Call Center Representative I - (MEM009450) Description Title: Call Center Representative/Call Agent ILocation: Fountain ValleyDepartment: Navigation CenterStatus: Full-Time/Predominantly RemoteShift: This will be a remote position AFTER the onsite training period. This position is for a Monday thru Thursday schedule 930a-6p and Sunday 930p-6p once training is completed and navigator is working from home.Pay Range: $20.75/hr - $29.47/hr MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups - consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.Purpose Statement / To be the first reliable point of contact for Patients, Families and Providers. Providing the Simply Better MemorialCare Experience in every interaction with guests and colleagues.Essential Functions and Responsibilities of the Job· Deliver the Simply Better MemorialCare Experience in every interaction with Patients, Families, Providers and Colleagues. · Prioritize service and customer experience within each interaction.· Ensure unforgettable guest experiences through unmatched service.· Demonstrates strong guest-focused engagement over the phone, email, and chat.· Demonstrates effective communication, interpersonal, written and verbal skills.· Strong organizational skills.· Must be able to multi-task and maintain calm demeanor.· Must possess problem resolution and follow through skills.· Knowledge of managed care and the business segments.· Knowledge and ability to schedule reservations for patients/family.· Be at work and be on time.· Follow company policies, procedures and directives.· Interact in a positive and constructive manner.· Prioritize and multitask.Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare-that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there's more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards. Qualifications Experience
· 1-2 years customer service experience or other related guest-focused engagement preferred.
· Call center experience necessary in a fast-paced setting.
· Excellent computer and typing skills are necessary. Use and knowledge of Windows, Microsoft Office, and Outlook (operates PC with speed and accuracy)
· Some medical terminology preferred.
· Spanish speaking a plus.
Education
· High School diploma, GED required.
Primary Location: United States-California-Fountain ValleyWork Locations: MCSS-MemorialCare Shared Svcs 17360 Brookhurst Fountain Valley Fountain Valley 92708Job: Custmr Srvc,Patient Rel,ReceptOrganization: MemorialCare Health ServicesSchedule: Full-time Job Posting: Jan 28, 2026, 4:21:54 PMShift: Day JobScheduled Shift Start Time: varies - Scheduled Shift End Time: varies Department Name: MemorialCare Navigation Center
$20.8-29.5 hourly Auto-Apply 2d ago
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Facility Coding Inpatient DRG Quality Analyst
Banner Health 4.4
Remote
Department Name:
Coding-Acute Care Compl & Educ
Work Shift:
Day
Job Category:
Revenue Cycle
Estimated Pay Range:
$29.11 - $48.51 / hour, based on location, education, & experience.
In accordance with State Pay Transparency Rules.
Innovation and highly trained staff. Banner Health recently earned Great Place To Work Certification™. This recognition reflects our investment in workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of our team members. Find out how we're constantly improving to make Banner Health the best place to work and receive care.
Interested in joining our Coding team? We have great opportunities, whether you're looking for entry-level or have been coding for years! Requirements for each position noted below.
Not the right fit for you? Keep looking! We have a lot different teams with different focuses (Facility vs Profee).
In this Inpatient Facility-based HIMS Coding Quality Associate position, you bring your 5 years of acute care inpatient coding background to a team that values growth and development! This is a Quality position, not a day-to-day coding production role but does require coding proficiency and recent Hospital Facility Coding experience. This position is task-production-oriented ensuring quality in the Inpatient Facility Coding department. If you have experience with DRG and PCS coding/denials/audits, we want to hear from you.
Schedule: Full time, Monday-Friday 8am-5pm during training. Flexible scheduling after completion of training.
Location: REMOTE, Banner provides equipment
Ideal candidate:
5 years recent experience in acute-care Inpatient facility-based medical coding (clearly reflected in your attached resume);
DRG and PCS Coding, Auditing experience;
Bachelors degree or equivalent;
Must be currently certified through AAPC or Ahima, as defined in minimum qualifications below. Please upload a copy or provide certification number in your questionnaire.
This is a fully remote position and available if you live in the following states only: AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, MI, MN, MO, MS, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI & WY.
Interested in joining our Coding team? We have great opportunities, whether you're looking for entry-level or have been coding for years! Requirements for each position noted below.
Not the right fit for you? Keep looking! We have a lot different teams with different focuses (Facility vs Profee).
Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.
POSITION SUMMARY
This position is responsible for the interpretation of clinical documentation completed by the health care team for the health record(s) and for quality assurance in the alignment of clinical documentation and billing codes. Works with clinical documentation improvement and quality management staff to: align diagnosis coding to documentation to improve the quality of clinical documentation and correctness of billing codes prior to claim submission; to identify possible opportunities for improvement of clinical documentation and accurate MS-DRG, Ambulatory Payment Classification (APC) or ICD-10 assignments on health records. Provides guidance and expertise in the interpretation of, and adherence to, the rules and regulations for code assignment based on documentation for all levels of complexity to include accounts encountered in Banner's Academic, Trauma, high acuity and critical access facilities, as well as specialized services such as behavioral health, oncology, pediatric. Acts as subject matter expert regarding experimental and newly developed procedure and diagnostic coding.
CORE FUNCTIONS
1. Provides guidance on coding and billing, utilizing coding and billing guidelines. Demonstrates extensive knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment Classification (APC) or utilized operational systems. Provides explanatory and reference information to internal and external customers regarding coding assignment based on clinical documentation which may require researching authoritative reference information from a variety of sources.
2. Reviews medical records. Performs an audit of clinical documentation to ensure that clinical coding is accurate for proper reimbursement and that coding compliance is complete. Provides feedback on coding work and trends, and offers suggestions for improvement where opportunities are identified. Reviews accuracy of identified data elements for use in creating data bases or reporting to the state health department. If applicable, applies Uniform Hospital Discharge Data Set (UHDDS) definitions to select the principal diagnosis, principal procedure, complications and co morbid condition, other diagnoses, and significant procedures which require coding. Apply policies and procedures on health documentation and coding that are consistent with official coding guidelines.
3. Assists with maintaining system wide consistency in coding practices and ethical coding compliance. If applicable, initiates and follows through on physician queries to ensure that code assignment accurately reflects the patient's condition, treatment and outcomes. Identifies training needs for coding staff. Serves as a team member for internal coding accuracy audits and documents findings.
4. Acts as a knowledge resource to ancillary clinical departments, patient financial services and revenue integrity analysts regarding charge related issues, processes and programming. Participates in company-wide quality teams' initiatives to improve coding and clinical documentation. Assists with education and training of staff involved in learning coding. Assists in creating a department-wide focus of performance improvement and quality management. Assists and participates with management through committees to properly educate physicians, nursing, coders, CDM's, etc. with proper and accurate coding based on documentation for positive outcomes.
5. Performs ongoing audits/review of inpatient and/or outpatient medical records to assure the use of proper diagnostic and procedure code assignments. Collaborates on DRG and coding denials, billing edits/rejections to provide coding expertise to resolve issues and support appropriate reimbursement. Proficiency in claims software to address coding edits and claim denials utilizing multiple platforms and internal tracking tools. Provides findings for use as a basis for development of coding education and audit plans.
6. Maintains a current knowledge in all coding regulatory updates, and in all software used for coding, coding reviews and health information management for the operational group. Identifies and collects data to allow for monitoring and evaluation of trends in DRG (MS/APR-DRG), APC, HCC, other Heath Risk Adjusted Factors, National Correct Coding Initiative (NCCI) and the effect on Case Mix Index by use of specialized software.
