Why Children’s Health? At Children’s Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal.
Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well-being.
Our dedication to promoting children’s health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all.
Summary:
The Managed Care Credentialing Coordinator is responsible for performing credentials verification for Children’s Health employed and contracted practitioners and those who join 162.001(b) provider groups to ensure compliance with standards set forth by National Committee Quality Assurance (NCQA), Center for Medicare and Medicaid Services (CMS), Texas Medicaid &Healthcare Partnership (TMHP) and contracted payers. This position is responsible for submitting accurate and complete provider organizational and facilities providers enrollment applications, following up with payer credentialing departments and provider enrollment representatives to ensure providers are fully credentialed and loaded as participating with all applicable contracted health plans. Managed Care Credentialing Coordinators are accountable for maintaining and disseminating accurate plan participation status reports and billing information to all applicable Children’s Health internal departments to maximize collections in the revenue cycle management process.
Responsibilities:
Prepare credentialing files for individual and organizational providers per NCQA, CMS, TMHP, and contracted payor standards. Perform primary source verification using pre-approved sources, documenting verification efforts consistent with Children’s Health Provider Credentialing policies. Present files to Sr. Credentialing Coordinator for review and auditing prior to Credentials Committee meetings, highlighting red-flags for peer review and discussion.
Obtain, verify, and maintain complete and accurate demographic information and required licensure/ certification documentation for supported individual practitioners and organizational providers. Collaborate with multiple departments to obtain and retain current copies of certificates, etc. Maintain the accuracy of the credentialing database. Maintain the accuracy of provider CAQH profiles and re-attest every 120 days. Regular monitoring of licensure for individual and organization providers to ensure updates are made in a timely for local and out of state Medicaid plans.
Manage the enrollment process for government plans, Medicaid Managed Care plans, and commercial plans for supported individual and organizational providers. Coordinate the gathering and verification of necessary data, working directly with practitioners or appropriate representatives. Complete applications accurately and thoroughly, meeting standards set forth by CMS, HHSC, and commercial payors. Obtain application signatures from the authorized signatory and provide all required supporting documentation. Submit applications and follow up diligently to ensure timely processing. Respond to deficiency notifications in a timely manner. Follow up diligently on provider addition requests and communicate provider changes, corrections, and terminations. Responsible for providing monthly reporting of adds, terms, and changes via delegated rosters to payers for respective assigned provider groups.
Create, maintain, and disseminate plan participation status and billing information to all applicable Children’s Health internal departments and 3rd party billing agencies (as applicable) to maximize collections in the revenue cycle management process.
Complete a quarterly roster reconciliation process for all supported practitioners with applicable health plans. Verify accuracy and communicate additions, changes, and corrections in a timely manner, along with necessary supporting documentation.
Support Patient Financial Services and other Children’s Health billing departments by addressing concerns regarding claim rejections/denials in a timely manner, resolving provider enrollment issues. Participate in special claim projects, coordinating with Provider Relations/Network Management as needed.
Maintain positive working relationships with payer representatives, providers, and all Children’s Health internal departments.
Perform other duties as assigned
How You’ll Be Successful:
WORK EXPERIENCE At least 2 years’ experience in Payor Relations or Credentialing with an insurance company, hospital, or other large group of providers. Required
EDUCATION
Two-year associate’s degree or equivalent experience Required
Four-year bachelor’s degree or equivalent experience Preferred
LICENSES AND CERTIFICATIONS
Certification as a Certified Provider Credentialing Specialist (CPCS) Preferred
A Place Where You Belong
We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children’s Health a place where everyone can contribute.
Holistic Benefits – How We’ll Care for You:
· Employee portion of medical plan premiums are covered after 3 years.
· 4%-10% employee savings plan match based on tenure
· Paid Parental Leave (up to 12 weeks)
· Caregiver Leave
· Adoption and surrogacy reimbursement
As an equal opportunity employer, Children’s Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.
As an equal opportunity employer, Children’s Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.
