Manager Clinical Performance & Quality Coding (Nurse Practitioner or PA) Elevance Health IncManager Clinical Performance & Quality Coding (Nurse Practitioner or PA)seven fields, PADevelop and manage clinical quality reviews to ensure peer review and clinical quality chart audit process including targeting chart reviews, auditing percentages, score guidelines feedback mechanism and ensure compliance with remediation procedures. Requires a master's in Nursing (or PA equivalent) and at least 3 years of clinical experience in applying appropriate diagnosis in the Medicare HCC Mode; or any combination of education and experience, which would provide an equivalent background.
Manager Clinical Performance & Quality Coding (Nurse Practitioner Or PA) Elevance HealthManager Clinical Performance & Quality Coding (Nurse Practitioner Or PA)Seven Fields, PADevelop and manage clinical quality reviews to ensure peer review and clinical quality chart audit process including targeting chart reviews, auditing percentages, score guidelines feedback mechanism and ensure compliance with remediation procedures. Requires a master's in Nursing (or PA equivalent) and at least 3 years of clinical experience in applying appropriate diagnosis in the Medicare HCC Mode; or any combination of education and experience, which would provide an equivalent background.
NewSenior Hierarchical Condition Category (HCC) Coding Specialist Highmark IncSenior Hierarchical Condition Category (HCC) Coding SpecialistPAThis job will deliver value to the Health Plan and its beneficiaries enrolled in risk-adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA) through Hierarchical Condition Category (HCC) coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and support of Risk Adjustment Data Validation (RADV) audits. Completes analytics on providers and/or provider group coding trends and creates and delivers externally facing presentations to provider documentation and accuracy, acts as the point person for the provider office for any questions and additional trainings, as needed.20%.
Hierarchical Condition Category (HCC) Coding Specialist Highmark IncHierarchical Condition Category (HCC) Coding SpecialistPAThis job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Flexes between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models; works independently in various coding applications and electronic medical record systems to support departmental goals.
Senior Software Engineer (Claude Code or Google Gemini) Highmark IncSenior Software Engineer (Claude Code or Google Gemini)PATo include: 5 years in at least one modern programming languages (Java, Python, JavaScript, ACE, IIB/ITX, Informatica preferred), and experience with at least two of the following: React, Angular v4+, NodeJS, NoSQL databases, HTML5, CSS, Google Cloud Platform or Amazon Web Services. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Netsmart EHR RCM Consultant enkompas Technology SolutionsNetsmart EHR RCM ConsultantSewickley, PARemoteRevenue Cycle Management Integration: Ensure Netsmart EHR systems are fully integrated with revenue cycle management processes, from patient registration through billing and collection. Training and Support: Develop training materials and conduct training sessions for healthcare providers, clinical staff, and administrative staff on Netsmart EHR and RCM system usage.
Senior Field Reimbursement Specialist- Cell and Gene Therapy/Rare Disease Cencora IncSenior Field Reimbursement Specialist- Cell and Gene Therapy/Rare DiseasePA$93,500–$187,000 / yearProgressively responsible experience in field reimbursement, patient access, market access, revenue cycle, managed care, provider support, pharmaceutical/biologic support programs, or a related healthcare access role, with demonstrated experience working directly with health systems, hospitals, academic medical centers, authorized treatment centers, and/or large institutional accounts. This role will act as a liaison to patient assistance, reimbursement support, and access services offered by the client, with a focus on helping institutional stakeholders understand product acquisition pathways, CGT-specific prior authorization requirements, site-of-care considerations, coding and billing requirements, denial and appeal processes, and operational logistics that may affect timely access for patients with rare diseases.
Physician Assistant or Nurse Practitioner- Outpatient Domain - Medical Oncology/Hematology Highmark IncPhysician Assistant or Nurse Practitioner- Outpatient Domain - Medical Oncology/HematologyMonaca, PAProvides appropriate patient care to include recording patient medical history and physical assessment, developing therapeutic care plan, ordering diagnostic tests, interpreting test results, discharge planning and providing accurate medical record documentation for patients in physician office(s) and non- acute based settings (20%). National Board Certification for Nurse Practitioners through the American Academy of Nurse Practitioners (AANP), American Nurses Credentialing Center (ANCC), National Certification Corporation (NCC), or Pediatric Nursing Certification Board (PNCB).
Nurse Investigator The Health PlanNurse InvestigatorWheeling, WVRequired: Registered Nurse; Certified Coder (or eligible within 12 months)or similar certification; Basic knowledge of ICD-9/10, CPT, HCPCS, DRG and/or Rev codes; Proficiency with Office products, including Word and Excel; Critical problem-solving skills and attention to detail. The successful candidate will utilize their unique blend of coding, claims payment, clinical, and payment integrity/investigations expertise to assist the SIU in achieving its mission to prevent, detect, investigate, and resolve healthcare fraud, waste, and abuse.
