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HCA Healthcare jobs - 1,046 jobs

  • Claims Operations Lead

    HCA Healthcare 4.5company rating

    HCA Healthcare job in Nashville, TN or remote

    *** This role prefers candidates local to California and/or Pacific Time Zone*** Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a Claims Operations Lead today with Work from Home. **Benefits** Work from Home offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity and Consumer Discounts + Retirement readiness, rollover assistance services and preferred banking partnerships + Education assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) + Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits (********************************************************************** **_Note: Eligibility for benefits may vary by location._** Come join our team as a Claims Operations Lead. We care for our community! Just last year, HCA Healthcare and our colleagues donated $13.8 million dollars to charitable organizations. Apply Today! **Job Summary and Qualifications** The **Claims Operations Lead** position's primary function is to support the unit in work distribution and accurate adjudication of claims. In addition, the position is responsible for training and providing direction to Claims Examiners and Audit Research personnel. **DUTIES INCLUDE BUT NOT LIMITED TO:** Adjudicates and distributes work assignments including complex claims, resolving all system edits and audits for hard copy and electronic claims in accordance with policy. Works directly with Health Plans and external vendors to resolve claims issues. Coordinates necessary workflows for verification of referral and payment on non- participating provider claims. Resolves provider and eligibility issues relating to received claims. Processes high dollar claims in accordance with procedures. Identifies potential system programming issues and assists with resolution. Performs any necessary system testing for implementation of new processes within the -400. Provides technical support and training for claims processors and claims examiners. Provides staff with any and all internal communications regarding workflows/changes. Recognizes and appropriately routes claims for carved out services according to health plan contracts. Understands health plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans and capitation arrangements and processes claims using this knowledge. Understands general ledger accounts and posting of claims information to the appropriate accounts. Generates daily reports, assigns work, maintains weekly on hand reports Monitors performance and claims processing times to ensure compliance with performance standards. Perform other duties as assigned **KNOWLEDGE, SKILLS AND ABILITIES: This position requires the following minimum requirements:** Ability to communicate well with supervisors and co-workers. Knowledge of medical terminology. Knowledge of Department of Managed Health Care (DMHC), and Centers for Medicare and Medicaid Services (CMS) requirements. Knowledge of ICD-9, ICD-10, CPT, HCPCS, and revenue coding. Ability to analyze claim issues and "trouble shoot" claims problems. Ability to act as a resource and/or trainer for claims processors and claims examiners. Technical competence with claims processing software. Supervisory skills in claims processing. Ability to work in a high volume, production-oriented environment. Detail oriented with an ability to sit for extended periods of time. Ability to work under demanding performance standards for production and quality. Ability to understand, implement and train complex claim procedures. **EDUCATION:** High school diploma or equivalent. **EXPERIENCE:** Three years of experience processing claims, with at least two years of claims examiner experience. Physician Services Group (*********************************************************** is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcare's graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcare's commitment to the care and improvement of human life. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "The great hospitals will always put the patient and the patient's family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Claims Operations Lead opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. **Unlock the possibilities and apply today!** We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
    $74k-96k yearly est. 40d ago
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  • Lead Data Scientist

    HCA Healthcare 4.5company rating

    HCA Healthcare job in Nashville, TN or remote

    **Introduction** Do you want to join an organization that invests in you as a Lead Data Scientist? At HCA, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. **Benefits** Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity and Consumer Discounts + Retirement readiness, rollover assistance services and preferred banking partnerships + Education assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) + Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits (********************************************************************** _Note: Eligibility for benefits may vary by location._ You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated Lead Data Scientist like you to be a part of our team. **Job Summary and Qualifications** Job Summary At HCA Healthcare, we are committed to providing our patients and care providers with the highest quality of healthcare services. HCA's Care Transformation and Innovation (CT&I) team delivers a step change in that direction through clinically led integration of digital and AI technologies into care. Data Scientists within CT&I will play a critical role in helping us achieve this goal by actively solving for and implementing a broad range of data science solutions to drive transformational change. This includes delivery of data science products from incubation to deployment to monitoring; including solutioning for the business need, data analysis, feature engineering, building and validating models, deploying solutions to enterprise production platforms, and monitoring model performance and reliability. This individual will be responsible for actively delivering production grade data science products; including implementing best practices, frameworks, tooling, and documentation. They will be expected to bring hands-on expertise in predictive analytics, classification, image recognition, NLP, anomaly detection, machine learning, EDA, feature engineering, optimization, statistics, and generalized business problem solving by creatively applying AI/ML. What you will do: **- DATA INJECTION: Design and implement incoming data for feature engineering and machine learning** **- FEATURE CREATION AND TRANSFORMATION: Create features with usable predictive power by using domain knowledge of healthcare data, statistics, and data science** **- FEATURE EXTRACTION AND SELECTION: Extract features via cluster analysis, text analytics, principal components analysis and related methodologies to identify useful information without distorting original relationships or significant information in order to performance tune and promote scalability of the model** **- EXPLORATORY DATA ANALYSIS: Conduct data exploration and analysis to identify relevant patterns, trends, and relationships; understand the data deeply to appropriately align the data features with the appropriate machine learning methodologies** **- MODEL EXPERIMENTATION: Apply various statistical and machine learning techniques to develop, tune, and optimize predictive modeling to align with the use case requirements** **- DELIVERY: Deploy code using best practices** **- DOCUMENTATION: Document and present data science strategies and insights and solutions** **- MONITORING: Build and maintain pipelines, code, and processes to monitor the proper functioning of enterprise grade data science products** **- DATA AND OUTPUT QUALITY: Ensure high quality and integrity throughout the entire data science process** **- PRODUCT DEVELOPMENT MINDSET: Collaborate with stakeholders, data scientists, data engineers, and product managers to build and deliver high-quality data products** **What qualifications you will need:** - 6+ years of overall experience in various aspects of data science and machine learning (for Lead level) - Expert experience in SQL and Python - Experience with structured and unstructured data (ie. tabular, text, images, video, etc) - Experience with SQL relational and non-relational databases - Experience with data processing and ETL tools (e.g Apache Spark) - Experience with data visualization and data monitoring tools - Experience with modern software engineering practices (e.g. automated testing, continuous integration and continuous development) - Experience with Docker - Experience with cloud deployments in GCP or another cloud platform - Experience with Agile development methods and tools (e.g. Azure Dev Ops) - Excellent communication and collaboration skills, with the ability to work effectively across multiple teams and stakeholders - Ability to tell a story using data and insights that drives action and change - Domain knowledge of healthcare data preferred - Expertise in healthcare protocols and formats such as HL7, FHIR, DICOM preferred - Expert in the regulatory aspects of the healthcare domain preferred - Experience in GCP platform preferred "Good people beget good people."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Lead Data Scientist opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
    $75k-94k yearly est. 36d ago
  • Gastroenterologist Opening with Private Group in Mentor, Ohio