7. May code inpatient and outpatient records as needed. Works as a member of the overall HIMS team to achieve goals in days-to-bill.
8. Works independently under limited supervision. Uses an expert level of knowledge to provide coding and billing guidance and oversight for all Banner facilities and services they provide. Internal customers include but are not limited to medical staff, employees, and management at the local, regional, and corporate levels. External customers include but are not limited to, practicing physicians, vendors, and the community.
MINIMUM QUALIFICATIONS
Requires a level of education as normally demonstrated by a bachelor's degree in Health Information Management or experience equivalent to same.
Demonstrated proficiency in hospital coding as normally obtained through 5 years of current and progressively responsible coding experience required.
Requires Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC) or Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) or Certified Coding Specialist-Physician (CCS-P) or Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) or other qualified coding certification in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).
Demonstrated proficiency in hospital coding as normally obtained through 5 years of current and progressively responsible coding experience required.
Must possess a thorough knowledge of ICD Coding and DRG and/or CPT coding principles, as recommended by the American Health Information Management Association coding competencies. Requires an in-depth knowledge of medical terminology, anatomy and physiology, plus a thorough understanding of the content of the clinical record. Extensive knowledge of all coding conventions and reimbursement guidelines across services lines, LCD/NCDs and MAC/FIs.
Extensive critical and analytical thinking skills required. Ability to organize workload to meet deadlines and maintain confidentiality. Excellent written and oral communication skills are required, as well as effective human relations skills for building and maintaining a working relationship with all levels of staff, physicians, and other contacts.
Must consistently demonstrate the ability to understand the Medicare Prospective Payment System, and the clinical coding data base and indices, and must be familiar with coding and abstracting software, claims processing tools, as well as common office software and electronic medical records software.
PREFERRED QUALIFICATIONS
Additional related education and/or experience preferred.
EEO Statement:
EEO/Disabled/Veterans
Our organization supports a drug-free work environment.
Privacy Policy:
Privacy Policy
Opportunity Information
Sutter Medical Group (SMG) seeks to hire a BE/BC fellowship-trained Body Imaging Radiologist to join an established practice in Jackson, CA.
Sutter Imaging is seeking a fellowship-trained imager and to join our close-knit, quality care-centered group within a larger, financially strong, and stable organization. We are seeking a candidate who enjoys the flexibility to work from home and working on-site including diagnostics and IR. This role offers a dynamic work environment with moderate volumes and opportunities for professional growth. The schedule is flexible to allow a good work/life balance. Weekend, STAT, & Flex shifts are available to read from home for anyone wishing to expand income beyond their base salary.
Qualifications
Board certified/Board eligible
Join Us and Enjoy
PLSF eligible
Subspecialty-structured radiology group with advanced practice technology
$600,000 Base compensation with opportunities to earn additional income through flex shifts*
$50k sign-on bonus (paid in 2 parts)
Assistance with relocation expenses
Generous benefits, including employer-matched 401(k) and profit-sharing
Shareholder track
CME allowance
Equitable practice and scheduling structure
A positive work-life balance and Northern California's natural beauty and lifestyle
10 weeks scheduled vacation
4-day average work week
Holidays are shared equitably
Ability to work some shifts from home (Weekend, STAT, & Flex Shifts)
Organization Details
Sutter Medical Group (SMG) is a vibrant and talented community committed to delivering safe, affordable and high-quality care. Our multi-specialty medical group is comprised of over 1,600 clinicians practicing in seven counties in northern California, most within a 50-mile radius of Sacramento. SMG contains primary care and specialty Physicians and Advanced Practice Clinicians -- nurse practitioners, physician assistants, certified nurse midwives, licensed clinical social workers and licensed marriage and family therapists, who make up about 20% of our group. Our clinicians not only excel in clinical practice but are also actively engaged in teaching, research, leadership, community outreach, and volunteer work. SMG has earned both local and national recognition for excellence in patient care and experience.
Community Information
Jackson, CA is a charming historic town nestled in the Sierra Nevada foothills, known for its Gold Rush heritage and small-town appeal. The downtown area features preserved 19th-century architecture, boutique shops, and local wineries that reflect the region's rich past. Surrounded by scenic rolling hills and outdoor recreation, it's a gateway to hiking, fishing, and exploring California's wine country. Jackson offers a peaceful lifestyle with a strong sense of community, just an hour southeast of Sacramento.
Equal Opportunity Statement
It is the policy of Sutter Health and its partners to provide equal employment for all qualified individuals; to prohibit discrimination in employment because of basis of race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state or federal law, ordinance or regulation. We promote the full realization of equal employment opportunities through a positive continuing program within each medical group, company, hospital, department, and service area. Equal employment opportunities apply to every aspect of Sutter's employment policies and practices.
$58k-74k yearly est. Auto-Apply 60d+ ago
Care Manager - Central Placement Center - Hybrid/Miramar - Casual/Per-Diem
Scripps Health 4.3
San Diego, CA jobs
Scripps Health Administrative Services supports our five hospital campuses, 31 outpatient centers, clinics, emergency rooms, urgent care sites, along with our 17,000 employees, more than 3,000 affiliated physicians and 2,000 volunteers. This is a casual/per-diem position with a 12-hour varied hours primarily being evening shifts 7pm to 7am or 3pm to 3am. Weekend requirements are one day every other week and holidays are rotated.
This position is hybrid, being remote majority of the time. There are on-site requirements for one week each quarter. All training initially begins on-site or if there are any technical issues at home.
This position is located off Miramar Road.
At Scripps Health, your ambition is empowered, and your abilities are appreciated:
* Nearly a quarter of our employees have been with Scripps Health for over 10 years.
* Scripps is a Great Place to Work Certified company for 2025.
* Scripps Health has been consistently ranked as a top employer for women, millennials, diversity, and as an overall workplace by various national publications.
* Becker's Healthcare ranked Scripps Health on its 2024 list of 150 top places to work in health care.
* We have transitional and professional development programs to create a learning environment that enables you to thrive in your specific field as well as in your overall career.
* Our specialties have been nationally recognized for quality in areas such as cardiovascular care, oncology, orthopedics, geriatrics, obstetrics and gynecology, and gastroenterology.
We invite you to join our highly engaged Central Placement Center as a Care Manager.
As a Care Manager you will be responsible for screening patients in their assigned caseload to identify those that are medically vulnerable, who may have needs that may be addressed at another location; or within contracted programs/vendors specific to their needs/health plan. In addition, you will coordinate with the health care team and the patient/family to address issues that may impact their care, and to develop a transition plan of care based on the patients' needs.
Preferred Education/Experience/Specialized Skills/Certification:
* Bachelor of Science in Nursing (BSN) highly desired.
* Case management certification is highly preferred.
* EPIC experience preferred.
* Demonstrate knowledge of utilization management including experience managing prior-authorization and concurrent review.
* Knowledge of Medicare and Commercial health plans.
* 3+ years of managed care and/or case management experience.
* Strong computer skills that can easily adapt to using multiple different programs.
Required Education/Experience/Specialized Skills:
* RN 2+ years clinical experience
* 1-2 years inpatient acute hospital case management experience OR experience in either acute or non-acute case management.
* Excellent verbal and written communication (including documentation) skills demonstrated by completing the required forms and the ability to work effectively with individuals and or teams across disciplines.
