Career Opportunities
This service is available to employers and our members but is not an AAMAS endorsement of the employers or positions advertised. Positions are posted for 3 months at $200. If you wish to place an advertisement on this page please email our postion description to .(JavaScript must be enabled to view this email address).
NURSE AUDITOR
Community Medical Centers
Fresno, California
Job Title: Nurse Auditor
Reports To: Vice President, Internal Audit
Location: Fresno, California
Contact: Qualified candidates, please apply online at http://www.communitymedical.org
Company Overview
Community Medical Centers is a 792-bed hospital system that’s locally owned and not-for-profit. We provide Level 1 trauma service, acute care, outpatient centers, clinics, home care, community education, physician groups and a physician residency program in conjunction with the University of California, San Francisco and Davis Schools of Medicine. Community is the region’s largest health care provider and private employer.
At Community, we’re boldly moving forward – growing to meet the ever-changing needs of the dynamic communities we serve. We’re financially solid and all of our facilities are adding new technology and undergoing exciting expansion projects. That means we’re able to offer an exceptional variety of ways for you to grow – both in the way you do your job as a professional, and in the way you live your personal life as well.
Community is located California’s Central Valley, with lower housing costs, top schools, big city amenities and small town charm, plus a wealth of exciting destinations a short drive away – from Yosemite to Monterey, San Francisco to the Sierra Nevadas.
Position Summary
We are currently seeking qualified candidates for the position Nurse Auditor for our growing Internal Audit department.
In this position the chosen candidate will:
- Conduct revenue cycle audits.
- Perform coding accuracy reviews.
- Provide coding education to Physicians and health systems staff.
- Provide quality assistance monitoring for health system.
- Develop and implement compliance plans and audit programs under the direction of the Compliance Officer.
Requirements
Minimum Required:
Bachelor's degree in Nursing, Health Information Management, Business or a related field and 3-4 years experience in a health care facility, Blue Cross/Blue Shield, state auditor office or other related organizations.
OR
An Associate's degree in Nursing, Health Info Mgmt or Business and 5-6 years experience in clinical auditing or compliance reviews may be substituted for Bachelor's degree.
Preferred:
Current California Registered Nurse License
Please apply for position via Community Medical Centers’ website, www.communitymedical.org.
For more information on how to apply, please call 559-449-6207.
Community Medical Centers offers a competitive wage, benefits package, and career development opportunities.
Posted September 3, 2010
Clinical Documentation Improvement Specialists - Lanham, MD
The nurse who stays to educate a worried family. The lab tech with the deft skills that make a test easier to take. The physical therapist who knows just how to motivate a frustrated patient. These are the kinds of people who make up the DCH team and who have earned us our reputation for outstanding quality care.
An award-winning acute care medical and surgical hospital, Doctors Community Hospital wins high praise from area professionals as well. Our exceptional clinical training programs, our leading-edge technology and services, and our open channels of communication that just don’t exist at larger institutions are some of the reasons why.
If you’re an experienced nurse extremely savvy in medical record interpretation and coding, you can make a real difference at Doctors Community Hospital. Our Clinical Quality Specialists have a significant financial and quality of care impact through comprehensive chart reviews to ensure proper coding is being applied.
Potential for Sign-On/Retention Bonus.
Refer another successful candidate for an additional $5,000 bonus.
BSN (MSN preferred), 5 years clinical nursing experience in an acute care setting, and extensive experience conducting concurrent and retrospective medical review and data analysis required.
To discuss your future in one of these openings, apply at www.dchweb.org or contact Richard Fappiano at 301-552-8083; fax: 301-552-3355. EOE
Posted August 30, 2010
Revenue Management Utilization Compliance Nurse
Baptist Health South Florida
Miami, Florida
The best place to be your best.
Baptist Health South Florida is a place for people who take pride in reaching their goals, but never rest on their accomplishments. It’s a community where quality always comes first. Where we live our mission and share our vision. Come find out why Baptist Health is the best place for you to be your best and become even better at what you do.
