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Senior Counsel - Healthcare IT and AI Technology Contracts
Akron Children's Hospital 4.8
Hudson, OH jobs
Full-Time, 40 hours/week
Monday - Friday 8 am - 5 pm
Onsite
The Senior Associate Counsel provides legal support for hospital information technology operations, including comprehensive legal and strategic guidance on the procurement, deployment, and governance of information technology systems (ISD) and artificial intelligence. This position reports to the Vice President, Senior Associate Counsel with a reporting matrix to the Chief Information Officer.
Responsibilities:
Advise hospital leadership and procurement teams on the legal implications of acquiring new technologies, such as electronic health records (EHR), telemedicine platforms, cybersecurity tools, and medical devices and the implementation of artificial intelligence tools.
Draft, review, and negotiate a broad array of information technology contracts-such as software-as-a-service (SaaS) agreements, cloud hosting terms, data processing addenda, and business associate agreements. Identify and address legal risks in vendor offerings and technology solutions.
Advise hospital leadership on legal considerations surrounding digital transformation initiatives, innovation adoption, and strategic partnerships with technology providers.
Collaborate with hospital IT and security teams to develop policies and protocols for safeguarding patient data and critical systems. Advise on incident response plans, breach notification procedures, and risk mitigation strategies. Stay abreast of emerging threats and evolving best practices.
Provide legal support for hospital-wide policies on technology use, social media, device management, remote work, mobile access to sensitive information, and enterprise risk for information technology. Ensure policies reflect current legal requirements and operational needs.
Support the hospital in managing disputes or litigation related to technology vendors, data breaches, intellectual property claims, and other technology-related matters. Coordinate with litigation counsel as needed.
Education and Training: Provide ongoing education to staff and leadership on legal implications of technology adoption, emerging regulatory requirements, and evolving risks in the health technology landscape.
Identify and assess legal, operational, and compliance risks in IT contract.
Other duties as assigned.
Other information:
Technical Expertise
Openness to learning and keeping pace with rapid changes in both healthcare delivery and technological innovation.
Aptitude for working effectively with clinicians, IT professionals, administrators, vendors, and regulators.
Capacity to guide organizational leadership through complex legal and strategic decisions regarding technology investments.
Resourcefulness and creativity in navigating novel legal challenges emerging from digital health transformation.
Education and Experience
Education: Juris Doctor (JD) degree from an accredited law school; Ohio bar admission or ability to obtain admission prior to start date.
Experience: Minimum of 5 years of legal practice advising in healthcare Information technology contracts is required.
Technical Knowledge: Familiarity with healthcare IT systems, data privacy and security laws, and emerging technologies (such as artificial intelligence, cloud computing, and IoT).
Skills: Strong contract negotiation, drafting, and analytical skills. Excellent verbal and written communication abilities. Competency in risk assessment and strategic thinking.
Demonstrated integrity, discretion, and ability to work collaboratively with multidisciplinary teams.
Full Time
FTE: 1.000000
Status: Onsite
$97k-148k yearly est. 18d ago
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Remote VP of Customer Success - Enterprise Health Systems
Getwellnetwork, Inc. 4.1
Bethesda, MD jobs
A leading healthcare solutions provider is seeking a Head of Customer Success to lead its customer success organization. This role requires a results-driven leader with over 10 years of experience in customer success and a proven track record in enterprise settings. Responsibilities include defining customer success strategies, driving customer retention and growth, and collaborating with cross-functional teams to foster exceptional customer experiences. The ideal candidate will thrive in a data-driven environment and possess strong communication skills.
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$119k-178k yearly est. 4d ago
EMR Informatics Specialist, Health Information Management, Days Hybrid
Norton Healthcare 4.7
Louisville, KY jobs
Responsibilities
Design and develop electronic medical record keeping and documentation systems. Implement structures and algorithms to optimize the use, storage, and retrieval of medical information.
Key Responsibilities:
Assists with evaluation, design, testing, implementation, upgrades, support, and maintenance of the HIM system(s).
Trains, supports and provides assistance to users; and, provides ongoing education and training when needed.
Provides technical consultation to health information management, other departments, vendors, and information technology on HIM system(s) and processes.
Manages tools such as procedure and information flowcharts, policies and procedures, instructional manuals, and forms in order to promote effective use of applications. Provides documentation and training for users when there is a system change or update.
Special projects as directed.
**This position has the opportunity to work from home. You may be asked to complete training at a Norton Healthcare facility or be able to come to a Norton Healthcare facility for business purposes. Employees in this role must reside in Kentucky or Indiana**
Qualifications
Required:
With an Associates Degree: Three years in Health Information Management or Health Information Technology
With a Bachelor's Degree: One year Health Information Management or Health Information Technology
One of: RHIA or RHIT
Desired:
Bachelor Degree
Registered Health Information Administrator
Registered Health Information Technician
Project Management Professional
EPIC Certification
OnBase Certification
$26k-32k yearly est. 1d ago
EHR Optimization Lead - Remote, Flexible & Impactful
Aledade 4.1
Bethesda, MD jobs
A health technology organization is looking for an EHR Optimization Lead to coordinate optimization efforts for EHR solutions in partner practices. The ideal candidate will have over 6 years of experience in client-facing project roles within the healthcare industry and deep knowledge of popular EHR systems. Responsibilities include leading EHR optimization efforts, fostering client relationships, and mentoring team members. This role emphasizes innovation and collaboration within a remote-first environment.
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$68k-115k yearly est. 3d ago
Senior Systems Engineering Lead - ABMS DI Network (Remote)
Leidos 4.7
Bethesda, MD jobs
A leading technology solutions company is seeking a Systems Engineering Lead to manage the product lifecycle for an agile development program. The role requires a minimum of Top Secret clearance and extensive relevant experience (BS: 12-15 years; MS: 10-13 years). Key responsibilities include work with the Systems Engineering Lifecycle and documentation of requirements. Strong communication skills and the ability to collaborate across various disciplines are essential. This position offers a competitive salary range between $131,300 and $237,350.
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$131.3k-237.4k yearly 4d ago
Maternity Care Authorization Specialist (Hybrid Potential)
Christian Healthcare Ministries 4.1
Barberton, OH jobs
This role plays a key part in ensuring maternity care bills are processed accurately and members receive timely support during an important season of life. The specialist serves as a detail-oriented professional who upholds CHM's commitment to excellence, compassion, and integrity.
WHAT WE OFFER
Compensation based on experience.
Faith and purpose-based career opportunity!
Fully paid health benefits
Retirement and Life Insurance
12 paid holidays PLUS birthday
Lunch is provided DAILY.
Professional Development
Paid Training
ESSENTIAL JOB FUNCTIONS
Compile, verify, and organize information according to priorities to prepare data for entry
Check for duplicate records before processing
Accurately enter medical billing information into the company's software system
Research and correct documents submitted with incomplete or inaccurate details
Verify member information such as enrollment date, participation level, coverage status, and date of service before processing medical bills
Review data for accuracy and completeness
Uphold the values and culture of the organization
Follow company policies, procedures, and guidelines
Verify eligibility in accordance with established policies and definitions
Identify and escalate concerns to leadership as appropriate
Maintain daily productivity standards
Demonstrate eagerness and initiative to learn and take on a variety of tasks
Support the overall mission and culture of the organization
Perform other duties as assigned by management
SKILLS & COMPETENCIES
Core strengths like problem-solving, attention to detail, adaptability, collaboration, and time management.
Soft skills such as empathy (especially important in maternity care), professionalism, and being able to handle sensitive information with care.
