and discipline those staff members under their 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 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.

Experience We Love:

• 3+ years of cardiology coding experience
• 3+ years of leadership experience
• Ability to function independently with minimal supervision, as well as part of a team
• Knowledge of medical record content to include electronic medical records, (EMRs.)
• Ability to function under continual deadlines. Ability to maintain accuracy during frequent interruptions
• Proficiency in keyboarding skills and working knowledge of computers
• Excellent communication skills

Minimum Education:

• Bachelors Degree or Equivalent Experience

Licensure/Certification Required:

Candidates must have and keep current at least one of the following professional certifications (CPC, CPMA or CCS Preferred):

• CPC (Certified Professional Coder)
• CCS-P (Certified Coding Specialist-Phys Based)
• CCS (Certified Coding Specialist)
• RHIA (Registered Health Information Administrator)
• RHIT (Registered Health Information Technician)

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

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

Title: Wellness Nurse Care Manager

Location: Remote – USA

Job Description:

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

• • Our complex care programs are designed to improve care and outcomes for our most medically complex members. Clover wants to take accountability for these members’ healthcare journeys and provide high-quality personalized care that is consistent with members’ values and preferences.

• • The Wellness Nurse Care Manager collaborates closely with members, their health providers, and Clover clinical teams to improve member health outcomes. To do so, the WNCM facilitates member assessments, evaluations, care planning, care coordination, and advocacy related to a member’s comprehensive health needs. This process includes medical, social, developmental, behavioral, financial, and educational intervention with focus on high quality and cost effective outcomes. The Wellness Nurse Care Manager will report directly to the program lead.

    As a Wellness Nurse Care Manager, you will:

• • Engage and provide telephonic care coordination and management to identified patient populations.

• • Effectively collaborate with members of Clover clinical teams (e.g. In Home Care team, Readmission Prevention Program team, Supportive Care team, Behavioral Health team, field Nurse Practitioners, Medical Assistants).

• • Initiate referrals to specialty services, follow up on open referrals, and foster continuity of care.

• • Create a personalized care plan for each member to resolve barriers to care and engage with social support systems as appropriate.

• • Follow NCQA Care management accreditation standards.

• • Document all member care activities and escalate findings in accordance with Clover Policies.

• • Coordinate with the interdisciplinary team as needed, including members’ outpatient providers.

• • Provide telephonic teaching and counseling in the areas of health promotion, disease prevention, maintenance, and management of acute/chronic diseases.

• • Attend and participate in regular ongoing meetings.

• • Demonstrate flexibility in assignments within Clover’s Clinical Programs based on member and company needs.

• • Advocate for members to ensure their needs and choices are fully represented and supported.

• • Participate in ongoing professional development and self-improvement.
    You will love this job if:

• • You genuinely enjoy interacting with erse iniduals on a daily basis

• • You want to make a positive difference; you’re passionate about helping members live healthier lives

• • Your mode of operation is being meticulous in your work and motivational to others.

• • Technology is your friend; you embrace learning about new software and working alongside a tech team.

You should get in touch if you have:

• • 3-5 years of post-licensure care management experience

• • Bachelor’s degree (BSN) from an accredited school of nursing

• • Current unencumbered NJ Licensure as a Registered Nurse

• • Case management certification or completion of CCM certification within 1 year of employment preferred

• • Experience in completion of assessment, care plans, care coordination, and issue resolution

• • Knowledge of healthcare reimbursement, utilization management, discharge planning, disease management

• • Knowledge of geriatrics and chronic illness

• • Basic knowledge of Medicare, Medicare Advantage Plans, preferred

• • Comfortable with documenting in electronic medical record and utilizing electronic data and reports

• Intermediate level of proficiency with Mac/PC computer skills

#LI-Remote

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

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

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

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

Certified Medical Coder

Location: Phoenix United States

Salary Range : (27) $24.00 – $35.40

Job Description:

As an Outpatient Medical Coder for Valleywise Health, you will collaborate with peers and offer suggestions and solutions to improve workflow for our Primary Care and Specialty Clinics. Using your certification skills, you will assist the hospital coding team with meeting our HIMs and organizational goals. We need your experience and knowledge in assigning ICD-10-CM/CPT codes based on the provider’s documentation in our primary care and specialty clinics.

Our HIMs team is a family; we like to make work fun. We embrace ersity and different learning styles. Not only do we have a dedicated Coding Educator to provide you guidance during your onboarding, we also offer easy-to-find and follow coding guidelines and workflow resources in one location within our OP Coding One Note tool to assist you to be successful in your role here.

Apply now to join our remote outpatient medical coding team, where you are constantly learning and growing due to a wide array of multi-specialty departments for our primary care and specialty clinics. This is a 100% remote position.

Hourly Pay Range: $24.00 – $35.40

Qualifications

Education:

• Requires an associate degree in a Health Information Technology related field or an equivalent combination of training and progressively responsible experience that results in the required specialized knowledge and ability to perform the assigned work in lieu of degree.
• A Bachelor’s degree is preferred.

Experience: 

• Requires prior healthcare coding experience that demonstrates an understanding of the required knowledge, skills, and abilities.

Specialized Training:

• Requires the ability to pass a coding exam prior to hire.

Certification/Licensure:

• Must have certification as either RHIA, RHIT, CCS, or CPC.

Knowledge, Skills, and Abilities:

• Must have knowledge of and be able to code patient medical records.
• Must be able to demonstrate an understanding of ICD-10, CPT, and HCPCS codes.
• Must be able to achieve and maintain appropriate coding quality and productivity established in the Coding Department Policy and Procedure.
• Must have a good understanding of computer applications and automated encoder systems.
• Must have knowledge of anatomy and physiology, medical terminology, surgical terminology, pharmacological terminology, patient care documentation terminology, ICD-10, CPT, HCPCS codes, Severity of Illness, Risk of Mortality, and HCC codes for PQRS RAF scores, as appropriate for outpatient.
• Must have the analytical ability necessary to interpret data contained in records and to assign appropriate codes.
• Must also have knowledge of, ICD10, APC coding systems, and MS Diagnostic-Related Groups and APC’s.
• Must be able to abide by the Standards of Ethical Coding as set forth by the American Health Information Management Association and Certified Professional Coders Association.
• Must be able to communicate effectively and have excellent customer service skills.
• Requires the ability to work well independently and demonstrate independent decision-making abilities.
• Requires the ability to read, write, and speak effectively in English.

Title: Nurse Manager

Location: United States

Job Description:

OUR MISSION

Calibrate is on a mission to change the way the world treats weight. We’re defining a new category in metabolic health that mirrors what the research shows-that weight reflects our biology, not our willpower. Our program was designed by world leaders in obesity and nutrition science to improve metabolic health and drive long-term weight loss that’s impactful, realistic, and sustainable.

Obesity is America’s underlying pandemic and largest category of chronic disease, and Calibrate is closing the gap in care for 175mm adults in a $600bn market where we spend millions of dollars each year and do not lose millions of pounds.

To bring Calibrate to everyone who needs it, we’re building the first value-based model in obesity treatment, aligning incentives for patients, providers, payors, and pharmaceutical companies. We’ve built a suite of products that combine medication with our proprietary intensive lifestyle intervention to deliver results that last.Calibrate launched in 2020 direct-to-consumer and has since expanded into enterprise channels to increase access to effective obesity treatment.

Calibrate’s programs bring decades of clinical research directly to consumers, immersing members in a biweekly 1:1 coaching program and curriculum that educates and encourages them to build enduring healthy habits across the four areas essential to lasting metabolic health: food, sleep, exercise, and emotional health. A purpose-built app enables daily tracking of food, energy levels, weight, and bi-weekly goals and helps members interact with their Coaching and Medical teams, while a members’ group and events calendar create additional opportunities to engage with the Calibrate community.

KEY RESPONSIBILITIES

• • Develop and manage Calibrate nursing team to support member outcomes, high-touch clinical program communications, and completion of appropriate nursing-scope tasks (eg. lab review, Rx renewals, message triaging)

• • Manage a team of direct reports and deliver continuous support through routine touchpoints that address iniduals’ career development, successes, and growth opportunities, approximately 40% of weekly hours will be dedicated to people management; address and/or advocate for general nursing team needs

• • Consistently provide a world-class level of patient experience and clinical care through direct clinical care, allotting up to 20% of weekly hours on direct patient contact

• • Approximately 40% of allotted hours will be devoted to specifically-assigned projects and ownerships working directly in conjunction with leadership, scope of which may include weekly staffing, queue management, workflow writing, cross-functional collaboration, data management, quality control, and more.