As the Revenue Management Utilization Compliance Nurse, you will be responsible for reviewing medical charts in order to properly coordinate and generate appeal to overturn carrier denials. This position requires auditing UR notes on concurrent review for acute and/or sub-acute inpatient stays, inclusive of the admission review, and hospital discharge. This review is conducted using Milliman and/or Inter-Qual Guidelines, with physician referral and review as appropriate. Assesses level and completes appropriate documentation for tracking/trending data. May create or maintain reporting and/or statistics.
Qualified candidates will possess a current FL RN license (BSN preferred); experience in the field of Utilization Management; Medical Chart Auditing and Government and Managed Care Appellate process experience; knowledge of observation stay regulations, one and two day admissions, roll over's, ICD-9, CPT-4 and HCPCS coding, CMS as well ad 1500 and UB04 forms; familiar with compliance regulatory AHCA guidelines; knowledge and interpretation of Statutory Guidelines and Carrier; and knowledge of contracts relating to Denials Management.
There’s a sense of pride that comes with working at Baptist Health South Florida. We have a reputation for quality outcomes and patient-centered care, and a true commitment to the communities we serve.
Find out why this is the best place for you to lead. Working within our award-winning culture means getting the respect and support you need to continue setting the quality standard for South Florida and beyond.
* Baptist Health made Fortune magazine's annual “100 Best Companies to Work For” list for the 10th time in 2010, and is the only Florida-based healthcare organization to be recognized as a great employer.
* 100 Best Companies for Working Mothers and Working Mother Hall of Fame – Working Mother magazine
Apply online today to Job Numbers 37163 or 37164.
baptisthealthjobs.net
This position is not open to any third party recruiters, consultants and/or staffing vendors at this time.
Baptist Health is an Equal Employment Opportunity employer.
Posted August 5, 2010
When Your Work Moves You
At Gwinnett Medical Center, we care for our employees as much as we do our patients, which is one of the reasons we’ve been named “2009 Best Employer in Gwinnett.” In this progressive environment, the support of your team and our ongoing development programs give you the opportunity to learn and grow – and to move forward in your career. You’re encouraged to contribute ideas to a responsive leadership, and you will see first-hand how you make an impact. We’re a growing organization, with $13 million in new equipment that reinforces your ability to provide a sophisticated level of care.
Charge Master Coordinator – Revenue Integrity
Lawrenceville, GA
This job is located in Lawrenceville, GA, in the northern suburbs of Atlanta. As Charge Master Coordinator, you will join a team of highly dedicated healthcare professionals. You will be responsible for the accuracy of the Charge Description Master (CDM) as designated by regulatory agencies and payers. The CDM Coordinator has the responsibility of interpreting government regulations and affecting related process changes throughout the System to ensure compliance with these regulations. Duties include audit, analysis and verification of charging procedures, ensuring correctness of coding in the CDM and providing pertinent education related to these procedures. This position is responsible for the assessment of individual and departmental compliance issues and reporting any non-compliance to the appropriate responsible parties.
Requires a Bachelor’s degree in Health Information Management or Nursing. You must have at least five years’ recent experience in the Healthcare industry with knowledge of Healthcare revenue cycle functions, including coding and billing guidelines, government payor regulations and cost reporting. Revenue code and CPT coding knowledge is required. Knowledge of multiple reimbursement systems to include PPS will also be necessary. You should be skilled in Windows-based software including Microsoft Windows, Excel and Access. You must have the ability to interpret and implement regulatory standards. Strong communication, teaching and presentation skills are a plus.
Discover the support and state-of-the-art technology that lets you make the most of your passion for healthcare. For more information or to apply, visit gwinnettmedicalcenter.jobs/pulse today. EOE.
Move your career forward.
Gwinnett Medical Center
Posted July 30, 2010
Medicaid Purchasing Administration
Office of Program Integrity
Office Chief
Salary: $5,416.00 - $7,221.00 Monthly
Job Type: Full Time - Permanent
Location: Thurston County – Olympia, Washington
The mission of the Department of Social and Health Services (DSHS) is to improve the quality of life for individuals and families in need. The Department helps people achieve safe, self-sufficient, healthy and secure lives. In accomplishing this mission, the Department offers comprehensive and coordinated social, health and financial services to meet the unique needs and strengths of individuals and families.
