Hawaii Pacific Health Remote jobs - 50 jobs

The Spec, Application Support is tasked with the optimization and management of specified technology. This position will work closely with various vendors, ensuring the most up-to-date information and changes are evaluated for use and effectiveness in the process. Will work with the process team to determine what technology changes and needs are required to drive process improvements. Will own the development and follow through of any service requests or new implementations. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Stays current and has deep, ingrained knowledge of systems, including end user applications, reporting and enhancements. Can demonstrate full understanding of how the technology supports and is used within specific processes and brings technology driven ideas to the process team. * Reviews all ISB's for procedural impact. Edits and works with process leaders and trainers to develop procedural and training documentation. Clarifies system processes and responds to additional requests for information. * Works closely with peers to reduce redundancies and ensure there are no conflicts between multiple technologies within processes. * Ensures that Software Transfer Implementations are completed accurately and develops test plans. Meets user deadlines for system changes and other requested information. * Coordinates with IS to ensure that facility IS departments have the knowledge required to ensure the front-end system is set up appropriately. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. * Understands workflow and technology needs within the business. * Excellent grammar and writing skills * Must have good organizational skills * Able to work independently with little supervision * Able to communicate with all levels of management * Must have general computer skills and be proficient in Word, Excel, and PowerPoint * Excellent working knowledge of Patient Financial Services operations with specific focus on applicable discipline. * Ability to work and coordinate with multiple parties * Ability to manage projects * Knowledge of AR management technology tools being utilized to deliver on key performance * Knowledge of healthcare regulatory rules and how they apply to revenue cycle operations and outsourcing service providers * Excellent verbal and written communication skills EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * 4-year college degree in Healthcare Administration, Business or related area or equivalent experience * 2 - 6 years of experience in Healthcare Administration or Business Office * Lean, Six Sigma or other process improvement certification is a plus 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. * Must be able to work in a sitting position, use computer and answer telephone WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Office Work Environment As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation * Pay: $21.70 - $34.70 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * Discretionary 401k match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. #LI-NO3 Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

Conducts data quality audits of inpatient admissions and outpatient encounters to validate coding assignment is in compliance with the official coding guidelines as supported by clinical documentation in health record. Validates abstracted data elements that are integral to appropriate payment methodology. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Consulting: Consults facility leaders and staff on best practices, methodology, and tools for accurately coding. * Chart Analysis IP, OP Coding Data auditing and validation: Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Adheres to Standards of Ethical Coding (AHIMA). Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures. Reviews claim to validate abstracted data including but limited to discharge disposition which impacts facility reimbursement and/or MS-DRG assignment. Adheres to Standards of Ethical Coding (AHIMA).Reviews medical records to determine accurate required abstracting elements (facility/client/payer specific elements) including appropriate discharge disposition * IP, OP Coding: Reviews medical records for the determination of accurate assignment of all documented ICD-9-CM codes for diagnoses and procedures. Abstracts accurate required data elements (facility/client specific elements) including appropriate discharge disposition. * Coding: Uses discretion and specialized coding training and experience to accurately assign ICD-9, CPT-4 codes to patient medical records. * Abstracting: Reviews medical records to determine accurate required abstracting elements (client specific elements) including appropriate discharge disposition. * Coding Quality: Demonstrates ability to achieve accuracy and consistency in the selection of principal and secondary diagnoses (including MCC & CC) and procedures. Demonstrates ability to achieve accuracy and consistency in abstracting elements defined by SOW. * CDI: Identifies and communicates documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.) to appropriate personnel for follow-up and resolution. * Professional Development: Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-9-CM and CPT coding. Attends mandatory coding seminars on annual basis (IPPS and OPPS, ICD-9-CM and CPT updates) for inpatient and outpatient coding. Quarterly review of AHA Coding Clinic. Attends Quarterly Coding Updates and all coding conference calls KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to consistently code at 95% accuracy and quality while maintaining client specified production standards * Must successfully pass coding test * Knowledge of medical terminology, ICD-9-CM and CPT-4 codes * Must be detail oriented and have the ability to work independently * Computer knowledge of MS Office * Must display excellent interpersonal skills * The coder should demonstrate initiative and discipline in time management and assignment completion * The coder must be able to work in a virtual setting under minimal supervision * Intermediate knowledge of disease pathophysiology and drug utilization * Intermediate knowledge of MSDRG classification and reimbursement structures * Intermediate knowledge of APC, OCE, NCCI classification and reimbursement structures Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE * Associates degree in relevant field preferred or combination of equivalent of education and experience * Three years coding experience including hospital and consulting background CERTIFICATES, LICENSES, REGISTRATIONS * AHIMA Credentials, and or AAPC 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. * Duties may require bending, twisting and lifting of materials up to 25 lbs. * Duties may require driving an automobile to off- site locations. * Duties may require travel via, plane, care, train, bus, and taxi-cab. * Ability to sit for extended periods of time. * Must be able to efficiently use computer keyboard and mouse to perform coding assignments. WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Floats between clients as requested. * Capacity to work independently in a virtual office setting or at hospital setting if required to travel for assignment. OTHER * Regular travel may be required As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $30.85 - $46.28 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

Who We Are We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community. Our Story We started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals. Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care. We have a rich history at Tenet. There are so many stories of compassionate care; so many 'firsts' in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need. Tenet and our predecessors have enabled us to touch many different elements of healthcare and make a difference in the lives of others. Our Impact Today Today, we are leading health system and services platform that continues to evolve in lockstep with community need. Tenet's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions. Our impact spreads far and deep with 65 hospitals and approximately 510 outpatient centers and additional sites of care. We are differentiated by our top notch medical specialists and service lines that are tailored within each community we serve. The work Conifer is doing will help provide the foundation for better health for clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions. Together as an enterprise, we work to save lives and can accept nothing less than excellence from ourselves in service of our patients and their families, every day. Under general supervision and with aid of Official Coding Guidelines, the Corporate Coding Coordinator codes diagnoses and procedures of inpatient accounts according to ICD-10-CM/PCS. The Corporate Coding Coordinator is responsible for assisting the Corporate Coding Manager with second level coding reviews and educates coders on correct coding. Assists the coding department with coding questions, reviews, or inquiries. * Performs second level coder reviews on accounts that are sent back from Revint, Iodine, coding audits, and coding/billing editor. * Provides coders with education and guidance on correct coding based on second level reviews. * Assists coding manager and coding department with coder questions, coding reviews, and coding inquiries. Codes inpatient accounts when coverage is needed. * Monitors and assists coding manager with DNFC management to goals. * Attends Tenet coding educations and maintains coding credentials. Required: * Associates Degree in Health Information Management * RHIT or CCS * 3-5 years acute hospital coding experience * Skilled and working knowledge of MS Office suite * Ability to analyze coding related reports and take action Preferred: * Bachelor's Degree in Health Information Management * RHIA and CCS * 5 plus years' experience in a large, complex, multi-system acute care hospital organization A pre-employment coding proficiency assessment will be administered. Compensation * Pay: $30.00-$45.00 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. Benefits The following benefits are available, subject to employment status: * Medical, dental, vision, disability, AD&D, and life insurance * Paid time off (vacation & sick leave) * Discretionary 401k match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance. * For Colorado employees, paid leave in accordance with Colorado's Healthy Families and Workplaces Act is available. #LI-CM7 Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

