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Inova Health Remote jobs - 185 jobs

  • Revenue Cycle Net Revenue Manager

    Inova Health System 4.5company rating

    Virginia jobs

    Inova Health is looking for a dedicated Net Revenue Manager Lead to join their Revenue Cycle - Financial team. This remote role will be full-time day shift from Monday - Friday, 9:00 a.m. - 5:30 p.m. We are seeking a Revenue Cycle Net Revenue Manager with a strong background in finance and analytics to drive revenue cycle performance and net revenue optimization. The ideal candidate brings advanced Excel skills, proven experience in financial modeling and reporting, and the ability to translate complex data into actionable insights that support strategy, process improvement, and payer contract success. Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. Featured Benefits: Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program. Retirement: Inova matches the first 5% of eligible contributions - starting on your first day. Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost. Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules Revenue Cycle Net Revenue Manager Job Responsibilities: Creates and enforces work standards, quality measures, and process improvements that are consistent with the organization's goals and objectives. Ensures regulatory compliance with Medicare and state authorities, Generally Accepted Accounting Principles and any external governing authority. Assures claims are reviewed, corrections are identified/made or resolutions are initiated while ensuring all follow-up claims/actions are submitted via the appropriate medium and with all required attachments. Maintains knowledge of government regulations, payer requirements, UB-04 standards, information system functionality (i.e. Hospital, clearinghouse, payer), hospital policies/procedures and departmental SRGs. Evaluates the impact of new or upgrades to existing systems/tools while performing testing of system changes, providing technical/operational support during implementation and evaluating the success of new systems/tools. Ensures timely/accurate billing, collection, posting, servicing, and/or auditing of the $1.5 billion receivable stream. Ensures follow-up is completed utilizing TRAC work lists, QMS, or other systems/reports according to department policy/procedure, SRG, or industry best practice standards. Demonstrates a working knowledge of CareMedic systems, DSS electronic billing systems, Syntellect IVR systems, HealthQuest 2000, QMS, and Premis electronic billing systems. Provides feedback and training to supervisors and staff. Provides resolution for pended (WIP backlog) claims within allowable timeframes (as defined for appropriate deficiency) and/or ensures billed claims receive timely and appropriate follow up based on established protocol or SRG. Oversees assigned department or functional area to ensure it is performing effectively, which may include but not limited to, hiring and training team members, creating and implementing business strategies, managing performance of team members, and delegating tasks. Minimum Qualifications: Experience: Four years of experience in Revenue Cycle, Clinic Operations, Credentialing, Denials Management and/or HB/PB Operation roles; Two years in leadership roles Education: Bachelors Degree or lesser educational degree with four additional years of experience Preferred Qualifications: Bachelor's degree in Accounting, Finance, or related field preferred; advanced degree or certification a plus. Strong proficiency in Microsoft Excel (advanced formulas, pivot tables, financial modeling, dashboards). Proven experience in financial analytics, reporting, budgeting/forecasting, and revenue cycle performance metrics (Net Revenue, AR, Denials, Cash). Demonstrated ability to support managed care contract strategy, including payer trend analysis, financial modeling, and negotiation support. Skilled in process improvement, workflow streamlining, and ensuring accuracy, timeliness, and completeness of financial data. Strong communication and presentation skills with experience translating complex data into actionable insights for leadership. Remote Eligibility: This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV
    $73k-101k yearly est. Auto-Apply 60d+ ago
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  • Sr. IT Epic ECSA Administrator

    Inova Health System 4.5company rating

    Virginia jobs

    Inova IT Server Engineering is looking for a dedicated Sr. IT Epic ECSA Administrator to join the Team. This remote role will be full-time working Monday - Friday day shift. The Sr. IT Epic ECSA Administrator is responsible for expert installation/configuration, operation and support of systems hardware and software related infrastructure. Focuses on advanced design, implementation, maintaining high availability, performance, and security of Windows and Virtual host based systems for the Inova Epic EMR system and other ancillary integrated systems. Manages urgent and complex issues by setting customer expectations, devises and implements action plans. Ensures successful and cooperative completion of tasks and projects and resolves problems in a timely manner. Ensures minimal disruptions & unplanned downtimes of assigned systems. Manages computing infrastructure including servers, data storage, and supporting infrastructure. Serves as technical expert that provides support to other IT areas and coaches/mentors other members of the team for the Epic EMR environment. Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. Featured Benefits: Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program. Retirement: Inova matches the first 5% of eligible contributions - starting on your first day. Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost. Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities. Sr. IT Epic ECSA Administrator Responsibilities: Provides administrative and technical expertise for a large, virtual Windows Server environment supporting the Inova Epic environment. Focuses on expert design, implementation, and maintaining high availability, performance, and security of Windows and Virtual host systems that are provided either on premise or for the Inova Epic environment. Applies Citrix PVS vDisk updates for Epic Hyperspace images. Uses Kuiper to manage and deploy Epic client applications. Works with AppOrchard vendors and Inova project teams for new Interconnect functionality. Installs and maintains print infrastructure consisting of EPS and VPSX. Performs Epic Windows server build and maintenance work. Monitors Epic-related servers and performs necessary preventative maintenance Quickly and effectively troubleshoots issues as they arise. May lead work on complex projects. Prepares and executes Epic quarterly upgrades with monthly downtimes in between. Creates and maintains documentation covering the various servers and applications used in Epic deployment. Minimum Qualifications: Education: Bachelor's degree; or Associate's degree and 2 years relevant professional experience in addition to the minimum experience required; or HS Diploma/GED and 4 years relevant professional experience in addition to the minimum experience required Experience: 5 years working in Epic ECSA role Certification: 2 Epic ECSA certifications, recommended ECSA tracks include Hyperspace, Hyperspace Web, Interconnect, System Pulse, Care Everywhere, MyChart, EpicCare Link, BLOB, BCA, Printing. This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV.
    $90k-111k yearly est. Auto-Apply 60d+ ago
  • Home Base Veteran Outreach Coordinator