Located in the vibrant and diverse Tampa Bay region of Florida’s gulf coast, the University of South Florida (USF) is a Preeminent State Research University with campuses in Tampa, St. Petersburg and Sarasota-Manatee. Rated as one of the top places to live in the U.S., Tampa Bay offers a high quality of life, year-round sunshine, and easy access to top-rated entertainment. USF is one of the nation’s largest public universities, serving more than 50,000 students with an annual budget of $1.8 billon. Over the past five years, USF has been the fastest-rising university in the nation, public or private, on the U.S. News and World Report’s list of best universities, which it ranks as the 44th best public university in America.
USF is proud to be an innovating partner within the Tampa Bay region, listed by Forbes as the top emerging tech city in the country.
USF Information Technology (USF IT) provides technology services and support for the University of South Florida. The IT team, led by the Vice President and CIO, provides the following services: Administrative Services, Client Support, Communication Services, Teaching and Learning, Analytics and Reporting, Mobile and Web Services, Consulting Services, Cybersecurity Service and Research Technologies. For more information, please visit: Information Technology | University of South Florida (usf.edu)
ADDITIONAL INFO FOR APPLICANTS:
The selected candidate must have current work authorization in the United States. This position is not eligible for Visa Sponsorship.
USF offers GREAT BENEFITS to full time employees!!
Tuition Assistance (available for yourself, spouse, partner or dependent)
For more information about your total compensation package and other USF benefits, please visit: Work at USF
POSITION SUMMARY:
The ERP Systems Analyst I provides system support for various business applications. This includes security set up for new users, creation of training materials and providing training for users. Assist with system upgrades and maintenance. This position will provide first level system support. Troubleshooting day-to-day issues and escalation as appropriate to next level of support.
RESPONSIBILITIES:
Perform system enhancements, upgrades, and modifications. Develop testing plans and troubleshoot issues as needed.
Manage projects using Jira Kanban boards. Keeping projects up to date. Work with customer and senior analyst to develop future planning.
Provides system support to resolve problems related to UMSA business and USF Health related systems. Primarily Unit4 Financials and Axiom budget and finance systems.
Develop and maintain documentation associated with system updates, department policy, work flow changes and job aids.
Create and maintain system reports as needed.
Perform other duties as assigned.
POSITION QUALIFICATIONS:
MINIMUM:
Bachelor’s degree and 0-2 years of related experience or equivalent combination of education and experience.
PREFERRED:
This position requires a Bachelor’s degree in information technology, business/operations analysis or a related field, with two years of experience in related positions; or a Master’s degree in directly related fields.
USF Tampa
Information for Applicants
This position is subject to a Level 1 criminal background check.
Job Opening Number: 38176
Posting Date: 11/08/2024
Posting End Date: 11/22/2024
How To Apply
Click on the Apply Now button. When applying to an opening you will have the opportunity to upload a cover letter and resume.
Apply online by completing the required information and attaching your cover letter and resume. Please include your experience as it relates to the qualifications stated above. YOUR COVER LETTER AND RESUME, PLUS ANY OTHER REQUESTED MATERIAL, MUST BE IN ONE ATTACHMENT. Only online applications are accepted for this position.
To request an accommodation with the application or interview process, please contact Central Human Resources by telephone: 813-974-2970 or email [email protected].
Equal Employment Opportunity
USF is an equal opportunity, equal access academic institution that embraces diversity in the workplace.
The University of South Florida does not discriminate on the basis of sex and prohibits sexual harassment. Any person may report sex discrimination, including sexual harassment (whether or not the person reporting is the person alleged to be the victim of conduct that could constitute sex discrimination or sexual harassment), in person, by mail, by telephone, or by electronic mail, using the contact information listed for the Title IX Coordinator. Reports may be made at any time either online or directly to the University’s Title IX Coordinator.
The University of South Florida is a high-impact global research university dedicated to student success. Over the past 10 years, no other public university in the country has risen faster in U.S. News and World Report’s national university rankings than USF. Serving more than 50,000 students on campuses in Tampa, St. Petersburg and Sarasota-Manatee, USF is designated as a Preeminent State Research University by the Florida Board of Governors, placing it in the most elite category among the state’s 12 public universities. USF is a member of the American Athletic Conference.