The Director of Revenue Integrity serves in a senior leadership capacity and demonstrates client and unit-specific leadership to Revenue Integrity personnel by designing, directing, and executing key Conifer Revenue Integrity processes. This includes Charge Description Master ("CDM") and charge practice initiatives and processes; facilitating revenue management and revenue protection for large, national integrated health systems; regulatory review, reporting and implementation; and projects requiring expertise across multiple hospitals and business units. The Director provides clarity for short/long term objectives, initiative prioritization, and feedback to Managers for individual and professional development of Revenue Integrity resources. The Director leverages project management skills, analytical skills, and time management skills to ensure all requirements are accomplished within established timeframes. Interfaces with highest levels of Client Executive personnel. * Direct Revenue Integrity personnel in evaluating, reviewing, planning, implementing, and reporting various revenue management strategies to ensure CDM integrity. Maintain subject-matter expertise and capability on all clinical and diagnostic service lines related to Conifer revenue cycle operations, claims generation and compliance. * Influence client resources implementing CDM and/or charge practice corrective measures and monitoring tools to safeguard Conifer revenue cycle operations; provide oversight for Revenue Integrity personnel monitoring statistics/key performance indicators to achieve sustainability of changes and compliance with regulatory/non-regulatory directives. * Assume lead role and/or provide direction/oversight for special projects and special studies as required for new client integration, system conversions, new facilities/acquisitions, new departments, new service lines, changes in regulations, legal reviews, hospital mergers, etc. * Serve as primary advisor to and collaboratively with Client/Conifer Senior Executives to ensure requirements are met in the most efficient and cost-effective manner; provides direction to clients for implementation of multiple regulatory requirements. * Serve as mentor and coach for Revenue Integrity personnel and as a resource for manager-level associates. * Maintain a high-level understanding of accounting and general ledger practices as it relates to Revenue Cycle metrics; guide client personnel on establishing charges in appropriate revenue centers to positively affect revenue reporting FINANCIAL RESPONSIBILITY (Specify Revenue/Budget/Expense): Adherence to established/approved annual budget SUPERVISORY RESPONSIBILITIES This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Direct Reports (incl. titles) : Revenue Integrity Manager/Supervisor Indirect Reports (incl. titles) : Charge Review Specialist I-II, Revenue Integrity Analyst I-III, Charge Audit Specialist To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to set direction for large analyst team consistent with Conifer senior leadership vision and approach for executing strategic revenue management solutions * Demonstrated critical-thinking skills with proven ability to make sound decisions * Strong interpersonal communication and presentation skills, effectively presenting information to executives, management, facility groups, and/or individuals * Ability to present ideas effectively in formal and informal situations; conveys thoughts clearly and concisely * Ability to manage multiple projects/initiatives simultaneously, including resourcing * Ability to solve complex issues/inquiries from all levels of personnel independently and in a timely manner * Ability to define problems, collect data, establish facts, draw valid conclusions, and make recommendations for improvement * Advanced ability to work well with people of vastly differing levels, styles, and preferences, respectful of all positions and all levels * Ability to effectively and professionally motivate team members and peers to meet goals * Advanced knowledge of external and internal drivers affecting the entire revenue cycle * Intermediate level skills in MS Office Applications (Excel, Word, Access, Power Point) Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * Bachelor's degree or higher; seven (7) or more years of related experience may be considered in lieu of degree * Minimum of five years healthcare-related experience required * Extensive experience as Revenue Integrity manager * Extensive knowledge of laws and regulations pertaining to healthcare industry required * Prior healthcare financial experience or related field experience in a hospital/integrated healthcare delivery system required * Consulting experience a plus CERTIFICATES, LICENSES, REGISTRATIONS * Applicable clinical or professional certifications and licenses such as LVN, RN, RT, MT, RPH, CPC-H, CCS highly desirable 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 regularly required to sit for long periods of time; use hands and fingers; reaching with hands and arms; talk and hear. * Must frequently lift and/or move up to 25 pounds * Specific vision abilities required by this job include close vision * Some travel required WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Normal corporate office environment TRAVEL * Approximately 10 - 25% Compensation and Benefit Information Compensation Pay: $104,624- $156,957 annually. Compensation depends on location, qualifications, and experience. * Position may be eligible for an Annual Incentive Plan bonus of 10%-25% depending on role level. * Management level positions may be eligible for sign-on and relocation bonuses. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, life, and business travel insurance * Management time off (vacation & sick leave) - min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

may qualify for a sign-on bonus. Performs imaging procedures with the use of radioactive isotopes. Responsible for preparation, calculations, and administration of isotope products in various diagnostic and therapeutic procedures. Performs under the direction of the physician during therapeutic procedures. Minimum Education: Completion of an accredited educational program in nuclear medicine or radiologic technology. Minimum Experience: 1-year radiologic technology diagnostic and/or nuclear medicine experience Required Certification: BLS Required Licensure: TDH (MRT), NMTCB FLSA Status: Salary Grade: Skills: ** Note - Required certifications are to be completed by 3 months of employment. #LI-NS1

Responsible for answering inbound customer service calls related to patient accounting questions. When inbound call volumes are low incumbent may make outbound follow up calls on outstanding AR accounts. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Answer inbound customer service calls and make some outbound follow up calls in a professional, service-oriented manner. Answer the calls timely without drops/abandons. * Ascertain the reason for the call and assist the caller with their questions, concerns or problems with the focus on first call resolution. Facilitate resolution by referring the matter to the issue/content expert. Escalate the matter to a supervisor, request the appropriate information or take appropriate action so that the issue expert is able to effectively resolve the matter. * Other duties as assigned. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Exceptional customer service skills including effective and efficient problem solving and analyzing skills * Professional and calming tone of voice with complete command of the English language free of use of inappropriate grammar * Ability to facilitate conversations with others and establish an understanding of the customer's issue/reason for contact * Ability to perform essential job functions with high degree of independence, flexibility, and creative problem-solving techniques * Ability to maintain control of the call by de-escalating issues and instilling confidence that the resolution has been found. * Ability to function effectively under stress of conflicting demands on time and attention and, sometimes, under duress from difficult personalities * Ability to interpret and apply reimbursement aspects of managed healthcare contracts * Attentive listening skills * Ability to clearly articulate a response to the customer using appropriate voice modulation Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. * High school education or the equivalent * 1 - 2 years prior experience in an inbound call center and/or customer service environment; hospital patient account billing with experience or knowledge of 3rd party reimbursements from insurance companies and government payers is a plus. 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. * Ability to sit at a computer terminal for extended periods of time WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Call Center environment with headset and multiple workstations within close proximity * Hospital Environment may include direct patient interaction As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $15.80 - $23.70 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