    Brigham and Women's Hospital 4.6company rating

    Boston, MA jobs

    Site: The General Hospital Corporation Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Home Base, a Red Sox Foundation and Massachusetts General Hospital program, is dedicated to healing the invisible wounds - including post-traumatic stress, traumatic brain injury, anxiety, depression, co-occurring substance use disorder, family relationship challenges and other issues associated with Military service - for Veterans of all eras, Service Members, Military Families and Families of the Fallen through world-class clinical care, wellness, education, and research. The Home Base Veteran Outreach Coordinator is a point of contact for veterans and their families seeking care and/or education regarding Post Traumatic Stress (PTS), Traumatic Brain Injury (TBI) and other combat-related stress. When not assigned to the Intensive Clinical Program, the Veteran Outreach Coordinator role changes to educate and provide outreach to New England-based veterans and their families about Post Traumatic Stress (PTS), Traumatic Brain Injury (TBI), and encourages the community to take advantage of services available through the Home Base Program. The Coordinator is an employee of MGH and works alongside a team of world class medical professionals to help educate veterans, their families, social workers, employers, community service providers, veterans' groups, and others as to how to recognize symptoms of PTS/TBI and the ways in which they or their loved ones can seek help. The Veteran Outreach Coordinator guides veterans through the treatment evaluation process in the Home Base Clinic and works closely with the clinical staff in the Home Base Program around patient case management and ongoing monitoring of patient needs. The Coordinator provides active patient outreach, including phone, email, in-person meetings and text messaging. Job Summary Summary Responsible for community outreach, engagement, and support to enhance access to behavioral health programs. The Outreach Coordinator collaborates with community partners, healthcare professionals, and social service agencies to promote mental health awareness and address the behavioral health needs of individuals. Does this position require Patient Care? Yes Essential Functions * Conduct proactive outreach within the community to identify individuals in need of behavioral health services. * Establish relationships with community organizations, schools, primary care providers, and other relevant stakeholders to enhance outreach efforts. * Conduct initial assessments to identify the behavioral health needs of individuals. * Provide information and referrals to appropriate behavioral health services and resources. * Respond to crisis situations and provide immediate support and intervention. * Collaborate with crisis intervention teams, law enforcement, and emergency services as needed. * Advocate for individuals with behavioral health needs to ensure they receive timely and appropriate care. * Conduct community education and awareness programs on mental health topics. Qualifications Education Bachelor's Degree preferred Experience * minimum of 1-3years of military experience with at least one deployment preferred but not required * must have honorable discharge (proof of DD 214 required). Knowledge, Skills and Abilities * Strong knowledge of behavioral health services, resources, and crisis intervention techniques. * Excellent communication, interpersonal, and organizational skills. * Ability to work independently and collaboratively within a team. * Sensitivity to the understanding of the social determinants of health. * Proficiency in using electronic health records and documentation systems. * Valid driver's license and reliable transportation for community outreach. Additional Job Details (if applicable) Physical RequirementsStanding Frequently (34-66%) Walking Frequently (34-66%) Sitting Occasionally (3-33%) Lifting Frequently (34-66%) 35lbs+ (w/assisted device) Carrying Frequently (34-66%) 20lbs - 35lbs Pushing Occasionally (3-33%) Pulling Occasionally (3-33%) Climbing Rarely (Less than 2%) Balancing Frequently (34-66%) Stooping Occasionally (3-33%) Kneeling Occasionally (3-33%) Crouching Occasionally (3-33%) Crawling Rarely (Less than 2%) Reaching Frequently (34-66%) Gross Manipulation (Handling) Frequently (34-66%) Fine Manipulation (Fingering) Frequently (34-66%) Feeling Constantly (67-100%) Foot Use Rarely (Less than 2%) Vision - Far Constantly (67-100%) Vision - Near Constantly (67-100%) Talking Constantly (67-100%) Hearing Constantly (67-100%) Remote Type Hybrid Work Location One Constitution Wharf Scheduled Weekly Hours 40 Employee Type Regular Work Shift Rotating (United States of America) Pay Range $20.43 - $29.21/Hourly Grade 4 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: The General Hospital Corporation is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
    $20.4-29.2 hourly Auto-Apply 38d ago
  • Home Base Patient Services Coordinator II (PSC II)

    Brigham and Women's Hospital 4.6company rating

    Boston, MA jobs

    Site: The General Hospital Corporation Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Home Base, a Red Sox Foundation and Massachusetts General Hospital program, is dedicated to healing the invisible wounds - including post-traumatic stress, traumatic brain injury, anxiety, depression, co-occurring substance use disorder, family relationship challenges and other issues associated with Military service - for Veterans of all eras, Service Members, Military Families and Families of the Fallen through world-class clinical care, wellness, education, and research. The Home Base Patient Service Coordinator (PSC) serves as a key member of the team that provides superior care and exceptional service to its patients. One critical dimension of this service focuses on patient check-in process and improving the human experience upon our patients' arrival to our practice and throughout the duration of their visit. The Home Base PSC will play an important role in redefining and reinvigorating the patient welcome and check-in experience. The PSC will be the crucial "face and attitude" of this patient-centered practice. While also providing medical scheduling services, the PSC will have the unique opportunity to work within a supportive team setting enabled by systems and technologies that will allow the employee to provide patient care and services at their highest levels. In addition, the PSC will be responsible to assist in special projects when skillset and capacity allow, as deemed appropriate by the Practice Manager. Job Summary Summary Performs both administrative and clinical functions to support smooth and efficient clinical service or practice operations under general supervision. Performs basic clerical work and tasks that are repetitive and routine. Administrative duties related to patient visits including scheduling, check-in, check-out duties. Actual job duties may vary by Department. Does this position require Patient Care? No Essential Functions * Perform routine administrative and clerical duties relating to a clinical service or physician practice office. * Make patient appointments and maintain appointment records. * Greet and assist patients. * Answer telephones, assist callers with routine inquiries, and schedule appointments. * File materials in patient folders and print appointment schedules. * Process patient billing forms and scan documents to patient medical record/LMR. * Call for patient medical records and laboratory test results. * Open and distribute unit mail or faxes. * Type forms, records, schedules, memos, etc., as directed. * Handles, screens and/or takes messages related to prior authorizations, provider questions, prescription refills, and test results. * Acts as "Super User" for scheduling, registration and billing systems. * Provides assistance and training to others in these areas. * May perform more complex or specialized functions (i.e. schedule changes/blocking) at more advanced competency level. Qualifications Education High School Diploma or Equivalent required Can this role accept experience in lieu of a degree? No Licenses and Credentials Certified Medical Administrative Assistant [CMAA] - Data Conversion - Various Issuers preferred Experience office experience 2-3 years required Knowledge, Skills and Abilities * Proficiency with all Office Suite, * Knowledge of office operations and standards and understanding of office procedures including filing, copying, scanning, printing and faxing. * Ability to use phone system and manage more non-routine phone calls and solve routine issues as appropriate. * Communicating effectively in writing as appropriate for the needs of the audience and talking to others to convey information effectively. * Understanding written sentences and paragraphs in work related documents, to correspond and communicate with others clearly and effectively (including composing/editing e-mail, memos and letters), and to take complete and accurate messages. * Managing one's own time and the time of others. * Well organized and good time management skills to manage multiple tasks effectively, follow established protocols, and work within systems. Additional Job Details (if applicable) Physical RequirementsStanding Occasionally (3-33%) Walking Occasionally (3-33%) Sitting Constantly (67-100%) Lifting Occasionally (3-33%) 20lbs - 35lbs Carrying Occasionally (3-33%) 20lbs - 35lbs Pushing Rarely (Less than 2%) Pulling Rarely (Less than 2%) Climbing Rarely (Less than 2%) Balancing Occasionally (3-33%) Stooping Occasionally (3-33%) Kneeling Rarely (Less than 2%) Crouching Rarely (Less than 2%) Crawling Rarely (Less than 2%) Reaching Occasionally (3-33%) Gross Manipulation (Handling) Constantly (67-100%) Fine Manipulation (Fingering) Frequently (34-66%) Feeling Constantly (67-100%) Foot Use Rarely (Less than 2%) Vision - Far Constantly (67-100%) Vision - Near Constantly (67-100%) Talking Constantly (67-100%) Hearing Constantly (67-100%) Remote Type Hybrid Work Location One Constitution Wharf Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $17.36 - $24.45/Hourly Grade 3 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: The General Hospital Corporation is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
    $17.4-24.5 hourly Auto-Apply 40d ago
  • SIU Investigator - Remote

