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).
Senior HCM and Compensation Consultant, Healthcare Workday IncSenior HCM and Compensation Consultant, HealthcareSD$117,000–$175,400 / yearStrong influencing skills, including persuasive communication and the ability to drive consensus and effectively collaborate with stakeholders, Exceptional relationship management skills are crucial, with a focus on building and maintaining strong relationships with clients, partners, and colleagues to foster collaboration, loyalty, and a positive work environment. The Workday Healthcare Consulting team is an industry focused team that ensures successful deployments by architecting, configuring, and testing the Workday solution to meet the specific needs of our customers.
Architect - Healthcare Architecture IncorporatedArchitect - HealthcareSioux Falls, SDArchitecture Incorporated is seeking a Healthcare Architect to join our growing team and help shape innovative healthcare facilities throughout the region. For nearly 50 years, Architecture Incorporated has been committed to design excellence, client service, and creating meaningful spaces that positively impact communities.
Architect - Healthcare TSP IncArchitect - HealthcareSioux Falls, SDThe ideal candidate will bring strong healthcare design expertise, leadership experience, and the ability to guide multidisciplinary teams through all phases of project delivery, from programming and planning through construction administration. This position will work alongside Mark Averett and other TSP leaders to help advance the strategic growth of the firm's Healthcare Practice while delivering high-quality, patient-centered design solutions.
Principal Financial Implementation Consultant (Healthcare) Workday IncPrincipal Financial Implementation Consultant (Healthcare)SD$140,300–$210,500 / yearWe know that flexibility can take shape in many ways, so rather than a number of required days in-office each week, we simply spend at least half (50%) of our time each quarter in the office or in the field with our customers, prospects, and partners (depending on role). As an experienced financial functional consultant, you will play a key role in ensuring the successful implementation of Workday's financial solutions for our healthcare customers and guiding them through transforming their financial operations.
Lead Director, Healthcare Medicaid Risk Adjustment Analytics CVS Health CorpLead Director, Healthcare Medicaid Risk Adjustment AnalyticsSD$100,000–$231,540 / yearThe Lead Director should also demonstrate leadership in innovation and adoption of modern technologies, data platforms, machine learning, process automation, AI, and data science for optimized insights, workflows, reporting, and process controls. This senior-level role will provide strategic and operational leadership for all Medicaid risk adjustment analytics, reporting, and informatics functions to ensure complete, accurate, and compliant revenue capture.
Dietitian Nutritionist I - Healthcare Sodexo SADietitian Nutritionist I - HealthcareWATERTOWN, SD$50,660–$65,560 / yearWhether you"re just beginning your career or looking to grow your expertise, you"ll contribute to high-quality care through evidence-based practice, collaboration, and continuous improvement in a supportive healthcare environment. Act as a nutrition resource for patients, peers, and foodservice staff; collaborate across interdisciplinary teams and departments to ensure safe, high-quality care.
Employee Experience (EX) Advisor - Healthcare Press Ganey Associates LLCEmployee Experience (EX) Advisor - HealthcareSDRemote$81,000–$115,000 / yearHowever, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. Press Ganey is the leading experience measurement, data analytics, and insights provider for complex industries-a status we earned over decades of deep partnership with clients to help them understand and meet the needs of their key stakeholders.
Licensed Healthcare Insurance Agent - Remote USA TTECLicensed Healthcare Insurance Agent - Remote USAHighmore, SDRemoteWebcam participation is expected during all instructor led TTEC and client required training, either throughout the session or at designated times, and is encouraged during coaching sessions to support meaningful connection and collaboration. Your training experience includes engaging, instructor led online sessions that use both webcam video and audio, so you can connect visually with trainers, leaders, and fellow teammates.
Strategic Account Executive - Healthcare UKGStrategic Account Executive - HealthcarePierre, SD$90,000–$95,000 / yearThis Account Executive will be in a role of focusing on both acute and non-acute care accounts between 1-500 employees; the role requires a hunter focus on existing accounts seeking to add on Payroll, HR, Talent, Benefits, and additional HCM products, as well as expanding their labor management solution with additional products such as absence management, scheduling, and the analytics solutions. This person will be tasked with creating and maintaining key stakeholder relationships, in the accounts, and maximize opportunities to attain and exceed annual sales goals for the territory and the UKG Healthcare sales team.
Representative I Client Support CVS Health CorpRepresentative I Client SupportSD$17–$28.46 / hourThe Client Support Representative I plays a critical role in delivering high-quality service to members by resolving inquiries with empathy, accuracy, and efficiency. 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.
Autism Support & Skill Building Specialist (RBT) - Sioux City, IA Heartland ABAAutism Support & Skill Building Specialist (RBT) - Sioux City, IANorth Sioux City, SDWe're actively seeking enthusiastic and devoted RBTs to become valued members of our team, contributing your expertise to support our clients in achieving their unique goals. As an accomplished professional in the Applied Behavior Analysis (ABA) field, your skills and dedication align with our dedication to providing excellence to our clients.