The Department of Psychology at the Children's Hospital of Michigan (CHM) is seeking a pediatric neuropsychologist to join our team of two pediatric neuropsychologists and four pediatric psychologists. The ideal candidate will have interest in working with our Epilepsy and Epilepsy Surgery programs. The neuropsychologists at CHM support hospital populations with various neurological, neurosurgical, medical, psychiatric and sports related injuries. CHM neuropsychologists conduct traditional outpatient neuropsychological evaluations, as well as provide consultation in our inpatient rehabilitation setting, and are integrated as part of multi-disciplinary teams within the following specialty clinics: concussion, myelomeningocele, genetics, NICU and cardiology neurodevelopmental follow-up programs. Additionally, we provide coverage on our inpatient epilepsy monitoring unit and actively participate in weekly and bi-weekly epilepsy and deep brain stimulation surgical conferences. In addition to clinical care, the incumbent neuropsychologist would be responsible for supervision of psychology externs and interns through our APA accredited doctoral internship program, which has been continually accredited by the APA since 1988. Competitive applicants must have a Psy.D./Ph.D. in clinical psychology from an APA or CPA accredited graduate program and have completed an APA accredited internship program. It is also expected that all neuropsychologist staff members have completed a formal two-year postdoctoral fellowship focused on specialty training in clinical neuropsychology with special focus in Epilepsy and Epilepsy Surgery care. Candidates are expected to be ABPP board-eligible or board certified. Duties include: 1) conducting screenings, consultations, and evidence-based neuropsychological evaluations of children and adolescents with medical, psychiatric, and neurodevelopmental disorders; 2) teaching and supervision of residents and interns in topics relevant to neuropsychological assessment; and 3) engagement in research or other scholarly activities. Eligible applicants may apply for clinical (non-tenured) faculty privileges with an affiliated educational institution, (e.g., Wayne State University and/or Central Michigan University) Salary and benefits are competitive and includes educational funding and fully paid malpractice with tail coverage. The ideal candidate will have strong written and verbal communication skills, experience working in a medical setting with multidisciplinary teams, teaching and supervisory experience, and a capability to see a wide range of conditions. Education: Required: Bachelor's degree in Psychology; Graduate degree. Experience: Required: Internship and/or clinical experience in Rehabilitation Psychology/Behavioral Medicine/Health Psychology and Neuropsychology Certifications: Required: Licensed psychologist. Additional certification(s) per governing board and in accordance with the facility Medical Staff Bylaws. Physical Demands:

Responsible for providing direct support to internal and subcontracted external legal resources engaged in the collection and recovery of managed care and/or Worker's Compensation claims. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Acts as liaison between the Business Office, Legal Department and outside counsel regarding outstanding litigation (ie.Venders) * Coordinates legal analysis for denied, underpaid and unpaid managed care accounts for legal referral; Compiles records and documentation for internal and external attorneys such as process documentation, copies of original contracts, etc to be used in litigation. * Reviews all existing documentation including but not limited to UB, IB, Explanation of Benefits (EOB), and Managed Care Contracts to verify claim balance calculation; ensures integrity in supporting documentation. * Works with Legal Department to file bankruptcy notifications on payers. May file liens on auto accident patients to state interest in claim. * Verifies in system that accounts have been adjudicated correctly once settled. If needed, adjust accounts per Legal request. * Works required reports (daily, weekly, monthly) to ensure legal payer issues are referred in a timely manner. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Intermediate writing skills * Intermediate Microsoft Word and Excel skills * Intermediate analytical and math skills * Ability to coordinate accounts and record detailed information * Ability to research and work independently * Ability to work in high volume environment at a fast pace * Ability to communicate in a professional manner Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. * High school diploma or equivalent * Some college helpful * 3-5 years experience in medical billing, collections, appeals, legal department and/or contract interpretation 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. * Ability to sit at a computer terminal for extended periods of time WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Call-center environment with multiple workstations in close proximity As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $20.51 - $30.77 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

Tenet Healthcare has an immediate opening for a Manager, Hospital Regulatory and Accreditation to support the enterprise. This position will require a high percentage of nationwide travel. Manager, Regulatory and Accreditation is responsible for assessing, developing, educating, implementing, monitoring, and leading the Tenet Regulatory and Accreditation activities within the company. This includes preparation and survey readiness. The position develops and implements processes for current safe practices in Tenet. The Manager, Regulatory and Accreditation work closely with other corporate departments, groups, and facilities for collaboration and synergy around identified priorities. Develops, educates, implements, monitors, and leads, Tenet and USPI, regulatory requirements and accreditation standards, goals, and targets through collaboration with corporate departments and the Sr. Director, Regulatory and Accreditation Is a leader for the Clinical Operations Department in the formulation of Tenet and USPI regulatory and accreditation related goals and targets. Assists with the development of the Tenet and USPI strategy and tactics for regulatory and accreditation preparation and successful surveys Conducts on-site facility surveys Provides leadership and expertise in methods of performance improvement. Coordinates and collaborates with organizational leaders on activities related to the development, implementation, improvement of and adherence to the organization's policies and procedures covering the scope of regulatory requirements and accreditation standards Supports preparation for surveys (i.e., CMS, TJC, State,) Supports the formulation of responses [plans of correction] from surveyors, electronic communication, or third-party payers under the direction of the Sr. Director of Regulatory and Accreditation Remains current concerning industry-wide, leading practices Demonstrates ethical behavior in decision-making, performance of job responsibilities while maintaining confidentiality regarding patient information, quality, performance, and peer review information. Develops policies and procedures for areas of responsibility. Develops methods, tools, and other resources for regulatory and accreditation preparedness and sustainment. Develops and presents educational material to various audiences based on identified or trending regulatory and accreditation issues. Minimum education, training and background for the successful candidate include: Required: Registered Nurse with advanced degree in relevant field plus five years of regulatory, accreditation, and performance improvement experience or Advanced degree in a health-related field (Masters) with five years of relevant regulatory, accreditation, and performance improvement experience. A minimum of 75% national travel annually is a requirement. Selected candidate will be required to pass Motor Vehicle Record check and maintain valid driver's license. Experience leading interdisciplinary initiatives in process improvement and directly with improving reliability of healthcare delivery at the point of care. Functional knowledge of TJC, CMS COP's, and other federal and state requirements regulatory standards. Relevant experience in healthcare/clinical setting. Strong organizational, written, communication, and presentation skills. REQUIRED CERTIFICATION: Certified Joint Commission Professional (CJCP) or Certified Professional Healthcare Quality (CPHQ) within twelve months of hire date. SKILLS, KNOWLEDGE, AND ABILITIES: Skilled at developing and conducting educational presentations. Adept at developing methods, tools, reports, data aggregation and conducting regulatory and operational surveys for USPI facilities, including the review of regulatory requirements and accreditation standards and Conditions of Participation. Prepares written reports of clinical and operational survey findings. Skilled in developing corrective action plans, provide educational programs, monitor implementation of action plan and other oversight activities through follow-up visits to facilities as needed, and provide guidance on regulatory and accreditation communications as needed. Expert on regulatory requirements and accreditation standards, preparation activities, and success with surveys. Knowledgeable in the areas of peer review, risk management, patient safety, infection control prevention and reporting Polished communicator (written, verbal and presentation skills) with many levels of key stakeholders from the board level to the point of care staff. Expert with working, leading, following, coordinating, and managing activities to driving change within Tenet/USPI to achieve strategic initiatives for clinical/operational initiatives related to regulatory and accreditation. PRIMARY INFORMATION, TOOLS AND SYSTEMS USED: PC based Word and Excel spreadsheet programs Industry publications as they relate to Quality and other areas, as applicable, such as Safety, Risk Management, etc. Electronic Health Record eSRM (Risk Management System) Balanced Score Card / Clinical Operations Scorecard SharePoint AMP with Tracers Compensation Pay: $114,192-$165,000 annually. Compensation depends on location, qualifications, and experience. Position may be eligible for an Annual Incentive Plan bonus of 10%-25% depending on role level. Management level positions may be eligible for sign-on and relocation bonuses. Benefits The following benefits are available, subject to employment status: Medical, dental, vision, disability, life, AD&D and business travel insurance Manager Time Off - 20 days per year Discretionary 401k match 10 paid holidays per year Health savings accounts, healthcare & dependent flexible spending accounts Employee Assistance program, Employee discount program Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance. For Colorado employees, paid leave in accordance with Colorado's Healthy Families and Workplaces Act. #LI-JR1