• • Conduct QA for Calibrate nursing team; work with clinical leadership to support QA of Calibrate medical team

• • Create care management workflows for patients throughout the program lifespan in coordination with cross-functional teams

• • Develop clinical program liaison training to address clinical and programmatic questions for patients at all stages of their Calibrate journey

• • Work with clinical leadership on cross-functional care coordination between clinical, coaching, pharmacy, and member experience teams

• • Drive product solutions and optimizations to help propel our transition to a product-lead company

• • Own, drive progress, and report on finite or continuous projects approved by and in conjunction with leadership

BACKGROUND & EXPERIENCE

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

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

• • At least five years of direct clinical experience, digital health experience preferred

• • A minimum of 3 years people management experience

• • Leadership in startup or innovative health practice preferred

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

• • Demonstrated excellence in leadership and clinical operations roles. Exceptional written/verbal communication skills and virtual “bedside” manner

• Multiple active, unrestricted licenses preferred, but license in any current Calibrate state acceptable. Must be willing and able to become broadly licensed

Ideal Qualities:

• • Experience leading and developing clinical teams

• • Experience with project management and strong organizational skills; preferably involving cross-functional teams

• • Organized, solutions-oriented, self-starter

• • Excellent communicator with a customer service mentality

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

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

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

• • Excellent at forging successful and respectful relationships within a team and across the organization

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

• Natural driver of team culture

The salary range for this role is $115,000-125,000.

BENEFITS

At Calibrate, we’re committed to our vision of putting our members and our teammates in control of their health. Some of our benefits for 2024 include:

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

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

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

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

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

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

• • Remote-first team

• • Competitive Paid Parental Leave for parents

OUR VALUES

We’re in it together: We have an audacious mission, and we’re building a lot of things for the first time – from the first DTC pharma business within the healthcare ecosystem to the data infrastructure for providing real-world evidence in the largest category of chronic disease. It takes superpowers to build something simple and intuitive within the complex healthcare market, so we identify and work as a team from our inidual points of strength. Not everyone has to be good at everything, but we know that when we harness what we’re each great at, we’re unstoppable.

Small wins create big wins: We ground every experience in optimism, recognizing and celebrating successes along the way. We break projects down into smaller components. And we focus on where we have momentum. We always plan for larger goals with the knowledge that our plans will evolve as we achieve smaller milestones.

You’re in control: We don’t let location stand in the way of the best talent – and from coaches to engineers, we are a remote-first team. Our business is multi-faceted, so each Calibrater is hired to be an expert in their piece of it – in control of their own initiatives, in control of their own impact, and in control of driving their own (real) results.

Real results matter: We’re obsessed with outcomes because when our members win, we win, and the data proves that we’ve built the best metabolic health program on the market. We’re purposeful, optimistic, and relentlessly confident that we can solve the biggest medical issue of the 21st century.

Calibrate is proud to be an equal opportunity workplace, providing equal employment and advancement opportunities to all team members. To achieve our mission of changing the way the world treats weight, we are building an environment where every Calibrater can thrive, feel a sense of belonging, and do the best work of their careers. We value ersity and recruit, hire, and promote iniduals solely based on talent, qualifications, competence, and merit. We evaluate candidates without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics as required by law and as a matter of our company values.

#LI-REMOTE

Registered Nurse – Transitions of Care

Remote

*Scheduling includes 4 10-hour shifts, every weekend required*

The Transitions of Care Registered Nurse for CareBridge is a key member of the clinical team and is responsible for providing patient outreach, triage and disease education through telehealth modalities to patients who receive Home and Community-Based Services (HCBS) services through state Medicaid programs and who have recently experienced an acute transition of care.  The Registered Nurse works closely with the family and natural supports, paid caregivers, specialty, CareBridge providers and primary care physicians to ensure the patient receives the necessary care to keep them home.

Responsibilities:

• Provide compassionate care to erse patients and their families.
• Educate and triage the care of iniduals experiencing an acute transition of care with a multitude of health problems ranging from primary care to urgent care issues.
• Thrive as a member of the interdisciplinary team and facilitate the continuum of care.
• Reinforce cost-effective, high-quality care to patients.
• Perform follow up and check in with patients to monitor post-discharge course.
• Communicates with hospital, skilled nursing and other acute setting staff as needed to monitor acute admission course and complete discharge planning
• Active participation in quality improvement processes and initiatives as well as customer service programs.
• Reviews and reconciles medications
• Escalates complex cases to the advanced practice provider or clinical pharmacist as needed to get the best outcomes for the patient
• Recognizes and responds promptly and appropriately to emergency situations
• Provides effective patient education using the Teach-Back technique.
• Documents all patient encounters per documentation standards.
• Participates in clinical case conferences.
• Able to organize and track multiple tasks throughout the day.
• Maintains excellent punctuality and attendance during work hours.
• This role will provide cross coverage on the inbound acute nurse line.
• Other duties as assigned.

Qualifications:

• Holds active, unencumbered, compact RN license
• Experience in care of adult, chronically ill patients, chronically ill pediatric patients, and patients with IDD
• Utilization Management or Case Management experience strongly preferred
• Previous Transitions of Care experience a plus
• Working knowledge of computers and ability to document effectively and efficiently in an electronic system
• Expert communicator over the telephone, providing timely, appropriate advice and/or guidance with health care issues

 

Those who thrive at CareBridge tend to possess these qualities:

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

Employment Type: Full-Time 

Location: Remote

About CareBridge

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

Inpatient Coding Coordinator

Location: Remote United States

Job Description:

Under general supervision and with aid of Official Coding Guidelines, the Inpatient Corporate Coding Coordinator codes diagnoses, and procedures of inpatient accounts according to ICD-10-CM/PCS. The Inpatient Corporate Coding Coordinator is responsible for assisting the Corporate Coding Manager with second level coding reviews and educates coders on correct coding. Assists the coding department with coding questions, reviews, or inquiries. A pre-employment coding proficiency assessment will be administered.

Essential Duties and Responsibilities

• Performs second level coder reviews on accounts that are sent back from Revint, Iodine, coding audits, and coding/billing editor.
• Provides coders with education and guidance on correct coding based on second level reviews.
• Assists coding manager and coding department with coder questions, coding reviews, and coding inquiries. Codes outpatient accounts when coverage is needed.
• Monitors and assists coding manager with DNFC management to goals.
• Attends Tenet coding educations and maintains coding credentials.

Required

• 3-5 years acute hospital coding experience.
• Skilled and working knowledge of MS Office suite.
• Ability to analyze coding related reports and take action.
• Associate degree in health information management.
• RHIT or CCS certification.

Preferred

• 5 plus years’ experience in a large, complex, multi-system acute care hospital organization.
• Bachelor’s Degree in Health Information Management.
• RHIA and CCS certification.

Compensation

• Pay: $27.70-$44.00 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Observed holidays receive time and a half.

Benefits

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

Responsibilities for Internal candidates

• Performs second level coder reviews on accounts that are sent back from Revint, Iodine, coding audits, and coding/billing editor.
• Provides coders with education and guidance on correct coding based on second level reviews.
• Assists coding manager and coding department with coder questions, coding reviews, and coding inquiries. Codes inpatient accounts when coverage is needed.
• Monitors and assists coding manager with DNFC management to goals.
• Attends Tenet coding educations and maintains coding credentials

Qualifications for Internal candidates

Required:

• Associates Degree in Health Information Management
• RHIT or CCS
• 3-5 years acute hospital coding experience
• Skilled and working knowledge of MS Office suite
• Ability to analyze coding related reports and take action

Preferred:

• Bachelor’s Degree in Health Information Management
• RHIA and CCS
• 5 plus years’ experience in a large, complex, multi-system acute care hospital organization

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

2403036913

Title: Inpatient Coding Specialist

Location: United States

Job ID: 2800477

Full-time • Work From Home

Job Description:

Introduction

Sign-On Bonus Eligible*

Are you looking for a work environment where ersity and inclusion thrive? Submit your application for our Inpatient Coding Specialist opening with Work from Home today and find out what it truly means to be a part of the HCA Healthcare team.

Benefits

Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

We are seeking an Inpatient Coding Specialist for our team to ensure that we continue to provide all patients with high quality, efficient care. Did you get into our industry for these reasons? We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply!

Job Summary and Qualifications

As an Inpatient Coding Specialist, you will review and evaluate hospital inpatient medical record documentation to assign, sequence, edit, and/or validate the appropriate ICD-10-CM and ICD-10- PCS codes. You will perform coding and/or code/DRG validation across multiple entities.