Nurse Practitioner - Outpatient Domain - Pain Managment Highmark IncNurse Practitioner - Outpatient Domain - Pain ManagmentWexford, PAProvides appropriate patient care to include recording patient medical history and physical assessment, developing therapeutic care plan, ordering diagnostic tests, interpreting test results, discharge planning and providing accurate medical record documentation for patients in physician office(s) and non- acute based settings. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Managing Optometrist - Washington, PA - LensCrafters EssilorLuxottica SAManaging Optometrist - Washington, PA - LensCraftersWashington, PAIf you would like to provide feedback regarding an active job posting, or if you are an individual with a disability who would like to request a reasonable accommodation, please call the EssilorLuxottica SpeakUp Hotline at 844-303-0229 (be sure to provide your name, job id number, and contact information so that we may follow up in a timely manner) or email EmployeeRelations@luxotticaretail.com. LensCrafters is part of EssilorLuxottica, a global leader in the design, manufacture and distribution of world-class vision care products, including iconic eyewear, advanced lens technology and cutting-edge digital solutions.
COLLECTION/CREDIT SPEC Trinity Health SystemCOLLECTION/CREDIT SPECSteubenville, OHAccountable for reducing delinquency for assigned collection accounts requiring advanced knowledge of accounts receivable management and collection process. Medical terminology or medical billing certficate from college or technical school preferred.
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Claims Specialist ConnectiveRxClaims SpecialistPittsburgh, Pennsylvania$17–$20.60 / hourFull timeWhen things get messy along the prescription journey, pharmaceutical manufacturers rely on us to untangle the process and create a clear path—allowing patients to build trusting relationships with their medication brands. The Claims Specialist, under the direction of the Supervisor (with guidance from a Team Lead), is responsible for processing medical claims received from patients and/or HCPs across a broad product suite.
Patient Access Representative Heritage Valley Health SystemPatient Access RepresentativeSewickley, PAThey are also responsible for combining ancillary schedules for all patients and for assisting patients with the automated check-in process via our patient kiosks. Preferred: Healthcare background and/or bachelor or associates degree, knowledge of ICD-9 or ICD-10 coding, medical terminology, billing, and health insurance rules/processes.
Coder - Outpatient Highmark IncCoder - OutpatientPAIn connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Job Description: GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD and CPT coding systems and assists in decreasing the average accounts receivable days.
Coder - Inpatient (CCS/CIC REQUIRED), Remote, Sign on Bonus Eligible Highmark IncCoder - Inpatient (CCS/CIC REQUIRED), Remote, Sign on Bonus EligiblePARemoteIn connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD coding systems and assists in decreasing the average accounts receivable days.
Nurse Practitioner - PRN Amedisys, Inc.Nurse Practitioner - PRNSt. Clairsville, OhioPer diemOverview: Nurse Practitioner - PRN PRN Schedule: Weekday evenings and Weekends Make a difference every day as an Amedisys nurse practitioner Join Amedisys-one of the largest and most trusted home health and hospice companies in the U.S.-where flexibility, purpose and growth come together to help patients heal where they feel most comfortable, at home. Must meet physician-nurse practitioner restrictive collaborative requirements specific to state assigned to work by the Company and supply a copy of all active collaborating physician agreements and indicate whether these will be transferable to your employment with Amedisys.
Coordinator - Purchasing PHS Bio-Medical ServicesCoordinator - PurchasingEast Liverpool, Ohio$10.70–$16.09 / hourFull timeOverview: Join our team of dedicated professionals who provide services and operational support to award winning hospitals through roles in supply chain, IT and cybersecurity, clinical engineering, capital procurement, medical coding, project management and more. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Hospice Nurse Practitioner, Flex/Per Diem/PRN Gentiva Health Services Inc (Inactive)Hospice Nurse Practitioner, Flex/Per Diem/PRNWexford, PAComplete all visit types for patients on services, including Medicare-required hospice Face-to-Face (F2F) visits within CMS established regulatory timeframes, History & Physical/Initial Comprehensive visits, Problem-focused Symptom Management visits, Admission visits, Goals of Care discussions, and routine follow up visits. Assist with and/or manage all aspects of patient care including diagnosis, acute and chronic symptoms, treatment, medication management, assessments, longitudinal serious illness support, quality-of-life optimization, and consultations, while reducing avoidable or unnecessary acute care utilization.