Land your dream remote job

Medicare Part C Medical Review Nurse

Job Location

Remote

Position Type

Full-Time/Regular

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving iniduals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.

Our Investigations MEDIC (I-MEDIC) clinical team is seeking a Medical Review RN (Claims Analyst II) with superior analytical skills and a proven ability to evaluate medical claims data. If you love digging into the data, this is the perfect job for you! As a Claims Analyst II on the I-MEDIC, you will play a key role on a team that detects and prevents fraud, waste and abuse in the Medicare Part C program on a national level. This is a home-based, full-time position with excellent benefits.

Job Summary:

Mid-level professional performs medical record and claims review for Medicare Part C and/or other claims data in order to ensure that proper guidelines have been followed. As a member of an investigative team, may act as a facilitator as well as a case manager regarding assessment for potential overpayment, fraud, waste, and abuse with regards to Medicare, Medicaid, and/or other claims.

Essential Duties and Responsibilities include some or all of the following. Other duties may be assigned.

• Review beneficiary, provider, and/or pharmacy cases for drug seeking, drug selling, beneficiary and other potential overpayment, fraud, waste, and abuse.
• Completes desk review to meet applicable contract requirements and to identify evidence of potential overpayment or fraud.
• Effectively identifies and resolves claims issues and determines root cause.
• Consults with Benefit Integrity investigation experts and pharmacists for advice and clarification.
• Completes inquiry letters, investigation finding letters, and case summaries.
• Investigates and refers all potential fraud leads to the Investigators/Auditors.
• Has basic understanding of the use of the computer for entry and research.
• Responsible for case specific or plan specific data entry and reporting.
• Participates in internal and external focus groups and other projects, as required.
• Identifies opportunities to improve processes and procedures.
• Has the responsibility and authority to perform their job and provide customer satisfaction.
• May participate as an audit/investigation team member for both desk and field audits/investigations
• Has developed expertise with standard concepts, practice and procedures in field. Relies on limited experience and judgment to plan and accomplish goals.
• Testifies at various legal proceedings as necessary.
• May mentor and provide guidance to other analysts.
• Performs a variety of tasks some requiring independent thought and research. A degree of creativity and latitude is required.

Required Skills

To perform the job successfully, an inidual should demonstrate the following competencies:

• Analytical – Synthesizes complex or erse information; Collects and researches data; Uses intuition and experience to complement data.
• Problem Solving Gathers and analyses information skillfully; Identifies and resolves problems.
• Judgment – Supports and explains reasoning for decisions.
• Written Communication – Writes clearly and informatively; Able to read and interpret written information.
• Quality Management – Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
• Interpersonal Skills – Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others’ ideas and tries new things.
• Teamwork – Balances team and inidual responsibilities; Exhibits objectivity and openness to others’ views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; able to build morale and group commitments to goals and objectives; Supports everyone’s efforts to succeed.
• Professionalism – Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
• Computer Applications – Must have intermediate level experience with Microsoft Office to include Excel.

Required Experience

Education and/or Experience

• BSN OR an RN with additional current and active degree/license/certification/s in a relevant healthcare discipline (i.e., CPC, CPHM, CFE, CCM, HCAFA).
• Must possess at least five years clinical experience.
• At least one year healthcare experience that demonstrates expertise in conducting utilization reviews.
• ICD-10 coding, CPT coding, and knowledge of Medicare regulations preferred.
• Prior successful experience with CMS, State Medicaid, and OIG/FBI or similar agencies preferred.
• Medicare Advantage experience preferred
• Experience writing case summaries. Writing sample will be required.
• Legal case experience preferred.

Certificates, Licenses, Registrations: Current, active and non-restricted RN licensure required. An LVN does not meet requirements.

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Iniduals with Disabilities.

CODING SUPERVISOR – REMOTE

Molina Healthcare

Job ID 2023465

Job Description

Job Summary

The Supv, Coding is responsible for providing assistance to the department leadership by ensuring compliance with coding guidelines. Subject Matter Expert who researches coding, coding relating issues, and reporting findings to management, providers and staff while providing direction and leadership to the team.

Knowledge/Skills/Abilities

Assist department leadership with oversight of coders’ day to day work including supervision of the internal coding staff to include hiring, performance management, recognition and development.

Ensures quality, productivity standards, and adherence to state and federal guidelines are met. Monitors compliance with corporate policies and procedures.

Identifies, assists, develops, and maintains corporate documentation, policy and procedures for standardized operations.

Acts as a coach and positive role model for staff and colleagues establishing/maintaining a positive work environment.

Coordinates staff schedules to ensure staging levels meet business needs.

Develops processes to ensure complete and accurate coding of assigned product lines.

Tracks coding issues and reviews coding inaccuracies to highlight areas of improvement.

Collaborates with interdepartmental or cross-functional teams for any assigned projects and provides departments with coding issues and updates to be shared with providers

Maintains a library of coding material and relevant resources to be available to personnel, when necessary.

Maintains a positive relationship with all clients and serves as a resource for clients and co-workers in regards to coding inquiries.

Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies as necessary or required. Maintains current knowledge of health care billing laws, rules and regulations and developments.

• Healthcare insurance experience
• 4+ years of medical coding experience
• Proven ability to perform strategic planning and priority setting for a coding department.
• High attention to detail

Job QualificationsRequired Education

Bachelor’s Degree or equivalent experience

Preferred Education

Bachelor’s Degree in related field

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

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

Pay Range: $49,430.25 – $107,098.87 / ANNUAL

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

About Us

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

Job Type: Full Time

Coding Denial Specialist

US – Remote (Any location)

Full time

15602

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Do:

The Coding Denial Specialist will review assigned coding denials across multiple specialties, determine root cause and following established client workflow resolve and/or appeal denials based on clinical documentation and diagnostic results in alignment with Federal & State Coding regulations; including the National Correct Coding Initiative, CPT, HCPC’s and ICD10 CM Guidelines This position is full time as and 100% remote. What You Will Need:

• High School diploma and 1-3 years of prior relevant experience
• Minimum 3 years physician Coding experience
• Minimum 1 year physician coding denial management experience
• CPC certification from AAPC
• Must maintain credential throughout employment
• Excellent verbal, written and interpersonal communication skills
• Basic knowledge of Excel, Word and PowerPoint
• High level of accuracy and attention to detail
• Strong Working Knowledge of Federal & State Coding regulations; including the National Correct Coding Initiative
• Strong working knowledge of CPT, HCPC’s and ICD10 CM Guidelines
• Good working knowledge of HIPAA regulations, hospital operations, and working with electronic health record (EHR) systems such as EPIC or Cerner

What Would Be Nice To Have:

• Epic experience
• AAPC specialty credential(s)
• Proficient in the interpretation of Claim Adjustment and Remittance Advice Reason Codes

The annual salary range for this position is $39,200.00-$58,700.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

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

Benefits include:

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

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Title: Strategic Account Manager – Remote – Medical Benefit Products and Processes

Location: Orlando, FL

The Account Manager cultivates and maintains AssistRx’s relationship with our Pharmaceutical manufacturing partners. In this role, you’ll be working with pharmaceutical executives (Associate Director and above) on a daily basis to ensure they are receiving maximum value from iAssist’s features and services. The Pharmaceutical Account Manager presents new ideas and innovations to clients, upselling and enhancing their product and is the liaison between the Pharmaceutical Brand Teams and all key AssistRx stakeholders.

Responsibilities:

• Forms strategic partnership with clients by developing a working knowledge of their business goals, technical challenges and infrastructure configurations to ensure an outstanding customer experience.
• Establish and maintain a role as advisor to clients and colleagues.
• Present new ideas and innovations to client to upsell and enhance their products and services.
• Research high-level solutions for the client.
• Develop the relationship with the client through regular meetings/conference calls to review service quality and ensure they are receiving maximum benefit from iAssist’s features and benefits
• Works with Client Services to solve complex support issues effectively.
• Manages the delivery of recommended/agreed-upon services to achieve high client satisfaction and trust.
• Determines most effective method of problem resolution by utilizing internal resources when necessary.
• Primary point of contact for sales and service.
• Determines most effective method of problem resolution by utilizing internal resources when necessary.
• Participates in client quarterly reviews, attends annual Plan Of Action meetings and other travel as needed.
• Plan milestones and track progress.
• Effectively keeps others adequately informed by presenting information to everyone involved.

Requirements:

• Ability to effectively express ideas and thoughts verbally and in written form.
• Exhibits good listening skills and comprehension.
• Effectively keeps others adequately informed by presenting information to everyone involved.
• Ability to define problems, collect data, establish facts and draw valid conclusions.
• Bachelor’s Degree (B.A.) from four-year college or university or equivalent experience.
• Minimum three years of experience working in a customer support and/or sales capacity role.
• Experience working for or in Pharma.
• Experience working with Pharmaceutical Brand Teams is essential.
• Project Management, HUB Operations or Specialty Pharmacy Operations/Account Management strongly desired.
• Technical skills a must

Benefits:

• Supportive, progressive, fast-paced environment
• Competitive pay structure
• Matching 401(k) with immediate vesting
• Medical, dental, vision, life, & short-term disability insurance

AssistRx, Inc. is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors, or any other protected categories protected by federal, state, or local laws.

All offers of employment with AssistRx are conditional based on the successful completion of a pre-employment background check.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Sponsorship and/or work authorization is not available for this position.

AssistRx does not accept unsolicited resumes from search firms or any other vendor services. Any unsolicited resumes will be considered property of AssistRx and no fee will be paid in the event of a hire

PAC Nurse

Job Locations Remote

Job ID

2023-15347

Category

Clinical / Post Acute Care

Min

USD $28.85/Yr.

Max

USD $38.46/Yr.

Overview

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

Responsibilities

In this role, you will:

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

Support the following additional duties as requested:

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

Qualifications

You should reach out if:

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

What we offer:

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

CareCentrix maintains a drug-free workplace

#IDCC

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

Job Title: Certified Medical Billing and Coding Specialist

Location: Remote

$25 $30 Hourly

Job Type: Full-Time

Company Overview:

Flow Health is a rapidly growing clinical diagnostic laboratory services provider, leading the way in inidualized, data-driven diagnostics. Based in Los Angeles, we hold both CAP accreditation and CLIA certification, uniquely positioned to combine the power of artificial intelligence (AI) with an end-to-end full service laboratory diagnostics platform. Our mission is clear: to revolutionize how clinicians and patients order and access personalized diagnostic insights, ultimately improving clinical outcomes and patient care.

Job Description:

We are seeking a highly skilled and detail-oriented Certified Medical Billing and Coding Specialist to join our laboratory team. The successful candidate will play a crucial role in ensuring accurate coding processes, contributing to the financial health of our organization. The ideal candidate should possess strong analytical skills, knowledge of medical terminology, and a deep understanding of coding principles and regulations within the diagnostic laboratory setting. The role is 100% remote, offering the applicant outstanding work flexibility.

Key Responsibilities:

• Assign appropriate codes to diagnoses, procedures, and laboratory services based on documentation provided by healthcare providers and laboratory professionals.
• Ensure compliance with all relevant coding guidelines, specifically ICD-10.
• Stay up-to-date with changes in coding regulations, payer policies, and healthcare laws relevant to diagnostic laboratory coding.
• Conduct regular audits to ensure compliance with coding and billing standards specific to diagnostic laboratory services.
• Demonstrate sound knowledge of laboratory coding guidelines and regulations to assist providers with the impact of diagnosis coding on risk adjustment payment models.
• Requires solid oral and written communication skills, and strong attention to detail.

Qualifications:

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification is required.
• Associate s degree in Medical Billing and Coding or related field is preferred.
• Minimum of 2 years experience in medical billing and coding, ideally within a clinical or laboratory setting.
• Familiarity with medical billing software and claims processing systems specific to laboratory services.
• Expertise in ICD-10, with emphasis on diagnostic codes.
• Must have excellent time management skills, be highly organized, and self-motivated.

Title: Remote Pro Fee Coder

Location: Helena, MT

Job Family: General Coding

Travel Required: None

Clearance Required: None

What You Will Do:

• The General Surgery Coder must be proficient in surgical coding for all Trauma Surgery type cases.
• E/M experience is also required for associated providers.
• The coder will review clinical documentation and diagnostic results as appropriate 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 and 100% remote.

• Demonstrates the ability to perform quality surgical coding on General and Trauma surgery 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.
• 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.
• 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.
• 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.

What You Will Need:

• Minimum 3-5 years General Surgery Coding experience, both IP and OP coding for physician claims.
• 2-3 years coding Trauma or other complex procedures.
• CPC certification from AAPC
• EMR experience
• Must maintain credential throughout employment
• Must be able to work independently, multi-task well and interface with all levels of personnel as well as clients
• Advanced knowledge of Excel, Word and PowerPoint
• Strong Working Knowledge & experience with Federal & State Coding regulations and Guidelines

What Would Be Nice To Have:

• Multiple EMR and/or practice management systems experience
• E/M experience along with surgical coding experience (Office, OP and OR procedures

\#Indeedsponsored

\#LI- Remote

The annual salary range for this position is $40,200.00-$72,300.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

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

Benefits include:

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

About Guidehouse:

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

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

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

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

Clinical Coder II – Surgery

JOB DESCRIPTION:

The Department of Surgery is seeking a full-time Clinical Coder II position to assure that all clinical evaluation and management procedure services are captured, coded, and billed accurately and timely. Primary area of responsibility will be Surgical Critical Care. Candidates are required to be certified by one of the following institutions: Certified Professional Coder (CPC)/ American Academy of Professional Coders (AAPC) or Certified Coding Specialist (CCS-P) required. This position is remote, however, an on-site training period may be required based on experience and qualifications.

Duties include:

• Performing highly specialized diagnosis and procedure coding for all non-operative and operative procedures performed.
• Verify all patient data for accuracy and resolve discrepancies.
• Review reports to determine billable services and apply the appropriate codes in a timely manner.
• Accurate and timely processing of charges in EPIC.
• Contacting Physicians or other clinical staff when appropriate to discuss coding, documentation, and/or compliance problems.
• Discussing coding, documentation, and compliance issues with co-workers on coding, documentation, and/or compliance issues.
• Demonstrating proficiency in the preparation and communication of physician queries.
• Remain current on coding and compliance information/guidelines and to become an expert in this specialized area of coding.
• Performs independent research and generates reports as requested by the department chairman, ision chiefs, and faculty members via the Assistant Director regarding amounts billed versus amounts paid to determine the effectiveness of coding practices.
• Review reimbursement reports and track payments for coding issues.
• Review reports from University of Florida Physicians reflecting payments for charges and uses this information to determine if coding is appropriate.

EXPECTED SALARY:

$21.70-$23.75 per hour; commensurate with education and experience.

MINIMUM REQUIREMENTS:

High school diploma or equivalent and three years of professional medical coding experience.

Appropriate college coursework or vocational/technical training may be substituted at an equivalent rate for the required experience. Certified Professional Coder (CPC)/American Academy of Professional Coders (AAPC) or Certified Coding Specialist (CCS-P) required.

PREFERRED QUALIFICATIONS:

• Ability to code for both diagnosis and procedure required.
• Epic system knowledge preferred.
• The incumbent must be comfortable speaking with physicians and payers regarding procedure and diagnosis relationships, billing rules, and payment variances.
• Incumbent should be proficient in Microsoft Excel and Microsoft Word

SPECIAL INSTRUCTIONS TO APPLICANTS:

For consideration, you must apply online. Please upload your cover letter of interest, resume, and three professional references.

The University of Florida is committed to nondiscrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, gender identity and expression, marital status, national origin, political opinions or affiliations, genetic information, and veteran status in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training.

This position is eligible for veteran’s preference. If you are claiming veteran’s preference, please upload a copy of your DD 214 Member Copy 4 with your application for consideration.

Application must be submitted by 11:55 p.m. (ET) of the posting end date.

Location: USA-

Contract Specialist I – Remote

Job Title

Contract Specialist I – Remote

Duration

Open until Filled.

Work From Home

Yes

Work Remote

Yes

Description

Let’s do great things, together

Founded in Oregon in 1955, ODS, now Moda, is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

This position is a subject matter expert regarding health plan contracts; preparation of a high volume of medical and dental plan documents for standard and non-standard groups in compliance with company specifications, turnaround time requirements and all state and federal laws and regulations; production of Summary of Benefit and Coverage and Plan Change Form documents.

