Senior Reimbursement Analyst-Full Time Days (Remote)
Mary Washington Healthcare 4.8
Fredericksburg, VA jobs
Start the day excited to make a difference…end the day knowing you did. Come join our team.
Performs duties of moderate to high complexity, judgment and scope. Assists the Director in preparing Medicare and Medicaid cost reports, wage index reviews and other reimbursement analysis. Prepares workpapers to support the cost reports, as well as analyzing the data for accuracy and additional reimbursement opportunities is a resource to other decision support analysts. Oversees the cost report preparation performed by outside consultants and performs initial review prior to leadership. The Senior Reimbursement Analyst prepares and reviews high-level analytical reports and data, including cost reports, a monthly reserve analysis, and reimbursement related activities. The incumbent in this role performs duties which impact revenue and reimbursement of the organization.
Essential Functions & Responsibilities:
Responsible for handling financial and third-party government audits.
Maintains an ongoing understanding of government regulations as they relate to reimbursement issues, analyzes the impact of these regulations, and applies them to the documentation that is maintained for the preparation of the third-party cost reports.
Performs other related third-party reimbursement responsibilities as needed.
Responsible for key Revenue Enhancement initiatives such as the Disproportionate Share, Wage Index which account for large reimbursement dollars.
Prepares monthly reserve analysis.
Analyzes revenue trends across the organization.
Maintains a clear and thorough understanding of the cost report process to ensure efficient and accurate support of required data.
Analyzes and reviews all third payer Cost Report Accruals accounts. Reports any discrepancies or inaccuracies to appropriate leadership to maintain the integrity of the financial statements.
Prepares appeals, or other required information for third party payers.
Assists in preparing third-party cost reports for fiscal year end.
Reviews, analyzes, and documents all third-party audit adjustments, recommending either acceptance or rejection of those adjustments.
Performs other duties as assigned.
Qualifications:
Bachelor's degree in accounting/finance or related business field required.
Six years of related experience in the reimbursement field or health care finance field preferred.
Excellent analytical and organizational skills.
Proficient with Microsoft Office tools.
Strong understanding of healthcare business processes and technology.
As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.
Required
Physical Requirements: Constant (67-100% of workday) sitting and use of arms and hands; occasional (0-33% of workday) standing, walking, bending, squatting; ability to lift, push, and pull up to 10 lbs.; auditory and visual skills.
Mental Requirements: Possesses critical thinking and analytical skills. Ability to multi-task. Ability to communicate effectively and collaborate with a multi-disciplinary team.
Environmental Requirements and Exposure Hazards: Potential risk of exposure to chemicals.
“It is the policy of Mary Washington Healthcare to provide reasonable accommodations to qualified individuals with a disability who are applicants for employment or Associates.”
$51k-66k yearly est. Auto-Apply 6d ago
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Hospice Operations Administrator, Implementation
Adena Home Health and Hospice 4.8
Remote
Our culture and people are what set us apart from other post-acute care providers. We're dedicated to the growth and development of our team to set them up for success. We CARE for our patients like they are our own FAMILY.
Schedule: Monday through Friday 8:00 am to 5:00 pm
Company: Alternate Solutions Health Network
Location: Remote
SUMMARY
The Implementation, Hospice Operations Administrator plays a critical role in the successful launch and operational integration of hospice agencies formed through joint ventures with leading healthcare systems. This role supports all phases of the implementation process - from 30 days pre-launch through 90 days post-launch - and ensures operational readiness, regulatory compliance, and local leadership development. The Administrator partners with cross-functional teams to optimize resources, standardize workflows, and drive agency performance aligned with ASHN standards and strategic growth goals.
KEY RESPONSIBILITIES
Lead the implementation of ASHN's hospice operational procedures at new joint venture (JV) agencies.
Coordinate pre-launch readiness and post-launch stabilization phases, ensuring successful transitions through the initial 60 days.
Develop, maintain, and continuously improve implementation tools, checklists, and workflows to support consistent, scalable, and cost-effective execution.
Collaborate with the broader Implementation Team to align project timelines, allocate resources, and execute communication plans effectively.
Coach and mentor new agency leadership on ASHN processes, operations dashboard use, and overall quality of operations management of agency through the use of key performance indicators.
Guide agency leaders in the development of Performance Improvement Plans (PIPs) and Managing for Daily Improvement (MDI) strategies.
Ensure local leadership is equipped to sustain performance beyond the stabilization period.
Ensure agency operations are compliant with Medicare Conditions of Participation as well as all applicable state and federal regulations.
Promote adherence to best practices in clinical documentation, charting, and quality assurance processes.
Monitor for regulatory risk and support the development and execution of corrective action plans when necessary.
Develop and manage a program delivery schedule for operational training throughout the implementation period.
Collaborate with the Director of Clinical Training and Development to oversee the effectiveness of training content tailored to agency-specific and individual participant needs.
Stay abreast of emerging trends, regulatory updates, and best practices in the hospice industry through ongoing education and professional affiliations.
Actively participate in internal training sessions and professional development programs to enhance knowledge and skills.
Performs other duties as assigned.
MANAGEMENT RESPONSIBILITIES
Directly supervise assigned implementation team members, Training Manager(s), and other staff as needed
Provide ongoing coaching, performance feedback, and professional development
Set team priorities, delegate assignments, and ensure accountability for implementation deliverables
Foster a culture of collaboration, execution, and continuous improvement across teams
QUALIFICATIONS
5+ years of experience in hospice or post-acute operations, including leadership or project management experience
Proven ability to lead cross-functional teams and manage complex project timelines
In-depth knowledge of Medicare Conditions of Participation and hospice operations
Strong facilitation, coaching, and interpersonal communication skills
Experience managing training programs and evaluating instructional effectiveness preferred
Ability to travel up to 50% as needed for on-site support
EDUCATION AND CREDENTIALS
Bachelor's degree in Healthcare Administration, Nursing, Business, or a related field required
#INDASHN3
We'll help you put your passion for patient care to work. Apply today!
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
We are an Equal Opportunity Employer.
$41k-67k yearly est. Auto-Apply 2d ago
Regional Vice President, Hospice Implementation
Adena Home Health and Hospice 4.8
Remote
Our culture and people are what set us apart from other post-acute care providers. We're dedicated to the growth and development of our team to set them up for success. We CARE for our patients like they are our own FAMILY.
Schedule: Monday through Friday 8:00 am to 5:00 pm
Company: Alternate Solutions Health Network
Location: Remote
SUMMARY
The Regional Vice President of Hospice Implementations is responsible for the successful execution of new hospice agency launches within an assigned region. This senior leader ensures the consistent application of enterprise strategy at the market level by managing cross-functional implementation plans, overseeing regional operations readiness, and serving as the primary execution lead for Joint Venture (JV) and acquisition onboarding of new hospice agencies. This role requires operational precision, stakeholder alignment, and strong leadership to ensure sustainable, compliant, and high-performing agency startups.
KEY RESPONSIBILITIES
Regional Implementation Execution
Oversee all phases of new agency implementation in assigned region, from due diligence through post-launch optimization
Manage market-specific launch plans, coordinating timelines, resources, and deliverables across departments (clinical, HR, IT, compliance, talent)
Execute implementation playbooks while customizing to local partner and market needs
Operational Readiness and Systems Integration
Ensure all operational systems, policies, and processes are implemented in accordance with company standards and regulatory requirements
Facilitate transition from implementation to steady-state operations, coordinating handoff with local leadership and operational leaders
Track compliance and survey readiness, ensuring policies and systems align with state and federal standards
Cross-Functional Leadership
Serve as regional implementation lead, managing stakeholder relationships across enterprise and local partners
Engage with IT, Compliance, HR, Legal, Finance, and Clinical Ops to identify and resolve launch barriers
Escalate risks proactively and partner with the VP of Implementation on critical issues
Metrics and Performance Accountability
Track key performance indicators (KPIs) including go-live readiness, implementation timelines, onboarding progress, and early performance benchmarks
Provide regular reporting to the VP of Implementation and executive stakeholders, offering recommendations for continuous improvement
Monitor early-stage operational metrics, including census growth, visit volume, staffing success, and onboarding satisfaction
Partner Engagement and Communication
Maintain strong relationships with health system partners, local leadership, and JV executives
Communicate updates, progress, and risks clearly across multiple stakeholders
Participate in steering committees or partner meetings as regional implementation representative
Other duties as assigned
MANAGEMENT RESPONSIBILITIES
Directly lead the regional implementation team, including Implementation Managers, Coordinators, and other project-specific staff.
Provide day-to-day oversight, coaching, and performance management to ensure consistent execution of implementation plans across markets.
Set clear goals, KPIs, and success metrics for implementation team members aligned with company priorities.