    Tenet Healthcare 4.5company rating

    Mentor, OH job

    OneGI is seeking a BC/ BE Gastroenterologist in Mentor, Ohio. A terrific opportunity to join an outpatient practice that provides world-class care! Highlights: General GI Practice; only 1 office location! APP support Infusion, Pathology, Imaging, Research, Anesthesia, Hem Banding available support services 1 ASC location with ownership potential 2-year practice partnership track Benefits: Competitive Base Salary with Competitive Production Earnings Sign On Bonus and Moving Expenses Medical, Dental, Vision, 401k Match Malpractice Insurance At One GI , we provide exceptional gastroenterology care that puts patients at the forefront. Since our inception in 2020, we have grown rapidly while remaining steadfast in our commitment to driving excellence and upholding the highest standards in gastroenterology practice. Our renowned physician leadership, collaborative team culture, state-of-the-art ancillary services, and robust network strength empower our physicians to deliver personalized, compassionate care tailored to each patient's unique needs. One GI is more than just an organization; it's a community of over 1,300 dedicated individuals united by a shared purpose: creating a better healthcare experience for patients, colleagues, and communities. We are a diverse team of professionals who bring our unique perspectives and expertise to the table, fostering an environment of collaboration and continuous improvement. Each One GI practice is the leading provider of gastroenterology care in its respective community, retaining its regional name and unique reputation while leveraging the expansive resources and backing of our national organization. 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.
    $157k-236k yearly est. 5d ago
  • Gastroenterology Opening with Private Group in Canton, Ohio

    Tenet Healthcare 4.5company rating

    Canton, OH job

    OneGI is seeking a BC/ BE Gastroenterologist to join an established practice in Canton, Ohio. A patient-centric group providing world-class care! Highlights: General GI Practice w/ APP support Pathology, Research, Imaging, Anesthesia support services Strong relationship with community hospital 1 ASC location with ownership potential 2-year practice partnership track Benefits: Competitive Base Salary with Competitive Production Earnings Sign On Bonus and Moving Expenses Medical, Dental, Vision, 401k Match Malpractice Insurance At One GI , we provide exceptional gastroenterology care that puts patients at the forefront. Since our inception in 2020, we have grown rapidly while remaining steadfast in our commitment to driving excellence and upholding the highest standards in gastroenterology practice. Our renowned physician leadership, collaborative team culture, state-of-the-art ancillary services, and robust network strength empower our physicians to deliver personalized, compassionate care tailored to each patient's unique needs. One GI is more than just an organization; it's a community of over 1,300 dedicated individuals united by a shared purpose: creating a better healthcare experience for patients, colleagues, and communities. We are a diverse team of professionals who bring our unique perspectives and expertise to the table, fostering an environment of collaboration and continuous improvement. Each One GI practice is the leading provider of gastroenterology care in its respective community, retaining its regional name and unique reputation while leveraging the expansive resources and backing of our national organization. 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.
    $29k-33k yearly est. 5d ago
  • Arizona Long Term Care ALTCS Case Manager

    Banner Health 4.4company rating

    Remote job

    Department Name: ALTCS CM Work Shift: Day Job Category: Clinical Care Estimated Pay Range: $26.40 - $44.00 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. **Travel is required for the role, must be located in Graham or Greenlee counties.** Recognized nationally as an innovative leader in health care, Banner Plans & Networks (BPN) integrates Medicare and private health plans to reduce healthcare costs while keeping our members in optimal health. Known for our innovative, collaborative, and team-oriented approach, BPN offers a variety of career opportunities and innovative employment options by offering remote and hybrid work settings. We are part of the insurance division with Banner Health. We service the Arizona long term care AHCCCS population. We case manage beneficiaries to ensure services are identified and authorized according to member's person centered assessments. The Case managers evaluate members and determine what type of services are required and authorize services. Our populations include members in the nursing home, assisted living, behavioral health settings and in member's home. Case managers day include phone calls, data entry, setting appointments for pre assessment call and assessments. Case managers travel to member's home. Assist with schedule medical appointments and transportation. Filing grievance from members. Collaborate with department nurses and behavioral health coordinators. Will attend community functions. 8am to 5pm Monday - Friday **Travel is required for the role, must be located in Graham or Greenlee counties.** Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs. POSITION SUMMARY This position is responsible for assessing, documenting and monitoring the overall functional, physical and behavioral health status of members assigned to them. Based on the assessments, the case manager, collaborating with the member and his/her support system, develops a service plan that meets member needs in the most cost-effective and most integrated setting. CORE FUNCTIONS 1. Is the primary contact for the ALTCS member, explaining the program to members, including their rights and responsibilities, the grievance and appeal system and other information according to regulations. 2. Comprehensively assesses and documents the member's bio psychosocial functioning in accordance with AHCCCS time frames, identifying the individual's strengths and needs. 3. Develop and implements a service plan based on the member's strengths, needs and placement preferences, authorizes and coordinates with provider agencies. 4. Assists the member to define personal goals, identifying barriers to achieving these goals and encouraging the member to resolve the difficulties identified. 5. Acts as a facilitator and/or advocate for the member in dealing with issues with providers, community programs or other organizations. 6. Acts as a gatekeeper to ensure that the member is receiving the most appropriate, cost-effective services in the most appropriate setting. 7. Facility based while remaining within budgetary allowances. Internal customers: all levels of nursing management and staff, medical staff, and all other members of the interdisciplinary healthcare team. External customers: physicians, payers, community agencies, provider networks and regulatory agencies. MINIMUM QUALIFICATIONS Knowledge, skills and abilities as normally obtained through the completion of a bachelor's degree in social work, and two years of experience serving persons who are elderly and/or persons with physical disabilities or who are determined to have a Serious Mental Illness (SMI). PREFERRED QUALIFICATIONS Bilingual, preferred in some assignments. Additional related education and/or experience preferred. EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy
    $26.4-44 hourly Auto-Apply 16d ago
  • Travel Nurse RN - Long Term Acute Care - $2,149 per week

    Healthtrust Workforce Solution External 4.2company rating

    Dayton, OH job

    HealthTrust Workforce Solution External is seeking a travel nurse RN Long Term Acute Care for a travel nursing job in Dayton, Ohio. Job Description & Requirements Specialty: Long Term Acute Care Discipline: RN Duration: 13 weeks 36 hours per week Shift: 12 hours, days Employment Type: Travel JA3 Pending approval position
    $79k-101k yearly est. 2d ago
  • Supervisor, Healthcare Services Operations Support - Remote in Ohio

    Molina Healthcare 4.4company rating

    Remote or Long Beach, CA job

    Leads and supervises a team supporting non-clinical healthcare services activities for care management, care review, utilization management, transitions of care, behavioral health, long-term services and supports (LTSS), and/or other program specific service support - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Supervises healthcare services operations support team members within Molina's clinical/healthcare services function, which may include care review, care management, and/or correspondence processing, etc. • Researches and analyzes the workflow of the department, and offers suggestions for improvement and/or changes to leadership; assists with the implementation of changes. • Conducts employee and team productivity/quality assurance checks and documents results for accuracy and time compliance. • Provides regular verbal and written feedback to staff regarding performance and opportunities for improvement. • Assists in the development and implementation of internal desktop processes and procedures. • Establishes and maintains positive and effective work relationships with coworkers, clients, members, providers, and customers. Required Qualifications • At least 5 years of operations or administrative experience in health care, preferably within a managed care setting, or equivalent combination of relevant education and experience. • Strong analytic and problem-solving abilities. • Strong organizational and time-management skills. • Ability to multi-task and meet project deadlines. • Attention to detail. • Ability to build relationships and collaborate cross-functionally. • Excellent verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Supervisory/leadership experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
    $57k-96k yearly est. Auto-Apply 20d ago
  • Hospice Medical Director - Remote Only, Per Diem, Flexible Schedule