This is a Remote Role.

Follow the link below and complete an application for this position.

https://j.brt.mv/jb.do?reqGK=27719378&refresh=true

Benefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Requirements:

• Bachelor’s degree or combination of college level coursework and relevant experience.
• 1-2 years of insurance experience preferred in areas such as Claims and/or Customer Service.
• Demonstrated proficiency using Adobe and Microsoft Office applications, including Word and Excel.
• Proficiency in computer keyboard; minimum typing ability of 35 wpm.
• Effective verbal, written and interpersonal communications skills.
• Demonstrated ability to identify problems and initiate a solution.
• Ability to initiate and follow departmental policies and procedures.
• Ability to work under pressure and exhibit flexibility in changing priorities.
• Ability to learn new information and apply it to a variety of situations.
• Highly effective organizational skills with the ability to prioritize and meet deadlines.
• Maintain confidentiality and project a professional business image to internal and external customers.
• Ability to come to work on time and on a daily basis.

Contact with Others:

Internally with Sales and Account Services, Regulatory, Claims, Business Implementation Unit, Benefit Configuration, Membership Accounting, Pharmacy, Underwriting, and Contract Services

Duties & Responsibilities:

• Analyze and comprehend source documents such as Group Application identify potential errors, research as appropriate and correct any incorrect information.
• Accurately prepare plan documents for new and renewing standard and non-standard groups.
• Learn and understand company products, including annual changes and new products, and how they relate to plan documents.
• Learn and understand the difference in standard and non-standard language.
• Function as subject matter expert and respond to inquiries from internal departments regarding plan documents.
• Identify discrepancies between source documents and contract department records and articulate questions to relevant internal departments.
• Communicate with internal departments on requested changes to plan documents
• Develop a chronology of actions taken and maintain group files and work logs accordingly.
• Assist in development of policies and procedures.
• Produce Summary of Benefit and Coverage (SBC) and Plan Change Form documents.
• Perform peer-audits and self-audits of plan documents for accuracy.
• Produce a quality product under short turnaround time requirements, in accordance with department productivity and accuracy standards.
• Support peers in a team structure.
• Train lower level staff, such as temporary staff.
• Perform other duties as assigned.

Working Conditions:

Office environment with extensive close PC and keyboard work, constant sitting, and phone work. Must be able to navigate multiple screens. Work in excess of 37.5 hours per week during peak business periods.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our [email protected] email.

Pay Range

$22.00 Hourly to $25.25 Hourly

Title: Remote Medical Coder- Hospital Inpatient

Job Family :

General Coding

Travel Required :

None

Clearance Required :

None

What You Will Do :

The Remote Inpatient Coder will review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10 and PCS 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 and any other official coding guidelines established for use with mandated standard code sets.

• Maintains a working knowledge of ICD-9-10 PCS 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/PCS 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.Maintains average productivity standards as follows: 2 IP charts per hour (These productivity standards are Guidehouse general expectations and are subject to change based upon Guidehouse client agreements and/or other factors as determined by management. Notification of expected productivity will be conveyed by Management prior to assignment of a client project).

What You Will Need :

• Minimum 2 – 5 years+ previous work experience coding hospital acute care Inpatient records.
• Minimum 5+ years medical coding experience
• CCS, RHIT or RHIA Certification from AHIMA or CIC required.
• Must have experience working in systems such as EPIC, Cerner, Optum and/or 3M
• Must have good working knowledge of Anatomy and Physiology as well as Medical Terminology.
• Must have advanced knowledge of Coding clinics ICD-10-CM and PCS
• High School Diploma

What Would Be Nice To Have :

• Previous experience working with CDI and physician queries.
• Has ability to analyze Provider documentation and assign codes accurately.
• Strong knowledge and application of Government and other payer guidelines as they relate to compliant coding.

#Indeedsponsored

#LI- Remote

The annual salary range for this position is $50,600.00-$91,100.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer :

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

Benefits include:

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

About Guidehouse

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

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

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at or via email at. 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: Remote Medical Coder- Hospital Inpatient

Location: OH-Columbus

**Job Family** **:**

General Coding

**Travel Required** **:**

None

**Clearance Required** **:**

None

**What You Will Do** **:**

The Remote Inpatient Coder will review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10 and PCS 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 and any other official coding guidelines established for use with mandated standard code sets.

• Maintains a working knowledge of ICD-9-10 PCS 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/PCS 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.Maintains average productivity standards as follows: 2 IP charts per hour (These productivity standards are Guidehouse general expectations and are subject to change based upon Guidehouse client agreements and/or other factors as determined by management. Notification of expected productivity will be conveyed by Management prior to assignment of a client project).

What You Will Need :

• Minimum 2 – 5 years+ previous work experience coding hospital acute care Inpatient records.
• Minimum 5+ years relevant experience
• CCS, RHIT or RHIA Certification from AHIMA or CIC required.
• High School Diploma
• Must have experience working in systems such as EPIC, Cerner, Optum and/or 3M
• Must have good working knowledge of Anatomy and Physiology as well as Medical Terminology.
• Must have advanced knowledge of Coding clinics ICD-10-CM and PCS

What Would Be Nice To Have :

• Previous experience working with CDI and physician queries.
• Has ability to analyze Provider documentation and assign codes accurately.
• Strong knowledge and application of Government and other payer guidelines as they relate to compliant coding.

\#Indeedsponsored

\#LI- Remote

The annual salary range for this position is $50,600.00-$91,100.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

**What We Offer** **:**

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

Benefits include:

+ Medical, Rx, Dental & Vision Insurance

+ Personal and Family Sick Time & Company Paid Holidays

+ Position may be eligible for a discretionary variable incentive bonus

+ Parental Leave

+ 401(k) Retirement Plan

+ Basic Life & Supplemental Life

+ Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

+ Short-Term & Long-Term Disability

+ Tuition Reimbursement, Personal Development & Learning Opportunities

+ Skills Development & Certifications

+ Employee Referral Program

+ Corporate Sponsored Events & Community Outreach

+ Emergency Back-Up Childcare Program

**About Guidehouse**

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

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

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

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

Remote Pro Fee Neurosurgery Coder

Location: MILWAUKEE Wisconsin; United States

Job Description & Requirements

Pay Rate: $35.00 – $50.00

POSITION SUMMARY : Remote Pro Fee Neurosurgery Coding

POSITION DUTIES: Coding of Provider services for Pro Fee Neurosurgery Services

MINIMUM REQUIRED QUALIFICATIONS: CPC, CCS-P or RHIT; 3-5 Years Hospital Based Pro Fee Neurosurgery Coding

PREFERRED QUALIFICATIONS: CRC credential, Pediatric experience a plus within specialtiy

LENGTH OF ASSIGNMENT: Ongoing

SHIFT / HOURS PER WEEK: 20-24 per week

SYSTEMS: EPIC, Optum

Facility Location

Experience the entertainment, celebration and fun of the City of Festivals, where a thriving seaport combines with great neighborhoods and a small-town atmosphere. From the sparkling shoreline of Lake Michigan to an impressive array of museums, performing arts and shopping and dining options, the city is filled with endless unexpected surprises!

Job Benefits

Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary but the perks don’t stop there. There are many additional benefits to enjoy, including:

• Medical, dental and vision benefits
• Earned time off and paid holidays
• Paid continuing education time
• 401(K) retirement planning
• Short-term disability, life insurance, paid jury duty
• Access to the largest network of facilities and providers in the country
• Industry experienced workforce management team
• Licensure and certification reimbursement

About the Company

At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.

Title: Remote Medical Coder- Hospital Inpatient

Location: CT-Hartford

**Job Family** **:**

General Coding

**Travel Required** **:**

None

**Clearance Required** **:**

None

**What You Will Do** **:**

The Remote Inpatient Coder will review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10 and PCS 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 and any other official coding guidelines established for use with mandated standard code sets.

+ Maintains a working knowledge of ICD-9-10 PCS 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/PCS 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.Maintains average productivity standards as follows: 2 IP charts per hour (These productivity standards are Guidehouse general expectations and are subject to change based upon Guidehouse client agreements and/or other factors as determined by management. Notification of expected productivity will be conveyed by Management prior to assignment of a client project).

**What You Will Need** **:**

+ Minimum 2 – 5 years+ previous work experience coding hospital acute care Inpatient records.

+ Minimum 5+ years relevant experience

+ CCS, RHIT or RHIA Certification from AHIMA or CIC required.

+ High School Diploma

+ Must have experience working in systems such as EPIC, Cerner, Optum and/or 3M

+ Must have good working knowledge of Anatomy and Physiology as well as Medical Terminology.

+ Must have advanced knowledge of Coding clinics ICD-10-CM and PCS

**What Would Be Nice To Have** **:**

+ Previous experience working with CDI and physician queries.

+ Has ability to analyze Provider documentation and assign codes accurately.

+ Strong knowledge and application of Government and other payer guidelines as they relate to compliant coding.

#Indeedsponsored

#LI- Remote

The annual salary range for this position is $50,600.00-$91,100.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

**What We Offer** **:**

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

Benefits include:

+ Medical, Rx, Dental & Vision Insurance

+ Personal and Family Sick Time & Company Paid Holidays

+ Position may be eligible for a discretionary variable incentive bonus

+ Parental Leave

+ 401(k) Retirement Plan

+ Basic Life & Supplemental Life

+ Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

+ Short-Term & Long-Term Disability

+ Tuition Reimbursement, Personal Development & Learning Opportunities

+ Skills Development & Certifications

+ Employee Referral Program

+ Corporate Sponsored Events & Community Outreach

+ Emergency Back-Up Childcare Program

**About Guidehouse**

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

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

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: Triage Registered Nurse

(Part-Time Evening)

Location: Remote

Type: Part-time

Workplace: remote JobDescription:

Role Summary:

The Remote Triage Registered Nurse / RN supports patients and their families by providing clear, safe and effective telephone triage using evidence-based processes and tools. The Registered Nurse on this team will blend critical thinking skills with a decision support tool enabling safe, standardized care to our patient population.

2 Part-Time Evening positions available!

Shift/Schedule:

#1

Week 1: Tues-Fri 3p-7p PST

Week 2: Tues and Wed 3p-7p PST, Sat and Sun 10a-7p PST

#2

Week 1: Tues and Wed 3p-7p PST, Sat and Sun 10a-7p PST

Week 2: Tues-Fri 3p-7p PST

Essential Job Duties:

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

Requirements:

• Bachelor of Science in Nursing required
• Registered Nurse, currently residing and licensed in a compact state with eligibility to obtain RN licensure in all 50 states
• 2+ years experience in a triage setting, preferably some of that experience being focused on phone triage, or 2+ years experience in an emergency room, or 4+ years experience in an ambulatory primary care role that included triage
• Ability to work in PST Timezone
• Rotating holiday and weekend rotation (every 3rd weekend for Full Time and every other weekend for Part Time)
• Expertise in advanced clinical decision making
• Comfortable working with a wide variety of medical conditions for both pediatric and adult populations
• Experience in engagement in complex decision making, including situations of uncertainty
• Excellent written and verbal communication skills. The ability to gather a clinical history, answer questions at a patient level, and succinctly summarize findings is critical.
• Strong competence and ability to use multiple computer/medical record systems, as well as Google suite
• Must be able to work efficiently. We are a fast growing company and we are busy. Our team is expected to meet role specific metrics without sacrificing quality. Good judgment for balancing priorities is a must.
• Maintain current nursing licensure by completing applications for renewal in a timely manner and by complying with all requirements for continuing education.

Other Skills/Abilities:

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

The United States base salary range for this full-time position is $30.52 AND $39.67 + benefits.

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. Included Health reserves the right to modify these ranges in the future. For further information, please ask your Recruiter.

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

• 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
• Up to $25,000 Fertility and Family Building Benefit
• 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
• Your recruiter will share more about the benefits for this role during the hiring process.

#LI-Remote

#LI-LC1

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.

Spanish Speaking Registered Nurse

Remote

Watertown, Massachusetts, United States

Clinical

Full time

Description

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

Founded by experienced clinicians and technology leaders, Firefly Health is on a mission to deliver half-priced health care that’s twice as good, clinically and emotionally. We are flipping the script on what it means to be a health plan and actually providing a true health benefit to members.

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

What you’ll do:

As a Registered Nurse on the Firefly team, you’ll be responsible for:

• Acute and chronic disease management
  • Triage all new patient concerns that arise from the Firefly mobile application or phone calls to determine the urgency and disposition based on the patient’s clinical need. Along with the NP or MD, the RN facilitates the transition to the correct level of care, whether with a Firefly clinician, urgent care, specialty care, or the emergency department (ED)
  • Provide patient-tailored education on the management of acute conditions
  • Conduct follow-up on patients with evolving or recovering illnesses.
• Prescription management
  • Evaluate all prescription refill requests and coordinate refills with the prescriber, patient, and pharmacy; complete prior authorizations, review of controlled substance portals
  • Conduct medication training for patients with complex regimens, medicine adherence challenges, and injection education
• Care coordination and case management
  • Coordinate the delivery of care within the practice setting and across health care settings, including post ED and discharge
  • Work on a multi-disciplinary team to care for patients with hypertension, diabetes, and patients who are in need of oral anticoagulation
• Provide culturally sensitive, patient-centered care in line with Firefly Health’s member-first principles

You’ll be a good fit if you:

• Are Bi-Lingual English/Spanish. Fluent in conversational Spanish with competency in medical Spanish (written and spoken required)
• Hold a current RN license in Massachusetts
• Have at least 2+ years of clinical practice experience, preferably in primary care or family medicine
• Fluency with EMR systems, including web-based applications
• Have the ability to summarize and communicate moderately complex information verbally and in varied written formats; collaborate with all members of the clinical and operations teams as well as other key stakeholders to ensure that patients receive optimal clinical care
• Can provide a high level of customer service to our patients; resolve service issues in a timely and respectful manner
• Can respond to patient electronic messages and phone calls received during hours on shift
• Have experience with tools related to process improvement and rapid-cycle change
• Are available to work 11am-7pm EST Monday-Friday

It’d be nice if:

• You have compact Licensure/multiple RN licenses
• You have previous telehealth experience

Note-This is a remote work from home position, however, occasional travel for work events/training may be required.

Our office is located in Watertown, Massachusetts but we’ve developed a robust remote working structure to give us more flexibility geographically while hiring for many positions.

This role can be done largely remotely, there are several times a year when staff come together onsite for planning and team building.

We are always looking for valuable talent to add to our growing team. Even if you’re not sure this role is the one for you, don’t let that stop you. We’d love to have a conversation to see where you could fit.

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

Utilization Review Nurse- FT (4p-12a EST)

remote type

Fully Remote

locations

Remote – Other

time type

Full time

job requisition id

R012177

Responsible for utilization review work for emergency admissions and continued stay reviews.

Responsibilities

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

Qualifications

Required

• Current RN licensure
• At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
• At least 2 years utilization management experience in acute admission and concurrent reviews
• Intermediate level experience with InterQual and/or MCG criteria within the last two years
• Proficiency in medical record review in an electronic medical record (EMR)
• Experience in MS Office and basic Excel
• Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs

Preferred

• 3+ years utilization management experience within the hospital setting
• Bachelors of Science in Nursing
• Proficient in InterQual/MCG criteria
• Case Management Certification (CCM, ACM, CMCN, or CMGT-BC

Expectations

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

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

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

If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please contact[email protected] to request the details to which you may be legally entitled.

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

Title: Remote Telehealth Nurse Practitioner: Weight Loss Management Program

Location: Los Angeles CA US

SteadyMD has partnered with a digital healthcare company offering quality, virtual weight-loss consultations and prescriptions. We are currently recruiting Nurse Practitioners with weight loss experience and at least one license in one of the following states: CA, TX, NY, PA, OH, WI, NC, IL, MA, MI, NJ, MN, KY, AR, OK.

Clinicians must be available to work between 8am and 8pm CST, any day of the week, and be able to commit a minimum of 15 hours per week. This is an hourly contract position and fully remote.