    UPMC 4.3company rating

    Pittsburgh, PA jobs

    UPMC Health Plan has an exciting opportunity for a SIU Investigator! This is a remote, full-time role working daylight hours Monday through Friday. Experience as a Dental Hygienist to perform dental audits and investigations highly preferred. Under the direction of the manager, the Special Investigations Unit (SIU) Investigator is responsible for investigating assigned dental fraud, waste and abuse (FWA) cases, as well as researching and analyzing claims data in order to identify potential dental FWA. The SIU Investigator is also responsible for maintaining the FWA case system with accurate and detailed investigative activities related to assigned cases. Responsibilities: - Investigative actions include member/provider outreach, financial tracking, adhering to compliance regulations, and making healthcare oversight referrals. - Plan, organize and execute dental investigations or dental audits utilizing document review, witness interviews, and data analysis to identify, evaluate and measure potential healthcare fraud, waste and abuse to determine valid cases for appropriate action. - Risk Assessments on FWA dental trends using fraud detection software and/or as assigned by Manager. - Present FWA training to internal staff. - Perform dental chart reviews to assess compliance with dental coding and billing regulations. - Utilize standard coding guidelines, principles, and coding clinics to monitor the appropriate ICD-10, CDT and CPT codes for all record types to ensure accurate reimbursement. - Document and track activity in an internal database, provide case updates on the progress of the dental audit and dental investigation and coordinate with management recommendations and further actions and/or resolutions. - Conduct detailed research to identify and apply appropriate regulatory, contractual, and industry requirements to the different dental benefits and products within investigations. - Maintain or exceed designated quality and production goals. Understand and adhere to HIPAA privacy requirements. Perform special projects assigned by Management. Bachelor's Degree preferred or 2-4 years of related experience in investigations, claims, medical coding, auditing, compliance, risk management and/or data analysis required. The ability to problem solve and communicate professionally. Detail oriented individual with excellent organizational skills. High degree of oral and written communication skills. Proficiency in MS Office/PC skills including Microsoft Excel and Word. Preferred Skills: Experience conducting investigations within a healthcare environment preferred. Knowledge of CPT and ICD-10 coding of procedures and diagnosis is preferred. Knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology is preferred. Licensure, Certifications, and Clearances: + Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran
    $37k-62k yearly est. 9d ago
  • Clinical Review Specialist, Remote

    Brigham and Women's Hospital 4.6company rating

    Somerville, MA jobs

    Site: Mass General Brigham Incorporated Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary General Summary: Under the general direction of the Director of Risk Capture, the Pre-Visit Clinical Review Specialist (CRS) facilitates the accurate and appropriate identification of patient medical conditions through comprehensive chart review combined with review of coding output data sources (internal and external claims) that results in improvement in the overall quality, completeness and accuracy of problem lists, visit documentation and disease registry assignments. The CRS utilizes both clinical and coding knowledge of Hierarchical Condition Categories (HCCs) to inform accurate and appropriate diagnosis considerations for suspect condition identification and recapture opportunities. This role serves to educate providers and the clinical care team on all aspects of risk capture and linkages with quality. Qualifications Principle Duties: Drive Clinical Delivery * Performs accurate and timely pre-visit review of selected ambulatory encounters to identify opportunities to recapture medical conditions that meet criteria as HCC diagnoses and to capture new, suspected HCC conditions. * Accurately interprets clinical information in the medical record, evaluating clinical indicators to identify potential diagnoses * Presents clear HCC Consideration Communication to provider and educates providers to obtain greatest possible diagnostic specificity to accurately reflect the patient's condition(s) Identify Education Opportunities * Identifies themes through chart review that might present education opportunities for individual or groups of providers * Gathers feedback from periodic post-visit chart reviews and incorporates these learnings into educational opportunities with providers * Identifies opportunities for Process Improvement and Quality Improvement, as needed Foster collaborative relationships across the enterprise * Communicates appropriately and compliantly with physician or care team through Epic resources to improve medical record documentation * Participates in ambulatory unit/organizational programs and meetings as needed * Maintains professional competency by keeping abreast of new coding issues and guidelines. Attends classes and meetings as assigned. Reviews professional CDI and coding literature regularly * Maintains clinical licensure and/or medical coding credentials (e.g. RN, PA, NP, CRC, CDEO, CCS, CPC) and completes all required Organizational Competencies and trainings (if applicable) * Meets with providers on an as-needed basis to address concerns or areas of opportunity, and performs chart reviews as needed * Maintains good rapport and professional relationships, as outlined in MGB Code of Conduct - * Approaches conflict in a constructive manner, helps identify problems, offers solutions and participates in resolution * Responsible to perform any other assigned duties as requested Qualifications: * Minimum three (3) - five (5) years' experience required in either, case management, outpatient coding, utilization review, CDI or other disciplines with either coding experience however, an equivalent combination of education and experience, which provides proficiency in the areas of responsibility, may be substituted for the stated education and experience requirements. * 2 years' experience in Primary Care, medical coding, risk adjustment or CDI preferred * Current certification in Clinical Documentation Improvement (CDIP, CCDS, CCDS-O or CDEO) preferred * Certification in medical coding and or risk adjustment (i.e., CRC, CPC, CCS, CDEO, or CCS-P or other pertinent to outpatient) preferred (CRC Required training within 1 year of employment) * Medical licensure (RN, PA, NP) preferred * Bachelor's degree healthcare related preferred * Strong PC skills / Microsoft applications, including Outlook, Teams, Excel, PowerPoint Additional Job Details (if applicable) Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $62,400.00 - $90,750.40/Annual Grade 6 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
    $62.4k-90.8k yearly Auto-Apply 7d ago
  • Payment Compliance and Contracts Specialist

    Community Health Systems 4.5company rating

    Remote

    The Payment Compliance & Contract Management (PCCM) Specialist serves as a subject matter expert and team lead, responsible for maximizing reimbursement through the identification of revenue opportunities and resolution of contractual variances. This role oversees quality assurance and performance management processes, providing guidance to team members and allocating workloads effectively. This role also involves analyzing reimbursement discrepancies, providing strategic insights, and collaborating with internal and external stakeholders to improve revenue cycle processes. Essential Functions Conducts quality monitoring to ensure team performance meets departmental metrics, and provides actionable recommendations to senior leadership when KPIs are not achieved. Trains and mentors staff to ensure team efficiency and compliance with departmental standards. Manages, maintains, and directs key technologies administered by the department to support payment compliance and contract management activities. Analyzes workload demands through data analysis, assigning tasks to team members based on priorities and department needs. Identifies opportunities for process improvement and collaborates with external organizations to enhance payment integrity and optimize contract modeling. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. Qualifications Bachelor's Degree or equivalent work experience on a year-for-year basis required 3-5 years of experience in healthcare reimbursement, contract management, or revenue cycle operations required Demonstrated expertise in analyzing and interpreting payer contracts and reimbursement methodologies required Knowledge, Skills and Abilities Strong analytical and data interpretation skills. Advanced understanding of healthcare reimbursement systems and payer contracts. Excellent leadership and team collaboration abilities. Effective communication and presentation skills. Proficiency in data analysis tools and healthcare billing software. High attention to detail and ability to manage multiple priorities.
    $36k-58k yearly est. Auto-Apply 16d ago
  • Third Party Risk Engineer, Digital Technology (Remote)