EXPERIENCE REQUIREMENTS
Required: High school diploma or passage of a high school equivalency exam
Medical background preferred but not required.
Capacity to maintain confidentiality.
Ability to recognize, research and maintain accuracy.
Excellent communication skills both written and verbal.
Able to operate a PC, including working with information systems/applications.
Previous experience with Microsoft Office programs (I.e., Outlook, Word, Excel & Access)
Experience operating routine office equipment (i.e., faxes, copy machines, printers, multi-line telephones, etc.)
About Christian Healthcare Ministries
Founded in 1981, Christian Healthcare Ministries (CHM) is a health care sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other's medical bills. The mission of CHM is to glorify God, show Christian love, and experience God's presence as Christians share each other's medical bills.
$31k-35k yearly est. 2d ago
Medical Dosimetrist positions in Pittsburgh, PA - Hybrid work schedule
UPMC Southwestern Pa 4.3
Lebanon, PA jobs
UPMC Hillman Cancer Center is currently hiring for a regular Full-Time Staff/Sr. Medical Dosimetrist to join our team in the Central Region of the UPMC Hillman Cancer Center Network. The dosimetrist in this position will be based out of the UPMC Hillman Cancer Center at UPMC Shadyside in Pittsburgh, PA, and will provide planning services for the clinic.
This role offers a hybrid work arrangement with on-site duties, work-from-home capability and will work a regular Full-Time schedule Monday through Friday.
This position joins 6 other medical dosimetrists dedicated to this department and a larger team of 40+ dosimetrists across the UPMC Hillman Cancer Center Network.
Collaboration and remote support across the group is facilitated by our integrated ARIA/Eclipse and Citrix-based IT infrastructure, as well as standardized policies, procedures, and care pathways across UPMC.
The medical dosimetrist is responsible for generating clinically optimal treatment plans for radiation therapy patients in collaboration with radiation oncologists, radiation therapy technologists, and medical physicists.
This includes participating in CT simulation, radiation treatment planning, quality management for radiation oncology patients, and communicating with the clinical team during treatment planning and treatment plan implementation.
Treatment techniques include 3DCRT, IMRT, VMAT, SBRT, and motion management (e.g., respiratory gating and DIBH). UPMC Shadyside delivers radiotherapy treatments with a variety of platforms(2 Varian TrueBeams, 1 Varian Halcyon, and 1 Reflexion).
We offer a Dosimetry career ladder which allows our staff to grow within the field at UPMC Hillman Cancer Center. The incumbent will be placed into the appropriate level of our Dosimetry Career ladder based on education and experience.
Staff/Sr. Dosimetrist salary range between $48.08/hr. to $73.65/hr.
Sr. level requires three (3) years of post-graduate clinical medical dosimetry experience.
Responsibilities:
Participates in acquisition of patient data via computer generated data sets from medical imaging devices such as CT, PET, MR, etc., or manual methods such as physical measurements and wire contours, and incorporation of these data into radiation treatment plans, calculations, and treatment devices.
Assists the RTT in the treatment simulation process including the use or necessity of ancillary treatment devices, patient immobilization techniques, and other patient positioning techniques as needed for simulation and treatment. Assists in fabrication of these ancillary treatment devices.
Contours and delineates clearly discernable normal critical structures and expanded planning structures using different imaging modalities.
Performs rigid and deformable image registration for multi-modality image sets.
Applies the principles and concepts of radiation physics in radiation treatment planning, which includes, but is not limited to: 2D treatment planning, 3D conformal treatment planning, intensity modulated radiation therapy (IMRT) treatment planning, 4D treatment planning, volumetric modulated arc therapy (VMAT) planning, stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) planning, and brachytherapy treatment planning.
Applies knowledge of radiobiology with respect to dose tolerances, time dose fractionation calculations, hypofractionation, BED and EQD2 calculations and other applications of radiobiology to the radiation therapy treatment process.
Accurately performs radiation dose calculations, both manual and computer generated, for treatment delivery including the effects of beam modifying devices, irregular fields, gaps for adjacent fields, and off-axis calculations.
Participates in special treatment procedures including, but not limited to, total body irradiation (TBI), total skin electron irradiation (TSEI), intra-operative radiation therapy (IORT).
Assists with quality assurance procedures as directed by a qualified medical physicist.
Performs or assists with patient-specific radiation measurement including, but not limited to diodes, optically stimulated luminescent dosimeters (OSLD), ion chambers, thermo-luminescent dosimeters (TLD), or film measurements as directed by the MP.
Assists with high dose rate (HDR) and low dose-rate (LDR) brachytherapy procedures including patient set up, simulation, and treatment planning.
Participates in quality management in accordance with departmental policies, national guidelines, and accreditation standards.
Performs routine chart checks per departmental policy.
Participates in charge capture and generates documentation for billing in accordance with departmental policies.
Participates in clinical research for the development and implementation of new techniques in radiation therapy.
Participates in educational activities such as providing instruction and training to new staff members, physician residents, physicist residents, RTT trainees, and medical dosimetrist trainees.
Maintains an atmosphere of caring, concern, and support for patients, visitors, medical staff, and colleagues.
Performs miscellaneous job-related duties as directed by supervising medical physicists.
Adheres to high ethical standards in relation to patients, students, trainees, and colleagues.
Ensures accurate data transfer of patient and treatment plan information to clinical systems including but not limited to record and verify systems, imaging guidance systems, surface guidance systems, treatment delivery systems, and electronic medical record systems.
UPMC Hillman Cancer Center is internationally recognized for its leadership in the prevention, detection, diagnosis, and treatment of cancer and is the region's only comprehensive cancer center designated by the National Cancer Institute. As the preeminent institution in western Pennsylvania for the delivery of cancer care, the performance of basic, translational, and clinical research, and the education of the next generation of cancer researchers and physicians, UPMC Hillman Cancer Center is exceptionally well-positioned to contribute to the global effort to reduce the burden of cancer.
Qualifications:
Qualifications:
Bachelor's degree preferred.
Completion of a Medical Dosimetry educational program accredited by the Joint review Committee on Education in Radiologic Technology (JRCERT)
Board certified by the Medical Dosimetrist Certification Board (MDCB).
Board eligible candidates must become board certified within two attempts in the first two consecutive years of employment.
Licensure, Certifications, and Clearances:
Certified Medical Dosimetrist (CMD) or board eligibility required. Must maintain adequate CE credits to retain certification. CPR required based on AHA standards that include both a didactic and skills demonstration component within 30 days of hire
Basic Life Support (BLS) OR Cardiopulmonary Resuscitation (CPR)
UPMC is an Equal Opportunity Employer/Disability/Veteran
$48.1-73.7 hourly 1d ago
Sr Principal Java Architect Developer | Portware EMS | 250k+ Hybrid
Living Talent 4.1
Jersey City, NJ jobs
Implement automation strategies to improve trading workflows (Equities, Futures, FX, Options)
Hybrid: 4 days in office
Compensation: 200k - 230k base + bonus
PTO: Unlimited
Benefits: Exceptional
Architect, Design and Develop customizations and interfaces in Portware using Java
New Development 30%
Enhancements 50%
Maintenance 20%
Backend 70%
Frontend 30%
Interface with Traders and Portfolio Managers; collaborate with Product Owner
Provide architectural input - influence design aligning with future state
Hands-on implementation
Tech Stack
Java (50%)
Java Swing (30% - for custom interfaces to EMS platform)
SQL Server (10%)
VB.net (10%)
Portware EMS
AWS, Snowflake
Agile, Microservices
TDD, Unit Testing (Pytest, UnitTest)
GIT Co-pilot, Eclipse, VS Code, Jira, Confluence, Docker,
Ideal experience: DevSecOps (ANT, Maven, Artifactory)
Skills & Qualifications
Trading workflow (Equities, Futures, Options, FX)
Portware (or other EMS)
Expert Java skills and concepts (Java 8)
10+ years Fullstack Software Engineering
4+ years Architecture (microservices and other architectural concepts)
Experience with Java Swing is a plus
Cloud-native development expertise (ideally AWS)
Skilled in troubleshooting and debugging performance issues
Nice to haves: BS or MS in Computer Science, Math or related, CFA, CRD/CRIMS experience
$111k-137k yearly est. 20d ago
Radiology - Breast Physician
The Medicus Firm 4.1
Mobile, AL jobs
Academic Breast Imaging Leadership Opportunities Gulf Coast Metro
Join a prestigious academic health system dedicated to pioneering patient care and training the next generation of healthcare providers and researchers. We are seeking a fellowship-trained Breast Imager to join our dynamic team.
