Case Manager (LCSW) TriWest Healthcare AllianceCase Manager (LCSW)Phoenix, AZRemoteFull timeFunctions as an advocate for the beneficiary by ensuring access to necessary care and maintaining Beneficiary's safety, locating specialized services outside the network by identifying providers, exploring nature of services offered, and facilitating process. Independent Thinking / Self-Initiative: Resourceful critical thinker who is able to prioritize tasks essential to achieving desires outcomes, demonstration a proactive commitment to task completion and the ability to identify and secure necessary resources.
Utilization Clinical Reviewer TriWest Healthcare AllianceUtilization Clinical ReviewerPhoenix, AZRemoteFull timeApplies clinical knowledge to make determinations for preauthorization, inpatient and continued stay reviews for Behavioral Health and Medical/Surgical requests to establish medical necessity, benefit coverage, appropriateness of quality of care, and length of stay or care plan. The Utilization Management Clinical Review nurse reviews and makes decisions about the appropriateness and level of beneficiary care being provided in an effort to provide cost effective care and ensure proper utilization of resources.
HCC Coder II Arizona Priority CareHCC Coder IIChandler, Arizona$28–$32 / hourThe HCC Coder II is a highly organized, team-oriented individual who possesses the ability to quickly understand and carry out verbal and written directions and can efficiently multi-task and work on special projects in addition to regular review of outpatient and inpatient charts. Perform a comprehensive review of outpatient and inpatient charts for documentation consistency and adequacy to identify all appropriate coding based on Centers for Medicare & Medicaid Services (CMS) HCC categories.
Center Admin- Center Administrator ArchWell HealthCenter Admin- Center AdministratorMesa, AZEducation and Experience: Bachelor's degree in Healthcare Administration, Business Administration, or a closely related discipline preferredA minimum of 5 years of related work experience in a medical clinic, hospital, or hospitality setting requiredA minimum of 3 years supervisory/managerial experience in a medical clinic, hospital setting, or similarly regulated environment requiredExperience with ECW is strongly preferredA passion for mentorship and team-development, particularly across multiple functional areasA problem-solving orientation and eagerness to identify process gaps and implement practical solutions in a matrixed organizationProficient PC skillsFluency in Spanish or other languages spoken by people in the communities we serve (where necessary). In partnership with the Market Operations Director, gather appropriate team and member information to build a best-in-class customer service experience with demonstrated continuous improvement to member satisfaction scoresEnsure all systems are running efficiently, including scheduling and billing; continuously monitors administrative team to provide feedback and coaching in use of systemsCreate a positive and productive work environment to attract and retain staff, providers and membersOversight for all compliance, including physician documentation and coding audit program, member and staff safety regulations, and HIPAA guidelines for member/employee confidentiality.
Senior Pharmacovigilance Physician (Remote - US) MMSSenior Pharmacovigilance Physician (Remote - US)Phoenix, AZRemoteProficient in safety analysis process used to identify potential new safety signal, aggregate report authoring and experience reviewing cumulative safety data with ability to interpret, synthesize and communicate complex clinical information (e.g., DSURs, PADER, PBRER). Senior Physician independently manages more complex medical-review assignments, provides more comprehensive medical judgment on safety issues, leads client discussions on medical topics, and serves as a medical subject-matter expert for other reviewers.
NewDedicated Claims Auditor Redirect HealthDedicated Claims AuditorPhoenix, ArizonaThis is an opportunity to make a direct impact, examine and improve workflows, and support the Claims Management team in sustaining our vision of 0% Error Rates —all while helping people access the care they need. We’re looking for someone who: Experience: 2+ years in a dedicated claims and/or auditing role, preferably in healthcare or customer service.
Revenue Cycle Trainer American Vision PartnersRevenue Cycle TrainerPHOENIX, ArizonaFull timeOur practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. Keeps up-to-date on the following knowledge areas: Revenue Cycle workflows, revenue cycle software system upgrades and enhancements, clinic department operations, medicare regulations and commercial billing guidelines, adult education theory and technologies, and NextGen systems patient access and revenue cycle systems.
Center Admin- Center Administrator ArchWell Health LLCCenter Admin- Center AdministratorMesa, AZThe Center Administrator will be responsible for practice profitability, revenue goals and other metrics including clinical quality of care, member satisfaction, staff satisfaction, productivity, revenue enhancement, managed care performance, and staff leadership. Develop and maintain positive relationships with healthcare partners, community organizations, senior‑service agencies, and marketing collaborators to support membership growth and reputation.