About SteadyMD

Ranked by Forbes in Top 100 for Best Startup Employer, SteadyMD is powering the telehealth needs of the modern healthcare industry by enabling healthcare organizations and other enterprises to scale their online care offerings quickly and efficiently. Our 50-state clinician workforce, clinical operations, technology platform, and legal and regulatory guidance allows our partners to go-to-market with speed and ease. For the thousands of clinicians behind our telehealth solution, SteadyMD offers a unique opportunity to provide online care in areas such as urgent care, primary care, and mental health therapy. Our clinicians share our commitment to improve access to convenient, affordable, quality care.

Responsibilities

• Conduct initial intake evaluation video visits (15-30 minutes) with new patients (ages 18+)
• Provide holistic evaluation of patient, review labs, and if appropriate, prescribe different weight loss medications (primarily GLP-1s such as Wegovy, Trulicity, or Ozempic)
• Work with a erse population. We are an organization that values inclusivity and evidence based care for all populations
• Log into patient portal every 48 hours to check on requests
• Conduct asynchronous chat responses to patient questions
• Send in prescription refills

Requirements

• Actively licensed in good standing in at least one of the following states: CA, TX, NY, PA, OH, WI, NC, IL, MA, MI, NJ, MN, KY, AR, OK
• Must have state license in the state where you reside
• Availability to work 15+ clinical hours per week (anytime during 8AM-8PM CST, 7 days a week)
• Background in Internal or Family Medicine
• 1+ years prior experience in weight loss medicine and prescribing GLP1 agonists
• Must be comfortable with complex chronic condition management
• Board Certified (AGNP-BC or FNP-BC) by the ANCC or AANP
• At least 2 year of independent practice experience as NP
• Above average comfort with technology
• Timely and professional
• Telemedicine or virtual care experience preferred

Benefits

• Hourly contract: $56 (W2) or $60 (1099)
• 1099 or W2 hourly position
• Fully Remote work with flexible hours
• Focus on patient care and leave the administrative work to us
• Malpractice insurance provided, including tail coverage
• Startup environment focused on real healthcare innovation and disrupting the status quo

Diversity and inclusion

At SteadyMD, we know we will go further together by celebrating ersity and that starts by honoring each of our unique lived experiences. We look for a erse pool of applicants including those from historically marginalized groups. We are committed to ensuring a safe work environment that is distinctly anti-discriminatory against any person.

Remote IP Coder

Location: ENGLEWOOD Colorado; United States

Job Description & Requirements

Pay Rate: $30.00 – $40.00

TYPE OF JOB ORDER: Remote IP Coder

START DATE: 12/18 or ASAP

JOB DESCRIPTION: his is an intermediate coding position that codes and abstracts Inpatient records for data retrieval, analysis, reimbursement and research. Codes and enters diagnostic and procedure codes into the designated coding and abstracting system utilizing the 3M encoder, as appropriate. Meets quality and productivity coding standards and demonstrates the ability to navigate an EMR. Ability to code any inpatient at any level from level I to community hospital.

REQUIRED SKILLS:

Accurately assigns codes from the current Coding and Indexing systems for inpatient accounts, creates DRG group assignments while adhering to coding guidelines, regulations and compliance plan.

Responsible for coding inpatient accounts <$100K that may include multiple different service lines.

Accurately abstracts pertinent information from inpatient records into the designated computer system and utilizes reports/workqueues effectively for follow up.

Ability to communicate well verbally and written, stay organized and demonstrate effective time management skills.

Meets qualitative and quantitative standards.

Demonstrates proficiency of designated coding and abstracting system, 3M encoder, online resources and electronic medical record (EMR).

Actively seeks to promote and helps to maintain a professional, team-oriented, service-conscious environment, which contributes to the goals of the team and reflects the values of the system.

Ability to troubleshoot computer issues while working remotely.

PREFERRED QUALIFICATIONS:

5+yrs Academic Acute Care Inpatient Coding experience.

MINIMUM REQUIRED QUALIFICATIONS:

Must have a High School Diploma; or GED required, Associate Degree preferred.

Four (4) years recent acute care hospital Inpatient Coding and abstracting experience.

Must demonstrate competency of inpatient coding guidelines and DRG assignment.

Knowledge 3M 360 and EPIC software experience.

CCS, RHIA, RHIT, CCS-P, COC, CIC, CPC-H, CPC Credentials required by client.

Demonstrate beginner to intermediate technical coding competency in ICD-10CM/PCS

Must be technically savvy and have some remote experience.

# OF WEEKS: 26 weeks with extension

SHIFT/HOURS: FT M-F Between 4:30a 7p CST

LICENSE/CREDENTIALS REQ:

Requires AHIMA (CCS, CCS-P, or RHIA/RHIT); AAPC (CPC, COC, CPC-H)

SYSTEMS:

3M360 CAC Encoder

EPIC Electronic Record

Facility Location

An amphitheater close to the Civic Center in Englewood is the focal point for visitors of this Rocky Mountain town where many summer concerts take place. Englewood is also famous for the Broken Tree golf facility with its award winning golf course complete with an 18 hole championship course. Kids love Pirates Cove which is open in the summer and includes a play structure, a six lane pool and 35 foot slide facility which includes three different types of slides.

Job Benefits

Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary but the perks don’t stop there. There are many additional benefits to enjoy, including:

• Medical, dental and vision benefits
• Earned time off and paid holidays
• Paid continuing education time
• 401(K) retirement planning
• Short-term disability, life insurance, paid jury duty
• Access to the largest network of facilities and providers in the country
• Industry experienced workforce management team
• Licensure and certification reimbursement

Title: Inpatient Coding Quality Reviewer – Remote

Location: United States

Full-Time

Overview

As our Inpatient Coding Quality Reviewer, you will be responsible for reviewing inpatient-coded cases for coding completeness and accuracy. Identify potential coding and DRG errors, research appropriate guidelines to support recommended changes, and communicate the changes to the coder involved on a timely basis. Every day, you will provide expert coding advice to coding staff and relay needed coding educational topics to the Regional Manager, IP Coding Quality. To thrive you will have CCS, RHIA, or RHIT credentials and extensive knowledge of AHIMA Coding Guidelines and Coding Clinic and CMS guidelines.

About Us

At R1 RCM, we deliver innovative solutions by bringing together the best people and technologies that enable providers to simplify the healthcare experience. Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our 22,000+ global associates are given valuable opportunities to contribute, innovate, and create meaningful work that makes an impact in the communities we serve around the world. Interested?

Here’s What You Can Expect

• Conduct daily pre-bill reviews of cases flagged by the PwC SMART coding quality monitoring software tool, and maintain required productivity standards and high-quality results.
• Review cases flagged by the coding quality software daily for multiple hospitals, including validating the completeness of documentation, identifying diagnoses and procedures that have been missed, proposing physician queries, and ensuring the accuracy of diagnoses, procedures, POA, discharge disposition, and DRG assignment.
• Perform retrospective coding quality reviews as requested.
• Follows, and maintains up-to-date knowledge of, industry coding and documentation guidelines (e.g., Official ICD-10 Coding and Billing Guidelines, Coding Clinic advice, R1 and Ascension coding policies and procedures, and AHIMA/ACDIS Query Guidelines) to maintain system-wide coding consistency and remain in compliance with governmental and other regulatory guidelines.
• Communicates audit findings with coders in a timely manner and supports the teams in effectively and efficiently addressing and resolving local coding issues.
• Serves as an inpatient coding expert and resource for the coding teams and other departments.

At R1, we are committed to promoting ersity, equity, and inclusion. We are proud to be an equal opportunity employer. We do not discriminate based on 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 regarding public assistance, veteran status or any other characteristic protected by federal, state, or local law. We are committed to providing a workplace free of harassment.

If you need assistance or accommodation to complete any part of the job application process, please contact us at 312-496-7709 or [email protected] for assistance.

For this US-based position, the base pay range is $20.91 – $38.39. Inidual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.

Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package including:

• Comprehensive Medical, Dental, Vision & RX Coverage
• Paid Time Off, Volunteer Time & Holidays
• 401K with Company Match
• Company-Paid Life Insurance, Short-Term Disability & Long-Term Disability
• Tuition Reimbursement
• Parental Leave

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.

LPN Care Coach

Remote

Atlanta, Georgia, United States

Care Coach

Contract

Description

Our Mission:

CircleLink Health is a company of passionate clinicians, technologists and business people tackling the $600B problem of preventable chronic condition complications. Our mission is to accelerate the shift to preventative care (from status quo reactive care) through our world-class preventative care platform.

Your Impact On Our Mission:

As a Care Coach you will work remotely for 20-25 hours per week with a team of nurses to manage patients with chronic conditions enrolled in Medicare’s Chronic Care Management program.

Your day to day is

• Educating patients on self-management skills and goal setting. Chronic conditions include: Diabetes, CHF, COPD/Asthma, Hypertension, CAD, Ischemic Heart Disease, Anxiety, Depression.
• Implement and improve the Plan of Care by updating medications, appointments due, record biometrics, vital signs, and care coaching provided.
• Utilize Motivational Interviewing or other behavior change techniques to coach and assist the patient with self-management.
• Conduct Transitional Care Management activities to high risk patients discharged from the hospital and the ER to reduce unnecessary readmissions, including medication reconciliation, medication adherence, identify red flags, address barriers, encourage follow-up care, how and when to seek appropriate level of care.
• Reduce care gaps by encouraging or assisting with preventive care, and chronic care management, i.e. annual well visits, follow up visits, medication management, pre-visit labs, diagnostic tests due, preventive cancer screens.
• Connect the patient with community resources as needed, including transportation, personal care needs, homemaker or chore services, social services, etc.

Requirements

Required Skills and Abilities:

• Fluent in English.
• Meet communication skills, must be self-directed, able to work independently with little supervision while meeting performance metrics
• Passion for nursing.
• Detail-oriented.
• Excellent organizational and time management skills.
• Strong communication and telephonic skills.
• Strong critical thinking and problem solving skills.
• Commitment to certain number of hours per day and days of week
• Availability to make calls on weekdays between 9am-7pm.
• LPN needs a STRONG internet-connected computer.

Education and Experience:

• Current, unrestricted Compact LPN license
• Proficiency with electronic health records and web based applications
• 5+ years experience as a Licensed Practical Nurse

Preferred Education and Experience, but not required:

• Case Management or Chronic Disease Management experience
• Case Management Certification
• Certified Diabetes Educator
• Transitional Care Management experience
• Experience with Motivational Interviewing or other behavior change communication techniques

Benefits

Compensation:

This is a 1099 contract position with no end date. Care Coaches are responsible for their own taxes and insurance.

Compensation is paid at the rate of $10.00 per initial clinical encounter per patient per month. A clinical encounter occurs after two criteria are met: a patient has a successful clinical call, and the patient has 20 minutes or more of time in their chart timer. Ex: If in one hour you called and spoke with 2 patients and spent 20 minutes with each of them, your pay for that hour would be $20.00 ($10.00/pt. reached x 2).

• In addition to successful clinical encounters, Care Coaches shall be entitled to $3.00 in the event that a patient within their caseload withdraws from the Chronic Care Management Program.
• Additionally, a compensation of $4.00 will be paid out following five unsuccessful attempts to contact the patient without receiving a response.

About CircleLink Health:

CircleLink is a digital healthcare company that improves health for the chronically ill by engaging patients through personal phone calls and/or mobile technology, helping to solve the ~$600 billion problem of preventable chronic complications. Our patient engagement software and services enable physicians to monitor and manage their patients’ chronic conditions between office visits without investing in additional staff or technology.

Title: Senior Medical Coder – Remote

Location: United States

Piper Clinical Solutions is actively seeking medical coders for full time work at a revenue cycle management organization. This is a Monday through Friday position working fully remote / work from home.

Responsibilities for Senior Medical Coder:

• Evaluate medical records to ensure proper coding of procedures, diagnoses, and billing
• Review and identify trends in documentation issues, coding practices, and coding techniques to provide process improvements and make recommendations to new standard operating procedures
• Educate medical providers, junior staff, and other departments on proper coding techniques, resource allocation, and medical necessity of services
• Coordinate with medical professionals to ensure quality of care and cost-effective care for the patients
• Review medical charts, analyze data, oversee claims, develop educational materials and audit results as a consultative expert

Technical Requirements for Senior Medical Coder:

• At least 2 years of experience in medical coding in a health organization including hospital, insurance or other related health administration organization
• Required to have a professional medical coding certification including CPC, COC, CCS, RHIT, or RHIA
• Excellent written, verbal, communication, and organizational skills.
• Must have experience with EMR systems, word processing applications and data management systems
• Hands on experience with evaluating medical records, medical coding, and making recommendations

Compensation & Benefits for Senior Medical Coder:

• Compensation: $20-35/hr based on previous salary history and experience
• Full Benefits: Medical, Dental, Vision, 401k etc

Telehealth – Women’s Health Nurse Practitioner

• United States – Remote OK
• Contract
• Clinical

• Job Openings
• Telehealth – Women’s Health Nurse Practitioner
• Apply To Position
• Use My Indeed Resume
• Apply Using LinkedIn

Allara is on a mission to improve care for the millions of women living with chronic hormonal, metabolic and gynecological conditions such as PCOS, endometriosis, etc.

We are looking for NPs with significant experience in women’s health. Our patient’s are choosing Allara because they want an ongoing relationship with an empathetic provider who understands what they are going through. This is not a role to simply write prescriptions, you’ll have an opportunity to build strong relationships with patients through video visits and ongoing check ins.

What You’ll Do:

• Conduct consultations via video
• Follow up with patients via messaging as necessary, and oversee prescriptions
• Operate as an independent provider, collaborating with physicians and RDs on the care team as needed
• Complete required training, and adhere to company guidelines and policies
• Commit to a minimum of 10 hours per week on the EMR conducting consults, answering patient questions, prescribing medication, and providing medical guidance as necessary
• Hours are flexible and we are 100% remote

Qualifications:

• APRN or WHNP Licensed in CA, NY, FL, TX
• Experience treating patients with chronic gynecological conditions
• Ability or experience operating as an independent provider
• Excellent written and verbal communication with an emphasis on clarity and compassion
• Strong webside manner
• Dedication to providing evidence based care

Registered Nurse, Complex Case Manager – Remote

Remote

Full time

REQ202311-047

About Accolade

Accolade (Nasdaq: ACCD) provides millions of people and their families with an exceptional healthcare experience that is personal, data driven and value based to help every person live their healthiest life. Accolade solutions combine virtual primary care, mental health support and expert medical opinion services with intelligent technology and best-in-class care navigation. Accolade’s Personalized Healthcare approach puts humanity back in healthcare by building relationships that connect people and their families to the right care at the right time to improve outcomes, lower costs and deliver consumer satisfaction. Accolade consistently receives consumer satisfaction ratings over 90%. For more information, visit accolade.com.

Accolade’s Complex Case Management team is currently recruiting for a Full Time Registered Nurse (Complex Case Manager).

This position is remote. Applicants will be required to work 8:00am to 4:30pm your local time.

Role Overview

As an Accolade Case Manager, you will be a trusted resource who assists our clients with any concerns or issues related to their health or health benefits. Through a combination of clinical acumen and expertise in advocacy and navigation, you will have the opportunity to help members get the right care at the right time.

A day in the life

• Consult with clients identified by Accolade as needing case management services.
• Applying critical thinking and clinical skills to maximize clinical outcomes while interacting with members in a fast-paced environment
• Building trusting relationships by asking deep rooted questions in order to influence care decisions
• Conducting behavioral and medical assessments to identify an inidual’s needs in a holistic manner
• Becoming knowledgeable on our clients’ employer-sponsored benefits in order to answer questions around medical benefits, claims, care coordination and other complexities of the healthcare system by explaining complicated medical and benefits terms in plain language
• Educating iniduals about their condition, medication, and care journey including receiving care in the most appropriate setting to meet their needs. Assisting iniduals to understand diagnostic tests, test alternatives, costs, risks, treatment options, and preparing for hospital admissions, inpatient stays and returning home
• Interfacing with clients’ health plans to facilitate coverage and care decisions; directing iniduals to facilities, agencies and specialists for care, including working with client-appointed delegates and interfacing with providers to coordinate care
• Getting a holistic view of who our members are, understanding what is important to them and providing options so they can make an informed decision about their true care needs
• Educating and empowering our members so they are able to confidently navigate the healthcare system getting the right care at the right time is important
• Advocating for our members consistently and continuously throughout their healthcare journeys
• Maintaining quality metrics
• Participating in Interdisciplinary Rounds

What we are looking for

Required:

• Hold a current/active Certified Case Manager License (CCM)- If not certified, must obtain 1 yr of hire

• Completed Bachelor’s Degree in Nursing (BSN) or equivalent
• Minimum of 5 years as an active Registered Nurse with a current Compact unrestricted license
• Minimum of 3 years of experience as a Nurse Case Manager.
• Telephonic Case management and Discharge Planning experience a must
• Computer strength is a MUST you’ll be listening, talking, typing all at one time
• Be an empathetic critical thinker there are no scripts here speak with your mind and heart, be able to think outside of the box on a large variety of topics from claims to colonoscopies!
• Possess excellent communication skills, organization skills and have a high tolerance for ambiguity change is how we grow!