Position Highlights:
100% Breast Imaging - Focused clinical practice
Flexible Options - Call and remote work opportunities available
Academic Engagement - Teach and mentor radiology residents
Dedicated Facilities - Women's Hospital and Mitchell Cancer Institute
Leadership Roles - Opportunities for advancement
Fellowship Support - Minimum $30,000 stipend
Visa Sponsorship - H1B and J1 visa support available
Where Southern Charm Meets Coastal Living
Charming Neighborhoods - From tree-lined streets in Midtown to waterfront views on Dauphin Island, there's a perfect spot for every lifestyle.
Mardi Gras Magic - Experience the oldest celebration in America with parades, balls, and colorful culture all year long.
Festivals & Food - From seafood to soul food, every weekend brings something to taste and celebrate.
Booming Job Market - Aerospace, healthcare, shipping, tech-Mobile is growing and hiring.
Easy Access - Quick drive to New Orleans, Gulf Shores, or Florida. Plus, a revitalized downtown scene full of energy!
Reference: RBI 23030
Interested candidates should inquire to learn more about this unique blend of academic excellence and coastal lifestyle.
Breast Radiology, Mammography, Breast Imaging, Academic Breast Imaging,
Academic Mammo, Academic Radiology, Breast Imaging Radiology, Breast Imaging Fellowship, Mammography
$150k-268k yearly est. 1d ago
Senior Counsel - Healthcare IT and AI Technology Contracts
Akron Children's Hospital 4.8
Medina, OH jobs
Full-Time, 40 hours/week
Monday - Friday 8 am - 5 pm
Onsite
The Senior Associate Counsel provides legal support for hospital information technology operations, including comprehensive legal and strategic guidance on the procurement, deployment, and governance of information technology systems (ISD) and artificial intelligence. This position reports to the Vice President, Senior Associate Counsel with a reporting matrix to the Chief Information Officer.
Responsibilities:
Advise hospital leadership and procurement teams on the legal implications of acquiring new technologies, such as electronic health records (EHR), telemedicine platforms, cybersecurity tools, and medical devices and the implementation of artificial intelligence tools.
Draft, review, and negotiate a broad array of information technology contracts-such as software-as-a-service (SaaS) agreements, cloud hosting terms, data processing addenda, and business associate agreements. Identify and address legal risks in vendor offerings and technology solutions.
Advise hospital leadership on legal considerations surrounding digital transformation initiatives, innovation adoption, and strategic partnerships with technology providers.
Collaborate with hospital IT and security teams to develop policies and protocols for safeguarding patient data and critical systems. Advise on incident response plans, breach notification procedures, and risk mitigation strategies. Stay abreast of emerging threats and evolving best practices.
Provide legal support for hospital-wide policies on technology use, social media, device management, remote work, mobile access to sensitive information, and enterprise risk for information technology. Ensure policies reflect current legal requirements and operational needs.
Support the hospital in managing disputes or litigation related to technology vendors, data breaches, intellectual property claims, and other technology-related matters. Coordinate with litigation counsel as needed.
Education and Training: Provide ongoing education to staff and leadership on legal implications of technology adoption, emerging regulatory requirements, and evolving risks in the health technology landscape.
Identify and assess legal, operational, and compliance risks in IT contract.
Other duties as assigned.
Other information:
Technical Expertise
Openness to learning and keeping pace with rapid changes in both healthcare delivery and technological innovation.
Aptitude for working effectively with clinicians, IT professionals, administrators, vendors, and regulators.
Capacity to guide organizational leadership through complex legal and strategic decisions regarding technology investments.
Resourcefulness and creativity in navigating novel legal challenges emerging from digital health transformation.
Education and Experience
Education: Juris Doctor (JD) degree from an accredited law school; Ohio bar admission or ability to obtain admission prior to start date.
Experience: Minimum of 5 years of legal practice advising in healthcare Information technology contracts is required.
Technical Knowledge: Familiarity with healthcare IT systems, data privacy and security laws, and emerging technologies (such as artificial intelligence, cloud computing, and IoT).
Skills: Strong contract negotiation, drafting, and analytical skills. Excellent verbal and written communication abilities. Competency in risk assessment and strategic thinking.
Demonstrated integrity, discretion, and ability to work collaboratively with multidisciplinary teams.
Full Time
FTE: 1.000000
Status: Onsite
$97k-147k yearly est. 18d ago
Member & Recipient Services Clinician (Sun-Wed, Remote NC)
Vaya Health 3.7
North Carolina jobs
LOCATION: Remote - this is a home based, virtual position. This person must reside in North Carolina or within 40 miles of the NC border. Work Schedule: Sunday - Wednesday from 10am-9pm. Due to the nature of the Call Center and the Behavioral Health Crisis line, the job may require some holiday work throughout the year.
GENERAL STATEMENT OF JOB
This position is within the Member and Recipient Services Department at Vaya Health. The Member and Recipient Services Clinician is responsible for providing an array of functions to assist consumers in receiving clinically appropriate assessments and services. Telephone calls come to the unit via a 1-800 number from members, recipients, families, agencies, organizations, professionals and others within Vaya's catchment area. The Behavioral Health Crisis service line operates 24 hours per day, seven days per week, 365 days per year and the employee is subject to working holidays and holiday rotation as deemed necessary by the business.
The primary purpose of the position is to provide telephone screening and triage for callers and families who are seeking mental health, substance abuse, or developmental disability services. The unit assesses the nature of the caller's situation, determines the urgency of the caller's need, and makes a referral to the most appropriate service available based on the caller's location and insurance plan.
Duties include linking callers to needed services within clinically appropriate time frames, including telephonic clinical triage and referral which includes a determination of need for urgent or emergent services. In addition to providing clinical support the position will also directly handle any telephonic requests for services at times of heavy call volume.
The employee works productively and efficiently with a wide variety of consumers, families, agencies, professionals, law enforcement and others in the community. Callers may be in distress or in emergency or crisis situations requiring speedy assessment and intervention. Some callers are at risk to harm themselves or others and this risk must be accurately assessed. The high volume of calls requires the employee to balance the need to do a careful and accurate telephone assessment of the consumer's need and situation, with the need to be efficient in the use of time to complete the screening and triage interaction. The employee develops and maintains the knowledge and skills necessary to accurately assess and refer consumers from all disability areas, and also maintains a good working knowledge of resources available throughout Vaya's entire catchment area.
Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Health. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Health.
