Blue Cross and Blue Shield AssociationMedical Policy & Coding Support Coordinator (CPC/CPC-A preferred) Blue Cross and Blue Shield AssociationMedical Policy & Coding Support Coordinator (CPC/CPC-A preferred)Sioux Falls, SDRemotePerform monthly medical policy coding analyses and SAP BusinessObjects reports to identify and recommend necessary changes based on comparison to BCBSA reference medical policies, sentinel commercial health plan benchmarks and utilization patterns and implementation of claim system edits to support its intent. Support Medical Policy Team's operations, including creating and managing monthly Medical Policy production timelines, quarterly production timeline for N/R/D Code processing, maintaining Medical Policy material distribution lists, and filing external appeals.
Blue Cross and Blue Shield AssociationHealth Services Coding Analyst (CPC Required) Blue Cross and Blue Shield AssociationHealth Services Coding Analyst (CPC Required)Sioux Falls, SDRemoteWork directly with Health Services leadership, Medical Review staff, leadership within Claims and Customer/Provider Services and Network Engagement, Medical Directors to provide medical coding expertise and PGE rule knowledge to resolve complex claims and/or customer and provider issues. Contribute to the achievement of corporate and UM Product Team objectives by independently serving as primary points of contact and UM Product Team Subject Matter Expert/Guest Star to provide expertise to support the various claims processing systems, including but not limited to PGE rules and table maintenance (FACETS and STAR).
Black Hills Regional EYE Institute Llp.Senior Medical Billing Specialist Black Hills Regional EYE Institute Llp.Senior Medical Billing SpecialistRapid City, SDStrong ability to problem solve using multiple means such as office training manuals, internal e-mail guidelines, payer websites, internet search features etc. In addition to you will also be working with patients regarding outstanding bills, and handling incoming patient and insurance calls, and assisting with billing discrepancy/issues.
CVS Health CorpClaim Benefit Specialist CVS Health CorpClaim Benefit SpecialistWork At Home, SD$17–$28.46 / hourAnalyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department. Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing.
Ceribell, IncNewSenior Manager, Reimbursement - Central (remote) Ceribell, IncSenior Manager, Reimbursement - Central (remote)North Sioux City, SDRemote$184,000–$210,000 / yearThe Ceribell System is a novel, point-of-care electroencephalography ("EEG") platform specifically designed to address the unmet needs of patients in the acute care setting, and is being used in hundreds of community hospitals, large academic facilities and major IDN's across the country. Data Analysis and Reporting: Utilize reimbursement data, claims data, and other relevant sources to perform data analysis and generate reports on reimbursement trends, payment patterns, and financial outcomes.
Ophthalmology LTDMedical Coder Ophthalmology LTDMedical CoderSioux Falls, SDOphthalmology LTD delivers treatment for cataracts, glaucoma, and diabetic eye disease, as well as cornea transplants, oculoplastic surgery, retina surgery, vitreoretinal surgery, and pediatric eye care in Sioux Falls. Minimum of 2 years of medical coding experience in a physician office setting or equivalent with knowledge of various medical payer practices and insurance laws/guidelines (Medicare, Medicaid, Work Comp, VA, and other third-party payers).
Ceribell IncSenior Manager, Reimbursement - Central remote Ceribell IncSenior Manager, Reimbursement - Central remoteSDRemote$184,000–$210,000 / yearThe Ceribell System is a novel, point-of-care electroencephalography ("EEG") platform specifically designed to address the unmet needs of patients in the acute care setting, and is being used in hundreds of community hospitals, large academic facilities and major IDN's across the country. Data Analysis and Reporting: Utilize reimbursement data, claims data, and other relevant sources to perform data analysis and generate reports on reimbursement trends, payment patterns, and financial outcomes.
US Department of Health and Human ServicesNewMedical Records Technician (Coder) US Department of Health and Human ServicesMedical Records Technician (Coder)Pine Ridge, SD$50,460–$72,644 / yearRequired as applicable for the purposes of specific eligibility and appointment claim(s), and position requirements: Indian Preference Applicants: If claiming Indian preference, applicants must provide a completed copy of the Form BIA-4432, "Verification of Indian Preference for Employment in the BIA and IHS Only." Refer to BIA-4432 link: Verification of Indian Preference for Employment in the BIA and IHS When an Indian Preference candidate possesses Veterans preference the rules regarding Veterans preference apply under ESEP and the applicant must provide documentation in order to receive preference.
