by twochickswithasidehustle | Sep 27, 2021 | Uncategorized
Medical Report Proofreaders come from all different backgrounds including legal assistants, paralegals, medical scribes, transcriptionists, and more!
This position is 100% remote. Candidate must be available to work 8:30a-5:00p or 9:00a-5:30p EST. Office equipment (office phone, screen, keyboard, mouse and virtual desktop) will be provided. In order to work remote you must have access to your own ISP with a router (both the phone and virtual desktop must be plugged in) and a dedicated “office space” where you can set up your work station with desk and chair.
Responsibilities
- Performs quality assurance review of IME reports, correspondences, addendums or supplemental reviews.
- Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
- Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
- Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
- Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
- Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
- Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
- Ensures the provider credentials and signature are adhered to the final report.
- Identifies any inconsistencies within the report and contacts the Provider to obtain clarification, modification or correction as needed.
- Assists in resolution of customer complaints and quality assurance issues as needed.
Qualifications
- High school diploma or equivalent required.
- Two years IME experience preferred.
- Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers’ compensation, no-fault, liability, and/or disability preferred.
- Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
- Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
- Must possess excellent skills in English usage, grammar, punctuation and style.
- Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
- Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
- Must be able to work independently, prioritize work activities and use time efficiently.
- Must be able to maintain confidentiality.
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ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers’ compensation insurance coverages.
ExamWorks offers a fast-paced team atmosphere with competitive benefits, paid time off, and 401k.
APPLY HERE
by twochickswithasidehustle | Sep 26, 2021 | Uncategorized
Opportunity overview
QA Specialist will work for the Manager of Quality and Training under the Service Operations Team at Cohere Health. You will implement quality measurements, scoring, and performance improvement data designed to improve operational efficiency while exceeding industry standards for quality performance. You will provide support to all functions within the Quality department. With a solid foundation in QA, you are expected to be flexible and nimble in your role to manage short- and long-term projects as well as dealing with day-to-day QA tasks. Cohere culture is one of partnership and ownership. “Not My Job” doesn’t exist in this position.
What you will do
- Audit Individual Operations team members on processes
- Meet required audit counts
- Coach team members for improvement against quality metrics
- Provide reporting on performance and key areas of quality improvement to Sr Leadership
What we are looking for
- Experience in the process of Coverage Determinations in Healthcare
- Ability to conduct effective coaching sessions
- Attention to detail
- Communication skills – verbal and written
- Data collection, management and analysis
- Problem analysis and problem solving
- Planning and organizing
- Effective interaction with stakeholders
- Teamwork
- Mac usage
APPLY HERE
by twochickswithasidehustle | Sep 26, 2021 | Uncategorized
Opportunity Overview:
The RN Reviewer position is a crucial role in our organization — in this role you are responsible for performing a full range of activities that will positively impact the organization and contribute to guiding the strategic operations for the company.
As an RN Reviewer, you will perform prospective review (prior authorization) admission, concurrent, and retrospective reviews according to established criteria and protocols to determine the medical appropriateness of the clinical requests from providers. You will work closely with Medical Directors and other Cohere Health staff to ensure appropriate cost-effective care by applying your clinical knowledge and critical thinking skills to assess the medical necessity of inpatient admissions, outpatient services and procedures, and provider out of network requests. You will be required to review Commercial, Medicare, and Medicaid lines of business.
You will need to be an agile and comprehensive thinker and planner and be able to work in an environment that is in flux. This position offers the ability to make a substantive mark in simplifying the way healthcare is delivered and contributes to an up and coming company with exponential growth opportunity.
What will you do
- Performs medical necessity review which includes: inpatient review, concurrent review, prior authorization, retrospective, out of network, treatment setting reviews to ensure appropriateness and compliance with applicable criteria, medical policy, member eligibility and benefits
- Consults with Medical Directors when care does not meet applicable criteria or medical policies
- Documents clinical information completely, accurately, and in a timely manner
- Meets or exceeds production and quality metrics
- Maintains a thorough understanding of the Cohere Health’s provider and member centric focus, authorization requirements and clinical criteria including Milliman care guidelines and Cohere Health’s internal criteria which includes both National and Local coverage guidelines
- Identifies Clinical Program opportunities and refers members to the appropriate healthcare programs (e.g. case management, disease management, and other health plan programs)
- Collaborates, educates, and consults with Providers, Operations, Product, Implementation, Compliance, Quality, and Health Plans to ensure consistent application of clinical criteria as well as promote the CarePath concept to ensure optimal patient outcome
- Maintains a thorough understanding of accreditation and regulatory requirements, and ensures these requirements are accurately followed and Utilization Management (UM) decision determinations and timeliness standards are within compliance
- Supports the Plan’sQuality Program: Identifies and participates in quality improvement activities as it relates to internal programs, processes studies, and projects
- Performs other duties as assigned.
