Friday, November 5, 2010

Spot Light Jobs for November 5, 2010

Claims Adjudication Specialist w/Arizona State

Become part of the Arizona Health Care Cost Containment System (AHCCCS) team as a Claims Adjudication Specialist to work from home in a virtual office environment for the Division of Fee For Service Management (DFSM).

DFSM is the Health Plan for AHCCCS' Fee For Service Population, responsible for the clinical, administrative and claims functions of more than 159,000 members. This includes American Indians enrolled in the AHCCCS Fee For Service Program and individuals in the Federal Emergency Service Population. Of the 70 DFSM employees, over 60% are able to contribute to the division's goals and objectives while working from home.

This position is responsible for processing claims that are pended and have to be adjudicated per agency policies and procedures. This involves asking for medical documentation from providers, looking for consent forms, reviewing history for potential duplicate claims, ensuring the system is appropriately processing claims, looking for third party liability, and ensuring that documentation needed is included with submissions. The position is also responsible to re-process Prior Authorization claims, supplement and link documentation, and recoup and void claims.

Auditing and analysis procedures to determine compliance with AHCCCS

Medical terminology, CPT codes, ICD-9 codes, HCPCS codes, and CDT codes.
Third party liability laws as apply to State and Federal Programs.
Principles of medical pricing (i.e., DME equipment, drugs, multiple surgical procedures).
Thorough knowledge of all aspects of claims processing.
Word, Excel, Mainframe.
Research and analysis techniques.
Intermediate computer use
Data Entry.
10 key by touch typing.
Analyzing specific problem areas and making recommendations for resolution.
Verbal and written communication skills with providers.
Interpreting rules and regulations, policies and procedures as relate to adjudication decisions.
Time management in order to complete special projects as assigned.
Determine a pattern of inappropriate billing.
Analyze system issues, elevating concerns to management.
Maintain a pre-determined production level.
Multitask in a fast paced environment.
Provide technical training as required.
The ideal candidate will have at least two to five years experience in medical claims processing, specifically adjudication with a working knowledge of medical coding, or medical coding certification.

AHCCCS is Arizona's Medicaid program, designed to deliver quality health care under cutting-edge concepts of managed care. The ALTCS was the first long-term care Medicaid Managed Care program in the nation. Over the years, independent evaluations repeatedly have praised the program's effectiveness and AHCCCS has received national acclaim as a model for other Medicaid programs. AHCCC is a 2010 recipient of the prestigious Alfred P. Sloan Award for Business Excellence in Workplace Flexibility because of its flexible work place practices such as virtual office, teleworking, ample holiday and sick leave and excellent health insurance.

The paycheck that you receive is only a portion of the total package that the State offers to its employees. Many employees identify the benefits and other intangible workplace flexibility benefits as top reasons why they continue to work for the State. The following are some of the most significant benefits that, added together, make up a very competitive compensation package.

We offer medical, dental and vision insurance as well as basic life insurance and long-term disability. You will also have the option to buy additional life insurance, short-term disability insurance and discounted auto and/or home insurance.

Become part of the Arizona State Government retirement plan (ASRS) - the state-sponsored retirement contribution plan with 100% employer match; and in which you can become fully vested after 10 years of state service! You will also have the option to participate in a deferred compensation program to take advantage of tax-deferred retirement investments.

Enjoy 10 paid holidays and generous vacation leave (up to 21 days) and sick leave (12 days) allowances.

We offer flexible schedules and telecommuting for most positions.
General Information
Applicants for this position will be required to submit to a criminal history investigation pursuant to A.R.S. 41-777.
All newly hired employees will be subject to the E-Verify Employment Eligibility Verification Program.

State employees are subject to mandatory furlough days scheduled for FY 2011 (6 days) and in FY 2012 (6 days). A furlough is time off without pay and equals 8 hours per day for full-time employees and is pro-rated for part-time employees
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by calling (602) 417-4589. Requests should be made as early as possible to allow sufficient time to arrange the accommodation. AHCCCS is an AA/EOE/ADA Reasonable Accommodation Employer.

Ordained Minister

Do you have a passion for helping people through the guidance of faith? We are currently searching for ORDAINED ministers that are interested in sharing their faith in the lord through counseling and guidance. Our organization has created a faith based outreach program that will allow people from all reaches of the United States to seek guidance and direction thru the power of Christian teachings and values.

We are currently looking for dedicated ministers interested in sharing their knowledge of Christ and helping people through all of life’s issues. Our program is designed to help people through anything from career advice to relationship counseling. We believe all of those answers can be found in Christ’s teachings and need individuals that feel the same.

This position is a work from home opportunity and is available for both part time and full time job seekers. If you are interested in this chance to share your faith with those in need please forward a resume to [Click Here to Email Your Resumé].
MUST BE AN ORDAINED MINISTER. Must have documentation.

Revenue Cycle Appeals Clinician

Conifer Health Solutions is growing and adding Revenue Cycle Clinician positions to our Clinical Resource Center! The Clinical Resource Center (CRC) performs medical necessity reviews for the purposes of preauthorization and retrospective authorization/appeals to our hospital clients. Successful candidates can work from one of our existing locations in Atlanta, GA; Boca Raton, FL; St. Louis, MO; Frisco, TX. This is an excellent opportunity for the right person who is ready to work independently in a non-clinical setting and apply your knowledge and experience gained from previous managed care, utilization review and hands-on clinical care settings. Conifer provides on-going training, development and career growth opportunities. Youll enjoy the benefits of working day shifts, being off on weekends and major holidays, and participating in a monthly incentive plan. Once youve demonstrated mastery of the position and strong work habits you could also earn the opportunity to work from home as a telecommuter!