AveraCoder III - Outpatient AveraCoder III - OutpatientSioux Falls, South DakotaAssist staff with denials management, including the processing of edits, serving as a subject matter expert, or helping to provide input for medical necessity and other related appeals using appropriate coding guideline references. Responsible for the timely and accurate assignment of diagnostic and procedural codes for most types of outpatient charts for multiple facilities within Avera Health, with a focus on the more complex and high-dollar cases.
Monument Health.Coder III Monument Health.Coder IIIrapid city, SD$24.19–$30.24 / hourAccurately and efficiently codes and abstracts comprehensive acute care inpatient, rehabilitation inpatient, outpatient surgery, swing bed, long term care, ancillary services and short stay observation patient records according to official coding guidelines for accurate coding and benchmarks for productivity. Certifications - Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA); Certified Professional Coder - Apprentice (CPC-A) - American Academy of Professional Coders (AAPC); Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA); Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA).
Monument Health Rapid City HospitalCoder III Monument Health Rapid City HospitalCoder IIIRapid City, South DakotaAccurately and efficiently codes and abstracts comprehensive acute care inpatient, rehabilitation inpatient, outpatient surgery, swing bed, long term care, ancillary services and short stay observation patient records according to official coding guidelines for accurate coding and benchmarks for productivity. Certifications - Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA); Certified Professional Coder - Apprentice (CPC-A) - American Academy of Professional Coders (AAPC); Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA); Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA).
TriWest Healthcare AllianceClaims Recoup & Collect Anlyst TriWest Healthcare AllianceClaims Recoup & Collect AnlystSioux Falls, SDRemoteFull timeUnder limited supervision, manages and performs claims department activities related to recoupments and collections, including validation of recoupment setup, conducting collections calls with providers, establishing payment arrangements, tracking and trending outstanding recoupments, establishing payment arrangements, and coordinating collections activities with other departments. Proficient with claim and coding tools such as Supercoder, Clinical Decision Support Tool, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding.
AveraNewCoder II - Inpatient AveraCoder II - InpatientSioux Falls, South DakotaIP Coder II is distinguished by specific services lines which could include but not limited to the following: Surgery, NICU/PICU, Cardiovascular, Women’s Health, OB, Nursery, Behavioral Health, Orthopedics, Inpatient Rehabilitation and others as appropriate. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
Akicita FederalCertified Medical Assistant (CMA) – Regional Drug Dependency Unit Akicita FederalCertified Medical Assistant (CMA) – Regional Drug Dependency UnitBrookings, South Dakota$50,000–$65,000 / yearKey ResponsibilitiesClinical Support-Prepare patients for examinations, treatments, and procedures, ensuring comfort and safety.-Obtain and document vital signs, height, weight, and other patient data.-Assist licensed staff with specimen collection.-Administer medications as delegated by the supervising provider and within scope of practice.-Monitor and report changes in patient condition to the supervising nurse.-Reinforce program education, policies and treatment plan that fosters a supportive experience to achieve individualized treatment goalsAdministrative Duties-Maintain accurate and timely documentation in patient medical records and electronic health systems.-Schedule appointments, coordinate referrals, and assist with patient intake and discharge processes.-Manage inventory of clinical supplies, ensuring proper storage and availability.-Support compliance with billing and coding requirements for medical services provided. Patient Education and Support-Provide patient education on prescribed treatments, medications, and recovery plans as directed by the provider.-Offer emotional support and encouragement, helping patients engage in their recovery process.-Demonstrate cultural sensitivity and awareness when working with patients from diverse backgrounds, particularly Native American communities.
United Surgical Partners InternationalBilling Assistant United Surgical Partners InternationalBilling AssistantSioux Falls, SDPrint all paper claims from Vision/AdvantX, review claims for accuracy including modifiers, payers, claims addresses, and additional pertinent information included. Gather all supporting documentation such as operative notes, block reports, implant logs, etc. which MUST be attached with mailed claims.
TriWest Healthcare AllianceSupervisor, Claims Admin TriWest Healthcare AllianceSupervisor, Claims AdminSioux Falls, SDRemoteFull timeThe Supervisor, Claims Administration interacts and collaborates frequently with beneficiaries, Veterans, providers, sub-contractors, the Government, and internal business partners to resolve issues, respond to inquiries, and improve processes. Organizational Skills: Ability to organize people or tasks, adjusts to priorities, learns systems within time constraints and with available resources; detail-oriented.