* Ability to independently utilize critical thinking skills, nursing judgement and decision-making skills.
* Ability to prioritize, plan, and handle multiple tasks/demands simultaneously as evidence by capacity of open cased, active care plan rate and the ability to handle multiple tasks.
* Ability to read, analyze and interpret information in medical records, and health plan documents.
* Demonstrates knowledge in Microsoft Office applications including Outlook, Word, and Excel
Required Certification/Registration:
* Current California RN License.
#LI-JS1
At Scripps Health, you will experience the pride, support and respect of an organization that has been repeatedly recognized as one of the nation's Top 100 Places to Work.
You'll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So if you're open to change, go ahead and unlock your potential.
Position Pay Range: $59.81-$86.71/hour
$38k-74k yearly est. 3d ago
Outpatient Coding Specialist - Work at Home - Any State
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. Advanced outpatient coding position that reviews medical record documentation and accurately assign ICD-10-CM, ICD-10-PCS, as well as CPT IV codes based on the specific record type and abstract specific data elements for each case in compliance with federal regulations. This position codes all types of outpatient visits to include ancillary, urgent care, emergency department, observation, same day surgery, and interventional procedures. Follows the Official Guidelines for Coding and Reporting, the American Health Information Management Association, (AHIMA,) Coding Ethics, as well as the American Hospital Association, (AHA) Coding Clinics, CMS directives and Bulletins, Fiscal Intermediary communications. Utilizing Coding Applications in accordance with established workflow. . Follows Mercy Policies and Procedures and maintains required quality and productivity standards.
**ESSENTIAL FUNCTIONS**
+ Reviews medical record documentation and accurately assigns appropriate ICD-9-CM, ICD-10, CPT IV, and HCPCS codes utilizing the 3M software tools for all OP Work Types (Ancillary, ED Charge/Code, Same Day Surgery, and Observation. . The assigned codes must support the reason for the visit and the medical necessity that is documented by the provider to support the care provided. When applicable, apply the appropriate charges such as the Evaluation & Management, (E&M) level and injections and infusions, and/or other necessary requirements for Observation cases, using a third party software systems such as LYNX.
+ ·Correctly abstract required data per facility specifications.
+ ·Perform "medical necessity checks" for Medicare and other payers as required per payment guidelines.
+ Responsible for monitoring and working of accounts that are Discharged Not Final Billed, failed claims, stop bills, and premise as a team, ensure timely, compliant processing of outpatient claims in the billing system.
+ Responsible to maintain established productivity requirements, key performance indicators established for 3M 360 CAC for CRS & Direct Code as well as ensure accuracy to maintain established quality standards.
+ Remain abreast of current requirements of the Centers for Medicare & Medicaid Services, (CMS,) to include National Coverage Determinations, (NCD) and Local Coverage Determinations, (LCD) guidelines, related to the assignment of modifiers, to ensure the submission of a clean claim the first time through.
+ Maintains competency and accuracy while utilizing tools of the trade, such as the 3M encoder, Computerized Assisted Coding, (CAC,) Medical Necessity software, abstracting system, code books, and all reference materials. Reports inaccuracies found in Coding Software to HIM Management/Supervisor, reports any potential unethical and/or fraudulent activity per compliance policy
+ Follows all established Mercy Health policies and procedures to include abiding by paid time off, (PTO) requirements.
+ Attends required system, hospital and departmental meetings and educational sessions as established by leadership, as well as completion of required annual learning programs, to ensure continued education and growth.
+ Training/Mentoring - SMART Responsibilities where applicable
**Required Minimum Education:**
+ Vocational/Technical Degree, Specialty/Major: HIM / Coding Certification
+ Preferred Education: 2 year/Associate's Degree, Specialty/Major: HIM / Coding Certification
+ LICENSURE/CERTIFICATIONS (must be non-expired/active unless otherwise stated):
+ Required: If RHIA or RHIT or CCA upon hire without COC or CCS, will be required to acquire COC or CCS and CRCR within 1 year of hire
+ Preferred: RHIA or RHIT or CCS or COC or CCA or CPC
**MINIMUM QUALIFICATIONS**
+ Minimum Years and Type of Experience: Completion of Coding Curriculum with one year of previous coding experience.
+ Other Knowledge, Skills and Abilities Required: Satisfactory completion of Medical Terminology and Anatomy and Physiology. Completion of ICD-10 training. Previous use of Coding Software Tools.
+ Knowledge of medical record content to include electronic medical records, (EMRs.) Ability to function independently, with minimal supervision, as well as part of a team.
+ Ability to function under continual deadlines. Ability to maintain accuracy during frequent interruptions.
+ Proficiency in keyboarding skills and working knowledge of computers. Excellent communication skills.
+ Other Knowledge, Skills and Abilities Preferred: Previous coding experience in an acute care setting and previous use of coding software tools. Previous use of CAC.
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 *********************
$40k-52k yearly est. 41d ago
Application Specialist
Scripps Health 4.3
San Diego, CA jobs
Scripps Health Administrative Services supports our five hospital campuses, 31 outpatient centers, clinics, emergency rooms, urgent care sites, along with our 17,000 employees, more than 3,000 affiliated physicians and 2,000 volunteers. Expert on assigned application. Acts independently to lead cross functional, integrated team to create performance improvements across multiple domains. Translates business requirements into operational solutions. Proactively evaluate technical enhancements and consults with business to provide solutions to technical or process issues, guiding to best practices. Provides guidance, trains and develops the skills of less experienced IT staff.
This position is based in La Jolla, CA, and is offered as a remote opportunity. Candidates must reside within the San Diego metropolitan area or in one of the approved out-of-area (OOA) states listed below under Work Location Eligibility. This role is supported through Scripps Health's partnership with Superlanet, a professional employer organization (PEO).
Required Education/Experience/Specialized Skills: Five years related experience. Excellent critical and analytical thinking and excellent customer service skills. Exhibit excellent written and verbal communication skills. Expert knowledge of relevant application workflows. Excellent organizational and project management skills. Business acumen in multiple functional areas.
Required Certification/Registration: Specific to applications supported. Must currently hold an active Epic Beaker AP or CP certification
Preferred Education/Experience/Specialized Skills/Certification: Certification: Bachelor's degree. 7 years of related experience
Work Location Eligibility
* This position is remote, but only open to candidates who reside in: San Diego Metropolitan Area or one of the following U.S. states:
AL, AR, AZ, DE, FL, GA, IA, ID, IN, KS, KY, LA, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, RI, SC, SD, TN, TX, UT, VA, VT, WI, WV, WY
* Applicants outside these locations will not be considered at this time.
* Candidates who reside in the approved U.S. states would be considered Out of Area (OOA) and Scripps Health partners with professional employer organization (PEO) Superlanet.
At Scripps Health, you will experience the pride, support and respect of an organization that has been repeatedly recognized as one of the nation's Top 100 Places to Work.
You'll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So if you're open to change, go ahead and unlock your potential.
Position Pay Range: $54.24-$78.66/hour
$54.2-78.7 hourly 39d ago
Hospice Medical Director - Remote Only, Per Diem, Flexible Schedule
Banner Health 4.4
Greeley, CO jobs
**Per Diem Hospice Medical Directorin Beautiful Northern, CO** **Remote Only & Flexible Schedule** **BANNER HEALTH and the Home Care & Hospice Division** , one of the countrys premier, nonprofit health care networks with more than 1,500 physicians and advance practice providers, **has an excellent opportunity for a compassionate, skilled clinician to join our interdisciplinary team! This position serves the growing community in Northern Colorado in partnership with the current care team.**
Utilizing a multidisciplinary approach, the qualified candidate will provide remote support to the Home Care & Hospice team of Advanced Practice Providers.