ESSENTIAL JOB FUNCTIONS
Handle telephonic requests for services, respond to member and recipient calls, and provide requested information:
Member and Recipient Svcs Clinician perform clinical screening, triage and referral to callers needing services, answer and provide disposition to service request calls at times of heavy call volume, and handle crisis calls in the Member and Recipient Services Call Center. Member and Recipient Svcs Clinicians triage calls for urgency and facilitate access to crisis services when risk indicators are present. Where safety is at risk, the employee initiates immediate intervention via law enforcement or emergency medical assistance. Member and Recipient Svcs Clinicians will provide information and educate callers about the involuntary commitment process, as appropriate based on assessment of risk.
The employee provides brief crisis interventions and/or support when indicated to facilitate the assessment process, encourages compliance, addresses safety issues, etc. Clinical functions are performed by the Member and Recipient Services Clinicians.
Member & Recipient Svcs Clinician will inquire about the caller's needs, determine clinical urgency, review and confirm member and recipient eligibility, collect necessary demographic information, offer choice of available providers based upon the consumers request and service needs, and schedule appointments within established access time standards.
The Member & Recipient Svcs Clinician will inform a Member Services Manager and/or appropriate Network Development staff of gaps and needs associated with trends that are detected within the services system for timely analysis and resolution.
For information calls, this position will provide information about Vaya, the Vaya provider network, community resources, and about Medicaid services in the State of NC. Member & Recipient Svcs Clinician shall receive extensive training on customer services skills such as the use of appropriate tone, cadence, inflection, and choice of recovery oriented and/or person-centered wording. All Member and Recipient Services Representatives must adhere to NCMT Call Grading Rubric provided by NCDHHS.
This position requires a high degree of communication skills and professionalism with various parties- members, recipients, providers, vendors, community organizations, legal guardians, and more. The Member and Recipient Svcs Clinician will complete warm transfers and linkages to a variety of different parties to assist the caller with correct linkage.
Documentation in the electronic information system:
The Member & Recipient Svcs Clinician completes call notes, forms, reports and other documentation as required. The Member and Recipient Services Clinician will complete required documentation at the time of call. This position requires a high degree of technical skills with utilization of multiple systems/logins throughout a phone call.
Specialized projects and reviews:
The Member & Recipient Svcs Clinician will assist in specialized Member Services Departmental projects as requested by the Member and Recipient Services Managers or Directors, and/or the Vice President of Member and Recipient Services.
Other duties as assigned.
KNOWLEDGE, SKILLS, & ABILITIES
A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance. This will require exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts. Problem solving, negotiation, arbitration and conflict resolution skills are essential to balance the needs of both internal and external customers.
Mastery of utilization review principles to resume continuity of care and clinical evaluations as needed for appropriate provision of intensive, crisis services and other levels of care to ensure linkage to correct services;
Knowledge of documentation and clinical protocols for utilization purposes.
Knowledge of linage, authorization and level of care determinations, assisting providers with creative problem solving to suggest alternative approaches to care.
Clinical knowledge of managed systems of mental health and substance abuse. Knowledge of managed behavioral care practices.
Ability to collaborate with providers and other agencies.
Clinical knowledge of mental health and substance abuse treatment as a basis for clinical triage and referral decisions
Comprehensive knowledge of resources and the ability to use a personal workstation.
Knowledge of databases and data entry is essential. A degree alone does not prepare an applicant for this position. Experience providing mental health, substance abuse, or intellectual/ developmental disabilities services are essential. This employee should have knowledge of individual and group dynamics, and will learn de-escalation of telephonic situations, and a thorough knowledge risk indicators. Considerable knowledge of governmental and private organizations and resources in the community is beneficial. Considerable knowledge of the laws, regulations, and policies that govern MCO operations is beneficial. Skill in establishing rapport with staff/consumers in discussing their issues in a sensitive, supportive and nonjudgmental way is necessary. Ability to establish and maintain effective working relationships with community members and provider agency staff is necessary.
Other skills or abilities require are as follows:
Knowledge of behavioral health principles, techniques, and practices, and their applications to complex treatment and service provision.
Considerable knowledge of person-centered and recovery philosophies.
Familiarity with mental health, developmental disability and substance abuse disorders.
The ability to remain professionally responsive in an ethical and sensitive manner to individual's needs throughout the course of the work day/shift.
The ability to work responsibility and effectively with others for a timely resolution of the caller's needs.
The ability to interact professionally and effectively with persons who are upset and who disagree.
Knowledge of the laws, regulations, and policies which govern human services and utilization management.
The ability to express ideas clearly and concisely orally and in writing, and to plan and execute work effectively and efficiently.
The ability to utilize complex telephone and computer systems, and to read and document information electronically.
EDUCATION & EXPERIENCE REQUIREMENTS
Master's degree in a Human Services field (such as Psychology, Social Work, etc.) and at least two (2) years of post-degree-progressive experience providing services in the population served OR graduation from a State accredited school of nursing and two years of experience in psychiatric nursing which provides the knowledge, skills, and abilities needed to perform the work; or an equivalent combination of education and experience.
Must possess a current and valid professional license or certificate in North Carolina; or possess a current and valid license or certificate from another state or be certified by the national accrediting body appropriate to their profession. (URAC HCC 5)
Experience in the public mental health field and a thorough understanding of the services available in the catchment area is highly desired due to the complexity of the work of the organization. Prior experience in a Call Center environment in Behavioral Healthcare would be valuable for this employee.
A degree alone does not prepare an applicant for this position. Experience providing mental health or substance abuse services are essential.
No experience can be substituted for the formal degree.
Licensure/Certification Required:
Must possess a current, active, unrestricted professional license or certification from North Carolina in a Human Services field (such as Psychology, Social Work, Counseling, Marriage and Family Therapy, Addictions, etc.). Acceptable licenses include Licensed Clinical Social Worker (LCSW), Licensed Clinical Mental Health Counselor (LCMHC), Licensed Clinical Addictions Specialist (LCAS), Doctor of Psychology (Psy. D.), PhD. Psychologist, Licensed Marriage and Family Therapist (LMFT) or Licensed Psychological Associate (LPA). For RN candidates, the employee must have a current, active, unrestricted professional license to practice as a registered Nurse in North Carolina by the NC Board of Nursing.
PHYSICAL REQUIREMENTS
Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
RESIDENCY REQUIREMENT: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border.
SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.
DEADLINE FOR APPLICATION: Open Until Filled
APPLY: Vaya Health accepts online applications in our Career Center, please visit ******************************************
Vaya Health is an equal opportunity employer.
WORK SCHEDULE: Sunday -Wednesday from 10am-9pm. Due to the nature of the Call Center and the Behavioral Health Crisis line, the job may require some holiday work throughout the year.
Responsibilities
The Sr. Revenue Integrity Pharmacy Analyst is responsible for expert review of pharmacy related charge audits, denials, quarterly HCPCS updates, and value analysis. They will review and analyze pharmacy claims, collaborating with pharmacy IS, Billing and Managed Care to ensure compliance with billing regulations while maximizing reimbursement. Additionally they provide support and education to Pharmacy and Revenue Cycle teams on coding and documentation requirements. Strong attention to detail with extensive knowledge in Pharmacy billing, coding, payor policies, federal regulations and reimbursement methodologies are essential for this role.