AveraConfiguration Analyst AveraConfiguration AnalystSioux Falls, South DakotaRequirement Analysis: Uses experience and judgement to plan and accomplish goals; performs a variety of complicated tasks to ensure that the core claims system is configured correctly by reviewing the system components and validating that the configuration aligns to legal plan documents and regulatory requirements. Converting benefit plan requirements into system configurations, collaborating with other analysts and business leaders, ensuring data accuracy, customizing settings to support payer-provider relationships and supporting the system's ongoing performance.
CVS Health CorpNewFraud Waste and Abuse - Sr. Analyst CVS Health CorpFraud Waste and Abuse - Sr. AnalystWork At Home, SD$46,988–$112,200 / yearActivities include reviewing billing activity for state agency referrals, assisting in the investigation and triage of FWA complaints, coordination with other departments and assist in prevention activities including training of internal staff and internal departments. Analyst, Fraud, Waste, and Abuse (FWA) will assist in detecting, investigating, remediating and referring to state regulatory agencies incidents of FWA arising in connection with medical, behavioral, transportation, and other healthcare services.
Sanford HealthNewClinical Quality Specialist - Canton Medical Center - Part Time Sanford HealthClinical Quality Specialist - Canton Medical Center - Part TimeCanton, SD$24–$38.50 / hourGraduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state.
Avera HealthHealth Plan Configuration Analyst Avera HealthHealth Plan Configuration AnalystSioux Falls, SD$49,920–$75,920 / yearConverting benefit plan requirements into system configurations, collaborating with other analysts and business leaders, ensuring data accuracy, customizing settings to support payer-provider relationships and supporting the systems ongoing performance. Requirement Analysis: • Uses experience and judgement to plan and accomplish goals; performs a variety of complicated tasks to ensure that the core claims system is configured correctly by reviewing the system components and validating that the configuration aligns to legal plan documents and regulatory requirements.
TriWest Healthcare AllianceClaims Reviewer TriWest Healthcare AllianceClaims ReviewerSioux Falls, SDRemoteFull timeProficient with claim and coding tools and resources, Clinical Decision Support Tool, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding. Provides clinical and coding-related information to medical director, providers, peer reviewers, Claims Administration, Program Integrity, Quality Management, and/or the Claims Subcontractor as needed.
TriWest Healthcare AllianceSr Claims Reviewer TriWest Healthcare AllianceSr Claims ReviewerSioux Falls, SDRemoteFull timeProficient with claim and coding tools such as Supercoder, Clinical Decision Support Tool, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding. This role will serve as a SME and will collaborate with Claims leadership, Training, the Claims Content Specialist, and internal business partners to ensure procedures and training materials are accurate and complete.
TriWest Healthcare AllianceUtilization Clinical Reviewer TriWest Healthcare AllianceUtilization Clinical ReviewerSioux Falls, SDRemoteFull 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.
Intermountain Health IncCT Tech PRN Intermountain Health IncCT Tech PRNplatte, SD$35.25–$54.39 / hourWe care about your well-being \u2013 mind, body, and spirit \u2013 which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. As an CT Technologist at Intermountain Health, you will play a vital role in supporting our clinical team, ensuring our patients receive the best care by: Maintains ARRT competency in all clinical and technical functions of the job.
Sun Dial ManorMDS Nurse Sun Dial ManorMDS NurseBristol, SDSun Dial Manor is seeking an MDS nurse to conduct and coordinate the development and completion of the Resident Assessment Instrument (RAI), that is, the Minimum Data Set (MDS), Care Area Assessments (CAAs) and Care Plan in accordance with State and Federal requirements. Ability to communicate in English both orally and in writing to complete required nursing department documentation.
CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)SD$46,988–$122,400 / yearAnticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse Required Qualifications 3 years working on health care fraud, waste, and abuse investigatory and audits required.
Sanford HealthMedicare Programs Clinical Lead - SD, ND, NE Sanford HealthMedicare Programs Clinical Lead - SD, ND, NESioux Falls, SD$31–$49.50 / hourGraduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Leads clinical operations of Medicare programs with a primary focus in model of care development and delivery, healthcare effectiveness data and information set (HEDIS), Medicare star rating, Chronic Care Improvement (CCIP) and risk adjustment .