What you will do in this role:

• Assigns, sequences, validates, and/or edits codes/DRGs and abstracted data (e.g., physician, discharge disposition, query tracking) for inpatient records for multiple facilities using ICD-10CM and ICD-10-PCS to include:
• Diagnosis description with appropriate 3-7 digit code assignment with corresponding Present On Admission (POA)
• Procedure description with appropriate 7 digit ICD-10-PCS code, date and surgeon
• Admitting Diagnosis
• Discharge disposition
• Where applicable, completes the coding portion of the IRF-PAI
• Maintains or exceeds established accuracy standards • Maintains or exceeds established productivity standards
• Utilizes the complete patient medical record documentation in code/DRG assignment, validation, and/or editing of codes/DRGs
• Initiates, reviews, and/or edits physician queries in compliance with Company and HSC policy where appropriate
• As needed, may periodically be asked to perform Coding Account Resolution Specialist III (CARS III) duties

Qualification you will need:

• High School graduate or GED equivalent required
• Undergraduate (Associates or Bachelors) degree in HIM/HIT preferred
• Minimum 1 year of acute care hospital inpatient coding required, 3 years preferred
• RHIA, RHIT or CCS preferred

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

“Across HCA Healthcare’s more than 2,000 sites of care, our nurses and colleagues have a positive impact on patients, communities and healthcare.

Together, we uplift and elevate our purpose to give people a healthier tomorrow.”- Jane Englebright, PhD, RN CENP, FAAN

Senior Vice President and Chief Nursing Executive

If you find this opportunity compelling, we encourage you to apply for our Inpatient Coding Specialist opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing apply today!

We are an equal opportunity employer and value ersity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Title: Coding Associate III

Location:

Remote, USA

time type

Full time

job requisition id

R240000008810

Job Description:

R1 RCM Inc. is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals, and physician practices. Headquartered in Chicago, R1® is a publicly traded organization with employees throughout the US and international locations. Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patients, and each other. With our proven and scalable operating model, we complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.

The Coding Assoc III will be responsible for reviewing clinical documentation and diagnostic results as appropriate (i.e., to extract data and apply appropriate ICD-10-CM, HCPCS and CPT-4 codes for billing, review and correct billing edits, internal and external reporting, research, and regulatory compliance).

Under the direction of the Coding Leadership Team, the successful candidate must be able to accurately code conditions and procedures as documented in the ICD-10-CM Official Guidelines for Coding and Reporting.

Schedule is primarily Monday – Friday in EST 8am – 4pm

Responsibilities:

• Assigns codes for diagnoses, treatments, and procedures according to the
• appropriate classification system for professional service encounters to determine the highest level of specificity ICD-10 codes, CPT codes, HCPCS codes, and modifiers.
• Reviews physician assigned diagnosis code after thorough review of the medical record and, if necessary, queries physician for additional clarity in a professional manner.
• Able to accurately abstract information from the medial records into the abstract system, according to established guidelines
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC) adheres to official coding guidelines
• Enters and validates codes, charges and other edits flagged in Athena or EPIC for review
• Review documentation (and returned accounts) to verify and correct place of service, billing and service providers, or other missing data elements (i.e.: NDC #, or number of units)
• Uses CCI edit software to check bundling issues, modifier appropriateness, and LCD’s/NCD’s for medical necessity
• Communication with other departments, including offshore team, to recommend coding guidance for charge corrections, appeals processes, and patient billing concerns
• Meet and/or exceeds the established coding productivity standards

Required Qualifications:

• High School Diploma or GED required
• CCS-P, CPC
• Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA) (i.e.: Documentation Guidelines ’95 & ’97)
• Basic knowledge of government, and commercial payer guidelines.
• Must be able to use standard office equipment and Microsoft Office.
• Ability to interact with other employees through effective communication.
• Ability to prioritize and shift workloads to ensure departmental goals align with revenue cycle goals
• Meet and/or exceeds the established quality standard of 95% accuracy while meeting and/or exceeding productivity standards

Preferred Qualifications

• 3 years professional coding experience
• Working in OBGYN, surgical or radiology
• Experience running reports

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

For this US-based position, the base pay range is $18.58 – $29.49 per hour . Inidual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

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

Title: Coding Specialist III – St. Peter’s Hospital – FT – Remote

Location: US

00552841

Job Description:

Employment Type: Full time

Shift: Day Shift

If you are looking for a career as a health care professional, where you are nurtured by collaboration and teamwork, open communication, and learning. We invite you to become part of an award winning health care system.

Position Highlights:

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

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

Work/Life: Positions and shifts to accommodate all schedules

Position Summary:

Inpatient coding position

Analyzes physician/provider documentation contained in assigned health records (electronic, paper or hybrid) to determine the principal diagnosis, secondary diagnoses, principal procedure and secondary procedures.

Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of

Internal Classification of Diseases,

Clinical Modification diagnosis and procedure codes, and

Current Procedural Terminology / Healthcare Common Procedure Coding System (HCPCS) procedure codes and all required modifiers.

Utilizes coding guidelines established by the Centers for Medicare/Medicaid Services (CMS), American Hospital Association (AHA) Coding Clinic, American Medical Association (AMA) for CPT codes and CPT Assistant, American Health Information Management Association (AHIMA) Standards of Ethical Coding, Revenue Excellence/Regional Health Ministry (RHM) coding policies and CHE Trinity Health Coding Manual (TBA).

Minimum Qualifications:

1. Completion of an AHIMA-approved coding program or an AAPC-approved coding program, or Associate’s degree in Health Information Management or a related field or an equivalent combination of years of education and experience is required. Bachelor’s degree in Health Information Management (HIM) or related healthcare field is preferred.

2. Certified Coding Specialist (CCS), Certified Procedural Coder (CPC), Registered Health Information Technologist (RHIT), or Registered Health Information Administrator (RHIA) is required.

3. Two years of current acute care coding emergency department and observation or physician coding experience is required.

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

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

All new employees are required to undergo and pass all applicable state and federally mandated pre-employment screening requirements.

Pay Range:$22.25 – $34.79

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

If you are looking for a career as a health care professional, where you are nurtured by collaboration and teamwork, open communication, and learning. We invite you to become part of an award winning health care system.

Our Commitment to Diversity and Inclusion

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

Title: Senior Coder – Inpatient (Remote)

time type

Full time

job requisition id

JR69231

Job Details

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

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

Scheduling Flexibility and Perks

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

Primary Function:

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

Principal Duties and Responsibilities:

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

Education and Experience Requirements:

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

Christianacare Offers:

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

EEO Posting Statement

Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.

Location: Irving United States

Job Description:

Job Applicant Privacy Notice

Professional Fee E/M Coder

Publication Date: Nov 13, 2024

Ref. No: 522606

Location:

Irving, TX, US, 75063

Who we are.

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

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

Learn more on Advancing what matters

The future is our choice

At Atos, as the global leader in secure and decarbonized digital, our purpose is to help design the future of the information space. Together we bring the ersity of our people’s skills and backgrounds to make the right choices with our clients, for our company and for our own futures.

Professional Fee E/M Coder

Location: Remote (US Wide)

Experience Required

• Minimum of 1 Coding Certification from AHIMA or AAPC; RHIA, RHIT, CPC, CCS, COC
• 3+ years Coder work experience
• 2+ years of Oncology coding experience. EPIC/3M 360 CAC

1. Ability to level/audit/abstract documentation for E/M level for:

• Outpatient E/M
• Inpatient E/M
• Observation
• Telehealth
• Critical Care
• Emergency Medicine
• Prolonged services

1. In-office procedure coding
2. Neoplasm coding experience
3. Knowledge of global periods
4. Knowledge and use of modifiers
5. LCD/NCCI
6. Teaching Physician rules and regulations Production Standard of 13-20 charts per hour.

Rewards and benefits:

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

Future career path:

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

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

For any questions, please contact our recruiter Juan Estrada / [email protected]

Join our phenomenal team to grow together!

#LI-US #LI-REMOTE

Learn more about us

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

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

Coder II – OP Physician Coding (Ortho Specialty)

Remote, United States

Full Time

JOB SUMMARY

• The Coder 2 is proficient in three or more types of outpatient, Profee, or low acuity inpatient coding.
• The Coder 2 may code low acuity inpatients, one time ancillary/series, emergency department, observation, day surgery, and/or professional fee to include evaluation and management (E/M) coding or profee surgery.
  • For professional fee coding, team members in this job code will be proficient for inpatient and outpatient, for multi-specialties.
• Coder 2 utilizes the International Classification of Disease (ICD-10-CM. ICD-10-PCS), Healthcare Common Procedure Coding System (HCPCS) including Current Procedural Terminology (CPT) and other coding references to ensure accurate coding.
  • Coding references will be used to ensure accurate coding and grouping of classification assignment (e.g., MS-DRG, APR-DRG, APC etc.)
• The Coder 2 will abstract and enter required data.

