Documentation Education Specialist IV - Remote must live in Washington or Idaho Kaiser PermanenteDocumentation Education Specialist IV - Remote must live in Washington or IdahoRenton, WARemoteContributes to coding quality audits by: conducting special projects, audits, reviews, and/or monitoring of assigned lines of business or scope independently to monitor the accuracy and quality of coding and documentation; using processes to assess accuracy and completeness of coded documentation integrity; and following guidelines and procedures to ensure special projects, audits, reviews, and/or monitoring align with state and federal regulatory and reimbursement requirements, current documentation, and coding guidelines, and guiding team members to do the same. Contributes to enhancing coding integrity by: assisting with the identification of coding/documentation trends and opportunities; leveraging expert knowledge to aid teams in their assigned lines of business or scope in developing, implementing, and monitoring new processes and workflows that support regulatory needs and requirements, organizational goals, and business objectives; and leading the process of communicating up-to-date and accurate regulation, policy, and guideline changes impacting coding and documentation to all impacted employees.
Director Clinical Operations and Medical Policy Cambia Health Solutions IncDirector Clinical Operations and Medical PolicyRenton, WADemonstrated knowledge of the following: Health Plan and benefit design structures and application; Medicare/CMS regulations and applicability in administering the Medicare Product; Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; Knowledge of health care coding and payment systems (such as ICD-10, CPT, HCPCS, NDC); Compliance related activities, legislative and regulatory activities, health insurance operations, or legal research helpful; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA. These activities include services pertaining to: evidence reviews of medications, formulary development, Pharmacy and Therapeutics (P&T) Committee support, medication use policy development, the Medication Policy Group (MPG), clinical prior authorization, implementation of utilization management activities, guidance for clinical edit coding for prescription claims processor or medical claims system, medication pipeline monitoring, medication trend management, and consultation and guidance on medication-related issues.
Accounts Receivable Specialist United Wound HealingAccounts Receivable SpecialistTacoma, WARemote$24–$27.25 / hourClaims Knowledge:Strong ability to read and understand EOBs; deep understanding of insurance denials and unresolved claims resolution; knowledge of ICD-10, CPT, HCPCS, and CMS-1500 claim format. Soft Skills: Critical thinker with strong problem-solving skills; high attention to detail; excellent organization and time management; ability to prioritize and manage time-sensitive situations with urgency.
NewData Science and Informatics Specialist 2 (DSIS2/SPI) State of WashingtonData Science and Informatics Specialist 2 (DSIS2/SPI)Olympia, WA$95,676–$128,688 / yearAbout the division: The DATA (Data Acquisition, Transformation and Analytics) section of the Health Care Authority (HCA), within the Strategy, Policy, and Innovation (SPI) division, is responsible for leading agency data strategy; and leading the implementation, maintenance, and enhancement of the data management, analytics and reporting systems that inform agency leadership in support of HCA's goals, as well as for monitoring program performance to ensure accountability and alignment with agency activities. Required qualifications: Qualifying candidates will meet one of the following criteria options: Option 1: Masters degree in informatics, data science, mathematics, computer science, statistics, biostatistics, epidemiology, or related technical or quantitative field.
NewData Science and Informatics Specialist 3 (DSIS3/SPI) State of WashingtonData Science and Informatics Specialist 3 (DSIS3/SPI)Olympia, WA$105,612–$142,020 / yearAbout the division: The DATA (Data Acquisition, Transformation and Analytics) team of the Health Care Authority, within the Strategy, Policy, and Innovation (SPI) division, is responsible for leading agency data strategy; and leading the implementation, maintenance, and enhancement of the data management, analytics and reporting systems that inform agency leadership in support of HCA's goals, as well as for monitoring program performance to ensure accountability and alignment with agency activities. This supervisory position will be responsible for ensuring HCA compliance with SAMSHA block grant reporting requirements, including submissions of the Treatment Episode Dataset (TEDS), Uniform Reporting System-National Outcome Measures (URS-NOM), URS Client-Level Data (URS-CLD), Inventory of Treatment Facilities (I-TF) and State Opioid Response prevention reports.