Foster a high-performance, collaborative culture focused on accountability, solution orientation, and teammate experience.
Partner with the Vice President of Implementation to resource the team appropriately and adjust structure as needed for volume and complexity.
Support recruitment, onboarding, and professional development of implementation team members.
Conduct regular check-ins, team meetings, and performance reviews, providing continuous feedback and leadership development opportunities.
Ensure implementation team members serve as effective partners to HR, Clinical, IT, Compliance, Talent Acquisition, and Operations leaders.
QUALIFICATIONS
7+ years of experience leading complex healthcare implementations or agency startups, including home health or hospice
Demonstrated success managing cross-functional projects across geographically distributed teams
Strong understanding of operational systems and regulatory frameworks in post-acute care
Proven ability to lead teams through ambiguity, establish timelines, and deliver outcomes
Exceptional communication and stakeholder management skills
Experience in Joint Venture implementation or multi-agency healthcare integration
Familiarity with Medicare Conditions of Participation, state licensure processes, and accreditation readiness
Knowledge of Workday, HCHB, and other healthcare IT platforms
Accountable for implementation success across assigned region, including timeline, financial impact, and operational readiness
Up to 50% travel required for on-site planning, launch support, and partner engagement
Models ASHN's leadership principles with a focus on collaboration, accountability, and teammate experience
EDUCATION AND CREDENTIALS
Bachelor's degree in Healthcare Administration, Nursing, Business, or related field; equivalent experience accepted; advanced degree preferred
#INDASHN3
We'll help you put your passion for patient care to work. Apply today!
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
We are an Equal Opportunity Employer.
$88k-158k yearly est. Auto-Apply 2d ago
Sports Safety Educator
Hospital for Special Surgery 4.2
West Palm Beach, FL jobs
How you move is why we're here. Now more than ever. Get back to what you need and love to do. The possibilities are endless... Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize the abundant opportunities for growth and success.
If this describes you then let's talk!
HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.
Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.
Emp Status
Per Diem Part time
Work Shift
What you will be doing
Job Qualifications
EDUCATION - Required
Bachelor's degree in Athletic Training, Exercise Science, Physical Education, Physical Therapy, Public Health, or a related field
EDUCATION - Preferred
Master's degree in Athletic Training, Exercise Science, Physical Education, Physical Therapy, Public Health, or a related field
In lieu of higher education 10 years experience working with children (Grade schools and or HS).
CERTIFICATION - Preferred
CPR/AED certification and at least one of the following: Performance Enhancement Specialist (NASM), Corrective Exercise Specialist (NASM), Certified Strength and Conditioning Coach (NSCA), Health/Physical Education Endorsement, Certified Health Education Specialist (CHES)
EXPERIENCE - Required
3 - 5 years professional experience with youth, high school, collegiate, or professional sports and/or physical education.
SKILLS - Required
Excellent verbal and written communication skills.
Strong customer service orientation.
Outstanding communication, human interaction, and customer service skills
Ability to meet productivity standards in a remote work environment
Proficient with Microsoft Office, Google Workspace, and various videoconference platforms
PHYSICAL WORKING CONDITIONS
Continuously stand/walk or lift/handle/carry material or equipment of moderate weight (20 to 50 lbs).
ENVIRONMENTAL WORKING CONDITIONS
Located in an indoor area with frequent exposure to mild physical discomfort from dust, fumes, temperature, and noise. Examples: patient care providers and laboratory technicians.
HAZARDS
OSHA Category 1
Tasks that involve exposure to blood, body fluids, tissues, and other potentially infectious materials.
POSITION & UNIT ACCOUNTABILITIES - AKA Competencies
* Presents program educational material at workshops and sports camps and clinics under the direction of the HSS Athlete Health Management Team.
* Contributes to the development, implementation, and improvement of educational materials and program curricula under the direction of the HSS Athlete Health leadership.
* Conducts live (on-site and virtual) health screenings and injury prevention workshops for students/athletes and their coaches, parents, teachers, and administrators.
* Contributes to the development, implementation, and evaluation of new screening/education programs.
* Contributes to the execution of clinical research studies, by assisting with data collection activities.
Non-Discrimination Policy
Hospital for Special Surgery is committed to providing high quality care and skilled, compassionate, reliable service to our community in a safe and healing environment. Consistent with this commitment, Hospital for Special Surgery provides care, admits, and treats patients and provides all services without regard to age, race, color, creed, ethnicity, religion, national origin, culture, language, physical or mental disability, socioeconomic status, veteran or military status, marital status, sex, sexual orientation, gender identity or expression, or any other basis prohibited by federal, state, or local law or by accreditation standards.
$35k-50k yearly est. Auto-Apply 50d ago
Lead VMG Coding Auditor & Educator
Virtua 4.5
Remote
At Virtua Health, we exist for one reason - to better serve you. That means being here for you in all the moments that matter, striving each day to connect you to the care you need. Whether that's wellness and prevention, experienced specialists, life-changing care, or something in-between - we are your partner in health devoted to building a healthier community.
If you live or work in South Jersey, exceptional care is all around. Our medical and surgical experts are among the best in the country. We assembled more than 14,000 colleagues, including over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques to provide exceptional care close to home. A Magnet-recognized health system ranked by U.S. News and World Report, we've received multiple awards for quality, safety, and outstanding work environment.
In addition to five hospitals, seven emergency departments, seven urgent care centers, and more than 280 other locations, we're committed to the well-being of the community. That means bringing life-changing resources and health services directly into our communities through our Eat Well food access program, telehealth, home health, rehabilitation, mobile screenings, paramedic programs, and convenient online scheduling. We're also affiliated with Penn Medicine for cancer and neurosciences, and the Children's Hospital of Philadelphia for pediatrics.
Location:
Lippincott - 301 Lippincott Drive
Remote Type:
Hybrid
Employment Type:
Employee
Employment Classification:
Regular
Time Type:
Full time
Work Shift:
1st Shift (United States of America)
Total Weekly Hours:
40
Additional Locations:
Job Information:
Local candidates preferred - requires ability to be onsite as needed.
Job Summary:
Responsible for leading professional fee (pro-fee) coding quality audits, education, and training, etc. for CPT, ICD-10-CM, and HCPCS codes for Virtua Medical Group clinicians and coding department. This includes leading the workflow of the audit team performing internal audits and providing education and training to the pro-fee coders and clinicians. Responsible for leading all activities related to the large scale external audit, including creating and maintaining audit documentation, ensuring audit schedule and reporting meet required timelines, and coordinating post-audit activities (including provider education and re-audit). Works with Director to implement and execute on the compliance plan for VMG coding.
Position Responsibilities:
Leads and coordinates all phases of external clinical professional fee coding audit:
Selects audit sample and applies national bell curve in system
Communicates audit results to clinicians and leads
Manages rebuttals
Coordinates and performs post audit education
Coordinates and performs re-audits
Tracks and reports results
Ensures phase schedule of audits and post-audit follow up is tracked and maintained.
Maintains all audit documentation and serve as a liaison for internal and external auditors
Lead and coordinate internal coder professional fee audit:
Selects audit sample
Assigns auditors as needed
Tracks progress and results
Communicates results to Coding Operations Managers
Leads workflow for the audit and education team who provide training and education for all internal coders, Leads confirmation audit planning for all internal coders once they approved to submit charges in the work queues and provides appropriate feedback. Develops coding and training resources for the entire coding team (modules, scenarios, tip sheets, etc.). Serves as an escalation point to the education and audit team when responding External Coding Audit Response: Conducts Trains new coders to utilize the medical record, clinical, coding and abstracting systems, in conjunction with UHDDS and other rules and regulations and other appropriate resources to properly abstract and code all HIM coded inpatient and outpatient accounts and provides appropriate feedback.exit interviews with external auditors, prepares rebuttals and appeals, take appropriate action with responses (including correcting data and educating providers and coders). to daily questions from VMG coders regarding correct application of coding guidelines to individual accounts. Responsible for initial onboarding education of all clinicians billing under VMG tax ID number (TIN) to include CMS 1995, 1997 and AMA 2021 Evaluation and Management guidelines.
Coordinates workflow of staff performing chart audits to review CPT, ICD-10- CM and HCPCS codes assigned by VMG coding staff and providing timely feedback to staff and director. . Performs chart audits to review CPT, ICD-10- CM and HCPCS codes for clinicians who scored below 80% on their external audit. Reviews work queue edits for provider coding trends and education needs. Confidently educates clinicians based on chart audit and coding trends.
Assists in implementation and maintenance of audit software system. Utilizes software for all audit activities and recommends changes and customization. Maintains Epic records for semi-compliant and non-compliant providers to ensure enhanced review levels are supported within the Epic work queues.
