Travel Ultrasound Tech - $2,495 per week in Golden, CO AequorTravel Ultrasound Tech - $2,495 per week in Golden, COGolden, CO$2,495Required Certifications & Licensure:-Health Services\BCLS - Basic life support (Certification for Healthcare Providers).-Registered Diagnostic Medical Sonographer - Breast Specialty (RDMS (BR)) from American Registry for Diagnostic Medical Sonography (ARDMS). Preferred Certifications & Licensure:-N/A Required Education:-N/A Preferred Education:-N/A Required Certifications & Licensure:-Health Services\BCLS - Basic life support (Certification for Healthcare Providers).
Coord Quality Coding University of Colorado HealthCoord Quality CodingDenver, CO$33.82–$50.73 / hourEmployees have access to free assistance navigating the Public Service Loan Forgiveness program and submitting their federal student loans for forgiveness. Performance bonus: UCHealth offers a 3-Year Incentive Bonus to recognize employee contributions to our success in quality, patient experience, organizational growth, financial goals and tenure.
Coding Outpatient Lead University of Colorado HealthCoding Outpatient LeadDenver, CORemote$25.80–$38.70 / hourEmployees have access to free assistance navigating the Public Service Loan Forgiveness program and submitting their federal student loans for forgiveness. Performance bonus: UCHealth offers a 3-Year Incentive Bonus to recognize employee contributions to our success in quality, patient experience, organizational growth, financial goals and tenure.
Coding Operations Manager American Family Care IncCoding Operations ManagerDenver, CORemote$90,000–$115,000 / yearHeadquartered in Birmingham, Alabama, AFC has grown into the nation's leading provider of accessible healthcare, with more than 400 company-owned and franchised centers across the United States, caring for over 3.5 million patients annually. Today, with more than 400 clinics and 800 in-network physicians caring for over 6 million patients a year, AFC is the nations leading provider of urgent care, accessible primary care, and occupational medicine.
Behavioral Health Medical Coding & Compliance Specialist Community Reach CenterBehavioral Health Medical Coding & Compliance SpecialistWestminster, CO$65,000–$75,000 / yearCreates, communicates and implements templates, systems and processes to ensure clinical documentation at the Center is in accordance with internal policies and procedures, Centers for Medicare and Medicaid Services (CMS), State and Federal regulations, third-party payors, and American Medical Association (AMA) guidelines. Essential Functions: Designs and implements internal compliance audits, regularly monitoring accuracy and adherence to documentation requirements in collaboration with Utilization Manager to support continuous quality improvement and compliance as identified in the Quality Management Plan (QMP).
Revenue Cycle Coder Lead-Inpatient Coding CommonSpirit HealthRevenue Cycle Coder Lead-Inpatient CodingEnglewood, COAs one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs.
IT Consultant IV, Solutions - SNOMED CT, Clinical Coding, Epic, EHR, Informatics Kaiser PermanenteIT Consultant IV, Solutions - SNOMED CT, Clinical Coding, Epic, EHR, InformaticsGreenwood Village, COEssential Responsibilities: Completes work assignments and supports business-specific projects by applying expertise in subject area; supporting the development of work plans to meet business priorities and deadlines; ensuring team follows all procedures and policies; coordinating and assigning resources to accomplish priorities and deadlines; collaborating cross-functionally to make effective business decisions; solving complex problems; escalating high priority issues or risks, as appropriate; and recognizing and capitalizing on improvement opportunities. Ability and/or having the capacity to learn -knowledge representation- logic to create, maintain subsets of clinical records to support reporting, business intelligence in the areas of best practice alerts, population and healthcare management, quality measurements, and health information exchanges.
Medical Coding Specialist - Certified (On-Site) SUNRISE COMMUNITY HEALTHMedical Coding Specialist - Certified (On-Site)Evans, COPosition Summary: With a Quality, Customer First, and Compassionate approach, The Medical Coding Specialist will: Analyze patient charts carefully to know the diagnosis and represent every item with specific codes. The Certified Medical Coding Specialist is responsible for correctly coding healthcare claims to obtain reimbursement from insurance companies and government health care programs.