Medical AR Specialist - Insurance Follow-Up & Denials Olympic Sports & Spine RehabilitationMedical AR Specialist - Insurance Follow-Up & DenialsTacoma, WAThis position works closely with insurance carriers, patients, and internal departments to resolve account issues, manage appeals, research denials, and maintain accurate account documentation. The Medical Accounts Receivable (AR) Specialist performs insurance follow-up and collections activities to ensure claims are processed accurately and reimbursed in a timely manner.
Primary Care Physician (Internal Medicine or Family Medicine) — Tacoma, Washington Prosperity Placement SolutionsPrimary Care Physician (Internal Medicine or Family Medicine) — Tacoma, WashingtonTacoma, WAProviders are supported by an interdisciplinary care team, including an onsite Health Coach, allowing physicians to focus on delivering comprehensive, whole-person care rather than high-volume patient visits. Located along the shores of Puget Sound, Tacoma provides easy access to Seattle, Mount Rainier National Park, hiking, skiing, waterfront living, and a vibrant arts and dining scene.
Primary Care Nurse Practitioner - Outpatient - Tacoma, WA Prosperity Placement SolutionsPrimary Care Nurse Practitioner - Outpatient - Tacoma, WATacoma, WAProviders are supported by an interdisciplinary care team, including an onsite Health Coach , allowing NPs to focus on delivering comprehensive, whole-person care rather than high-volume patient visits. Located along the shores of Puget Sound, Tacoma provides easy access to Seattle, Mount Rainier National Park, hiking, skiing, waterfront living, and a vibrant arts and dining scene.
Financial Advocacy Associate Valley Medical CenterFinancial Advocacy AssociateRenton, WAJOB OVERVIEW: This position is responsible to provide financial advocacy for patients and Valley Medical Center by exploring payer sources as well as payment options to ensure accounts are financially secure prior to rending services. Ability to research billing questions using EMR and billing systems, payer resources and is able to resolve or refer the customer to the appropriate resource.
Revenue Assurance Specialist IV - CDM and Epic experience needed Kaiser PermanenteRevenue Assurance Specialist IV - CDM and Epic experience neededRenton, WAPerforms routine review and maintenance of system codes by: performing a regular review (e.g., quarterly, annually) of coding records to ensure codes are updated, compliant, and accurately reflect policy and regulatory changes; conducting pre- and post-implementation assessments of automated and manual charge capture for quality and accuracy; analyzing moderately complex billing issues related to charges/codes and proposing and implementing action plans to resolve charge capture issues; and contributing to the maintenance of all Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS) codes, descriptions, revenue codes, Relative Value Units (RVU) information, and generic codes to assist in the understanding of fee schedule implications. Executes monitoring activities and process improvements by: independently performing tasks that support monitoring activities of the region(s) documentation, charge capture, coding, billing, and/or compliance activities; recording findings in accordance with relevant policies/procedures to ensure complete and consistent data integrity, partnering with other departments to resolve moderately complex deficiencies and/or compliance issues identified through monitoring activities; communicating results of monitoring activities to senior team members and/or department leaders; and implementing corrective action plans resulting from monitoring activities.
Clinical Investigator Behavioral Health Centene Corporation GroupClinical Investigator Behavioral HealthWA$56,200–$101,000 / yearPosition requires the associate to verify authorization for services and written documentation of services provided against claim information, ensure the appropriateness and accuracy of diagnosis and procedure codes supporting such claims, coordinate medical necessity and appropriate level of care determinations with Medical Directors, and validate services against CMS and State-specific coverage, limitations and exclusion guidelines. 3+ years of providing direct Psychotherapy or Inpatient group therapy within inpatient psychiatric hospitals or units, residential treatment centers, substance abuse rehabilitation facilities, military or veteran hospitals.
