div style="background-color:rgb( 255 , 255 , 255 );color:rgb( 38 , 35 , 33 );font-family:'circular' , '-apple-system' , 'blinkmacsystemfont' , 'segoe ui' , 'roboto' , 'oxygen' , 'ubuntu' , 'cantarell' , 'fira sans' , 'droid sans' , 'helvetica neue' , sans-serif;font-size:16px;font-style:normal;font-weight:400;letter-spacing:normal;outline:none;text-indent:0px;text-transform:none;white-space:normal;word-spacing:0px">HOURS: 40 hours week.
At LSS, we are committed to upholding the following values in all aspects of our work:
Compassionate – We engage with empathy and provide non-judgmental services.
Sioux Falls, SD30+ days ago
The incumbent will also work closely with MTF staff to support TRICARE beneficiaries and provide non-clinical support for patient referrals and authorizations; outreach to network providers as necessary; and to facilitate the support of applicable TriWest departments for resolving network gaps, provider and contract concerns, customer service requests, and discharge coordination for patients from network and non-network facilities. • Performs on-site and virtual outreach activities for military installation community and beneficiary groups such as Family Readiness Groups, Retiree Associations, and Installation New-comers Orientation, and provides educational briefings on such matters as transferring TRICARE enrollment, PCM selection, and other interest areas for new people to the community.
Sioux Falls, SD19 days ago
li>Advanced knowledge of policies and procedures associated with interdisciplinary coordinated care delivery and/or care in the community operational activities that affect patient flow, and patient support care [administrative functions] to include, but not limited to appointment cycles, outside patient referrals, follow-up care, overbooking, provider availability, etc. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents).
Hot Springs, SD30+ days ago
Sign in My jobs Profile Resumes & documents Search preferences Notifications Sign out My jobs Profile Resumes & documents Notifications Search preferences Sign out Events Help Center Search Back to results Apply. Monitors system backups ensures network connectivity mitigates cybersecurity vulnerabilities and maintains clinical systems.
Hot Springs, SD21 days ago
p>Leveraging 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.
Establishes regular meetings with other Service Desk staff to review aging of assigned service requests, share documentation and resolution of high severity issues, and drive solutions to minimize high severity issues. This role provides technical direction, manages customer relations, and performs related duties as assigned in order to document, assist and resolve tier 1 and 2 issues reported to the Service Desk.
Fort Meade, SD25 days ago
Ability to operate computerized programs and systems in order to enter, modify, and retrieve sensitive medical and patient identifying information (PII) into or from electronic health records, scheduling systems, and/or reports; Ability to schedule medical appointments in a clinical setting; Ability to work independently in the accomplishment of a wide variety of duties performing patient support work; Ability to communicate effectively and professionally in person, electronically, and/or by telephone, with internal and external customers; AND Candidates must be able to demonstrate all of the Knowledge, Skills and Abilities below: Advanced knowledge of the technical health care process (including, but not limited to, scheduling across interdisciplinary coordinated care delivery and/or care in the community models and patient health care portals) as it relates to access to care. If selected, to meet the basic requirement of high school education or equivalent and prior to a firm job offer being extended, applicants must provide one of the following as verification of the education requirement if not covered under the grandfathering provision: Copy of high school diploma OR high school transcript (unofficial or official) OR GED Certificate OR homeschooling completion OR proficiency certificate issued by a State or Territorial Board or Department of Education OR college transcript (official).
Perform 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.
Technical Skills: Proficient in current trends in health care management with emphasis in customer service, network management, utilization and financial trends; collaboration skills to work with TriWest management team across multiple locations; networking skills with all levels, including subcontractors. • Works on multiple high level projects including logistical coordination, data analysis, contract management and written communications in support of various business initiatives of high visibility, applying project management tools and methodologies and leadership skills to meet or exceed deadlines.
The Director ensures the delivery of exceptional service to providers and government stakeholders by directing cross-functional programs that enhance provider satisfaction, strengthen network engagement, and uphold contractual and regulatory compliance. Coaching / Training / Mentoring: Actively develops the skills and capabilities of direct reports and extended team members through constructive feedback, mentoring relationships, and structured development opportunities aligned with business outcomes.
