by twochickswithasidehustle | Aug 19, 2024 | Uncategorized
Position: Medical Claim Review Nurse
Location: Fully Remote (Candidates should be CST)
Schedule: M-F 9AM-5PM local time
Training Schedule: M-F 9AM-5PM CST
Employment Type: Contract to Permanent
Pay: $40/hr.
Benefits: Various levels of medical, dental, and vision offered by the agency
Daily Responsibilities:
- Review medical patient records against standard medical criteria.
- Perform clinical/medical reviews of retrospective medical claim reviews, medical claims, and previously denied cases, where an appeal has been submitted.
- Identify and report quality of care issues.
- Assist with complex claim review requiring clinical decision-making experience.
- Document clinical review summaries, bill audit findings, and audit details in the database.
- Provide supporting documentation for denial and modification of payment decisions.
- Re-evaluate medical claims and associated records by applying advanced clinical knowledge, Federal and State regulatory requirements and guidelines, organizational policies and procedures, and individual judgment to assess the appropriateness of service provided, length of stay, and level of care.
- Review medically appropriate clinical guidelines and other criteria with Medical Directors on denial decisions.
- Supply criteria supporting all recommendations for denial or modification of payment decisions.
- Serve as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals.
- Provide training, leadership, and mentoring for less experienced clinical peers and LVN, RN, and administrative support staff.
- Resolve escalated complaints regarding Utilization Management and Long-Term Services & Supports issues.
- Prepare and present cases in conjunction with the Chief Medical Officers and Medical Directors for Administrative Law Judge pre-hearings, State Insurance Commission, and Meet and Confers.
- Represent and present cases effectively to Judicial Fair Hearing Officer during Fair Hearings as may be required.
Job Function:
- Administer claims payments, maintain claim records, and provide counsel to claimants regarding coverage amount and benefit interpretation.
- Monitor and control backlog and workflow of claims.
- Ensure that claims are settled timely and in accordance with cost control standards.
Required Education:
- High School Diploma or GED
Required Experience:
- Minimum of three years of clinical appeals review experience.
- Minimum of one year of utilization review experience.
- DRG experience is prioritized.
Required License, Certification, Association:
- Active, unrestricted State Registered Nursing (RN) license in good standing.
Preferred License, Certification, Association:
- Certified Clinical Coder, Certified Medical Audit Specialist, Certified Case Manager, Certified Professional Healthcare Management, Certified Professional in Healthcare Quality, or other healthcare certification.
by twochickswithasidehustle | Aug 19, 2024 | Uncategorized
Job Posting Closing Date: Open until Filled
Where do you belong?
Your career is more than just a job, it’s part of your life. Whether you’re a clinician, or non-clinical professional, at USACS you’ll feel a sense of connection working with clinicians and office staff who share your interests and values. We want you to love coming to work each day because you believe in what you do and the people with whom you work. We care about your success.
USACS also understands that location is important. We offer career opportunities for clinicians and non-clinical support staff from New York to Hawaii and numerous points in between. Our supportive culture, outstanding benefits and competitive compensation package is best in class.
Job DescriptionResearches patient accounts on all requested refunds to determine if applied payment should be refunded. This includes reviewing explanation of benefits and contacting insurance carriers for additional information.
Essential Job Functions:
- Determines if applied payments should be refunded by researching patient accounts on all requested refunds or credit balances.
- Confirms how payment was applied to patient’s account by reviewing explanation of benefits.
- Communicates with insurance carriers via phone to gather additional information needed to process requested refund.
- Performs all necessary adjustments within guarantor account and/or enters adjustments for refund when applicable.
- Enters all necessary notations in system to allow for proper communication and tracking.
- Enters refunds into the billing system.
- Maintains corresponding back up documentation on all adjusted and refunded accounts.
- Performs and assists with other department duties as needed.
Knowledge, Skills, and Abilities:
- Thorough knowledge of the payment processing functions and all related issues
- Knowledge of and skill in using personal computers in a Windows environment. Emphasis on basic spreadsheet applications and data entry.
- Ability to pay close attention to detail.
- Ability to identify, research and solve problems and discrepancies
- Ability to communicate with coworkers, management, and third-party payers in a courteous and professional manner.
- Ability to maintain confidentiality
- Ability to process assigned duties in an organized manner
- Ability to perform basic mathematical calculations such as adding, subtracting, multiplying and dividing.