    Banner Health 4.4company rating

    Remote or Greeley, CO job

    **Per Diem Hospice Medical Directorin Beautiful Northern, CO** **Remote Only & Flexible Schedule** **BANNER HEALTH and the Home Care & Hospice Division** , one of the countrys premier, nonprofit health care networks with more than 1,500 physicians and advance practice providers, **has an excellent opportunity for a compassionate, skilled clinician to join our interdisciplinary team!This position serves the growing community in Northern Colorado in partnership with the current care team.** Utilizing a multidisciplinary approach, the qualified candidate will provide remote support to the Home Care & Hospice team of Advanced Practice Providers. **Position Requirements and Information:** + BC/BE in a relevant specialty + Colorado state licensed + Fellowship training in Hospice & Palliative Medicine - NOT REQUIRED + Experience preferred, new graduates also welcome to apply + Flexible schedule primarily providing back-up coverage for the acting Medical Director **Compensation & Benefits:** + **$140/hr** + Malpractice and Tail Coverage **About the area:** With more than 300 days of sunshine, Northern Colorado is one of the best places to live and work offering spectacular views along the Rocky Mountain Front Range, great weather, endless recreational activities, cultural amenities, education, and professional opportunities. + Within one hour of majestic Rocky Mountain National Park & 90 minutes to world-class ski resorts + Numerous outdoor activities including golf, biking, hiking, camping, rock climbing, hunting, and fishing + Thriving cultural and retail sectors + Highly educated workforce & broad-based business sector leading to substantial growth along the front range + Variety of public and private education options for K-12 and easy access to three major universities **PLEASE SUBMIT YOUR CV TODAY FOR IMMEDIATE CONSIDERATION** As an equal opportunity employer, Banner Health values culture and encourages applications from individuals with varied experiences and backgrounds. Banner Health is an EEO Employer. POS15101 Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability.
    $140 hourly 42d ago
  • Cardiovascular Data Abstractor II

    HCA 4.5company rating

    HCA job in Houston, TX or remote

    Introduction Do you have the career opportunities as a Cardiovascular Data Abstractor II you want with your current employer? We have an exciting opportunity for you to join Parallon which is part of the nations leading provider of healthcare services, HCA Healthcare. Benefits Parallon offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: * Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. * Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. * Free counseling services and resources for emotional, physical and financial wellbeing * 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) * Employee Stock Purchase Plan with 10% off HCA Healthcare stock * Family support through fertility and family building benefits with Progyny and adoption assistance. * Referral services for child, elder and pet care, home and auto repair, event planning and more * Consumer discounts through Abenity and Consumer Discounts * Retirement readiness, rollover assistance services and preferred banking partnerships * Education assistance (tuition, student loan, certification support, dependent scholarships) * Colleague recognition program * Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) * Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. Our teams are a committed, caring group of colleagues. Do you want to work as a Cardiovascular Data Abstractor II where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise! Job Summary and Qualifications As a work from home Data Abstractor II, you will be responsible for abstraction of data for complex core measures, complex cardiovascular services and infectious disease data. What you will do in this role: * Completes abstraction process for assigned facility(ies), including abstraction of cases into the required system (e.g., COMET, TheraDoc, Digital Innovations, NHSN, etc.). * Responsible for reviewing medical records to abstract information according to the standards of various regulatory and accreditation agencies (e.g., CMS, TJC, NHSN, etc.). * Performs timely abstraction to ensure compliance with standards. * Completes edit checks and makes appropriate changes on a timely basis. * Follow standards and CSG/Parallon instructions to abstract all reportable cases. * Assist with case follow-up as requested. * Attend educational activities as approved by Manager or Director. * Maintain clinical knowledge of various abstracted measures. * Communicate in a timely manner with manager to achieve measure compliance. * Submit data timely through the appropriate reporting system. * Resolve errors resulting in the rejection of records from the data entry system. What qualifications you will need: * 2+ years of experience in Health Information Management; Coding, Nursing, and/or Health Registry abstraction experience required * Completion of a certified coding or nursing program strongly preferred * RHIT, RHIA, CCS certification strongly preferred * LVN or RN preferred * Undergraduate degree in a healthcare related field required. Extensive experience (5 years or more) may be considered in lieu of formal education. " Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. " "Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Cardiovascular Data Abstractor II opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
    $71k-90k yearly est. 8d ago
  • Data Science Director

    HCA Healthcare 4.5company rating

    HCA Healthcare job in Nashville, TN or remote

    is incentive eligible. **Introduction** Do you want to join an organization that invests in you as a(an) Data Science Director? At Work from Home, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. **Benefits** Work from Home offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity and Consumer Discounts + Retirement readiness, rollover assistance services and preferred banking partnerships + Education assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) + Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits (********************************************************************** **_Note: Eligibility for benefits may vary by location._** You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated Data Science Director like you to be a part of our team. **Job Summary and Qualifications** At HCA Healthcare, we are committed to providing our patients and care providers with the highest quality of healthcare services. HCA's Digital Transformation and Innovation (DT&I) team delivers a step change in that direction through clinically led integration of digital and AI technologies into care. The Director, Data Science is a technical managerial position that provides technical and organizational leadership to deliver Data Science products. This person engages with department leadership to understand strategy to align long term data science initiatives and budgets with product roadmaps and business requirements. This person guides planning, development, and implementation of components with the Data Science team. This role is expected to drive a positive change throughout the organization (both Business and Technology) and is expected to show empathy for the stakeholders and build products which deliver a delightful experience. **What You will do:** + DATA SCIENCE LEADERSHIP: Manage, mentor, and coordinate teams of data scientists, product managers, analysts, and vendors/contractors to meet project goals and expectations. Facilitate the team to master full stack technical capabilities. Deep dive with Data Scientists on the design and performance of AI services. Explain data science approach and results to Business and IT stakeholders in understandable terms. + AGILE AND VALUE BASED DELIVERY: Lead, research, strategize, design, implement, document and evangelize Data Science products from incubation to deployment to monitoring. Responsible for team level OKRs related to product modules and agile delivery. + FRAMEWORK, TOOLING, AND BEST PRACTICES: Facilitate the delivery of enterprise wide, production grade, and accurate data science products by establishing and standardizing tooling and process frameworks for best practices that produce maintainable code, automated testing, and CI/CD. Enable good developer experience in code-centric and low-code environments. + CODE AND DELIVERABLE QUALITY: Provide technical code review for delivery work; ensure adherence to Responsible AI framework, ensure model interpretability, explainability, and model KPIs (both functional and non-functional) + STRATEGIC LEADERSHIP: Actively participate in the development of the company's data science strategy and roadmap, working closely with senior leadership. + DOMAIN LEADERSHIP: Stay up-to-date with healthcare industry trends and AI technologies, bringing new ideas and best practices to the team + PRODUCT DEVELOPMENT MINDSET: Communicate with senior management and stakeholders to ensure alignment of goals and priorities through an unrelenting focus on end users. Develop and track data product OKRs for measurable value creation for the enterprise. + Performs other duties as assigned + Practices and adheres to the "Code of Conduct" philosophy and "Mission and Value Statement." + Typical work week hours can vary depending on workload and project deliverables **What qualifications you will need:** + Bachelor Degree Required + Masters/PhD Degree Preferred + 8+ years of overall experience in various aspects of data science, machine learning, and generative AI with demonstrated progressive responsibilities + Expert experience in SQL and Python + Experience with structured and unstructured data (i.e.. tabular, text, images, video, etc.) + Experience with SQL relational and non-relational databases + Experience with data processing and ETL tools (e.g. dbt) + Experience with data visualization and data monitoring tools + Experience with Infrastructure as Code (IAC) such as Terraform, Github Actions, and Docker + Experience with cloud deployments in GCP or another cloud platform + Experience with Agile development methods and tools (e.g. Azure Dev Ops) + Excellent communication and collaboration skills, with the ability to work effectively across multiple teams and stakeholders + Strong leadership skills with a proven track record of motivating, mentoring, and managing multidisciplinary data science and engineering teams + Ability to tell a story using data and insights that drives action and change + Demonstrated leadership in a fast-paced environment with decisiveness, consensus-building, empathy and kindness Preferred Skills: + Healthcare domain knowledge and experience + Strong project management skills with the ability to manage multiple projects simultaneously + Agile Delivery, Product Management, or Scrum Master certifications + Experience managing and unblocking teams in GCP platform "Good people beget good people."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Data Science Direcctor opening. Qualified candidates will be contacted for interviews. **Submit your resume today to join our community of caring!** We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
    $77k-100k yearly est. 60d+ ago
  • Facility Coding Inpatient DRG Quality Analyst

