Recognizing incomplete or incorrect documentation and initiating physician queries. Utilizing computerized encoder and/or other reference guides online. Skills and Requirements Include: 2+ years working as a medical coder. Successful completion in a program with AHIMA or AAPC approval status.
5+ years recent experience in Managed Care in a regional or national health plan. 5+ years of experience leading large clinical projects and programs. 5+ years of experience as clinical program manager. Demonstrated ability to collaborate with senior physician and executive leaders.
Collaborating with Primary Care Physicians and other ancillary healthcare providers. Collecting member medical information from a variety of sources. Qualifications Include: Attend and participate required meetings, including staff meetings, internal Rounds, and other in-services.
Must be able to: Transcribe, edit, and interpret dictation by physicians and clinicians. Provide timely release of medical information to the EMR. Assist manager/director with mentoring/training of new team members. Skills and Requirements Include:
Providing care coordination/case management through physician practices for members. Conducting telephonic member needs assessments according to state and national guidelines. Reviewing member charts prior to a physician appointment and create alerts/triggers to highlight Star opportunities.
At least 2 years of physician or healthcare sourcing/recruiting experience. Ability to demonstrate experience with various sourcing tools and technologies. 2 years of experience meeting or exceeding defined metrics.
5 years of experience in healthcare INCLUDING. 3 years in physician practice coding, documentation, billing, and/or reimbursement. Proficient in Microsoft Office, including Word and Excel. Knowledge of federal/state regulations and guidelines and other standards outlined by company.
Knowledge of physician practice processes and workflows required. Excellent analysis and collaboration skills are critical to the success of this position. Demonstrated ability to work effectively with employees and customers at all levels.
A company providing night triage services to physicians has a current position open for a Virtual Pediatric Telephone Triage Registered Nurse. Individual must be able to fulfill the following responsibilities: Engage in clinical triage activities. Other duties as assigned.