Within the Department, the Medicaid Purchasing Administration (MPA) provides access to quality healthcare for Washington’s most vulnerable residents. In fulfilling this role, MPA operates under the following guiding principles and core values:- MPA strives to be a prudent purchaser: MPA pushes for higher quality, better outcomes and cost-efficiencies.
- MPA is accountable: MPA analyzes its decisions and outcomes in a meaningful way and takes responsibility for them.
- MPA manages its programs well: MPA provides expertise and is the best and fastest source of information about its own programs.
- MPA works to be more inclusive: MPA constantly seeks cross-divisional, cross-agency and external perspectives.
- MPA takes risks to improve: MPA is innovative and does not hesitate to challenge the status quo.
- MPA values good decisions: MPA strives for balanced, timely, informed and practical judgment.
- MPA is open and honest: Good communication builds trust.
- MPA values and supports the staff: Reward good work and provide opportunity.
- MPA strives for fairness and consistency: MPA policies are documented and apply to all.
- MPA takes pride in good customer service: MPA is committed to its clients’ needs and to the providers who furnish our services.
Position Objective
Within the MPA Division of Systems and Monitoring (DSM), the Office of Program Integrity (OPI) has responsibility to utilize advanced data analytics and to conduct comprehensive provider reviews and audits to protect the integrity of programs throughout DSHS.
OPI has responsibility for program integrity functions for Washington’s Medicaid Management Information System (MMIS) including Pharmacy Point of Sale (POS), a DSHS mission critical system which processes over 2 million claims per month and pays claims in excess of $3.5 billion annually to providers of services for DSHS clients. OPI responsibilities also include data analytics and program integrity reviews for data from the Social Service Payment System (SSPS), a DSHS mission critical system which authorizes the delivery and/or purchase of social services and initiates the payment process for those services.
This professional position plans, directs and monitors the activities of OPI to include:
- Responsibility for decision-making related to the daily operations of the program and supervision of approximately 40 OPI staff; manages staff in efficiently performing audit and post-payment review functions;
- Development of policies and procedures used by OPI to ensure compliance with state and federal requirements and industry best practice;
- Development and administration of the OPI strategic business plan;
- Identification, investigation, recovery and prevention of suspected fraud, waste and abuse in the Medicaid program, through comprehensive reviews and audits of Medicaid providers, and the use of advanced data analytics. Referral of inappropriate vendor billings and overpayment in DSHS statewide payment systems;
- Management of the Decision Support System contract (legacy) and management of the next generation Fraud and Abused Detection System (FADS) Project funded by a CMS Medicaid Transformation Grant;
- Coordination of program integrity activities with the Medicaid Fraud Control Unit of the Office of the Attorney General and other various local, state and federal entities; Facilitation and coordination of program integrity representation on applicable Steering Committees;
- Continued innovation in the discovery of new and advanced methods to protect Medicaid dollars, using information systems and leveraging technological advances.
Duties
Direct/manage the daily activities of the Department’s professional audit and post-payment review staff. Build mentoring relationships that integrate diverse responsibilities and functions, and foster a work environment based on mutual trust and respect. Enhance the effectiveness of employees through coaching, timely appraisal and professional development opportunities.
Specific unit responsibilities:
- Medical/Hospital Audit Unit and Clinical Review and Audit Unit: Manage audit policies and procedures used by OPI to ensure compliance with state and federal requirements and industry best practice. Participate in the audit planning process and direct the efficient utilization of resources for various audit activities.
- Surveillance Utilization and Review Section (SURS): Direct /manage process improvements that support SURS staff, assist in identification of actions for SURS cases including referrals to Medicaid Audit, Division of Fraud Investigations, and the Medicaid Fraud Control Unit.
- Veteran’s Benefit Enhancement Project: Guide and support staff to ensure that referrals being made to the WDVA are accurate and timely, assist in streamlining and automating project activities and facilitate regular status meetings with WDVA partners.
Cost Savings Initiatives and Fraud and Abuse Detection: Participate and guide staff in the use of advanced technology including algorithm and model development, provider review processes, and other program improvement and savings initiatives for both MMIS and SSPS.