- Ability to effectively perform in a multi-task environment
- Ability to work overtime as needed
Education and Experience:
- High school diploma or equivalent.
- At least one year of combined experience in a medical insurance, payment processing or insurance follow-up.
Hourly Rate: $14.53 – $26.88
Hourly rate may be determined on several factors including but not limited to knowledge, skills, experience, education, geographical location and requirements stated in job description.
US Acute Care Solutions current and potential employees enjoy best in class benefit programs with a wide array of options. To learn more, please visit the following link: https://www.usacs.com/benefits-guide-2024
Click the red apply button to submit an application and resume. If you are an USACS employee, please apply via the Jobs Hub in the Workday system.
by twochickswithasidehustle | Aug 19, 2024 | Uncategorized
Remote
Integrated Programs – Operations /
Temporary / Seasonal /
Remote
Apply for this job
We are seeking a highly organized and detail oriented Healthcare Credentialing Assistant (temp) to join our team. This is a two month temporary role, you will be essential in supporting the credentialing and enrollment process for healthcare providers, ensuring accuracy and compliance while managing multiple projects and deadlines.
How you will make an impact
- Manage Multiple Projects and Deadlines: Independently prioritize and manage multiple credentialing projects and deadlines to ensure timely completion.
- Data Entry and Accuracy: Perform accurate data entry of provider information into credentialing software and spreadsheets.
- Process Improvement: Identify opportunities for process improvement within the credentialing and enrollment processes and implement effective solutions.
- Communication and Engagement: Communicate effectively with healthcare providers to collect necessary information and engage them in the credentialing process.
- Collaboration with Leadership: Work closely with leadership to coordinate workflow, ensure deadlines are met, and resolve any issues that arise.
- Expert Tracking: Maintain detailed records and tracking systems for credentialing applications, expirations, and updates.
- Learning and Adaptation: Quickly learn and adapt to new credentialing and enrollment processes, staying updated on industry standards and regulations.
How you will make an impact
- Organization and Autonomy: Must be extremely organized, able to work autonomously, and effectively manage multiple projects and deadlines.
- Attention to Detail: Accuracy is critical in data entry and documentation management.
- Communication Skills: Excellent verbal and written communication skills with the ability to engage healthcare providers professionally.
- Proficiency in Spreadsheets: Experience working with spreadsheets (e.g., Excel) for data entry, tracking, and analysis.
- Process Orientation: Strong orientation towards process improvement and efficiency.
- Adaptability: Ability to quickly learn new systems, processes, and industry standards related to credentialing and enrollment.
- Previous experience in healthcare credentialing or related administrative role.
- Familiarity with credentialing software and databases.
- Understanding of healthcare compliance and regulatory requirements.
$20 – $27 an hour
by twochickswithasidehustle | Aug 19, 2024 | Uncategorized
Role
Backstop IntellX (a division of ION Group) seeks well-organized, detail-oriented, and quality-focused Data Entry Specialists to join our team. The primary responsibility of this role is to efficiently process the inflow of fund documents received via email and portals, ensuring accurate matching to the corresponding investor vehicles. No specific domain knowledge is required, though applicants should be savvy at navigating the web and working within web-based software applications. Past data-collection and data-entry experience is a plus. The ideal candidate will be a quick study who possesses the endurance necessary to deliver high focus for the entirety of the work day. Successful candidates will be tolerant of sometimes-repetitive workflows and driven to meet output targets each day.
This position will be remote, so candidates can be located anywhere in the United States. Preference will given to candidates willing to work 8:00 AM – 5:00 PM Central Time or 9:00 AM – 6:00 PM Eastern Time.
Rate is $20/hour W2 for a 40 hour work week and approximately a 9 month engagement.
Responsibilities
- Access fund-related documents from various sources, including emails and online portals.
- Accurately match received documents to the corresponding investor vehicles or portfolios.
- Follow client-specific instructions to ensure proper handling and processing of emails/documents.
- Conduct thorough verification processes to ensure data accuracy and integrity.
- Communicate effectively with fund managers, colleagues, and external parties as needed.
- Meet targets for email/document throughput as established by your direct manager/supervisor.
Required Skills, Experience and Qualifications
- Qualified candidates must possess a high school diploma or G.E.D.