Preferred

• Utilization Management & Managed Care experience
• Ability to understand and communicate client’s medical benefits, claims and care coordination with a focus on advocacy and effective utilization
• Experience with motivational interviewing and developing client-focused holistic care plans
• Demonstrated ability to educate and provide self-management support
• Strong communication skills, including the ability to actively listen and engage with clients telephonically
• Experience with real-time electronic health record documentation
• Self-discipline and ability to prioritize professional responsibilities
• Commitment to continue clinical education to ensure practice is at top of licensure.

Salary – $43.00/hr

Benefits

• Comprehensive medical, dental, vision, life, and disability benefits, including access to Accolade Advocacy, Accolade Care, and Accolade EMO.
• HDHP medical plan with generous employer contributions towards an HSA
• 401(k) Retirement Plan with matching employer contributions
• Open Time Off
• Generous Holiday Schedule + 5 floating holidays
• 18 weeks of paid parental leave
• Subsidized commuter benefits programs
• Virtual access to coaching, self-care activities, and video-based therapy and psychiatry through Ginger
• 1 Volunteer days per year
• Employee Stock Purchase Plan (ESPP) w/ employee discount

We strongly encourage you to be vaccinated against COVID-19.

What is important to us…

Creating an enduring company that is hyper-focused on our culture and making a meaningful impact in the lives of our employees, members and customers. The secret to our success is:

We find joy and purpose in serving others

Making a difference in our members’ and customers’ lives is what we do. Even when it’s hard, we do the right thing for the right reasons.

We are strong inidually and together, we’re powerful

Trusting in our colleagues and embracing their different backgrounds and experiences enable us to solve tough problems in creative ways, having fun along the way.

We roll up our sleeves and get stuff done

Results motivate us. And we aren’t afraid of the hard work or tough decisions needed to get us there.

We’re boldly and relentlessly reinventing healthcare

We’re curious and act big — not afraid to knock down barriers or take calculated risks to change the world, one person at a time.

Accolade is an Equal Opportunity and Affirmative Action Employer committed to advancing an inclusive environment for all qualified applicants and employees. We provide employment opportunities, without regard, to any legally protected status in accordance with applicable laws in the US. We are committed to help ensure you have a comfortable and positive interview experience.

Accolade, Inc., PlushCare, Inc., and Accolade 2ndMD LLC will never ask you to pay to get a job. Anyone who does this is a scammer. Further, we will never send you a check and ask you to send on part of the money or buy gift cards with it. These are also scams. If you see or lose money to a job scam, report it to the Federal Trade Commission at ReportFraud.ftc.gov. You can also report it to your state attorney general.

To review our policy around data use, visit our Accolade Privacy Policy Page. All your information will be kept confidential according to EEO guidelines.

Title: Coding Specialist Inpatient

Location: United States

Job Description

Description

Coding Specialist Inpatient AdventHealth

Medical Coder – HIM Coding

All the benefits and perks you need for you and your family:

Paid Parental Leave

Pet Insurance

Benefits from Day One

Student Loan Repayment Program & Debt-free Education

$5,000 Sign on Bonus*

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Full time

Shift: Monday Friday (8:00am to 4:30pm)

Location: Remote – Virtual

The role you’ll contribute:

The Inpatient Coder is responsible for reviewing, analyzing, and interpreting clinical documentation in the medical record, applying appropriate ICD-10-CM/PCS coding conventions and MS-DRG Medicare Prospective Payment System requirements. Actively participates in outstanding customer service and accepts responsibility for maintaining relationships that are equally respectful to all.

The value you’ll bring to the team:

• Reviews, analyzes, and interprets clinical documentation applying ICD-10 codes in accordance with ICD-10-CM rules and conventions, coding policy and procedures, requirements of Medicare/ payer specifications, and official coding guidelines as outlined by governing bodies. Evaluates and consider various DRG options and optimize them in accordance with UHDDS rules, official coding guidelines, regulatory agencies, and AH-approved policies.
• Verifies CAC codes and that assignment of diagnostic and procedure codes is based on and supported by the physician’s clinical documentation contained within the record.
• Effectively communicates with physicians and allied health personnel the need for comprehensive, accurate, timely clinical documentation.
• Discusses optimization and documentation issues with appropriate physicians and clinical personnel to ensure optimal coding and reimbursement, querying physicians for the clarification of discrepancies, additional diagnoses, complications, or co-morbid conditions present during the admission, on an as-needed basis.
• Applies ICD-10-CM/PCS codes, MS-DRG codes, Present on Admission codes, and patient status codes, with an understanding of how each is used and the impact the accuracy of the data has on mortality rates, clinical quality, reimbursement, internal scorecards, and key quality indicators.
• Utilizes a thorough understanding of the Official Coding Guidelines, Coding Clinic guidance, medical necessity, and coverage determinations.
• Uses critical thinking and sound judgment in decision-making, balancing reimbursement considerations with regulatory compliance.

Qualifications

The expertise and experiences you’ll need to succeed:

EDUCATION AND EXPERIENCE REQUIRED:

• High school diploma and two years of coding education (medical coding certificate program or 2-year HIM program), including medical terminology, anatomy & physiology, and pathophysiology coursework.
• Three or more (3+) years of inpatient hospital coding experience, including cases requiring specialized coding skills, such as cardiovascular surgery, neurosurgery, trauma surgery, neonatology, pediatrics, plastic and reconstruction surgery, bariatric surgery, cardiology, and other services and procedures provided in a tertiary care facility.
• RHIA, RHIT, CCS, or CIC certification

Remote Certified Professional Coder -Orthopedics

locations

US – Remote (Any location)

time type

Full time

job requisition id

14869

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Do:

The Orthopedic Pro Fee Coder must be proficient in surgical coding for Orthopedic cases. E/M experience is also required. The coder will review clinical documentation and diagnostic results as appropriate 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 managerthe 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 on Orhtopedic surgery and other orthopedic chart types as assigned. Must have the experience coding E/M associated with the orthopedic specialty as well.

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 defind by project scope of work. 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:

Minimum 3-5 years Physician Coding experience, both IP and OP coding for physician claims.

2-3 years coding orthopedic surgical procedures.

CPC certification from AAPC

High School Diploma EMR experience Must maintain credential throughout employment Must be able to work independently, multi-task well and interface with all levels of personnel as well as clients Advanced knowledge of Excel, Word and PowerPoint High level of accuracy Strong Working Knowledge & experience with Federal & State Coding regulations and Guidelines

What Would Be Nice To Have:

Multi-specialty surgical coding experience and Vascular Surgery Coding experience

Multiple EMR and/or Practice Management systems

#IndeedSponsored

The annual salary range for this position is $40,200.00-$72,300.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

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

Benefits include:

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

About Guidehouse

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

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

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

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

IRF Coder

remote type

Fully Remote

locations

Remote – Other

time type

Full time

job requisition id

R012178

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

Responsibilities

• Conduct reviews and provide recommended corrections of billed services as it relates to clinical documentation
• Assist in the reviews and responses to payor and governmental audits of billed services.
• Review and research new coding guidelines and codes.
• Maintain expertise in ICD-10 and CPT coding as well as ICD10 PCS coding and credentials.
• Meet daily accuracy and production standards as per established department policy.

Qualifications

Required

• High school diploma or GED
• One or more of the following: CCS credential through AHIMA; or a CPC and CIC credential from the AAPC.
• At least 1 year of experience in medical coding along with DRG validation.
• Strong analytical skills, excellent interpersonal and communication skills
• Must be capable of producing detailed, comprehensive documentation and reports

Preferred

• Associates or Bachelor’s degree
• Experience in coding or medical billing quality control is preferred.

Expectations

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

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

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

If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please contact[email protected] to request the details to which you may be legally entitled.

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

Title: Inpatient Coder (Hospital)

Role: Certified Coder, Inpatient (Hospital)

Location: Remote. Must work in a location within the United States.

Travel: No travel required.

Classification: Hourly, Non-Exempt

Reports to: Coding Leadership

Salary Range: Commensurate with experience

about the role

The Certified Coder (Inpatient) is responsible for abstracting clinical information from medical records to ensure high quality and compliant coding. They re able to analyze information and make decisions independently. Our coders have an eye for detail and an aptitude for accuracy.

responsibilities

• Abstracts relevant clinical and demographic information from the medical record to identify accurate and appropriate code selection and claim information.
• Selects the ICD-10-CM diagnoses (principal and others) to the highest specificity and correct sequencing as well as ICD-10-PCS procedure codes (principal and others) in accordance with the UHDDS definitions. Ensures appropriate DRG assignment as a result.
• Solicits additional information from providers regarding ambiguous or conflicting documentation in the medical record. Corrects coding and abstracting discrepancies as needed.
• Identifies and escalates system or process breakdowns to leadership; assists with resolution when requested.
• Serves as a resource for coding and revenue cycle leadership.
• Consistently achieves productivity and quality metrics.
• Complies with and holds with utmost regard all compliance requirements to protect patient privacy and confidentiality.
• Stays curious, kind and contributes positively to the revology culture. The health + harmony of the team is everybody s responsibility at revology.

The statements stated in this job description reflect the general duties as necessary to describe the basic function, essential job duties/responsibilities, job requirements, physical requirements and working conditions typically required, and should not be considered an all-inclusive listing of the job. Iniduals may perform other duties as assigned, including work in other functional areas to cover absences or relief, to equalize peak work periods or otherwise balance the workload.

requirements

• Certified Coding Specialist (CCS) license or similar from a nationally accredited medical coding organization required; Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) accepted.
• Minimum three (3) years of inpatient coding experience.
• Must remain current on coding guidelines, rules and regulations, and new codes. Must complete mandatory continuing education
• Ability to work independently to accomplish goals in a dynamic environment.
• High school diploma or equivalent required; bachelor s degree or equivalent experience preferred.

remote work requirements

Internet capability must be a high-speed internet connection.

Corporate Coder (Remote based in U.S)

United States (Remote)

JOB DESCRIPTION

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.
• 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.).
• 1-3 years inpatient coding experience.
• Skilled and working knowledge of MS Office suite.
• Strong technical background and electronic medical record experience.

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.

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.

JOB INFO

• Job Identification2305041276
• Job CategoryAdministrative Functions
• Degree LevelAssociate’s Degree/College Diploma (13 years)
• Job ShiftDay
• Locations NME Hospitals Inc (NME) (Remote)
• Assignment CategoryFull Time

Certified Professional Coder – ENT Surgery, Remote

US – Remote (Any location)

Part time

14908

Job Family:

General Coding

Travel Required:

None

Clearance Required:

None

What You Will Do:

The ENT Surgery Coder must be proficient in surgical coding for all ENT Surgery type cases. The coder will review clinical documentation and diagnostic results as appropriate 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 managerthe 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.

What You Will Need:

• Minimum 3-5 years coding complex ENT Surgeries
• CPC certification from AAPC
• EMR experience
• Must maintain credential throughout employment
• Must be able to work independently, multi-task well and interface with all levels of personnel as well as clients
• Excellent verbal, written and interpersonal communication skills
• High level of accuracy
• Strong Working Knowledge & experience with NCCI, CMS, AMA, Federal & State Coding regulations and Guidelines

What Would Be Nice To Have:

• AAPC Specialty credential
• Epic Experience

The annual salary range for this position is $40,200.00-$72,300.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

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

Benefits include:

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

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Quality Specialist I

locations

Home

time type

Full time

job requisition id

R-10643

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Quality Specialist I

Job Description Summary

Independently performs quality functions within the Quality Department of a Care Center or office. Coordinates projects resulting in continuous quality improvement and process improvement. Supports the maintenance of a strong quality program, measured processes and reported outcomes.

Job Description

• Coordinates assigned quality and process improvement activities which may include accreditation support, process improvement projects and monitoring of performance guarantees.
• Conducts quality control reviews and internal audits.
• Summarizes findings and prepare reports on findings.
• Assists in the preparation of customer and external audits.

Responsibilities

• Up to 2 years of quality improvement and auditing or related in healthcare field.
• Knowledge of healthcare quality improvement processes and performance measurement.
• Attention to detail and ability to work efficiently to meet deadlines and timelines.
• High degree of organization required.
• Expertise in data management, data analysis, reporting word processing, and project management skills.
• Strong working knowledge of Microsoft Excel, VISIO and MS Project.

Work Experience

Work Experience – Required:

Quality

Potential pay for this position ranges from $46,570.00 – $69,850.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

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

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

Nurse Advocate, Access Point – Remote – Part-time(Job Number: 488022)

Description

Access Point, a ision of Lifepoint Health, is a patient engagement company that works on behalf of physicians, hospital systems, and other key stakeholders to improve engagement and enhance outcomes for the populations they service. Our mission is to improve patient access to care. 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 hiring for a Nurse Advocate. This is a fully remote position! You must live in the United States.

This position supports a 24/7 nurse call line.

This is a part-time position, every other weekend, 9a-7:30 pm EST. Must be bilingual in Spanish.

Position Summary:

Access Point Nurse Advocate act as the company’s focal point for clients and assures that communication with each patient/caller will be handled in a professional and thoughtful manner through a variety of channels including telephone, email and live chat. Access Point Nurse Advocate documents and responds to patient/customer requests and questions including but not limited to symptoms, high risk alerts for patients with multiple comorbidities, or those with certain condition such as hypertension, diabetes, CHF, and COPD through remote patient monitoring, inpatient hospital transfer requests, locations and services, including instigating referral process for admission or services. When appropriate, patients’ symptoms will be assessed and triaged using the approved guidelines in order to help patients in obtaining the appropriate level of care and/or self-care advice. This is a remote position and involves being on the phone the majority of the day. This position reports to and its functions are supervised by the Manager of Clinical Services.

Essential Functions:

• Responds promptly to each incoming call as well as responds timely to any email or chat inquiry based on set service levels.
• Acts on behalf of the customer as a healthcare advocate.
• Responds to triage calls on the nurse triage phone line. If patient is in need of a triage, his/her stated symptoms will be assessed to determine the appropriate level of care required to safely meet the patient’s medical needs.
• In some instances refer patients to appropriate medical facilities including but not limited to emergency rooms (ERs), urgent care centers, and home care advice or to schedule patients to their physician during office hours, utilizing Schmitt-Thompson nurse triage protocols.
• Helps to educate and support patients with obtaining the appropriate level of care and/or self-care advice, as well as assisting them in post-acute care decision-making.
• Gather and evaluate clinical information to provide continuous quality care to patients to improve their overall health and well-being.
• For potential referrals, makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to a service site location or, if not available, look up and provide alternative services. Act as customer advocate throughout the referral process to ensure timely response and to maximize referral to admission conversion rate. Periodically update customer throughout process. Follow-up and track referral and admission outcomes.
• Utilize a variety of tools and methods to quickly provide information on patient options including but not limited to sites of service, specialty offerings, post-acute care, and other related questions. Appropriately handle a variety of customer issues including location lookup, directions, job search assistance and complaints.
• Thorough and complete documentation using appropriate software.
• Maintains awareness and orientation to department performance objectives, meets standards, and assures customer satisfaction goals are met.
• Actively participate in new employee orientation and on-going training, staff meetings, and continuous quality improvement.

Benefits:

At Access Point and Lifepoint Health, 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, PTO, 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.