WORK MODEL

100% Remote

SALARY

The pay range for this position is $26.27 (entry-level qualifications) – $39.41 (more experienced) The specific rate will depend upon the successful candidate’s specific qualifications and prior coding experience.

ESSENTIAL FUNCTIONS OF THE ROLE

• Examines and interprets documentation from medical records and completes accurate coding of diagnosis, procedures and professional fees.
• Reviews diagnostic and procedure codes and charges in the applicable documentation system to generate appropriate coding and billing.
• Communicates with providers for missing documentation elements and offers guidance and education when needed.
• Reconciles billing issues by formulating the rationale for rejecting and correcting inaccurate charges.
• Works collaboratively with revenue cycle departments to ensure coding and edits are processed timely and accurately.
• Reviews and edits charges.

KEY SUCCESS FACTORS

• Sound knowledge of applicable rules, regulations, policies, laws and guidelines that impact the coding area.
• Sound knowledge of transaction code sets, HIPAA requirements and other issues impacting the coding and abstracting function.
• Sound knowledge of anatomy, physiology, and medical terminology.
• Demonstrated proficiency of the use of computer applications, group software and Correct Coding Initiatives (CCI) edits.
• Sound knowledge of ICD-10 diagnosis and procedural coding and Current Procedural Terminology (CPT) procedural coding.
• Ability to interpret health record documentation to identify procedures and services for accurate code assignment.
• Flexibility and adaptability while also balancing requirements and regulatory and accreditation guidelines that are non-negotiables.

Must have one of the following Certifications:

• Registered Health Information Administrator (RHIA)
• Registered Health Information Technologist (RHIT)
• Certified Coding Specialist (CCS)
• Certified Coding Specialist Physician-based (CCS-P)
• Certified Professional Coder (CPC)
• Certified Outpatient Coder (COC)
• Certified Inpatient Coder (CIC)
• Certified Interventional Radiology Cardiovascular Coder (CIRCC)

BENEFITS

Our competitive benefits package includes the following:

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

• EDUCATION – H.S. Diploma/GED Equivalent
• EXPERIENCE – 2 Years of Experience
• CERTIFICATION/LICENSE/REGISTRATION – : Must have ONE of the coding certifications as listed:
  • Cert Coding Specialist (CCS)
  • Cert Coding Specialist-Physician (CCS-P)
  • Cert Inpatient Coder (CIC)
  • Cert Interv Rad CV Coder (CIRCC) – Cert Outpatient Coder (COC)
  • Cert Professional Coder (CPC)
  • Reg Health Info Administrator (RHIA)
  • Reg Health Information Technician (RHIT).

Multispecialty Outpatient Medical Coder

US – Remote (Any location)

Full time

Travel Required:

None

Clearance Required:

Ability to Obtain NACI

The Multispecialty Surgery Coder III will Code for Multispecialty Surgery physicians primarily Single Path Coding. Multi-specialty surgical coding experience, any Trauma, Urology, ENT, Plastics, GenSurg, OB/GYN, Cardiovascular, Interventional Radiology, etc. Ability to extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting, research as required, and regulatory compliance. Under the direction of the coding manager—the coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. The coder scope may involve reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines.

This position is full time as and 100% remote.

Responsibilities:

• Demonstrates the ability to perform quality surgical coding and multispecialty chart types as assigned
• Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing.
• Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards
• Achieves and maintains 97% accuracy in coding while maintaining a high level of productivity. Accuracy will be monitored during monthly reviews either within the facility
• Ability to maintain average productivity standards as follows
• Works the review queue daily to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary
• Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process. See re-bill policy in facility guidelines
• Coder downtime must be reported immediately to the administrative staff to ensure turnaround is met
• Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility
• Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request
• Responsible for coding or pending every chart placed in their queue within 24 hours
• It is the responsibility of the coder to notify administrative staff in the event they cannot meet the twenty-four hour turn around standard
• Coders are responsible for checking the Guidehouse email system at least every two hours during coding session
• Coders must maintain their current professional credentials while working for Guidehouse
• Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility
• Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy)
• It is the responsibility of each coder to review and adhere to the coding ision policy and procedure manual content
• Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services
• Communicates problems or coding principle discrepancies to their supervisor immediately
• Communication in emails should always be professional

What You Will Do:

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

• Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing
• Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards
• Achieves and maintains 97% accuracy in coding while maintaining a high level of productivity. Accuracy will be monitored during monthly reviews either within the facility
• Ability to maintain average productivity standards as follows
• Works the review queue daily to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary
• Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process. See re-bill policy in facility guidelines
• Coder downtime must be reported immediately to the administrative staff to ensure turnaround is met
• Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility
• Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request
• Responsible for coding or pending every chart placed in their queue within 24 hours
• It is the responsibility of the coder to notify administrative staff in the event they cannot meet the twenty-four hour turn around standard
• Coders are responsible for checking the Guidehouse email system at least every two hours during coding session
• Coders must maintain their current professional credentials while working for Guidehouse
• Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility
• Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy)
• It is the responsibility of each coder to review and adhere to the coding ision policy and procedure manual content
• Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services
• Communicates problems or coding principle discrepancies to their supervisor immediately
• Communication in emails should always be professional (reference e-mail policy)

What You Will Need:

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

What Would Be Nice To Have:

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

What We Offer:

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

Benefits include:

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

Remote Part-Time Outpatient Medical Coder

HIM | Remote Home Office | Part Time

Job Description

Remote VA Experienced Outpatient Medical Part Time Coders

Summary

Cooper Thomas, LLC, a leading provider of medical coding services to the Department of Veterans Affairs (VA), has immediate openings for experienced Outpatient Coders. Applicants must have at least 2 years of experience for part-time remote coding positions, with the opportunity for a flexible schedule. Previous experience with VA is required, whether as a VA employee or with another VA contractor. You must be able to pass an initial entrance exam and code at a minimum of 95% accuracy. This work will be performed remotely in your home office. Preference will be given to those candidates who meet the qualifications below and have an active Background Investigation, PIV Card, eToken, and Contractor/Moonlighter Account.

Ask about our productivity and quality incentives to maximize your pay.

We are looking for coders who can commit to a minimum of 20 hours per week, scheduled at your discretion from Monday through Sunday weekly.

Qualifications

· Must be able to perform the full scope of multi-specialty OP clinic, ED, minor procedures, radiology, rehabilitation, and lab encounters utilizing ICD-10, CPT, and HCPCS codes.

· At least two (2) years of VA or other relevant coding experience, either as a VA employee or with another Government contractor supporting VA

· Ability to code a minimum average of 10.0x Outpatient encounters per hour with 95% accuracy

· Must produce copies of and maintain active credentials as a certified coder or auditor

· Ability to follow site-specific coding guidelines

· Familiar with E/M leveling for OP and ED visits using 95′, 97′ and 2022 guidelines

· Familiar with E/M calculator and ability to use this tool proficiently

· Familiar with 3M Encoder for ICD10 and CPT coding

· Knowledge in anatomy and physiology, medical terminology, pathology and disease processes, pharmacology, health record format and content, reimbursement methodologies and conventions, rules and guidelines for current classification systems (ICD, CPT, HCPCS).

· Must be able to complete work within the required TAT of 5 days from the date of assignment.

Accepted Coding Credentials

American Health Information Management Association (AHIMA):

· Registered Health Information Administrator (RHIA) / Registered Health Information Technician (RHIT)

· Certified Coding Specialist (CCS) / Certified Coding Specialist-Physician (CCS-P)

American Academy of Professional Coders (AAPC):

· Certified Professional Coder (CPC)

· Certified Outpatient Coder (COC)

· Certified Professional Medical Auditor (CPMA)

Minimum Education

· High School Diploma or equivalent

Cooper Thomas, LLC is a leading provider of health information management services. Established in Washington, DC in 2003, Cooper Thomas offers a competitive salary, opportunities for quality bonuses, and the opportunity for growth. The selected candidate will be required to undergo a background investigation. Veterans encouraged to apply. Equal opportunity employer.

IMPORTANT NOTE: To apply, please go to the “Careers” section of our website at www.cooperthomas.com, and follow the instructions to register and apply.

Coding Specialist

Remote

How will this role have an impact?

Under the supervision of the Manager of Coding, this position is responsible for ICD-10 coding of Health Risk Evaluations of Medicare and Medicaid members that are performed by the Signify Health physicians and reviewing the Health Risk Assessments/Evaluations to insure completeness, accuracy and compliance with CMS guidelines.

What will you do?