    Banner Health 4.4company rating

    Remote job

    Department Name: Coding-Acute Care Compl & Educ Work Shift: Day Job Category: Revenue Cycle Estimated Pay Range: $29.11 - $48.51 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. Innovation and highly trained staff. Banner Health recently earned Great Place To Work Certificationâ„¢. This recognition reflects our investment in workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of our team members. Find out how we're constantly improving to make Banner Health the best place to work and receive care. Interested in joining our Coding team? We have great opportunities, whether you're looking for entry-level or have been coding for years! Requirements for each position noted below. Not the right fit for you? Keep looking! We have a lot different teams with different focuses (Facility vs Profee). In this Inpatient Facility-based HIMS Coding Quality Associate position, you bring your 5 years of acute care inpatient coding background to a team that values growth and development! This is a Quality position, not a day-to-day coding production role but does require coding proficiency and recent Hospital Facility Coding experience. This position is task-production-oriented ensuring quality in the Inpatient Facility Coding department. If you have experience with DRG and PCS coding/denials/audits, we want to hear from you. Schedule: Full time, Monday-Friday 8am-5pm during training. Flexible scheduling after completion of training. Location: REMOTE, Banner provides equipment Ideal candidate: 5 years recent experience in acute-care Inpatient facility-based medical coding (clearly reflected in your attached resume); DRG and PCS Coding, Auditing experience; Bachelors degree or equivalent; Must be currently certified through AAPC or Ahima, as defined in minimum qualifications below. Please upload a copy or provide certification number in your questionnaire. This is a fully remote position and available if you live in the following states only: AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, MI, MN, MO, MS, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI & WY. Interested in joining our Coding team? We have great opportunities, whether you're looking for entry-level or have been coding for years! Requirements for each position noted below. Not the right fit for you? Keep looking! We have a lot different teams with different focuses (Facility vs Profee). Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care. POSITION SUMMARY This position is responsible for the interpretation of clinical documentation completed by the health care team for the health record(s) and for quality assurance in the alignment of clinical documentation and billing codes. Works with clinical documentation improvement and quality management staff to: align diagnosis coding to documentation to improve the quality of clinical documentation and correctness of billing codes prior to claim submission; to identify possible opportunities for improvement of clinical documentation and accurate MS-DRG, Ambulatory Payment Classification (APC) or ICD-10 assignments on health records. Provides guidance and expertise in the interpretation of, and adherence to, the rules and regulations for code assignment based on documentation for all levels of complexity to include accounts encountered in Banner's Academic, Trauma, high acuity and critical access facilities, as well as specialized services such as behavioral health, oncology, pediatric. Acts as subject matter expert regarding experimental and newly developed procedure and diagnostic coding. CORE FUNCTIONS 1. Provides guidance on coding and billing, utilizing coding and billing guidelines. Demonstrates extensive knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment Classification (APC) or utilized operational systems. Provides explanatory and reference information to internal and external customers regarding coding assignment based on clinical documentation which may require researching authoritative reference information from a variety of sources. 2. Reviews medical records. Performs an audit of clinical documentation to ensure that clinical coding is accurate for proper reimbursement and that coding compliance is complete. Provides feedback on coding work and trends, and offers suggestions for improvement where opportunities are identified. Reviews accuracy of identified data elements for use in creating data bases or reporting to the state health department. If applicable, applies Uniform Hospital Discharge Data Set (UHDDS) definitions to select the principal diagnosis, principal procedure, complications and co morbid condition, other diagnoses, and significant procedures which require coding. Apply policies and procedures on health documentation and coding that are consistent with official coding guidelines. 3. Assists with maintaining system wide consistency in coding practices and ethical coding compliance. If applicable, initiates and follows through on physician queries to ensure that code assignment accurately reflects the patient's condition, treatment and outcomes. Identifies training needs for coding staff. Serves as a team member for internal coding accuracy audits and documents findings. 4. Acts as a knowledge resource to ancillary clinical departments, patient financial services and revenue integrity analysts regarding charge related issues, processes and programming. Participates in company-wide quality teams' initiatives to improve coding and clinical documentation. Assists with education and training of staff involved in learning coding. Assists in creating a department-wide focus of performance improvement and quality management. Assists and participates with management through committees to properly educate physicians, nursing, coders, CDM's, etc. with proper and accurate coding based on documentation for positive outcomes. 5. Performs ongoing audits/review of inpatient and/or outpatient medical records to assure the use of proper diagnostic and procedure code assignments. Collaborates on DRG and coding denials, billing edits/rejections to provide coding expertise to resolve issues and support appropriate reimbursement. Proficiency in claims software to address coding edits and claim denials utilizing multiple platforms and internal tracking tools. Provides findings for use as a basis for development of coding education and audit plans. 6. Maintains a current knowledge in all coding regulatory updates, and in all software used for coding, coding reviews and health information management for the operational group. Identifies and collects data to allow for monitoring and evaluation of trends in DRG (MS/APR-DRG), APC, HCC, other Heath Risk Adjusted Factors, National Correct Coding Initiative (NCCI) and the effect on Case Mix Index by use of specialized software. 7. May code inpatient and outpatient records as needed. Works as a member of the overall HIMS team to achieve goals in days-to-bill. 8. Works independently under limited supervision. Uses an expert level of knowledge to provide coding and billing guidance and oversight for all Banner facilities and services they provide. Internal customers include but are not limited to medical staff, employees, and management at the local, regional, and corporate levels. External customers include but are not limited to, practicing physicians, vendors, and the community. MINIMUM QUALIFICATIONS Requires a level of education as normally demonstrated by a bachelor's degree in Health Information Management or experience equivalent to same. Demonstrated proficiency in hospital coding as normally obtained through 5 years of current and progressively responsible coding experience required. Requires Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC) or Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) or Certified Coding Specialist-Physician (CCS-P) or Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) or other qualified coding certification in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC). Demonstrated proficiency in hospital coding as normally obtained through 5 years of current and progressively responsible coding experience required. Must possess a thorough knowledge of ICD Coding and DRG and/or CPT coding principles, as recommended by the American Health Information Management Association coding competencies. Requires an in-depth knowledge of medical terminology, anatomy and physiology, plus a thorough understanding of the content of the clinical record. Extensive knowledge of all coding conventions and reimbursement guidelines across services lines, LCD/NCDs and MAC/FIs. Extensive critical and analytical thinking skills required. Ability to organize workload to meet deadlines and maintain confidentiality. Excellent written and oral communication skills are required, as well as effective human relations skills for building and maintaining a working relationship with all levels of staff, physicians, and other contacts. Must consistently demonstrate the ability to understand the Medicare Prospective Payment System, and the clinical coding data base and indices, and must be familiar with coding and abstracting software, claims processing tools, as well as common office software and electronic medical records software. PREFERRED QUALIFICATIONS Additional related education and/or experience preferred. EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy
    $29.1-48.5 hourly Auto-Apply 16d ago
  • Inpatient Coding Quality Auditor