Access Point and Lifepoint Health are committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans’ status or any other basis protected by applicable federal, state or local law

Qualifications

Education:

• Associate’s degree required. Bachelor’s degree preferred.

Licenses/Certification:

• Registered Nurse with professional Compact State licensure and other states as deemed necessary by state law or client contract.
  • Washington D.C. and California license preferred.
• Must maintain current nursing licensure by completing applications for renewal in a timely manner and by complying with all requirements for continuing education. No nurse will be scheduled to work any shift if their nursing license has expired. It is the nurse’s responsibility to ensure that the Manager of the Clinical Call Center Operations is notify immediately if their license status changes. Failure to comply with this requirement will result in termination of employment.
• Maintain current nursing skills and knowledge base by attendance at workshops and seminars, completion of mandatory continuing education, reading of professional journals, publications, and participation in professional organizations.

Experience:

• Minimum 3 years in a physician office, home health, critical care and/or emergency room setting.
• Background in Telephonic Nurse Triage preferred.
• Background in telephonic call center strongly preferred.
• Fluency in Spanish – Must be Bilingual

Title: Psychiatric Mental Health Nurse Practitioner

Location: United States

Position is remote, 100% tele-health. Available as a part-time, 1099 role (15 hrs/week) with potential opportunities for full-time.

Who we are:

Bend Health is revolutionizing the treatment of mental health conditions for kids and teens. Our innovative technology achieves better outcomes and leads to happier, healthier lives while ensuring stigma, costs, and logistics are no longer barriers. Come and be part of a fun, collaborative, supportive, motivated, and data-driven team that’s creating the first scalable and integrated model in mental healthcare for kids and teens. Help us shape the future of pediatric mental health and bend the healthcare system to work better for everyone.

Today’s world can be intense and stressful, and it’s taking an unprecedented toll on kids, teens, and families. Bend Health’s collaborative care model relies on an evidence-based approach to help families manage the ups and downs of everyday life.

We are looking for a part-time psychiatric nurse practitioner passionate about whole-person, whole-family mental health care to join our clinical team. This position reports to the Medical Director.

What you’ll do:

• Reviews child/adolescent psychiatry cases with psychiatrist
• Work with kids and teens, as well as their family, by providing treatment and support as they progress towards improving skills and reaching their goals
• Work collaboratively as a team with the patient’s psychiatrist, care manager, and mental health wellness coach on the patient’s care plan.
• Have proven results in working with others.
• Be comfortable with analytics, detail oriented and process focused.
• Comfortable completing virtual tele-psychiatry sessions, asynchronously or synchronously
• Team oriented, high energy and driven for results

Who you are:

• Board certified or Board eligible Psychiatric Mental Health Nurse Practitioner (PMHNP) or an ARNP with Mental Health training
• Licensed in Massachusetts + other states is a plus!
• Familiarity with online web-based applications
• Experience working in virtual office situation
• Solid reading and writing skills in English

Title: Medical Coding Specialist, Behavioral Health

Location: US National

Remote

Headway’s mission is a big one – to build a new mental health care system everyone can access. We’ve built technology that helps people find great therapists with the first software-enabled national network of providers accepting insurance.

1 in 4 people in the US have a treatable mental health condition, but the majority of providers don’t accept insurance, making therapy too expensive for most people. Headway is building a new mental healthcare system that everyone can access by making it easy for therapists to take insurance and scale their practice.

Headway was founded in 2019 since then, we’ve grown into a erse, national network of over 25,000 mental healthcare providers across all 50 states who run their practice on our software. We’re a Series C company powering 500k+ appointments per month with over $225m in funding from a16z (Andreessen Horowitz), Accel, GV (formerly Google Ventures), Spark Capital, Thrive Capital, and Health Care Service Corporation.

We want your time here to be the most meaningful experience of your career. Join us, and help change mental healthcare for the better.

About The Role

Headway is looking for a Medical Coding Specialist to join our team. This person possesses licensure as a Certified Professional Coder (CPC). The CPC will be responsible for reviewing medical records to determine compliant clinical documentation related to outpatient behavioral health services. The ideal candidate will have experience with medical coding in behavioral health and be knowledgeable about mental health diagnoses, treatments, and the necessary documentation requirements. The CPC will work closely with the billing and administrative team to ensure accurate and timely submission of claims for behavioral health services.

You Will:

• Review medical records and verify the documentation justifies the diagnostic and procedural codes (ICD-10 CM and CPT codes).
• Verify and abstract all medical data from patient records, including treatment plans, diagnoses, and procedures.
• Ensure compliance with coding guidelines and regulations, including HIPAA and CMS guidelines.
• Monitor and report on coding-related trends and issues, and make recommendations for process improvements.
• Maintain up-to-date knowledge of coding guidelines and regulations, and attend continuing education courses as required to maintain CPC certification.
• Maintain accurate and complete documentation of coding activities and communicate effectively with team members and other stakeholders.
• Participate in quality improvement initiatives and other projects as assigned.

You’d be a great fit if

• High school diploma or equivalent; associate’s or bachelor’s degree in healthcare administration, business, or related field preferred
• CPC certification from the American Academy of Professional Coders (AAPC) or equivalent certification required
• Minimum of 2 years of experience in medical coding, preferably in an outpatient setting or for professional services
• Required: Behavioral health coding specialty experience
• Knowledge of ICD-10, CPT, and HCPCS coding systems and guidelines
• Strong attention to detail and ability to work independently
• Excellent communication, interpersonal, and organizational skills
• Familiarity with Google Workspace (Docs, Sheets, Calendar), Zoom and electronic medical record (EMR) systems, or eager to learn
• Proficient in navigating and managing multiple digital tools/platforms simultaneously
• Previous experience in a tech-driven environment is a plus

Compensation and Benefits:

• Salary information is based on a single salary target per role and is differentiated based on geographic location (Group A, B, or C)
  • Group A: $105,000
  • Group B: $94,500
  • Group C: $84,000
  • Examples of cities located in each Compensation Grouping:
    • Group A = NYC/Tri-State Area, SF/Bay Area, LA Area, Seattle, Boston, Austin, and San Diego
    • Group B = Chicago, Miami, Denver, Washington DC, Philadelphia, Atlanta, Minneapolis, Nashville, Sacramento, Phoenix, and Portland
    • Group C = All remaining cities

• Benefits offered include:
  • Medical, Dental, and Vision coverage
  • HSA / FSA
  • 401K
  • Work-from-Home Stipend
  • Therapy Reimbursement
  • 13 paid holidays each year as well as a Holiday Break during the week between December 25th and December 31st
  • Unlimited PTO
  • Employee Assistance Program (EAP)
  • Training and professional development

Headway employees work remotely across the US, with the option to work from offices in New York City and (coming soon!) San Francisco.

Credentialing Coordinator

Location: Remote

Hims & Hers Health, Inc. (better known as Hims & Hers) is the leading health and wellness platform, on a mission to help the world feel great through the power of better health. We are revolutionizing telehealth for providers and their patients alike. Making personalized solutions accessible is of paramount importance to Hims & Hers and we are focused on continued innovation in this space. Hims & Hers offers nonprescription products and access to highly personalized prescription solutions for a variety of conditions related to mental health, sexual health, hair care, skincare, heart health, and more.

Hims & Hers is a public company, traded on the NYSE under the ticker symbol HIMS . To learn more about the brand and offerings, you can visit hims.com and forhers.com, or visit our investor site. For information on the company’s outstanding benefits, culture, and its talent-first flexible/remote work approach, see below and visit www.hims.com/careers-professionals.

About the Role:

The Credentialing Coordinator will primarily be responsible for the buildout of an exciting, new function of the H&H Credentialing Program that supports supervising physicians on our platform. This involves the credentialing and onboarding of supervising physicians, as well as coordination with their corresponding supervisees. This role presents a unique ownership opportunity, and will be critical to the success of the H&H Provider Operations function.

Additionally, the Credentialing Coordinator will support in all other aspects of credentialing of healthcare professionals. This includes onboarding new providers, assisting in resolution of issues facing current providers, and ensuring all providers have current certification and licensure. The Credentialing Coordinator will report to the Credentialing Manager, and collaborate with Telemedicine leadership.

Responsibilities:

• End-to-end ownership and execution of the Supervising Physician credentialing program. This includes provider credentialing and onboarding, coordination with supervisees and third-party service providers, contract issuance, and regulatory filings.
• Partner with the Credentialing Manager to ensure all new and existing providers possess the required credentials and licenses to operate compliantly and safely on the H&H platform, that these are documented accurately, and work with providers to ensure that these credentials are kept up to date.
• Manage, resolve, or escalate credentialing related support issues through ZenDesk. Identifying common themes and developing processes to improve the provider experience.
• Coordinate with external credentialing verification organization (CVO) to both process applications in a timely manner and deepen partnership by providing regular feedback to support our needs.
• Audit and verify compliance with NCQA and state level requirements for providers to practice.
• Own agreement workflows with all contracted providers ensuring new applications/licenses are recorded accurately in the credentialing database.
• Continuously monitoring credentialing related data integrity between multiple provider data management systems. Identifying potential red flags or quality concerns during the credentialing process.
• Perform employment verifications and send out certificates of insurance for current providers.
• Work cross functionally with the Provider Success team to streamline and support credentialing processes related to provider onboarding.
• Work externally with third-party service providers to analyze, iterate, and document processes, providing recommendations for improving efficiencies.
• Work with the Credentialing Manager to analyze, recommend improvements, and build out the credentialing program.

Requirements:

• Bachelor’s Degree preferred and a minimum of five (5) years credentialing experience with working knowledge of credentialing accreditation regulations, policies and procedures, and NCQA standards.
• Must demonstrate exceptional communication skills – both written and verbal, listening effectively and asking questions when clarification is needed.
• Must be a self-starter with a strong attention to detail
• Must be able to plan and prioritize to meet deadlines; with the ability to re-prioritize as needed.
• Excellent computer skills including Excel, Word, Google Suite, and Internet use.

Our Benefits (there are more but here are some highlights):

• Competitive salary & equity compensation for full-time roles
• Unlimited PTO, company holidays, and quarterly mental health days
• Comprehensive health benefits including medical, dental & vision, and parental leave
• Employee Stock Purchase Program (ESPP)
• Employee discounts on hims & hers & Apostrophe online products
• 401k benefits with employer matching contribution
• Offsite team retreats

Conditions of Employment:

• This position will require working with Hazardous Drugs (HD) and would require that Personal Protective Equipment (PPE) be worn for the length of working with these drugs. These items would include gloves, respiratory protection, gown and other items as required.
• This position requires medical approval to wear respiratory protection in the form of negative or positive pressure respirators, including N95, full face respirator, SCBA, or Powered Air Purifying Respirator (PAPR).
• Physical exertion required. Including, but not limited to, walking up to 50% of the time, standing up to 100% of the time, squatting and bending up to 20% of the time and lifting up to 80% of the time for up to a twelve hour shift. Must be able to lift up to 50lbs.
• Due to the risk of reproductive capability in handling or compounding certain Hazardous Drugs (HD) associates must be willing to confirm that they understand the potential risks (teratogenicity, carcinogenicity and reproductive effects) of handling hazardous drugs.

Outlined below is a reasonable estimate of H&H’s compensation range for this role.

H&H also offers a comprehensive Total Rewards package that includes equity grants of restricted stock (RSU’s) so that H&H employees own a piece of our company. The actual amount will take into account a range of factors that are considered in making compensation decisions including but not limited to, skill sets, experience and training, licensure and certifications, and location. Consult with your Recruiter during any potential screening to determine a more targeted range based on the job-related factors. We don’t ever want the pay range to act as a deterrent from you applying!

An estimate of the current salary range for US-based employees is

$60,000$75,000 USD

We are focused on building a erse and inclusive workforce. If you’re excited about this role, but do not meet 100% of the qualifications listed above, we encourage you to apply.

Hims 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. Hims considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.

Hims & hers is committed to providing reasonable accommodations for qualified iniduals with disabilities and disabled veterans in our job application procedures. If you need assistance or an accommodation due to a disability, you may contact us at [email protected]. Please do not send resumes to this email address.

Care Experience Specialist

Remote, United States

Why Charlie Health?

Young people across the country need our help. The sad reality is that a mental health crisis has taken hold of our most vulnerable populationleading to record levels of depression, anxiety, substance abuse, and self-harm. From Manhattan to Montana, this reality is compounded by issues of access, both geographic and financial. The mental health landscape is systemically broken, and our young people are suffering as a result.

Charlie Health has set out on a mission to reimagine how high acuity care is delivered to young people and families in crisis. Our initial offering is a virtual intensive outpatient program, which places peers with similar mental health experiences and goals into customized virtual groups. Our team of masters-level clinicians lead groups multiple times per week to deliver a higher level of care.

Our goal is to help young people and families heal together. Through a combination of exceptional medical and psychological care, engaged community partnerships, and best-in-class technology, we provide an unparalleled approach to recovery support that serves inidual needs in an integrated way. Join us in our mission to ensure that every young personregardless of location or socioeconomic statuscan get the care that they deserve.

About the Role

Charlie Health is looking for a dynamic, passionate inidual to support our incredible clients and families throughout treatment as a Care Experience Specialist. This candidate will welcome clients and families into our program post-admission, build rapport, and provide care coordination and customer service to ensure all client needs are met throughout their time in treatment. The Care Experience Specialist will also act as the liaison between clients and other internal Charlie Health teams to provide a primary point of contact and an unparalleled experience for those in our care.

Our team is composed of passionate, forward-thinking professionals eager to take on the challenge of the mental health crisis and play a formative role in providing life-saving solutions. We are looking for a candidate who is inspired by our mission and excited by the opportunity to build a business that will impact millions of lives in a profound way.

Responsibilities

• Answering inbound calls and resolving patient and family concerns or requests efficiently and effectively
• Acting as a liaison between patients and admissions, billing, utilization review, outreach and clinical teams
• Supporting clinical care team requests to improve the patient’s experience.
• Identifying gaps in treatment attendance and reaching out to clients to resolve issues with treatment that may be leading to non-attendance proactively
• Communicate aftercare resources (i.e. outpatient therapy providers) to families and work with families to schedule appointments post-Charlie Health
• Managing client schedule, scheduling and rescheduling appointments
• Complete all documentation in a timely and accurate manner
• Adapt to organizational change and departmental restructuring to fit the needs of our clients, families, and referral sources
• Meet determined KPIs including: call answer rates, daily talk time, daily call volume, issue resolution rate, time to resolution, aftercare appointment scheduling rate, and customer satisfaction scores

Requirements

• Upholds Charlie Health’s Mission, Vision, and Values
• Bachelor’s degree in health sciences, business administration, communications or relevant field
• Minimum 2 years experience working in a customer/patient success or support role
• Experience working with young adults and adolescents (healthcare setting preferred)
• 1-2 years of Salesforce experience required
• 1-2 years of experience using contact center technology
• Take great pride in providing clients with exceptional service in order to support their mental health journeys
• Strong ability to multitask and work in a fast-paced environment
• Demonstrates a high level of emotional intelligence
• Knowledge of HIPAA policies and procedures
• Work authorized in the United States and native or bilingual English proficiency
• Proficiency with cloud-based communication and software (Slack, G-suite, Microsoft Office, Zoom & EMR)

Benefits

Charlie Health is pleased to offer comprehensive benefits to all full-time, exempt employees. Read more about our benefits here.

Additional Information

The expected base pay for this role will be between $47,500 and $57,500 per year at the commencement of employment. However, base pay will be determined on an inidualized basis and will be impacted by location and years of experience. Further, base pay is only part of the total compensation package, which, depending on the position, may also include incentive compensation, discretionary bonuses, other short and long-term incentive packages, and other Charlie Health-sponsored benefits. This role is not presently available in Illinois. #LI-Remote

Sowhat do you think?

If you’ve made it this far, well, we’re excited to meet you too. Just one more thing that we want you to remember: we pride ourselves on our meritocratic, performance-driven culture. There are lives on the line, and we have young people to save. There’s no room for complacency. Your scope of responsibility and opportunity to make a difference will be uncapped at Charlie Health, but we need your commitment that you will work tirelessly for our patients, parents, and partners. At the end of day, our team is committed to helping you succeed at Charlie Health because when you succeed, our patients succeed, and we get one step closer to solving the mental health crisis. We’re hopeful that this role will give you the experience to go and do whatever you want in life but the fulfillment to make you never want to leave our team. We look forward to solving the mental health crisis, together.