**Position Requirements and Information:**
+ BC/BE in a relevant specialty
+ Colorado state licensed
+ Fellowship training in Hospice & Palliative Medicine - NOT REQUIRED
+ Experience preferred, new graduates also welcome to apply
+ Flexible schedule primarily providing back-up coverage for the acting Medical Director
**Compensation & Benefits:**
+ **$140/hr**
+ Malpractice and Tail Coverage
**About the area:** With more than 300 days of sunshine, Northern Colorado is one of the best places to live and work offering spectacular views along the Rocky Mountain Front Range, great weather, endless recreational activities, cultural amenities, education, and professional opportunities.
+ Within one hour of majestic Rocky Mountain National Park & 90 minutes to world-class ski resorts
+ Numerous outdoor activities including golf, biking, hiking, camping, rock climbing, hunting, and fishing
+ Thriving cultural and retail sectors
+ Highly educated workforce & broad-based business sector leading to substantial growth along the front range
+ Variety of public and private education options for K-12 and easy access to three major universities
**PLEASE SUBMIT YOUR CV TODAY FOR IMMEDIATE CONSIDERATION**
As an equal opportunity employer, Banner Health values culture and encourages applications from individuals with varied experiences and backgrounds. Banner Health is an EEO Employer.
POS15101
Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability.
$140 hourly 50d ago
Ambulatory Clinical Pharmacist IV
Sutterhealth 4.8
San Francisco, CA jobs
We are so glad you are interested in joining Sutter Health!
Organization:
PAMF-Palo Alto Medical Foundation PAD is eligible to work from home but must be available to go on-site as needed** Oversees and delivers pharmaceutical care through the provision of patient-centered clinical service, medication information, education, medication preparation and distribution that ensures safe, effective, and cost efficient medication therapy. Exercises sound judgment, and developed clinical skills to provide input to and implement the patient's plan of care based on the diagnosis in a timely manner. Gains confidence and cooperation from the patient, their family/support group, and other healthcare providers through competent patient assessment, attentive monitoring and care, and effective communication. Adheres to all local/state/federal regulations, codes, policies and procedures to ensure privacy and safety while delivering optimal patient care. May also be responsible for performing specific procedures and/or teaching duties. Uses professional judgment and clinical expertise in the daily solving of complex problems.
Job Description:
JOB ACCOUNTABILITIES:
Initiates, monitors, modifies, and discontinues patients' drug therapy under the supervision of a physician in accordance with a collaborative practice agreement and approved protocol in keeping with the principles of comprehensive Medication Therapy Management (MTM) programs.
Completes medication regimen review from a clinical, safety, and cost perspective to identify duplicate therapy, high-risk medications, drug interactions and cost-effective alternatives
Supports patients and their families in their self-management of complex medication regimens, including the disease management of those living with a chronic condition.
Proactively contacts patients after hospital discharge to reconcile medications, answer questions on new medications that were started in the hospital, evaluate patient compliance with new drug regimens, and follow up with the patient regarding side effects of new medications.
Education of practice staff and team on contemporary issues related to pharmacotherapy and outcomes management, including communication efforts related to mediation management.
Develops and maintains positive, productive relationships with healthcare team members and representatives of community agencies.
Education and counseling of patients on medications.
Improvement efforts related to drug intelligence - research for evidence-based medication use and education on the same.
Supports process improvement efforts and educates co-workers.
Develops and maintains positive working relationships with hospital unit staff and management.
Relates with tact and respect to internal and external customers with diverse cultural and socioeconomic backgrounds, some of whom may be exhibiting varying levels of distress.
Effectively collaborates with other team members on interdependent tasks, and actively supports the implementation of plans to accomplish team objectives.
Actively builds positive relationships with internal and external customers. Uses effective communication skills with colleagues to resolve issues in a timely, positive, and productive manner.
Provides and accepts direct, constructive feedback from colleagues.
EDUCATION
PHARMD-Graduate of an accredited pharmacy school
CERTIFICATION & LICENSURE
PHARMR-Current registration or Registered Pharmacist within 120 days
TYPICAL EXPERIENCE:
3 years recent relevant experience.
SKILLS AND KNOWLEDGE:
Knowledge of medical terminology, generic and trade pharmaceutical names, pharmaceutical calculations and laws and regulations.
Knowledge and understanding of different Pharmacy practice settings, including narcotic delivery and procedures.
Knowledge and ability to identify and employ pharmaceutical and medical terms, abbreviations and symbols commonly used in prescribing, dispensing, and record keeping of medications.
Requires a basic working knowledge of legal requirements and accreditation standards including The Joint Commission, Title XXII, Department of Homeland Security (DHS), Drug Enforcement Administration (DEA), Food and Drug Administration (FDA), and United States Pharmacopeia (USP).
Possess written and verbal communications skills to explain sensitive information clearly and professionally to diverse audiences, including non-medical people.
General knowledge of computer applications, such as Microsoft Office Suite (Word, Excel and Outlook), related pharmaceutical technology, Electronic Health Records (EHR), and EPIC.
Job Shift:
Days
Schedule:
Full Time
Shift Hours:
8
Days of the Week:
Variable
Weekend Requirements:
None
Benefits:
Yes
Unions:
No
Position Status:
Non-Exempt
Weekly Hours:
40
Employee Status:
Regular
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $98.34 to $113.09 / hour
The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate's experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health's comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.
$98.3-113.1 hourly Auto-Apply 51d ago
Manager Reimbursement - Remote Opportunity
Lcmc Health 4.5
Remote
Your job is more than a job
REMOTE QUALIFICATIONS
Must be a resident of Texas, Louisiana, Mississippi, Alabama, Florida or Georgia
Manages all reporting functions related to gross revenue, revenue deductions, bad debt, patient accounts receivable and settlement receivables for consolidated financials and subsidiaries, and the preparation of all the schedules related to the above-mentioned transactions.
Supervises staff and ensures the filing of all the cost reports per timelines, the GME reimbursement applications, the outlier bills and other supplemental funding related reporting.
Verifies monthly financial statements and schedules related to revenue, revenue deductions, patient accounts receivable and settlement receivable for accuracy and reasonableness before submission to the leaders. Consults, advises and answers questions raised by the leadership..
Maintains a clear understanding of general ledger and patient accounting systems. Leverages analytical and interpretative skills in analyzing financial statements and reports.
Produce revenue budgets and financial projections. Assists with annual 990 filings.
Coordinates the completion of audit schedules for revenue, revenue deductions, patient accounts receivable and settlement receivables requested by the audit firm.
EXPERIENCE QUALIFICATIONS
5 years in healthcare cost report preparation (Medicare and Medicaid)
Experience in healthcare accounting
EDUCATION QUALIFICATIONS
Bachelor's Degree in Accounting
SKILLS AND ABILITIES
CMS cost report. Extensive knowledge of health care reimbursement practices and regulatory requirements. Strong analytical, advanced spreadsheet, and database skills. Working knowledge of EPIC, Lawson, Workday systems a plus. Excellent written and verbal communication skills and ability to interact professionally with management and leadership throughout the system.