Working at USF
With more than 16,000 employees at USF, the University of South Florida is one of the largest employers in the Tampa Bay region. At USF you will find opportunities to excel in a rich academic environment that fosters the development and advancement of our employees. We believe in creating a talented, engaged and driven workforce through on-going development and career opportunities. We also offer a first class benefit package that includes medical, dental and life insurance plans, retirement plan options, tuition program and generous leave programs and more.
Finalsite is the preferred website, communications, enrollment, and marketing platform of more than 7,000 schools and school districts in 119 countries around the world. The company’s people, products and services transform how schools connect and engage with their community, recruit students and staff, and fundraise; while managing the complex requirements around data privacy, accessibility, hosting and security. Finalsite products and services include award-winning website designs, a robust content management system, mass communications tools, a powerful enrollment management system, innovative inbound marketing tools, data integration, training, support and marketing consulting. Finalsite is headquartered in Glastonbury, CT, USA with employees who work remotely in nearly every state in the U.S. as well as Europe, South America, and Asia. For more information, please visit www.finalsite.com.
VISION
Finalsite will transform the way school communities engage with their schools.
SUMMARY OF THE ROLE
The Data Support Specialist plays a key role in meeting the data integration needs of clients, primarily through an email ticketing system. This position focuses on educating and empowering clients, troubleshooting issues, and implementing solutions to ensure data is reliable, accurate, and up-to-date across all platforms.
LOCATION
100% Remote – Anywhere within the US
RESPONSIBILITIES
Resolve client inquiries and issues related to data integrations and SSO across Finalsite’s software platforms.
Maintain and support deployed third-party data integration and authentication configurations.
Coordinate and conduct phone or Zoom meetings to collaborate with clients and resolve escalated concerns.
Advise clients on best practices to ensure secure, efficient, and sustainable data solutions.
Attend daily standup and escalation meetings, and collaborate with Product and Engineering to ensure integrations and SSOs function as expected.
Stay informed on internal best practices and integration partner functionality.
Troubleshoot, investigate, and create detailed bug reports and product enhancement requests.
Strengthen the Finalsite brand by demonstrating excellence in product knowledge and customer service.
Other Functions:
Assist with Product Support backlog, as volume dictates.
Participate in the After Hours On-Call Rotation
QUALIFICATIONS AND SKILLS
Associate’s or Bachelor’s degree preferred, or equivalent experience.
Experience with XSLT / XPath for XML data transformations
Familiarity working with APIs using Postman or other tools
Advanced knowledge of Excel or Google Sheets.
Strong multitasking skills and ability to handle pressure in challenging situations.
Experience with CMS platforms (WordPress, Squarespace, Wix, etc.) preferred.
Experience with mass communication products (email, SMS, voice) preferred.
2+ years of customer service or technical support experience preferred.
Flexibility to cover evening and weekend hours when required.
RESIDENCY REQUIREMENT
Finalsite offers 100% fully remote employment opportunities, however, these opportunities are limited to permanent residents of the United States. Current residency, as well as continued residency, within the United States is required to obtain (and retain) employment with Finalsite.
DISCLOSURES
Finalsite is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. EEO is the Law. If you have a disability or special need that requires accommodation, please contact Finalsite’s People Operations Team. Finalsite is committed to the full inclusion of all qualified individuals. As part of this commitment, Finalsite will ensure that persons with disabilities or special needs are provided a reasonable accommodation. Ensure your Finalsite job offer is legitimate and don’t fall victim to fraud. Ask your recruiter for a phone call or other type of verbal communication and ensure all email correspondence is from a finalsite.com email address. For added security, where possible, apply through our company website at finalsite.com/jobs.
Abstracts data from medical records into Epic and 3M 360 to provide a detailed case summary of medical, demographic, and statistical information. Identifies and codes diagnoses and procedures for medical records according to ICD-10-CM and CPT-4 guidelines, including department modifications. Identifies primary diagnosis and procedure as well as pertinent secondary diagnoses and procedures. Follows procedures mandated by government and other payers for completion of coded data including APC assignments and HCC codes.
Facility Specific: Responsible for coding ED, Diagnostic, and Ancillary records.