Please do not call our public clinical admissions line in regards to this or any other job posting.

Please be cautious of potential recruitment fraud. If you are interested in exploring opportunities at Charlie Health, please go directly to our Careers Page: https://www.charliehealth.com/careers/current-openings. Charlie Health will never ask you to pay a fee or download software as part of the interview process with our company. In addition, Charlie Health will not ask for your personal banking information until you have signed an offer of employment and completed onboarding paperwork that is provided by our People Operations team. All communications with Charlie Health Talent and People Operations professionals will only be sent from @charliehealth.com email addresses. Legitimate emails will never originate from gmail.com, yahoo.com, or other commercial email services.

Recruiting agencies, please do not submit unsolicited referrals for this or any open role. We have a roster of agencies with whom we partner, and we will not pay any fee associated with unsolicited referrals.

At Charlie Health, we value being an Equal Opportunity Employer. We strive to cultivate an environment where iniduals can be their authentic selves. Being an Equal Opportunity Employer means every member of our team feels as though they are supported and belong. We value erse perspectives to help us provide essential mental health and substance use disorder treatments to all young people.

Charlie Health applicants are assessed solely on their qualifications for the role, without regard to disability or need for accommodation.

Coder Certified (Remote) – Surgery

locations

Remote – Missouri

time type

Full time

job requisition id

JR78492

Scheduled Hours

40

Position Summary

Position reviews medical record documentation to determine appropriate billing codes and necessary documentation.

Job Description

Primary Duties & Responsibilities

• Reviews the documentation in the record to identify all pertinent facts necessary to select the comprehensive diagnoses and procedures that fully describe the patients conditions and treatment.
• Codes evaluation and management to appropriate CPT code and codes diagnosis to appropriate ICD-9 code.
• Meets with physicians to review documentation, resolve coding and secure signature of all unsigned dates of service, tagging files for follow up.
• Acts as lead person and assists coders with IBC staff with medical terminology and policy interpretation as required.
• Assists with efforts to increase physician awareness of documentation requirements.
• Prepares case reports and initiates follow-up for billing process.

Preferred Qualifications

• Previous coding experience or experience equivalent to an associate’s degree in a related field.
• Working knowledge of medical terminology and related computer systems.
• Knowledge of ICD-10 and CPT coding.

Required Qualifications

• Must have one of the following coding credentials: AHIMA (CCA, CCS, or CCS-P); AAPC (CPC, CPC-A, CPC-H, CPC-H-A, or one of the AAPC specialty-specific coding credentials (the specialty-specific credential is only valid for that employee’s department).
• REQUIRED LICENSURE/CERTIFICATION/REGISTRATION: The RHIT or RHIA (or eligible) certification in health information management may be recognized in lieu of a coding credential and does not require experience.

Grade

C10-H

Salary Range

$24.80 – $37.19 / Hourly

The salary range reflects base salaries paid for positions in a given job grade across the University. Inidual rates within the range will be determined by factors including one’s qualifications and performance, equity with others in the department, market rates for positions within the same grade and department budget.

Accommodation

If you are unable to use our online application system and would like an accommodation, please email [email protected] or call the dedicated accommodation inquiry number at 314-935-1149 and leave a voicemail with the nature of your request.

Pre-Employment Screening

All external candidates receiving an offer for employment will be required to submit to pre-employment screening for this position. The screenings will include criminal background check and, as applicable for the position, other background checks, drug screen, an employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. All offers are contingent upon successful completion of required screening.

Benefits Statement

Personal

• Up to 22 days of vacation, 10 recognized holidays, and sick time.
• Competitive health insurance packages with priority appointments and lower copays/coinsurance.
• Want to Live Near Your Work and/or improve your commute? Take advantage of our free Metro transit U-Pass for eligible employees. We also offer a forgivable home loan of up to $12,500 for closing costs and a down payment for homes in eligible neighborhoods.
• WashU provides eligible employees with a defined contribution (403(b)) Retirement Savings Plan, which combines employee contributions and university contributions starting at 7%.

Wellness

• Wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, employee assistance program (EAP), financial resources, access to dietitians, and more!

Family

• We offer 4 weeks of caregiver leave to bond with your new child. Family care resources are also available for your continued childcare needs. Need adult care? We’ve got you covered.
• WashU covers the cost of tuition for you and your family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years with us.

For policies, detailed benefits, and eligibility, please visit: https://hr.wustl.edu/benefits/

EEO/AA Statement

Washington University in St. Louis is committed to the principles and practices of equal employment opportunity and especially encourages applications by those from underrepresented groups. It is the University’s policy to provide equal opportunity and access to persons in all job titles without regard to race, ethnicity, color, national origin, age, religion, sex, sexual orientation, gender identity or expression, disability, protected veteran status, or genetic information.

Diversity Statement

Washington University is dedicated to building a erse community of iniduals who are committed to contributing to an inclusive environment fostering respect for all and welcoming iniduals from erse backgrounds, experiences and perspectives. Iniduals with a commitment to these values are encouraged to apply.

Supervisor – Coding – Revenue Cycle – Remote

Job ID 317926

Rochester, MN

Full Time

Finance

Why Mayo Clinic

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

Responsibilities

Supervises and directs professional and support staff for the Revenue Cycle ensuring effective use of employees, equipment & materials within budget & quality standards. Performs tactical planning and carries out strategic plan. Ensures staff has the resources to carry out their responsibilities. Optimizes staff productivity and service; resolves work place problems of staff and processes; develops procedures and guidelines. Possesses the technical knowledge of the function being supervised. Implements retention planning initiatives. Participates in the overall management of Revenue Cycle teams through involvement in Enterprise-wide projects, work groups, task forces, councils, and committees. Serves as liaison between area of responsibility and other constituents inside and outside of Mayo. May require occasional travel.

Is the coding subject matter expert for coding staff, members of the management team and other Sections within the Revenue Cycle, as well as multiple areas outside the Revenue Cycle including specific physician practices and the Legal Department. Maintains expert knowledge of coding work flow and optimizes use of available technology.

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

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

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

Qualifications

High School diploma and 9 years relevant CPT-4 surgical coding and/or ICD-10 diagnosis and procedure coding for outpatient and/or inpatient and/or MS-DRG assignment coding experience OR Bachelor’s Degree and 5 years relevant CPT-4 surgical coding and/or ICD-10 diagnosis and procedure coding for outpatient and/or inpatient and/or MS-DRG assignment coding experience required; Master’s Degree preferred.

Requires an excellent understanding of CPT-4 surgical coding and/or ICD-10 diagnosis and/or procedure coding and/or MS-DRG assignment. Requires an excellent understanding of anatomy, physiology, medical terminology and disease processes. Experience with direct physician interaction required. Knowledge of and experience with Finance systems and applications required. Possesses PC skills, both keyboarding and applications.

Licensure or Certifications

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

Exemption Status

Exempt

Compensation Detail

$78,582.00 – $110,032.00 / year. Education, experience and tenure may be considered along with internal equity when job offers are extended.

Benefits Eligible

Yes

Schedule

Full Time

Hours/Pay Period

80

Schedule Details

Monday-Friday, business hours of 8:00 am-4:30 pm CST

Weekend Schedule

Based on business needs

International Assignment

No

Site Description

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

Affirmative Action and Equal Opportunity Employer

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

Clinical Review Nurse

Fully Remote Remote Worker

Job Type

Full-time

Description

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

About Our Opportunity

As a Clinical Review Nurse for our Bill Review team, you will pre-screen claims to ensure that services rendered are medically necessary and appropriate. Every day, you will audit claims identifying clinical errors, overpayments, and/or experimental and investigational items based on accepted billing and plan policy exclusions and share findings with our negotiation team.

Things You’ll Do Here:

• Identify correct billing and savings on claims by running the codes through programs.
• Collaborate with the Negotiation team to resolve claim issues and obtain savings by applying corrected claims, letters of agreement, or other documentation necessary.
• Finalize IRO (Independent Review Organization) savings by identifying savings, requesting plan documents, medical records, create submission, finalize report.
• Participate in client review calls acting as a Subject Matter Expert in the clinical bill review space.
• Evaluate and respond to bill reconsideration requests.
• Maintains a consistent department bill review prescreen turnaround time. Standard TAT for Bill Review pre-screen 24 hours from UB/IB receipt.
• Partners with peers and management in the formulation and documentation of department processes and policies, interdepartmental resolutions, and system improvements.
• Assists direct supervisor in achievement of departmental goals and suggestions that will increase revenue relating to Bill Review.
• Complies with/supports HIPAA standards.

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

What You’ll Bring to the Team:

• 3+ years of experience in auditing, claims, bill review, or case management.
• 2+ years of experience in a clinical setting in medical surgical, critical care, or equivalent.
• Current BSN, RN, or MSN.
• Working knowledge of industry coding and guidelines, ICD-10, CPT, HCPCS and Revenue codes, CMS guidelines, etc.
• Strong aptitude for relationship building with a highly effective communication style.

A plus if you have:

• Experience with RevCycle Pro/or Encoder Pro/or SuperCoder.
• Knowledge of Investigative /Experimental reviews, HCD, implant repricing, level of care reviews, DRG reviews.
• CPC or CIC Certification
• Health insurance experience

Where You’ll Work

This role is remote.

Why You Will Love Working Here

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

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

Perks and Benefits

• Generously subsidized company-sponsored medical, dental, and vision insurance
• Company-funded HRA
• 401K with company match and immediate vesting
• Flexible working environment
• Generous Paid Time Off
• Paid maternity and paternity leave
• Paid company holidays
• Community giveback opportunities, including paid time off for philanthropic endeavors

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

Nurse Practitioner (Overnight / Night Shift)

Remote

Clinical – Nurse Practitioners

1099 or W2

Remote

Our mission at Curai is to make high-quality healthcare accessible to all. We are fulfilling this audacious mission by building a virtual-first primary care service. Blending high-touch clinical care augmented with artificial intelligence, we are building a scalable primary care model that provides patients with quality care anytime, anywhere, from their mobile phones at a very affordable price.

Our company is remote-first. We will consider any candidates that are US Nurse Practitioners fully licensed to practice in the United States and carry multiple state licenses.

Clinical Operations at Curai

The clinical team at Curai uses Artificial intelligence-empowered electronic records to deliver urgent care and primary care to our patients. Currently, we are searching for a team of pediatric or family medicine (who can do pediatrics) clinicians for overnight coverage. The position can be full-time (W2) or part-time (1099), depending on availability.

Who You Are

None of these inidually are hard requirements, but they do describe the type of folks that we think would be most effective and happy at Curai.

• Have worked remotely before or have a strong feeling that you’d work well with a 100% remote team spread across multiple time zones
• Value a team-based collaborative approach as it relates to providing healthcare
• Passionate about providing empathetic personalized patient care at scale
• Have informed opinions that you hold lightly but are flexible to meet the needs of patients and the business
• Understand what a startup is, that flexibility is key and change is inevitable

What You’ll Do

Working the overnight shift, a typical evening in the life of a Curai Clinician is spent doing things like:

• Work overnight shift providing telehealth care from 6pm to 6am Pacific Time
• Seeing acute/urgent care patients in our live text-based chat clinic. This can also include straightforward chronic care cases requiring refills.
• 90% clinical and 10% administrative tasks. Administrative time is broken down between clinical meetings, EHR/automation product feedback projects, and clinical operations quality improvement projects (1099 has less administrative responsibilities).
• Being responsible for accurately diagnosing patients using detailed patient history-taking and providing evidence-based treatment recommendations.
• Writing efficient encounter visit notes in a clear fashion that demonstrates strong medical decision-making skills, differential diagnoses, and a well-written and relevant care plan.
• Closing all notes optimally by the end of the encounter and/or at the latest by the end of the shift.
• Partnering with the AI/ML in the EHR to increase the machine’s ability to assist providers with clinical decision support.
• Providing feedback to the AI/ML and product teams on features that improve provider efficiency and accuracy.
• Staying abreast of EHR feature updates by continuously training and remaining current on the platform.
• Working closely with physicians in collaborative agreements for states that require it.

What You’ll Need

We recognize not everyone will have all of these requirements. If you meet most of the criteria below, are excited about the opportunity, and are willing to learn, we’d love to hear from you. You should have:

• Certified Pediatric Nurse Practitioner or Family Nurse Practitioner with experience in pediatrics.
• Active Massachusetts and New Hampshire licenses are required. California, Texas, Florida, New York, and Rhode Island are a plus for 1099 and required for W2. All 50 states plus DC are preferred. Preference is given to Indiana, Missouri, Mississippi, Georgia, and Tennessee if not all 50.
• Be willing to get licensed nationwide.
• You must also have a clear medical history (no nursing board actions or complaints).
• Completed an accredited Nurse Practitioner program in the United States.
• At least two years of clinical practice experience as a primary or urgent care nurse practitioner.
• Digital savviness, excellent typing skills, excellent grammatical construction, and excellent command of English.
• Prior telemedicine experience and/or start-up experience in healthcare is a plus.
• Proficiency in English. Spanish fluency is an added plus.
• Belief in AI/software as a tool to fundamentally leverage clinicians’ time (10x clinicians reach)
• Excellent written and oral communication skills to ensure a meaningful and professional patient experience.

Salary is dependent on a scale based on years of experience, number of licenses, and work location. The state licenses the professional has can also play a factor in the range. Thus our annual full-time base range is large at $110,000 to $175,000. Stock grants are also available for full-time employees, increasing the overall compensation package. If part-time/1099 hourly rate is $60.00 – $86.00 an hour. Benefits listed are for full time employees.

What We Offer

• Culture: Mission driven talent with great colleagues committed to embodying our values, collaborating closely, and driving performance
• Convenience: Remote working from the comfort of your home
• Benefits: PTO, floating holidays, excellent medical, dental, vision, flex spending plans, and paid parental leave
• Financial: 401k plan with employer matching

Curai Health is a startup with a small, but world-class team from high tech companies, AI researchers, practicing physicians, to team members from non-traditional career paths and backgrounds.. We also have research partnerships with leading universities across the country and access to medical data that facilitates research in this space. We are a highly collaborative, data-driven team, focused on delivering our mission with funding from top-tier Silicon Valley investors including Morningside, General Catalyst, and Khosla Ventures.

At Curai Health, we are highly committed to building a erse and inclusive environment. In keeping with our beliefs and values, no employee or applicant will face discrimination or harassment based on race, color, ancestry, national origin, religion, age, gender, marital domestic partner status, sexual orientation, gender identity, disability status, or veteran status. To promote an equitable and bias-free workplace, we set competitive compensation packages for each position and do not negotiate on our offers. We are looking for teammates that are mission-driven, embody our core values, and appreciate our transparent approach.

Medical Coder / Quality Assurance – REMOTE – Digitech

• Remote, United States

Job Description

Overview

Medical Coder Needed For Quality Assurance. MUST HAVE KNOWLEDGE OF, AND EXPERIENCE IN, MEDICAL BILLING.

FULLY REMOTE. Work from the comfort of your home, M-F 8AM-4:30PM.

The Quality Assurance Representative serves as a reviewer for all Medicare and Medicaid claims after they have been coded and prior to being released as a claim. The Quality Assurance Representative reviews patient care reports (PCRs) for accuracy and submits to the appropriate government payers. This is a high volume role with approximately 250-400 claims per day handled by our Quality Assurance Representatives. Prefered experience: LPN, RN, EMT, Paramedic.

Digitech is a leading provider of advanced billing and technology services to the EMS transport industry. Since its founding in 1984, Digitech has refined its software platform to create a cloud-based billing and business intelligence solution that monitors and automates the entire EMS revenue lifecycle. Digitech leverages its proprietary technology to offer fully outsourced services that maximize collections, protect compliance, and deliver results for clients.

Responsibilities

Summary

The Quality Assurance Representative serves as a reviewer for all Medicare and Medicaid claims after they have been coded and prior to being released as a claim. The Quality Assurance Representative reviews patient care reports (PCRs) for accuracy and submits to the appropriate government payers. This is a high volume role with approximately 250-400 claims per day handled by our Quality Assurance Representatives.