REPORTING RELATIONSHIPS
Does this position formally supervise employees? Yes
FUNCTIONAL DEMANDS
Light: Light physical requirements- Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.
PHYSICAL DEMANDS
Sitting - Frequent (36-66% of day)
Standing - Frequent (36-66% of day)
Walking - Frequent (36-66% of day)
Climbing (e.g., stairs or ladders) - Occasional (0-35% of day)
Carrying objects - Occasional (0-35% of day)
Push/pull - Occasional (0-35% of day)
Twisting - Occasional (0-35% of day)
Bending - Occasional (0-35% of day)
Reaching forward - Occasional (0-35% of day)
Reaching overhead - Occasional (0-35% of day)
Wrist position deviation - Frequent (36-66% of day)
Pinching/fine motor activities - Occasional (0-35% of day)
Keyboard use/repetitive motion - Frequent (36-66% of day)
Talk or hear - Frequent (36-66% of day)
OCCUPATIONAL EXPOSURE RISK POTENTIAL
Bloodborne pathogens - Not Anticipated
Chemical - Not Anticipated
Airborne communicable diseases - Not Anticipated
Extreme temperatures - Not Anticipated
Radiation - Not Anticipated
Uneven surfaces or elevations - Not Anticipated
Extreme noise levels - Not Anticipated
Dust/particular matter - Not Anticipated
Other (List) - Not Anticipated
POPULATION SERVED
Neonate/Infant up to 1 year: No
Youth (1yr to 15 yrs): No
Adult (16 and up): No
WORK SHIFT:
Days (United States of America)
LCMC Health is a community.
Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little “come on in” attitude is the foundation of LCMC Health's culture of everyday extraordinary
Your extras
Deliver healthcare with heart.
Give people a reason to smile.
Put a little love in your work.
Be honest and real, but with compassion.
Bring some lagniappe into everything you do.
Forget one-size-fits-all, think one-of-a-kind care.
See opportunities, not problems - it's all about perspective.
Cheerlead ideas, differences, and each other.
Love what makes you, you - because we do
You are welcome here.
LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.
The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.
Simple things make the difference.
1. To get started, take your time to fully and accurately complete the application for employment. Incomplete applications get bogged down and are often eliminated due to missing information.
2. To ensure quality care and service, we may use information on your application to verify your previous employment and background.
3. To keep our career applications up-to-date, applications are inactive after 6 months and, therefore, require a new application for employment to be completed.
4. To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.
$73k-112k yearly est. Auto-Apply 22d ago
CDM Analyst - Revenue Integrity - Remote
LCMC Health 4.5
New Orleans, LA jobs
Your job is more than a job REMOTE REQUIREMENT Must be a resident of Texas, Louisiana, Mississippi, Alabama, Florida or Georgia The CDM (Charge Description Master) Analyst is responsible for supporting the maintenance and optimization of the Charge Description Master (CDM) by analyzing charge codes, conducting data audits, and ensuring regulatory compliance. The CDM Analyst plays a critical role in ensuring the accuracy and efficiency of charge capture processes across clinical departments.
Your Everyday
* Review and analyze CDM data to ensure that all charge codes are accurate, current, and compliant with industry standards and payer regulations.
* Conduct regular audits of charge codes, procedure codes, and pricing to identify discrepancies or areas for improvement.
* Assist in updating the CDM by adding, modifying, or deleting charge codes as needed, in line with regulatory changes or departmental requests.
* Ensure that all changes to the CDM are appropriately documented and communicated to relevant departments.
* Analyze charge capture processes to ensure that services provided are accurately billed and correctly reflected in the CDM.
* Identify any missing or incorrect charges, working with clinical and billing teams to resolve issues.
* Ensure that all updates and modifications to the CDM adhere to regulatory guidelines, such as those from CMS, Medicare, Medicaid, and other payers.
* Monitor industry changes and payer updates to stay informed of new coding and billing requirements.
* Work with clinical, billing, and coding departments to address charge capture issues and ensure proper usage of CDM codes.
* Act as a resource for staff on CDM-related inquiries and charge coding concerns.
* Participate in audits of the CDM, assisting with the identification of any discrepancies in charge capture and compliance.
* Provide documentation and analysis during external audits, ensuring timely and accurate responses.
* Generate reports on CDM activity, including charge capture trends, audit results, and compliance metrics.
* Ensure the integrity and accuracy of CDM-related data by performing regular data quality checks.
* Identify opportunities to improve charge capture processes and optimize revenue by analyzing CDM usage and patterns.
* Provide recommendations for enhancing the efficiency and accuracy of CDM-related operations.
The Must-Haves
Minimum:
* Review and analyze CDM data to ensure that all charge codes are accurate, current, and compliant with industry standards and payer regulations.
* Conduct regular audits of charge codes, procedure codes, and pricing to identify discrepancies or areas for improvement.
* Assist in updating the CDM by adding, modifying, or deleting charge codes as needed, in line with regulatory changes or departmental requests.
* Ensure that all changes to the CDM are appropriately documented and communicated to relevant departments.
* Analyze charge capture processes to ensure that services provided are accurately billed and correctly reflected in the CDM.
* Identify any missing or incorrect charges, working with clinical and billing teams to resolve issues.
* Ensure that all updates and modifications to the CDM adhere to regulatory guidelines, such as those from CMS, Medicare, Medicaid, and other payers.
* Monitor industry changes and payer updates to stay informed of new coding and billing requirements.
* Work with clinical, billing, and coding departments to address charge capture issues and ensure proper usage of CDM codes.
* Act as a resource for staff on CDM-related inquiries and charge coding concerns.
* Participate in audits of the CDM, assisting with the identification of any discrepancies in charge capture and compliance.
* Provide documentation and analysis during external audits, ensuring timely and accurate responses.
* Generate reports on CDM activity, including charge capture trends, audit results, and compliance metrics.
* Ensure the integrity and accuracy of CDM-related data by performing regular data quality checks.
* Identify opportunities to improve charge capture processes and optimize revenue by analyzing CDM usage and patterns.
* Provide recommendations for enhancing the efficiency and accuracy of CDM-related operations.
EXPERIENCE QUALIFICATIONS:
* 3+ years of experience in healthcare auditing, revenue integrity, revenue cycle management, healthcare finance, or a related field
* Minimum of 2 years' experience as an analyst in a healthcare environment with emphasis on chargemaster, revenue capture, charge auditing, reporting and reimbursement.
* Must have 3 years of experience in a hospital or professional based CPT-4, HCPCS Level II coding and outpatient ICD-10-CM coding experience for multiple hospital departments.
* Strong knowledge of Chargemaster (CDM) management, including charge capture processes, coding (CPT, HCPCS, ICD-10), and compliance with CMS and third-party payer requirements.
* 2+ years of Epic experience, particularly in managing work queues and charge capture functions
EDUCATION QUALIFICATIONS:
* Minimum: An associate's degree in healthcare administration, health information management, or a related field is required.
* Preferred: Bachelor's degree in healthcare
LICENSES AND CERTIFICATIONS:
* Preferred: AAPC or AHIMA credential or Epic Certified
SKILLS AND ABILITIES:
* Demonstrate knowledge of OPPS reimbursement methodologies, as well as Medicare reimbursement and billing guidelines, familiar with CMS transmittals and manuals, and with the cms.gov website to obtain quarterly HCPCS, OCE, and MUE updates
* Demonstrate knowledge of NUBC revenue codes, mapping structures, UB-04 claim and payment remittance advice statements
* Demonstrate knowledge of the medical necessity of services through the CMS Local and National coverage Determinations
* Demonstrated ability to establish and maintain effective working relationships at all levels.