Support Specialist/Receptionist/Behavioral Health Technician Dakota Counseling InstituteSupport Specialist/Receptionist/Behavioral Health TechnicianMitchell, SDWe are seeking a friendly and organized Support Specialist / Receptionist / BHT (Behavioral Health Technician) to be the first point of contact for our clients and provide exceptional support to our professional staff. Administrative Support: Provide administrative assistance to professional staff (including therapists, medical providers, and other team members) as needed.
NewBiomedical Technician / Equipment Support Specialist - Level III Blue Water ThinkingBiomedical Technician / Equipment Support Specialist - Level IIIOnsite - Hot Springs, SD$75,000–$90,000 / yearLeveraging our executive team's military experience and private and public sector consulting expertise, Blue Water Thinking takes an integrated "one-team" approach and brings to bear best-fit solutions, thought leadership, and grit to meet our client's transformational needs. Your responsibilities will encompass a wide range of tasks including preventive and corrective maintenance, incoming inspections, medical device security, equipment installations, electrical safety inspections, addressing hazard recalls, software repairs, and working with Cerner integration.
Medical 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.
Customer Service Specialist - Multiple Shifts Available! WEX IncCustomer Service Specialist - Multiple Shifts Available!SDYou will be assigned to support one of the following call centers based on business needs: WEX Health (Benefits): Supporting participants with HSA, FSA, HRA, and Medicare Advantage products. This role is responsible for answering inbound inquiries regarding account maintenance, billing, and technical support through multiple channels, including phone and email.
Provider Program Manager - APM TriWest Healthcare AllianceProvider Program Manager - APMSioux Falls, SDRemoteFull timeDevelops effective collaborative relationships with TriWest's inter and intra-departmental stakeholders and other SMEs, C-Suite executives, and other leaders in Operations, Health Care Services, Provider Network, and IT to ensure that TriWest meets contractual requirements and fulfills organizational objectives. The Provider Program Manager ensures that strategic, enterprise-wide programs are well defined, planned, tracked, and communicated in a consistent manner; is responsible for collaborating with C-Suite executives and other stakeholders; and is responsible for deliverables that meet defined requirements and for utilizing project management best practices.
Contact Representative (Benefits Coordinator) US Department of Health and Human ServicesContact Representative (Benefits Coordinator)SD$45,409–$72,644 / yearGS-08: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: interpreting and applying federal, state, Tribal, and third-party program regulations to determine eligibility and ensure compliance for programs such as Purchase Referred Care, Medicare, Medicaid, Affordable Care Act, Veterans Affairs Healthcare, and other alternate resources; conducting in-depth patient interviews to assess eligibility, verify coverage, and complete applications; registering eligible patients in various assistance programs; resolving claim denials and eligibility issues through coordination with patients, healthcare providers, and outside agencies; reviewing Medicaid eligibility information and supporting billing requirements; and utilizing effective oral and written communication to explain program requirements, provide referrals, and resolve complex patient service issues. MINIMUM QUALIFICATIONS: GS-06: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-05 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: determining patient eligibility for alternate resources programs; interpreting and applying Medicare, Medicaid, VA, and other third-party payer policies and procedures; conducting patient interviews to identify available healthcare coverage and funding sources; assisting patients with enrollment and claims processes; researching and resolving eligibility, denial, and reimbursement issues; maintaining effective working relationships with patients and resource agencies; and safeguarding confidential patient information in accordance with Privacy Act and HIPAA requirements.
NewPatient Financial Advocate I Monument Health Rapid City HospitalPatient Financial Advocate IRapid City, South DakotaPerforms and completes the workflows of Pre-Arrival patient financial management functions within Revenue Cycle which may include but are not limited to: Financial Clearance (Pre-Registration, Pre-Arrival Insurance Benefit Management, and Authorization/Referral/Benefit Review); Patient Admission and Registration Support (Inpatient, Outpatient, ED Registration, Insurance verification); Financial Counseling (Price Estimations, Payment Planning and Arrangement, Fund Finding and Resource eligibility, Charity Care Review); Customer Service (Patient collections, Customer service follow-up, Third Party Insurance Follow up, Patient balance resolution). Through conducting of a variety of tasks such as creation of price estimates, counseling patients regarding insurance coverage and benefits, arranging payment plans, assessing referrals for care, handling billing issues with third party payers, and assistance with determining eligibility for resources to assist with management of out of pocket responsibilities, this caregiver assists the patients and families with the navigation of the patient financial journey.
Configuration Analyst AveraConfiguration AnalystSioux Falls, South Dakota$63,960–$96,200 / yearRequirement 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. A Brief Overview The Avera Health Plan Configuration Analyst is responsible for the design, implementation, and support of the Epic Tapestry module, which manages health plan administration, benefits, fee schedules, claims, enrollment, care coordination, clinical/authorizations and provider data.