Senior Clinical Coding Analyst TriWest Healthcare AllianceSenior Clinical Coding AnalystFargo, NDRemoteFull 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.
Coding Instructor Code NinjasCoding InstructorFargo, North DakotaWe are looking for a Code Sensei (Code Teacher) to join our team of dynamic, energetic, forward-thinking minds, working toward our common goal: providing a fun and safe learning environment for children. Parents are thrilled as their children gain confidence and new skills including coding, math, logic, and problem-solving, as they progress from white to black belt.
Supervisor, Utilization Management TriWest Healthcare AllianceSupervisor, Utilization ManagementFargo, NDRemoteFull 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.
Billing Specialist Anne Carlsen CenterBilling SpecialistFargo, NDRich in tradition, Anne Carlsen has positioned itself on the cutting edge of innovation with unique programs, creative therapies and advanced assistive technologies that meet the specific needs of those we serve. Anne Carlsen Center (Anne Carlsen) is a non-profit organization which has been providing supports and services for 80 years to individuals in North Dakota with developmental disability or delay.
Program Integrity Investigator (Healthcare Fraud Waste & Abuse) TriWest Healthcare AllianceProgram Integrity Investigator (Healthcare Fraud Waste & Abuse)Fargo, NDRemoteFull 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).
Billing Specialist Anne Carlsen Center for ChildrenBilling SpecialistFargo, NDExperience with the conversion of paper billing processes to electronic, development of various industry reports, and other electronic processes such as electronic remittance notification and claim clearing houses requiredMust be familiar with patient statements, medical claims, and billing practices focused on medical billing. JOB SUMMARYThe Billing Specialist will be responsible for supporting the billing system in the review and generation of billing for reimbursement and payment of services provided through the various Anne Carlsen Center programs.
NewPricing and Reimbursement Analyst I or II, DOE Cambia Health Solutions IncPricing and Reimbursement Analyst I or II, DOEFargo, NDRemote$21.99–$35.19 / hourWhat You Will Do at Cambia: Collaborate closely with Provider Services, Network Management, corporate business support, operations staff and others to ensure negotiated provider and institutional payments are implemented correctly and promptly. As a member of the Provider Reimbursement team, our Pricing and Reimbursement Analysts analyze, develop, and maintain contract payment terms and reimbursement rates for institutional, facility, and professional healthcare providers across all regions and Regence subsidiaries.
NewPricing And Reimbursement Analyst I Or II, DOE Cambia HealthPricing And Reimbursement Analyst I Or II, DOEFargo, NDRemote$21.99–$35.19 / hourWhat You Will Do at Cambia: Collaborate closely with Provider Services, Network Management, corporate business support, operations staff and others to ensure negotiated provider and institutional payments are implemented correctly and promptly. As a member of the Provider Reimbursement team, our Pricing and Reimbursement Analysts analyze, develop, and maintain contract payment terms and reimbursement rates for institutional, facility, and professional healthcare providers across all regions and Regence subsidiaries.
Field Reimbursement Manager - Kidney (Midwest - ND, SD, WI, MN) Vertex Pharmaceuticals IncField Reimbursement Manager - Kidney (Midwest - ND, SD, WI, MN)ND$136,000–$204,000 / yearKey Duties and Responsibilities: Compliantly establish strong connections with key nephrology office personnel, including members of the care team and administrative staff responsible for prior authorizations and patient access to specialty medications, to support patient access to prescribed medications. At Vertex, our Total Rewards offerings also include inclusive market-leading benefits to meet our employees wherever they are in their career, financial, family and wellbeing journey while providing flexibility and resources to support their growth and aspirations.
Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health CorpSenior Investigator, Special Investigations Unit (Aetna SIU)ND$46,988–$112,200 / yearThis position will routinely handle high profile or highly sensitive matters involving cases that are national in scope, as well as, complex cases involving multi-lines of business, multiple subjects, or intricate healthcare fraud schemes. Strong communication skills, both written and oral, are necessary for the development and implementation of professional presentations for internal and external stakeholders regarding healthcare fraud matters and Enterprise approach to FWA.
Payment Integrity Nurse I Cambia HealthPayment Integrity Nurse IFargo, NDRemote$73,230.90–$99,077.10 / yearAs a member of the Post Service Claim Review team, our Payment Integrity Nurse I conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Excellent computer skills and proficiency working software programs (i.e. Microsoft Word, Excel, and PowerPoint); learn new processes and systems quickly.
Payment Integrity Nurse I Cambia Health Solutions IncPayment Integrity Nurse IFargo, NDRemote$73,230.90–$99,077.10 / yearAs a member of the Post Service Claim Review team, our Payment Integrity Nurse I conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Excellent computer skills and proficiency working software programs (i.e. Microsoft Word, Excel, and PowerPoint); learn new processes and systems quickly.