    Community Health Systems 4.5company rating

    Remote

    As a key member of the Digital Technology Risk Assurance team, the Technology Risk Analyst will leverage their practical knowledge and experience to independently assess and manage technology risks associated with third-party vendors. This role requires a proactive individual capable of tackling complex challenges with minimal guidance, contributing significantly to the organization's overall risk posture. Essential Functions Comprehensive Vendor Evaluation: Conduct in-depth evaluations of third-party vendors and service providers, encompassing their financial stability, operational performance, and adherence to regulatory compliance requirements. Risk Identification and Mitigation: Proactively identify potential technology risks and vulnerabilities within third-party relationships, subsequently developing and implementing effective mitigation strategies and plans. Cross-Functional Collaboration and Communication: Foster strong collaborative relationships with internal teams, including procurement, legal, IT, and compliance, to ensure a unified and consistent approach to third-party risk management. Communicate and interact effectively and professionally with all stakeholders, including co-workers, management, business partners, and customers. Compliance and Standards Alignment: Ensure all third-party risk management practices are meticulously aligned with established industry standards, regulatory requirements, and the organization's strategic goals. Continuous Monitoring and Oversight: Implement and maintain continuous monitoring of third-party performance and compliance through regular audits, reviews, and performance assessments. Documentation and Record Keeping: Maintain thorough, accurate, and up-to-date records pertaining to all third-party risk management processes and activities. Organizational Awareness and Best Practices: Actively contribute to raising awareness of critical third-party risk issues and promote best practices across the organization. Qualifications Required Experience: 2-4 years in technology risk, cybersecurity, audit, compliance, or third-party risk management. Experience performing vendor risk assessments, due diligence, and ongoing monitoring. Working knowledge of risk frameworks (e.g., NIST, ISO 27001). Strong communication and stakeholder management skills. Analytical and detail-oriented with the ability to identify and address risk gaps. Familiarity with GRC or vendor risk management tools. Preferred Experience: 3+ years of third-party risk management experience, including process or framework improvement. Professional certifications (CISA, CISM, CRISC, CISSP, CTPRA, etc.). Experience in regulated industries or familiarity with third-party risk regulations. Understanding of IT and cybersecurity concepts (cloud, network, application security). Experience automating TPRM workflows or using GRC platforms (e.g., ServiceNow). Ability to work across teams such as Legal, Procurement, and Technology. Experience managing the full vendor risk lifecycle (onboarding through offboarding).
    $60k-125k yearly est. Auto-Apply 2d ago
  • Home Base SOF Admissions Social Worker

    Brigham and Women's Hospital 4.6company rating

    Boston, MA jobs

    Site: The General Hospital Corporation Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. LCSW: starting pay rate $68,224 LICSW: starting pay rate $92,227 SIGN ON BONUS AVAILABLE for eligible Non-MGB employees: $3,000 FOR LCSW, $10,000 FOR LICSW/LMHC, Please ask about the details! Job Summary Home Base, a Red Sox Foundation and Massachusetts General Hospital program, is dedicated to healing the invisible wounds - including post-traumatic stress, traumatic brain injury, anxiety, depression, co-occurring substance use disorder, family relationship challenges and other issues associated with Military service - for Veterans of all eras, Service Members, Military Families and Families of the Fallen through world-class clinical care, wellness, education, and research. The Massachusetts General Hospital seeks a dynamic Licensed Clinical Social Worker (LCSW)/Licensed Independent Clinical Social Worker (LICSW) to serve on the Special Operations Team. In this role, the LCSW/LICSW will provide and oversee the provision of psychiatric, psychosocial, and overall mental health services and referrals for military Special Operators into the Home Base program. They will also be dedicated to supporting the Special Operations Forces (SOF) program and will provide coverage to other clinical operations as needed. The LCSW/LICSW may help cover approximately 2-3 weekend shifts per year. Summary This position will collaborate with other professionals to evaluate patients' medical or physical condition and to assess client needs as part of the interdisciplinary team. They work collaboratively with all healthcare team members to develop and implement treatment plans that support patient-centered plans of care for both individual patients and the medical community. Does this position require Patient Care? Yes Essential Functions * Provides psychosocial assessments of patients and families with social, emotional, interpersonal, and/or environmental issues. Formulates biopsychosocial assessment, disposition, and treatment plans. * Collaborate with other professionals to evaluate patients' medical or physical condition and to assess client needs as part of the interdisciplinary team. * Monitor, evaluate, and record client progress according to measurable goals described in the treatment and care plan. * Coordinate care for Special Operations Forces (SOF) veterans and military-connected family members seeking care at Home Base with the appropriate internal or external clinicians in a multi-disciplinary team, coordinated care model. * Serve as a contact point for accepting and triaging SOF referrals from internal clinicians, outside clinicians and self-referred patients. * Serve as primary case manager for patients in SOF admissions process in collaboration with Admissions Coordinator, including, but not limited to, the following responsibilities: conduct pre-screening to assess treatment and evaluation needs for SOF patients referred; coordinate signing of Release of Information forms, acquire relevant medical records, and coordinate with SOCOM where applicable; serve as point of contact for ongoing questions from the patient as they arise. * Monitor patient's status in admissions process using appropriate documentation. * May be asked to collaborate with SOF/ComBHaT team, patients, clinical team, and Resource Specialist to identify clinical and psychosocial needs in patients' home communities and identify appropriate resources. * May provide direct clinical services to Veterans and/or family members, which may include group or individual therapy. * May provide psychoeducation regarding PTSD, TBI, and related conditions to Veteran patients and family members as clinically appropriate within the context of the Intake and triage duties. * Collaborate with an inter-disciplinary team of clinical staff (social workers, psychologists, nurses, psychiatrists, physiatrists, physical therapists, etc.) to coordinate patient care and plan for discharge/aftercare when needed. * Consult with team to facilitate mandated assessments when abuse is suspected (child, disabled adult, elder), and safety assessment when violence is reported. Collaborates with MGH resources (HAVEN and Child Protection Team). * May assist with crisis intervention and management. * Documents timely and relevant information in patient electronic medical record and Home Base database. * Provide coverage for social work responsibilities in Outpatient Clinic as needed. * For LICSWs: provide clinical supervision to LC-level and/or MSW students as needed. * Additional responsibilities as assigned. Qualifications Education Master's Degree Social Work required or Master's Degree Mental Health & Behavioral Medicine required Can this role accept experience in lieu of a degree? No Licenses and Credentials Current professional licensure in Massachusetts (LCSW required, LICSW preferred). Experience Clinical Social Worker I Clinical Experience in a medical setting 0-1 years required Clinical Social Worker II Clinical Experience in a medical setting 2-3 years required Knowledge, Skills and Abilities * Excellent organizational and time management skills. * Excellent crisis intervention skills. * Good problem solving and conflict resolution skills. * Ability to work well collaboratively and independently. * Strong written and verbal communication skills. * Knowledge of community resources and the aging process. * Demonstrates basic foundational skills, showing fundamental knowledge and a commitment to the application of professional values and ethics. * Demonstrates fundamental skills in formulation, assessment of risks, crisis intervention completion of psychosocial treatment plans, and appropriate documentation. * May need assistance and guidance in ensuring the patient's needs, safety measures, and concerns are brought forward. Emerging knowledge of internal and external resources. * Developing and demonstrating interpersonal collaboration in a medical setting- inpatient or outpatient. * May need coaching/guidance in this area. * May provide some assistance and support with onboarding for new team members. * Aware of opportunities in department/service initiatives; participates in initiatives at an entity level. Uses data to measure progress. * Demonstrate fundamental skills under supervision. May need assistance in promoting collaboration among healthcare team members, other colleagues, and the organization to support and enhance patient care. Additional Job Details (if applicable) Physical Requirements * Standing Frequently (34-66%) * Walking Frequently (34-66%) * Sitting Occasionally (3-33%) * Lifting Frequently (34-66%) 35lbs+ (w/assisted device) * Carrying Frequently (34-66%) 20lbs - 35lbs * Pushing Occasionally (3-33%) * Pulling Occasionally (3-33%) * Climbing Rarely (Less than 2%) * Balancing Frequently (34-66%) * Stooping Occasionally (3-33%) * Kneeling Occasionally (3-33%) * Crouching Occasionally (3-33%) * Crawling Rarely (Less than 2%) * Reaching Frequently (34-66%) * Gross Manipulation (Handling) Frequently (34-66%) * Fine Manipulation (Fingering) Frequently (34-66%) * Feeling Constantly (67-100%) * Foot Use Rarely (Less than 2%) * Vision - Far Constantly (67-100%) * Vision - Near Constantly (67-100%) * Talking Constantly (67-100%) * Hearing Constantly (67-100%) Remote Type Hybrid Work Location One Constitution Wharf Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $56,992.00 - $82,992.00/Annual Grade 6 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: The General Hospital Corporation is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
    $57k-83k yearly Auto-Apply 60d+ ago
  • Per Diem Health Plan UM Medical Director