The Contracts Analyst is responsible for healthcare insurance reimbursement analysis; validating pre-load and post-load of contracts; applying independent judgment in the maintenance of the claims adjudication system; formulating and implementing system improvements, acting as a subject matter expert during contract negotiation processes, making recommendations to the Managed Care negotiators regarding terms of the contract; and collaborating with key stakeholders for the resolution of related issues. The Contracts Analyst responsibilities ultimately affect the business operations to a substantial degree. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Analyzes the Contract Terms and Conditions in a timely manner and makes recommendations for new contract loads, formulates, and implements amendments and changes, and rollover contracts as part of the client audit, deviating from established procedures as necessary. * Regularly exercises discretion in analyzing and identifying issues associated with reprice impact reports after communication log issue have been corrected and re-priced. Formulates and implements solutions to identified issues and is empowered to make exceptions when required to move issues to resolution. * Independently audits and verifies post-contract changes. * Collaborates with Client Managed Care and Med Assets Account Rep to ensure contract profiles are pricing accurately, per contract language. * Reviews internal requests for assistance and executes work list/queries for newly opened communication logs. Documents affected accounts as required. * Identifies alternative opportunities in contract interpretation and revenue routing through the analysis of issues and, acting as a subject matter expert, provides alternative recommendations to management and staff. Activation of plan ID's in mainframe system and MedAssets complying with NIC standards. Request approvals from Managed Care for NCCI edits if stated in contract and forward to the appropriate parties for loading. * Communicates with appropriate leadership to ensure discrepancies are resolved prior to close of month end. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * This position requires knowledge of and the ability to perform all functions of the Contract Analyst. * Advanced understanding of hospital billing form requirements (UB-04) * Advanced understanding of ICD-9, HCPCS/CPT coding and medical terminology * Advanced Microsoft Office (Word, Excel) * Advanced knowledge of query writing applications a plus * Advanced managed care/government contract interpretation skills * Strong analytical abilities Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience preferred to perform the job. * Minimum 1 year contract interpretation experience required * Bachelor or Associate Degree preferred * 3-5 years of relevant hospital business office experience preferred * Must be able to implement a systematic, self motivated approach to problem solving and be able to identify, coordinate and optimize resources needed to execute plans 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. * Must be able to work in sitting position, use computer and answer telephone * Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments * Ability to lift and/or move up to 25 pounds * Specific vision abilities required by this job include close vision. * Ability to travel WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Office Work Environment * Hospital Work Environment OTHER * Other duties as assigned As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $22.56 - $33.85 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

Outpatient Coding Manager - Pediatrics/Primary Care Manages the Coding Section of Health Information Management (HIM) and functions as a resource and facilitator for all areas of hospital coding operations. Assures compliance with CMS, AMA and AHIMA standards for ethical coding, The Joint Commission Standards, Medical Staff Bylaws, Rules and Regulations, State and Federal Guidelines and department/organizational policies and procedures. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Plans, organizes, and supervises the work and systems of one or more of the following Health Information Management programs: * In Patient, Observation, Day Surgery, Emergency Department and Outpatient Coding * Post discharge physician queries * 3M Encoder processes * Coding Compliance Plan * Dissemination of coding changes and updates * Identification of coder educational needs through continual monitoring and auditing of coder accuracy * Continual monitoring of charts not final coded. Establish DNFC targets by patient type and coder. * Monitor and report individual coder productivity. Coach and counsel under performers. * Assignment and reassignment of un-coded charts to specific coders as necessary to better manage the DNFC. * Evaluate individual coder accuracy through focused audits. Identify education needs to facilitate coding accuracy improvement. * Review all DRG reclassifications before and after assigning correction to the coder who completed the original coding. Track and trend patterns by payer, coder, MS-DRG and physician. * Monitor the coding compliance manual. Monitor industry publications and implement changes as necessary. * Gives input regarding section needs in preparation of annual budget and monitors expenditures for budget compliance. * Attend meetings within and outside the facility as needed r requested to provide input and act as a coding information resource. FINANCIAL RESPONSIBILITY (Specify Revenue/Budget/Expense): * Provides input regarding departmental budget specific to area of responsibility. * Directly impacts days not final billed (DNFB), overall A/R and monthly revenue collection. SUPERVISORY RESPONSIBILITIES This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. No. Direct Reports (incl. titles) Inpatient and Outpatient Coders Coding Analyst Coding Supervisor KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Computer training: HBOC Star; 3M Coding & Reimbursement software; SoftMed Systems; MS OFFICE; Horizon Patient Folder; Groupwise; DVI Dictation System; External Transcription Agency Systems * Extensive knowledge of medical record documentation requirements mandated by Medical Staff Bylaws, Rules and Regulations * State and federal regulations regarding patient confidentiality * Excellent verbal/written communication and interpersonal skills * Thorough/detailed knowledge of ICD-10-CM, ICD-10-PCS and CPT coding systems * Skilled in formulating and writing statistical reports * Skilled in performing quality assessment/analysis * Must display strong interpersonal skills * Works collaboratively with CDI, quality, and other facility leaders Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * Associate Degree in Health Science Administration/HIM Technology, minimum * Bachelor's degree, preferred * Registered Health Information Technician (RHIT) certification * Registered Health Information Administrator (RHIA) certification * Minimum three years supervision of coding staff, required * Five years of progressive management experience CERTIFICATES, LICENSES, REGISTRATIONS * Required: RHIA, RHIT, CCS, CCA, CCS-P, and/or CPC-H 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. * Duties may require bending, twisting and lifting of materials up to 25 lbs. * Duties may require driving an automobile to off- site locations. * Ability to sit for extended periods of time. WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Work environment is at a moderate noise level. * Capacity to work independently in a virtual office setting or at hospital setting if required to travel for assignment. * Works in a private office space in the coder's home per conifer Telecommuter Policy as defined in the Telecommuting Program Guide OTHER * Duties may require travel via, plane, care, train, bus, and taxicab. As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $81,952.00 - $122,907.00 annually. Compensation depends on location, qualifications, and experience. * Position may be eligible for an Annual Incentive Plan bonus of 10%-25% depending on role level. * Management level positions may be eligible for sign-on and relocation bonuses. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, life, and business travel insurance * Management time off (vacation & sick leave) - min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