• Reviews health risk assessments/evaluations to determine completion and compliance with CMS guidelines on a timely basis.
• Reviews and assesses the accuracy, completeness, specificity and appropriateness of diagnosis codes identified in the health risk assessments/evaluations.
• Reviews health risk assessments/evaluations to accurately and completely assign all ICD-9/10 codes that are clinically identified and supported in the assessment/evaluation on a timely basis.
• Communicates timely and effectively with supervisor regarding issues with the health risk assessments/evaluations and/or corrections required to the health risk assessments/evaluations.
• Understanding the relationship between IC-9/10 coding and HCC (hierarchical condition category) coding.
• Utilizes advanced, specialized knowledge of medical codes and coding protocol by providing guidance to the Director of Coding to ensure the organization is following Medicare coding protocol for payment of claims.
• Demonstrate a commitment to integrating coding compliance standard into coding practices. Identify, correct and report coding problems.
• Maintain adequate knowledge of compliant coding procedures related top Medicare Risk Adjustment.
• Maintain coding credentials
• Complete special projects as assigned by management, which require defining problems, and implementing required changes.
• Follows all legal and policy requirements for HIPAA protected data.
• Actively demonstrates teamwork at all times.
• Ability to work overtime.
• Is able to meet and maintain required accuracy and efficiency standards.

We are looking for someone with:

Must hold an active CPC,COC, CCS, CCS-P. Current coding certification in good standing. CRC required ICD-10 Coding Certification will be required Minimum of 1 year of experience of ICD-10 coding. Prior work experience in the healthcare field specifically related to coding is preferred. Experience and knowledge of Medicare HCC coding. Experience with medical record documentation. Prior medical chart auditing/quality experience preferred. Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology

The base salary hiring range for this position is $16.44 to $28.08. Compensation offered will be determined by factors such as location, level, job-related knowledge, skills, and experience. Certain roles may be eligible for incentive compensation, equity, and benefits.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. Eligible employees may enroll in a full range of medical, dental, and vision benefits, 401(k) retirement savings plan, and an Employee Stock Purchase Plan. We also offer education assistance, free development courses, paid time off programs, paid holidays, a CVS store discount, and discount programs with participating partn

About Us:

Signify Health is helping build the healthcare system we all want to experience by transforming the home into the healthcare hub. We coordinate care holistically across iniduals’ clinical, social, and behavioral needs so they can enjoy more healthy days at home. By building strong connections to primary care providers and community resources, we’re able to close critical care and social gaps, as well as manage risk for iniduals who need help the most. This leads to better outcomes and a better experience for everyone involved. Our high-performance networks are powered by more than 9,000 mobile doctors and nurses covering every county in the U.S., 3,500 healthcare providers and facilities in value-based arrangements, and hundreds of community-based organizations. Signify’s intelligent technology and decision-support services enable these resources to radically simplify care coordination for more than 1.5 million iniduals each year while helping payers and providers more effectively implement value-based care programs. To learn more about how we’re driving outcomes and making healthcare work better, please visit us at www.signifyhealth.com.

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

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

#SignifyHealth

#LI-RD1

Nurse Practitioner

Remote, USA

Working here

Our team is passionate, talented, and driven by our purpose to improve the health and happiness of our members. Our culture empowers each Twin to do what’s needed to create impact for our members, partners, and our company, and enjoy their experience at work. Twin Health was awarded Innovator of the Year by Employer Health Innovation Roundtable (EHIR) (out of 358 companies), named to the 2021 CB Insights Digital Health 150, and recognized by Built In’s 2022 Best Places To Work Awards. Twin Health has the backing of leading venture capital funds including ICONIQ Growth, Sequoia, and Sofina, enabling us to scale services in the U.S. and globally and help solve the global chronic metabolic disease health crisis. We have recently announced broad and growing partnerships with premier employers, such as Blackstone and Berkshire Hathaway. We are building the company you always wished you worked for. Join us in revolutionizing healthcare and building the most impactful digital health company in the world!

Excited to join us and do your part in improving people’s health and happiness?

Opportunity

As a Twin Advanced Practice Provider, you make a difference in people’s lives by providing treatment, management, and guidance to empower your members seeking to achieve complete diabetic reversal and overall health improvement across multiple conditions, using artificial intelligence, machine learning, and a health coach, RN, and provider care management model. This role is to support members in multiple states through remote care management.

Responsibilities

• Engage with collaborative team of healthcare professionals including health coaches, physicians, chief medical officer, and other colleagues
• Conduct health assessments including review of laboratory results, medical history, and psychosocial history
• Assess symptoms and treat as appropriate, collaborating with Twin Health member’s primary care provider
• Willingness to deliver care using telemedicine and to document in Twin’s clinical platform
• Manage a high risk population and work collaboratively between the care team and member to understand social determinants of health and population specific needs
• Willingness to learn and understand the Twin Model of Care to support reversal of diabetes and other chronic conditions
• Basic understanding of business objectives and service level agreements that support both financial, clinical, and quality success and outcomes
• Collaborate with Twin medical team to provide excellent customer service and experience, focusing member care around multiple chronic conditions
• Provide patient education to promote habits that will prevent diseases and maintain good health as outlined by Twin Health Program
• Discussing and reviewing patients’ medical history, symptoms, allergies, and current medications.
• Asking patients situation-specific questions to assess symptoms
• Prescribing suitable medications to patients and providing proper dosage and administration instructions per Twin Health Policy
• Maintaining accurate records of patients’ contact details, medical history, prescribed medications, allergies, diagnoses, and progress
• Additional duties as assigned

Qualifications

• Advanced Practice Registered Nurse license, licensed in multiple states.
• 3-5 years of experience as an advanced practice provider.
• Clinical experience and passion in working with multiple different populations including underserved groups
• Experience managing patients remotely across different geographic areas and states
• Eager to collaborate with a wonderful team of internal medicine and family medicine physicians and health coaches
• Board-certified in family or internal medicine or a related field
• Proven experience working as an advanced practice provider
• Sound medical knowledge
• The ability to consult with patients through virtual communication channels
• Excellent analytical and problem-solving skills
• Exceptional communication skills
• A patient and compassionate disposition
• Detail-oriented
• Interest in working with underserved groups
• Experience using technology and data to guide care decisions
• Fluent in English and Spanish preferred

Compensation and Benefits

The compensation for this position is $120,000 annually.

Twin has an ambitious vision to empower people to live healthier and happier lives, and to achieve this purpose, we need the very best people to enhance our cutting-edge technology and medical science, deliver the best possible care, and turn our passion into value for our members, partners and investors. We are committed to delivering an outstanding culture and experience for every Twin employee through a company based on the values of passion, talent, and trust. We offer comprehensive benefits and perks in line with these principles, as well as a high level of flexibility for every Twin.

• A competitive compensation package in line with leading technology companies
• As a remote friendly company we are committed to providing opportunities for all who join to further build relationships, increase cross-functional collaboration, and celebrate our accomplishments.
• Opportunity for equity participation
• Unlimited vacation with manager approval
• 16 weeks of 100% paid parental leave for delivering parents; 8 weeks of 100% paid parental leave for non-delivering parents
• 100% Employer sponsored healthcare, dental, and vision for you, and 80% coverage for your family; Health Savings Account and Flexible Spending Account options
• 401k retirement savings plan

Title: Nurse Care Manager

Location: United States

Job Description:

Targeted Care Navigation Local Nurse Care Managers provide comprehensive, in-home care management services to high-risk patients. This role focuses on preventing hospital readmissions, improving health outcomes, and ensuring patients receive the support and resources they need to manage their conditions effectively. The Nurse Care Manager will work closely with patients, their families, and other healthcare providers to develop and implement personalized care plans that address each patient’s unique needs.

The Targeted Care Navigation Local Nurse Care Manager will work directly with members in their local communities to bring better health and quality of life to these iniduals and families. They will be a part of an integral team including a Community Health Worker and an Included Health Virtual PCP

Responsibilities:

• Conduct in person visits to assess patient health status, educational, and psychosocial needs of the patient and their family. This will be at patient’s homes, hospitals, or accompanying to medical appointments.
• Together with patients and our multidisciplinary care team, generate a comprehensive inidualized plan of care and targeted interventions to help patients achieve desired goals
• Provide education and support to patients and families on managing chronic conditions, medications, and lifestyle changes
• Identify and address barriers to care, including social determinants of health, and connect patients with community resources and support services with the support of a remote Licensed Social Worker and Local Community Health Worker.
• Collaborate with patients, the remote Included Heath team, community physicians, family members, and other members of the health care team in order to ensure coordinated care.
• Continually monitor patient response to the plan of care, and revise the care plan as indicated.
• Implement systems of care that facilitate close monitoring of high-risk patients to prevent and/or intervene early during acute exacerbations.
• Maintain required documentation for all care management activities.
• Participate in case conferences and care coordination meetings to ensure a holistic approach to patient care.
• Participate in member engagement initiatives, including outreach to local provider and hospital groups.
• Stay current with best practices and evidence-based guidelines in chronic disease management and care coordination.
• Provide compassionate, longitudinal follow-up care, building supportive relationships.
• Assist throughout acute healthcare episodes, such as hospitalizations and rehabilitation stays, providing coordinated Case Management to support the member and their family.