Manager, Clinical & Business Insight TriWest Healthcare AllianceManager, Clinical & Business InsightFargo, NDRemoteFull timeTechnical Skills: Strong knowledge of Microsoft Excel, Access, Preferred strong knowledge of Crystal Reports, SQL Reporting Services, and other query software; Knowledge of relational databases; Working knowledge of medical management systems; Working knowledge of referral and authorization systems; Working knowledge of healthcare; Working knowledge of medical coding, HIPAA regulations, claims processing, and healthcare reimbursement systems. • Drive improvements in cost efficiency, quality of clinical care, and effectiveness of clinical programs by performing data analysis to deliver actionable insights that are backed by empirical evidence.
Medical Director -Spine CVS Health CorpMedical Director -SpineNDRemote$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. The medical directors are responsible for precertification reviews of claim determinations, and provide clinical, coding and reimbursement expertise using multiple computer based applications.
Senior Software Development Engineer CVS Health CorpSenior Software Development EngineerND$83,430–$222,480 / yearCVS 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. Currently, we are seeking a Senior Software Development Engineer with deep expertise in Java/JEE, Spring Boot, RESTful microservices, and Kafka to lead the design and development of scalable, secure cloud-native solutions.
NewHealthcare Revenue Cycle Consultant - Remote Eligible Eide Bailly LLPHealthcare Revenue Cycle Consultant - Remote EligibleFargo, North DakotaRemote$100,000–$150,000 / yearFull timeA typical day as a Healthcare Revenue Cycle Consultant might include: Conducting onsite and remote revenue cycle assessments for healthcare providers (primarily hospitals), including evaluating patient access, mid-cycle, and back-end functions; identifying improvement opportunities and recommending solutions. You have well-rounded knowledge of CMS, and other state and federal regulatory guidance related to the healthcare industry with a strong understanding of inpatient, outpatient and professional billing and payer requirements.
AI Scientist Senior II Cambia Health Solutions IncAI Scientist Senior IIFargo, ND$148,000–$196,000 / yearThis position applies deep expertise in advanced analytical tools such as generative AI, machine learning, deep learning, optimization, and statistical modeling to solve complex, high-impact business problems in the healthcare payer domain. What You Bring to Cambia: Qualifications: The AI Scientist Sr II would have a degree (masters or PhD preferred) in a strongly a strongly quantitative field such as Computer Science, Statistics, Applied Mathematics, Physics, Operations Research, Bioinformatics, or Econometrics, and typically at least 12 years of related work experience.
AI Scientist Senior II Cambia HealthAI Scientist Senior IIFargo, ND$148,000–$196,000 / yearThis position applies deep expertise in advanced analytical tools such as generative AI, machine learning, deep learning, optimization, and statistical modeling to solve complex, high-impact business problems in the healthcare payer domain. What You Bring to Cambia: Qualifications: The AI Scientist Sr II would have a degree (masters or PhD preferred) in a strongly a strongly quantitative field such as Computer Science, Statistics, Applied Mathematics, Physics, Operations Research, Bioinformatics, or Econometrics, and typically at least 12 years of related work experience.
Autism Services Navigator TriWest Healthcare AllianceAutism Services NavigatorFargo, NDRemoteFull timeIn support of TRICARE beneficiaries enrolled in the Autism Care Demonstration (ACD), the Autism Services Navigator (ASN) collaborates and oversees the assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services for TRICARE beneficiaries diagnosed with autism spectrum disorder (ASD). • Current unrestricted licensure in an appropriate state or territory of the United States, as a Licensed Independent Clinical Social Worker (LICSW), Licensed Clinical Social Worker (LCSW), Registered Nurse, or other licensed mental health professionals who possess a Certification in Case Management (CCM).
Medical Director - Radiation Oncology - MD or DO CVS Health CorpMedical Director - Radiation Oncology - MD or DOND$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.
Staff Development Engineer - Fulfillment CVS Health CorpStaff Development Engineer - FulfillmentND$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.
Staff Software Development Engineer CVS Health CorpStaff Software Development EngineerND$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.
Senior Manager - Software Development Engineering CVS Health CorpSenior Manager - Software Development EngineeringND$106,605–$284,280 / year3+ years of experience defining technology strategy and leading the adoption and operationalization of technologies such as AI/ML, cloud services, automation, and developer productivity tools in a large-scale enterprise environment with evidence of measurable impact (e.g., reduction in MTTR, cost savings, efficiency gains, or adoption KPIs). Currently, we are seeking Senior Manager - Software Development Engineering who will lead and manage a team of software engineers, providing hands-on technical direction, architecture guidance, and mentorship while establishing measurable engineering goals aligned with business outcomes.