Interviewer jobs at Chestnut Health Systems - 11 jobs

Our Valparaiso Billing Department is in need of an Insurance Benefit Reviewer! Once training is complete there are hybrid work from home options with this role. Porter-Starke Services, Inc. is a Community Mental Health Center (CMHC) based in Valparaiso and serves northwest Indiana with additional offices in Portage, Knox, and LaPorte. Porter-Starke operates Marram Health Center, a Federally Qualified Health Center (FQHC) with offices in Gary, Hebron, and Portage. POSITION SUMMARY: Ensures that the organization receives the necessary information to maximize first and third party billing and collection for client services. This is an entry-level position providing valuable experience based at the Valparaiso location Billing Department. EMPLOYEE BENEFITS: 401K w/ 20% company matching Option to work some remote hours (once training is complete) 11 paid holidays Competitive wages Generous PTO Employee discounts (YMCA) Employee referral program HSA/FSA accounts Medical, dental, and vision insurance Tuition assistance (up to $5250/annually) Loan repayments (up to $200/month) Casual Fridays Company paid life insurance policy Company paid long term disability Optional insurances (short term disability) Employee recognition events Employee Assistance Program Free health screenings VITAL DUTIES AND RESPONSIBILITIES [Major Job Functions] * Reviews all admitting paper work that has been scanned into the electronic medical record (EMR) system for new patients. Checks for duplicate patient IDs. * Reviews all data in EMR for new patients. For selected departments, reviews and enters all HAP associated data. * Contacts insurance carriers to obtain insurance benefits and initial authorizations. * Enters all insurance and authorization information into the patient's account in the Accumed practice management system. * Verifies Medicaid eligibility on a weekly basis for all patients who are currently eligible for Medicaid and for all self-pay only patients. * Updates the patient's insurance profile and transfers all claims to the appropriate payor when a patient becomes eligible for Medicaid. * When notified that a patient is no longer eligible for Medicaid, updates the patient's insurance profile, transfers all claims to the appropriate payor and communicates the change in funding to all of the patient's program areas. * Re-verifies insurance benefits and authorizations for patients who have been transferred or referred by one PSS staff to another. * When notified that a patient's insurance has lapsed, communicates this to front desk staff and follows up with new insurance and authorization information. * Assists patients to examine their insurance coverage to determine the allowable services and co-payments. * Assists staff at satellite offices with insurance questions or problems. * Handles customer and insurance representative inquires in a timely and efficient manner. * Participates in the telephone rotation and assists with inquiries at the Client Financial Services window when needed. EDUCATION & EXPERIENCE * High school diploma or G.E.D is required * A certificate or degree from a vocational or technical school preferred * One to three years related experience and/or training is preferred Please feel free to visit our website at ******************** for additional information.

Insurance Reviewer - Clinical Willamette Valley Cancer Institute is looking for an Insurance Reviewer to support our patients receiving testing and treatment needed for their diagnosis by navigating insurance portals and obtaining all appropriate authorizations. With a focus on authorizations for infusion drugs, radiation therapy, imaging, genetics and surgeries our Insurance Reviewers pave the way for our patients and treatment team to follow the prescribed treatment pathway. An individual that thrives in a high-volume workspace, with the ability to manage shifting priorities will find success in this role. The general pay scale for this position at WVCI is $22.01-$31.00. The actual hiring rate is dependent on many factors, including but not limited to: prior work experience, education, job/position responsibilities, location, work performance, etc. Employment Type: Full Time Benefits: M/D/V, Life Ins., 401(k) Location: Eugene, OR Responsibilities * Reviews, processes and audits the medical necessity for treatments including radiation oncology, gynecologic surgery, genetic lab testing, imaging, and chemotherapy treatment for each patient. Documentation of regimen related to pathway adherence and payer guidelines. * Communicate with nursing, physician, pharmacists and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs. * Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions on an as needed basis * Obtains insurance authorization and pre-certification for various oncology & hematology related services. * Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization. Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient's records. * Other duties as requested or assigned. Qualifications * High school degree or equivalent. * Minimum three (3) years of prior authorization experience required. Revenue cycle experience preferred. PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range. Work Environment: The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites. The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

Essential Functions: * Authorize patient stays * Submit insurance PA for hospital admission insurance. * Continued stay submissions * Discharge submission to insurance * Appeals and Peer to Peer submission * InterQual submission for medical necessity. * Discharge planning for BHU and Acute Care. * Conduct UR Committee. * CDI Management * Swing Bed intake process * All other duties within the scope of practice. Working Conditions: * Possible exposure to inside environmental conditions. * Exposure to distressed patients, families or visitors. Physical Demands: * Requires standing, sitting or walking for up to 8 hours or longer per day. * The ability to lift up to 50 lbs. Qualifications: * Graduate of an Accredited School of Practical Nursing or Registered Nursing or Graduate of an approved program in Respiratory Care or BSW/MSW from accredited school of social work required or similar education and experience; Missouri Licensure preferred