**This position offers a fully remote work opportunity. Employees in this role must reside in one of the following states to be considered for fully remote positions: Kentucky, Indiana, Missouri, Ohio, Tennessee, Alabama, Virginia, Mississippi, North Carolina, South Carolina**
Qualifications
Required:
Three years of experience in healthcare revenue cycle, clinic operations or pharmacy technician
One of: CCA or CCS or CIC-ICD or COC or CPC or RHIA or RHIT
Desired:
Certified Coding Associate OR Certified Coding Specialist OR Certified Professional Coder OR Registered Health Information Administrator OR Registered Health Information Technician OR Certified Outpatient Coding OR Certified Inpatient Coder ICD-10
$40k-55k yearly est. 1d ago
Associate Director , Client Delivery - Clinical Research - Central Labs Services
Labcorp 4.5
Burlington, NC jobs
At Labcorp, we believe in the power of science to change lives. We are a leading global life sciences company that delivers answers for crucial health questions. Through our unparalleled diagnostics and drug development capabilities, we provide insights and accelerate innovations that not only empower patients and providers but help medical, biotech, and pharmaceutical companies transform ideas into innovations.
Central Laboratory Services is part of a global contract research organization within Labcorp. We offer the world's largest network of central laboratories and support global clinical trials testing. A common set of processes, procedures, and instrumentation is offered throughout our sites in Europe, Asia/Pacific, and the United States, allowing us to receive samples globally and provide more than 700 assays across all laboratory science disciplines.
LabCorp is seeking an **Associate Director, Global Client Delivery,** to join our **Central Labs Services** team. In this position, you will be accountable to create, implement and advance the Study Management function's vision and strategy in alignment with the Global Project Management (PM) strategy. This position is directly responsible for the day-to-day management and supervision of the study management team to ensure the successful implementation of the global project management strategy, structure, process, and metrics to deliver outstanding customer satisfaction.
The Associate Director will ensure integrated services with other global parts of Global Project Management, across departments and business units, focusing on innovative solutions to meet the needs of the pharmaceutical and biotech industries. The three primary areas of focus are:
+ People: Provide an environment where people can build their careers and thrive
+ Process: Contribute to an ongoing and sustainable improvement in cost, quality and service delivery for the Portfolio Manager, GSM and SDL functions.
+ Client: Deliver market-leading quality in an environment of increased regulatory scrutiny through a systematic quality program with focus on continuous improvement.
**This is a remote opportunity and can be located anywhere in the US. Indianapolis metro area preferred.**
**Responsibilities:**
+ Manage and supervise the day-to-day operations of the project management team including but not limited to:
+ Ensure the development of a competent workforce to meet growth plans within budget.
+ Ensure the seamless integration of project management services and influence pan-Labcorp Drug Development as necessary.
+ Accountable for the activities and outcomes of the project management team(s), taking corrective action where appropriate.
+ Ensure appropriate resource allocation to successfully implement and execute project plans to achieve agreed upon service levels.
+ Ensure consistent implementation, use, and review of SOPs.
+ Establish and monitor performance objectives for direct reports and take corrective action where appropriate.
+ Complete thorough, timely and well-documented performance evaluations and interim progress reviews.
+ Lead the study management team tasks related to planning, budgeting, and cross project management team issues.
+ Participate in the Project and Alliance Leadership team to establish strategy and business plans.
+ Engage in mentoring and developing staff and participate in Talent Assessment and Succession Planning processes.
+ Champion the PM Excellence strategy to continue to grow and enhance the PM competencies across the organization. Engage and partner with other PM pan-Labcorp Drug Development to share best practices and develop appropriate partnerships.
+ Drive a culture of continuous improvement, quality, and productivity.
+ Identify business growth opportunities and project management service enhancements. Monitor, track, and manage progress to the PM strategy. Share learning and best practices as appropriate.
+ Ensure all service failures and opportunities (CCLS and pan-Labcorp Drug Development) are identified, tracked, and resolved in a timely manner. Take preventative action to ensure that the same service failure(s) does not occur. Share learning and best practices as appropriate.
+ Accountable for the effective management of the study management team budget as appropriate.
+ Effectively partner and influence across CLS Leadership, Alliance Leaders, Business Development Directors, and Executive Sponsors to meet the growing and evolving client needs.
**Minimum Experience Required:**
+ Minimum 5 years of people leadership experience
+ Experience managing a team of up to 20 plus is preferred
+ Excellent written, verbal, and interpersonal skills
+ Demonstrated high degree of initiative and ability to work collaboratively
+ Proven ability to inspire effective teamwork and motivate staff in a multi-regional, matrixed environment
+ Knowledge of regulatory requirements in clinical or laboratory settings
+ Strong negotiation skills to facilitate, guide, and influence a unified approach within a global, cross-functional environment
+ Proven strength in planning, problem solving, and organization
+ Consistent track record of driving continuous improvement and achieving results through leadership
+ Demonstrated ability to interact with, influence and inspire staff at all levels of the organization
+ Inclusive and engaging presentation and communication skills
+ Demonstrated leadership development capabilities
**Minimum Education/Qualifications/Certifications and Licenses Required:**
+ 4-year degree
+ Clinical trial or central laboratory experience in a people leadership role
+ Regulatory experience (GXP)
**Preferred Education:**
+ MBA or master's degree
**Application Window:** closes at the end of the day 1/30/2026
**Pay Range:** 130-160K per annum
All job offers will be based on a candidate's skills and prior relevant experience, applicable degrees/certifications, as well as internal equity and market data.
The position is also eligible for an annual bonus under the Labcorp Bonus Plan. Bonuses are payable based on corporate and/or business segment performance and are subject to individual performance modifiers.
**Benefits:** Employees regularly scheduled to work 20 or more hours per week are eligible for comprehensive benefits including: Medical, Dental, Vision, Life, STD/LTD, 401(k), Paid Time Off (PTO) or Flexible Time Off (FTO), Tuition Reimbursement and Employee Stock Purchase Plan. Casual, PRN & Part Time employees regularly scheduled to work less than 20 hours are eligible to participate in the 401(k) Plan only. For more detailed information, please click here (************************************************************** .
**Labcorp is proud to be an Equal Opportunity Employer:**
Labcorp strives for inclusion and belonging in the workforce and does not tolerate harassment or discrimination of any kind. We make employment decisions based on the needs of our business and the qualifications and merit of the individual. Qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic. Additionally, all qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable law.
**We encourage all to apply**
If you are an individual with a disability who needs assistance using our online tools to search and apply for jobs, or needs an accommodation, please visit our accessibility site (**************************************************** or contact us at Labcorp Accessibility. (Disability_*****************) For more information about how we collect and store your personal data, please see our Privacy Statement (************************************************* .
$77k-101k yearly est. 8d ago
MDS Nurse - RN (Hybrid)
Ohio Living 3.8
Willoughby, OH jobs
It's fun to work in a company where people truly BELIEVE in what they're doing!
Our intention is to have employees who are passionate about making their personal mission statement come to life each day at work! Be it through providing healing, eradicating loneliness, contributing to efficiencies, streamlining processes, being dependable, sparking creativity or something else, the demonstration of HOW you do your job is just as important as WHAT you do in your job.
Alongside our valued employees, we are making a difference throughout the state of Ohio in the lives of those that need healthcare or those embracing the next chapter of their lives. Sustained members of our team demonstrate accountable behavior and share our values of customer service, innovation, integrity, inclusion, financial stewardship, leadership and care.
The MDS Nurse - RN provides necessary and accurate documentation for resident and patient assessments and care plans in accordance with company standards and federal, state, and local standards, guidelines, and regulations while serving as a team member or team leader of the interdisciplinary team.
Essential Activities and Tasks
Operations Management - 60%
* Oversees the RAI process and submission process by validating and monitoring reports (EHDS).
* Plans, develops, organizes, and communicates assessment and care plan information to staff members in order to optimize resident and patient care.
* Oversees and completes the computer data entry and electronic submission process for MDS transmission (EHDS).