The Physician Practice Supervisor is responsible for managing all administrative and operational functions associated with an assigned practice(s). Education Required: College degree, or an equivalent combination of education and experience Experience Required: 5 years of experience working in a physician office with at least 2 years in a supervisory capacity. #LI-RF1 Responsibilities include optimizing staff performance in the office Scheduling staff and assigning work Training/coaching And overseeing daily operations of the office including cash reconciliation, charge entry, and operational checks and balances. Resolves patient issues as needed

The Accounts Receivable Senior Representative is responsible for all aspects of follow-up activity, to include taking appropriate steps to resolve accounts timely. This candidate should have an increased knowledge of the Revenue Cycle as it relates to the entire life of a patient account from creation to expected payment. Representative will need to effectively follow-up on claim submission and; remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities. Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance is preferable. . Participate and assist in special projects as well as provide A/R support to the team. Assist new or existing staff with training or techniques to increase production and quality as well as provide A/R support for the team members that may be absent or backlogged. An effective revenue cycle process is achieved with working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving more complex accounts with minimal or no assistance. Senior Representative must have the ability to work closely with management and team members working an inventory of collectible accounts that bring in revenue and possess the the following: * Conduct telephone calls utilizing a professional demeanor when contacting payors and/or patients in order to obtain collection related information * Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions (may work in multiple systems for clients) * Access payer websites and discern pertinent data to resolve accounts * Utilize all available job aids provided for appropriateness in follow-up processes * Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account * Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership * Skilled in working with complex medical claim issues * Identify and communicate any issues including system access, payor behavior, account/work-flow inconsistencies or any other insurance collection opportunities * Compile data to substantiate and utilize to resolve payer, system or escalated account issues * Assist new or existing staff with training or techniques to increase production and quality * Provide support for team members that may be absent or backlogged ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. * Researches each account using company patient accounting applications and internet resources that are made available. Conducts appropriate account activity on uncollected account balances with contacting third party payors and/or patients via phone, e-mail, or online. Problem solves issues and creates resolution that will bring in revenue eliminating re-work. Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, identifies payor issues and trends and and solves re-coup issues. Requests additional information from patients, medical records, and other needed documentation upon request from payors. Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed. Takes appropriate action to bring about account resolution timely or opens a dispute record to have the account further researched and substantiated for continued collection. Maintains desk inventory to remain current without backlog while achieving productivity and quality standards. * Perform special projects and other duties as needed. Assists with special projects as assigned, documents findings, and communicates results to leaders. * Recognizes potential delays and trends with payors such as corrective actions and responds to avoid A/R aging. Escalates payment delays/ problem aged account timely to Supervisor. * Compile data to substantiate and utilize to resolve payer, system or escalated account issues. * Assist new or existing staff with training or techniques to increase production and quality as needed. * Participate and attend meetings, training seminars and in-services to develop job knowledge. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies * Good written and verbal communication skills * Intermediate technical skills including PC and MS Outlook * Strong interpersonal skills * Above average analytical and critical thinking skills * Ability to make sound decisions * Has a full understanding of the Commercial, Managed Care, Medicare and Medicaid collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements for government payors * Advanced knowledge of UB-04 and Explanation of Benefits (EOB) interpretation * Intermediate knowledge of CPT and ICD-9 codes * Advanced knowledge of insurance billing, collections and insurance terminology Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * High school diploma or equivalent education * 2-5 years experience in Medical/Hospital Insurance related collections * Minimum typing requirement of 45 wpm 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. * Office/Teamwork Environment * Ability to sit and work at a computer for extended periods of time WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $17.20 - $25.70 per hour. Compensation depends on location, qualifications, and experience. * Position may be eligible for a signing bonus for qualified new hires, subject to employment status. * Conifer observed holidays receive time and a half. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, and life insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

Detroit Medical Center is seeking a full-time Nurse Practitioner to join our Orthopedic Surgery team in Detroit, MI. This position offers the opportunity to work alongside a collaborative orthopedic team while providing comprehensive care to patients across the continuum of orthopedic treatment. The Nurse Practitioner will play a key role in supporting both inpatient and outpatient orthopedic services and contributing to an efficient, high-quality patient experience. Position Highlights • Full-time Orthopedic Surgery Nurse Practitioner opportunity • Mix of inpatient and outpatient responsibilities • Support pre-operative, post-operative, and ongoing orthopedic patient care • Collaborative, team-based environment within a large academic medical system • Monday through Friday schedule aligned with clinical and service needs Compensation and Benefits • Competitive salary • Health, dental, and vision insurance • 401(k) retirement plan • Paid time off (PTO) • Continuing medical education (CME) allowance • Malpractice insurance About Detroit Detroit is a dynamic and evolving city offering a unique blend of culture, history, and opportunity. Known for its revitalized downtown, thriving arts and music scene, and professional sports culture, Detroit continues to grow as a hub for healthcare innovation. With affordable housing, diverse neighborhoods, and easy access to lakes, parks, and nearby metropolitan areas, Detroit provides an excellent quality of life for healthcare professionals seeking both career growth and community connection. Education: Required: Master's Prepared Advanced Practice Nurse Practitioner Experience: Certifications: Required: Must be currently licensed, certified or registered to practice profession as required by law, regulation in state of practice or policy. RNP License. Additional certification(s) per governing board and in accordance with the facility Medical Staff Bylaws. Physical Demands: Per collaborative agreement and/or state requirements