* Demonstrated ability to work independently.
* Working knowledge of medical terminology, CPT, HCPCS, ICD 10, and Revenue Codes.
* Demonstrated knowledge of Medicare, Medicaid, Medicare OPPS reimbursement and third-party billing rules and coverage determinations.
* Demonstrated high level of computer skills, including spreadsheet programs, word processing, database programs, and various Microsoft applications and the ability to quickly learn and utilize new systems.
* Demonstrated ability to handle multiple responsibilities simultaneously and problem solve.
* The ability to think both creatively and analytically.
* Demonstrated process improvement skills.
* Demonstrated proficiency in verbal and written communication including writing and presenting formal reports, analysis and presentations
* Significant work experience in CPT, ICD10, and UB04 billing
* Knowledge of medical terminology required
* Strong analytical, problem solving, and organizational skills
* Ability to work independently with minimal supervision and in a team environment
* Competent in business functions, procedures, and information flows
* Strong verbal and written communication skills
* Advanced excel skills
* Office 365 (Word, Excel, PowerPoint, Outlook, Teams, Share point)
WORK SHIFT:
Days (United States of America)
LCMC Health is a community.
Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little "come on in" attitude is the foundation of LCMC Health's culture of everyday extraordinary
Your extras
* Deliver healthcare with heart.
* Give people a reason to smile.
* Put a little love in your work.
* Be honest and real, but with compassion.
* Bring some lagniappe into everything you do.
* Forget one-size-fits-all, think one-of-a-kind care.
* See opportunities, not problems - it's all about perspective.
* Cheerlead ideas, differences, and each other.
* Love what makes you, you - because we do
You are welcome here.
LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.
The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.
Simple things make the difference.
1. To get started, take your time to fully and accurately complete the application for employment. Incomplete applications get bogged down and are often eliminated due to missing information.
2. To ensure quality care and service, we may use information on your application to verify your previous employment and background.
3. To keep our career applications up-to-date, applications are inactive after 6 months and, therefore, require a new application for employment to be completed.
4. To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.
$70k-96k yearly est. 6d ago
Physician, Radiology - Body (Sacramento, CA)
Sutter Health 4.8
Sacramento, CA jobs
Opportunity Information
Sutter Medical Group (SMG) seeks to hire a BE/BC fellowship-trained Body Imaging Radiologist to join an established practice in Sacramento, CA.
Sutter Imaging is seeking a fellowship-trained body imager to join our close-knit, quality care-centered group of mammographers within a larger, financially strong, and stable organization. We are seeking a candidate who enjoys the flexibility to work from home and working on-site, dedicated almost exclusively to body imaging, including diagnostics and procedures. This role offers a dynamic work environment with moderate volumes and opportunities for professional growth. The schedule is flexible to allow a good work/life balance. Weekend, STAT, & Flex shifts are available to read from home for anyone wishing to expand income beyond their base salary.
Qualifications
Board certified/Board eligible
Join Us and Enjoy
PLSF eligible
Subspecialty-structured radiology group with advanced practice technology
$700,000 Base compensation with opportunities to earn additional income through flex shifts*
-Day Radiologist: 179 shifts/yr (130 weekdays, 22 weekends, 27 evenings)
-Evening Radiologist: 165 shifts/yr (143 weekdays, 22 weekends)
-Swing Radiologist: ~160 shifts/yr (138 weekdays, 22 weekends)
-Night Radiologist: 123 shifts/yr
$50k sign-on bonus (paid in 2 parts)
Assistance with relocation expenses
Generous benefits, including employer-matched 401(k) and profit-sharing
Shareholder track
CME allowance
Equitable practice and scheduling structure
A positive work-life balance and Northern California's natural beauty and lifestyle
10 weeks scheduled vacation
4-day average work week
Holidays are shared equitably
Ability to work some shifts from home (Weekend, STAT, & Flex Shifts)
Organization Details
Sutter Medical Group (SMG) is a vibrant and talented community committed to delivering safe, affordable and high-quality care. Our multi-specialty medical group is comprised of over 1,600 clinicians practicing in seven counties in northern California, most within a 50-mile radius of Sacramento. SMG contains primary care and specialty Physicians and Advanced Practice Clinicians -- nurse practitioners, physician assistants, certified nurse midwives, licensed clinical social workers and licensed marriage and family therapists, who make up about 20% of our group. Our clinicians not only excel in clinical practice but are also actively engaged in teaching, research, leadership, community outreach, and volunteer work. SMG has earned both local and national recognition for excellence in patient care and experience.
Community Information
Sacramento, the capital city of California, offers an exceptional quality of life that makes it a great place to live. One of the standout features of Sacramento is its vibrant food scene. Known as the "Farm-to-Fork Capital," the city boasts a plethora of restaurants, farmers' markets, and food festivals that celebrate fresh, locally sourced ingredients. This culinary richness is complemented by a strong sense of community, where residents enjoy a variety of local events, cultural festivals, and community activities that foster a warm and inclusive atmosphere. Additionally, Sacramento's strategic location provides easy access to some of California's most popular destinations. Just a short drive away, you can find yourself in the bustling city of San Francisco, enjoying the world-class wine country of Napa Valley, or experiencing the stunning natural beauty of Lake Tahoe, which offers both winter sports and summer recreational activities. The city's proximity to diverse landscapes means residents can easily enjoy the snow-capped mountains, scenic coastlines, and lush forests. Sports enthusiasts in Sacramento also have much to cheer about. The city is home to the Sacramento Kings, an NBA team that brings exciting basketball action to the Golden 1 Center. Moreover, the recent relocation of the Oakland A's to Sacramento has added another layer of excitement for baseball fans. With its rich cultural scene, convenient location, and passionate sports culture, Sacramento truly stands out as a dynamic and desirable place to live.
Equal Opportunity Statement
It is the policy of Sutter Health and its partners to provide equal employment for all qualified individuals; to prohibit discrimination in employment because of basis of race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state or federal law, ordinance or regulation. We promote the full realization of equal employment opportunities through a positive continuing program within each medical group, company, hospital, department, and service area. Equal employment opportunities apply to every aspect of Sutter's employment policies and practices.
$144k-189k yearly est. Auto-Apply 60d+ 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. 9d ago
Specialty Pharmacy Technician
Banner Health 4.4
Phoenix, AZ jobs
Primary City/State: Chandler, Arizona Department Name: Specialty Pharmacy Work Shift: Day Job Category: Pharmacy Pharmacy careers are better at Banner Health. We are committed to developing the careers of our team members. We care about you, your career today and your future. If you're looking to leverage your abilities - apply today.
Arizona is a year-round destination. Sunny skies and low humidity prevail 300 days a year across the state. From awesome natural wonders to culinary treats, tribal lands, vibrant cities, world-class resorts, renowned golfing and historic Western towns, there are some truly breathtaking moments to be had in the Grand Canyon State.
As a Specialty Pharmacy Technician, you will be part of this call center and will spend the majority of your time on the phone. 50% will be taking inbound calls and the other 50% will be making outbound calls. Retail pharmacy experience will be helpful in this position. The schedule for this role is Monday - Friday 9AM - 5:30PM, no weekends or major holidays. Work from home is available if metrics are met. This position has an 8 month work from home, 4 month onsite rotation.