Epic Resolute Application Developer (Charge Router and Coding Skills) - 6260321 Accenture PlcEpic Resolute Application Developer (Charge Router and Coding Skills) - 6260321Denver, COIn addition to delivering innovative solutions for Accenture's clients, you will work with a highly skilled, diverse network of people across Accenture businesses who are using the latest emerging technologies to address today's biggest business challenges. Dropping orders using chart review-> creating new patient encounter -> dropping an order and signing the order/Unite charge entry ->creating new encounter.
Clinician Coding Liaison - Vascular Advocate Aurora Health IncClinician Coding Liaison - VascularAurora, CORemote$35.50–$53.25 / hourProviding care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise.
Audit and Coding Specialist Community Reach CenterAudit and Coding SpecialistWestminster, CO$65,000–$71,000 / yearCreates, communicates and implements templates, systems and processes to ensure clinical documentation at the Center is in accordance with internal policies and procedures, Centers for Medicare and Medicaid Services (CMS), State and Federal regulations, third-party payors, and American Medical Association (AMA) guidelines. Essential Functions: Designs and implements internal compliance audits, regularly monitoring accuracy and adherence to documentation requirements in collaboration with Utilization Manager to support continuous quality improvement and compliance as identified in the Quality Management Plan (QMP).
Senior Clinical Coding Analyst TriWest Healthcare AllianceSenior Clinical Coding AnalystDenver, CORemoteFull timeIndependent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. Conducts retrospective medical claims review for coding and pricing determinations and/or coding review for inpatient (facility) claims to include diagnosis and procedural coding with DRG assignment.
NewCoding Specialist usebridge.comCoding SpecialistBoulder, ColoradoSkills & Attributes Strong organizational skills, time management, and attention to detail Self-motivated and able to work autonomously, multitask, and shift priorities quickly Sound judgment and reliable follow-through on deadlines Excellent written and verbal communication skills Experience with Candid Health billing software a plus Proficient in CPT, ICD-10, and HCPCS coding systems Strong knowledge of medical terminology, anatomy, and physiology Intermediate knowledge of revenue cycle processes and best practices .
Supervisor Coding, ED University of Colorado HealthSupervisor Coding, EDDenver, CORemote$29.54–$44.31 / hourEmployees have access to free assistance navigating the Public Service Loan Forgiveness program and submitting their federal student loans for forgiveness. Performance bonus: UCHealth offers a 3-Year Incentive Bonus to recognize employee contributions to our success in quality, patient experience, organizational growth, financial goals and tenure.
Managed Services - Revenue Cycle Coding - Senior Manager PricewaterhouseCoopers LLPManaged Services - Revenue Cycle Coding - Senior ManagerCO$124,000–$280,000 / yearPwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy . As a Senior Manager, you will leverage your skills and influence to deliver quality results, motivate and coach teams to solve complex problems, and apply sound judgment to recognize when to take action or escalate issues.
Security Testing Specialist - Code Review/Java, .NET, Python Developer The PNC Financial Services Group IncSecurity Testing Specialist - Code Review/Java, .NET, Python DeveloperLakewood, CO$91,000–$185,900 / yearIn addition, PNC generally provides the following paid time off, depending on your eligibility: maternity and/or parental leave; up to 11 paid holidays each year; 9 occasional absence days each year, unless otherwise required by law; between 15 to 25 vacation days each year, depending on career level; and years of service. Access Control (AC), Application Security, Application Security Code Review, Application Security Testing, Building Architecture, Customer Solutions, Disaster Recovery Planning, Information Security, Network Security, Physical Security, Risk Assessments, Security Technologies, Static Application Security Testing (SAST).