Your competencies
- Strong customer service skills
- Flexibility and agility, work well in ambiguous situations, clear understanding of an early stage start up environment
- Ability to work cross functionally across remote teams
- Collaborate effectively with multiple stakeholders
- Intellectual curiosity with a strong desire to understand a problem and work it to a viable solution
- Strong communication skills, able to effectively communicate in a positive and engaging manner and able to remain calm and professional under pressure
- Understand how utilization management and case management programs integrate
- Comprehensive thinker/planner with understanding of clinical algorithms, care pathways, and how to effectively manage utilization across the care continuum to achieve optimal patient outcomes
- Ability to work as a team player and assist other members of the UM team where needed
- Thrive in a fast paced, self-directed environment
- Knowledge of NCQA and CMS standards and requirements
- Proficient user of MCG guidelines, Care Web QI user a plus
- Knowledge of AAOS criteria guidelines is a plus
- Proficient in prioritizing work and delegating where indicated
- Highly organized with excellent time management skills
Your background
- Registered Nurse with active, unencumbered license in the state of residence
- Minimum of 3 years of clinical experience.
- Utilization Management experience (Required)
- MCG certification (Preferred)
- Experience working in acute care and/or post-acute care environments
- Orthopedic practice experience (Preferred)
- HEDIS RN/abstraction, Legal RN, Utilization Review/Utilization Management experience (Preferred)
- Preferred proficiency in using a Mac
- Preferred proficiency in G suite applications
- Demonstrated track record of continuous quality improvement
- Excellent communication skills both written and oral
- Thrives on continuous process improvement, always actively seeking out practical solutions
- Understanding that this position is very fluid and the term “not my job” doesn’t exist
- Bachelor’s degree (preferred) but not required in the following fields; Nursing, Business, or equivalent professional work experience
Important to know about this role:
- This is a 100% remote role, and requires robust internet speeds (above 50 megabytes/second), including the ability to utilize zoom meeting software and to stream video
APPLY HERE
by twochickswithasidehustle | Sep 26, 2021 | Uncategorized
ModSquad has partnered with multiple top tier brands/clients across the globe and we need the best of the best in Chat and Ticket Customer Support!
Do you have a Chat and Ticket Customer Support background?Do you enjoy work-from-home and flexible schedules?ModSquad is seeking Mod Contractors to join our network!
If you want the chance to work gigs on the coolest of client projects…then ModSquad is the place for you!! Our clients are strictly Top Tier whose product offerings and services are hip, contemporary and very current. You will instantly know who they are and very likely use them yourselves. Their customers expect the best service and support and that’s where we come in.
Our Mods bring super skills, a positive attitude and great vibe to project work everyday. Mods assist and guide customers to the right answers, solve concerns and are the GPS for customers to understand and optimize the best use of a client’s product or services. Project gigs available now and more are on the horizon.
Do you enjoy researching technical issues? A private email service is looking for a tech savvy, fast paced, mod contractor who can do simultaneous tickets and live chat support in Zendesk.
We need you ASAP!
Project Hours:Monday-Friday: 5:30AM – 6:30PM PSTSaturday and Sunday: 7:00AM – 2:00PM PST
Commitment:10 hours per week90 days (as needed)
Especially Seeking Availability:Tuesday – 12:00 pm – 2:00 pm PSTWednesday – 5:30 am – 7:00 am PSTThursday – 11:00 am – 2:00 pm PSTFriday – 12:00 pm – 3:00 pm PST
This is a very intense project at times with a lot of moving parts. Strong researching and troubleshooting skills are required.