* Oversees Medicare and managed care logs, directing decision-making regarding insurance coverage, cut dates, and MDS schedules.
* Oversees skilled resident and patient statuses to maximize reimbursement.
* Oversees Medicaid resident statuses to maximize case mix scores.
* Participates in care conferences.
* Remains available during surveys and audits of the facility and/or the facility's documentation.
* Assists with insurance appeals by reviewing documentation coded on MDS and verifying for consistency.
* Attends all-employee and departmental meetings and in-service training as scheduled or as directed.
Quality, Compliance, and Risk Management - 20%
* Ensures accurate and timely MDS, CAA, and Plan of Care documentation from the interdisciplinary team.
* Provides final review of MDS and Plan of Care documentation of all disciplines offering education and advice as necessary and provides authorization.
* Maintains and communicates schedule of MDS and Plan of Care due dates.
* Keeps up to date on changes in documentation regulations, RUG categories, and legislation affecting MDS reimbursement issues.
* Attends committee meetings as requested.
Administration and Reporting - 20%
* Maximizes reimbursement through team education, planning, accurate and timely MDS assessments.
* Assists with reviewing and addressing issues with quality measures, survey findings, quality assurance findings, and other findings and/or survey results as assigned.
All other duties as assigned
Qualifications
Education
* Nursing degree from an accredited college, university or vocational school required.
* Current unencumbered license for the state of Ohio to practice as a Registered Nurse (RN) required.
Experience
* Two years experience with MDS preferred.
* Two years experience as a nurse in a long-term care facility required.
* Experience as a nurse in a long-term care facility required.
* Experience in rehabilitative and restorative nursing practices required.
* Knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to long-term care with special emphasis placed on documentation.
* Proficiency with Windows, Microsoft Office (Word, Excel, PowerPoint), and the internet required.
* Proficiency with electronic medical records (EMR) systems required.
Other Requirements
* Must be able to read, write, speak, and understand the English language.
Working Conditions and Special Requirements
* Sitting - Up to 8 hours/day
* Standing - Up to 8 hour/day
* Walking - Up to 6 hours/day
* Lifting, transferring, pushing or pulling residents/patients or equipment/supplies - Up to 50 pounds
* Subject to falls, burns from equipment, odors, and cuts - Workday
* Subject to residents/patients with various disease processes - Occasional
* May be exposed to infectious waste, disease, conditions, etc. including exposure to the AIDS and Hepatitis B viruses - Work day
* Risk Category for Exposure to Bloodborne Diseases - I
**Prior Authorization Supervisor,** **Specialty** **Testing** **Location Not** **e:** **Applicants who live within 35 miles of either the Burlington, NC or Durham, NC location will follow a hybrid schedule. This schedule includes a minimum of three in-office days per week at an assigned location, either Burlington or Durham, supporting both collaboration and flexibility.**
At Labcorp, you are part of a journey to accelerate life-changing healthcare breakthroughs and improve the delivery of care for all. You'll be inspired to discover more, develop new skills and pursue career-building opportunities as we help solve some of today's biggest health challenges around the world. Together, let's embrace possibilities and change lives!
The Pre Authorization Supervisor position is responsible for leading a team of Specialty Test Prior Authorization Specialists.
**Primary Responsibilities:**
+ Oversee work assignments, ensuring efficient task distribution andtimelycompletion.
+ Generate and analyze inventory reports to guide decision-making.
+ Proactively assess inventory throughout the day tooptimizeworkflow and prioritize urgent cases.
+ Communicate effectively with various departments to resolve discrepancies, including missing work files and IT platform issues.
+ Audit employee work for accuracy, providing constructive feedback and coaching to enhance performance.
+ Conduct one-on-one meetings with employees, fostering professional growth and setting annual goals.
+ Offertimelysupport by answering employee and stakeholder inquiries.
+ Train new hires and develop comprehensive training resources.
+ Create and interpret complex SOPs, job aids, and special workflows for diverse processes.
+ Design and leadengagingteam meetings.
+ Navigate multiple platforms and websites tofacilitateprior authorization tasks.
+ Perform specimen history research toassistwith escalations, training, and troubleshooting.
+ Deliver exceptional customer service with professionalism, patience, and empathy.
+ Escalate critical issues to leadership when necessary.
+ Identifyand recommend process improvements to enhance efficiency.
+ Maintain a thorough understanding of policies, guidelines, and payer requirements related to specialty testing (such as oncology, women's health, and other advanced diagnostics).
+ Ensure compliance with specialty test regulations and proactively address any policy updates that impact workflow.
+ Meet deadlines consistently whilemaintaininghigh accuracy and minimal errors.
+ Complete requiredtrainingspunctually and thoroughly.
**Qualifications:**
+ High school diploma or equivalent required; associate degree orhigher stronglypreferred.
+ Minimum3 years of relevant work experiencerequired.
+ Minimum 1 year of experience in prior authorizations strongly preferred (concurrent experience acceptable).
+ 3+ years of leadershipexperienceis stronglypreferred.
+ Minimum2+ years priorworkexperience in insurance claims, pre-authorization, and medical benefits strongly preferred.
+ Utilize MS Excel,Wordand Outlook; PowerPointproficiencypreferred
+ Experience with specialty testing (such as oncology, women's health, and other advanced diagnostics) preferred.
+ Proven ability to identify improvement opportunities and implement recommendations preferred.
**Additional Desired Skills:**
+ Exceptional interpersonalcommunicatorwith the ability to build rapport and motivate teams.
+ Strong problem-solving and decision-making abilities.
+ Detail-oriented with a proventrack recordof delivering results.
+ Comfortable managing performance in a production-driven environment while enforcing company policies.
+ Demonstrates integrity, trustworthiness, accountability, and respect in all professional interactions.
+ Maintains confidentiality and upholds high ethical standards.
+ Strong verbal and written communication skills.
+ Self-motivated with the ability to thrive under pressure in a dynamic environment.
+ Reliable and punctual.
**Pay range: $52,200.00 - $92,600.00 a year**
**Schedule: Mon-Fri, 8am-5pm ET**
**Application window closes:** **02/02/2026**
All job offers will be based on a candidate's skills and prior relevant experience, applicable degrees/certifications, as well as internal equity and market data.
**Benefits** : Employees regularly scheduled to work 20 or more hours per week are eligible for comprehensive benefits including: Medical, Dental, Vision, Life, STD/LTD, 401(k), Paid Time Off (PTO) or Flexible Time Off (FTO), Tuition Reimbursement and Employee Stock Purchase Plan. Casual, PRN & Part Time employees regularly scheduled to work less than 20 hours are eligible to participate in the 401(k) Plan only. Employees who are regularly scheduled to work a 7 on/7 off schedule are eligible to receive all the foregoing benefits except PTO or FTO. For more detailed information, please click here (**************************************************************
**Labcorp is proud to be an Equal Opportunity Employer:**
Labcorp strives for inclusion and belonging in the workforce and does not tolerate harassment or discrimination of any kind. We make employment decisions based on the needs of our business and the qualifications and merit of the individual. Qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic. Additionally, all qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable law.
**We encourage all to apply**
If you are an individual with a disability who needs assistance using our online tools to search and apply for jobs, or needs an accommodation, please visit our accessibility site (**************************************************** or contact us at Labcorp Accessibility. (Disability_*****************) For more information about how we collect and store your personal data, please see our Privacy Statement (************************************************* .
$52.2k-92.6k yearly 1d ago
Revenue Cycle Net Revenue Manager
Inova Health System 4.5
Virginia jobs
Inova Health is looking for a dedicated Net Revenue Manager Lead to join their Revenue Cycle - Financial team. This remote role will be full-time day shift from Monday - Friday, 9:00 a.m. - 5:30 p.m.