    HCA 4.5company rating

    HCA job in Houston, TX or remote

    Introduction Do you want to join an organization that invests in you as an Inpatient Coding Quality Auditor? At Parallon, you come first. HCA Healthcare has committed up to 300 million in programs to support our incredible team members over the course of three years. Benefits Parallon offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: * Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. * Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. * Free counseling services and resources for emotional, physical and financial wellbeing * 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) * Employee Stock Purchase Plan with 10% off HCA Healthcare stock * Family support through fertility and family building benefits with Progyny and adoption assistance. * Referral services for child, elder and pet care, home and auto repair, event planning and more * Consumer discounts through Abenity and Consumer Discounts * Retirement readiness, rollover assistance services and preferred banking partnerships * Education assistance (tuition, student loan, certification support, dependent scholarships) * Colleague recognition program * Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) * Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. You contribute to our success. Every role has an impact on our patients' lives and you have the opportunity to make a difference. We are looking for a dedicated Coding Quality Audit Reviewer like you to be a part of our team. Job Summary and Qualifications As a work from home Inpatient Coding Auditor, you will be responsible for performing internal quality assessment reviews on Health Information Management Service Center (HSC) coders to ensure compliance with national coding guidelines, the HSC coding policies and the Company coding policies for complete, accurate and consistent coding which result in appropriate reimbursement and data integrity. You will review outcomes are communicated to the HSC team to improve the accuracy, integrity and quality of patient data, to ensure minimal variation in coding practices and to improve the quality of physician documentation within the body of the medical record to support code assignments. What you will do in this role: * Leads, coordinates and performs all functions of quality reviews (routine, pre-bill, policy driven and incentive plan driven) for inpatient and/or outpatient coding across multiple HSCs * Assists in ensuring HSC coding staff adherence with coding guidelines and policy * Demonstrates and applies expert level knowledge of medical coding practices and concepts * Participates on special reviews or projects * Maintains or exceeds 95% productivity standards * Maintains or exceeds 95% accuracy * Meets all educational requirements as stated in current Company policy * Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current What qualifications you will need: * High school diploma and/or GED preferred * Undergraduate degree in HIM/HIT preferred * Minimum of 3 years acute care inpatient/outpatient coding experience preferred * Minimum of 3 years coding auditing/monitoring experience strongly preferred * RHIA, RHIT and/or CCS preferred Please visit our Parallon HCA Healthcare Coding Landing Page for more information on Coding Opportunities. CLICK HERE for more information on Parallon HCA Coding Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Good people beget good people."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Coding Quality Audit Reviewer opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
    $36k-60k yearly est. 10d ago
  • Revenue Integrity Director- Remote

    Tenet Healthcare Corporation 4.5company rating

    Remote or Frisco, TX job

    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. **********
    $104.6k-157k yearly 60d+ ago
  • Care Transformation Intern

    Banner Health 4.4company rating

    Remote job

    Department Name: Digital Transform Fdn Clin App Work Shift: Day Job Category: General Operations Estimated Pay Range: $19.00 - $19.00 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. Find your path in health care. We want to change the lives of those in our care - and the people who choose to take on this challenge. If you're ready to change lives, we want to hear from you. This is a temporary part-time Internship position working in either Colorado or Arizona, 20hr/wk, typically 8:00a-1:00pm with some flexibility. This opportunity is open to Graduate level students pursuing degrees in Health Informatics, Data Analytics, Public Health, or related field, with strong analytical skills, attention to detail, and experience with Python. In this internship you will have the opportunity to work with our Quality Improvement team by reviewing and validating datasets prior to submission to National and State Registries. * Please note the email you apply with is where all updates and information will be sent to, even after you graduate. We recommend applying with a personal email rather than a school email address. Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care. POSITION SUMMARY This position typically will be up to one year in length and will work under the direct supervision of a department manager or designee. The position is responsible for expanding experiences and knowledge of practices and procedures as they relate to assigned department and area of study. These activities may include participation in a wide variety of projects. CORE FUNCTIONS 1. Expands and develops knowledge with exposure to a variety of roles related to area of study. 2. Participates on work teams, contributes to projects and initiatives, and performs various tasks as needed by the assigned unit/department. 3. Performs research and prepares reports on assigned topics and /or projects when required. 4. Works as a member of a team providing service to internal and external customers. MINIMUM QUALIFICATIONS Currently enrolled in an accredited college program with course work related to the internship or general knowledge normally obtained through the completion of a college degree. Must demonstrate effective verbal and written communication skills. Must have general knowledge related to the department/unit/area of study. PREFERRED QUALIFICATIONS Proficiency with commonly used office software and personal computers may be necessary, depending on assignment. Additional related education and/or experience preferred. EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy
    $19-19 hourly Auto-Apply 9d ago
  • PFS CBO Insurance Followup Ambulatory Denials