As a condition of employment, the successful applicant for this position must be fully vaccinated against the flu (including annual booster) and provide acceptable proof of vaccination against Hepatitis B, Varicella, and MMR. Although not required, Included Health highly encourages the successful applicant to be fully vaccinated against COVID-19 (including annual booster).

In accordance with its policies, Included Health provides reasonable accommodations, absent undue hardship, to those who are unable to be vaccinated, either because of a sincerely held religious belief or a disability. If granted a reasonable accommodation from a vaccination requirement, the successful applicant will be required to be masked when providing services within patients’ homes.

Required Qualifications:

• Current Bachelor of Science in Nursing (BSN)
• Must reside in and have an active RN license in good standing with your state (AZ, TX, or IL) medical board
• BLS certification
• Current driver’s license, reliable transportation, car insurance, and an acceptable driving record with willingness to travel within approximately 50 miles to meet in person with patients in their homes or other medical facilities including hospitals, and local physician offices.
• 2+ years of experience with adult medicine and pediatric patients in primary care/ambulatory care, home health agency, skilled nursing facility, or hospital medical-surgical setting, within the past five years
• Strong clinical assessment, physical exam, and critical thinking skills. Comfortable discussing a wide variety of medical conditions.
• Broad knowledge of chronic conditions, evidence based guidelines, prevention, wellness, health risk assessment, and patient education
• Demonstrate excellent communication–both verbal and written. Proficient at writing medical information in easy-to-understand, patient-centric language.
• Able to work independently with strong internal drive, yet able to actively communicate challenges and/or concerns to leadership.
• Excellent interpersonal and facilitation skills
• Excellent time-management skills and an ability to adapt to changing needs/priorities
• Be highly empathetic with the ability to understand cultural and socioeconomic issues affecting patients and excellent at building rapport with patients and families from erse backgrounds.

Valued Qualifications:

• Current CCM Certification (in states where not required)
• 5+ years of experience in nursing
• Comfortable with technology and experience working remotely or with innovative care teams
• Experience working with patients in their homes
• Bilingual: Spanish and English
• Ability to have flexible schedule, position may require weekend work

Physical/Cognitive Requirements:

• Driving to member’s homes up to 5 days per week over wide geographical area
• Prompt and regular attendance at assigned work location.
• Ability to remain seated in a stationary position for prolonged periods.
• Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment.
• No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required.
• Ability to interact with leadership, employees, and members in an appropriate manner.

$66,850 – $86,910 a year

The United States new hire base salary target ranges for this full-time position are:

Zone A: $66,850 – $86,910 + equity + benefits

This range reflects the minimum and maximum target for new hire salaries for candidates based on their respective Zone. Below is additional information on Included Health’s commitment to maintaining transparent and equitable compensation practices across our distinct geographic zones.

Starting base salary for the successful candidate will depend on several job-related factors, unique to each candidate, which may include, but not limited to, education; training; skill set; years and depth of experience; certifications and licensure; business needs; internal peer equity; organizational considerations; and alignment with geographic and market data. Compensation structures and ranges are tailored to each zone’s unique market conditions to ensure that all employees receive fair and competitive compensation based on their roles and locations. Your Recruiter can share details of your geographic alignment upon inquiry.

In addition to receiving a competitive base salary, the compensation package may include, depending on the role, the following:

Remote-first culture

401(k) savings plan through Fidelity

Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)

Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents

Generous Paid Time Off (“PTO”) and Discretionary Time Off (“DTO”)

12 weeks of 100% Paid Parental leave

Family Building Benefit with fertility coverage and up to $25,000 for Surrogacy & Adoption financial assistance

Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment)

11 Holidays Paid with one Floating Paid Holiday

Work-From-Home reimbursement to support team collaboration and effective home office work

24 hours of Paid Volunteer Time Off (“VTO”) Per Year to Volunteer with Charitable Organizations

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.

Title: RN Daytime Triage

Location: United States

R-0059875

Job Description:

Number of Job Openings Available: 1

Department: 62000635 Allina Health Group Daytime RN Triage

Shift: Day (United States of America)

Shift Length: 8 hour shift

Hours Per Week: 32

Union Contract: Non-Union

Weekend Rotation: Every 3rd

Job Summary:

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

Key Position Details:

Employee is required to live within one hour of Apple Valley, MN.

• Fully remote position, including orientation, occasional onsite requirements
• 0.8 FTE, 8-hr day shifts, every third weekend and holiday rotation required
• Cross trained to process medication refills
• Benefit eligible position

Job Description:

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

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

Principle Responsibilities

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

Required Qualifications

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

Preferred Qualifications

• Experience in triage, anticoagulation, or remote nursing support

Licenses/Certifications

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

Physical Demands

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

Title: Manager, Government Corporate Accounts (Remote)

Req ID: 46773

Job Category: Sales

Location: Mentor, OH, US, 44060

Workplace Type: Remote

Job Description:

At STERIS, we help our Customers create a healthier and safer world by providing innovative healthcare and life science product and service solutions around the globe.

How You Will Make a Difference:

Do you have a proven track record for navigating key decision makers and building rapport? The Manager, Government Corporate Accounts will play a pivotal role in developing and nurturing strategic relationships within the healthcare sector, leveraging key decision-makers and influencers to drive growth and enhance customer experiences.

As an Manager, Government Corporate Accounts expands the STERIS enterprise footprint and presence in the assigned market. Leverages corporate key decision makers and influencers in supply chain, clinical and administration by providing a comprehensive sales strategy and team approach to the STERIS total portfolio solution.

This is a remote based customer facing position. To support and service our customers in this assigned territory candidates must be based out of one of the following state/city: Candidate must be able to travel 50% and can live anywhere in the US.

What You Will Do:

• Identify opportunities to increase existing business and secure new Customer agreements, managing a range of 15 to 20 accounts, with responsibility for a minimum of $15 million in annualized business.
• Achieves all revenue, gross margin and business targets representing the assigned STERIS enterprise footprint.
• Ensures customer needs are communicated through proper internal channels
• Assures integration into customer’s business via membership and attendance to Customer group associations and functions
• Conducts regular check-ins and businesses reviews with AVP to review objectives, progress, successes and development opportunities
• Develop and implement strategies and tactics necessary to expand the STERIS “enterprise” through successful account penetration at levels of the assigned Customer groups.
• Facilitates the development and expansion of the business by developing and nurturing strategic relationships, industry associations within healthcare.
• Monitors and reports external business trends back to their team
• Develops and maintains cooperative relationships with field sales, marketing and internal support functions of the organization by consistently sharing information, responsibilities, decision-making and recognition with others to maximize sales growth.
• Develops, implements and monitors activities with key Customers with direct focus on improving the Customer Experience.
• Engages, collaborates and supports internal teams focused on project business.
• Identifies and expands partnership opportunities with 3rd party Customers supporting and influencing key Customers.
• Develops and supports distribution opportunities aligned with Business Unit objectives.
• Helps identify the key business implications or changes in existing processes, programs, and priorities to drive growth in the assigned Customer group.
• Networks with key industry leaders, corporate partners, and key influencers within area of responsibility
• Interacts regularly with marketing, sales and internal support leaders to ensure process improvements are implemented effectively.
• Ensure the success of existing and new products and services through focused programs at key corporate accounts and as a field sales support mechanism.
• Identify and develop alternative market opportunities through corporate contacts that are not a part of field sales normal call patterns
• Attends and promotes STERIS at strategic trade shows, conventions, and industry affairs.

We Take Care of You:

• Base salary plus commission
• Car stipend and mileage reimbursement
• Business travel and related expenses paid via company credit card
• Cell phone stipend
• Excellent healthcare/ dental/ vision benefits
• 401(k) with a company match
• A robust sales training program
• Excellent opportunities for advancement

What You Need to be Successful:

• Four-year Degree; MBA preferred
• 10+ years of demonstrated success in medical sales; Five (5) years STERIS sales preferred. Competitive or related experience considered; plus 3+ years of management experience (marketing, corporate accounts, system project management)
• High level of business and financial acumen based on strategies to drive business unit revenue and goals.
• Possess extensive knowledge of STERIS products and services (technical and clinical).
• Demonstrated sales management and negotiation experience in medical device, capital products, and services
• Demonstrated ability to lead and/or influence a cross functional team and operate successfully in a highly complex medical device environment.