Hours: Shift Start Time: Variable Shift End Time: Variable AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: Weekend Requirements: No Weekends On-Call Required: No Hourly Pay Range (Minimum - Midpoint - Maximum): $49.700 - $64.130 - $71.820 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. *This is a remote position* What You Will Do The Compliance Coding Auditor is responsible for the administration of the Sharp HealthCare's (SHC's) compliance audit program. The position provides oversight and maintenance of a high-quality, effective, best practices coding, billing, and reimbursement audit compliance program to prevent and detect violations of law and other misconduct. This role will help promote ethical practices and a commitment to compliance with applicable federal, California, and local laws, rules, regulations, and internal policies and procedures. The position plays a key role in oversight of Sharp HealthCare's (SHC) compliance audit function and maintaining Sharp HealthCare's view of coding, billing and reimbursement compliance audits. Required Qualifications 5 Years experience in acute care inpatient/outpatient coding or professional E/M coding in the following coding systems: ICD-10-CM/PCS, DRG, CPT& HCPCs, and/or E/M CPT. Preferred Qualifications Other : Strong background in in ICD-10-CM/PCS coding, DRG coding and CPT coding classification. Certified Clinical Documentation Specialist (CCDS) - Various-Employee provides certificate -PREFERRED Certified Health Care Compliance (CHC) - Compliance Certification Board -PREFERRED Other Qualification Requirements Bachelor's degree in Business, Healthcare Administration, or related field - required. In lieu of Bachelor's degree, Associate's degree and a minimum of 5 years experience in coding, billing and compliance may be considered. One of the following is required: AHIMA's Certified Coding Specialist (CCS), or Certified Documentation Improvement Practitioner (CDIP), or AAPC Certified Inpatient Hospital/Facility (CIC), or Certified Professional Coder (CPC) certification. Certified Clinical Documentation Improvement Practitioner or Specialist (CDIP or CCDS) is required within 1 year of hire. Department management is responsible for tracking and ensuring employee receive certification within specified timeframe. Essential Functions Coding Compliance Compliance Coding and Billing Audits The Compliance Coding Auditor has the primary responsibility of performing all audits and chart reviews required for inpatient and/or outpatient coding and billing, daily retrospective chart reviews and communication to key stakeholders regarding audit findings and corrective actions, if necessary. Reviews the electronic health record to identify potential coding and billing compliance issues. Prepares written reports of audits, including recommendations to improve compliance. The Auditor will analyze and assess Sharp's potential risks using SHC's billing and coding claims data, risk assessment data, MDAudit risk analyzer software, OIG Work plan, CMS, PEPPER Reports, RAC Denials, industry experts, etc. Policy and Procedure maintenance Works in collaboration with the Director and Manager of Compliance and System Management (HIM, CDI, Case Management, Quality, etc.) in developing SHC's standardized documentation, medical necessity, coding and billing policies and guidelines in accordance with state and federal laws, regulations and policies. Professional development Maintain current credentials and knowledge of ICD-10-CM/PCS, MS-DRG, CPT and HCPCs coding classification changes, compliance issues and updates regarding changes in federal and state regulations, policies and procedures pertaining to the Compliance Program. Adheres to a personal plan of professional development and growth through professional affiliations, activities and continuing education. Unit support Key Stakeholder/Business Unit Support Responsible for inpatient and/or outpatient coding and billing investigations and inquiries, as well as answering correspondence from key stake holders regarding inpatient and/or outpatient coding and billing matters and other general Compliance reimbursement inquiries. Will continuously evaluate the quality of clinical documentation and monitor the appropriateness of queries with the overall goal of improving physician documentation and achieve accurate coding. Maintain professional relationship with key stakeholders focusing on high level of client satisfaction. Must demonstrate excellent written and oral communication presentation skills in training SHC workforce and physicians. Professional competency Certified Clinical Documentation Improvement Practitioner or Specialist (CDIP or CCDS) is required within 1 year of hire. Department management is responsible for tracking and ensuring employee receive certification within specified timeframe. Knowledge, Skills, and Abilities Ability to perform independent research and factual analysis of coding and billing matters and create proposed solutions to root causes. Computer proficiency with Microsoft office applications is required. Ability to function within a fast-paced, dynamic, and growing environment. Excellent time management and problem solving skills. Must demonstrate analytical ability, motivation, initiative, and resourcefulness. Teamwork and flexibility required. Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

Under minimal supervision, performs basic to complex diagnostic radiographic procedures, as requested by a licensed physician. Exercises professional judgment in providing health care services, applying x-ray energy, to assist in diagnosis or treatment of patients in all age groups from newborn to elderly. Completes established competencies for the position within designated introductory period. Other related duties as assigned. Education Required: Graduate of accredited Imaging Program Preferred: Associate degree Experience Preferred: 1-3 years Certifications Required: ARRT or registry eligible; must have ARRT within one year post graduation; BLS, state license if required #LI-RF1 Produces high quality diagnostic radiographs, rotates through advanced areas of diagnostic radiology to include OR, Urography, open reductions, myelography, arthrography, placements, and trauma; assists practitioner with fluoroscopy, arthrography, OR procedures and trauma.