    Banner Health 4.4company rating

    Remote job

    Department Name: Amb Billing & Follow Up Work Shift: Day Job Category: Revenue Cycle Estimated Pay Range: $18.02 - $27.03 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. Innovation and highly trained staff. Banner Health recently earned Great Place To Work Certificationâ„¢. This recognition reflects our investment in workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of our team members. Find out how we're constantly improving to make Banner Health the best place to work and receive care. The PFS Insurance Follow-Up Representative (Ambulatory Denials) is responsible for following up with assigned payer for various denials, such as no authorization, eligibility denials, etc. This position is a higher-level PFS role, as it does range across all groups of patients and all types of provider specialties. Experience within medical insurance accounts receivable (AR) and physician fee-for-service billing is ideal. Location: Remote Schedule: Monday-Friday, varying shifts 6am-6pm after successful completion of training program. Ideal Candidate: Minimum of 1 year experience in Medical Insurance AR and/or Physician Fee for Service Billing clearly reflected in uploaded resume; Minimum of 1 year experience writing appeal letters for payer/payor denials; Intermediate to Advanced skill level in Microsoft Excel. This can be a remote position if you live in the following state(s) only: AL, AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, LA, MD, MI, MN, MO, MS, NC, ND, NE, NH, NY, NM, NV, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI, WV, WY Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care. POSITION SUMMARY This position coordinates and facilitates patient billing and collection activities in one or more assigned areas of billing, payment posting, collections, payor claims research, and other accounts receivable work. Works as a member of a team to ensure reimbursement for services in a timely and accurate manner. CORE FUNCTIONS 1. May be assigned to process payments, adjustments, claims, correspondence, refunds, denials, financial/charity applications, and/or payment plans in an accurate and timely manner, meeting goals in work quality and productivity. Coordinates with other staff members and physician office staff as necessary ensure correct processing. 2. As assigned, reconciles, balances and pursues account balances and payments, and/or denials, working with payor remits, facility contracts, payor customer service, provider representatives, spreadsheets and the company's collection/self-pay policies to ensure maximum reimbursement. 3. May be assigned to research payments, denials and/or accounts to determine short/over payments, contract discrepancies, incorrect financial classes, internal/external errors. Makes appeals and corrections as necessary. 4. Builds strong working relationships with assigned business units, hospital departments or provider offices. Identifies trends in payment issues and communicates with internal and external customers as appropriate to educate and correct problems. Provides assistance and excellent customer service to these internal clients. 5. Responds to incoming calls and makes outbound calls as required to resolve billing, payment and accounting issues. Provides assistance and excellent customer service to patients, patient families, providers, and other internal and external customers. 6. Works as a member of the patient financial services team to achieve goals in days and dollars of outstanding accounts. Reduces Accounts Receivable balances. 7. Uses systems to document and to provide statistical data, prepare issues list(s) and to communicate with payors accurately. 8. Works independently under general supervision, following defined standards and procedures. Reports to a Supervisor or Manger. Uses critical thinking skills to solve problems and reconcile accounts in a timely manner. External customers include all hospital patients, patient families and all third party payers. Internal customers include facility medical records and patient financial services staff, attorneys, and central services staff members. MINIMUM QUALIFICATIONS High school diploma/GED or equivalent working knowledge. Requires knowledge of patient financial services, financial, collecting services or insurance industry experience processes normally acquired over one or more years of work experience. Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently. Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences. Strong knowledge in the use of common office software, word processing, spreadsheet, and database software are required. PREFERRED QUALIFICATIONS Work experience with the Company's systems and processes is preferred. Previous cash collections experience is preferred. Additional related education and/or experience preferred. EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy
    $18-27 hourly Auto-Apply 2d ago
  • Care Transformation Program Manager

    Banner Health 4.4company rating

    Remote job

    Department Name: Care Transformation Work Shift: Day Job Category: General Operations Estimated Pay Range: $32.09 - $53.48 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. Banner Plans & Networks (BPN) is an integrated network for Medicare and private health plans. Known nationally as an innovative leader, BPN insurance plans and physicians work collaboratively to keep members in optimal health while reducing costs. Supporting our members and vast network of providers is a team of professionals known for innovation, collaboration, and teamwork. If you would like to contribute to this leading-edge work, we invite you to bring your experience and skills to BPN. The Care Transformation Program Manager will support network performance by organizing, structuring and analyzing performance data to identify operational opportunities, trending data and developing reports that will be used in a variety of meetings. Will be responsible for creating solutions, not managing established processes. The ideal candidate will have a strong data analytics and data reporting background with Excel and PowerBI experience. Schedule Generally Monday - Friday 8am - 5pm Hybrid most work can be done remotely with occasional travel to Phoenix Corporate or Mesa Corporate. Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs. POSITION SUMMARY This position provides oversight of the Care Transformation department initiatives, projects, communications and operational work that is provided by the Care Transformation department. This position will support leadership in development and implementation of processes to increase efficiency and effectiveness in successfully achieving department and organizational goals. CORE FUNCTIONS 1. Serves as an example to peers for both behaviors and performance of job functions. Provides Managerial Care Transformation experience and training to Care Transformation representatives, and acts as a knowledge resource for internal customers. Serve as a primary resource in complex and/or sensitive cases. 2. Provides coaching, training, staff development, mentoring and overall support to assigned staff. Participation and responsibilities related to performance evaluation, performance improvement, coaching, training, mentoring, and time card processes. Creates a strong culture of engagement, inclusiveness, creativity, knowledge sharing to support the provider relations team and department. 3. Provides collaborative approach with leadership, partner departments and contracted providers in leading this work. 4. Create, develop, and manage communication materials, letters, content for provider newsletters, power point presentations, and other Care Transformation or provider communication resources as required. 5. Oversee, coordinate, and support provider engagement, and communications. Maintains all levels of communication with network providers, informing them of any operational, procedural, and contractual changes and updates. 6. Support Directors to consistently meet monthly goals as determined by management. Assists Directors with network development in various geographic regions within the organization, negotiates, implements and maintains managed care initiatives with payers and providers. 7. Works cohesively with appropriate parties to ensure delivery of outstanding customer service while facilitating timely research and issue resolution, in a positive work environment, that supports the department's ongoing goals and objectives. 8. Works on special projects as assigned. 9. Assists in the development and maintenance of a comprehensive provider network for Banner Networks. The incumbent must have a thorough understanding of managed care, medical office procedure, provider relations experience, medical claims and contracting. In addition, the incumbent must have excellent verbal and written communication skills, determine work priorities and is expected to accomplish all tasks with minimal supervision and instruction. Experience required in direct supervision and coaching of assigned teams. Analytical knowledge required. MINIMUM QUALIFICATIONS Must possess a strong knowledge of healthcare as normally obtained through the completion of a bachelor's degree in business, healthcare administration, or related work experience. Requires a proficiency level typically acquired through a minimum of four years of experience in healthcare operational/financial management or related field. Must have an excellent understanding of medical terminology and knowledge of CPT and ICD-10 coding. Must have an understanding of HEDIS, STARS and other value-based performance initiatives as required by government programs. Must have the ability to effectively communicate both verbally and in writing. Must know how or learn to program data retrieval utilities and queries. The incumbent must possess the ability to track and analyze statistical data. This position requires a mathematical aptitude, computer experience, typing skills and the ability to work on a variety of projects in an organized fashion. Adept at creating and communicating a clear and detailed program plan to internal/external stakeholders, effectively aligning resources and motivating multi-disciplinary teams to achieve goals and create partnership-style relationships. Demonstrated technical, organizational, project management and negotiation capabilities. Proficient in written communications, power point and presentations. Must be a self-starter with excellent ability to implement and execute. Ability to balance the big picture with the day-to-day delivery details, connecting key project needs and internal resources to prioritize the workload. Strong desire to improve the lives of patients, their care givers, and families. Possesses compassion and empathy coupled with accountability and execution. Requires proficiency in the use of sophisticated software programs. PREFERRED QUALIFICATIONS Five to ten years of experience in the healthcare field preferred, preferably in a managerial or supervisory capacity. Two years of medical office and/or provider representative experience is preferable. Additional related education and/or experience preferred. EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy
    $32.1-53.5 hourly Auto-Apply 3d ago
  • Associate Specialist, Appeals & Grievances