    Brigham and Women's Hospital 4.6company rating

    Somerville, MA jobs

    Site: Mass General Brigham Incorporated Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary Mass General Brigham Health Plan UM Medical Director Qualifications Education: MD or DO required Licenses and Credentials: * Physician - Massachusetts active full license required Experience: * 5+ years of Health Plan UM experience * at least 5 years of clinical practice experience Knowledge, Skills and Abilities: * Utilization Management experience * Excellent written and oral communications skills * Proficient in basic computer skills, use of EHR's, digital tools * Multitasking abilities * Adaptable to change due to business growth Job Description: * Handles utilization management initial determinations, appeals and grievances within the scope of their expertise as defined by Medicare, MassHealth, NCQA and the Division of Insurance and within the compliance requirements of key regulatory and accreditation entities * Use CMS, state and internal medical necessity policies to guide MN determinations * Complete peer to peer case discussions with requesting providers as assigned * Refer to IRO/external review if specialist match or expertise is needed * Interact, communicate and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees * Monitors performance metrics to identify areas for continuous improvement and ensure compliance * Establishes and maintains positive relationships with colleagues and customers and gains their trust and respect * Ensure diversity, equity and inclusion are integrated as a guiding principle Other duties as assigned with or without accommodation Additional Job Details (if applicable) * Primarily remote position * M-F 830-5pm EST * Ensures that all assigned work is completed within regulatory timelines * Checks and addresses assigned work queues, email, Teams messages during assigned work hours Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 0 Employee Type Regular Work Shift Day (United States of America) EEO Statement: Balance Sheet Cost Centers is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
    $179k-266k yearly est. Auto-Apply 13d ago
  • Phlebotomist CDU/ER Nights

    Community Health Systems 4.5company rating

    Remote

    Shift: 7:00PM-7:00AM The Phlebotomist is responsible for the proper collection of blood specimens to support accurate laboratory testing for the diagnosis and treatment of diseases. This role ensures positive patient identification, timely specimen collection, and adherence to safety and regulatory standards. The Phlebotomist provides exceptional patient care by maintaining professionalism and demonstrating effective communication during interactions with patients, staff, and visitors. Essential Functions Performs venipuncture and capillary blood collection following laboratory policies and procedures to ensure accurate and timely specimen collection. Ensures positive patient identification by using two patient identifiers and labeling specimens at the patient's bedside to prevent errors. Prepares, packages, and transports specimens to the laboratory while maintaining sample integrity and adhering to safety protocols. Explains procedures to patients, providing reassurance and addressing concerns to ensure a positive patient experience. Cleans, sterilizes, and maintains phlebotomy equipment and workspace in compliance with safety and infection control standards. Accurately documents patient and specimen information in the laboratory system, ensuring compliance with regulatory requirements. Collects timed specimens as ordered, prioritizing and efficiently completing phlebotomy tasks to meet clinical needs. Identifies and resolves specimen issues, including addressing rejections and recollecting samples when necessary. Collaborates with healthcare team members to clarify orders, resolve collection challenges, and communicate specimen status. Adheres to all laboratory and hospital safety requirements and follows Laboratory procedures to ensure compliance with accreditation and regulatory standards. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. Qualifications 0-2 years of phlebotomy experience required Phlebotomy Certification Required BLS Certification Required Knowledge, Skills and Abilities Knowledge of safety guidelines, sanitation, and infection control protocols. Ability to perform blood collection techniques successfully across all age groups (neonates to geriatrics). Understanding of standards for patient identification, specimen handling, and lab testing requirements. Strong communication skills, both written and verbal, with the ability to interact professionally with patients, staff, and physicians. Ability to multitask, remain calm in stressful situations, and adapt to a dynamic environment. Proficiency in distinguishing sample types and understanding order-of-draw requirements for lab testing. Demonstrates a high level of attention to detail and accuracy in specimen collection and documentation.
    $30k-35k yearly est. Auto-Apply 17d ago
  • Psychologist Neuropsychologist

    Inova Health System 4.5company rating

    Fairfax, VA jobs

    Inova Women's Behavioral Health is seeking a dedicated Psychologist Neuropsychologist to join the team. As a Perinatal Psychologist with the Women's Behavioral Health Program, you will work as part of an interdisciplinary team within the award-winning Level IV Women's Hospital at Fairfax Medical Campus providing professional psychology consultation and service to perinatal women. There is flexibility to work remotely 1 day per week providing outpatient therapy services to perinatal women and work the remaining 4 days onsite at the hospital. This role will be full-time Monday - Friday, Day shift 8:00 a.m.- 5:00 p.m. Featured Benefits: Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program. Retirement: Inova matches the first 5% of eligible contributions - starting on your first day. Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost. Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules. Psychologist Neuropsychologist Job Responsibilities: Primarily inpatient responsibilities include consultation liaison with the NICU, High Risk Pregnancy, Family Centered Care, and Fetal Care Team. This role includes initial assessment of risk, triage, brief/short-term therapy and counseling while on the inpatient unit and providing a bridge to in-house or community outpatient services for an appropriate level of therapeutic services This role includes an opportunity to retain an outpatient caseload (1 day per week) within Women's Behavioral Health and provide direct clinical services Lead role with ongoing implementation of inpatient universal screening regarding perinatal mental health (Edinburgh Postnatal Scale, PHQ-9, GAD-7). Ongoing development of appropriate follow-up protocols and procedures for elevated screening results. Develop and provide educational seminars and lectures on perinatal and post-partum mental health to nurses, residents, and expectant parents within INOVA Fairfax Women's Hospital and community stakeholders and partners Develop and maintain strong partnerships and collaborative relationships with staff throughout the INOVA Women's and Children's Hospital (e.g., nursing staff, OB/GYN, social workers, case managers, pediatricians, breastfeeding medicine) Opportunity for participation and collaboration with ongoing research and development of clinical and outcomes-based research within perinatal and postpartum behavioral health Minimum Qualifications: Education: Doctorate Psychology Certification: Basic Life Support - Upon Start Licensure: Clinical Psychologist - Upon start. Experience: 1 year of clinical experience in assessment/ treatment of children and adolescence with developmental disorders Preferred Qualifications: Experience working with the perinatal population.
    $81k-101k yearly est. Auto-Apply 60d+ ago
  • Remote Medical Billing Specialist