Security Testing Specialist - Code Review/Java, .NET, Python Developer PNC BankSecurity Testing Specialist - Code Review/Java, .NET, Python DeveloperDenver, ColoradoAccess Control (AC), Application Security, Application Security Code Review, Application Security Testing, Building Architecture, Customer Solutions, Disaster Recovery Planning, Information Security, Network Security, Physical Security, Risk Assessments, Security Technologies, Static Application Security Testing (SAST) Competencies . In addition, PNC generally provides the following paid time off, depending on your eligibility: maternity and/or parental leave; up to 11 paid holidays each year; 9 occasional absence days each year, unless otherwise required by law; between 15 to 25 vacation days each year, depending on career level; and years of service.
Energy Code Specialist City of LovelandEnergy Code SpecialistLoveland, CO$85,272.51–$115,118.02 / yearJob Summary: This position coordinates the development, implementation, and ongoing improvement of the City's building energy codes while providing analytical and coordination support to climate-related initiatives. Qualifications: Education: Required: 4 Year/Bachelors Degree in Mechanical Engineering, Construction Management, Environmental Science or related field from an accredited college or university required.
NewProduct Manager - Code Data ZOLL MedicalProduct Manager - Code DataBroomfield, ColoradoRemote$102,900–$128,000 / yearThe Acute Care Technology division of ZOLL Medical Corporation develops and delivers innovative lifesaving products and software solutions to EMS, hospital, public safety, and military customers globally. Coordinate with product managers, market managers, and Product Owners to ensure integration requirements are successfully communicated and implemented.
Paralegal I - Prosecution and Code Enforcement City & County of DenverParalegal I - Prosecution and Code EnforcementDenver, CO$30–$35.62 / hourIts responsibilities include handling city lawsuits, prosecuting ordinance violations, providing victim support in criminal cases, representing the city in investigations and litigation, advising on contractual and transactional matters, offering regulatory and compliance assistance, addressing employment matters for the city's more than 12,000 workers, and providing guidance on local, state, and federal law. Specifically, as the Prosecution Paralegal, you will: Conducts legal and factual research into various cases and/or matters, such as identifying essential witnesses and evidence, interviewing witnesses, memorializing witness statements, and locating needed evidence.
Victim Advocate I - Prosecution and Code Enforcement City & County of DenverVictim Advocate I - Prosecution and Code EnforcementDenver, CO$26.84–$30.20 / hourSpecifically, as the PACE Victim Advocate of City Attorney's Office, you will: Respond to crisis calls, provides information on the criminal justice process: The Victim Advocate candidate will accompany victims to court, assist with obtaining protection orders, answer questions about court cases, offer safety planning, provide referrals to community resources, and staff cases with the prosecutorial team. Its responsibilities include handling city lawsuits, prosecuting ordinance violations, providing victim support in criminal cases, representing the city in investigations and litigation, advising on contractual and transactional matters, offering regulatory and compliance assistance, addressing employment matters for the city's more than 12,000 workers, and providing guidance on local, state, and federal law.
Paralegal I - Prosecution And Code Enforcement City & County of Denver, COParalegal I - Prosecution And Code EnforcementDenver, CO$30–$35.62 / hourIts responsibilities include handling city lawsuits, prosecuting ordinance violations, providing victim support in criminal cases, representing the city in investigations and litigation, advising on contractual and transactional matters, offering regulatory and compliance assistance, addressing employment matters for the city's more than 12,000 workers, and providing guidance on local, state, and federal law. Specifically, as the Prosecution Paralegal, you will: Conducts legal and factual research into various cases and/or matters, such as identifying essential witnesses and evidence, interviewing witnesses, memorializing witness statements, and locating needed evidence.
Victim Advocate I - Prosecution And Code Enforcement City & County of Denver, COVictim Advocate I - Prosecution And Code EnforcementDenver, CO$26.84–$30.20 / hourSpecifically, as the PACE Victim Advocate of City Attorney's Office, you will: Respond to crisis calls, provides information on the criminal justice process: The Victim Advocate candidate will accompany victims to court, assist with obtaining protection orders, answer questions about court cases, offer safety planning, provide referrals to community resources, and staff cases with the prosecutorial team. Its responsibilities include handling city lawsuits, prosecuting ordinance violations, providing victim support in criminal cases, representing the city in investigations and litigation, advising on contractual and transactional matters, offering regulatory and compliance assistance, addressing employment matters for the city's more than 12,000 workers, and providing guidance on local, state, and federal law.