We are seeking a Revenue Cycle Net Revenue Manager with a strong background in finance and analytics to drive revenue cycle performance and net revenue optimization. The ideal candidate brings advanced Excel skills, proven experience in financial modeling and reporting, and the ability to translate complex data into actionable insights that support strategy, process improvement, and payer contract success.
Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.
Featured Benefits:
Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.
Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules
Revenue Cycle Net Revenue Manager Job Responsibilities:
Creates and enforces work standards, quality measures, and process improvements that are consistent with the organization's goals and objectives. Ensures regulatory compliance with Medicare and state authorities, Generally Accepted Accounting Principles and any external governing authority.
Assures claims are reviewed, corrections are identified/made or resolutions are initiated while ensuring all follow-up claims/actions are submitted via the appropriate medium and with all required attachments.
Maintains knowledge of government regulations, payer requirements, UB-04 standards, information system functionality (i.e. Hospital, clearinghouse, payer), hospital policies/procedures and departmental SRGs.
Evaluates the impact of new or upgrades to existing systems/tools while performing testing of system changes, providing technical/operational support during implementation and evaluating the success of new systems/tools.
Ensures timely/accurate billing, collection, posting, servicing, and/or auditing of the $1.5 billion receivable stream.
Ensures follow-up is completed utilizing TRAC work lists, QMS, or other systems/reports according to department policy/procedure, SRG, or industry best practice standards.
Demonstrates a working knowledge of CareMedic systems, DSS electronic billing systems, Syntellect IVR systems, HealthQuest 2000, QMS, and Premis electronic billing systems.
Provides feedback and training to supervisors and staff. Provides resolution for pended (WIP backlog) claims within allowable timeframes (as defined for appropriate deficiency) and/or ensures billed claims receive timely and appropriate follow up based on established protocol or SRG.
Oversees assigned department or functional area to ensure it is performing effectively, which may include but not limited to, hiring and training team members, creating and implementing business strategies, managing performance of team members, and delegating tasks.
Minimum Qualifications:
Experience: Four years of experience in Revenue Cycle, Clinic Operations, Credentialing, Denials Management and/or HB/PB Operation roles; Two years in leadership roles
Education: Bachelors Degree or lesser educational degree with four additional years of experience
Preferred Qualifications:
Bachelor's degree in Accounting, Finance, or related field preferred; advanced degree or certification a plus.
Strong proficiency in Microsoft Excel (advanced formulas, pivot tables, financial modeling, dashboards).
Proven experience in financial analytics, reporting, budgeting/forecasting, and revenue cycle performance metrics (Net Revenue, AR, Denials, Cash).
Demonstrated ability to support managed care contract strategy, including payer trend analysis, financial modeling, and negotiation support.
Skilled in process improvement, workflow streamlining, and ensuring accuracy, timeliness, and completeness of financial data.
Strong communication and presentation skills with experience translating complex data into actionable insights for leadership.
Remote Eligibility: This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV
$73k-101k yearly est. Auto-Apply 60d+ ago
Analytics QA Tester (Remote)
Vaya Health 3.7
North Carolina jobs
LOCATION: Remote - This is a home based, virtual position that operates Monday - Friday from 8:30am-5:00pm (EST). Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL.
GENERAL STATEMENT OF JOB
The Analytics QA Tester works independently, as well as with developers and business analysts, to test complex software and Business Intelligence solutions. Develop test plans, participate in peer reviews of software solutions (including code reviews), and assist end-users with user acceptance testing. Responsible for automated regression testing. Work closely with other software developers and analysts to understand what the product is meant to do, to identify issues in design and development, and to provide recommendations for improvements. Analyze and understand complex data sources in order to validate developed applications, Business Intelligence solutions, data warehouses, data visualizations, and extract, transform, and load (ETL) procedures. As a member of an agile development team this position will test new features for functionality and user experience.
ESSENTIAL JOB FUNCTIONS
Work with the Analytics Development Team to test applications and Business Intelligence products during the systems development life cycle (SDLC).
Assist end-users in performing user acceptance testing on developed solutions.
Responsible for designing and implementing test plans and test cases based on product specifications.
Perform post-implementation testing of developed solutions.
Document test plans, test cases, and test results.
KNOWLEDGE OF JOB
Integrity and decision-making skills necessary to work with and protect confidential personal health information
Problem solver, with ability to debug complex processes and applications
Analytical and troubleshooting skills
Experience within an agile development process, creating and using automating acceptance tests, automated test framework, de-bugging tools and analyzing stack traces.
Microsoft Team Foundation Server for work item tracking and source code control is preferred
Experience testing web applications, including the ability to use and understand advanced features of web browsers
Experience testing end-user reports, ETL packages, and data visualizations including the ability to test Microsoft T-SQL procedures
Excellent verbal and written communication skills, ability to articulate ideas clearly
Proven ability to meet development commitments and manage expectations
Desire for constant improvement
Ability to work independently and as a strong team player
Ability to work in a fast-paced, deadline driven environment running multiple projects simultaneously
High level of computer literacy with spreadsheets, word processing and database software and business systems (Word, Access, Excel, PowerPoint, MS Project, VISIO and other graphic software).
Extensive development, architecture, and configuration skills in Microsoft SQL Server 2008, 2012, or 2014 including strong SQL development skills (preferably Microsoft T-SQL).
Extensive development, architecture, and configuration skills with the Microsoft .NET framework including development of applications using C# or VB.NET.
EDUCATION & EXPERIENCE REQUIREMENTS
Bachelor's Degree in Computer Science, Information Technology, Engineering, or a related discipline required and 5 years of experience testing highly complex software applications crossing multiple platforms and diverse technologies.
PHYSICAL REQUIREMENTS
Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
Mental concentration is required in all aspects of work.
RESIDENCY REQUIREMENT: The person in this position must live in NC, SC, GA, TN, VA, MD, or FL.
SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.
DEADLINE FOR APPLICATION: Open until filled.
APPLY: Vaya Health accepts online applications in our Career Center, please visit ******************************************
Vaya Health is an equal opportunity employer.
$54k-67k yearly est. Auto-Apply 60d+ ago
Collections Specialist
Vital Care Infusion Services 4.8
Pittsburgh, PA jobs
Recognized as a “Best Place to Work Modern Healthcare” - Join a team where people come first. At Vital Care, we are committed to creating an inclusive, growth-focused environment where every voice matters. Vital Care is the premier pharmacy franchise business with franchises serving a wide range of patients, including those with chronic and acute conditions. Since 1986, our passion has been improving the lives of patients and healthcare professionals through locally-owned franchise locations across the United States. We have over 100 franchised Infusion pharmacies and clinics in 35 states, focusing on the underserved and secondary markets. We know infusion services, and we guide owners along the path of launch, growth, and successful business operations. What we offer:
Comprehensive medical, dental, and vision plans, plus flexible spending, and health savings accounts.
Paid time off, personal days, and company-paid holidays.
Paid Paternal Leave.
Volunteerism Days off.
Income protection programs include company-sponsored basic life insurance and long-term disability insurance, as well as employee-paid voluntary life, accident, critical illness, and short-term disability insurance.
401(k) matching and tuition reimbursement.
Employee assistance programs include mental health, financial and legal.
Rewards programs offered by our medical carrier.
Professional development and growth opportunities.
Employee Referral Program.
Job Summary:
Perform duties to collect Home Infusion claims, focusing on accuracy, timeliness, and adherence to processes to reduce denial rate, DSO, and bad debt. Recognize additional revenue opportunities and improve collection rates; perform revenue cycle collection duties within standard or accepted practice limits.