NewSenior Data Scientist - Clinical Informatics (Analytics Enablement) CVS Health CorpSenior Data Scientist - Clinical Informatics (Analytics Enablement)WA$83,430–$222,480 / yearExperience designing patient-centric data models, feature stores, and dashboards that aggregate longitudinal data across sources, including demographics, encounters, conditions, medications, labs, utilization, cost, and enrichment attributes. A&BC leverages advanced analytics, clinical informatics, and hypothesis-driven approaches to transform data into actionable, customer-centric insights that drive growth, improve health outcomes, and expand access to healthcare across all CVS Health businesses.
Medical Director - ENT CVS Health CorpMedical Director - ENTWA$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.
NewMedical Director - Spine CVS Health CorpMedical Director - SpineWA$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. Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise, using multiple computer based applications.
Medical Director - Radiation Oncology - MD or DO CVS Health CorpMedical Director - Radiation Oncology - MD or DOWA$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.
CT Tech - Flexible Hours + Multiple Day Shifts Available TRA Medical ImagingCT Tech - Flexible Hours + Multiple Day Shifts AvailableTacoma, WashingtonAccurately compiles all patient information to include reconfirms patient identification and verifies the procedure requested; verifies the patient’s pregnancy status when appropriate; determines whether the patient has been appropriately prepared for the procedure and assesses factors that may contraindicate the procedure, such as medications, insufficient patient preparation or artifacts. Understands patient flow of the department, can perform patient scheduling when required, understands the functions of coding and charging of examinations, files examinations properly.
CT Technologist - Float TRA Medical ImagingCT Technologist - FloatTacoma, WA$33.68–$57.26 / hourAccurately compiles all patient information to include reconfirms patient identification and verifies the procedure requested; verifies the patient's pregnancy status when appropriate; determines whether the patient has been appropriately prepared for the procedure and assesses factors that may contraindicate the procedure, such as medications, insufficient patient preparation or artifacts. Understands patient flow of the department, can perform patient scheduling when required, understands the functions of coding and charging of examinations, files examinations properly.
CT Technologist - Resident TRA Medical ImagingCT Technologist - ResidentTacoma, WA$34.13–$58.02 / hourAccurately compiles all patient information to include reconfirms patient identification and verifies the procedure requested; verifies the patients pregnancy status when appropriate; determines whether the patient has been appropriately prepared for the procedure and assesses factors that may contraindicate the procedure, such as medications, insufficient patient preparation or artifacts. Administers contrast agents as directed, monitors patients physical condition during the procedure, monitors patient for reaction to contrast material, and uses appropriate radiation safety devices.
Resident CT Technologist TRA Medical ImagingResident CT TechnologistTacoma, WashingtonAccurately compiles all patient information to include reconfirms patient identification and verifies the procedure requested; verifies the patient’s pregnancy status when appropriate; determines whether the patient has been appropriately prepared for the procedure and assesses factors that may contraindicate the procedure, such as medications, insufficient patient preparation or artifacts. Understands patient flow of the department, can perform patient scheduling when required, understands the functions of coding and charging of examinations, files examinations properly.
ProviderOne Interface Analyst (ITBA-J/AHA) State of WashingtonProviderOne Interface Analyst (ITBA-J/AHA)Olympia, WA$85,800–$115,416 / yearThis includes a working knowledge of ACES eligibility categories, strong analytic skills and the ability to assess, interpret and report on data elements related to eligibility; Knowledge of the other WA state agency systems (CARE, BARCODE, ACES, WHALES, JBRS) that interact with ProviderOne to assist with troubleshooting and/or testing of the interfaces that are used to update ProviderOne client data. The required experience includes one or a combination of: Progressive (continuing to grow professionally) professional IT experience in: Consulting, analyzing, designing, programming, installing, and/or maintaining computer software applications, hardware, telecommunications, or network infrastructure equipment; Directing projects.