Technical Skills: Project management skills, including data analysis, facilitation and proficiency in the use of project management tools; ability to effectively interact and maintain effective working relationships with all levels of TriWest staff and with external shareholder organizations; ability to consistently meet meeting materials deadlines. Provides project management support for division and special company-wide projects and initiatives, supports TriWest's senior leadership with annual and day-to-day strategic and operational planning and projects, research activities, data analysis, drafts or edits plans and white papers related to specific initiatives.
p>GS-08: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the GS-07 grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: applying and interpreting complex federal, state, Tribal, and private-sector regulations to make eligibility and funding determinations for programs such as Purchased/Referred Care, Medicare, Medicaid, Veterans Affairs healthcare, and Affordable Care Act plans; independently analyzing medical, financial, and eligibility documentation to resolve complex or controversial benefit issues; coordinating with agencies, providers, and patients to ensure fiscal accountability and continuity of care; issuing medical authorizations or denial determinations based on regulatory, clinical, and fiscal requirements; maintaining fund control records, monitoring expenditures, and applying appropriate accounting codes; identifying and resolving program or funding discrepancies; and compiling and analyzing reports related to program operations, funding, and utilization. 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: identifying and verifying patient eligibility for Medicare, Medicaid, SSA benefits, private insurance, Tribal programs, and other assistance resources; interviewing patients to obtain required documentation; assisting individuals and families with benefit applications; reviewing records to determine the status of claims and applications; responding to inquiries regarding patient eligibility requirements, benefits, and program guidelines; and maintaining accurate patient records through data entry, discrepancy resolution, and follow-up on pending claims and missing documentation.
p>GS-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.
Rapid City, SD10 days ago
Utilizing their expertise, the PreArrival Services Coordinator reviews payer medical policies, assesses the medical necessity criterion, and employs critical thinking to ascertain if the criteria are met to facilitate the scheduling of financially cleared services and provides an escalated level of referral management and processing to ensure the proper interpretation, recording, adjudication, approval, and payment of requests for healthcare services. The PreArrival Services Coordinator must proficiently guide and support all staff, providers, and/or patients on available options and effectively address barriers to obtaining prior authorizations, complete financial clearance, or timely scheduling of services that will ensure resolution and closure to referrals or case requests.
As part of an assigned team, develops 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.
As part of an assigned team, develops 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.
As part of an assigned team, develops 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.
Independent Thinking / Self-Initiative: Demonstrates strong critical thinking and sound judgment to prioritize high-impact work and drive results; proactively identifies needs, solves problems, and mobilizes resources with minimal direction to achieve operational and organizational objectives. Computer Literacy: Demonstrates advanced proficiency in a multi-system environment, including Microsoft Office applications and credentialing platforms; effectively leverages internal systems, intranet resources, and industry tools to manage credentialing operations, ensure data integrity, and drive operational efficiency.
Independent Thinking / Self-Initiative: Applies critical thinking to prioritize high-impact work and drive results with minimal direction; demonstrates ownership and accountability by proactively identifying solutions, securing necessary resources, and following through to achieve outcomes aligned with organizational and compliance objectives. Computer Literacy: Demonstrates advanced proficiency in a multi-system Microsoft environment and internal platforms, including the TriWest Intranet, internet-based tools, and department-specific applications; leverages technology effectively to manage workflows, ensure data accuracy, and support compliant, efficient operations.
Your travel team will include a designated credentialing expert to help you navigate every step of the on-boarding process, a payroll specialist who you can communicate with directly, and a skilled recruiter who takes the time to understand your needs and works hard to find the right position for you. You'll collaborate closely with RNs, CNAs, and an interdisciplinary team to deliver safe, high-quality care, administer medications, monitor changes in condition, and communicate proactively with residents, families, and providers.
Rapid City, South Dakota12 days ago
ul>Performs 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). Current Employees:
If you are a current Monument Health employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage..
Sioux Falls, SD30+ days ago
Serving as a trusted advisor to executive hiring leadership, the Executive Recruiter develops and executes proactive, research-driven search strategies to identify, attract, and secure top-tier leadership talent. The Executive Recruiter leads full lifecycle recruitment for executive level Director, Vice President, Chief-level, and other highly specialized leadership roles across TriWest Healthcare Alliance.
Rapid City, SD10 days ago
p>Essential Functions: - Performs 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.
Sioux Falls, South Dakota30+ days ago
li>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. 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.
p>In this role, you'll help support the daily operations of the business office while working closely with residents, families, vendors, and our leadership team to ensure accurate billing, financial processes, and exceptional customer service. If you're ready to bring your administrative and financial skills to a team that values compassion and excellence, we encourage you to apply today and become part of the Pine Ridge Post Acute family.
Serves as TriWest's senior individual contributor and account manager for the Veterans Affairs' (VA) healthcare facilities, regional offices, and Veterans Integrated Services Networks (VISN) in support of the VA Community Care Network (CCN). Operating without direct reports, the incumbent exercises significant independent judgment and works at an executive level of complexity, managing high-stakes external relationships and translating VA operational intelligence into actionable guidance for TriWest senior leadership.