Medical Biller Roth Staffing CompaniesMedical BillerLoveland, Colorado$20–$23 / hourA healthcare services organization specializing in professional and institutional medical billing is seeking an experienced Medical Biller to support charge entry, coding, and billing operations. Support billing activities across medical specialties including radiology, pathology, dermatology, family practice, wound care, and urology.
Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG) Elevance Health IncDiagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)CO$86,560–$155,808 / yearPreferred Skills, Capabilities and Experiences: One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.
Senior Consultant - Clinical Documentation Specialist Deloitte Touche Tohmatsu LtdSenior Consultant - Clinical Documentation SpecialistCO$110,700–$218,300 / yearOther skills include the ability to analyze, act and design action plans upon monthly and quarterly reports related to individual providers, facilities, MS-DRGs, APR, PSIs, severity of illness and risk of mortality, capture rates, quality metrics and can effectively prioritize their work activities. Clinical Payments Optimization: Assisting clients by validating that payments for clinical healthcare services comply with regulatory, clinical based evidence and contractual requirements while also determining that payments are appropriate for the type and level of care provided.
Medical Office Representative Denver Full Time Days AdventHealthMedical Office Representative Denver Full Time DaysLakewood, CO$19.38–$31.01 / hourKnowledge, Skills, and Abilities: Education: Associate and/or higher-level education or completed coursework in health services administration or other related medical or business field. Maintains a working relationship with clinical partners to ensure open communication between clinical, ancillary, and patient access departments, enhancing patient experiences.
Medical Office Representative Full Time Days AdventHealthMedical Office Representative Full Time DaysEnglewood, CO$19.38–$31.01 / hourKnowledge, Skills, and Abilities: Education: Associate and/or higher-level education or completed coursework in health services administration or other related medical or business field. Maintains a working relationship with clinical partners to ensure open communication between clinical, ancillary, and patient access departments, enhancing patient experiences.
Medical Office Representative AdventHealthMedical Office RepresentativeLouisville, CO$19.38–$31.01 / hourKnowledge, Skills, and Abilities: Education: Associate and/or higher-level education or completed coursework in health services administration or other related medical or business field. Maintains a working relationship with clinical partners to ensure open communication between clinical, ancillary, and patient access departments, enhancing patient experiences.
Certified Professional Coder, Special Investigations Unit (Aetna SIU) CVS Health CorpCertified Professional Coder, Special Investigations Unit (Aetna SIU)CO$43,888–$93,574 / yearThe Certified Professional Coder (CPC) will perform medical claim reviews for the Special Investigations Unit (SIU) to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. Uses department resources regularly and follows workflows with minimal assistance or intervention to perform daily work to meet metrics.
Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG) Elevance HealthDiagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)Denver, ColoradoOne or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.
Diagnosis Related Group Clinical Validation Auditor-Rn (Cdi, Ms-Drg, Ap-Drg And Apr-Drg) Elevance HealthDiagnosis Related Group Clinical Validation Auditor-Rn (Cdi, Ms-Drg, Ap-Drg And Apr-Drg)Denver, CO$86,560–$155,808 / yearPreferred Skills, Capabilities and Experiences: One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.
Optometric Technician West Point OpticalOptometric TechnicianBoulder, ColoradoThe position will interact with patients/customers by delivering an exceptional patient/customer experience, foster patient/customer retention, and promotes outstanding associate/doctor satisfaction. An Optometric Office Technician role may combine skills of a medical office administrator, medical billing and collections, appointment scheduler or medical records clerk and direct patient care.