If you are passionate about helping people who need treatment for substance use, interested in working in research, and are familiar with communities in Jackson, Josephine, Klamath and/or Lake Counties in Southern Oregon, this may be the role for you! We are looking for a field tracker/interviewer to work part-time who will travel around Southern Oregon to meet with and interview parents. Responsibilities Help recruit individuals in community settings. Use personal vehicle to travel across designated region for interviews with participants (mileage reimbursement provided). Provide participant transportation if/when needed. Network to expand agency contacts. Participate in regular case review meetings. Complete duties outlined in data collection protocol within specified time frame. Consult with the Field Director and other Field Trackers/Interviewers on hard-to-find cases. Conduct interviews in participants homes as well as other public locations. Set up and walk participants through a smartphone application. Collect urine drug screens as needed to gather follow-up data. Receive supplies by mail and inventory supplies on a regular basis. Maintain specified performance levels including quality assurance standards. Qualifications A minimum of a high school diploma or equivalent. Must be knowledgeable of neighborhoods within the study area. Must possess a valid driver's license and proof of valid automobile insurance and must be insurable with agency automobile insurance carrier. May need to obtain GAIN/ABS certification, if relevant, within 6-months of hire date. Excellent communication skills required. Ability to work required hours and adjust work schedule to meet the position requirements. Must be able to work evenings and/or weekends as assigned. Must be able work outdoors for extended periods of time daily (must be aware that there is exposure to rain, sleet, snow, extreme heat and/or cold. Are you intrigued by this job but don't meet every single requirement? Research shows that women and people of color are less likely to apply for jobs when that's the case. Chestnut is committed to building a diverse, inclusive, and authentic workplace. If you're excited about any of our posted positions but your experience doesn't line up perfectly, please apply anyway! You might be just the right candidate for another role. We'd love to explore the possibilities with you! EOE - Minorities/Females/Veterans/Disabled. Chestnut welcomes applications from qualified individuals with recovery experience. The anticipated starting pay for new hires for this position is between $23.69 - $27.01 an hour. There are several factors taken into consideration in determining base pay, including but not limited to: job-related qualifications, skills, education, experience, local market conditions, and internal equity.

The trainee will review behavior intervention plans (BIPs) to ensure alignment with current data and treatment goals. This includes assessing the effectiveness of interventions, adjusting reinforcement schedules, modifying antecedent strategies, and ensuring plans are clearly written and practical for implementation. Requirements Strong understanding of functional behavior assessments and behavior plans Knowledge of proactive and reactive intervention strategies Ability to analyze behavior data and assess intervention effectiveness Proficiency in writing clear and comprehensive intervention plans Collaboration with the clinical team to ensure ethical and effective interventions

At Zelis, we Get Stuff Done. So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview As part of the Price Optimization division, this role is responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG Quality Assurance reviews in an effort to increase the savings achieved for Zelis clients. Conduct reviews on inpatient DRG claims as they compare with medical records utilizing ICD-10 Official Coding Guidelines, AHA Coding Clinic evidence based clinical criteria and client specific coverage policies. What you'll do: Perform comprehensive inpatient DRG validation Quality Assurance reviews to determine accuracy of the DRG billed, based on industry standard coding guidelines and the clinical evidence supplied by the provider in the form of medical records such as physician notes, lab tests, images (x-rays etc.), and with due consideration to any applicable medical policies, medical best practice, etc. Implement and conduct quality assurance program to ensure accurate results to our clients Manage assigned claims and claim report, adhering to client turnaround time, and department Standard Operating Procedures Serve as the Subject Matter Expert on DRG validation to team members and other departments within the organization Prepare and conduct training for new team members Identify new DRG coding concepts to expand the DRG product Meet and/or exceed all internal and department productivity and quality standards Must remain current in all national coding guidelines including Official Coding Guidelines, AHA Coding Clinic and AMA CPT Assistant Recommend efficiencies and process improvements to improve departmental procedures Maintain awareness of and ensure adherence to Zelis standards regarding privacy What you'll bring to Zelis: Registered Nurse licensure preferred Inpatient Coding Certification required (i.e., CCS, CIC, RHIA, RHIT) 5+ years reviewing and/or auditing ICD-10 CM, MS-DRG and APR-DRG claims preferred Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs Strong understanding of hospital coding and billing rules Clinical and critical thinking skills to evaluate appropriate coding Strong organization skills with attention to detail Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships. Demonstrated thought leadership and motivation skills, a self-starter with an ability to research and resolve issues Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future. Location and Workplace Flexibility We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies. Base Salary Range $95,000.00 - $127,000.00 At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role. Zelis' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage. Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. Accessibility Support We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email ***************************. Disclaimer The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.