Responsibilities:
- Responding to customers requiring support with email service
- Following approved processes and adhering to client guidelines
- Providing thorough and accurate ticket and chat documentation for all interactions
- Protecting and promoting client’s brand when communicating with customers
- Keeping up to date on all product and support knowledge
- Submitting timely shift reports detailing all activity from any shift
- Forwarding customer feedback to the client via the proper channels
- Assisting customers with advanced technical troubleshooting relating to email setup and delivery
- Notifying client of any potential system issues uncovered during troubleshooting customer issues
What’s In It For You:
- The potential to work with some of the coolest clients around the world like the NFL, Vimeo, and Topps!
- Flexible self-scheduling
- Access to ‘Hot Gigs’ postings exclusive to the Mod Network
- Work from home
- Competitive hourly rate – Discussed during your first interview
- Paid orientation
What We Are Looking For:
- Familiarity with basic internet mail protocols (POP, IMAP) and their configuration
- Proficiency with cloud-based service ticket tools (ZenDesk)
- Ability to discuss, and research, technical information with a customer base that is mostly non-technical
- Utilizing knowledge bases and other process documentation
- Patience and composure at all times when facing customers
- Knowledge/experience setting up and using email on many types of devices such as: iOS, Android, PC, Mac
- Advanced proficiency with configuring and troubleshooting all relevant email protocols and clients
- Positive attitude
- Strong work ethic
- Critical thinking is a MUST
- Typing @ 45WPM or more
- Must be able to work independently with no supervision
- Reliable and able to assist with last minute shift swaps
WorkSpace Requirements:
- Dedicated laptop or desktop computer with Windows 10 or above
- PC that is able to handle multitasking with upwards of 10 tabs open at a time
- Fast and reliable internet
- Quality headset
- Quiet workspace
- Willingness to install MSQ security software and 2FA app on phone
***PRO TIP***: Take your time and make sure you do a thorough job in completing your application. Your responses should be grammatically correct and comprehensive. This will greatly increase the probability of scoring an interview!
Please note: A Chromebook is not sufficient for ModSquad projects.
APPLY HERE
by twochickswithasidehustle | Sep 26, 2021 | Uncategorized
The Data Entry Specialist for the Implementation Team completes manual data entry projects for use in the FACTS School Information System (SIS) and in Microsoft Excel. This position also includes data entry projects for use in other FACTS internal software platforms. The Data Entry Specialist works with a high level of accuracy and compares data entered with original records to detect errors and correct data. The work is performed according to established methods, procedures and practices.
JOB RESPONSIBILITIES:
1. Utilize the software implementation process to perform data entry projects.
2. Perform time sensitive data entry projects using paper records or non-linear electronic records accurately and efficiently.
3. Enter or correct demographic and academic information in various platforms provided by schools or from Data Conversion and assigned by members of the SIS Implementation Team.
4. Work all projects with attention to detail and compare completed data entry work with original documents for accountability.
5. Communicate and coordinate work efforts with the Implementation Team including answering questions, as well as providing clarification and timeline updates on projects.
6. Communicate with customers to resolve issues with data.
7. Can identify and explain discrepancies in data received in order to prevent transferring incorrect information into the SIS.
8. Advise Implementation Team members of issues related to data concerns and follow all PII and documentation handling in accordance with company policies and procedures.
9. Contribute ideas and feedback during team meetings that add or enhance efficiencies to projects or processes within our business.
EDUCATION:
High School Diploma.
EXPERIENCE:
Minimum of two years’ experience in data entry.
COMPETENCIES – SKILLS/KNOWLEDGED/ABILILTIES:
1. Above average computer skills using Microsoft Word and Excel.
2. Capable of navigating corporate human resource and learning management software and websites.
3. Ability to prioritize and manage time to complete multiple project deadlines daily.
4. Above average proofreading, editing, and grammar skills.
5. Capable of demonstrating professional etiquette in verbal and written communication.
6. Ability to work with confidential data in a responsible manner as defined by company policies.
7. Follow all Work At Home Agreement bullets including providing a dedicated, safe, secure workspace free from distractions.
8. Effectively work in a team environment interacting verbally or in person, as requested, with other employees.
9. Flexible and willing to learn new tasks as requested.
10. Flexible to accept any data entry project with instructions from team members and other departments.
APPLY HERE
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