Develop and administer strategic plan for OPI including annual reporting. Responsible for tracking of detailed regular reporting including contract expenditures, recoveries, costs avoided and calculation of return on investment for all program integrity functions.
Develop policies and procedures to ensure compliance with state and federal requirements, audit standards and industry best practice. Responsible for policy and procedure evaluation and implementation to ensure OPI’s activities are effective, efficient, legally defensible, and mitigate policy weaknesses that increase risks to DSHS payment systems. Recommend necessary changes to WAC, policies, and/or user training based on data analysis activities and provider billing patterns and trends.
Ensure MPA compliance with federal program integrity requirements. Managed federal program integrity programs and reviews. Represent DSHS on national fraud, waste and abuse committees. Support continuous efforts to maximize the use of data for payment integrity improvements.
Develop relationships with stakeholders and partners, both internal and external, to support and ensure effective and timely communication on program integrity issues. Provide assistance and consultation to executive leadership and program administrations and work collaboratively with program/policy managers at all levels. Build and sustain review teams across multiple DSHS organizations for the development of processes for the identification of potential fraud, waste and abuse and the recovery of inappropriate payments from DSHS providers and/or vendors.
Direct and oversee the Decision Support System contractor activities and the Fraud and Abuse Detection System (FADS) Project contract. Direct the day-to-day management of the $5.9 million Medicaid Transformation Grant and oversee the design and testing of the new FADS implementation. Coordinate with the ProviderOne Project and ProviderOne Operations to assure accuracy in data understanding.
Present complex technical information and data both orally and in writing to a broad spectrum of managerial, administration and professional staff. This includes facilitating and/or presenting to the governing PRP Executive Steering Committee and the Executive Steering Committee governing the Veteran’s Benefit Enhancement Project. Maintains the highest standards of personal, professional and ethical conduct and supports the State’s goals of a diverse workforce.
Qualifications
Required Education, Experience, Skills and Abilities
Bachelor’s degree in business administration, health care administration, public administration or accounting OR Three years health care review/audit experience and three years progressively responsible supervisory and management experience;
- Knowledge of state and federal law, policies, rules and procedures, regulations and requirements regarding Medicaid payments, fraud, waste and abuse and overpayment recoveries
- Knowledge of Generally Accepted Auditing Standards and GAO Yellow Book standards
- Ability to interpret complex regulations and formulate goal oriented and defensible actions
- Applied knowledge of Washington State personnel policies and labor relations Competence in directing staff and managing a unit of professional staff with diverse responsibilities and talents, willing to advocate for staff, programs and ideas to build a team, and provide a work environment based on respect and trust
- Ability to interpret complex regulations and formulate goal oriented and defensible actions. Experience in conflict resolution
- Ability to understand and communicate complex operational and technical information both orally and in writing, facilitate meaningful communication with non-technical policy makers and stakeholders, negotiate agreement with stakeholders with differing demands and expectations across a broad spectrum of managerial, administrative and professional staff including Center for Medicare and Medicaid Services (CMS), contracted vendors, DSHS staff, internal and external customers and private sector consultants
- Knowledge of the fee-for service and managed care environments and the social service delivery system and the unique differences
- Experience in continuous process improvement when participating in writing the section’s annual strategic plan. Knowledge and expertise of management and organizational methods and techniques and process development, including a knowledge of the political, technical, management and fiscal conditions that exist in DSHS or a similarly complex organizational structure
- Strong planning analysis and problem-solving skills involving a high degree of originality and independent judgment, including the ability to identify program risks and critical issues and prepare recommendations for meeting established goals
- Project management skills; the ability to organize and prioritize a wide range of responsibilities, balance competing demands, utilize available resources efficiently and negotiate agreement with stakeholders with differing demands and expectations
- Ability to effectively organize and prioritize in a multi-task, multi-priority environment, balance competing demands, and advance assigned projects from inception to completion. This includes the ability to make decisions independently or as a team member
- Strong statistical analysis skills involving the processing, analysis, interpretation and presentation of data. Ability to analyze overpayment results and work with program staff and system experts to develop edits/ audits to prevent future inappropriate billing
- Knowledge of large information systems and DSHS claims and payment systems and processes, including functional knowledge and experience in Decision Support System development and maintenance activities.