Billing Specialist Boulder Valley Health CenterBilling SpecialistBoulder, ColoradoThe Revenue Cycle Specialist plays a key role in supporting the financial health of the organization while providing clear and compassionate communication to patients regarding billing and payment options Duties and Responsibilities Work collaboratively with internal teams to identify and implement process improvements within the revenue cycle. Founded in 1973, Boulder Valley Health Center (BVHC) is a small outpatient community clinic that has been a leader in providing reproductive and sexual health services, abortion, and education to all people, including those who face barriers to accessing high-quality and equitable healthcare.
NewRevenue Cycle Specialist Stride Community Health CenterRevenue Cycle SpecialistDenver, CO$22–$26 / hourAs one of Colorado's largest Federally qualified healthcare centers (FQHC), we offer comprehensive services-including primary care, dental, pharmacy, behavioral health, health education and outreach services across 13 clinics in the Denver Metro area. Verify validity of account balance by researching, reviewing, and ensuring accuracy or payment and adjustment posting Review and interpret explanation of benefits (EOB) for denials and reimbursement underpayments.
Optometric Technician- $2500 SIGN-ON BONUS Pearle VisionOptometric Technician- $2500 SIGN-ON BONUSBoulder, ColoradoThe position will interact with patients/customers by delivering an exceptional patient/customer experience, foster patient/customer retention, and promotes outstanding associate/doctor satisfaction. An Optometric Office Technician role may combine skills of a medical office administrator, medical billing and collections, appointment scheduler or medical records clerk and direct patient care.
Billing Specialist Infusion Pharmacy / Remote BrightSpring Health ServicesBilling Specialist Infusion Pharmacy / RemoteEnglewood, CORemote$20–$22 / hourThe home infusion market is positioned for rapid growth driven by the aging population, increase in chronic diseases, robust pipeline of infusible drugs coming to market, and an industry shift from hospital delivery settings to lower-cost, high-quality alternative providers such as Amerita. Process confirmed tickets in "unworked" status within 48 hours of confirmation date; assign appropriate status to ensure proper handling by branch and billing personnel; make necessary demographic changes to reduce rejections of submitted electronic and paper claims.
Supervisor, Utilization Management TriWest Healthcare AllianceSupervisor, Utilization ManagementDenver, CORemoteFull timeTechnical Skills: Thorough knowledge of policies and procedures, knowledge of managed care principles and methods; medical terminology; proficiency in the application of clinical criteria: InterQual, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, current Procedural Terminology, and Healthcare Common Procedural Coding System, and American Dental codes; working knowledge with medical management systems; proficient with Microsoft Office; knowledge of UM Process; reporting techniques. • Prepares work schedules and monitors staff caseloads to ensure adequate staffing levels at all times and accurate data entry and application of the medical management system.
Product Security Engineer Candid HealthProduct Security EngineerCO$180,000–$258,000 / yearMedical billing is expensive because it's nuanced and hard - maybe ~100x harder than credit card payment processing - and because it's traditionally done by armies of humans who track and manage complex rules and processes specific to individual insurance companies with little or no supporting software. We're rethinking medical billing from the ground up, building software backed by best-in-class data science (and, soon, a dash of machine learning) to automate much of this complexity so healthcare providers can get paid dramatically more easily and inexpensively.
Palliative Care Nurse Practitioner CompassusPalliative Care Nurse PractitionerDenver, CO$123,260–$139,917 / yearThe Palliative Care Nurse Practitioner provides palliative care for patients facing chronic, complex, and /or life-threatening conditions at various locations within the flow of patient care. Meaningful Work: Make an impact every day by honoring the quality of life of our patients, supporting them and their families with compassion, and creating moments that truly matter.
NewMedical Director - Spine And Brain Surgery - Remote UnitedHealth Group Inc.Medical Director - Spine And Brain Surgery - RemoteDenver, CORemote$248,500–$373,000 / yearTotal cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
NewUM Medical Director - Plastic Surgeon - Remote Anywhere In US UnitedHealth Group Inc.UM Medical Director - Plastic Surgeon - Remote Anywhere In USDenver, CORemote$248,500–$373,000 / yearWe are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes.
