Coder II, ER (Remote)

by Irma Moore | Jan 21, 2025 | Uncategorized

Employment Type:

Full time

Shift:

Description:

POSITION PURPOSE

Analyzes physician/provider documentation contained in assigned Emergency Department (ED) and Outpatient Observation health records (electronic, paper or hybrid) to determine the principal diagnosis, secondary diagnoses, principal procedure and secondary procedures. Accesses charge work queues and systems to assign ER and Observation charges if performed by HIM. May also require calculation of Observation hours if performed by HIM.

Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of Internal Classification of Diseases, Clinical Modification diagnosis and procedure codes, and Current Procedural Terminology / Healthcare Common Procedure Coding System (HCPCS) procedure codes and all required modifiers.

Utilizes coding guidelines established by:

• The Centers for Medicare/Medicaid Services (CMS) ICD-CM Official Coding Guidelines for Coding and Reporting, ICD-PCS Official Guidelines for Coding and Reporting
• The American Hospital Association (AHA) Coding Clinic
• The American Medical Association (AMA) for CPT codes and CPT Assistant
• The American Health Information Management Association (AHIMA) Standards of Ethical Coding
• Revenue Excellence/Health Ministry (HM) coding procedures and guidelines

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.   

Navigates the patient health record and other computer systems/sources in determination of diagnoses, reason for visit, procedures and modifiers to be coded and/or for APC assignment.

Codes Emergency Department and Outpatient Observation records utilizing encoder software and online tools and references, in the assignment of ICD, CPT, and HCPCS codes and modifiers. 

Accesses charge work queues, systems to assign ER and Observation charges and hours, based on medical record documentation, if performed by HIM at a Health Ministry.  

Demonstrates knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation.  

Communicates effectively with clinical staff, physicians and office staff regarding documentation issues or needs. Communicates with case management concerning Outpatient Observation documentation issues. 

Works with HIM and Patient Business Services (PBS) teams, when needed, to help resolve billing, claims, denials and appeals issues affecting reimbursement.

Exhibits awareness of health record documentation or other coding ethics concerns. Notifies appropriate leadership for assistance, resolution when appropriate.

Utilizes EMR communication tools to track missing documentation or Outpatient queries that require follow-up to facilitate coding in a timely fashion.

Maintains current knowledge of changes in Outpatient coding and reimbursement guidelines and regulations e.g., new modifiers.  

Consistently meets or exceeds coding quality and productivity standards established by Revenue Excellence/HM.

Maintains CEUs as appropriate for coding credentials as required by credentialing associations.

Performs other duties as assigned by leadership.

Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

MINIMUM QUALIFICATIONS

Completion of an AHIMA-approved coding program or an AAPC-approved coding program, or Associate’s degree in Health Information Technology or a related field or an equivalent combination of years of education and experience is required. Bachelor’s degree in Health Information Management (HIM) or related healthcare field is preferred. 

Certified Coding Associate (CCA), Certified Procedural Coder Apprentice (CPCA), Certified Procedural Coder (CPC), Certified Outpatient Coder (COC), Registered Health Information Technician (RHIT),  Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS) is required.

Two (2) years of current acute care coding emergency department and observation or physician coding experience is required. 

Current experience utilizing encoding/grouping software or CAC is preferred. 

Ability to use a standard desktop/laptop, email and other Windows applications, if needed, Internet and web-based training tools preferred.  

Strong oral and written communication skills. Ability to communicate effectively with individuals and groups representing diverse perspectives.

Ability to work with minimal supervision and exercise independent judgment.

Ability to research, analyze and assimilate information from various sources based on technical and experience-based knowledge.  Must exhibit critical thinking skills, strong problem- solving skills and the ability to prioritize workload.

Excellent organizational and customer service skills. Ability to perform frequent detailed tasks and provide productivity standard driven results. Ability to adapt to change and be flexible with work priorities and interruptions. 

Must be comfortable functioning in a 100% virtual, collaborative, shared leadership environment. with minimal supervision and able to exercise independent judgement

Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

Must be able to set and organize own work priorities and adapt to them as they change frequently.  Must be able to work concurrently on a variety of tasks/projects in physical or virtual environments that may be stressful with individuals having diverse personalities and work styles.

Must possess the ability to comply with Trinity Health policies and procedures.

Must be able to spend majority of work time utilizing a computer, monitor, and keyboard.

Must be able to work with interruptions and perform detailed tasks.

If applicable, involves a wide array of physical activities, primarily standing, sitting and reading.  Must be able to sit for long periods of time.

Must be able to travel to various Trinity Health sites as necessary.

If applicable, telecommuting (working remotely), must be able to comply with Trinity Health’s and the Region/HM Working Remote Policy.