- Ability to create an environment that regards MPA Division of Systems and Monitoring as the source of trusted data and information.
Compensation
This position is Washington Management Service position. The salary range is up to $86,652 annually depending upon experience and qualifications.
To Apply
Interested parties with the proper qualifications should submit:
- A chronological resume with detailed work history and education
- A letter of interest that supports your qualifications for this position
- Name, address and current contact information for three professional references
Electronic applications in Word format or PDF are preferred, please enter QL32 Office Chief in the subject line:
.(JavaScript must be enabled to view this email address)
If needed, hard copies may be sent to:
Medicaid Purchasing Administration
Division of Systems and Monitoring
Aimee Cathers
PO Box 45502
Olympia, WA 98504-5502
Phone (360) 725-1134
Fax (360) 586-9551
The State of Washington is an equal opportunity employer. Persons with a disability who need assistance in the application or testing process or those needing this announcement in an alternative format may call (360) 664-1960 or toll free (877) 664-1960. For Telecommunications Device for the Deaf please call (360) 664-6211.
Posted July 14, 2010
UM Manager
CHW Medical Foundation (CHWMF), established in 1993, is affiliated with Catholic Healthcare West - the eighth largest hospital system in the nation, with 40 hospitals and medical centers in California, Arizona and Nevada. Today, CHWMF works hand-in-hand with medical groups throughout northern California to provide comprehensive healthcare services to the many communities we serve.
As CHWMF continues to grow, establishing new premier medical groups, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service.
This position is responsible for successful implementation of the Utilization Management program. Develops and implements effective and efficient standards, protocols and processes; department decision support systems; and reports and benchmarks that support continual enhancement of utilization management functions and promote quality health care for members. Success in this position requires ability to promote communication and teamwork between physicians, case managers, nurse reviewers, Mercy hospital staff, and management.
- Develop and manage inpatient/outpatient activities to meet key initiatives and demonstrate quality improvement. This includes daily monitoring of inpatient days and tracking of specific outcomes such as catastrophic cases.
- Educate company personnel and providers regarding UM/Care Management policies, procedures and techniques.
- Direct daily operations of inpatient/outpatient activities and analysis of reports relevant to the departments. This includes daily monitoring of inpatient census and outpatient service metrics and productivity reports.
- Review and analyze utilization data, identify trends and interventions as needed;
- Annually review utilization management program description and policies and procedures to comply with Health Plan, Federal and State regulatory guidelines.
- Work with regulatory/ Compliance departments to represent Utilization and Care Management in internal/external audits.
- Ensure that confidentiality of clinical information is maintained.
This position has the accountability and authority for the budget performance of the Utilization Management division of the Managed Care Services department. Further the person in this position is to evaluate and implement workflow and process improvement, determine staffing and overtime needs, evaluate and effectively recommend hiring and termination of staff and perform corrective action and progressive discipline as necessary.
Promotes excellent communication between the Hospital Liaison nurses, the Case Managers, and the Medical Directors to promote optimal outpatient care and efficient use of hospital resources.
Trains and promotes continuous improvement in the referral staff to effectively review requests for coding accuracy and medical necessity/appropriateness by using applicable criteria, medical policy, member eligibility, benefits and contracts.
Manages the relationship between CHWMF UM and the Sequoia Physicians Network Administrator and Medical Director.
Facilitates continuity and coordination of medical care and services for new enrollees and members transitioning providers while in the middle of care
Collaborates with the Mercy Medical Group Medical Director in determining medical necessity of service, level of care and appropriateness of care in the most cost effective, quality setting, as appropriate.
Facilitates the benefit interpretation request process by reviewing and researching all requests for any service, procedure or regulatory requirement that requires clarification and/or consistency in decision-making regarding appropriateness for coverage.
Assists with the development of policies, procedures, and prior authorization guidelines.
Coaches and provides feedback to associates regarding goal setting, work performance and performance management. Initiates action on staffing and performance reviews.