    Community Health Systems 4.5company rating

    Remote

    The Remote Medical Billing Specialist is responsible for processing, auditing, and submitting primary and secondary insurance claims, ensuring accuracy, compliance, and timely reimbursement. This role utilizes electronic claims management systems to review, correct, and resolve billing errors, denials, and rejections. The Billing Specialist I collaborates with internal teams, facility liaisons, and payers to ensure clean claim submission and adherence to federal, state, and payer-specific regulations. As a Billing Specialist at Community Health Systems (CHS) - Shared Services Center, you'll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental, and vision insurance, paid time off (PTO), 401(k) with company match, tuition reimbursement, and more Essential Functions Processes and submits primary and secondary insurance claims accurately and in a timely manner, ensuring compliance with payer guidelines and regulatory requirements. Reviews and resolves claim errors, rejections, and denials, making necessary corrections and resubmitting claims as needed. Demonstrates working knowledge of billing forms, including UB-04, CMS-1500, or state-specific billing forms, ensuring claims are submitted with the appropriate documentation. Audits claims for accuracy, checking for duplicate charges, overlapped accounts, and missing information before submission. Investigates and processes rebill requests, verifying claim accuracy and making necessary updates per facility or coding liaison direction. Maintains knowledge of billing regulations, payer policies, and electronic submission guidelines, staying up to date with federal, state, and local billing requirements. Utilizes electronic billing systems to analyze, research, and transmit claims, ensuring proper documentation of actions taken in the collection system. Monitors and reports charging or edit trends, collaborating with internal teams (such as coding, patient access, and ancillary departments) to improve billing accuracy. Performs daily balancing tasks using SSI and other billing systems, escalating unresolved issues or billing delays to the Billing Services Manager. Communicates professionally with payers, facility representatives, and internal teams, ensuring efficient issue resolution and proper follow-up on outstanding claims. Performs other duties as assigned. Complies with all policies and standards. This is a fully remote opportunity. Qualifications H.S. Diploma or GED required Associate Degree in Business, Healthcare Administration, Medical Billing, or a related field preferred 0-1 years of experience in medical billing, insurance claims processing, or revenue cycle operations required 1-3 years of billing experience in a medical facility, ambulatory surgery facility, or acute-care preferred Experience with hospital or physician billing, including knowledge of payer policies and electronic claims systems preferred Knowledge, Skills and Abilities Basic understanding of insurance claim processing, medical billing, and reimbursement guidelines. Familiarity with billing software, electronic claims management systems (e.g., SSI, Pulse/DAR), and eligibility tools. Knowledge of CMS, Medicaid, Medicare, and commercial insurance billing regulations. Ability to analyze and resolve claim errors, denials, and rejections efficiently. Strong attention to detail, organizational skills, and ability to meet deadlines. Proficiency in Microsoft Office Suite (Excel, Outlook, Word) and electronic health record (EHR) systems. Excellent communication and problem-solving skills, with the ability to interact professionally with internal teams and external payers. We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible. Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers. This position is not eligible for immigration sponsorship now or in the future. Applicants must be authorized to work in the U.S. for any employer.
    $29k-36k yearly est. Auto-Apply 3d ago
  • Remote - CLINICAL DIETITIAN PRN

    Johns Hopkins Medicine 4.5company rating

    Bethesda, MD jobs

    * The Clinical Dietitian works collaboratively with a multi-disciplinary health team to promote wellness, maintain current health, and/or intervene in acute or chronic illness * Plans and calculates nutrition support for therapeutic diets based on patients' health care needs * Instructs patients and their families on nutrition * Charts and documents patients' progress and performs other professional duties Shift: REMOTE!!!! PRN- Casual/On-Call (Based on the Need of the Dept) Every other Weekend of Work Day Shift: 8:00am - 4:30pm Location: Suburban Hospital, 8600 Old Georgetown Rd, Bethesda, MD 20814 Education: * Requires a Bachelor degree from an accredited college or university Licensure/Certification: * Requires registration with the Commission on Dietetic Registration * Must be a Licensed Dietitian-Nutritionist within the State of Maryland or be eligible to apply for licensure prior to hire Salary Range: Minimum 38.00/hour - Maximum 38.00/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority. JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins! Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices. Johns Hopkins Health System and its affiliates are drug-free workplace employers.
    $41k-49k yearly est. 60d+ ago
  • VP/CFO- Ambulatory Services - Johns Hopkins Health System