- Excellent organizational skills and attention to detail in data entry.
- Proficient in Microsoft Office (Word, Excel, and Outlook)
- Ability to work collaboratively in a team-oriented environment.
- Demonstrated capacity to work in a fast-paced professional role.
Desired Experience and Qualifications
- Associates Degree or Bachelor of Arts (BA) or Bachelor of Science (BS) degree is a plus.
- Previous experience in data entry, operations, administration, or a similar role is a plus.
- Knowledge/experience within the financial services industry is a plus.
About ION
We’re a diverse group of visionary innovators who provide trading and workflow automation software, high-value analytics, and strategic consulting to corporations, central banks, financial institutions, and governments. Founded in 1999, we’ve achieved tremendous growth by bringing together some of the best and most successful financial technology companies in the world.
Over 2,000 of the world’s leading corporations, including 50% of the Fortune 500 and 30% of the world’s central banks, trust ION solutions to manage their cash, in-house banking, commodity supply chain, trading and risk.
Over 800 of the world’s leading banks and broker-dealers use our electronic trading platforms to operate the world’s financial market infrastructure.
ION is a rapidly expanding and dynamic group with 13,000 employees and offices in more than 40 cities around the globe.
Our ever-expanding global footprint, cutting edge products, and over 40,000 customers worldwide provide an unparalleled career experience for those who share our vision.
ION is committed to maintaining a supportive and inclusive environment for people with diverse backgrounds and experiences. We respect the varied identities, abilities, cultures, and traditions of the individuals who comprise our organization and recognize the value that different backgrounds and points of view bring to our business. ION adheres to an equal employment opportunity policy that prohibits discriminatory practices or harassment against applicants or employees based on any legally impermissible factor
by twochickswithasidehustle | Aug 19, 2024 | Uncategorized
Job Title: Care Access and Monitoring (CAM) Data Entry Specialist
Location: 100% Remote
Time Zone Requirements: EST time zone
Job Type: Full-Time
Schedule: 8:00 AM to 5:00 PM
Overview: The Care Access and Monitoring (CAM) Data Entry Specialist will provide clerical and data entry support for Managed Care Organization members requiring hospitalization and/or utilization review for other healthcare services. Responsibilities include checking eligibility, verifying benefits, data entry, and triaging information to the appropriate Health Care Services staff to ensure the delivery of high-quality, cost-effective healthcare services according to State and Federal requirements.
Must-Have Requirements:
- Knowledge of Microsoft Office products
- Healthcare experience
Day-to-Day Responsibilities:
- Provide computer entries for authorization requests/provider inquiries via phone, mail, or fax, including:
- Verifying member eligibility and benefits
- Determining provider contracting status and appropriateness
- Determining diagnosis and treatment requests
- Assigning billing codes (ICD-9/ICD-10 and/or CPT/HCPC codes)
- Determining COB status
- Verifying inpatient hospital census (admissions and discharges)
- Performing required actions per protocol using the appropriate database
- Respond to requests for authorization of services submitted to CAM within operational timeframes
- Participate in interdepartmental integration and collaboration to enhance continuity of care for members, including Behavioral Health and Long-Term Care
- Contact physician offices as per department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director
- Provide excellent customer service to internal and external customers
- Meet department quality standards, including inter-rater reliability (IRR) testing and quality review audit scores
- Notify Care Access and Monitoring Nurses and case managers of hospital admissions and changes in member status
- Meet productivity standards
- Maintain confidentiality and comply with HIPAA
- Participate in CAM meetings as an active team member
- Follow attendance guidelines and standards of conduct as per Managed Care Organization HR policy
- Comply with required workplace safety standards
Knowledge/Skills/Abilities:
- Ability to communicate, problem-solve, and work effectively with people
- Working knowledge of medical terminology and abbreviations
- Analytical thinking and problem-solving skills
- Good communication and interpersonal/team skills
- High regard for confidential information
- Ability to work in a fast-paced environment
- Ability to work independently and as part of a team
- Proficient computer skills and experienced user of Microsoft Office software
- Accurate data entry at a minimum of 40 WPM
Required Education:
Required Experience:
- 0-2 years of experience in a Utilization Review Department in a Managed Care Environment
- Previous hospital or healthcare clerical, audit, or billing experience
- Experience with medical terminology
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