Maintains professional and technical knowledge by attending educational and/or skills workshops; computer classes.
Performs other duties as assigned.
Job Requirements
BSN/BS/BA and/or Masters Degree in Healthcare related field
Demonstrated track record in managed care (5+ years experience preferred)
Leadership experience in the California delegated model a plus
Registered Nurse (Current and active California RN license in good standing)
Clinical claims review experience highly desired
Knowledge of relevant State and Federal laws, statutes and regulations preferred
Strong supervisory and management skills
Excellent verbal and written communication and computer skills
Considerable interpersonal skills
For consideration, please apply to requisition ID #94931 via our website: www.chwcareers.org. CHW Medical Foundation is an equal opportunity employer.
Posted July 14, 2010
Medical Internal Auditor - Greenville, North Carolina
Pitt County Memorial Hospital is an 860+ bed Level I Trauma center, regional referral hospital and is the flagship hospital for University Health Systems of Eastern Carolina. We serve as the teaching hospital for Brody School of Medicine at ECU. PCMH provides acute, intermediate, rehabilitation and outpatient services to more than 1.3 million people in 29 counties.
We are seeking a Medical Internal Auditor to conduct audits involving the entire revenue cycle. Perform daily concurrent audits, review medical record documentation against billing to assess compliance with all rules, laws, policies, procedures and regulations. Identify charge error rates, procedural weaknesses, system weaknesses and coding appropriateness. Perform coding accuracy reviews. Provide coding education to Physicians and health systems staff. Provide quality assistance monitoring for health system.
Requirements include a Bachelor’s degree in Nursing, Health Information Management, Business or a related field and 3-4 years experience in health care facilities, Blue Cross/Blue Shield, state auditors office or other related organizations. An Associate’s degree in Nursing, Health Info Mgmt or Business with two additional years of experience in clinical auditing or compliance reviews may be substituted for the four year education requirement.
In addition to an excellent compensation and benefits package, we have superb opportunities for professional growth. Pitt County Memorial Hospital offers all the benefits of Greenville, NC, a progressive community located only a short drive from Carolina’s magnificent seashore, where the low cost of living is matched by the high quality of life.
Please visit www.pcmhcareers.com to submit an application or resume online. For more information on how to apply, call 800-346-4307.
We are diverse talents brought together by a common dedication: EOE.
Posted July 1, 2010
Internal Auditor, Compliance/Medical Coding
International Capital & Management Company
The Internal Auditor, Compliance & Medical Coding is primarily responsible for conducting audits of medical records and billing statements to verify patient charges, ensure proper documentation and identify compliance issues; develop detailed audit plans and programs with regard to policy and procedure based on knowledge of applicable laws, rules, best practices and regulations; ensure the existence, completeness and proper functioning of internal control systems and the reliability and accuracy of financial data. The Internal Auditor must possess adequate knowledge of legal documents and Medicare billing requirements and the knowledge, skills and ability to interact with hospital insurance representatives to justify charges and minimize losses. Prior experience evaluating financial internal controls and designing internal control systems to ensure safeguarding of company assets is required. Additional responsibilities include planning and executing audits as assigned by the Director of Internal Audit.
Requirements:
- Bachelors degree and 3+ years of billing practice audits
- Knowledge of applicable laws, rules, best practices and regulations
- Experience with Electronic Medial records (EMR); specifically the Eclypsis System
- Clinical experience in a hospital or physician’s office preferred • RHIT, CCS and or CCS-P preferred
- RN with medical billing experience preferred
- Relocation to St. Thomas, US Virgin Islands is required.
Email your resume: .(JavaScript must be enabled to view this email address) or apply online at: www.career.vi
Posted June 18, 2010
Clinical Nurse Auditor
Job Title: Clinical Nurse Auditor
Reports To: Director, Bill Review and Audit
Location: Bedminster, NJ
Contact: Forward resumes to .(JavaScript must be enabled to view this email address)
COMPANY OVERVIEW
Premier Healthcare Exchange delivers advanced cost management solutions for health plans. The company's services consists of claims editing, clinical bill review and audit, anti-fraud services and out of network claim repricing. The firm's solutions are used by a number of the industry's leading insurance companies, Health Maintenance Organizations (HMOs), and Third Party Administrators (TPAs).