    Johns Hopkins Medicine 4.5company rating

    Baltimore, MD jobs

    The Vice President of Finance and Chief Financial Officer (CFO) for Ambulatory Services must have the requisite skills and characteristics to be both an advisor and partner with key stakeholders across the Johns Hopkins Health System and Johns Hopkins Medicine enterprise including appropriate Boards and Finance Committees. As a key member of the executive team, the CFO will provide functional and business leadership through financial acumen and strategic experience. The CFO will work as a peer with healthcare executives and functional heads, developing, overseeing, and tracking strategic and operational plans and results; suggesting improvements; and re-examining assumptions as needed. At the enterprise level, the CFO may lead initiatives to implement best practices, consolidate operations, influence allocation of resources, manage costs, and improve revenues. As such, the CFO will bring strong persuasive, collaborative, and influencing skills forward. Key aspects of the role include: * Serves as a strategic thought partner to support all financial leadership activities proactively advises stakeholders on relevant factors impacting financial performance * Works closely with and as part of the broader executive finance team reporting across Johns Hopkins Medicine * Oversees the administration, planning, and coordination of Ambulatory Care financial activities * Participates in and influences institution-wide financial planning and decision-making, leveraging financial expertise and knowledge of best practices in a way that is consistent with and supportive of the overall mission, vision, and strategy of the affiliate sites, the Johns Hopkins Health System (JHHS), and Johns Hopkins Medicine (JHM) * Drives efficient and effective delivery of financial services, acting as a catalyst for change to ensure the needs of service lines and leaders are aligned and fulfilled including fiscal management, capital planning, contract management, and executing strategic initiatives * Develops the workforce of the future, hiring team members and accelerating performance through clear expectations and goal setting and ensuring that career conversations, succession planning, and development plans are embedded in the work culture REPORTING RELATIONSHIP: Reports directly to Vice President Corporate Finance, Johns Hopkins Health System KEY RESPONSIBILITIES The Vice President of Finance and Chief Financial Officer for Ambulatory Services will have a broad set of responsibilities that will encompass the following: * Plans, develops, and provides financial oversight of the JHHS ambulatory sites, including Johns Hopkins Community Physicians, Johns Hopkins Regional Physicians, Johns Hopkins Ambulatory Surgery Center Series, and Johns Hopkins Care at Home * Works closely and collaboratively with senior leadership, clinical, and administrative colleagues to provide leadership in the identification and implementation of performance improvement initiatives across areas of responsibility to help drive improved patient safety and satisfaction, as well as cost savings and efficiencies * Cultivates, nurtures, and builds strong relationships across the JHM eco-system and helps develop metrics and measures to monitor, track, and maintain the positive impacts of key initiatives * Advises leaders across the enterprise to help develop and manage operating and capital budgets * Leads month-end and quarter-end financial close activities relative to their areas of responsibility * Collaborates with peers and business leaders (i.e. revenue cycle, supply chain, contracting and payer relations, and financial and accounting services) to establish and coordinate service line initiatives as appropriate * Assists affiliate leaders in real time, serving as a key partner to the executive team * Drives performance improvement within the ambulatory enterprise; aligns with shared services across JHHS and JHM to ensure actions are taken and plans are made, in context of the greater good, with transparency and mutual accountability * Provides oversight of the financial performance of all aspects of the ambulatory business; monitors trends and performance and develops corrective action plans as needed. Ensures that affiliate Presidents and the JHHS Vice President of Corporate Finance are provided with accurate and timely financial and statistical information - as well as any systemwide reports -- regarding all subsidiaries assigned to the CFO. Appropriately escalates areas of concern EXPERIENCE & QUALIFICATIONS * CPA or Master's Degree in Accounting, Finance, Business or related field required. * Minimum ten years' experience in Business and Financial Planning as well as program development in complex environment. Physician practice management experience desirable * Experience in a large academic health system preferred * Sitting CFO experience highly preferred * Significant senior management experience in healthcare financial planning, budget management, financial reporting, general accounting, financial controls, and information systems, or equivalent * Knowledge of current physician and ambulatory reimbursement and clinical issues confronting complex healthcare organizations * Demonstrated success serving in a complex, multi-stakeholder environment * Experience with capital budgeting, FP&A/operational finance, financial control, and reporting * Advanced knowledge of budget development, control and evaluation, financial forecasting, planning and analysis Salary Range: Minimum /hour - Maximum /hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices. Johns Hopkins Health System and its affiliates are drug-free workplace employers.
    $97k-172k yearly est. 31d ago
  • Sr. Epic BI Developer

    Inova Health System 4.5company rating

    Fairfax, VA jobs

    Inova Clinical Analytics is looking for a dedicated Sr. Epic BI Developer to join the Team. This hybrid role will be full-time day shift working Monday - Friday. The Sr. Epic BI Developer assesses client requirements, details their current data needs, and designs a data sourcing strategy for developing and implementing proper BI contents. Acts as subject matter expert in the organization to build, organize, publish, share and manage BI contents. Works closely with Data Administrators and Data Architects to enforce proper end-to-end management of BI assets. Responsible for preparation and delivery of training for end-users, new and existing team members for content created. Works with vendor and other support organizations on BI related incident tickets, software upgrade evaluation and testing, process automation and continuous process improvements in varied platforms. Maintains applications and facilitates updates, new releases and system enhancements. Communicates project and team status to internal and external audiences including the operations teams, steering committees, Executive sponsors and project principles as required. Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. Featured Benefits: Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program. Retirement: Inova matches the first 5% of eligible contributions - starting on your first day. Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost. Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities. Sr. Epic BI Developer Responsibilities: Works independently to develop high quality BI contents that meets business needs Promotes consistent use of BI contents and calculations; recommend standards and BI best practices for the organization Assists in gather information and support on data governance processes Analyzes the use of data and interpreting data directly against requirements. Captures source data characteristics and abstracting them into consolidated data repository with proper data lineage and change control - including data from internal and external sources, also on premises or from the Cloud. Determines the logical design characteristics and information management strategies necessary to store, move, and manage data from a wide variety of database platforms. Responsible for creating, vetting and publishing data sources for common use in our BI tools (currently Tableau, Crystal and EPIC reporting products). Gathers, documents and designs data integration and data visualization requirements for projects for small organizations through large corporations. Assists BI content creators to rapidly generate impactful, interactive visualizations with consistent and proper data elements Troubleshoots complex issues and addresses resolutions. Minimum Qualifications: Education: Bachelor's degree; or Associate's degree and 2 years relevant professional experience in addition to the minimum experience required; or HS Diploma/GED and 4 years relevant professional experience in addition to the minimum experience required Experience: 3 years of experience with advanced report writing using SQL, Tableau and Tableau Prep, Business Objects, Crystal Reports, Clarity report writer or similar relational database concepts with query techniques Certification: Epic Cogito certification or SQL or BI tools certificate Preferred Qualifications: Previous experience supporting Epic preferred. Previous experience with backend data builds and with data storytelling using PowerBI, Tableau, or other data visualization tools preferred. This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV.
    $79k-99k yearly est. Auto-Apply 24d ago
  • Home Base Family Support Specialist