Must be able to be compliant with hospital/customer credentialing requirements

#LI-BS1

Skills

Pay range for this opportunity is $98,750.00 – $130,000.This position is eligible for commission.

Minimum pay rates offered will comply with county/city minimums, if higher than range listed. Pay rates are based on a number of factors, including but not limited to local labor market costs, years of relevant experience, education, professional certifications, foreign language fluency, etc.

Employees (and their families) may enroll in our company-sponsored medical, dental, vision, flexible spending, health savings account, voluntary benefits, supplemental life/AD&D plans and the company’s 401k plan. Employees are covered by an employee assistance program (also available to household members) and long-term disability. Full-Time Employees are also eligible for short-term disability. Full-time Employees will also receive Paid Time Off (PTO) based on years of service and paid Holidays. Part-time employees working 20 or more hours receive a pro-ration of the full-time PTO allocation and paid Holidays based on their standard hourly work week. Full-Time employees are eligible for four weeks of paid parental leave. Part-time employees also receive paid parental leave, pro-rated based on their standard hourly work week.

STERIS is an Equal Opportunity Employer. We are committed to equal employment opportunity and the use of affirmative action programs to ensure that persons are recruited, hired, trained, transferred and promoted in all job groups regardless of race, color, religion, age, disability, national origin, citizenship status, military or veteran status, sex (including pregnancy, childbirth and related medical conditions), sexual orientation, gender identity, genetic information, and any other category protected by federal, state or local law. We are not only committed to this policy by our status as a federal government contractor, but also we are strongly bound by the principle of equal employment opportunity.

Req ID: 46773

Job Category: Sales

Location:

Mentor, OH, US, 44060

Workplace Type: Remote

STERIS Sustainability

Life at STERIS

Title: Payer Operations Specialist (Remote)

Location: US

Type: Contract

Job Description:

About Carda

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

Who are we?

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

Who are you?

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

What will you do?

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

In a little more detail:

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

What we look for:

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

Sr Admin – Medical Records (Remote)

General information

Job Posting Title

Sr Admin – Medical Records (Remote)

City

Remote

Country

United States

Working time

Full-time

Description & Requirements

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

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

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

Essential Duties and Responsibilities:

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

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

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

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

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

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

– Perform other duties as may be assigned by management.

– Perform data entry tasks with accuracy.

Minimum Requirements

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

– 4 to 6 years of related experience required.

– Medical-related experience preferred.

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

– Strong analytical skills

– Detail and solution oriented

– Ability to work independently

– Excellent written and oral communication skills

– Proficiency in Microsoft Office suite

Preferred Requirements

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

Home Office Requirements

– Maximus provides company-issued computer equipment

– Reliable high-speed internet service

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

– Minimum 5 Mpbs upload speeds

#NYMC #LI-Remote

EEO Statement

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

Pay Transparency

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

Minimum Salary

$22.00

Maximum Salary

$22.00

Centralized Coding Specialist – Remote-7410-7798

Pacific Medical Data Solutions

Description

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

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

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

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

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

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

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

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

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

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

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

Qualifications

ESSENTIAL FUNCTIONS

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

Other Functions

1. Maintains regular and predictable attendance.

2. Performs other essential duties as assigned.

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

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

Experience:3-5 years of medical coding experience

License or Certification:

This position requires credentialing through AHIMA, and/or AAPC

The following certifications are accepted:

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

Skills and Abilities:

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

Benefits

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

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

We also offer a flexible, remote work environment.

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

Primary LocationColorado-Denver

ScheduleFull-time

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

Clinical Nursing Coordinator

Fully Remote • Remote Worker – N/A

Description

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

Clinical Nursing Coordinator: Job Description

POSITION SUMMARY:

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

PRIMARY DUTIES AND RESPONSIBILITIES:

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

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

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

MINIUMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

1. Knowledge and familiarity with call center and telehealth processes

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

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

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

Physical Demands

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

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

Work Environment

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

Schedule

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

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

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

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

Content and Curriculum Manager, Nursing

Job Description

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

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

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

Primary Responsibilities

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

Education & Experience

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

Preferred Qualifications

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

We offer a competitive benefits package including:

Remote work provides a flexible work/life balance

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

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

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

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

And so much more!

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

#LI-DK1

#LI-Remote

Location

Remote/Nationwide, USA

Additional Locations

Employee Type

Employee

Job Functional Area

Content/Material Creation

Business Unit

00092 Kaplan Health

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

Diversity & Inclusion Statement:

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

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

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

Title: Medicare Nurse Reviewer

Location: United States

Job Description:

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

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

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

Responsibilities

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

Qualifications

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

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

A Great Place to Work:

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

Excellent Benefits and Compensation:

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

An Investment in You:

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

About Medical Mutual:

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

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

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

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

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

#LI-REMOTE

Healthcare Revenue Cycle SNF Billing Consultant II

Job Locations: US

Job ID

2024-6404

Category

Consulting

Remote

Yes

At Wipfli, people count.

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

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

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

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

Responsibilities:

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

Qualifications:

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

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

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

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

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

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

#LI-CL2 #LI-remote

Part Time Case Manager RN

Job Locations: US-Remote

Job ID

2024-3583

Category

Care Management

Type

Regular Part-Time

Overview

Now is the time to join us!

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

Responsibilities

Who are you?

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

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

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

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

Qualifications

What you bring to the Personify Health team:

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

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

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

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

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

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

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

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

#LIRemote

#WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded

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

Application Deadline: Open until position is filled.

Remote Multispecialty Surgery Coder III

locations

US – Remote (Any location)

Full time

Job Family:

Health

Travel Required:

None

Clearance Required:

Ability to Obtain NACI

The Multispecialty Surgery Coder III will Code for Multispecialty Surgery physicians primarily Single Path Coding. Multi-specialty surgical coding experience, any Trauma, Urology, ENT, Plastics, GenSurg, OB/GYN, Cardiovascular, Interventional Radiology, etc. Ability to extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting, research as required, and regulatory compliance. Under the direction of the coding manager—the coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. The coder scope may involve reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines. This position is full time as and 100% remote.

Responsibilities:

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

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

What You Will Do:

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

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

What You Will Need:

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

ONE of the following recognized professional coding certifications:

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

What Would Be Nice To Have:

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

Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

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

Benefits include:

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

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

Title: Inpatient Coder

Location: Phoenix United States

time type: Full time

job requisition id: R4392719

Job Description:

Department Name:

Work Shift: Day

Job Category: Revenue Cycle

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

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

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

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

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

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

POSITION SUMMARY

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

CORE FUNCTIONS

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

MINIMUM QUALIFICATIONS

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

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

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

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

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

PREFERRED QUALIFICATIONS

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

Previous experience in large, multi-system healthcare organization.

Additional related education and/or experience preferred.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

PRN Corporate Coder

Location: Dallas United States

Job ID: 2403035697-0

Facility: Other Staff

Job Description:

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

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

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

Required:

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

Preferred:

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

A pre-employment coding proficiency assessment will be administered.

Compensation

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

Benefits

The following benefits are available, subject to employment status:

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

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

#LI-DM4

2403035697

Registered Nurse Care Manager

Remote, United States

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

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

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

What you will do: 

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

What you will need: 

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

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

– We care deeply about the people we serve.

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

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

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

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

Title: Inpatient Coder Senior Associate

Location: Remote – USA

Job Description:

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

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

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

As an Inpatient Coder Senior Associate, you will:

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

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

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

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

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

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

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

• • Identify and review potential program efficiencies and opportunities.

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

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

You will love this job if:

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

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

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

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

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

You should get in touch if:

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

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

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

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

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

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

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

Benefits Overview:

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

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

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

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

Additional Perks:

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

• • Reimbursement for office setup expenses

• • Monthly cell phone & internet stipend

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

• • Paid parental leave for all new parents

• • And much more!

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

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

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

#LI-Remote

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

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

Colorado/Washington Pay Range

$64,000 – $89,000 USD

California/New Jersey/New York Pay Range

$64,000 – $99,000 USD

Title: CODING SPECIALIST II – Remote – FT Days

Location: United States

Category: Health Information Management

Job Id: 00548737

Job Description:

Employment Type: Full time

Shift: Day Shift

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

Position Highlights:

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

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

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

What you will do:

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

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

What you will need:

Two years of current E&M Coding Experience

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

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

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

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

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

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

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

Ability to work with minimal supervision and exercise independent judgment.