Professional Fee: Responsible for Diagnostic, HCC, Retrospective Coding, Documentation Quality Assurance, and Ancillary Records.
Requirements
Educational Requirements
Degree/Diploma Obtained
Program of Study
Required/ Preferred
and/or
High School Diploma or Equivalent
Required
Experience Requirements
Minimum Years Required
Area of Experience
Required/ Preferred
and/or
1 Year
Outpatient Coding
Preferred
Additional Requirements
1 Year of Outpatient (Acute Care Hospital or Physician) Coding or completion of coding course
State of Florida Licensure Requirements
Licenses
Required/ Preferred
and/or
Not Required
Certifications/Registration Requirements
Certificates/Registrations
Required/ Preferred
and/or
CPC (Certified Professional Coder)
Required
or
COC (Certified Outpatient Coding)
Required
or
CPC-P (Certified Professional Coder-Payer)
Required
or
CCS (Certified Coding Specialist)
Required
or
Additional Requirements
CRC (Certified Risk Adjustment Coder) required -or- CIC (Certified Inpatient Coder) required -or- RHIT (Registered Health Information Technician) required -or- RHIA (Registered Health Information Administrator) required. Minimum of one coding certification (listed above). Other specialty certifications from AAPC or AHIMA will be considered.
The Decision Science & Analytics team is dedicated to building an end-to-end analytics solution to provide business insights, improve decision-making and provide empirical assessment of performance at the institutional, divisional and team levels with respect to constituent engagement and philanthropy.
MD Anderson Cancer Center is seeking a Philanthropy Specialist (Data) to play a key role in supporting varied projects across the Decision Science & Analytics department. This role requires a dynamic, results-oriented individual who can provide on-demand support for initiatives related to analytics, reporting, business solutions, project management, prospect development, and campaign management. The ideal candidate should have experience in Salesforce, data management, and data quality, along with proficiency in data mining techniques. Previous experience in nonprofit philanthropy is preferred. The role demands an individual with project management skills who can adapt to dynamic work environments and contribute to the department’s success.
KEY FUNCTIONS
Programmatic Project Execution (60%)
Consistently deliver skillful execution of team-specific work with an eye toward continuous improvement, while being aware of the impact of the team’s work on and in partnership with others.
• Lead and support various projects related to decision science and analytics teams.
• Utilize project management tools to track progress, manage timelines, and communicate updates to stakeholders.
• Manage data within Salesforce, ensuring data integrity, accuracy, and quality.
• Design and implement data management best practices, including data cleansing, validation, and migration.
Collaboration and Teaming (20%)
Work co-operatively with all stakeholders, contribute to the success of collaborative work teams and support completion of initiative or project to achieve stated goals.
• Works with stakeholders to identify the business requirements and expected outcomes.
• Works with and alongside other analysts, suggesting other solutions of interest to client business processes and/or decisions.
• Coordinate with cross-functional teams to ensure project goals are achieved on time and within budget.
• Communicates and works with business subject matter experts.
Stakeholder Engagement (20%)
Display social awareness, professional etiquette, and the ability to interact and build rapport with internal and external stakeholders. Create an environment where yours and others’ ideas, experiences, perspectives, contributions, and well-being are valued. Take personal responsibility for enabling an environment that supports fair and equal contributions.
• Work with team leaders and members to solve analytics problems and document results and methodologies.
• Work with team members to ensure accurate and timely data collection and reporting.
• Collaborate with cross-functional teams to develop and deploy innovative tools and resources that enhance divisional strategies.
EDUCATION
Required: Bachelor’s degree in Marketing, Advertising or related field.
EXPERIENCE
Required: One year of clerical, office, administrative, organizational, or related support experience. May substitute required education degree with additional years of equivalent experience on a one to one basis.
Preferred: Experience in manipulating large datasets and using databases, Salesforce, SQL, project management, data management, and reporting, with a focus on nonprofit philanthropy. Proficiency in data science tools and Power BI or other data visualization tools. Viable understanding of information systems. Ability to communicate with end-users, effectively understanding their needs and communicating appropriate expectations to them. Adaptable to change and able to interact with co-workers and end-users in a positive manner.
It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html
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