Banner Pharmacy Services is a recognized leader in healthcare and trusted partner in proactively providing innovative pharmacy services through excellence in integration, care coordination, medication management and services to make a difference in people's lives. Clinical Pharmacy Services is responsible for the management of the Banner formulary, development of standardized system wide clinical pharmacy services, and management of adverse drug event preventions. Clinical Pharmacy Services provides collaborative drug therapy management and educational interventions in patient care to optimize medication therapy, improve outcomes, promote wellness, and disease prevention. As a division, Banner Pharmacy services provides excellent patient care across our entire continuum through convenient access, improved medication outcomes and innovative pharmacy practices.
POSITION SUMMARY
This position will assist the specialty pharmacist with preparation, compounding and dispensing of medications, non-clinical specialty assessments, order processing, and delivery setup for patients receiving prescription services from the Specialty Pharmacy. Assisting the specialty pharmacists with claims processing, inventory management, and all necessary reporting requirements to maintain URAC Specialty Pharmacy Accreditations and access to a network of limited distribution drugs.
CORE FUNCTIONS
1. Enroll selected patients in specialty pharmacy services. Communicate with patient and utilize electronic medical record to gather all relevant medical, demographic, and insurance information and input patient into Specialty Pharmacy software platform.
2. Work in a call center environment and communicate effectively with patients over the phone to overcome financial barriers to treatment. Communicate complex billing issues to patients in a manner easily understood.
3. Provide adherence management and adherence improvement services to patients of the Specialty Pharmacy.
4. Assist, provide, and maintain records for accreditation, licensure, manufacturer limited distribution agreements, payer contracts, and REMS programs as required.
5. Assist with expanding scope and continuous quality improvement initiatives across specialty pharmacy services.
6. Work collaboratively with specialty pharmacists and Fulfillment Center team to ensure an excellent patient experience.
7. Prepare, dispense, and compound appropriate amount of medication under the direct supervision of a pharmacist, and accurately deliver medication to the patient.
8. Follow policies, procedures, and regulatory requirements and perform other work assignments.
MINIMUM QUALIFICATIONS
Requires Pharmacy Technician licensure and active Pharmacy Technician certification OR Pharmacy Intern licensure in the state of practice. Incumbents in Arizona are also required to provide the AZ Board of Pharmacy Wallet Card at time of hire.
Minimum of one year of pharmacy technician experience required. Ability to attend and successfully complete 160 hours of on the job training required. Strong customer service focus, superior problem-solving abilities required. Ability to complete moderate to difficult mathematical calculations using a hand-held calculator required.
BSS Registry Team members and Travelers are not eligible to drive on behalf of Banner and are not required to possess a valid driver's license or be eligible for coverage under the company's auto insurance policy.
PREFERRED QUALIFICATIONS
Associates or bachelor's degree in business, healthcare or related field preferred. Proficiency and experience with third party claims adjudication and claims rejection reconciliation preferred. Proficiency and experience with non-sterile, sterile and hazardous drug compounding preferred. Work experience which demonstrates analytical ability, judgment and interpersonal skills in pharmacy or healthcare preferred.
Additional related education and/or experience preferred.
EEO Statement:
EEO/Disabled/Veterans
Our organization supports a drug-free work environment.
Privacy Policy:
Privacy Policy
$36k-42k yearly est. Auto-Apply 6d 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
Enterprise Architect - IAM/SailPoint
Scripps Health 4.3
San Diego, CA jobs
Required Education/Experience/Specialized Skills: Five years related experience plus excellent critical and analytical thinking and excellent customer service skills. Excellent written and verbal communication skills. Advanced infrastructure design skills. Excellent organizational and project management skills. Solid understanding of multiple disciplines such as operating systems, virtualization, networking, integration, software development, endpoint devices, security or cloud services
Required Certification/Registration:
Preferred Education/Experience/Specialized Skills/Certification\:
7+ years in IAM, with 4+ years hands-on SailPoint experience.
Strong skills in Java, BeanShell, SQL, REST/SOAP APIs.
Expertise in RBAC, compliance frameworks (SOX, GDPR, HIPAA).
Familiarity with LDAP, Active Directory, and major databases.
Certifications\: CISSP, CISA, or SailPoint certifications.
Bachelors degree.
Work Location Eligibility
This position is remote, but only open to candidates who reside in\: San Diego Metropolitan Area or one of the following U.S. states:
AL, AR, AZ, DE, FL, GA, IA, ID, IN, KS, KY, LA, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, RI, SC, SD, TN, TX, UT, VA, VT, WI, WV, WY
Applicants outside these locations will not be considered at this time.
Candidates who reside in the approved U.S. states would be considered Out of Area (OOA) and Scripps Health partners with professional employer organization (PEO) Superlanet.
What You'll Do
Administer, develop and architect the SailPoint Security Cloud solution at Scripps for identity and access governance and lifecycle management.
Integrate SailPoint with ServiceNow, Active Directory, HR systems (Lawson/Taleo/MDStaff), disconnected applications and other cloud platforms.
Define RBAC models, access policies, and certification campaigns to meet compliance standards.
Onboard additional applications to SailPoint.
Provide technical leadership, mentor team members, and ensure best practices.
Troubleshoot complex issues and maintain system performance and security.
Responsible for the overall direction for the organization's technical infrastructure within an IS discipline (IAM).
Works with technical staff to integrate hardware, software and/or network interfaces to form a system.
Build strategic roadmaps for technology, lifecycle and standards.
Builds integrated system design by gathering current state, transition state and future state for a single discipline.
Maintains deep technical expertise in area of specialization & influence others within the job area through explanation of facts, policies and practices.
This position is based in La Jolla, CA, and is offered as a remote opportunity. Candidates must reside within the San Diego metropolitan area or in one of the approved out-of-area (OOA) states listed below under Work Location Eligibility. This role is supported through Scripps Health's partnership with Superlanet, a professional employer organization (PEO).
$138k-178k yearly est. Auto-Apply 32d ago
IT Senior System Analyst - Epic Cadence Certification Required
Lcmc Health 4.5
Remote
Your job is more than a job
The Systems Analyst Senior performs a variety of technical work associated with analyzing user requirements, procedures and problems to automate clinical functions or to improve existing information technology related systems. Develops the Electronic Medical Record (EMR) and inter-related systems to meet use and regulatory standards as well as to meet the needs of the system. Leads the designing and building software packages to meet the needs of providers, staff, and patients. Assists in developing the tools, the providers and staff need to give health care to the patients while ensuring security and efficiency.
GENERAL DUTIES
Develops the Electronic Medical Record (EMR) and inter-related systems to meet use and regulatory standards of the system.
Manages integrated functionality, usability, reliability, performance, and support requirements of a system.
Implements technology solutions that maximize efficiency and align with established standards and technology roadmaps.
Creates feature test strategies and environment needs for the systems to run properly.
Identifies and recommends efforts to implement technical and business alternatives/upgrades that meet business needs.
Assists in developing training documentation and proactive identification of documentation needs.
Ensures processes and high level designs including architecture requirements are correctly documented.
Troubleshoots application software issues and identify solutions.
