NewPart Time – Billing Specialist and Coding Technician City of Sioux FallsPart Time – Billing Specialist and Coding TechnicianSioux Falls, SDOur employees partner with local businesses and community members to provide the infrastructure, safe neighborhoods and recreation opportunities that keep Sioux Falls consistently ranked among the top places to live and work. The billing specialist is responsible for processing insurance claims, maintaining accurate patient billing records, and supporting timely reimbursement within a fast-paced community healthcare environment.
Senior Clinical Coding Analyst TriWest Healthcare AllianceSenior Clinical Coding AnalystSioux Falls, SDRemoteFull 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.
Billing and Insurance Specialist/Medical Office Midwest Ear, Nose & ThroatBilling and Insurance Specialist/Medical OfficeSioux Falls, SDThis role will verify hearing aid benefits and prepare patient estimates and prior authorizations, establish patient payment plans within approved guidelines, and provide exceptional customer service by assisting patients and insurance carriers with billing inquiries. This position is responsible for ensuring accurate charge entry, payment posting, and account reconciliation while supporting efficient revenue cycle operations.
Certified Professional Coder, Special Investigations Unit (Aetna SIU) CVS Health CorpCertified Professional Coder, Special Investigations Unit (Aetna SIU)SD$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.
Supervisor, Utilization Management TriWest Healthcare AllianceSupervisor, Utilization ManagementSioux Falls, SDRemoteFull 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.
Program Integrity Investigator (Healthcare Fraud Waste & Abuse) TriWest Healthcare AllianceProgram Integrity Investigator (Healthcare Fraud Waste & Abuse)Sioux Falls, SDRemoteFull 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).
Coder 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.
Coder II - Inpatient Avera HealthCoder II - InpatientSioux Falls, SD$25.50–$38 / hourIP 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.
Graphic Designer Sammons Financial GroupGraphic DesignerSioux Falls, South Dakota$44,498–$74,162 / yearFull timeManage business forms and marketing materials maintenance, including: • Building and maintaining branded business forms (e.g., applications, enrollment/change requests, claims/service forms, disclosures, rate sheets) as print PDFs, translating complex requirements into clear, usable, accessible layouts that reflect the brand. Proficient in Mac computer systems using Adobe Creative Suite—Photoshop, Illustrator, InDesign, Adobe XD, Acrobat Pro, Dreamweaver; CSS; HTML; responsive web design; User Experience design; interactive landing pages; and typography.
Certified Medical Assistant (CMA) – Regional Drug Dependency Unit Akicita FederalCertified Medical Assistant (CMA) – Regional Drug Dependency UnitSioux Falls, South Dakota$50,000–$65,000 / yearThis role is responsible for assisting with patient care activities, performing routine clinical tasks, managing patient records, and supporting the overall operation of the unit, ensuring compassionate, culturally sensitive care for individuals undergoing substance abuse treatment. $50,000 - $65,000 a year Position Summary The Certified Medical Assistant (CMA) will provide clinical and administrative support to the healthcare team in the Regional Drug Dependency Unit (RDDU) at the Great Plains Area facility in Winnebago, NE.
NewRegistered Nurse (Rn) | Clinical Documentation Specialist Avera HealthRegistered Nurse (Rn) | Clinical Documentation SpecialistSioux Falls, SD$31–$46.25 / hourAccurately reviews the entire inpatient medical record (dictation, templates, lab, orders, and nursing notes) to determine appropriate coding utilizing: ICD-9-CM, ICD-10 (CM and PCS), DRG Grouper and APR-DRG Grouper for strategizing SOI, ROM and DRG assignment. Utilizing advanced experience and in-depth knowledge, accurately determines the appropriate sequence of principle diagnosis code, procedure codes, MS-DRG/APR- DRG, SOI, ROM and POA reporting on Inpatient Coding Product Lines.
Clinical Quality Specialist - Canton Medical Center - Full Time Sanford HealthClinical Quality Specialist - Canton Medical Center - Full 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.
Billing 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.
Field Reimbursement Manager - Kidney (Midwest - ND, SD, WI, MN) Vertex Pharmaceuticals IncField Reimbursement Manager - Kidney (Midwest - ND, SD, WI, MN)SD$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.
Medical Claim Analyst CVS Health CorpMedical Claim AnalystSD$18.50–$35.29 / hourThis function includes, but is not limited to the following: Review provider re-submissions of ClaimsXten, Clinical Validation, Prospective Claim Accuracy, Novologix and DRG claims and resolve or prepare them for review by an Aetna clinician. The Medical Claim Analyst will be part of the Provider Coding and Reimbursement (PCR) team who reviews provider coding and reimbursement denial disputes from providers.
Manager, Clinical & Business Insight TriWest Healthcare AllianceManager, Clinical & Business InsightSioux Falls, SDRemoteFull 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 - ENT CVS Health CorpMedical Director - ENTSD$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.
Medical Director -Spine CVS Health CorpMedical Director -SpineSDRemote$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.
NewMedicare Programs Clinical Lead Sanford HealthMedicare Programs Clinical LeadSDRemote$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.
Medicare 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.
Senior Software Development Engineer CVS Health CorpSenior Software Development EngineerSD$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.
Staff 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.
Senior Manager - Software Development Engineering CVS Health CorpSenior Manager - Software Development EngineeringSD$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.
Autism Services Navigator TriWest Healthcare AllianceAutism Services NavigatorSioux Falls, SDRemoteFull 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). • Function as an advocate for the beneficiary/family by ensuring access to necessary care and maintaining beneficiary safety, locating specialized services outside the network by identifying providers, exploring the nature of services offered, and facilitating collaboration with associated providers.
Medical Director - Radiation Oncology - MD or DO CVS Health CorpMedical Director - Radiation Oncology - MD or DOSD$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.
Application Security Engineer (REMOTE) EnerSysApplication Security Engineer (REMOTE)SDRemote$117,200–$146,600 / yearCollaborate within an expanding Cybersecurity team, and work closely with internal EnerSys teams to ensure new and continued compliance with cybersecurity frameworks and required programs and initiatives. Serve as a primary liaison between the Cybersecurity and development teams, ensuring security is integrated into design, development, deployment, and operations.