Assigns audit and education team members to works closely with VMG Practices and third party billing company to resolve coding and reimbursement issues, serves as an escalation point, and answers questions regarding coding requirements. Provides education to their staff, including clinicians and billers on pro-fee coding issues. Recommends changes to workflows to ensure appropriate documentation and reimbursement.
Develops policies and procedures on coding, data abstraction and compliance for VMG. Documents and enforces policies and procedures for VMG and provides feedback to appropriate supervisors and/or staff. Recommends changes to policies, procedures, charge master and documentation requirements to ensure appropriate reimbursement. Assists Coding Director with monitoring and reporting on productivity and quality standards.
Position Qualifications Required:
Required Experience:
3+ years professional fee(provider) coding and healthcare auditing experience required.
Professional fee auditing and education experience required.
Multi-specialty professional fee coding experience preferred
Advanced organizational skills - ability to work proactively with multiple priorities
High level of technical proficiency in Word, Excel, PowerPoint, Outlook, EMR systems
Subject matter expertise in the areas of CPT, ICD-10-CM and HCPCS coding required
Ability to develop and present education presentations required
Required Education:
Coding Certificate Program, or equivalent experience, leading to appropriate certification
Training / Certification / Licensure:
CPC Certification by AAPC required
CPMA Certification by AAPC preferred
Annual Salary: $70,935 - $110,268 The actual salary/rate will vary based on applicant's experience as well as internal equity and alignment with market data.Virtua offers a comprehensive package of benefits for full-time and part-time colleagues, including, but not limited to: medical/prescription, dental and vision insurance; health and dependent care flexible spending accounts; 403(b) (401(k) subject to collective bargaining agreement); paid time off, paid sick leave as provided under state and local paid sick leave laws, short-term disability and optional long-term disability, colleague and dependent life insurance and supplemental life and AD&D insurance; tuition assistance, and an employee assistance program that includes free counseling sessions. Eligibility for benefits is governed by the applicable plan documents and policies.
For more benefits information click here.
$70.9k-110.3k yearly Auto-Apply 6d ago
Scheduler (32 hours)
SSM Health Saint Louis University Hospital 4.7
Remote
It's more than a career, it's a calling.
WI-REMOTE
Worker Type:
Regular
Job Highlights:
Full time, 32-hour Scheduler position, must be able to complete Orientation and training on site in Wisconsin as needed.
Responsible for collecting data directly from patients and referring provider offices to confirm and create scheduled appointments for patient services.
Job Responsibilities and Requirements:
PRIMARY RESPONSIBILITIES
Coordinates scheduling and referrals to other healthcare providers and services. Obtains approval for schedule changes or cancellations as appropriate.
Assists with maintenance and updating of provider contact information.
Ensures that all medical appointments, special instructions and patient information is entered into electronic medical system.
Follows site-specific protocols and maintains up-to-date documentation to ensure compliance.
Performs other duties as assigned.
EDUCATION
High School diploma/GED or 10 years of work experience
EXPERIENCE
No experience required
PHYSICAL REQUIREMENTS
Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
Frequent keyboard use/data entry.
Occasional bending, stooping, kneeling, squatting, twisting and gripping.
Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
Rare climbing.
REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS
None
Department:
5910000166 FLOATS Reception
Work Shift:
Day Shift (United States of America)
Scheduled Weekly Hours:
32
Benefits:
SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.
Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members.
Explore All Benefits
SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.
$30k-36k yearly est. Auto-Apply 2d ago
Social Worker (LSW) - Lorain
Bon Secours Mercy Health 4.8
Lorain, OH jobs
At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. In the capacity of a Social Worker, provide clinical care management services to identified eligible patients, coordinating care to obtain desired health outcomes, improve self-care abilities, and decrease unnecessary cost of care. Work as a member of the Interdisciplinary Team (IDT) along with the Ambulatory Care Manager (ACM) and Care Coordinator to ensure the assigned patient's individual needs are identified and addressed in a timely manner. Perform standardized comprehensive needs assessment, identifying and addressing barriers to care and aligning patients with available benefits and resources.
* This position is remote/work from home. Hire will support our Lorain, OH market and could be asked to go onsite up to 10%.
Essential Job Functions
* Maintain a caseload of patients according to department policies.
* Identify, enroll and manage patients in program for Complex Case Management.
* Develop and implement care plans to maximize wellbeing with periodic review and update according to department protocols.
* Collaborate with ACM, PCPs, Specialists, and Hospitalists to effectively implement a patient-centered care plan.
* Perform situational and family assessment of social determinants of care and develop goals as part of the comprehensive care plan.
* Perform patient outreach according to established protocols and document in electronic medical record.
* Identify, execute, and track needed referrals to care and community resources.
* Provide resource management to improve care, patient experience and reduce unnecessary cost and utilization: right care, right place, and right time.
* Assist patient in advanced care planning to complete Advanced Directives.
* Document all communications with patient and/or care team in electronic medical record.
* Perform coordination of services for disabled status and/or facilitate placement in post-acute facility for rehabilitation or long term care.
* Act as patient advocate to address primary physical and socioeconomic needs and link patient to appropriate community resources and services.
This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job related duties as required by their supervisor, subject to reasonable accommodation.
Education Qualifications
Bachelor's Degree (required)
Bachelor's or Master's Degree in Social Work (preferred)
Licensing/ Certification
Master's Degree or Licensure as required by state of practice (required)
Case Management certification, LSW or LCSW (preferred)
Minimum Qualifications
2-3 years acute care, home health or case management experience
Other Knowledge, Skills and Abilities Required
Excellent interpersonal communication and negotiation skills. Strong analytical, data management and computer skills. Demonstrate basic knowledge of healthcare and health education across the lifespan in a practice health setting. Ability to work with individuals, groups and families. Familiarity and knowledge of Community Resources. Flexibility to work non- traditional hours. Works well in a Team Setting. Personal computer skills. Experience with database entry, EMR documentation, Power Point preferred and basic Excel skills. Highly organized and detail oriented. Accepts responsibility and follows through on projects and activities
Other Knowledge, Skills and Abilities Preferred
Demonstrated success in improving the health of a distinct population of patients in the ambulatory or community setting
Patient Population
The following must be included in all position descriptions that involve direct or indirect patient care. This is a JCAHO requirement. Also select the age of the patient population served:
Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.
Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to his or her age, specific needs and to provide the care needed as described in departmental policies and procedures.
Neonates (0-4 weeks)
Adolescents (13-17 years)
Infant (1-12 months)
Adults (18-64 years).
Pediatrics (1-12 years)
Geriatrics (65 years and older)
As a Bon Secours Mercy Health associate, you're part of a Mission that matters. We support your well-being-personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.
What we offer
* Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
* Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, mental health resources and discounts
* Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
* Tuition assistance, professional development and continuing education support
Benefits may vary based on the market and employment status.
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Bon secours Mercy Health - Youngstown, Ohio or Bon Secours - Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email *********************. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at *********************
$51k-62k yearly est. 21d ago
Compliance Audit Manager
Bon Secours Mercy Health 4.8
Cincinnati, OH jobs
At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Compliance Audit Manager** **
Under the direct supervision of the Director, Compliance this position contributes to the Bon Secours Mercy Health mission and vision by managing acute and provider revenue cycle compliance initiatives to identify and mitigate emerging governmental and payer revenue cycle compliance risks to the ministry. This position assists the Director of Compliance to perform tracking, trending, and reporting of data analytics to help identify risks and establish proactive monitoring initiatives and is responsible to manage the performance of assigned work plan audits, management requests, due diligence reviews and responses to governmental audits and inquiries.
***This is a remote/work from home position. Hire must live be willing to work eastern time zone hours.
**Essential Job Functions**
+ Works collaboratively with the Director, Compliance on creating auditing and monitoring protocols that align with Bon Secours Mercy Health's overall compliance audit and compliance responsibilities relative to acute and physician revenue cycle services performed for Bon Secours Mercy Health.
+ Oversees acute and provider compliance audits including work plan items, management requests, Merger and Acquisition due diligence coding audits and assessments, and responses to governmental audits and inquiries.
+ Assesses and makes recommendations to improve internal controls and policies and procedures for both acute and provider Revenue Cycle operations including the development of SOPs.
+ Develops acute and provider compliance monitoring and audit protocols specific to revenue cycle compliance risk areas highlighted by the Office of Inspector General (OIG), Medicare, State Medicaid, State Insurance Fraud, Managed Care or Governmental Value-Based payment programs or other enforcement agencies on behalf of Bon Secours Mercy Health.
+ Coordinates periodic review and analysis of Bon Secours Mercy Health provider claims denial reports, operational assessment reports, internal quality control reviews, internal and external third-party claims payment peer analysis systems to detect provider-billing trends, potential fraudulent or abusive billing practices or vulnerabilities indicative of potential underlying operational compliance issues.