    Brigham and Women's Hospital 4.6company rating

    Boston, MA jobs

    Site: The General Hospital Corporation Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Home Base, a Red Sox Foundation and Massachusetts General Hospital program, is dedicated to healing the invisible wounds - including post-traumatic stress, traumatic brain injury, anxiety, depression, co-occurring substance use disorder, family relationship challenges and other issues associated with Military service - for Veterans of all eras, Service Members, Military Families and Families of the Fallen through world-class clinical care, wellness, education, and research. The Family Support Specialist (FSS) Role is multifaceted. The FSS engages with veterans, service members and military-connected family members to spread awareness about the impacts of military service on entire family systems. They encourage family members to take advantage of clinical, wellness and educational services available through the Home Base Program. The Family Support Team (FST) is the first point of contact for military connected family/supports seeking information or care at Home Base. FSS provide peer support for military connected family/supports participating as part of their service member/veteran's clinical programming. Finally, the FST team delivers/facilitates resiliency offerings in addition to hosting recreational activities for families in New England. In addition to patient-facing outreach, the FST works to build and maintain relationships with other local, regional and national military-serving organizations in an effort to collaborate in support of military families. The FST may need to work outside of normal working hours, to include some nights and weekends. Travel may also be required for this role. Job Summary Summary Responsible for community outreach, engagement, and support to enhance access to behavioral health programs. The Outreach Worker collaborates with community partners, healthcare professionals, and social service agencies to promote mental health awareness and address the behavioral health needs of individuals. Does this position require Patient Care? Yes Essential Functions * Conduct proactive outreach within the community to identify individuals in need of behavioral health services. * Establish relationships with community organizations, schools, primary care providers, and other relevant stakeholders to enhance outreach efforts. * Conduct initial assessments to identify the behavioral health needs of individuals. * Provide information and referrals to appropriate behavioral health services and resources. * Respond to crisis situations and provide immediate support and intervention. * Collaborate with crisis intervention teams, law enforcement, and emergency services as needed. * Advocate for individuals with behavioral health needs to ensure they receive timely and appropriate care. * Conduct community education and awareness programs on mental health topics. Qualifications Education Bachelor's Degree Related Field of Study required Can this role accept experience in lieu of a degree? No Experience * Experience in behavioral health outreach or related field 1-2 years preferred * Lived experience as a military family member * Minimum of 3 years working with military families Knowledge, Skills and Abilities * Knowledge of military structure * Knowledge of community services and resources available to military families * Familiarity with PTSD and TBI and the challenges that accompany such diagnoses * Compassionate and empathetic spirit * Ability to listen and manage stressful situations and respond calmly and professionally in a safe and reassuring manner * Strong knowledge of behavioral health services, resources, and crisis intervention techniques. * Excellent communication, interpersonal, and organizational skills. * Ability to work independently and collaboratively within a team. * Proficiency in using electronic health records and documentation systems. * Valid driver's license and reliable transportation for community outreach. Additional Job Details (if applicable) Physical Requirements * Standing Frequently (34-66%) * Walking Frequently (34-66%) * Sitting Occasionally (3-33%) * Lifting Frequently (34-66%) 35lbs+ (w/assisted device) * Carrying Frequently (34-66%) 20lbs - 35lbs * Pushing Occasionally (3-33%) * Pulling Occasionally (3-33%) * Climbing Rarely (Less than 2%) * Balancing Frequently (34-66%) * Stooping Occasionally (3-33%) * Kneeling Occasionally (3-33%) * Crouching Occasionally (3-33%) * Crawling Rarely (Less than 2%) * Reaching Frequently (34-66%) * Gross Manipulation (Handling) Frequently (34-66%) * Fine Manipulation (Fingering) Frequently (34-66%) * Feeling Constantly (67-100%) * Foot Use Rarely (Less than 2%) * Vision - Far Constantly (67-100%) * Vision - Near Constantly (67-100%) * Talking Constantly (67-100%) * Hearing Constantly (67-100%) Remote Type Hybrid Work Location One Constitution Wharf Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $20.43 - $29.21/Hourly Grade 4 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: The General Hospital Corporation is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
    $20.4-29.2 hourly Auto-Apply 15d ago
  • Radiologic Technologist (Rad Tech)

    Inova Health System 4.5company rating

    Remote

    Inova Occupational Health - Alexandria is looking for a dedicated Radiologic Technologist (Rad Tech) to join the team. This role will be Full-Time Day Shift from Monday - Friday 8am - 4:30pm. Sign-On Bonus and Relocation Assistance Available. Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. Featured Benefits: Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program. Retirement: Inova matches the first 5% of eligible contributions - starting on your first day. Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost. Radiologic Technologist (Rad Tech) Job Responsibilities: Demonstrates a thorough understanding of radiologic principles, theory, anatomy and pathology processes by utilizing the most appropriate techniques and/or positioning for optimal examinations. Adheres to department policies and protocols by ensuring all examinations are optimized for interpretation. Confidently operates radiological equipment in all care settings (i.e. fluoroscopy, trauma, Emergency department and the Operating Room). Demonstrates the effective use of radiation protection procedures with collimation devices and protective shielding. Operates Imaging and other related equipment according to manufacturers' specifications. Demonstrates proper technique for injection of IV contrast under the American College of Radiology guidelines. Assists in teaching radiography students sound radiography principles. Communicates effectively with patients to obtain clinical history and informed consent from patients' and/or patients' charts to assist physicians in optimizing the performance and interpretation of examinations. Explains procedures to patients/families and answers any questions to ease anxiety and assure patient cooperation. Correctly identifies patients and their files while ensuring a high degree of accuracy. Tracks patients according to department procedures. Assists physicians in performing a variety of examinations by using standard department protocols, isolation precautions, and/or sterile techniques. Minimum Qualifications: Education: Graduate of accredited school/program of radiography Licensure: American Registered Radiologic Technologists within 12 months of hire Certification: Basic Life Support from the American Heart Association Experience: One year of combined classroom and clinical training in radiology. Recent experience in a hospital/healthcare environment as a Radiologic Technologist or student
    $50k-71k yearly est. Auto-Apply 60d+ ago
  • Oracle ERP System Analyst 3 - HCM

    Inova Health System 4.5company rating

    Virginia jobs

    Inova Oracle ERP is looking for a dedicated Oracle ERP System Analyst 3 - HCM to join the Team. This remote role will be full-time working Monday - Friday day shift. The Oracle ERP System Analyst 3 - HCM provides guidance and hands-on support to the Human Resources business customers. Partners with business analysts and other stakeholders to configure and support the Oracle system across the Enterprise. Serves as liaison between IT, business analysts (if applicable), and multiple user communities. Provides high-level technical support and leadership for the maintenance, development and customization of the system(s). Serves as project leader for small to mid-size system upgrades and enhancements. Participates in the design and architecture of technical specifications needed to affect system installations, modifications, and on-going enhancements to system operations. Works at a high technical level in most phases of SDLC while considering the business implications of the application of technology to the current and future business environment. May train and provide oversight to level 1 and 2 Analysts. Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. Featured Benefits: Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program. Retirement: Inova matches the first 5% of eligible contributions - starting on your first day. Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost. Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities. Oracle ERP System Analyst 3 - HCM Job Responsibilities: Supports two or more of the following modules of Oracle ERP or HCM Cloud applications: core and self-service HR, Payroll, Recruiting, Learning and Performance Management. Evaluates upgrades released by software vendors for assigned ERP systems, collaborates with cross-functional IT teams, business analysts (if applicable) and users, and sometimes leads the testing and implementation of the upgrades. Coordinates implementation of assigned functional and technical release installations, modifications and enhancements to existing application design and configuration. Orchestrates all phases of SDLC needed to implement in a production environment. Reviews and evaluates software packages as needed. Monitors and tracks service tickets systems both internal and with Oracle for issue resolution and customer requests. Resolves problems effectively and efficiently and solicits input from all appropriate parties to ensure solutions are consistent and with enterprise direction. Creates complex reports as needed and appropriate in response to requests from customers Helps identify and implement process improvements through changes in practice, standardization or IT automation. Develops and maintains basic project plans to ensure successful completion. Focuses on goal completion within determined timeframe, quality expectations and budget and continues to self-train in multiple business areas operations and the Oracle Cloud platform. Collaborates with third-party vendors and consultants to optimize the ERP system performance and participates in leading scope/priority of ERP system enhancements as necessary. Serves as point of contact for vendors as it relates to the system Minimum Qualifications: Education: Bachelor's degree; or Associate's degree and 2 years relevant professional experience in addition to the minimum experience required; or HS Diploma/GED and 4 years relevant professional experience in addition to the minimum experience required Experience: 8 years of experience as an Oracle ERP Analyst Preferred Qualifications: Previous experience working with all Oracle HCM modules preferred. Previous technical experience working with HDL (HCM Data Loader) preferred. Previous experience working with Oracle Redwood and Visual Builder Express (VBS) preferred. Previous experience developing Fast Formulas preferred. Knowledge of utilizing AI especially within Oracle preferred. This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV.
    $69k-88k yearly est. Auto-Apply 16d ago
  • Collections Specialist II

    Community Health Systems 4.5company rating

    Remote

    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. 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.
    $30k-35k yearly est. Auto-Apply 14d ago

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