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

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

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

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

Pay Range:$21.20 – $29.15

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

Our Commitment to Diversity and Inclusion

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

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

Location: Orlando United States

Job Description:

Job description

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

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

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

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

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

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

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

Skills:

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

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

Location: Remote, US

Type: Full Time – Regular

Workplace: remote

Category: Clinical Delivery

Job Description:

Registered Nurse

Department: Global Delivery

Level: Inidual Contributor

Work Location: Remote

______________________________________________________________________________________

What We Do

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

Who We Are

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

Position Overview

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

What You’ll Be Working On

Duties include but not limited to:

Lab Results Management:

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

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

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

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

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

Physical and Travel Requirements

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

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

What You Bring

Knowledge, Skills, and Abilities:

Skills:

Excellent communication and patient interaction skills.

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

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

Certifications/Licenses, Education, and Experience:

Education:

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

BSN or equivalent degree preferred.

Experience:

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

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

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

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

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

Benefits (US Full-Time Employees Only)

PTO/vacation days, sick days, holidays.

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

HSA plan

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

Culture of growth and equality

401k retirement plan

Diversity & Inclusion

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

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

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

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

Production Coding Specialist I – REMOTE

Job ID 2024-15406

Function

Revenue Cycle Management

Location

US-Remote

Employment Status

Full Time

Overview

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

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

Job Highlights

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

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

Qualifications

Knowledge/Skills/Abilities (KSAs):

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

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

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

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

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

Title: Clinical Care Coordinator – Remote

Location: Mooresville United States

Position Type: Part-Time

Category: Operations

Company: Gentiva

Job Description:

Our Company

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

Overview

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

The shift is

Monday 8am – 6:30pm

Tuesday 10am – 8:30pm

Thursday 10am – 8:30pm

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

About You

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

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

We Offer

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

Legalese

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

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

Care Coordinator, Care Management

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

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

Job Summary:

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

Our Investment in You:

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

Key Functions/Responsibilities:

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

Qualifications:

Experience:

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

Education:

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

Preferred/Desirable:

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

Competencies, Skills, and Attributes:

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

About WellSense

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

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

Pre-Screening Coordinator

Remote, US

Full time – Temporary

Remote

What We Do

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

Who We Are

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

Position Overview

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

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

Lab Management:

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

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

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

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

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

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

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

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

Physical and Travel Requirements

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

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

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

Certifications/Licenses, Education, and Experience:

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

Benefits (US Full-Time Employees Only)

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

Title: Senior Post-Award Grants Administrator

Location: Boston United States

Job Description:

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

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

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

Principal Duties and Responsibilities:

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

Qualifications

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

Skills/Abilities/Competencies

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

About Us:

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

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

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

Primary Location

MA-Boston-MGB Remote See Posting for Details

Work Locations

MGB Remote See Posting for Details

399 Revolution Drive

Somerville 02145

Job

Research Finance

Organization

Mass General Brigham

Schedule

Full-time

Standard Hours 40

Shift

Day Job

Employee Status

Regular

Recruiting Department MGB Research Management

Job Title: Survey Coder

Location: us

Job Description:

Time type: Full time

job requisition id: REQ1299

Location: Evansville IN or Remote

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

What You’ll Do:

· Perform verbatim review to identify adverse events

· Perform coding on verbatim comments from survey responses

· Code advertising content elements on media associated with a survey

· Create Storyboards and scripting for media associated with a survey

· Finalize and release code sheet

· Create and maintain documentation on processes, automation

· Seek ways to enhance productivity and finds efficiencies

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

What You’ll Need:

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

· Working knowledge of MS Office Suite

· Strong verbal and written communication skills

· Ability to be creative in troubleshooting issues and solving problems

· Strong project management and time management skills

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

About Comscore

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

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

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

Title: Complex Coder Outpatient

Location: CO-Colorado

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

Arizona, Arizona

**Department Name:**

Coding-Acute Care Hospital

**Work Shift:**

Day

**Job Category:**

Revenue Cycle

**Primary Location Salary Range:**

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

In accordance with State Pay Transparency Rules.

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

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

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

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

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

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

POSITION SUMMARY

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

CORE FUNCTIONS

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

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

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

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

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

MINIMUM QUALIFICATIONS

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

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

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

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

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

PREFERRED QUALIFICATIONS

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

Previous experience in large, multi-system healthcare organization.

Additional related education and/or experience preferred.

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

2025-02-18

**EEO Statement:**

Our organization supports a drug-free work environment.

**Privacy Policy:**

EOE/Female/Minority/Disability/Veterans

Banner Health supports a drug-free work environment.

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

Nurse Care Manager, Infertility-Maternity

Location: Remote

Type: Contractor

Workplace: remote

Category: Clinical Strategy and Services

Job Description:

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

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

Responsibilities

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

Qualifications:

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

Schedule

M-F 9a-6p PST

About Included Health

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

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

Clinical Coding Appeals Nurse

Remote, USA

Full time

R240000002599

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

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

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

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

Required Skills:

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

For this US-based position, the base pay range is $71,930.00 – $109,236.00 per year . Inidual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

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

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

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

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

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

Sr Director, Clinical Operations

Work at Home

Full time

Your Future Evolves Here

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

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

Join Evolent for the mission. Stay for the culture.

What You’ll Be Doing:

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

Key responsibilities include:

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

• Coordinating with key stakeholders internally and externally

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

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

• Planning, prioritizing, and scheduling projects to meet timelines

• Acting as a liaison between Clinical Operations and Partner Operations

• Monitoring performance metrics and driving initiatives to optimize performance

• Ensuring compliance with service level agreements

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

• Coordinating service delivery across a matrixed operational model

Additional duties:

• Providing technical guidance on problem definition and resolution

• Establishing client quality objectives and benchmarks

• Identifying and resolving operational deficiencies for dedicated clients

• Adhering to company policies, procedures, and standards

• Addressing and resolving user issues and understanding user terminology

• Providing customer support to both internal and external customers

• Offering guidance on conflict resolution

• Developing and ensuring compliance with policies and procedures

• Promoting professional growth and development through education and skills competency

The Experience You’ll Need (Required):

• Bachelor’s degree or 10 years of related experience

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

• Experience in working directly with Health Plan customers is required

• Demonstrates strong analytical, organizational and critical thinking skills.

• Ability to travel 25% for internal and external meetings

Technical requirements:

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

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

Technical Requirements:

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

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

Physician Practice Coder

locations

Remote

time type

Full time

job requisition id

37114

Position: Physician Practice Coder

Department: Coding & Education

Schedule: Full Time, Remote

POSITION SUMMARY:

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

JOB REQUIREMENTS

EDUCATION:

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

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

CPC – Certified Professional Coder

CPC-A – Certified Professional Coder Apprentice

EXPERIENCE:

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

KNOWLEDGE AND SKILLS:

• Work requires in-depth knowledge of medical terminology, ICD-10-CM and CPT-4 Work also requires basic concepts of human anatomy, physiology and pathology.
• Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
• Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
• Ability to work with accuracy and attention to detail
• Ability to solve problems appropriately using job knowledge and current policies/procedures.
• Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.
• Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.

ESSENTIAL RESPONSIBILITIES / DUTIES:

Coding support

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

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

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

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job.  The above is not intended to represent an exhaustive list of accountable duties and responsibilities required). IND123

Equal Opportunity Employer/Disabled/Veterans

Manager Coding

US-Remote

Full-Time

Overview

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

Responsibilities

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

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

Qualifications

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

Mental Requirements:

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

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

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

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

Medical Coder – Hospital Outpatient

Location:Remote, United States

Full time

job requisition id: 23567

Job Description:

Job Family:

Health

Travel Required:

None

Clearance Required:

Ability to Obtain NACI

Join Guidehouse’s Best in KLAS medical coding team!

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

We offer:

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

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

What You Will Do:

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

What You Will Need:

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

What Would Be Nice To Have:

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

What We Offer:

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

Benefits include:

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

About Guidehouse

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

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

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

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

Title: Hospital Coding Specialist II (Remote)

locations

Marshfield, WI

time type

Full time

job requisition id

R-0040187

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

Job Title:

Hospital Coding Specialist II (Remote)

Cost Center:

101651098 HIM-Facility Coding

Scheduled Weekly Hours:

40

Employee Type:

Regular

Work Shift:

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

Job Description:

JOB SUMMARY

Hospital Outpatient Coding:

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

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

Hospital Inpatient Coding:

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

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

JOB QUALIFICATIONS

EDUCATION

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

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

Preferred/Optional: None

EXPERIENCE

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

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

Preferred/Optional: Experience with electronic health record systems.

CERTIFICATIONS/LICENSES

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

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

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

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

Alabama

Alaska

Arkansas

Florida

Georgia

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Michigan

Minnesota

Mississippi

Missouri

Nebraska

North Carolina

North Dakota

Ohio

Oklahoma

South Carolina

South Dakota

Tennessee

Texas

Utah

West Virginia

Wisconsin

Wyoming

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

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

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

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

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