Hourly Pay Range: $24.05 – $36.08

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification.  They are not to be construed as an exhaustive list of duties so assigned.

Our Commitment to Diversity and Inclusion
 

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Payment Research Rep – REMOTE

by Irma Moore | Jan 21, 2025 | Uncategorized

(Full Time, Remote)
Monitors and matches unpostables to the appropriate charge, initiate refunds or determines payment allocation.

Required:

• 3+ years of experience with insurance billing, A/R and account follow up procedures
• Must be able to read an EOB (Explanation of Benefits)
• Strong computer skills including but not limited to; Microsoft Exceland any practice management systems.
• Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations.
• Ability to apply common sense understanding to carry out detailed written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
• Education: High school diploma or general education degree (GED) or equivalent combination of education and experience.

Preferred:

• Insurance payment posting/payment allocation experience is preferred.

About the opportunity:

• Analyzes unpostables to determine where payment should be posted or if a refund is needed
• Analyzes and accurately matches bank deposit to billing system deposits
• Prepares and submits a detailed log with deposit reconciliations to CFOs each month for legacy payments.
• Researches outstanding deposits
• Posts payments to practice management system
• Other duties may be assigned.
• This is a remote position

Competencies:

• Analytical – Collects and researches data; Uses intuition and experience to complement data
• Customer Service – Responds promptly to customer needs
• Interpersonal Skills – Maintains confidentiality of all patient information and company documents
• Oral Communication – Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions
• Written Communication – Writes clearly and informatively; Edits work for spelling and grammar; Presents numerical data effectively; Able to read and interpret written information
• Professionalism – Approaches others in a tactful manner; Treats others with respect and consideration regardless of their status or position
• Quality – Demonstrates accuracy and thoroughness
• Quantity – Meets productivity standards
• Adaptability – Adapts to changes in the work environment
• Attendance/Punctuality – Is consistently at work and on time

We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.

Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.

INDSSPPSI

Billing and Medical Coding Specialist

by Irma Moore | Jan 20, 2025 | Uncategorized

Our mission: to eliminate every barrier to mental health.

At Spring Health, we’re on a mission to revolutionize mental healthcare by removing every barrier that prevents people from getting the help they need, when they need it. Our clinically validated technology,Precision Mental Healthcare, empowers us to deliver the right care at the right time—whether it’s therapy, coaching, medication, or beyond—tailored to each individual’s needs.

We proudly partner with over 450 companies, from startups to multinational Fortune 500 corporations, as a leading provider of mental health service, providing care for 10 million people. Our clients include brands you use and know like Microsoft, Target, J.P. Morgan Chase, and Delta Airlines, all of whom trust us to deliver best-in-class outcomes for their employees globally. With our innovative platform, we’ve been able to generate a net positive ROI for employers and we are the only company in our category to earn external validation of net savings for customers.

We have raised capital from prominent investors including Generation Investment, Kinnevik, Tiger Global, William K Warren Foundation, Northzone, RRE Ventures, and many more. Thanks to their partnership and our latest Series E Funding, our current valuation has reached $3.3 billion. We’re just getting started—join us on our journey to make mental healthcare accessible to everyone, everywhere.

The Billing and Coding Specialist  helps support provider chart notes review of CPT codes and diagnoses. They are also responsible for entering the billing information and submitting invoices to deliver a best in class customer support experience. This is a full time position that is fully remote.

What you’ll be doing: 

• Responsible for entering the billing information and submitting invoices
• Properly code medical services, diagnosis such as CPT and diagnosis codes based on provider notes up to including analyzing chart notes and identifies documentation deficiencies 
• Serves as a resource and subject matter expert with coding 
• Provide billing support by reviewing, researching, investigating, re-submitting, re-processing and adjusting claims.
• Own ad hoc operational projects as needed by the Billing Manager

What success looks like in this role:

• Applies up-to-date knowledge of medical coding guidelines (e.g., ICD-10, CPT, HCPCS) to ensure compliance and accuracy
• Correctly identifies and assigns codes based on thorough understanding of medical records and payer requirements
• Completes data entry and coding assignments within established deadlines
• Ensures all data is entered and coded with a high degree of precision, minimizing errors and rework
• Maintains clear communication with team members and supervisors regarding project progress and challenges
• Collaborates effectively with departments like billing and quality assurance to resolve coding discrepancies and ensure accurate and compliant documentation
• Achieves or exceeds key performance indicators, such as error rate, productivity benchmarks, and coding accuracy
• Adheres strictly to data privacy and confidentiality protocols (e.g., HIPAA compliance)

What we expect from you: 