EXPERIENCE QUALIFICATIONS
3 years of IT, Epic, or healthcare experience with a Bachelor's Degree
5 years of IT, Epic, or healthcare experience with Associate's Degree
7 years of IT, Epic, or healthcare experience with High School Diploma/GED
Preferred: IT Healthcare experience, Epic implementation experience
EDUCATION QUALIFICATIONS
Required: High School Diploma/GED or equivalent OR 2 years of work experience.
Preferred: Bachelor's Degree.
LICENSES AND CERTIFICATIONS:
EPIC application certification required for EPIC positions, and is expected to be maintained as required by EPIC - CEE
WORK SHIFT:
Days (United States of America)
LCMC Health is a community.
Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little “come on in” attitude is the foundation of LCMC Health's culture of everyday extraordinary
Your extras
Deliver healthcare with heart.
Give people a reason to smile.
Put a little love in your work.
Be honest and real, but with compassion.
Bring some lagniappe into everything you do.
Forget one-size-fits-all, think one-of-a-kind care.
See opportunities, not problems - it's all about perspective.
Cheerlead ideas, differences, and each other.
Love what makes you, you - because we do
You are welcome here.
LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.
The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.
Simple things make the difference.
1. To get started, take your time to fully and accurately complete the application for employment. Incomplete applications get bogged down and are often eliminated due to missing information.
2. To ensure quality care and service, we may use information on your application to verify your previous employment and background.
3. To keep our career applications up-to-date, applications are inactive after 6 months and, therefore, require a new application for employment to be completed.
4. To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.
$80k-104k yearly est. Auto-Apply 7d 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 *********************
$70k-109k yearly est. 48d ago
Inpatient Coder - Work at Home - Any State
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. Advanced coding position that requires review of medical record documentation and accurately assigns ICD-10-CM, ICD-10 PCS, CPT IV codes, as well as assignment of the Medicare Severity Diagnosis Related Group, (MS-DRG) / All Patient Refined - Diagnosis Related Group, (APR-DRG) based on payor classification and abstracts specific data elements for each case in compliance with federal regulations. This position codes all types of inpatient records and follows the Official Guidelines of Coding and Reporting, the American Health Information Management Association, (AHIMA) Coding Ethics, as well as all American Hospital Association, (AHA) Coding Clinics, CMS directives and bulletins, Fiscal intermediary communications. Utilizes 3M 360 in accordance with established workflow. Follows Ensemble policies and procedures and maintains required quality and productivity standards.
**Essential Job Functions**
+ Reviews medical record documentation and accurately assigns appropriate ICD-10 diagnoses and procedure codes, leading to the assignment of the correct Medicare Severity-Diagnosis Related Group, (MS-DRG) or All Patient Refined Diagnosis Related Group, (APR-DRG.) The Inpatient Coding Specialist is responsible for verification of the patient's discharge disposition and to ensure the appropriate present on admission, (POA) indicators are assigned to each code. The assigned codes must support the reason for the visit that is documented by the provider in order to support the care provided.
+ Correctly abstract required data per facility specifications.
+ Responsible to assist with writing appeals for Diagnosis Related Group, (DRG) denials in order to support the assigned Diagnosis Related Group, (DRG) and to address the clinical documentation utilized in the decision making process to support the validity of the assigned codes.
+ Responsible for monitoring and working of accounts that are Discharged Not Final Billed, failed claims, stop bills, and epremis, and as a team, ensure timely, compliant processing of inpatient accounts through the billing system.
+ Collaborates with Clinical Documentation Specialists, (CDEs,) and members of the medical staff to ensure completeness of documentation in the charts so that appropriate codes, and ultimately the correct Diagnosis Related Group (DRG,) may be assigned.
+ Responsible to ensure accuracy and maintain established quality, productivity standards, and key performance indicators established for 3M 360 CAC for CRS and Direct Code.
+ Remain abreast of current Centers for Medicare and Medicaid Services, (CMS) requirements as well as Correct Coding Initiative, (CCI) edits, Hospital Acquired Conditions, (HAC's) and when applicable, National Coverage Determinations, (NCDs) and Local Coverage Determinations, (LCDs,) including the addition of appropriate modifiers to ensure a clean claim the first time through.
+ Maintains competency and accuracy while utlizing tools of the trade, such as the 3M encoder, Computer Assisted Coding, (CAC,) Clinical Documentation Improvement System, (CDIS,) and abstracting systems, and all reference materials. Reports inaccuracies found in software applications to HIM Coding Manager/Supervisor, reports any potential unethical and/or fradulent activity per compliance policy.
+ This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Associates may be required to perform other job related duties as required by their supervisor, subject to reasonable accommodation
**Required Licensure:**
RHIA, RHIT, CCS, CIC, or CCA
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 *********************
$40k-52k yearly est. 41d ago
Application Specialist
Scripps Health 4.3
San Diego, CA jobs
Required Education/Experience/Specialized Skills\: Five years related experience. Excellent critical and analytical thinking and excellent customer service skills. Exhibit excellent written and verbal communication skills. Expert knowledge of relevant application workflows. Excellent organizational and project management skills. Business acumen in multiple functional areas.
Required Certification/Registration\: Specific to applications supported. Must currently hold an active Epic Beaker AP or CP certification
Preferred Education/Experience/Specialized Skills/Certification\: Certification\: Bachelor's degree. 7 years of related experience
Work Location Eligibility
This position is remote, but only open to candidates who reside in\: San Diego Metropolitan Area or one of the following U.S. states:
AL, AR, AZ, DE, FL, GA, IA, ID, IN, KS, KY, LA, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, RI, SC, SD, TN, TX, UT, VA, VT, WI, WV, WY
Applicants outside these locations will not be considered at this time.
Candidates who reside in the approved U.S. states would be considered Out of Area (OOA) and Scripps Health partners with professional employer organization (PEO) Superlanet.
Expert on assigned application. Acts independently to lead cross functional, integrated team to create performance improvements across multiple domains. Translates business requirements into operational solutions. Proactively evaluate technical enhancements and consults with business to provide solutions to technical or process issues, guiding to best practices. Provides guidance, trains and develops the skills of less experienced IT staff.
This position is based in La Jolla, CA, and is offered as a remote opportunity. Candidates must reside within the San Diego metropolitan area or in one of the approved out-of-area (OOA) states listed below under Work Location Eligibility. This role is supported through Scripps Health's partnership with Superlanet, a professional employer organization (PEO).
$73k-103k yearly est. Auto-Apply 60d+ ago
Physician, Radiology - Remote Per Diem (Modesto, CA)
Sutter Health 4.8
Modesto, CA jobs
Opportunity Information
Gould Medical Group is seeking a per diem, BE/BC remote Radiologist for established and collegial radiology team in Modesto, California.
Must be resident of CA and have CA medical license
$362.99 per hour
Malpractice insurance provided
Non-benefited W2 employee position
Outpatient only
No call required
No procedures required
Support from other radiologists onsite and remote
Modalities: PF, US, CT, MRI, ultrasound
Epic/Visage PACS
Nuance PowerScribe dictation
Qualifications
Board certified/Board eligible
Organization Details
Gould Medical Group is a growing, 525+ clinician multi-specialty group located about two hours east of San Francisco, California.
Equal Opportunity Statement
It is the policy of Sutter Health and its partners to provide equal employment for all qualified individuals; to prohibit discrimination in employment because of basis of race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state or federal law, ordinance or regulation. We promote the full realization of equal employment opportunities through a positive continuing program within each medical group, company, hospital, department, and service area. Equal employment opportunities apply to every aspect of Sutter's employment policies and practices.