Essential Duties and Responsibilities:

• Reviews all claims and assigns a level of service. Reviews medical records to ensure billing compliance.
• Reviews all claims prior to the claim being released to Medicare or Medicaid.

Experience/Skills/ Required:

• Medical background: LPN, RN, EMT, Paramedic, LNA, Aide.
• Strong knowledge of medical terminology
• Must have Internet Speed of 15mbs or higher.
• Must be able to successfully complete the “basic computer skills assessment” prior to interview.
• Passionate about your work.
• Must be willing and able to navigate between multiple programs at the same time.
• Able to meet deadlines
• Willingness to complete a typing speed and accuracy assessment prior to interview.
• Willingness to ask questions
• Punctual, dependable, team player.
• Ability to handle stress due to time sensitive nature of work.

Sarnova is an Equal Opportunity Employer. We offer a competitive salary, commensurate with experience, along with a comprehensive benefits package, including 401(k) Plan. EEO/M/F/Veterans/Disabled

Our mission is to be the best partner for those who save and improve patients’ lives. Excellence in delivering upon our mission is dependent upon having a erse team that is empowered to bring their full, authentic self to work each day. We strive to create a workplace that reflects the communities we serve, and we are passionate about creating an inclusive workplace that promotes and values ersity.

Psychiatric Mental Health Nurse Practitioner – California

Location

Remote – United States

Type

Full time

Department

Clinical

Overview

About Path

Path is a healthcare company powered by technology, dedicated to making mental health care work for everyone. Path takes a patient-first approach, where treatment is more accessible, personalized, and effective. With Path, it’s easy to find a high-quality therapist or psychiatric clinician who accepts insurance and is actively accepting new patients.

We are deeply committed to providing high-quality care that improves the lives of patients, investing in the providers who deliver that care, and always operating in an ethical and compliant manner.

What we’re solving

Over 65 million Americans have a treatable mental health issue that’s 1 in 5 people. Today it’s difficult to find a provider, and for those with complicated conditions, it’s nearly impossible to find coordinated care. There’s a good chance someone close to you could have used the help, even if it wasn’t obvious to the people around them. We’re here to fix this.

Our Mission

Path’s mission is to make mental healthcare work for everyone.

The Opportunity

We’re excited to be expanding our telehealth clinic where providers focus on delivering high-quality care directly, without being overworked. We’re looking for high-quality board-certified Psychiatric Mental Health Nurse Practitioners (PMHNP) to join our erse community.

Salary range: $140,000 to $280,000k*

*Our target compensation is $187,000 for clinicians that are billing 33 clinical hours a week and taking all of their paid time off. The range is a function of how many weekly visits are done, documentation and billing practices reflecting complexity and services provided, and paid time off utilized.

Our Clinic

We’re an organization committed to building a comprehensive, modern psychiatric clinic with a north star of delivering patient care at the highest quality standards. Our clinic was designed with the needs of PMHNPs in mind; at Path, you can count on end-to-end clinical and administrative support that gives you the time, space, and autonomy to care for your patients. We don’t cut corners and we take seriously our responsibilities as a telehealth-based organization to be ethical, compliant, and to put patient safety first.

What sets us apart

• Comprehensive support: Our team of RNs, Medical Assistants, crisis coordinators, Collaborating MDs, and patient schedulers work alongside you to ensure your time is spent on the work only someone at your license level can perform.
• Flexibility: At Path, you get to work as a part of a team while retaining your autonomy. You choose when you work, between 7am and 7pm PST, 7 days a week from the clinical environment that works best for you.
• Work/life balance: We know great patient care starts with healthy, engaged clinicians. We set sustainable clinical hour standards, cap daily intakes, and build in time for meetings and documentation.
• Clinical Leadership: Our leadership team includes multiple licensed, practicing clinicians, so you can feel confident this organization is guided by clinical best practice.
• Innovation: We’re on a mission to raise the standard of care, and are building the technology and tools to empower our clinicians and patients across every step of their care journey.

We equip clinicians with what you need to thrive

• Full administrative support: We manage the administrative tasks, so you can focus on what matters most. We take care of finding patients, getting them scheduled, and handling everything related to insurance and billing. Plus, our dedicated support team is on hand to answer any questions you or your patients have.
• Advanced technology for efficient documentation: Every Path PMHNP gets a subscription to a medical autoscribe to aid in note-taking. With this tool, our team has seen up to an 80% reduction in documentation time.
• Coordinated care: Our in-house team helps to ensure your patients get the help they need. Whether that’s a higher level of care escalation or a rematch to another clinician, you can rely on a dedicated team of experts.
• Investments in your development: We’re building a culture of collaboration and continuous learning. In addition to an annual stipend for continuing education, our team works to share best practice and insights to improve the quality of care for Path patients.

You Will:

• Provide clinical consultations with clients seeking mental health care including diagnostic assessments, psychiatric workup, treatment planning including medication management
• Work with iniduals who are struggling with mental health issues such as depression, anxiety, ADHD, trauma, and addiction
• Have access to our EHR & telehealth platform
• Receive MD Supervision & support from Registered Nurses, Care Coordinators, Scheduling, and Technical Support

• Have adequate time to engage with patients — half-hour sessions for follow-ups and 1 hour for initial consultations.

• Be free to focus on care. Path Mental Health takes care of all the credentialing, billing, and marketing
• Engage in collaborative case conferences and clinical team culture as well as collaborative meetings with an MD
• Abide by our policies and procedures, including timely completion of documentation/charge slips, participation in quality audits, and using measurement-informed care as part of the treatment of your patients

You Are:

• A clinician with 3+ years as a psychiatric Nurse Practitioner with experience with mental health assessment, diagnosis, triage, managing common psychiatric medication and treatment plans, and managing crisis situations
• Certified by the ANCC as a PMHNP
• Looking for a full-time job that requires 33 bookable hours per working week
• In possession of a Master’s or doctoral degree from an accredited university or graduate program in psychiatric mental health nursing
• Actively licensed in the state of California with an active CA DEA number including schedule 2-5 controlled substances
• Willing and able to explore 103B independent practice in California
• Comfortable working independently and proficient with technology, EHR, and telehealth best practices
• Deeply empathetic and skilled at building a rapport with your clients
• No suspension/exclusion/debarment from participation in federal healthcare programs (e.g., Medicare, Medicaid, SCHIP)
• No adverse actions by any nursing board, hospital, or other credentialing body in the past 3 years

As Part Of Our Team, Full-Time Employees Receive

• Competitive pay and benefits that do not change based on location
• 4 weeks of discretionary paid time off annually, plus federal holidays
• Paid parental leave to support you and your family
• Medical, dental, and vision insurance through our employer plan for you and your dependents
• Access to our 401K
• Continuing education stipend
• DEA and licensure renewal coverage
• Short-term disability benefits
• Access to an Employer Assistance Plan (EAP) through our insurance plan
• Tech equipment and $250 stipend to ensure your home office sets you up for success

Our Team

The people of Path are what truly define our mission and determine our impact on the communities we serve. We believe in building not only a team, but a erse community, inspiring each other by taking on big challenges, growing and succeeding together.

Senior Quality Consultant, Ops Excellence

at Cityblock Health

Remote, USA

#communityhealth #healthcare

About the Role:

We are seeking a talented Senior Quality Consultant, Ops Excellence to help manage day to day Quality Assurance/ Strategic Ops responsibilities as we scale. You’ll work closely with internal teams in a collaborative, consultative capacity to drive towards improved outcomes across all Markets within the organization. This is an exceptional opportunity for a process-oriented, hungry self-starter who is interested in a cross-functional role at a rapidly scaling organization.

Responsibilities:

• Manage multiple projects, make judgements around objectives and scope, ensure effective and efficient implementation execution.
• Development and delivery of key strategies, plans, and improvement initiatives for the CM program to include: data pursuit strategy, barrier analysis, interventions and compliance for new market implementations.
• Partnership with internal and external teams to ensure alignment on strategy as well as tactical initiatives.
• Conduct reviews/ assessments against CB P&P’s, industry standards, and best practices.Monitor, analyze data, and identify non-compliance with CB Model of Care
• Act as an operational expert and interventionist through communication, education and design of programs and strategies to assist delegated entities to meet regulatory and accrediting standards.
• Aggregate and analyze audit findings into a reportable format and report to appropriate departments.
• Participate in Care Management/Clinical Committee meetings.
• Assist with planning of formal education sessions to Market Ops teams to address non-compliance issues.
• Develop and maintain policies and procedures.
• Other projects and duties as assigned.

Requirements for the Role:

• Bachelor’s degree in Nursing, or Social Work, or Masters in Healthcare Administration preferred; however, an equivalent combination of education and experience that provides proficiency in the areas of responsibility, may be substituted for the stated education and experience requirements
• Minimum 2 years clinical and non clinical auditing experience
• Strong knowledge of managed care principles and delivery systems, medical management process, accreditation and regulatory standards delegated oversight processes, and workflow systems
• Ability to strategically think and provide solutions for gaps in care delivery
• Experience with implementation or new program development.
• Knowledge of managed care compliance, CMS regulatory and NCQA standards.
• Strong ability to quickly build relationships and trust with our non clinical and clinical ops teams
• Strong understanding of Medicaid and Medicare requirements across multiple states
• Must possess a high level of organizational skills to maintain accurate records and documentation.
• Attention to detail with analytical and problem-solving capabilities.
• Knowledge of audit processes and applicable federal regulatory and accredited standards.
• Excellent verbal and written communication skills and able to maintain positive relations with internal and external partners at all levels.
• Solid presentation and facilitation skills

About Us:

Cityblock Health is the first tech-driven provider for communities with complex needs—bringing better care to where it’s needed most, block by block. Founded in 2017 on the premise that “health is local” and based in Brooklyn, we are backed by Alphabet’s Sidewalk Labs along with some of the top healthcare investors in the country.

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

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

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

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

Our Values:

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

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

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

We take into account an inidual’s qualifications, skillset, and experience in determining final salary. This role is eligible for health insurance, life insurance, retirement benefits, participation in the company’s equity program, paid time off, including vacation and sick leave. The expected salary range for this position is $81,700 to $109,500. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location.

Medical Clearance (for Member-Facing Roles):

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

Covid 19 Update – Please Read:

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

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

RN/NP Clinical Educator 

Location: Remote

Nice to meet you, we’re Vesta Healthcare.

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

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

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

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

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

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

The ideal teammate would be

• A registered nurse leader who is passionate about educating our members, teammates, and clients and can leverage technology to create new programs, systems, and processes to drive exceptional clinical team performance
• Someone who has a proven track record of using an evidence based approach to drive high quality and efficient clinical outcomes
• Someone who has experience in chronic care management, remote patient monitoring, and value based care of vulnerable populations
• Loves learning and helping others learn: you’re excited to bring your wisdom and coach others, and you’re equally energized to learn from other’s experience (such as product managers, software engineers, and data scientists), and then continue improving how Vesta does care management as we learn more together
• Comfortable working in an ambiguous environment within an organization that is growing and changing quickly

The ideal teammate would be able to:

• Achieve continued professional development of the clinical staff through education
• Assess learning needs using formal and informal assessment data, QI data, audit data, and leadership input to plan education programs.
• Design, implement and evaluate high quality and frequently complex educational activities, programs. or projects for staff at all stages of their career development based on identified knowledge and practice gaps, using relevant evidence, adult learning principles, theory, research, innovative process and practical experiences.
• Create and improve onboarding, orientation, and continuing education material
• Provide remedial support to learners when necessary
• Measure program outcomes in terms of learning change, impact and professional role competency and revise future outcomes based on trends, evidence, and changes in stakeholder expectations.
• Provide multidisciplinary health care professionals and clinical support teams with leadership, coaching and development through 1:1 interactions, round table discussions, and formal presentations.
• Perform direct care management activities as assigned
• Implement appropriate member education leveraging software as needed
• Identify needs, develop, and support materials for Member and Caregiver education
• Develop and maintain strong relationships with our team identifying inefficiencies and assisting in creating and implementing process improvement to achieve member and provider satisfaction
• Serve as a subject matter expert for current CCM and RPM programming as well as future clinical programs

Would you describe yourself as someone who has:

• Registered Nurse or Nurse Practitioner with an unrestricted license (required)
• 2+ years of experience educating clinical teams (including MA/CNAs, LPNs, RNs) and overseeing several complex projects simultaneously (required)
• 1+ year of leading orientation classes for groups of 10+ (required)
• Bachelor’s degree from an accredited institution (preferred)
• 4+ years of nursing experience within care management, homecare, and/or outpatient (required)
• An Education Certificate (preferred)
• Digital health or hybrid digital health experience (preferred)
• Experience educating a remote team (preferred)
• Experience in providing education based on adult learning principles
• Passionate about our mission to improve people’s lives
• An ability and humility to roll up your sleeves
• Detail- and process-oriented, ability to context- and mode-switch easily, fast learner
• Excellent communication skills, combined with the ability to collaborate across functions and use available tools
• Self-driven, self-starter and excited to support new technology

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

Pay range is $100,000-$130,000 based on experience. (The referenced salary range is based on the Company’s good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level).

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

Medical Coder II (Radiation Oncology)

Remote

locations

US-Remote

time type

Part time

job requisition id

R0018924

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

This is a part-time remote radiation oncology coding role.

PURPOSE:

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

ESSENTIAL DUTIES:

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

RESPONSIBILITIES/QUALIFICATIONS:

• Perform coding work requiring independent judgment with speed and accuracy.
• Examining and verifying coding errors through audits.
• Required In-services.
• Communicating clearly and concisely, orally and in writing.
• Confidentiality.
• Ability to use the computer.
• Understanding and carrying out verbal and written directions.
• Follow 21st Century Oncology’s policies and procedures.
• Work independently in the absence of supervision.

GenesisCare is an Equal Opportunity Employer.

Title: Associate Director, Trial Start Up Lead

Location: Copenhagen, , Denmark

Utrecht

Princeton, NJ

Full time

At Genmab, we’re committed to building extra[not]ordinary futures together, by developing antibody products and pioneering, knock-your-socks-off therapies that change the lives of patients and the future of cancer treatment and serious diseases. From our people who are caring, candid, and impact-driven to our business, which is innovative and rooted in science, we believe that being proudly unique, determined to be our best, and authentic is essential to fulfilling our purpose.

The Role & Department

The Associate Director, Trial Start Up Lead is key member of the Trial Strategy and Delivery Team, responsible for overseeing and driving trial start up on a compound level in close collaboration with the clinical project lead, the trial start up team and the clinical CROs.

Key responsibilities include

• Provide CPL with operational insights for initial trial strategies related to start-up, including country selection, submission strategy, and site selection/activation
• Oversee delivery of timely site activation across trials within a program
• Oversee planning and execution of start-up activities across trials within a program
• Serve as the point of escalation for start-up managers on trial start-up issues
• Identify underlying causes and develop effective solutions to mitigate or eliminate challenges
• Work with team members to develop and implement solutions to identify challenges
• Contribute to novel collaborations with relevant recruitment companies, site referral networks, and CRO networks
• Collaborate with Genmab legal on country-specific CTA templates and master CTA
• Develop CDA strategy for compound/trial
• Assess Start-Up KPI/KQI from CROs
• Support IRB/EC/CEC submissions
• Ensure learnings from IRB/EC/CEC feedback across clinical trials within a program but also across different programs are collected and shared
• Drive interactions with CRO for start-up activities and optimization
• Support, identify, and address site activation challenges on a program level and
• Document and share lessons learned across trials and programs
• Line management for up to 7 members of the trial start up team.