As a Revenue Cycle Clinician you will be responsible for recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review and preparing and documenting appeals based on industry accepted criteria. Other duties include:
* Performs retrospective (post -discharge/ post-service) medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review. * Constructs and documents a succinct and fact based clinical case to support appeal utilizing appropriate module of InterQual® criteria (Acute, Procedures, etc). If clinical review does not meet IQ criteria, other pertinent clinical facts are utilized to support the appeal. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization. * Demonstrates ability to critically think, problem solve and make independent decisions supporting the clinical appellate process. * Demonstrates proficiency in use of medical necessity criteria sets, currently InterQual®, as evidenced by Inter-rater reliability studies and other QA audits. * Demonstrates proficiency in utilization of electronic tools including but not limited to ACE, Accuro (formerly IMaCs), eCARE, Authorization log, InterQual®, VI, HPF, as well as competency in Microsoft Office. * Demonstrates basic patient accounting knowledge i.e. UB92/UB04 and EOB components, adjustments, credits, debits, balance due, patient liability, etc. * Serves as a resource to non-clinical personnel. * Assist in development of policy and procedures as business needs dictate. * Assists Law Department with any medical necessity reviews as capacity allows up to and including attending mediation hearings, other litigation forums, etc.

: * Demonstrates proficiency in the application of medical necessity criteria, currently InterQual® * Possesses excellent written, verbal and professional letter writing skills * Critical thinker, able to make decisions regarding medical necessity independently * Ability to interact intelligently and professionally with other clinical and non-clinical partners * Demonstrates knowledge of managed care contracts including reimbursement matrixes and terms * Ability to multi-task * Ability to conduct research regarding State/Federal appellate guidelines * Ability to conduct research regarding off-label use of medications * Must possess a valid nursing license (Registered or Practical/Vocational) * Minimum of 5 years recent acute care experience with the last 2 years in a facility environment * Medical-surgical/critical care experience preferred * Minimum of 2 years UR/Case Management experience within the last 2 years * Managed care payor experience a plus either in Utilization Review, Case Management or Appeals * Patient Accounting experience a plus * Previous classroom led instruction on InterQual® products (Acute Adult, Peds, Outpatient and Behavioral Health) preferred * Current, valid RN/LPN/LVN licensure * Certified Case Manager (CCM) or Certified Professional in Utilization Review/Utilization Management/Healthcare Management (CPUR , CPUM, or CPHM) preferred * Ability to travel approximately 10% of the time; either to facility sites, National Insurance Center (NIC) sites, Headquarters or other designated sites
Conifer Health Solutions offers a competitive compensation and benefits package that includes a monthly incentive program, health, dental, vision, disability insurance, discounted cell phone service, 401(k) match, two weeks paid vacation in your first year including 9 company paid holidays and much more!

Job : Conifer Health Solutions
Primary Location : TX-Dallas

Other Locations : GA-Alpharetta, TX-El Paso, FL-Boca Raton, TX-Frisco
Hospital/Facility : 238-Conifer - Dallas - TX
Job Type* : Full-time
Shift Type* : Exempt 80 Hour Pay Period
Shift begin time : 8:00 AM
Shift end time : 5:00 PM
Please refer to job code 1415261 when responding to this ad.

NICU Social Worker

NICU Social Worker - Telecommuter (home based nationwide)-339674

We're searching for an experienced Social Worker to fill an exciting role in our Neonatal Resource Services program, with emphasis in serving the Medicaid population. This position provides telephonic and on-site hospital support of families of babies receiving services through the neonatal intensive care unit (NICU). In this position you will enjoy excellent benefits, a regular Monday through Friday work schedule, and have the ability to make a significant, positive difference in the lives of the families we serve.

Primary responsibilities include:
•Communicate directly with families of babies currently in or recently discharged from the NICU, physicians, and community/governmental agencies.
•Collaborate with NICU nurses regarding barriers or challenges families are confronting, and assist family with solutions
•Through direct telephonic or on-site assessment, assist family members to continue to function when their baby's illness impacts their physical health, mental status and social roles.
•Assess for social, economic, and emotional factors.
•Assist members and families in long-term care planning where necessary.
•Develop working knowledge of resources readily available to interdisciplinary team and families.
•Promote effective utilization and monitoring of community resources and assist in optimization of available benefits, including referrals to outside vendors.
•Provide education on community, local, Federal, and State resources
The chosen candidate must possess:
•Masters in Social Work (MSW) with active/unrestricted social work licensure in your state of residence
•Very strong oral and written communication skills for a variety of audiences (families of babies in NICU, providers, community resources)
•At least 2 years recent experience in discharge planning
•Knowledgeable of pertinent websites, community resources, and other ways to provide assistance to consumers
•Strong computer skills
•Appreciates diversity and treats everyone with respect and dignity
We also prefer:
•Certified Case Manager
•Knowledge and experience of Medicaid programs and regulations
•3 years clinical experience in neonatal or labor/delivery clinical setting

OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you want more meaning in your career - as a clinician or a business professional - think of OptumHealth as your calling.
By providing 58 million Americans with information, tools and solutions, we are helping to guide them through the health care system, financing their health care needs, and enabling them to achieve their personal health and well-being goals.
At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Job Social Work
Primary LocationUS-Illinois
Other LocationsUS-Tennessee, US-New York
Organization CS Network Solutions
Schedule Full-time

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