+ Utilizes data analytics techniques, statistical analysis and modeling, and databases developed internally, or in conjunction with other third-party vendors to detect and trend potential claims and billing compliance issues.
+ Assists in the development of corrective action plans (CAP), oversight tools and technical edit enhancements to support acute and physician revenue cycle services operational efforts. Assists in tracking of all activities related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation.
+ Maintains awareness of regulations and current industry changes that may impact healthcare physician revenue cycle services domestic and international through personal initiative, continuing education and peer-to-peer networking
+ Ensures that the Director, Compliance is apprised of local, remote and client-network emerging issues, adverse outcomes and/or deficiencies that could impact Bon Secours Mercy Health's public status.
+ Develops educational content and trending of non-compliant activities to enhance proficiency and competency, understanding of standards and the consequences of non-compliance. Prepares multi-faceted oral, written and electronic communications and presentations to facilitate discussion, networking, decision-making and proactive responses to meet current and emerging challenges among affected parties and entities
This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.
**Licensing/Certification**
+ Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) (required)
+ Certificate of Healthcare Compliance (CHC) (preferred)
+ EPIC Electronic Medical Records System (preferred)
**Education**
Bachelor's Degree in Healthcare Auditing, Physician Revenue Cycle, or related field (required)
**Work Experience**
5 years' of experience within healthcare revenue cycle operations and healthcare auditing either from a consulting perspective or as an associate or manager (required)
As a Bon Secours Mercy Health associate, you're part of a Mission that matters. We support your well-being-personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.
**What we offer**
+ Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
+ Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, mental health resources and discounts
+ Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
+ Tuition assistance, professional development and continuing education support
_Benefits may vary based on the market and employment status._
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Bon secours Mercy Health - Youngstown, Ohio or Bon Secours - Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email ********************* . If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at *********************
$89k-122k yearly est. 8d ago
Respiratory Therapy Coordinator
Baycare Health System 4.6
Winter Haven, FL jobs
**Why BayCare?** At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers, and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy built on trust, dignity, respect, responsibility, and clinical excellence.
BayCare Health System is currently in search of our newest **Respiratory Therapist Coordinator** who is passionate about providing outstanding care to our community. We are looking for an individual seeking a career opportunity with one of the largest employers in the Tampa Bay area. Our team members focus on tomorrow by achieving personal and professional success today.
**Position Details**
+ **Facility** : BayCare Health System - Respiratory Care Services-WHH
+ **Location** : Winter Haven, FL
+ **Status** : Full Time, Exempt: No
+ **Shift Hours** : 6:30 PM - 7:00 AM
+ **Shift** : Nights (Shift 3)
+ **Weekend Work** : Every Other
+ **On Call** : No
+ **Remote Work** : Never
**Job Summary**
Functions as a coordinator and provides advanced respiratory care in high-acuity settings including hospital-based and free-standing emergency/trauma centers, as well as neonatal, pediatric, and adult intensive care units. Demonstrates proficiency in performing complex respiratory interventions and treatment modalities validated through observation, competency check-offs, and formal assessments. Serves as a lead therapist, preceptor, mentor, and role model within the department. Supports clinical excellence by guiding peers, promoting best practices, and ensuring high standards of patient care.
**Responsibilities**
+ Deliver advanced respiratory care under physician orders and hospital protocols
+ Perform complex interventions validated through competency assessments
+ Serve as a mentor and resource for respiratory care team members
+ Provide coverage across multiple critical care settings as needed
**Certification and Licensure Required**
+ Active NBRC Registered Respiratory Therapist (RRT)
+ **Adult-only care setting** : Advanced Critical Care Specialist (RRT-ACCS)
+ **Mixed care setting** : RRT-ACCS **OR** Neonatal Pediatric Specialist (RRT-NPS)
+ **Additional Certifications:**
+ BLS (Basic Life Support)
+ ACLS (within 30 days)
+ PALS (within 6 months, if pediatric care)
+ NRP (within 6 months, if neonatal care)
**Education Required**
+ Technical Respiratory Therapy Program Completion
+ **Preferred:** Associate Degree in Respiratory Therapy
**Specific Skills Required**
+ Advanced respiratory assessment in high-acuity settings
+ Clinical judgment and critical thinking
+ Ability to mentor and collaborate within a team
+ Problem-solving in complex clinical scenarios
**Equal Opportunity Employer Veterans/Disabled**
**Position** Respiratory Therapy Coordinator
**Location** Winter Haven:Winter Haven | Clinical | Full Time
**Req ID** 120223
$54k-84k yearly est. 60d+ ago
Clinical Documentation Specialist, First Reviewer
SSM Health Saint Louis University Hospital 4.7
Remote
It's more than a career, it's a calling
IL-REMOTE STL PLAN
Worker Type:
Regular
Job Highlights:
**Must have prior experience as a Clinical Documentation Specialist**
Required Qualifications:
1 year of experience as a Clinical Documentation Specialist
Additional Two years' in an acute care setting or relevant experience
Graduate of accredited school of nursing, PA, NP, or medical school, or Associate's degree and Certified Clinical Documentation Specialist (CCDS) certification from the Association of Clinical Documentation Improvement Specialist (ACDIS)
Preferred Qualifications:
CCDS certification
Proficiency with MS Office Tool - especially Excel.
Prior experience reviewing PSI (patient safety indicator) or experience with Vizient specialized mortality reviews.
Eligible Remote States:
Candidates are required to reside on one of SSM's approved States:
Alabama, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, and Wisconsin.
Pay Range:
$74,484.80 - $111,737.60
Pay Rate Type:
SalarySSM Health values the skills and talents that each team member brings to our organization. Compensation for this role is based on a variety of components including relevant experience, labor market, and other qualifications. The posted pay range for this position is what SSM Health reasonably expects, in good faith, to offer based on the circumstances at the time of posting. SSM Health may ultimately pay more or less than the posted range as permitted by law.
Job Summary:
Performs concurrent analytical reviews of clinical and coding data to improving physician documentation for all conditions and treatments from point of entry to discharge, ensuring an accurate reflection of the patient condition in the associated Diagnosis Related Group (DRG) assignments, case-mix index, severity of illness (SOI), and risk of mortality (ROM) profiling, and reimbursement. Facilitates the resolution of queries and educates members of the patient care team regarding documentation guidelines and the need for accurate and complete documentation in the health record, including attending physicians and allied health practitioners. Collaborates with coding professionals to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine a working and final DRG, SOI, and/or ROM.
Job Responsibilities and Requirements:
PRIMARY RESPONSIBILITIES
Completes initial reviews of patient records and evaluates documentation to assign the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate diagnosis review group (DRG) assignment, risk of mortality (ROM), and severity of illness (SOI). Maintains appropriate productivity level.
Conducts follow-up reviews of patients every to support and assign a working or final DRG assignment upon patient discharge, as necessary.
Queries physicians regarding missing, unclear, or conflicting health record documentation by requesting and obtaining additional documentation within the health record when needed. Identifies issues with reporting of diagnostic testing proactively. Enhances expertise in query development, presentation, and standards including understanding of published query guidelines and practice expectations for compliance.
Educates physicians and key healthcare providers regarding clinical documentation improvement and the need for accurate and complete documentation in the health record.
Attends department meetings to review documentation related issues. Conducts independent research to promote knowledge of clinical topics, coding guidelines, regulatory policies and trends, and healthcare economics.
Collaborates with coding to reconcile the DRG and resolves mismatches utilizing the escalation policy. Troubleshoots documentation or communication problems proactively and appropriately escalates.
Reviews and clarifies clinical issues in the health record with the coding professionals that would support an accurate DRG assignment, SOI, and/or ROM. Assists in the mortality review and risk adjustment process utilizing third-party models.
Demonstrates an understanding of complications, comorbidities, SOI, ROM, case mix, and the impact of procedures on the billed record. Imparts knowledge to providers and other members of the healthcare team. Maintains a level of expertise by attending continuing education programs.
Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient's age-specific needs and clinical needs as described in the department's scope of service.
Works in a constant state of alertness and safe manner.
Performs other duties as assigned.
EDUCATION
Graduate of accredited school of nursing, PA, NP, or medical school, or Associate's degree and Certified Clinical Documentation Specialist (CCDS) certification from the Association of Clinical Documentation Improvement Specialist (ACDIS)
EXPERIENCE
Two years' in an acute care setting or relevant experience
PHYSICAL REQUIREMENTS
Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
Frequent keyboard use/data entry.
Occasional bending, stooping, kneeling, squatting, twisting and gripping.
Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
Rare climbing.
REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS
State of Work Location: Illinois
Certified Clinical Documentation Specialist (CCDS) - Association of Clinical Documentation Improvement Specialists (ACDIS)
Or
Physician Assistant in Medicine, Licensed - Illinois Department of Financial and Professional Regulation (IDFPR)
Or
Physician - Regional MSO Credentialing
Or
Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)
Or
Advanced Practice Nurse (APN) - Illinois Department of Financial and Professional Regulation (IDFPR)
Or
APN Controlled Substance - Illinois Department of Financial and Professional Regulation (IDFPR)
Or
Full Practice Authority APRN Control Substance - Illinois Department of Financial and Professional Regulation (IDFPR)
Or
Full Practice Authority APRN - Illinois Department of Financial and Professional Regulation (IDFPR)
State of Work Location: Missouri
Certified Clinical Documentation Specialist (CCDS) - Association of Clinical Documentation Improvement Specialists (ACDIS)
Or
Physician Assistant - Missouri Division of Professional Registration
Or
Physician - Regional MSO Credentialing
Or
Registered Nurse (RN) Issued by Compact State
Or
Registered Nurse (RN) - Missouri Division of Professional Registration
Or
Nurse Practitioner - Missouri Division of Professional Registration
State of Work Location: Oklahoma
Certified Clinical Documentation Specialist (CCDS) - Association of Clinical Documentation Improvement Specialists (ACDIS)
Or
Acknowledgement of Receipt of Application for Physician Assistant - Oklahoma Medical Board
Or
Physician Assistant - Oklahoma Medical Board
Or
Physician - Regional MSO Credentialing
Or
Registered Nurse (RN) Issued by Compact State
Or
Registered Nurse (RN) - Oklahoma Board of Nursing (OBN)
Or
Advanced Practice Registered Nurse (APRN) - Oklahoma Board of Nursing (OBN)
Or
Certified Family Nurse Practitioner (FNP-C) - American Academy of Nurse Practitioners (AANP)
State of Work Location: Wisconsin
Certified Clinical Documentation Specialist (CCDS) - Association of Clinical Documentation Improvement Specialists (ACDIS)
Or
Physician Assistant - Wisconsin Department of Safety and Professional Services
Or
Physician - Regional MSO Credentialing
Or
Registered Nurse (RN) Issued by Compact State
Or
Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services
Or
Advanced Practice Nurse Prescriber (APNP) - Wisconsin Department of Safety and Professional Services
Work Shift:
Day Shift (United States of America)
Job Type:
Employee
Department:
********** Sys Clinical Documentation ImprovementScheduled Weekly Hours:40
Benefits:
SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.
Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members.
Explore All Benefits
SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law.
Click here to learn more.
$35k-48k yearly est. Auto-Apply 17d ago
Health Information Documentation Rep - PRN
SSM Health 4.7
Saint Louis, MO jobs
**It's more than a career, it's a calling.** MO-REMOTE **Worker Type:** PRN **Job Highlights:** **Available hours for this per diem role are Monday - Friday 7:00 am - 5:00 pm. Position is scheduled as needed when employee has availability. Weekend hours are also available.**
**Technology/Computer proficiency is a must. Must be able to problem solve and be a self-starter.**
**Candidates must be local as in-office training is required for a minimum of 60 days at 7980 Clayton Rd, St. Louis, MO. Following the training period employees meeting metrics may work remote.**
**Job Summary:**
Responsible for requesting, receiving, preparing, digitizing and entering patient information into the electronic health record.
**Job Responsibilities and Requirements:**
PRIMARY RESPONSIBILITIES
+ Preps, scans and indexes documents into electronic health record under the appropriate document types utilizing tools provided.
+ Provides a detailed analysis of the scanned documents in the queue to ensure all information has been scanned appropriately, is clear and without inaccuracies, possesses the correct patient identification, and is scanned to the correct document type in line with our commitment to patient safety.
+ Perform quality assurance audits on scanned documents in order to ensure accuracy.
+ Performs priority scanning upon receipt utilizing appropriate Integrated Scanning method.
+ Analyzes personal health information (PHI) documents to determine if scanning is necessary and then selects the document type/scanning protocol to use.
+ Uploads and/or imports documents and enters information into the electronic health record.
+ Performs other duties as assigned.
EDUCATION
+ High School diploma/GED or 10 years of work experience
EXPERIENCE
+ One year experience
PHYSICAL REQUIREMENTS
+ Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
+ Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
+ Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
+ Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
+ Frequent keyboard use/data entry.
+ Occasional bending, stooping, kneeling, squatting, twisting and gripping.
+ Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
+ Rare climbing.
REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS
+ None
**Department:**
7720000125 EPIC Scan - South
**Work Shift:**
Day Shift (United States of America)
**Scheduled Weekly Hours:**
0
**Benefits:**
SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.
+ **Paid Parental Leave** **:** we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
+ **Flexible Payment Options:** our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
+ **Upfront Tuition Coverage** : we provide upfront tuition coverage through FlexPath Funded for eligible team members.
Explore All Benefits (******************************************
_SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity,_ _pregnancy, veteran status_ **_,_** _or any other characteristic protected by applicable law. Click here to learn more. (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?\_ga=2.205***********55970.1667***********70506.1667719643)_
$46k-55k yearly est. 54d ago
VMG Coding Auditor & Educator
Virtua 4.5
Remote
At Virtua Health, we exist for one reason - to better serve you. That means being here for you in all the moments that matter, striving each day to connect you to the care you need. Whether that's wellness and prevention, experienced specialists, life-changing care, or something in-between - we are your partner in health devoted to building a healthier community.
If you live or work in South Jersey, exceptional care is all around. Our medical and surgical experts are among the best in the country. We assembled more than 14,000 colleagues, including over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques to provide exceptional care close to home. A Magnet-recognized health system ranked by U.S. News and World Report, we've received multiple awards for quality, safety, and outstanding work environment.
In addition to five hospitals, seven emergency departments, seven urgent care centers, and more than 280 other locations, we're committed to the well-being of the community. That means bringing life-changing resources and health services directly into our communities through our Eat Well food access program, telehealth, home health, rehabilitation, mobile screenings, paramedic programs, and convenient online scheduling. We're also affiliated with Penn Medicine for cancer and neurosciences, and the Children's Hospital of Philadelphia for pediatrics.
Location:
100% RemoteCurrently Virtua welcomes candidates for 100% remote positions from: AZ, CT, DE, FL, GA, ID, KY, MD, MO, NC, NH, NJ, NY, PA, SC, TN, TX, VA, WI, WV only.
Remote Type:
100% Remote
Employment Type:
Employee
Employment Classification:
Regular
Time Type:
Full time
Work Shift:
1st Shift (United States of America)
Total Weekly Hours:
40
Additional Locations:
Job Information:
Job Summary:
Responsible for professional fee (pro-fee) coding quality and audits, education and training, etc. for CPT, ICD-10-CM, and HCPCS codes for Virtua Medical Group clinicians and coding department. This includes performing internal audits, overseeing external audits, and providing education and training to the pro-fee coders. Responsible for working with VMG practices to resolve all coding issues that prevent accounts from being processed appropriately. Responsible for developing, implementing and maintaining compliance plan for pro-fee coding and abstracting.
Position Responsibilities:
Training and Education:
Providing training and education for newly hired coders that includes utilizing the medical record in conjunction with rules and regulations to properly code VMG encounters. Audits new coders once they approved to submit charges in the work queues and provides appropriate feedback. Developing coding and training resources for the entire coding team (modules, scenarios, tip sheets, etc.). External Coding Audit Response: Conducts Trains new coders to utilize the medical record, clinical, coding and abstracting systems, in conjunction with UHDDS and other rules and regulations and other appropriate resources to properly abstract and code all HIM coded inpatient and outpatient accounts and provides appropriate feedback.exit interviews with external auditors, prepares rebuttals and appeals, take appropriate action with responses (including correcting data and educating providers and coders). Responds to daily questions from VMG coders regarding correct application of coding guidelines to individual accounts. Responsible for initial onboarding education of all clinicians billing under VMG tax ID number (TIN) to include CMS 1995, 1997 and AMA 2021 Evaluation and Management guidelines.
Auditing:
Performing chart audits to review CPT, ICD-10- CM and HCPCS codes assigned by VMG coding staff and providing timely feedback to staff and director. Overseeing the annual external audit process for all clinicians that bill under the VMG TIN by creating audit samples, communicating results to clinicians and providing annual coding education. Performing chart audits to review CPT, ICD-10- CM and HCPCS codes for clinicians who scored below 80% on their external audit. Reviewing work queue edits for provider coding trends and education needs. Confidently educates clinicians based on chart audit and coding trends.