CVS Health CorpInformatics Consultant CVS Health CorpInformatics ConsultantSD$43,888–$102,081 / year1+ year(s) computer skills and knowledge of Microsoft Word, Excel, PowerPoint and Adobe Acrobat Pro experience with reporting platforms such as: Big data analytics, data mining, and Tableau. Become a subject matter expert for Client Management, clients and brokers related to our internal analytics tool and their client's data.
Sterling Computers CorporationFull Stack Developer/Engineer Sterling Computers CorporationFull Stack Developer/EngineerNorth Sioux City, SDRequired Technical Skills: 3-5 years experience in full-stack development with strong working knowledge of React, Node.js, Python, and cloud technology (Google, AWS, Azure). Responsibilities: Design, develop, and maintain full-stack web applications using modern frontend frameworks (React, Angular, or Vue.js) and backend technologies (Node.js,
D.A. Davidson & Co.CRM Lead Engineer D.A. Davidson & Co.CRM Lead EngineerSD$95,000–$110,000 / yearSummary: We are looking for a Microsoft Dynamics 365 (CRM) Senior Software Engineer, experienced in designing and developing Microsoft-based business solutions in cloud environments using Dynamics 365 and Power Platform, to join our rapidly growing team. Highly desirable to have experience in Microsoft Azure Cloud solutions, including possessing a solid understanding of Microsoft Dataverse, Power Apps (Model-driven Apps, Canvas Apps, Power Pages), Power BI, Power Automate, and Data Factory.
Ryder System IncApplication Security Engineer Ryder System IncApplication Security EngineerPierre, SDCompensation Information : The compensation offered to a candidate may be influenced by a variety of factors, including the candidate's relevant experience; education, including relevant degrees or certifications; work location; market data/ranges; internal equity; internal salary ranges; etc. Current Employees : If you are a current employee at Ryder, please click here (http://wd5.myworkday.com/ryder/d/task/1422$3.htmld) to log in to Workday to apply using the internal application process.
CVS Health CorpStaff Software Development Engineer - Fulfillment CVS Health CorpStaff Software Development Engineer - FulfillmentSD$106,605–$284,280 / yearCollaborate closely with engineering, platform, and business teams to deliver cost optimized, scalable solutions-leveraging cloud cost profiling tools, storage tiering strategies, service right sizing, and architectural simplification. Apply advanced software engineering practices across the full SDLC-including domain driven design (DDD), design patterns, secure coding, automated testing strategies (unit, contract, integration), code quality gates, trunk based development, and continuous observability.
CVS Health CorpStaff Development Engineer - Fulfillment CVS Health CorpStaff Development Engineer - FulfillmentSD$106,605–$284,280 / year7+ years of software development in enterprise / web / cloud applications • 5+ years of backend software development experience with programming languages/tools including: Java, Spring Boot, Kafka • 3+ years of distributed caching experience • 3+ years of experience having a track record developing in AWS or GCP or Azure or similar public cloud environments (GCP preferred) • 3+ years of experience in design, development and operationalizing microservices based web/webservices application in cloud native environment • 3+ years of technical lead experience within a matrixed environment, including mentoring junior engineers and working cross collaboratively between architecture, product, etc. • Understand security threats and patterns and ensure adherence to all regulatory initiatives, HIPAA, PHI, PII, locational and contractual data restrictions • Experience with build automation technologies like Maven, Gradle, Jenkins, Harness • Expert knowledge with functional, imperative and object-oriented languages and methodologies • Experience with Cassandra and Postgres - preferred • Experience with test-driven development and automated testing frameworks • Experience with Scrum/Agile development methodologies.
CVS Health CorpStaff Software Development Engineer CVS Health CorpStaff Software Development EngineerSD$106,605–$284,280 / yearFurthermore, the Staff Engineer role includes closely working with a team of engineers to drive delivery excellence, partner with business and other IT leaders to build digital assets, provide expert level support to resolve complex issues and provide RCA, identify gaps in systems in current digital eco system and provide solutions to enhance overall performance. CVS Health Digital is looking for hands-on, passionate people who want to join a high energy and growing team to make a difference in customers' lives and who want to be on the forefront of digital innovation that aims to reinvent what a pharmacy and a health care company can be in the digital world.
MaximusData Conversion Lead MaximusData Conversion LeadSioux Falls, SDFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at applicantaccom@maximus.com.