WHO WE ARE: The National Multiple Sclerosis Society mobilizes people and resources to drive research for a cure and to address the challenges of everyone affected by MS. To fulfill this mission, the Society funds cutting-edge research, drives change through advocacy, facilitates professional education, collaborates with MS organizations around the world, and provides programs and services designed to help people with MS and their families move their lives forward. We partner with volunteers to accomplish our work. Staff members engage volunteers through effective and timely communications, facilitating meaningful opportunities, and continually seeking and providing feedback for reciprocal growth and learning. Job Summary: The Bilingual MS Navigator Information Specialist serves as the first point of contact for individuals affected by MS, initiating a supportive partnership that fosters trust, empathy, and connection. This role sets the tone for a person-centered experience, guiding constituents to the most appropriate resources and services offered by the National MS Society. Through active listening, assessment, and compassionate engagement, the Information Specialist enhances constituent knowledge, satisfaction, and connection to the Society. Bilingual Fluency Required: Must be fully fluent in both English and Spanish (verbal and written). You will be required to read, write, and speak in both languages daily. Main Responsibilities: Establish rapport and trust with constituents to initiate a supportive, person-centered relationship. Assess individual needs and guide constituents to the most appropriate staff member, service, or resource. Provide accurate information about Multiple Sclerosis as well as Society programs, events, and services. Connect constituents with MS Navigators for ongoing support and goal achievement. Collaborate with healthcare providers to create seamless experiences for shared clients. Ensure equitable access to educational and support resources, regardless of technical ability. Respond to acute situations with sound judgment, connecting individuals to internal or external crisis support as needed. Maintain healthy boundaries while remaining present and empathetic in all interactions. Stay current with industry trends and Society developments to align with best practices. Support innovation and outreach by engaging volunteers and modeling essential work functions across the organization. What We're Looking For: Exceptional active listening and empathetic communication skills. Strong critical thinking and judgment, especially in high-stakes or crisis situations. Ability to build trust and rapport quickly with diverse individuals. Deep understanding of Society programs and ability to navigate interconnected services. Commitment to culturally responsive practices and inclusive service delivery. Proficiency with digital tools and technology for resource sharing and relationship management. Collaborative mindset with the ability to work cross-functionally and support team learning. Adaptability and resilience in a dynamic, service-oriented environment. Location Requirements Remote - Flexible Location Work is primarily performed remotely, however, when possible and necessary, teams meet in person to conduct the business of the organization and build team relationships. Compensation | Benefits: The estimated hiring compensation range for this role is $24.00 - $26.00 per hour. Final offers will be based on the candidate's geographic location, consider career experience and may vary from this range due to these and other factors. You will have the opportunity for a highly competitive, comprehensive benefit package that the Society provides to employees. Your benefits include a considerable Paid Time Off Plan; Paid Holidays; 401k Retirement Savings Plan with Society match; Commuter Benefit Plan; Comprehensive Health & Welfare benefits including Medical, Dental, Vision, Flex Spending Accounts, Life Insurance, Disability Coverage, Spring Health Membership offering free therapy and professional coaching, as well as additional voluntary benefit offerings. Not to mention, you will join an incredible mission focused team of people! We're committed to supporting the growth of every employee through a structured and transparent approach to career development. We use Talent Portraits to define clear expectations, development opportunities, and advancement paths - whether you're growing as a people leader or deepening your expertise as an individual contributor. Each role is thoughtfully placed within one of these pathways (Leadership or Partner) to help you understand how it fits into our broader organization and your potential career journey. This position is classified as Partner- Professional. The National MS Society is committed to building a diverse and inclusive workforce. We strive to create a workforce that reflects the communities we serve and where everyone feels empowered to bring their authentic selves to work. We need you and your unique talents and perspectives to help us write the last chapter on MS. APPLICATION INSTRUCTIONS: We appreciate your consideration of our job opportunities and strive to make it as effortless as possible to apply for our positions. With only a few required sections and the option to use our resume parsing tool, we aim to streamline the application experience, saving you time and effort. Additionally, if you wish to include a cover letter with your application, please feel free to attach it along with your resume, and any other documents required, to the Resume/CV document upload section at the bottom of the My Experience page. We appreciate your interest in joining our team and look forward to receiving your application! Important: You will not be able to modify your application after you submit it. The "My Experience" page is the only opportunity to add your cover letter and supporting document attachments. If you experience any trouble submitting your materials, please check out our FAQ & Contact Us page.

WHO WE ARE: The National Multiple Sclerosis Society mobilizes people and resources to drive research for a cure and to address the challenges of everyone affected by MS. To fulfill this mission, the Society funds cutting-edge research, drives change through advocacy, facilitates professional education, collaborates with MS organizations around the world, and provides programs and services designed to help people with MS and their families move their lives forward. We partner with volunteers to accomplish our work. Staff members engage volunteers through effective and timely communications, facilitating meaningful opportunities, and continually seeking and providing feedback for reciprocal growth and learning. Job Summary: Reporting to the Chief Financial Officer (CFO), the Controller is a strategic financial leader responsible for ensuring the integrity of financial operations, driving compliance, and partnering with executive leadership to advance organizational goals. This role serves as a trusted strategic partner to the CFO and National Board of Directors (NBOD) Audit and Finance Committees, ensuring transparency, accuracy of financial reporting, and robust internal control systems. The Controller is the primary liaison with banking, investment, audit, and tax partners and plays a critical role in safeguarding organizational assets and supporting long-term financial sustainability. Location Requirement: Remote - Flexible Location Work is primarily performed remotely, however, when possible and necessary, teams meet in person to conduct the business of the organization and build team relationships. Compensation | Benefits: The estimated hiring compensation range for this role is $175,000 - $200,000. Final offers will be based on the candidate's geographic location, consider career experience and may vary from this range due to these and other factors. You will have the opportunity for a highly competitive, comprehensive benefit package that the Society provides to employees. Your benefits include: considerable Paid Time Off Plan Paid Holidays 401k Retirement Savings Plan with Society match Commuter Benefit Plan Comprehensive Health & Welfare benefits including: Medical Dental Vision Flex Spending Accounts Life Insurance Disability Coverage Spring Health Membership offering free therapy and professional coaching, as well as additional voluntary benefit offerings. Not to mention, you will join an incredible mission focused team of people! As a key leader, the Controller must maintain a broad knowledge of the Society, consistently demonstrating the Society's operating principles and cultural values. Strategic Leadership (40%) Financial Strategy & Decision Support: Provide proactive leadership and sound judgment in identifying opportunities, mitigating risks, and making decisions that strengthen financial health and advance the mission. Serve as a key advisor to the CFO and senior leadership. Governance & Committee Support: Act as the primary financial resource for the NBOD Audit and Finance Committees, preparing reports, presenting findings, and contributing to strategic discussions. Internal Controls & Risk Management: Design, implement, and monitor a comprehensive internal control framework to safeguard assets and ensure compliance with policies and regulations. Proactively identify, assess, and address risks and opportunities for control enhancements. Policy Development: Establish and maintain financial policies and procedures, including adoption of new accounting standards and best practices. Process Optimization: Lead continuous process improvement initiatives, leveraging technology and automation to enhance efficiency, accuracy, and scalability. Team Leadership & Development: Mentor and coach the accounting team, fostering a culture of accountability, collaboration, and professional growth. Implement structured succession planning and talent development strategies. Partner with People & Culture to align workforce planning with long-term organizational goals and foster a culture of growth and retention. Audit and Tax Compliance (20%) Oversee annual external audits, ensuring timely and accurate completion Manage preparation and filing of IRS Form 990 and all state/local tax filings, ensuring full compliance. Serve as subject matter expert on tax regulations, advising leadership on compliance and risk mitigation. Treasury Management (20%) Administer banking, investment, and payment platforms to ensure secure and efficient operations. Serve as an authorized signatory on all bank accounts, ensuring compliance with Society Signature Authority policy and proper controls. Monitor liquidity and funding levels to support strategic financial planning and decision-making, providing recommendations to the CFO. Accounting Operations (20%) Oversee general ledger, cash and investments, payroll and benefits, grants, lease accounting, accounts payable and net asset classification. Ensure monthly and quarterly financial statements comply with Generally Accepted Accounting Principles. Analyze variances in salaries, taxes and benefits versus budget and prior year. Ensure appropriate approval controls are maintained in Workday. Manage month-end and year-end close processes and ensure timely reporting Conclude on proper accounting treatment for new donor and purchase agreements. Provide expertise on complex accounting transactions and donor agreements. What We're Looking For: Bachelor's degree in accounting, finance, or related field (REQUIRED); CPA or equivalent certification strongly preferred. 10+ years of progressive financial management experience in nonprofit or corporate financial leadership. Expertise in ERP systems (SAP, Oracle Netsuite, Sage, etc.) and emerging financial technologies; proficiency with Workday preferred. Demonstrated success in treasury management, process improvement and internal control frameworks. Strong analytical, communication, and interpersonal skills. Proven ability to exercise initiative and make sound decisions in a complex, fast-paced environment. Experience supporting board-level committees and working closely with executive leadership. Proven ability to lead and develop high-performing teams in a dynamic environment Experience supporting board-level committees and collaborating with executive leadership. We're committed to supporting the growth of every employee through a structured and transparent approach to career development. We use Talent Portraits to define clear expectations, development opportunities, and advancement paths - whether you're growing as a people leader or deepening your expertise as an individual contributor. Each role is thoughtfully placed within one of these pathways (Leadership or Partner) to help you understand how it fits into our broader organization and your potential career journey. This position is classified as Leader - Leading Leaders. Here's a quick rundown of what our hiring process looks like, so you know what's coming: Step 1: We'll kick things off with a phone chat to talk about your background and what you're looking for. Step 2: Then you'll have a conversation with a recruiter to see how you might fit into the role. Step 3: After that, you'll meet the hiring manager and someone from our People & Culture (P&C) team for a deeper dive. Step 4: Lastly, you'll join a team culture chat to get a feel for our values (besides, this is a two-way interview, right?) We want to keep things open and easy, making sure your time is valued every step of the way. The National MS Society is committed to building a diverse and inclusive workforce. We strive to create a workforce that reflects the communities we serve and where everyone feels empowered to bring their authentic selves to work. We need you and your unique talents and perspectives to help us write the last chapter on MS. APPLICATION INSTRUCTIONS: We appreciate your consideration of our job opportunities and strive to make it as effortless as possible to apply for our positions. With only a few required sections and the option to use our resume parsing tool, we aim to streamline the application experience, saving you time and effort. Additionally, if you wish to include a cover letter with your application, please feel free to attach it along with your resume, and any other documents required, to the Resume/CV document upload section at the bottom of the My Experience page. We appreciate your interest in joining our team and look forward to receiving your application! Important: You will not be able to modify your application after you submit it. The "My Experience" page is the only opportunity to add your cover letter and supporting document attachments. If you experience any trouble submitting your materials, please check out our FAQ & Contact Us page.