Accounts Receivable:
Assisting with monitoring of pre-AR aging reports. Troubleshooting and resolving complex problems with individual accounts in order to facilitate appropriate reductions in A/R and accounts held for coding. Coding charts when urgently needed to facilitate A/R goals. Working closely with Practice Directors and Practice Managers to provide efficiencies in operational workflows related to clinician coding.
Review and Resolution of Interdepartmental Coding-related Issues:
Working closely with VMG Practices and third party billing company to resolve coding and reimbursement issues, serves as an escalation point, and answers questions regarding coding requirements. Providing education to their staff, including clinicians and billers on pro-fee coding issues. Recommending changes to workflows to insure appropriate documentation and reimbursement.
Policies and Procedures:
Developing policies and procedures on coding, data abstraction and compliance for VMG. Documenting and enforcing policies and procedures for VMG and provides feedback to appropriate supervisors and/or staff. Recommending changes to policies, procedures, charge master and documentation requirements to ensure appropriate reimbursement. Monitoring and reporting on productivity and quality standards.
Position Qualifications Required / Experience Required:
3 years professional fee (provider) coding or a combination of 3 years professional fee (provider) coding and healthcare auditing experience required
Professional fee auditing and education experience preferred
Multi-specialty professional fee coding experience preferred
Knowledge of PC database applications, Microsoft Office, spreadsheet design, encoder required
Subject matter expertise in the areas of CPT, ICD-10-CM and HCPCS coding required
Ability to develop and present education presentations required
Required Education:
Coding Certificate Program, or equivalent experience, leading to appropriate certification
Training/Certifications/Licensure:
CPC Certification by AAPC required
CPMA Certification by AAPC preferred
Annual Salary: $66,950 - $104,059 The actual salary/rate will vary based on applicant's experience as well as internal equity and alignment with market data.Virtua offers a comprehensive package of benefits for full-time and part-time colleagues, including, but not limited to: medical/prescription, dental and vision insurance; health and dependent care flexible spending accounts; 403(b) (401(k) subject to collective bargaining agreement); paid time off, paid sick leave as provided under state and local paid sick leave laws, short-term disability and optional long-term disability, colleague and dependent life insurance and supplemental life and AD&D insurance; tuition assistance, and an employee assistance program that includes free counseling sessions. Eligibility for benefits is governed by the applicable plan documents and policies.
For more benefits information click here.
$67k-104.1k yearly Auto-Apply 22d ago
Remote ER Registrar
Baycare Health System 4.6
Oldsmar, FL jobs
BayCare is currently in search of our newest Team Member who is passionate about providing outstanding customer service to our community. We are looking for an individual seeking a career opportunity with one of the largest employers within the Tampa Bay area.
**Training is on-site in Clearwater, FL and required for at least 15 business days after hire.
**This position requires hospital registration experience.
**The position hours are until 1AM.
**Responsibilities**
+ The Registrar II may be responsible for any of the following: Registration, Customer Service, Insurance Verification, Financial Counseling, Scheduling, Bed Control, Cashier or Reception and must demonstrate proficiency in at least four (one must be Registration) of these modalities. Successful completion of additional modalities within department may qualify team member for career advancement (Registrar Career Ladder). Team member may be required to rotate shifts periodically and take call. Team member will perform other duties as assigned.
**Specific Skills**
+ Work with minimal supervision
+ Multi-tasking skills
+ Written and verbal communication skills
+ Computer skills appropriate to position
+ Customer service skills
+ Equipment use and maintenance appropriate for position
+ Work in a fast-paced environment
+ Organizational skills
**Why BayCare?**
Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that is built on a foundation of trust, dignity, respect, responsibility, and clinical excellence. Our team members focus on tomorrow by achieving personal and professional success today. That is why you will thrive in our forward-thinking culture, where we combine the best technology with compassionate service. We blend high-tech with high touch in ways that are advancing superior health care throughout the communities we serve.
**Certifications and Licensures**
+ None required
**Education**
+ Required High School or equivalent
**Experience**
+ Required 6 months Admitting
+ And 6 months BayCare Related
+ OR 2 years Registration
**Facility:**
BayCare Health System, PFS Central ER Registration-HSS
**Location:** **BayCare Central Billing Office**
**Status:** **Full Time, Exempt: No**
**Shift Hours:** **WED - SAT (2:30 p.m. - 1:00 a.m.)**
**Shift:** **Shift 2**
**Shift 1 = Days, 2 = Evenings, 3 = Nights, 4 = Varies**
**Weekend Work:** **Every**
**On Call:** **No**
**How often will this team member be working remotely?** Always
Equal Opportunity Employer Veterans/Disabled
**Position** Remote ER Registrar
**Location** Oldsmar:BayCare Central Billing | Business and Administrative | Full Time
**Req ID** 125996
$27k-34k yearly est. 60d+ ago
Reg NICU-PICU Respiratory Specialist
Baycare Health System 4.6
Tampa, FL jobs
**Why BayCare?** At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers, and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy built on trust, dignity, respect, responsibility, and clinical excellence.
BayCare Health System is currently in search of our newest Respiratory Therapist NICU/PICU Specialist who is passionate about providing outstanding customer service to our community. We are looking for an individual seeking a career opportunity with one of the largest employers within the Tampa Bay area. Our team members focus on tomorrow by achieving personal and professional success today
**Position Details**
+ **Facility:** BayCare Health System - Respiratory Service Care - SJHW&C
+ **Location:** St. Josephs Womens and Children's
+ **Status:** Full Time, Exempt: No
+ **Shift Hours:** 6:30 PM - 7:00 AM
+ **Shift:** Nights (Shift 3)
+ **Weekend Work:** Every Other
+ **On Call:** No
+ **Remote Work:** Never
**Job Summary**
Provides advanced and specialized respiratory care in Neonatal ICU (Level IV), PICU, PCICU, Emergency and/or Trauma Services, and Transport Team. Demonstrates proficiency in complex respiratory interventions and treatment modalities for neonatal and pediatric patients. Serves as a lead therapist, preceptor, mentor, and role model within assigned areas. Supports clinical excellence by guiding peers, promoting best practices, and ensuring high standards of patient care.
**Responsibilities**
+ Deliver advanced respiratory care under physician orders and hospital protocols.
+ Perform complex interventions validated through competency assessments.
+ Serve as a mentor and resource for NICU/PICU respiratory care.
+ Provide coverage across multiple critical care settings as needed.
**Certification and Licensure Required**
+ Active NBRC Registered Respiratory Therapist (RRT)
+ Neonatal Pediatric Specialist (RRT-NPS)
+ **Additional Certifications:**
+ BLS (Basic Life Support)
+ ACLS (within 30 days)
+ PALS (within 6 months)
+ NRP (within 6 months)
**Education Required**
+ Technical Respiratory Therapy Program Completion
+ **Preferred:** Associate Degree in Respiratory Therapy
**Specific Skills Required**
+ Advanced neonatal and pediatric respiratory assessment
+ Clinical judgment in high-acuity settings
+ Ability to mentor and collaborate within a team
+ Critical thinking and problem-solving
Equal Opportunity Employer Veterans/Disabled
**Position** Reg NICU-PICU Respiratory Specialist
**Location** Tampa:St Josephs | Clinical | Full Time
**Req ID** 130533
$32k-49k yearly est. 22d ago
Experience of Care, Program Manager - Work at Home - Ohio Toledo Market
Bon Secours Mercy Health 4.8
Toledo, OH jobs
At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Mercy Health** As a faith-based and patient-focused organization, Mercy Health exists to enhance the health and well-being of all people in mind, body and spirit through exceptional patient care. Success in this goal requires a culture of compassion, collaboration, excellence and respect. Mercy Health seeks people that are committed to our values of compassion, human dignity, integrity, service and stewardship to create an environment where associates want to work and help communities thrive.
**Experience of Care (Program Manager) - St. Vincent's Medical Center.**
**In this role, you will be supporting the Mercy Health - Toledo Market, from**
**your** **office at St. Vincent's, with flexibility to work from home on occasion.**
The Experience of Care leader drives experience of care system and market strategies, tactics, and behaviors in the respective market(s) to achieve experience of care excellence as noted by achieving experience of care KPI targets and selected quality KPI's. This leader has experience and working knowledge in hospital operations to assist in action planning and feedback.
**Essential Job Functions**
+ Deploys system and market experience of care strategies, tactics, and behaviors.
+ Institutes structure and processes that drive standardization of practices and policies across assigned market to continually drive quality and efficiency.
+ Supports facility leadership by serving as a subject matter expert through data insight and training for understanding of their reports, provides support/guidance and patient experience reporting in appropriate venues/meetings.
+ Participates in system and market experience of care committees and workgroups to consult and collaborate on system experience of care strategies and initiatives.