    Molina Healthcare 4.4company rating

    Cincinnati, OH job

    Provides entry level support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Enters denials and requests for appeals into information system and prepares documentation for further review. - Researches claims issues utilizing systems and other available resources. - Assures timeliness and appropriateness of appeals according to state, federal and Molina guidelines. - Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. - Determines appropriate language for letters and prepares responses to member appeals and grievances. - Elevates appropriate appeals to the next level for review. - Generates and mails denial letters. - Provides support for interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. - Creates and/or maintains appeals and grievances related statistics and reporting. - Collaborates with provider and member services to resolve balance bill issues and other member/provider complaints. **Required Qualifications** - At least 1 year of experience in claims, and/or 1 year of customer/provider service experience in a health care setting, or equivalent combination of relevant education and experience. - Customer service experience. - Organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting experience. - Completion of a health care related vocational program (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $34.88 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $21.7-34.9 hourly 5d ago
  • Dietitian

    HCA Healthcare 4.5company rating

    HCA Healthcare job in El Paso, TX or remote

    **Introduction** Do you have the career opportunities as a(an) Dietitian you want with your current employer? We have an exciting opportunity for you to join Las Palmas Medical Center which is part of the nation's leading provider of healthcare services, HCA Healthcare. **Benefits** Las Palmas Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. + Free counseling services and resources for emotional, physical and financial wellbeing + 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny and adoption assistance. + Referral services for child, elder and pet care, home and auto repair, event planning and more + Consumer discounts through Abenity and Consumer Discounts + Retirement readiness, rollover assistance services and preferred banking partnerships + Education assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) + Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits (********************************************************************** **_Note: Eligibility for benefits may vary by location._** Our teams are a committed, caring group of colleagues. Do you want to work as a(an) Dietitian where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise! **Job Summary and Qualifications** POSITION SUMMARY: Directs the evidence-based Medical Nutrition Plan of Care for hospitalized patients determined to be at moderate to complex nutritional risk. POPULATION SERVED: Core competencies will be assessed primarily on the following patient population(s) served: acute medical/ surgical care of diseases and conditions including but not limited to: cardiovascular (cardiac medical only) pulmonary, neuron, GI, GU, GYN, skeletal/muscular, renal, ortho conditions and diseases including but not limited to: AMI, CAD, PVD, CVA/TIA, COPD, CHF, shock, renal failure, metabolic disorders, etc. ESSENTIAL FUNCTIONS: + Assesses patients for risk for potential malnutrition, & consults with members of the health care team to provide best practice. + Demonstrates ability to assess & develop nutrition plan of care for patients with moderate to complex nutritional risk. + Educate patients/families, community providers & the medical team of Medical Nutrition Plan of Care. + Achieves & maintains evidence based clinical expertise by participating in professional development activities. + Work in off-site facilities, ie LP Rehab Hospital, as needed + Assist in Support groups as needed on weekends, and nights. + Participate as needed in educational seminars during weekends and nights. + Demonstrates ability to assess & develop nutrition plan of care for patients with moderate to complex nutritional risk in other areas within the outpatient services department i.e. Kidney Transplant center and other Life Care Center service lines. + Other duties as assigned. **What qualifications you will need:** EDUCATION REQUIRED AND/OR PREFERRED: (list required and preferred separately) REQUIRED + Four-year degree in food and nutrition and successful completion of experience through ADA program as evidenced by diploma or certificate of completion. LICENSURE/CERTIFICATION: (list required and preferred separately) REQUIRED + Registered Dietitian by the Commission on Dietetic Association required, or must be obtained within 3 months of employment + Licensed by the State of Texas required, or must be obtained within 3 months of employment. EXPERIENCE REQUIRED OR PREFERRED: (list required and preferred separately) PREFERRED + Minimum of 1 year of clinical hospital experience. SKILLS, KNOWLEDGE, AND ABILITIES: PREFERRED + Ability to deal with employees, physicians, patients, and visitors, to understand and follow oral and written English instructions, to maintain effective working relationship with fellow employees, to read, understand and communicate in English related to nutritional standards. + Experience in heavy demand, fast paced environment. + Bilingual in English/Spanish. Las Palmas Medical Center (************************************************************************* is a **300+ bed** full-service hospital in El Paso. It is home to **the region's only** kidney transplant center (********************************************************* . The facility offers a range of services (*************************************************************************************** including emergency care with a **Level III trauma center** , cardiac care, women's services, pediatric care and NICU, cancer care, and more. Las Palmas Medical Center is part of Las Palmas Del Sol Healthcare. We are a leading healthcare provider for El Paso and the surrounding region that is part of HCA Healthcare. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Dietitian opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. **Unlock the possibilities and apply today!** We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
    $57k-67k yearly est. 60d+ ago
  • Cybersecurity Network Security Engineer III