The Insurance Reviewer II is responsible for completing assigned tasks involved in securing payment from third-party payors and reporting to management on observed trends and issues. Job Relationships Reports to the Insurance Review Supervisor Principal Responsibilities Handle all phone calls and messages received specific to designated insurance area. Update registration screens when requested by patients or as necessary. Review and process all designated insurance vouchers received, rebilling charges not paid and processing adjustments as needed utilizing websites or telephone as necessary. Process all secondary billing as requested by patients or defined by procedure. Distribute incoming insurance mail received and respond to all audits, inquiries and additional information requests. Process corrections/adjustments as necessary to correct the patient's invoice. Process designated insurance reviews when requested to obtain additional payments on claims utilizing websites or telephone as necessary. Analyze and process front-end system edits for correct physician productivity and billing of claims. Analyze and process back-end system edits for correct registration and billing of claims. Analyze and process claims denied through clearinghouse. Investigate and process claims in the insurance work files and/or on the insurance reports. Must report all incidents to immediate Supervisor or Manager. Assist with special projects and assignments as directed. Must attend in-services and training relevant to position. Perform other job duties as assigned. Confidentiality required. Comply with the Springfield Clinic incident reporting policy and procedures. Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy. Provide excellent customer service and adhere to SC Way customer service philosophy. Education/Experience High School graduate or GED required. Previous experience in a medical billing office required. Knowledge, Skills and Abilities Working knowledge of medical terminology preferred. Working knowledge of CPT and ICD-9 coding preferred. Computer, typing and calculator skills required. Must be able to work individually or on a team. Working Environment Office environment, sitting for long periods PHI/Privacy Level HIPAA1

Job DescriptionMedical Record Reviewer Community Home Health Care is hiring an in-office QA Nurse to oversee the accuracy, completeness, and regulatory compliance of all clinical documentation. This role is essential to ensuring our client records meet professional standards and support safe, high-quality care. What You'll Do Clinical Record Audits & Documentation Review Perform monthly audits of skilled nursing notes for all visiting nurses. Provide direct, timely feedback to nurses on missing or incorrect documentation. Re-audit records when deficiencies continue and notify the Clinical Manager as needed. Audit OASIS assessments (SOC, ROC, Recertification, and Follow-Up) prior to transmission. Audit at least 10% of each RN Case Manager's charts monthly, focusing on recerts, SOC, and ROC visits. Audit all documentation for newly hired RN Case Managers during their probation period. Complete discharge record reviews and notify RN Case Managers when discharge charts need QA review. Deficiency Identification & Follow-Up Review charts for accuracy, completion, legal compliance, and proper care documentation. Document deficiencies on the Case Conference Review form. Notify nurses and department staff of deficiencies and required corrections. Conduct discharge analysis when clients leave the agency. Reporting & Collaboration Track patterns and trends in documentation issues. Communicate concerns and recurring problems to the Clinical Manager. Support corrective action steps when needed. Compile a quarterly audit report summarizing the previous three months. Assist with ongoing chart review processes as assigned. What We're Looking For Active RN license in the State of Indiana. Strong understanding of home health documentation standards, Medicare/Medicaid requirements, and OASIS. Excellent attention to detail and strong organizational skills. Ability to communicate clearly, professionally, and constructively with nursing staff. Comfortable working fully in-office in a fast-paced environment. Previous QA or chart auditing experience preferred, but strong clinical documentation skills will also be considered. Schedule & Work Environment Monday-Friday schedule, in-office at the Fort Wayne location. Works closely with the Clinical Manager, RN Case Managers, and field staff. Computer-based role with consistent chart auditing and record review responsibilities. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state, or local laws. We are committed to creating a diverse and inclusive workplace for all employees.

This is where your selected resumes from MyCNA will be put. It is an INTERNAL job, so will not be seen on job boards/career sites/etc. It is just for organization. Please do not close, delete, or rename this job. Do not worry about location details either.

The Insurance Reviewer II is responsible for completing assigned tasks involved in securing payment from third-party payors and reporting to management on observed trends and issues. Job Relationships Reports to the Insurance Review Supervisor Principal Responsibilities Handle all phone calls and messages received specific to designated insurance area. Update registration screens when requested by patients or as necessary. Review and process all designated insurance vouchers received, rebilling charges not paid and processing adjustments as needed utilizing websites or telephone as necessary. Process all secondary billing as requested by patients or defined by procedure. Distribute incoming insurance mail received and respond to all audits, inquiries and additional information requests. Process corrections/adjustments as necessary to correct the patient's invoice. Process designated insurance reviews when requested to obtain additional payments on claims utilizing websites or telephone as necessary. Analyze and process front-end system edits for correct physician productivity and billing of claims. Analyze and process back-end system edits for correct registration and billing of claims. Analyze and process claims denied through clearinghouse. Investigate and process claims in the insurance work files and/or on the insurance reports. Must report all incidents to immediate Supervisor or Manager. Assist with special projects and assignments as directed. Must attend in-services and training relevant to position. Perform other job duties as assigned. Confidentiality required. Comply with the Springfield Clinic incident reporting policy and procedures. Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy. Provide excellent customer service and adhere to SC Way customer service philosophy. Education/Experience High School graduate or GED required. Previous experience in a medical billing office required. Knowledge, Skills and Abilities Working knowledge of medical terminology preferred. Working knowledge of CPT and ICD-9 coding preferred. Computer, typing and calculator skills required. Must be able to work individually or on a team. Working Environment Office environment, sitting for long periods PHI/Privacy Level HIPAA1