POSITION SUMMARY
We currently have an exciting opportunity for a seasoned Clinical Nurse Auditor to join a growing Bill Review & Audit department located in Bedminster, NJ. This is an outstanding opportunity for a savvy individual with a motivated spirit to join one of the fastest growing companies in healthcare.
This candidate will be responsible for clinically auditing hospital claims and ensuring accuracy by performing a line by line review of appropriate medical records, operative reports, labs, implant information, etc. Candidate will communicate directly with medical providers nationwide to ensure medical claims payment accuracy. Candidate will use web based tools and in house systems to effective analyze data.
QUALIFICATIONS
- LPN or RN License Required
- Excellant verbal and written communication skills
- Good organizational skills
- Ability to work in a fast paced environment
Please apply for position by e-mailing resume to .(JavaScript must be enabled to view this email address). Please visit our website at www.phx-online.com.
Premier Healthcare Exchange (PHX) was recently recognized as one of 2009 Fifty Fastest Growing Companies, by NJBIZ, New Jersey’s leading statewide business news publication. PHX offers a competitive wage, benefits package, plus the opportunity for career development as the company continues to grow.
Posted June 17, 2010
Revenue Integrity Manager
Sunrise Hospital and Medical Center, located in Las Vegas, has an immediate opening for an enthusiastic and dedicated Revenue Integrity Manager. Now celebrating more than 50 years in the community, Sunrise Hospital & Medical Center provides the most sophisticated, quality healthcare in Southern Nevada. Join our team, today.
In this key role, you will assuf hospital resources.
Trains and promotes continuous improvement in the referral staff to effectively review requests for coding accuracy and medical necessity/appropriateness by using applicable criteria, medical policy, member eligibility, benefits and contracts.
Manages the relationship between CHWMF UM and the Sequoia Physicians Network Administrator and Medical Director.
Facilitates continuity and coordination of medical care and services for new enrollees and members transitioning providers while in the middle of care
Collaborates with the Mercy Medical Group Medical Director in determining medical necessity of service, level of care and appropriateness of care in the most cost effective, quality setting, as appropriate.
Facilitates the benefit interpretation request process by reviewing and researching all requests for any service, procedure or regulatory requirement that requires clarification and/or consistency in decision-making regarding appropriateness for coverage.
Assists with the development of policies, procedures, and prior authorization guidelines.
Coaches and provides feedback to associates regarding goal setting, work performance and performance management. Initiates action on staffing and performance reviews.
Maintains professional and technical knowledge by attending educational and/or skills workshops; computer classes.
Performs other duties as assigned.
Job Requirements
BSN/BS/BA and/or Masters Degree in Healthcare related field
Demonstrated track record in managed care (5+ years experience preferred)
Leadership experience in the California delegated model a plus
Registered Nurse (Current and active California RN license in good standing)
Clinical claims review experience highly desired
Knowledge of relevant State and Federal laws, statutes and regulations preferred
Strong supervisory and management skills
Excellent verbal and written communication and computer skills
Considerable interpersonal skills
For consideration, please apply to requisition ID #94931 via our website: www.chwcareers.org. CHW Medical Foundation is an equal opportunity employer.
Posted July 14, 2010
Medical Internal Auditor - Greenville, North Carolina
Pitt County Memorial Hospital is an 860+ bed Level I Trauma center, regional referral hospital and is the flagship hospital for University Health Systems of Eastern Carolina. We serve as the teaching hospital for Brody School of Medicine at ECU. PCMH provides acute, intermediate, rehabilitation and outpatient services to more than 1.3 million people in 29 counties.
We are seeking a Medical Internal Auditor to conduct audits involving the entire revenue cycle. Perform daily concurrent audits, review medical record documentation against billing to assess compliance with all rules, laws, policies, procedures and regulations. Identify charge error rates, procedural weaknesses, system weaknesses and coding appropriateness. Perform coding accuracy reviews. Provide coding education to Physicians and health systems staff. Provide quality assistance monitoring for health system.