Medical Director - ENT CVS Health CorpMedical Director - ENTAZ$174,070–$374,920 / yearLeads all aspects of utilization review/quality assurance, directing case management Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Healthcare Claim Processor Qualfon, Inc.Healthcare Claim ProcessorPhoenix, AZOur mission is to help as many people as possible pursue their total vocation - as individuals and as members of society by creating an ever-growing number of job opportunities as we strive to become the partner of choice for our clients. What You'll Do: As a Medi-Cal Claims Examiner, you will be responsible for reviewing, processing, and adjudicating suspended healthcare claims to ensure accurate and timely payment.
Senior Post-Market Pharmacovigilance Specialist (Remote) MMSSenior Post-Market Pharmacovigilance Specialist (Remote)Phoenix, AZRemoteWith a global footprint across four continents, MMS not only maintains an industry-leading customer satisfaction rating but also fosters a collaborative and inclusive work environment where employees can thrive. We support the pharmaceutical, biotech, and medical device industries with our proven scientific approach to complex trial data and regulatory submission challenges.
Quality Assurance Auditor Wollborg Michelson RecruitingQuality Assurance AuditorPhoenix, AZOne of the following certifications: Certified Coding Specialist Physician Based (CCS-P), Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), or Certified Outpatient Coding (COC). Review medical records, abstract codes to the highest supported specificity, validate qualifying face-to-face encounters, and audit supplemental HCC data submissions.
Medical Scribe Virtual TeammateMedical ScribeGlendale, ArizonaRemoteIn this role, you will assist physicians and medical professionals by documenting patient encounters, ensuring accurate medical records, and enhancing overall workflow efficiency. Collaborate with healthcare providers to ensure proper documentation of diagnoses, lab results, medications, and procedures.
Medical Director - Radiation Oncology - MD or DO CVS Health CorpMedical Director - Radiation Oncology - MD or DOAZ$174,070–$374,920 / yearThe Radiation Oncology Medical Director supports the CVS Health Specialty oncology business in managing oncology specific utilization of providers, clinical reviews of oncology specific data, and assist with growing our oncology footprint. In the Medical Director role, you will provide oversight for medical policy implementation; you will support the ensuring timely and consistent responses to members and providers; you will focus on prior authorization cases and consultation cases.
Dental Biller Virtual TeammateDental BillerGlendale, ArizonaStrong knowledge of dental billing and coding, including ICD-10, CDT, and HCPCS codes. Strong problem-solving skills for resolving claim issues and payment discrepancies.
Insurance Follow Up/ Medical Biller Healthcare Outcomes Performance CompanyInsurance Follow Up/ Medical BillerPhoenix, ArizonaThe Center for Orthopedic Research and Education, We don't mean to brag but did you know The CORE Institute has been ranked by Ranking Arizona: The Best of Arizona Businesses!?. Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working relationships with both internal and external customers.
Medical Biller/Insurance follow up- Full time Healthcare Outcomes Performance CompanyMedical Biller/Insurance follow up- Full timePhoenix, ArizonaThe Center for Orthopedic Research and Education, We don't mean to brag but did you know The CORE Institute has been ranked by Ranking Arizona: The Best of Arizona Businesses!?. Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working relationships with both internal and external customers.
HIM Coder III Tucson Medical CenterHIM Coder IIIPhoenix, AZLICENSURE OR CERTIFICATION: Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS), or Certified Coding Specialist-Physician-based (CCS-P), or Certified Professional Coder (CPC), or Certified Inpatient Coder (CIC) or Certified Outpatient Coder (COC). SUMMARY: Provides timely and accurate administrative and clinical data through the accurate assignment of current ICD-10-CM/PCS, CPT or HCPCS codes while complying with the regulations and requirements of the Federal Government, State licensing agencies and the Hospital's policies and procedures.
Associate Operations Director CenterWellAssociate Operations DirectorMesa, ArizonaRepresent CenterWell/Conviva brands in community and media activities while collaborating with the recruitment team to build and network a pipeline of high-quality primary care clinicians (physicians, APPs, MAs, and other clinical professionals)Clinical/Patient Experience: Experienced in managing outpatient care teams to maintain high patient satisfaction and strong brand in the community. The AOD develops and implements staffing plans, oversees change, ensures adherence to policies, and procedures, and collaborates with their clinical dyad partner to achieve optimal patient outcomes and company initiatives, including Quality, HEDIS/STARs, AHCA, optimal patient scheduling, financial management, patient engagement, recruiting/hiring, and employee and patient retention.
Insurance Follow Up/ Medical Biller The Center for Orthopedic and Research EInsurance Follow Up/ Medical BillerPhoenix, AZPart timeThe Center for Orthopedic Research and Education, We don't mean to brag but did you know The CORE Institute has been ranked by Ranking Arizona: The Best of Arizona Businesses!?. Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working relationships with both internal and external customers.