Requirements

• A minimum of 12 years of relevant global study start-up experience from biotechnology-/pharmaceutical-, CRO- or healthcare industry
• Solid understanding of trial start up
• Demonstrated ability to leadand collaborate with cross-functional teams to drive operational excellence
• Experience in leading & managing global teams
• Experience in mentoring trial start up managers
• Vendor management experience
• Strong stakeholder management
• Ability to anticipate issues with proactivity to offer solutions & to timely escalate risks and issues when needed
• Ability to foster a “One Team” spirit, inclusive mindset
• Confidence to challenging status-quo thinking and behaviour; can work with agility and an innovative mindset
• Excellent written and oral communication skills
• Bachelor’s Degree within life science or equivalent combination of education, training, and relevant experience
• Experience in Clinical Operations and a thorough understanding of GCP, relevant ICH standards, and FDA/EMA guidelines would be beneficial
• Experience in line management (preferred)
• Strong organizational skills, including the ability to prioritize and handle a high volume of tasks within a given timeframe
• Ability to proactively identify risks, develop mitigations & resolve issues
• Good understanding of the operational structure within CRO
• Strategic mindset

Moreover, you meet the following personal requirements

• You can work independently as well as in teams
• You are capable of prioritizing work in a fast paced and ever-changing environment
• You have a quality focus and an eye for detail
• You are result and goal-oriented and committed to contributing to the overall success of Genmab

This role can be located in Copenhagen, Denmark or Princeton, NJ or Utrecht, the Netherlands; and is hybrid or can be remote.

About You

• You are passionate about our purpose and genuinely care about our mission to transform the lives of patients through innovative cancer treatment
• You bring rigor and excellence to all that you do. You are a fierce believer in our rooted-in-science approach to problem-solving
• You are a generous collaborator who can work in teams with erse backgrounds
• You are determined to do and be your best and take pride in enabling the best work of others on the team
• You are not afraid to grapple with the unknown and be innovative
• You have experience working in a fast-growing, dynamic company (or a strong desire to)
• You work hard and are not afraid to have a little fun while you do so

Locations

Genmab leverages the effectiveness of an agile working environment, when possible, for the betterment of employee work-life balance. Our offices are designed as open, community-based spaces that work to connect employees while being immersed in our state-of-the-art laboratories. Whether you’re in one of our collaboratively designed office spaces or working remotely, we thrive on connecting with each other to innovate.

About Genmab

Founded in 1999 in Copenhagen, Denmark, Genmab is an innovative biotech company that has become a leader in antibody biology and innovation. Our product pipeline and next-generation antibody technologies are the result of our strong company culture, a deep passion for innovation, and desire to transform cancer treatment and serious diseases.

When you work with us, you’ll be part of a warm, fun, dynamic community, and team up with some of the best, most authentic iniduals in locations around the world, who care deeply and share in a relentless drive to innovate and create transformational medicines. People who are candid, impact-driven, and a little unconventional; who seek out and embrace the opportunity to build new and bold futures within a rapidly growing and innovative biotech company; who bring their full selves to work and show up for each other – rolling up their sleeves to get the job done. This translates into a place where you can be authentically you; are empowered to innovate, build solutions, and execute; feel cared for and supported in growth; and are a critical part of changing the lives of patients around the world through transformative cancer treatment.

Our commitment to ersity, equity, and inclusion

We are committed to fostering workplace ersity at all levels of the company and we believe it is essential for our continued success. No applicant shall be discriminated against or treated unfairly because of their race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, or genetic information. Learn more about our commitments on our website.

Genmab is committed to protecting your personal data and privacy. Please see our privacy policy for handling your data in connection with your application on our website https://www.genmab.com/privacy.

Virtual Triage Nurse

locations

Remote USA

job requisition id

R1466

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

Job Description

A bit more about this role:

Our Care OnDemand services span the continuum of acute care, beginning with helping members navigate new or urgent symptoms with a nurse triage line, delivering best-in-class virtual urgent care services, and (when needed) connecting our members to high value urgent and emergency care providers in the community, and following up with them after an acute event. We are building a novel, intensely patient-centered virtual front door that provides access to immediate health care in a way that has never been done before.

As a Clinical Guide: Care OnDemand RN you’ll be responsible for providing telephonic advice to members when they call Devoted for clinical needs. By providing clinical advice and triaging clinical concerns when members call Devoted, you can help members achieve better health outcomes. You’ll serve as an advocate for these members, helping them get the care they need, and connecting them with necessary resources.

Our ideal clinical guide is caring, compassionate, solution-oriented and enthusiastic about providing an outstanding experience for Devoted Health’s members. They have excellent clinical judgment and triage skills. They are ready to innovate, adaptable to a continuously evolving startup environment, and willing to start scrappy, working with the whole Devoted family to create a revolution in how care is delivered.

A day at Devoted could include:

Working with members

• Engaging with members via telephonically and/or video to provide clinical advice, in response to member reported clinical concerns.
• Connecting members with the care they need, whether it be primary care or urgent/ emergent care.
• Explaining complicated medical terms in plain language.
• Educating members on their conditions including teaching red flags

Working with other providers and resources

• Working closely with our PCP partners, as well as Devoted Medical Group, to coordinate care and deliver evidence based, effective, and accessible health care.

Improving how we work

• Providing feedback and advice to help improve the operational processes, software tools, and data capabilities to improve how Devoted does transitions of care case management

Attributes to success:

• You have a desire to make a change in the healthcare experience: you love to serve and make a difference.
• You enjoy being on the phone caring for patients.
• You have strong clinical skills that will help you understand over the phone what a patient needs to help her avoid poor health outcomes.
• You can articulate and break down complex information to ensure patients and caregivers are able to absorb and act on your guidance.
• You are comfortable working with technology and in a dynamic, startup environment.
• Comfort or interest in working remotely post COVID
• 4 – 10 hour shifts per week 9 AM-7:30 PM EST -OR- 10 AM-8:30 PM EST, with rotating weekend and holiday requirement.
• 3 -12 hour shifts, alternating 3 and 4 days worked per week. 8:00pm – 8:00am EST.

Skills and experience:

Must haves:

• A compact RN license and willingness to obtain additional licenses as needed (for non-compact states)
• A minimum of 4 years of RN experience (preferably ER or ICU).
• Prior clinical triage experience– either through a helpline or provider office.
• Team player mentality with a can-do attitude.

• BSN Degree
• BLS Certification

Nice to haves:

• Bilingual in English and Creole or Spanish.

Salary Range: $80,000 – $95,000 annually

Our Total Rewards package includes:

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

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

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

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

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

Nurse Clinical Informaticist

at Amwell

Remote

Company Description

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

Brief Overview:

The Senior Clinical Informaticist serves as the hub of information management for program development within our clinical chat platform. They support the development of complex clinical chat programs within our conversation platform. They play an essential role adapting and repurposing existing clinical design frameworks for new program development.

As a cross-functional role, the Senior Clinical Informaticist works closely with both client clinicians and internal teams – clinical informaticists, clinical modelers, conversation design and implementation teams to design an evidence-based clinical framework for chat programs, as well as maintain the clinical chat program library. This role also partners with product and engineering teams to support platform efficiencies.

The Senior Clinical Informaticist plays an essential role in gathering and documenting clinical workflows and chat program requirements from clinical clients. They partner with internal informatics, modelers, conversation designers, and implementation teams to ensure coordinated and efficient program development.Guided by client clinical workflow, goals, and the patient journey, the Senior Clinical Informaticist also systematically compiles knowledge from research papers, published guidelines, client clinicians, and clinical and informatics advisors to create a chat program framework that leads to actionable data and informs conversation design.

The Senior Clinical Informaticist helps manage the clinical chat program library a repository of knowledge artifacts and documents that provide a framework for creating or adapting programs. They are responsible for maintaining the specification documentation that tracks and outlines program iterations, overseeing change management, defining best practices and supporting standardization across programs.

The Senior Clinical Informaticist role will report to the Sr. Manager, Clinical Program Design, with oversight from our physician informaticists.

Core Responsibilities:

• Work with client clinicians and internal clinical informatics to define and design clinical frameworks for clinical chat programs.
• Ensure clinical framework and program scope is appropriately and effectively communicated and maintained in specification documentation.
• Partner with conversation design team to translate clinical frameworks. Ensure clinical accuracy and appropriateness of chat program content.
• Assist with coding of data elements and provide oversight of interoperability aspects of a program (e.g., coding and selection of data elements for Epic Flowsheet integration)
• Organize knowledge artifacts/documents and reconcile with chat scripts and other assets.
• Create visualizations and summaries of program proposals to facilitate stakeholder decision-making.
• Stay abreast of current clinical evidence and update existing programs and patient education in a erse set of clinical domains.
• Work with the analytics/operations team to incorporate user feedback and drive program improvement.
• Lead a testing group in testing and debugging of programs.

Qualifications:

• Bachelor of Science Degree in a healthcare related role that incorporates patient care
• 3+ years’ experience in delivering healthcare or supporting the delivery of healthcare in a variety of service lines
• 5+ years demonstrative experience with supporting informatics solutions in the context of clinical processes, e.g., support of clinical information flow for decision support, development of patient facing applications, or equivalent academic work
• Experience implementing business rules logic in the operationalization of clinical processes
• Experience working with clinical taxonomies and ontologies, how they are organized and used in organizing health care data
• Experience in designing impactful CDS (Clinical Decision Support) solutions
• Comfort and familiarity with a range of software tools (Microsoft 365, Lucidchart/Visio, Jira, etc.) to produce documentation and figures, manage tasks, etc.
• Ability to work remotely with dynamic teams across a wide range of time zones, and stay on top of multiple projects
• Experience with the display of complex clinical data

Preferred

• Advanced degree in Clinical Informatics (master’s or higher)
• Demonstrative knowledge of programming and coding language, preferably in JavaScript
• Editorial experience, documentation management
• Project management experience

Additional information

Working at Amwell:

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

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

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

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

Salaried, Exempt Roles:

The typical base salary range for this position is $98,400- $135,300. The actual salary offer will ultimately depend on multiple factors including, but not limited to, knowledge, skills, relevant education, experience, complexity or specialization of talent, and other objective factors. In addition to base salary, this role may be eligible for an annual bonus based on a combination of company performance and employee performance. Long-term incentive and short-term variable compensation may be offered as part of the compensation package dependent on the role. Some roles may be commission based, in which case the total compensation will be based on a commission and the above range may not be an accurate representation of total compensation.

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

Additional Benefits

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

Coding Specialist

at Signify Health

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, CPC-A, COC, CCS, CCS-P or CCA
• 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

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.

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.

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.

Professional Coding Lead

Job LocationsUS-Remote

ID

2023-4024

Category

Revenue Cycle

Position Type

Regular Full-Time

Company Overview

#LI-Remote

Shriners Children’s is a family that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience defines us as leaders in pediatric specialty care for our children and their families.

Job Overview

Shriners Children’s is the premier pediatric burn, orthopaedic, spinal cord injury, cleft lip and palate, and pediatric subspecialties medical center. We have an opportunity for a Professional Coding Lead reporting into our Corporate Headquarters.

The Professional Coding Lead performs at an advanced level medical professional coding position and serves as an expert utilizing International Statistical Classification of Diseases (ICD-10) and Current Procedural Terminology (CPT 4) classification system coding to all diagnoses, treatments and procedures in all types of Hospital, Clinic and Ambulatory Surgical Center (ASC) locations at stated minimum performance levels. The Revenue Integrity Professional Coder Team Lead supervises daily operations specific to professional coding and coder productivity. Develop staff coverage strategies to maintain consistent productivity flow and assists to cover staff PTO/position vacancies. Reviews employee timesheets and validates with timecards in the payroll system biweekly. Monitors the Professional Hold Report weekly to ensure coding is completed timely and to request information from responsible departments as well as develop strategies to minimize un-coded accounts greater than the bill hold period. Supports Professional Coding Team by discussing complex coding cases, answering questions, providing education and interfacing with Leadership. Runs daily and weekly status reports and distributes to appropriate parties. Completes edits in Bill scrubber and CBO and identifies payer specific guidelines and process improvement opportunities. Communicates documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.) to appropriate personnel for follow-up and resolution. The Revenue Integrity Professional Coder Team Lead will also provide training for all new professional coders and monitors staff progress.

Responsibilities

• Interpret health record documentation using knowledge of anatomy, physiology, clinical disease processes, pharmacology and medical terminology to identify diagnoses and procedures
• Interpret ICD-10; CPT 4; Healthcare Common Procedure Coding (HCPC) and modifier codes for services rendered accurately and completely
• Follows coding guidelines and legal requirements to ensure compliance with federal and state regulations
• Identifies trends in documentation deficiencies and presents along with creative solutions
• Acts as a key liaison for the clinical staff as it relates to coding and compliance
• Interacts with Physician and Executive Leadership and other professional staff of documentation issues relating to coding data
• Acts as a mentor to Professional Coding team
• Reviews employee timesheets and validates with timecards in the payroll system biweekly
• Manages Professional Coding Team schedule including PTO and coverage
• Provides onboarding system and workflow training to newly employed coders
• Performs 100% audit for all newly employed coders and provides feedback
• Monitors staff quality performance and provides education to support correct coding
• Prepares and presents education in conjunction with the Revenue Integrity Professional Coding Educator
• Primary contact for Revenue Cycle and Clinical teams throughout Shriners Hospitals for Children (SHC) system to assist with coding questions
• Prepares and distributes queue status reports to Coding Leadership on a daily and weekly basis
• Performs scheduled surgical audits for Provider feedback and communicates results to Surgeons
• Bill Scrubber coding WQ Edits and trends results
• Professional Coding WQ and trends denial reasons

Qualifications

Experience:

• 7 years of professional coding experience required
• Experienced with Surgery Coding Guidelines, E/M Coding Guidelines, CPT coding, ICD-10, HCPCS and NCCI Edits required
• Pediatric, orthopedic and/or injury, and burn coding experience required
• Intermediate Excel skills required
• Advanced knowledge of 3M system or other encoder program required
• Advanced knowledge of Medical Terminology required
• Advanced knowledge of professional coding practice standards required

Education:

• High School Diploma/GED required
• Current certification in one of the following required: CCS (AHIMA), CCS-P (AHIMA) and/or CPC (AAPC)

Nurse Member Advocate

Remote – USA

Full time

JR15936

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

Summary of Position

The Nurse Member Advocate is an integral part of a cross-functional clinical team comprised of physicians, nurses, medical assistants, pharmacy technicians and support staff that facilitates the 24/7 delivery of whole person healthcare, ensuring the optimal use of internal and external, erse health care resources to improve health outcomes.

The nurses are responsible for care delivery in all Teladoc service lines focusing on ensuring the highest clinical quality, as well as member and client satisfaction.

Essential Duties and Responsibilities

• Works in partnership with clinical team in support of case development and management, care and treatment plans including accurate case documentation, identifying relevant medical data to be collected and providing clear, concise communication to members, internal and external partners.
• Serve as the ongoing coordinator of primary and preventative care, episodic care, expert medical opinion and other service lines
• Obtains a comprehensive health history by leading members through a systematic and dynamic intake assessment to capture all relevant data about their current condition and health history and directs members to most appropriate service line; sets appropriate member expectations for each process
• Resolves prescription issues related to episodic care within established protocols and turn-around times
• Maintains his/her own availability within Outlook for scheduling of member visits and all follow ups
• Utilizes the company’s proprietary database to help connect members to Teladoc Health and external physicians and completes referrals where appropriate, both internal and external
• Conducts member health coaching and provides treatment decision support service via printed educational materials and videos
• Uses clinical judgment in the review of complex medical issues to ensure accuracy of clinical summaries/reports and care plans
• Provides clinical support and guidance to support staff regarding case related inquiries
• Ensures adherence to established processes and compliance with privacy legislation and regulations with all parties encountered in the service delivery
• Is accountable for meeting service standards for speed of case progression, overall quality, and member satisfaction
• Support additional projects as needed

Qualifications Required for Position

• Active Registered Nurse license
• BSN Preferred
• 5 years recent experience in the acute care setting preferred
• Med-surg background preferred
• Quality driven with a focus on flawless customer service
• Strong clinical knowledge base
• Excellent written and verbal communication skills
• Outstanding team player & strong interpersonal skills
• Bilingual-Spanish Speaking a plus
• Strong organizational skills and the ability to multitask with ease
• Ability to work independently but recognize when escalation is warranted
• Proficiency using technology and software including Microsoft Word, Excel, Outlook
• Ability to work required shift: evenings and weekend coverage

The base salary range for this position is $75,000-$85,000. In addition to a base salary, this position is eligible for performance bonus, RSU’s, and benefits (subject to eligibility requirements) listed here: Teladoc Health Benefits 2023. Total compensation is based on several factors including, but not limited to, type of position, location, education level, work experience, and certifications. This information is applicable for all full-time positions.

Why Join Teladoc Health?

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

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

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