    Banner Health 4.4company rating

    Remote job

    Department Name: IT Data Protection-Corp Work Shift: Day Job Category: Information Technology Estimated Pay Range: In accordance with State Pay Transparency Rules. Banner Health was named to Fortune's Most Innovative Companies in America 2025 list for the third consecutive year and named to Newsweek's list of Most Trustworthy Companies in America for the second year in a row. We're proud to be recognized for our commitment to the latest health care advancements and excellent patient care. The Cybersecurity Network Engineering Team at Banner Health plays a critical role in safeguarding one of the most vital sectors-healthcare. As part of Banner Health's broader cybersecurity and business strategy, this team is dedicated to detecting, mitigating, and preventing network threats before they can impact patient care or sensitive data. By leveraging advanced technologies and modern security frameworks, the department ensures that the organization's digital infrastructure remains resilient, compliant, and aligned with the mission of delivering safe, uninterrupted healthcare services. Team members are key contributors to implementing the organization's Zero Trust Network Access (ZTNA) vision, engineering secure solutions that protect both internal and external access to systems and applications. A day in the life of a Cybersecurity Network Engineer at Banner Health is dynamic and impactful. You'll collaborate with cross-functional teams to analyze network traffic, fine-tune security controls, and respond to real-time detections that help prevent potential cyber incidents. Your toolkit will include industry-leading technologies such as Zscaler, Cloud Browser Isolation (CBI), Web Application Firewalls (WAFs), IDS/IPS, and API security platforms, all essential to defending against evolving threats. Beyond operational responsibilities, you'll design and implement new security architectures, contribute to the development of secure access models, and ensure certificate management and governance are seamlessly executed. Each day presents the opportunity to enhance both your technical expertise and Banner Health's cybersecurity maturity-protecting what matters most: patient trust and safety. Schedule: Monday - Friday 8am - 5pm AZ Time This is a fully remote position and available if you live in the following states only: AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, MD,MI, MN, MO, MS, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WV, WA, WI & WY. Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care. POSITION SUMMARY This position leads the designs, develops, configures, implements, tunes, maintains solutions, resolve technical and business issues related to cybersecurity threat & vulnerability management, identity management, security operations center, forensics, and data protection. Cybersecurity Engineers work with Cybersecurity Architects to execute strategic cyber initiatives, evaluate security components of the network, applications and end-user devices, and provides guidance to ensure new systems meet regulatory and technical standards. Cybersecurity Engineers leads root-cause analysis on Cyber systems to determine improvement opportunities when failures occur. Cybersecurity Engineers work closely with other IT organizations to ensure cyber products are working and integrating with non-cyber environments (apps, networks, End User devices, Servers, etc). CORE FUNCTIONS 1. Proactively initiates the design and implementation of cybersecurity solutions, upgrades, enhancements, while looking forward three to five years. 2. Leads in providing technical expertise and support for cybersecurity solutions, including operational aspects of the software. 3. Serves as subject matter expert in the design, implementation, and compliance of secure baseline configurations for applications and infrastructure components. 4. Proactively initiates technical assessments of systems and applications to ensure compliance with policy, standards and regulations. 5. Authors new cybersecurity standards and procedures. Leads the revision of existing cybersecurity policies, standards, and procedures, as needed. 6. Serves as technical leader for cybersecurity projects, including the development of project scope requirements, budgeting, work breakdown and operational handoff. 7. Identify threats and develop suitable defense measures, evaluate system changes for security implications, and recommend enhancements, research, and draft cybersecurity white papers, and provide first-class support to the cybersecurity operations staff for resolving difficult cybersecurity issues. 8. Under limited direction, self starter, this position is responsible for cybersecurity across multiple departments system-wide and requires interaction at all levels of staff and management. Work closely on cross functional IT Teams. Leads work through indirect leadership across other cyber resources. Articulate complex Security functions into simple business ease. MINIMUM QUALIFICATIONS Must possess strong knowledge of business, information security and/or computer science as normally obtained through the completion of a bachelor's degree. Bachelor's Degree in Computer Science, Information Security, Information Systems, or related field, or equivalent. Experience normally obtained through seven plus years of experience of enterprise-scale information security engineering, preferably in healthcare. Must also possess three plus years' experience in a healthcare environment or an equivalent combination of relevant education, technical, business and healthcare experience. Experience with IT operations, automation of security processes, coding and scripting languages, ability to document security processes as well as use case development. Experience with the assessing cyber products, including vendor selection, define requirements, contractual documentation development. Experienced assessing and reaching out to vendors for needed features via enhancement requests. Expert understanding of regulatory and compliance mandates, including but not limited to HIPAA, HITECH, PCI, Sarbanes-Oxley. Experienced in planning, designing and implementing cybersecurity solutions, operating, maintaining and managing the lifecycle of cybersecurity solutions. Advanced knowledge of Security Engineering Principles, including risk management, resilience, vulnerability management, Information Security, NIST, MITRE ATT@CK, etc. Advanced expertise in Cyber products supporting Data Loss Prevention, EDR, AntiVirus, Perimeter services, threat systems, cyber platform analytics, SIEM, CASB, CLOUD Security, ETC. Proven Cloud Security experience. Requires independent judgment, critical decision making, excellent analytical skills, with excellent verbal and written communications. Ability to think quickly under difficult or complex conditions and clearly communicate to appropriate staff; ability to balance project workloads with customer support and on-call demands. Must demonstrate deep knowledge of information technology and information security principles and practices. Requires communication and presentation skills to engage technical and non-technical audiences. Requires ability to communicate and interact across facilities and at various levels. Incumbent will have skills to mentor less experienced team members. As is typical in this industry, variable shifts and hours and responding to after-hours notifications may be required. PREFERRED QUALIFICATIONS Certification in two or more of the following areas Systems Security Certified Practitioner (SSCP), HealthCare Information Security & Privacy Practitioner, (HCISPP), CompTIA Security+, Certified Information Systems Security Professional (CISSP) - Engineering (ISSEP), Certified Ethical Hacker (CEH), SANS GIAC, or Certified Information Systems Auditor (CISA). Four plus years as a System Administrator or in IT Operations. Or four plus years in risk management or GRC experience in the healthcare/medical environment. Five plus years' experience in a healthcare environment or an equivalent combination of relevant education, technical, business and healthcare experience. Additional related education and/or experience preferred. Anticipated Closing Window (actual close date may be sooner): 2026-05-20 EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy
    $52k-66k yearly est. Auto-Apply 3d ago
  • Collections Specialist II-Remote

    Community Health Systems 4.5company rating

    Remote or Franklin, TN job

    The Collections Specialist II is responsible for managing outstanding patient accounts, ensuring accurate and timely collections from insurance companies, third-party payers, and self-pay patients. This role requires strong knowledge of insurance processes, medical billing, and collection regulations to maximize reimbursement and minimize bad debt. The Collections Specialist II works independently to research accounts, resolve payment discrepancies, and negotiate payment arrangements while maintaining compliance with federal, state, and organizational guidelines. **This position is REMOTE** **Essential Functions** + Manages assigned inventory of outstanding patient accounts, following up on insurance, third-party, and self-pay balances to ensure timely payment collection. + Reviews and analyzes patient accounts, identifying alternative payment options, including insurance coverage, financial assistance programs, or legal action when necessary. + Communicates with patients, guarantors, and insurance representatives via phone, email, and written correspondence to secure outstanding balances. + Understands and explains the litigation process and its requirements, providing guidance on legal collections procedures when applicable. + Resolves claim denials and payment discrepancies, working with payers and internal revenue cycle teams to ensure accurate reimbursement. + Demonstrates knowledge of third-party collections regulations, utilizing automated resources and payer collection guidelines. + Handles inbound and outbound collection calls professionally, ensuring courteous and compliant communication with all stakeholders. + Accurately updates and maintains patient account records, documenting all actions taken in the system for compliance and audit purposes. + Abides by all local, state, and federal collection laws, including HIPAA, FDCPA, TCPA, and CFPB regulations. + Performs other duties as assigned. + Maintains regular and reliable attendance. + Complies with all policies and standards. **Qualifications** + H.S. Diploma or GED required + 2-4 years of experience in medical billing, collections, accounts receivable, or insurance follow-up required + Experience in hospital revenue cycle, third-party collections, or litigation-related collections preferred **Knowledge, Skills and Abilities** + Strong knowledge of insurance billing, reimbursement processes, and collection regulations. + Familiarity with third-party payer requirements, claim denial management, and payment posting procedures. + Ability to interpret and explain patient financial responsibilities, payment options, and litigation processes. + Strong communication and negotiation skills, ensuring positive patient interactions and effective payer negotiations. + Proficiency in healthcare billing software, electronic health records (EHR), and collections management systems. + Knowledge of federal, state, and industry regulations related to collections, including HIPAA, FDCPA, and consumer protection laws. + Strong problem-solving skills, with the ability to analyze account details, resolve billing disputes, and secure payments. Equal Employment Opportunity This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to ************************************************* to obtain the main telephone number of the facility and ask for Human Resources.
    $28k-32k yearly est. 13d ago

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HCA Healthcare may also be known as or be related to HCA, HCA Healthcare, HCA Healthcare Inc, HCA Healthcare, Inc., HCA Holdings, Inc., HCA Management Services, L.P., Hca, hospital corporation of america, hca, hospital corporation of america and hca patient account services.