+ Serves as a primary resource providing guidance, coaching, direction, and training to BSMH associates.
+ Supports market leadership by providing reports, deep dive data drills, and organizes data analytics resources in partnership with regional director for meetings and other requests.
+ Review EOC KPI targets and data regularly, identifies areas of strength and those with opportunities, drives performance based with collaborating leaders based on results while providing consistent feedback.
+ Works in conjunction with Experience of Care and Market Leadership to develop market vision and strategic planning and implementation of strategies for patient experience.
+ Serves, manages, and supports internal and external stakeholders and customers across the continuum of care.
+ Participates as a team member and is accountable for own work responsibilities within assigned market or initiative.
This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.
**Licensing/Certification**
One of the following (required):
RN license
CPXP (Certified Patient Experience Professional from Patient Experience Institute)
**Education**
Bachelors Degree in; Healthcare, Nursing, or related field (required)
**Work Experience**
1 year experience with experience of care/customer relations (required)
1 year experience in an operational leadership role in a hospital setting (required)
**Working Conditions**
Periods of high stress and fluctuating workloads may occur.
Long-distance or air travel as needed- not to exceed 10% travel.
General office environment.
May be exposed to high noise levels and bright lights.
May be exposed to limited hazardous substances or body fluids.*
May have periods of constant interruptions.
_* Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control._
**Skills**
Change Management
Data Analysis
Ability to assess deviation from best practices and effectively apply solutions .
Problem/conflict resolution
Customer service champion
Leadership aptitude
As a Bon Secours Mercy Health associate, you're part of a Mission that matters. We support your well-being-personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.
**What we offer**
+ Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
+ Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, mental health resources and discounts
+ Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
+ Tuition assistance, professional development and continuing education support
_Benefits may vary based on the market and employment status._
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Bon secours Mercy Health - Youngstown, Ohio or Bon Secours - Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email ********************* . If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at *********************
$49k-74k yearly est. 60d+ ago
Coder - Physician Practice - CPC Required
Virtua 4.5
Remote
At Virtua Health, we exist for one reason - to better serve you. That means being here for you in all the moments that matter, striving each day to connect you to the care you need. Whether that's wellness and prevention, experienced specialists, life-changing care, or something in-between - we are your partner in health devoted to building a healthier community.
If you live or work in South Jersey, exceptional care is all around. Our medical and surgical experts are among the best in the country. We assembled more than 14,000 colleagues, including over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques to provide exceptional care close to home. A Magnet-recognized health system ranked by U.S. News and World Report, we've received multiple awards for quality, safety, and outstanding work environment.
In addition to five hospitals, seven emergency departments, seven urgent care centers, and more than 280 other locations, we're committed to the well-being of the community. That means bringing life-changing resources and health services directly into our communities through our Eat Well food access program, telehealth, home health, rehabilitation, mobile screenings, paramedic programs, and convenient online scheduling. We're also affiliated with Penn Medicine for cancer and neurosciences, and the Children's Hospital of Philadelphia for pediatrics.
Location:
100% RemoteCurrently Virtua welcomes candidates for 100% remote positions from: AZ, CT, DE, FL, GA, ID, KY, MD, MO, NC, NH, NJ, NY, PA, SC, TN, TX, VA, WI, WV only.
Remote Type:
On-Site
Employment Type:
Employee
Employment Classification:
Regular
Time Type:
Full time
Work Shift:
1st Shift (United States of America)
Total Weekly Hours:
40
Additional Locations:
Job Information:
Please note all candidates must complete & pass onsite testing in Marlton, NJ prior to an interview.
Position Responsibilities:
Responsible for abstracting clinical information and assigning CPT-4 and ICD-10 codes from medical records and documents to support physicians professional fees, including but not limited to outpatient evaluation and management (E/M) services and procedures in accordance guidelines.
Job Description
Position Responsibilities:
• Abstract billing for outpatient evaluation and management codes, minor surgical procedure(s) and HCPCS (supplies and pharmaceuticals) codes from provider documentation to include; assignment of CPT-4, ICD-10-CM codes and modifiers.
• Research simple coding/billing issues for the physicians to identify and recommend the most appropriate method of coding/billing. Research may involve interaction with such organizations as American Medical Association, specialty societies, or other coding consultants.
• Analysis of the medical record to determine the appropriateness of coding and potential patterns of abuse. Including working with the Coding/Charge/Audit Analyst(s) to resolve the issue(s).
Position Qualifications Required / Experience Required:
Minimum of two years records coding experience and/or equivalent education (completion of AAPC course or completion of Coding program at trade school).
Ability to perform functions in a Microsoft Windows environment.
Ability to be detailed oriented and perform tasks at a high level of accuracy.
Ability to make sound decisions.
Demonstrate good communication and team work skills.
Previous experience with an electronic legal health record system preferred.
Knowledge of Anatomy & Physiology/ Medical terminology required.
Required Education:
High School Diploma or GED required.
Knowledge of Anatomy & Physiology/ Medical terminology required
CPC (Certified Professional Coder) Certified required.
Hourly Rate: $26.00 - $39.11 The actual salary/rate will vary based on applicant's experience as well as internal equity and alignment with market data.Virtua offers a comprehensive package of benefits for full-time and part-time colleagues, including, but not limited to: medical/prescription, dental and vision insurance; health and dependent care flexible spending accounts; 403(b) (401(k) subject to collective bargaining agreement); paid time off, paid sick leave as provided under state and local paid sick leave laws, short-term disability and optional long-term disability, colleague and dependent life insurance and supplemental life and AD&D insurance; tuition assistance, and an employee assistance program that includes free counseling sessions. Eligibility for benefits is governed by the applicable plan documents and policies.
For more benefits information click here.
$26-39.1 hourly Auto-Apply 20d ago
Referral Coordinator - Oncology Network
SSM Health Saint Louis University Hospital 4.7
Remote
It's more than a career, it's a calling.
MO-REMOTE
Worker Type:
Regular
Job Highlights:
Schedule is Full time, Day shift, 40 hours a week
Ideal candidate will have insurance experience and working with Epic
Job Summary:
Coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans.
Job Responsibilities and Requirements:
PRIMARY RESPONSIBILITIES
Attends in-services provided by various health plans.
Travels to off-site locations as necessary.
Gathers necessary clinical information and processes referrals, pre-certification, pre-determinations, and pre-authorizes according to insurance plan requirements.
Logs, tracks and reviews managed care approvals and denials.
Responds in a timely manner to last minute/emergency referrals or additional codes performed during a procedure, or procedural changes for pre-authorizations.
Verifies insurance coverage, benefits and creatrs price estimates, reverifications as needed (ex; first of the month reverifications for managed Medicaid's).
Works collaboratively with insurance companies, providers and staff to ensure plan requirements have been met prior to patient services being rendered in order to maximize reimbursement.
Performs all other duties as assigned.
EDUCATION
High School diploma/GED or 10 years of work experience
EXPERIENCE
No experience required
PHYSICAL REQUIREMENTS
Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
Frequent keyboard use/data entry.
Occasional bending, stooping, kneeling, squatting, twisting and gripping.
Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
Rare climbing.
REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS
None
Department:
********** Oncology Network
Work Shift:
Day Shift (United States of America)
Scheduled Weekly Hours:
36
Benefits:
SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.
Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members.
Explore All Benefits
SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.
$32k-37k yearly est. Auto-Apply 2d ago
Epic Application Analyst (S)
SSM Health Saint Louis University Hospital 4.7
Remote
It's more than a career, it's a calling.
WI-REMOTE
Worker Type:
Regular
Job Highlights:
Join our Epic team and put your technical expertise to work optimizing key clinical and financial workflows. As an Epic Systems Analyst, you'll configure, support, and enhance Epic applications-solving complex issues, improving Hospital Billing/Claims performance, and partnering with teams and Community Connect sites to reduce defects and streamline processes. If you excel at problem‑solving, collaboration, and delivering a clean, reliable Epic build, this role offers the opportunity to make a meaningful systemwide impact.
Job Summary:
Configures, implements, supports and maintains applications and technical integrations, specifically Epic applications, to meet the needs of the organization. Serves as a coordinator and collaborates with business operations, information technology, leadership, system users and vendors.
Job Responsibilities and Requirements:
PRIMARY RESPONSIBILITIES
Builds requirements and translates into configuration and business process changes, using knowledge of standard workflows.
Provides routine maintenance and standard build for Epic applications and systems using existing internal processes, policies and procedures.
Provides technical knowledge analyzing Epic vendor software updates and the impact to the business for Epic applications.
Troubleshoots and resolves basic to moderately complex application issues and provides end-user support for Epic applications.
Codes complex functions including building application tables and reports for Epic applications.
Updates testing scripts to incorporate ongoing system development and implementations.