Position is 100% remote
Duties/Responsibilities:
Review claims with outstanding balances and identifies actions to successfully collect revenues. Follow up with insurers and patients to collect outstanding balances in an environment focused on building enduring customer and business relationships. Utilize Payer Portals via the internet for claim disposition.
Review documents received including Explanations of Benefits (EOBs), Remittance Advices (RAs), and other documents indicating denials or claims acceptance. Identify reasons for denials, take required corrective action, and take ownership of claims through to timely, successful collection.
Analyze denials, identify trends, and recommend process improvement opportunities that will result in DSO reduction, superior collection rate, intervals reduced bad debt and simplified processes that are responsive to the requirements of specific payers.
Identify payor requirements for submittal of appeals for denied claims. Verify insurance information with patients, order medical records, review original claim coding, compile other validating documentation required, and submit appeals in keeping with payor requirements and VCI processes.
Communicate effectively with franchise partners and other VCI departments regarding the status of collections. Resolve payer issues/concerns timely.
Document case activity, communications, and correspondence in the computer system to ensure completeness and accuracy of account activity and actions are taken to resolve outstanding claims issues. Schedule follow-ups in required intervals.
Investigate and verify benefits for pharmacy and medical third-party claims.
Communicate billing problems found during collection process as to avoid the same issues in the future.
Communicate financial obligation information with patients so that they have a clear understanding of all costs of therapy prior to starting service.
Contribute medical billing expertise to the design of training and knowledge transfer programs, materials, policies, and procedures to improve the efficiency and effectiveness of the RCM team. Assist with the processing of online adjudication of collection issues and nurse billing as assigned.
Perform other related duties as assigned.
Required Skills/Abilities:
Excellent communications skills; listening, speaking, understanding, and writing English while influencing patients, caregivers, payer representatives, and others, answering questions, and advancing reimbursement and collection efforts.
Proven understanding of processes, systems, and techniques to ensure successful billing and collection working with all payer types.
Proven ability to identify gaps and problems from the review of documentation, determine lasting solutions, make effective decisions, and take necessary corrective action.
Strong organization skills with the ability to track and maintain clear, complete records of activities, cases, and related documentation.
Proven knowledge and skill in the utilization of MS Office suite of software and pharmacy applications.
Ability to complete job duties in a designated workspace outside the dedicated RCM location
Disciplined work ethic with ability to work remotely with minimum direct supervision, to effectively meet production and collection targets.
Education and Experience:
2-5 years home infusion billing and/or collections experience required.
High School Diploma and additional specialized training in intake, pharmacy/medical billing, and/or collections.
Previous remote work environment is a plus but not required.
Detailed oriented with post-billing and post-payment investigative experience preferred.
Physical Requirements:
Sitting: Prolonged periods of sitting are typical, often for the majority of the workday.
Keyboarding: Frequent use of a keyboard for typing and data entry.
Reaching: Occasionally reaching for items such as files, documents, or office supplies.
Fine Motor Skills: Precise movements of the fingers and hands for tasks like typing, using a mouse, and handling paperwork
Visual Acuity: Good vision for reading documents, computer screens, and other detailed work.
Be part of an organization that invests in you! We are reviewing applications for this role and will contact qualified candidates for interviews.
Vital Care Infusion Services is an equal-opportunity employer and values diversity at our company. We do not discriminate on the basis 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.
Vital Care Infusion Services participates in E-Verify. This position is full-time. #LI-remote
$36k-53k yearly est. 3d ago
Physician Assistant / Cardiology / Maryland / Permanent / Physician Assistant Hybrid Cardiac Clearance Opportunity - MedStar Union Memorial Hospital
Medstar Health 4.4
Baltimore, MD jobs
MedStar Health is seeking an experienced Physician Assistant with a minimum of four years of post-graduation cardiology experience to join our Hybrid Outpatient Cardiac Clearance team. The ideal candidate will have a strong background in cardiology within an ambulatory, inpatient, or combined setting.
$144k-254k yearly est. 1d ago
Senior Security Engineer I
Aledade 4.1
Bethesda, MD jobs
As a Senior Security Engineer I at Aledade, you will play a central role in enhancing the security posture of our enterprise, cloud-native environments, and applications. We are seeking a dedicated professional with in-depth knowledge of security principles, standards, and best practices to help safeguard our systems and support our security compliance initiatives.
In this role, you will work to design, implement, and maintain robust security solutions across diverse platforms and technologies. You will collaborate closely with various teams to ensure alignment between security solutions and organizational requirements, enabling secure operations across the enterprise. Your ability to partner cross-functionally will be key to driving impactful security outcomes and strengthening our digital landscape.
Your expertise will be crucial as we continue to mature our security capabilities and maintain our commitment to protecting critical systems and data.
Primary Duties
Working cross-functionally to design, build, and operate solutions that improve and mature our security capabilities
Leveraging data to understand trends, metrics, and opportunities to improve our security posture, researching options, and then making recommendations as options to secure those opportunities with stakeholders
Leading and enhancing incident / issues response efforts, spearheading analysis, containment, and mitigation strategies in a cross-functional environment to ensure effective resolution and remediation of security incidents / issues
Helping craft and refine security documentation pertinent to our Security Program, such as policies, standards, baselines, and standard operating procedures
Minimum Qualifications
BS / BTech (or higher) in Computer Science, Information Technology, Cybersecurity or a related field, 6 years security domain experience without degree.
4+ years combined experience as a security engineer in an enterprise environment (preferably cloud) across multiple disciplines.
3+ years of relevant work experience in security posture management.
2+ years of experience acting as a trusted technical decision-maker in a team setting, solving for short-term and long term business value.
Preferred KSA's
Prior experience working in the healthcare industry with health-tech systems, like Electronic Health Records, Clinical data, etc.
Experience in scripting languages such as Python and Bash is required.
Experience with Cloud Native Software Development environments and practices with a focus on multi-cloud deployments in AWS, Azure and/or GCP is required.
Prior experience with a focus on tooling, automation, and distributed systems development is preferred.
Experience with continuous integration tools (e.g. Cloud formation, Code deploy, Jenkins, CircleCI, Codefresh, Github Actions etc.).
Experience with configuration management platforms (e.g. Ansible, Chef, Salt).
Hands-on experience using Terraform, Python and/or other orchestration platforms at scale.
Familiarity with Agile and waterfall development methodologies.
Familiarity with automated testing methodologies, and continuous integration concepts.
Experience in creating, deploying, maintaining, and troubleshooting Docker images.
Experience in scoping, deploying, maintaining and troubleshooting Kubernetes clusters.
Experience with deploying policies with AWS Control tower, Azure Security hub, Google Resource Manager etc.
Experience generating automated metrics to measure service and program effectiveness and consistency
Strong communication skills, both written and verbal, with the capability to articulate complex technical issues to a diverse audience
Physical Requirements
Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.
Who We Are:
Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.
What Does This Mean for You?
At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.
In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:
Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners
Robust time-off plan (21 days of PTO in your first year)
Two paid volunteer days and 11 paid holidays
12 weeks paid parental leave for all new parents
Six weeks paid sabbatical after six years of service
Educational Assistant Program and Clinical Employee Reimbursement Program
401(k) with up to 4% match
Stock options
And much more!
At Aledade, we don't just accept differences, we celebrate them! We strive to attract, develop and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.
Privacy Policy: By applying for this job, you agree to Aledade's Applicant Privacy Policy available at *************************************************
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$102k-141k yearly est. 4d ago
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