Requirements include a Bachelor’s degree in Nursing, Health Information Management, Business or a related field and 3-4 years experience in health care facilities, Blue Cross/Blue Shield, state auditors office or other related organizations. An Associate’s degree in Nursing, Health Info Mgmt or Business with two additional years of experience in clinical auditing or compliance reviews may be substituted for the four year education requirement.
In addition to an excellent compensation and benefits package, we have superb opportunities for professional growth. Pitt County Memorial Hospital offers all the benefits of Greenville, NC, a progressive community located only a short drive from Carolina’s magnificent seashore, where the low cost of living is matched by the high quality of life.
Please visit www.pcmhcareers.com to submit an application or resume online. For more information on how to apply, call 800-346-4307.
We are diverse talents brought together by a common dedication: EOE.
Posted July 1, 2010
Internal Auditor, Compliance/Medical Coding
International Capital & Management Company
The Internal Auditor, Compliance & Medical Coding is primarily responsible for conducting audits of medical records and billing statements to verify patient charges, ensure proper documentation and identify compliance issues; develop detailed audit plans and programs with regard to policy and procedure based on knowledge of applicable laws, rules, best practices and regulations; ensure the existence, completeness and proper functioning of internal control systems and the reliability and accuracy of financial data. The Internal Auditor must possess adequate knowledge of legal documents and Medicare billing requirements and the knowledge, skills and ability to interact with hospital insurance representatives to justify charges and minimize losses. Prior experience evaluating financial internal controls and designing internal control systems to ensure safeguarding of company assets is required. Additional responsibilities include planning and executing audits as assigned by the Director of Internal Audit.
Requirements:
- Bachelors degree and 3+ years of billing practice audits
- Knowledge of applicable laws, rules, best practices and regulations
- Experience with Electronic Medial records (EMR); specifically the Eclypsis System
- Clinical experience in a hospital or physician’s office preferred • RHIT, CCS and or CCS-P preferred
- RN with medical billing experience preferred
- Relocation to St. Thomas, US Virgin Islands is required.
Email your resume: .(JavaScript must be enabled to view this email address) or apply online at: www.career.vi
Posted June 18, 2010
Clinical Nurse Auditor
Job Title: Clinical Nurse Auditor
Reports To: Director, Bill Review and Audit
Location: Bedminster, NJ
Contact: Forward resumes to .(JavaScript must be enabled to view this email address)
COMPANY OVERVIEW
Premier Healthcare Exchange delivers advanced cost management solutions for health plans. The company's services consists of claims editing, clinical bill review and audit, anti-fraud services and out of network claim repricing. The firm's solutions are used by a number of the industry's leading insurance companies, Health Maintenance Organizations (HMOs), and Third Party Administrators (TPAs).
POSITION SUMMARY
We currently have an exciting opportunity for a seasoned Clinical Nurse Auditor to join a growing Bill Review & Audit department located in Bedminster, NJ. This is an outstanding opportunity for a savvy individual with a motivated spirit to join one of the fastest growing companies in healthcare.
This candidate will be responsible for clinically auditing hospital claims and ensuring accuracy by performing a line by line review of appropriate medical records, operative reports, labs, implant information, etc. Candidate will communicate directly with medical providers nationwide to ensure medical claims payment accuracy. Candidate will use web based tools and in house systems to effective analyze data.
QUALIFICATIONS
- LPN or RN License Required
- Excellant verbal and written communication skills
- Good organizational skills
- Ability to work in a fast paced environment
Please apply for position by e-mailing resume to .(JavaScript must be enabled to view this email address). Please visit our website at www.phx-online.com.
Premier Healthcare Exchange (PHX) was recently recognized as one of 2009 Fifty Fastest Growing Companies, by NJBIZ, New Jersey’s leading statewide business news publication. PHX offers a competitive wage, benefits package, plus the opportunity for career development as the company continues to grow.
Posted June 17, 2010
News
AAMAS
10200 W 44th Avenue
Suite 304
Wheat Ridge, CO 80033
720-881-6045
Fax: 303-422-8894
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