Acts as a resource for Epic colleagues with less experience. May lead small projects with manageable risk and resource requirements.
Analyzes, prioritizes, and organizes technical requirement specifications, using data, diagrams, and flowcharts to inform decision making.
Solves complex problems, takes a new perspective on existing solutions and exercises judgment based on the analysis of multiple sources of information.
Performs other duties as assigned.
EDUCATION
Bachelor's degree in computer science or related field, or equivalent years of experience and education
EXPERIENCE
Three years' relevant experience
Experience in Epic builds
CERTIFICATION
Epic certified in HB Claims
PHYSICAL REQUIREMENTS
Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
Frequent keyboard use/data entry.
Occasional bending, stooping, kneeling, squatting, twisting and gripping.
Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
Rare climbing.
Department:
********** Release Management
Work Shift:
Day Shift (United States of America)
Scheduled Weekly Hours:
40
Benefits:
SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.
Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members.
Explore All Benefits
SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.
$56k-77k yearly est. Auto-Apply 8d ago
RN-Utilization Review (S)
SSM Health Saint Louis University Hospital 4.7
Remote
It's more than a career, it's a calling
MO-REMOTE
Worker Type:
Regular
Job Highlights:
This role is open to applicants that reside in SSM Health's 4 state footprint - this includes Missouri, Illinois, Wisconsin and Oklahoma only.
Preference for candidates with strong computer skills and if possible EPIC experience.
Prior UR is preferred.
Compact license or licensure in more than one state is preferred.
Job Summary:
Evaluates the medical necessity and appropriateness of hospital admissions and surgical procedures. Ensures payors receive clinical information to support services provided by hospital. Ensures hospital receives authorization from payor.
Job Responsibilities and Requirements:
PRIMARY RESPONSIBILITIES
Discusses with payor regarding criteria and payor decision.
Escalates denials to physician (advisor, attending consultant, outside consultant) for peer to peer consideration.
Documents outcome in electronic medical record.
Participates with other members of team regarding opportunities for improvement in standard work.
Performs review of pre-admission, perioperative, and post operative surgical cases.
Performs other utilization management tasks as assigned.
Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient's age-specific needs and clinical needs as described in the department's scope of service.
Performs other duties as assigned.
EDUCATION
Graduate of accredited school of nursing or education equivalency for licensing
EXPERIENCE
Two years' registered nurse experience
REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS
State of Work Location: Illinois
Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)
State of Work Location: Missouri
Registered Nurse (RN) Issued by Compact State
Or
Registered Nurse (RN) - Missouri Division of Professional Registration
State of Work Location: Oklahoma
Registered Nurse (RN) Issued by Compact State
Or
Registered Nurse (RN) - Oklahoma Board of Nursing (OBN)
State of Work Location: Wisconsin
Registered Nurse (RN) Issued by Compact State
Or
Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services
Work Shift:
Day Shift (United States of America)
Job Type:
Employee
Department:
********** Sys Utilization ManagementScheduled Weekly Hours:40
Benefits:
SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.
Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members.
Explore All Benefits
SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law.
Click here to learn more.
$43k-96k yearly est. Auto-Apply 3d ago
System Director, Privacy
Bon Secours Mercy Health 4.8
Cincinnati, OH jobs
At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **SYSTEM DIRECTOR, PRIVACY** **| Work From Home/Remote**
**WFH/Remote anywhere in the US (Eastern/Central Time Zone Preferred)**
***We operate in the Eastern Time Zone***
**Reports to: Vice President of Privacy and Compliance**
**\# of Direct Reports: 3**
**Primary Function/General Purpose of Position**
Under the strategic direction of compliance leadership this position contributes to the Bon Secours Mercy Health mission and vision by assisting in the development and implementation of the Ministry-wide compliance program. This position provides support and guidance for compliance related activities to Bon Secours Mercy Health operational and clinical leaders.
**Essential Job Functions**
+ Implements the BSMH Compliance program within their assigned functional areas, including application of innovative, leading practice approaches to support the Compliance team in identification, assessment, and mitigation of risks, auditing and monitoring, education of leaders on compliance regulations, establishing functional compliance committees, and implementing compliance policies.
+ Implements system wide compliance strategy and deployment of functional area compliance priorities and initiatives.
+ Provides advice/consultation to BSMH Leadership regarding compliance and regulatory initiatives impacting the organization and assists in mitigating system-wide risks to the organization. This will include presentations and education sessions on emerging risk areas. Meet monthly with system and market leadership on compliance concerns and initiatives.
+ Assists in the development and evaluation of system-wide operational policies and procedures.
+ Leads advanced investigations across the ministry relative to their functional area. Works collaboratively with Advice and Counsel, Medical Group, Patient Experience, Legal, and other BSMH Partners to conduct interviews, document investigatory steps, and make recommendations for corrective actions.
+ Serves as compliance leader with responsibility for communication to system and market leadership. Coordinates functional issues that arise with the appropriate functional Director, Compliance.
+ Leads and develops functional compliance directors, conduct system training, ensure consistent application of investigative protocols, compliance tracking system integrity, awareness of BSMH strategic initiatives, and standardization of established processes across the compliance program.
+ Develops and implements compliance monitoring and auditing protocols specific to compliance functional risk areas highlighted by the OIG, Medicare, State Medicaid, State Insurance Fraud; Managed Care or Governmental Value-Based payment programs and/or other enforcement agencies as part of the overarching BSMH compliance program.
+ Evaluates and utilizes data analytics techniques, statistical analysis and modeling, and databases developed internally, or in conjunction with other third-party vendors to detect and trend potential compliance issues, makes recommendations for compliance program changes and develops education in response to identified trends.
+ Supports and coordinates data for the internal compliance leadership meetings, system and market leaders, and the BSMH Executive Compliance Committee.
+ Identifies the need and develops education content and trending of non-compliant activities to enhance proficiency and competency, understanding of standards and the consequences of non-compliance. Prepares multi-faceted oral, written and electronic communications and presentations to facilitate discussion, networking, decision-making and proactive responses to meet current and emerging challenges among affected parties and entities.
**Licensing/Certification**
Certified in Healthcare Compliance (CHC) - Health Care Compliance Association (required)
**Education**
+ Masters - Healthcare, Business Administration or related field. (required)
+ Bachelors - Healthcare, Business Administration or related field. (required)
**Work Experience**
+ Eight to ten years of in-depth experience within healthcare operations or compliance-related activities.
+ Demonstrated working knowledge of the Department of Health and Human Services
**Skills:**
**Hard Skills**
+ Translates enterprise compliance strategy into coordinated programs and workflows across multiple functional areas.
+ Interprets complex regulations and operationalizes compliant practices across diverse service lines.
+ Utilizes compliance data, dashboards, and AI-enabled insights to identify emerging risk patterns and inform mitigation.
+ Oversees system-level auditing and monitoring processes, ensuring alignment with risk assessment priorities.
+ Leads consistent execution of enterprise compliance policies and ensures harmonization across markets and departments.
+ Manages complex compliance investigations with consistency, through documentation and cross-functional collaborations.
+ Oversee the designs and delivery of targeted compliance education and training aligned with system priorities and risk trends.
+ Measures effectiveness of compliance initiatives using qualitative and quantitative metrics, recommending improvements based on results.
+ Works closely with Legal, Audit, I&T, HR and Operations to embed compliance within business processes.
+ Ensures appropriate use of compliance systems, tools, and vendor solutions supporting program management and monitoring.
**Soft Skills**
+ Translates high-level compliance strategy into actionable, measurable results across teams and regions.
+ Build strong partnerships with operational leaders, physicians, and functional stakeholders to align compliance outcomes with organizational goals.
+ Approaches compliance challenges with balanced analytical rigor and pragmatic problem-solving.
+ Drives adoption of new compliance processes and behaviors through communication, coaching, and relationship-building.
+ Serves as a visible role model for ethical conduct and accountability consistent with the system's mission and values.
+ Tailor communication to executive, operational, and frontline audiences with clarity and diplomacy.
+ Mentors Compliance Directors and emerging leaders to build depth and consistency within the compliance function.
+ Adjust priorities quickly in response to evolving regulatory demands and emerging risk areas.
+ Navigates sensitive investigations and organizational challenges with composure, empathy, and fairness.
+ Thinks system-first, balancing local needs with ministry-wide objectives and ensuring alignment with enterprise values and mission.
As a Bon Secours Mercy Health associate, you're part of a Mission that matters. We support your well-being-personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.
**What we offer**
+ Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
+ Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, mental health resources and discounts
+ Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
+ Tuition assistance, professional development and continuing education support
_Benefits may vary based on the market and employment status._
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Bon secours Mercy Health - Youngstown, Ohio or Bon Secours - Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email ********************* . If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at *********************