• Certification from the American Academy of Professional Coders (AAPC)
• > 2 years of experience as a medical billing and coding specialist
• Knowledge of Codes like CPT, ICD-10, and HCPCS
• Knowledge of medical terminology and basic math
• Strong written and verbal communication skills with a patient-centric tone. 
• Hyper-organized and attentive to all angles of a given problem
• Creative and analytical thinking
• Maintaining a positive, empathetic, and professional attitude toward members at all times.
• Interpersonal and customer service skills
• Responding promptly to member inquiries 
• Experience with Google Sheets a plus
• Demonstrates adaptability to frequent process updates and changes

The target base salary range for this position is $62,500 – $77,250, and is part of a competitive total rewards package including stock options and benefits. Individual pay may vary from the target range and is determined by a number of factors including experience, location, internal pay equity, and other relevant business considerations. We review all employee pay and compensation programs annually using Radford Global Compensation Databaseat minimum to ensure competitive and fair pay. 

Benefits provided by Spring Health:

Note: We have even more benefits than listed here and below, your recruiter will provide more in-depth information as you continue in the interview process. Benefits are subject to individual plan requirements and eligibility criteria.

• Health, Dental, Vision benefits start on your first day at Spring. You and your dependents also receive access to One Medicalaccounts HSA and FSA plans are also available, with Spring contributing up to $1K for HSAs, depending on your plan type.
• Employer sponsored 401(k) match of up to 2% for retirement planning
• A yearly allotment of no cost visits to the Spring Health network of therapists, coaches, and medication management providers for you and your dependents.
• We offer competitive paid time off policies including vacation, sick leave and company holidays.
• We offer parental leave up to 18 weeks, depending on your eligibility including tenure and medical situation.
• Access to Noom, a weight management program—based in psychology, that’s tailored to your unique needs and goals. 
• Access to fertility care support through Carrot, in addition to $4,000 reimbursement for related fertility expenses.
• Access toWellhub,  which connects employees to the best options for fitness, mindfulness, nutrition, and sleep in one subscription
• Access to BrightHorizons, which provides sponsored child care, back-up care, and elder care
• Up to $1,000 Professional Development Reimbursement a year.
• $200 per year donation matching to support your favorite causes.

Don’t meet every requirement? Studies have shown that women, communities of color and historically underrepresented talent are less likely to apply to jobs unless they meet every single qualification. At Spring Health we are dedicated to building a diverse, inclusive and authentic workplace

To ensure intentional and equitable hiring practices, we use a balanced candidate slate in our interviews. This approach guarantees that our pool of qualified candidates includes individuals who are underrepresented in our organization at all levels. This is a key performance indicator (KPI) for our recruiting and hiring teams, reported quarterly to maintain accountability.

Casualty Claims Adjuster I

by Irma Moore | Jan 20, 2025 | Uncategorized

At EMC, you’ll put your skills to good use as an important member of our team. You can count on gaining valuable experience while contributing to the company’s success. EMC strives to hire and retain the best people by engaging, developing and rewarding employees.

**This position is eligible to work from home anywhere in the United States**

Exercises independent judgment in the investigation, negotiation, and disposition of auto and casualty claims of moderate complexity within limitations of authority outlined in the Claims Guide.  Communicates effectively with insureds, claimants, vendors, and agents, regarding coverage, claims status and other claims questions.  Negotiates, settles, and/or resolves claims.

Essential Functions:

• Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees
• Initiates timely contact with insureds and claimants to explain the claim process and initiate the investigation
• Obtains statements from insureds, claimants, and witnesses and documents summaries within the claims system
• Request and analyze investigative and other relevant reports, claim forms and documents when appropriate
• Identifies, investigates, and proactively pursues opportunities for recovery including arranging of evidence preservation in legal compliance that meets custody, control, transfer, analysis, and disposition of physical and/or electronic evidence
• Adheres to all state requirements regarding regulatory compliance by sending out letters/forms containing appropriate language according to timelines
• Drafts reservation of rights and coverage denial letters with supervisor approval
• Assigns vehicle/property damage appraisals and vehicle rentals
• Makes recommendations to people leader on the assignment of independent adjusters
• Provides prompt, detailed responses to agents, insureds, and claimants on the status of claims
• Resolves questions of coverage, liability and the value of the claims and communicates with insureds and claimants to resolve claims in a timely manner
• Prepares bodily injury and/or damage evaluations, negotiation ranges and target settlement numbers prior to negotiation. Obtains authority when required
• Identifies and protects all liens as appropriate
• Investigates Medicare liens and resolves issues in accordance with EMC and Medicare guidelines
• Prepares and issues settlement and release documents verifying accuracy and ensuring they are properly executed
• Reviews and audits estimates written by independent adjusters for accuracy and to ensure the most cost-effective repair approach
• Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units and Claims Legal teams as appropriate
• Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage and damage

Education & Experience:

• Bachelor’s degree or equivalent relevant experience
• One year of casualty claims adjusting experience or related experience
• Relevant insurance designations preferred

Knowledge, Skills, & Experience:

• Good knowledge of the theory and practice of the claim function
• Good knowledge of insurance contracts, medical terminology and substantive and procedural laws
• Strong knowledge of computers and claims systems
• Ability to obtain all applicable state licenses
• Ability to adhere to high standards of professional conduct and code of ethics
• Good organizational and empathetic interpersonal skills
• Strong written and verbal communication skills
• Good investigative and problem-solving abilities
• Excellent customer service skills
• Ability to maintain confidentiality
• Occasional travel required; a valid driver’s license with an acceptable motor vehicle report per company standards required if traveling

Per the Colorado Equal Pay for Equal Work Act, the hiring range for this position for Colorado-based team members is $58,618.44 – $75,262.27. The hiring range for other locations may vary

Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.

Intake Specialist, Claims – Remote

by Irma Moore | Jan 20, 2025 | Uncategorized

rum & Forster Company Overview

Crum & Forster (C&F)  with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of “A” (Excellent) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry.

Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the October 2023 Great Place to Work® Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion.

C&F is part of Fairfax Financial Holdings, a global, billion dollar organization.  For more information about Crum & Forster, please visit our website: www.cfins.com.

Job Description

Travel Insured International is a leading travel insurance provider with more than 30 years in business. As a key component of our Specialty Business Unit, within the Accident & Health division, TII provides travel protection plans to help each individual travel confidently. Travel Insured International is proud to offer products to consumers and to agency partners of all sizes. We’re committed to providing dependable coverage, great value, and end-to-end satisfaction for all customers. 

This role is responsible for providing superior customer service and support to our customers and travel advisors during the claim submission process as well as supporting the Claims Department to achieve service goals and established KPI’s. The Intake Specialist, Claims, serves as a customer advocate in all interactions by providing an exceptional customer experience that differentiates TII from our competitors.

This is a 100% remote position.  

The Intake Specialist, Claims role will report to the Claims Supervisor, Operations.

What you will do for C&F:

• Ensure all claim documentation (RFI) is accurately gathered based on claim type and provided to the claims team within established Service Level Agreement (SLA)’s.
• Proactively follow up with insureds to ensure all required documentation is provided in a timely manner, is accurate for the claim type and facilitates claim processing within established SLA’s.
• Corresponds and assists through both verbal and in written communications with insureds, travel advisors, etc. to gather important information to support the claim review.
• Provide accurate and timely responses both verbally and in written communications to routine claim inquiries with appropriate notations in all applicable claim systems.
• Provide daily phone coverage for First Notice of Loss (FNOL) and call inquiries for the Claims department to service and support customers and travel advisors as needed per business needs to meet SLAs.
• Contribute to a collaborative team environment by raising new ideas and demonstrating teamwork, positive behavior, eliminating Claims backlogs, adherence to workforce management, effort to achieve goals and objectives. 
• Meet and exceed Key Performance Indicators (KPIs), including department objectives and service levels.
• Provide mentoring and guidance to other team members and act as a resource for others.
• Allows peers, new hires and others across TII shadow as a means to learn the roles and responsibilities of the position
• Other duties as assigned

What YOU will bring to C&F:

• Ability to produce high work volume with precise accuracy
• Ability to readily adjust to multiple demands, shifting priorities, and rapid change
• Ability to communicate in a clear, concise manner appropriate to the audience via phone, email, and in writing
• Ability to produce high work volume with precise accuracy
• Ability to learn, communicate and apply new business information
• Active listening skills
• Exhibits service behaviors that include empathy and patience when communicating with customers
• Organizational skills and the ability to prioritize
• Skilled at problem solving
• Strong computer literacy with demonstrated keyboard skills, solid knowledge of technology used for claims administration
• A High School Diploma or GED is required
• 2 years of experience in a Customer Service role in Insurance or Financial Services is required
• An Intermediate level of proficiency in MS Word, MS Excel, MS Outlook, Teams is required
• Proven ability to navigate multiple systems, utilize dual screens and tools is required
• Experience working in a fast pace, team-oriented environment is required
• Prior customer service experience, within a claim environment is preferred
• Familiarity with claims, imaging and workflow systems is preferred
• Experiences with Salesforce, MS Teams, Five9 Telephony system is preferred

What C&F will bring to you

Competitive compensation package

Generous 401K employer match

Employee Stock Purchase plan with employer matching

Generous Paid Time Off

Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family’s wellness, including your physical, mental and financial wellbeing

A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path

A dynamic, ambitious, fun and exciting work environment

We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community.

At C&F you will BELONG

We value inclusivity and diversity. We are committed to equal employment opportunity and welcome everyone regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you require special accommodation, please let us know.