The USPI Utilization Review/Appeals RN is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and right to self-determination across United Surgical Partners International (USPI) Hospitals. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. This position manages medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case-by-case basis. This position integrates national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention Coordination with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient Compliance with state and federal regulatory requirements, TJC accreditation standards and USPI policy Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered services and administration of benefits Recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review Preparing and documenting appeal letters based on industry accepted criteria. REQUIREMENTS Required: 5 years of acute hospital or behavioral health patient care experience with at least 2 years utilization review in an acute hospital, surgical hospital, or commercial/managed care payer setting. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered. Experience in writing appeals. Preferred: Accredited Case Manager (ACM). Previous classroom led instruction on InterQual products (Acute Adult, Peds, Outpatient and Procedures). Patient Accounting experience a plus. Managed care payor experience a plus either in Utilization Review, Case Management or Appeals. Interaction with facility Case Management, Physician Advisor, and Revenue Cycle Team is a requirement. May require travel up to 25% travel across USPI hospitals. The selected candidate will be required to pass a Motor Vehicle Records check. Compensation Pay: $70,096-$112,112 annually. Compensation depends on location, qualifications, and experience. Management level positions may be eligible for sign-on and relocation bonuses. Benefits The following benefits are available, subject to employment status: Medical, dental, vision, disability, life, AD&D, and business travel insurance Paid time off (vacation & sick leave) Discretionary 401k match 10 paid holidays per year Health savings accounts, healthcare & dependent flexible spending accounts Employee Assistance program, Employee discount program Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance. For Colorado employees, paid leave in accordance with Colorado's Healthy Families and Workplaces Act is available. RESPONSIBILITIES Clinical Denials/Appeals Performs retrospective (post -discharge/ post-service) medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review. Constructs and documents a succinct and fact-based clinical case to support appeal utilizing appropriate module of InterQual criteria (Acute, Procedures, etc.). If clinical review does not meet IQ criteria, other pertinent clinical facts are utilized to support the appeal. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization. Demonstrates ability to critically think, problem solve and make independent decisions supporting the clinical appellate process. Demonstrates proficiency in use of medical necessity criteria sets, currently InterQual , as evidenced by Inter-rater reliability studies and other QA audits. Demonstrates basic patient accounting knowledge i.e. UB92/UB04 and EOB components, adjustments, credits, debits, balance due, patient liability, etc. Utilization Management Balances clinical and financial requirements and resources in advocating for patient needs with judicious resource management Promotes prudent utilization of all resources (fiscal, human, environmental, equipment and services) by evaluating resources available to the patient and balancing cost and quality to assure optimal clinical and financial outcomes Completes and sends admission and concurrent reviews for payers with an authorization process identifies and documents Avoidable Days using the data to address opportunities for improvement Coordinates clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay and discharge) compared to evidence-based practice, internal and external requirements. Payer Authorization Assures the patient is in the appropriate status and level of care based on Medical Necessity and submits case for Secondary Physician review per USPI policy Ensures timely communication and documentation of clinical data to payers to support admission, level of care, length of stay and authorization Advocates for the patient and hospital with payers to secure appropriate payment for services rendered Prevents denials and disputes by communicating with payers and documenting relevant information Manages payer dispute processes utilizing secondary review, peer to peer and payer type changes Education Ensures and provides education to physicians and the healthcare team relevant to the: Effective progression of care, Appropriate level of care, and Safe and timely patient transition Provides healthcare team education regarding resources and benefits available to the patient along with the economic impact of care options Compliance Ensures compliance with federal, state, and local regulations and accreditation requirements impacting case management scope of services Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and USPI policies Operates within the RN scope of practice as defined by state licensing regulations Remains current with USPI Case Management practices 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. Ability to lift 15-20lbs Ability to travel approximately 25% of the time; either to facility sites, headquarters or other designated sites Ability to sit and work at a computer for a prolonged period conducting medical necessity reviews and appeal letters