NewMedical Director - General Surgery - Remote From Anywhere UnitedHealth Group Inc.Medical Director - General Surgery - Remote From AnywhereDenver, CORemote$248,500–$373,000 / yearWe are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes.
DRG Clinical Validation Lead Elevance Health IncDRG Clinical Validation LeadDenver, CO$89,520–$161,136 / yearPreferred Skills, Capabilities and Experiences: One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. How you will make an impact: Conducts pre-certification, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Senior Medical Assistant- Westminster CO UnitedHealth Group IncSenior Medical Assistant- Westminster COWestminster, COAdministrative Duties Responsible for routine and basic front and back-office duties to include answering phones scheduling and confirming appointments preparing schedules data entry including referral contracts post appointment information prefill document retrieval filing performing data entry and assisting in the examination process of patients under the direction of a physician or other licensed provider. Collaboration and Compliance Partner with Clinical Quality Leadership and other healthcare professionals to ensure compliance with all clinical policies and training programs maintain and enhance quality assurance processes adhere to best practices and clinical guidelines participate in performance improvement initiatives engage in continuous professional development.
Program Integrity Investigator (Healthcare Fraud Waste & Abuse) TriWest Healthcare AllianceProgram Integrity Investigator (Healthcare Fraud Waste & Abuse)Denver, CORemoteFull timeComplies with the Veterans Affairs Community Care Network (CCN) and TRICARE T-5 contracts; DHA and TRICARE program guidelines and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies interfaces directly with Veterans, Military members and family (as warranted), providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters; prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals. The PI Investigator t is responsible for the identification, analysis, case development, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA), the Healthcare Finance Administration (HCFA) and the Department of Defense, Defense Health Agency for the TRICARE program; requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s).
DRG Clinical Validation Lead Elevance HealthDRG Clinical Validation LeadDenver, CO$89,520–$161,136 / yearPreferred Skills, Capabilities and Experiences: One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. How you will make an impact: Conducts pre-certification, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Field Reimbursement Manager (Seattle, Denver or Salt Lake City) Recordati SpAField Reimbursement Manager (Seattle, Denver or Salt Lake City)Denver, CORemoteServe as subject matter experts on issues of coverage, access and reimbursement by providing compliant, limited support to US health care providers (HCPs) and their office staff in navigating the reimbursement landscape for products of Recordati Rare Diseases Inc. (RRD) after the HCP made an independent decision to prescribeCollaborate with HCP staff and Specialty Pharmacy to follow up with accounts that have outstanding prior authorization or appeals submissions. The FRM is responsible for providing access and reimbursement education to healthcare providers (HCPs)and office personnel, including information regarding medical policies, prior authorization requirements, coding and billing, product access via buybill or specialty pharmacy with the goal of minimizing barriers to therapy.
Revenue Cycle Management Lead usebridge.comRevenue Cycle Management LeadBoulder, ColoradoThe Role We're hiring our first RCM Lead to drive strategic improvement across Bridge's highest-leverage revenue cycle opportunities: coding automation, audit rigor, eligibility performance, and claim success for every new service line. Cross-functional RCM strategy: Take on emerging high-priority RCM problems as directed — denial spikes, payer-specific issues, fee schedule anomalies, service line discovery.
Pre-Authorization Specialist University of ColoradoPre-Authorization SpecialistDenver, CO$51,360–$61,632 / yearIf you work, visit, or volunteer in healthcare facilities or clinics operated by our affiliated hospital or clinical partners or by CU Anschutz, you will be required to comply with the vaccination and medical surveillance policies of the facilities or clinics where you work, visit, or volunteer, respectively. Job Summary: The Orthotics Pre-Authorization Specialist is responsible for managing all aspects of Durable Medical Equipment (DME) precertification and preauthorization within the Department of Orthopedics.