Qureos Mentor

Appalachian Regional Healthcare

<div>Overview:
<div>
Under general supervision, the Clinic Billing and Follow-Up Specialist handles essential billing and insurance follow-up functions. This role requires a fundamental understanding of insurance claim processing, knowledge of HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handle denials, and perform follow-up with insurers to ensure claims resolution. The position encompasses business office responsibilities related to patient accounts, including charge import, appeals, diagnostics and procedural coding, and claim follow-up with third-party payers to achieve a zero-balance resolution.</div>
Special Instructions: Position is On-Site with Hybrid work option after at least six months Responsibilities:
<ul><li>Promote the mission, vision, and values of the organization</li><li>
Import charges from queues in a timely manner and append modifiers or any required information for claim transmission</li><li>
 Review daily accounts that are ready to be billed in Waystar from Meditech</li><li>
 Initiate correction on all claims with errors by the designated time</li><li>
Follow up on any correspondence that may have been received on that day or the previous day</li><li>
 Cross train on billing all lines of business to the different payers</li><li>
 Pull listing of all accounts assigned to be follow up by specific payer</li><li>
 Diagnostic and procedural coding</li></ul><div><b>
Follow-Up Responsibilities</b></div><ul><li>
Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies.</li><li>
Communicate with third-party representatives as necessary to complete claims processing and /or resolve problem claims.</li><li>
Follow-up daily on post processing activity including but not limited to, rejected billings, adjustments, and rebilling, and denied claims for accounts.</li><li>
Maintain accounts receivable detail of their accounts through tasking.</li><li>
Maintains standards per payer for percentage accounts &gt;90 days.</li><li>
Works minimum standard number of accounts per payer per day.</li><li>
Meets or exceeds collection goals by payer each month.</li><li>
Works all assigned accounts as assigned, depending on balance.</li><li>
Complete appeals as required.</li><li>
Participates in educational activities and attends monthly department staff meetings.</li><li>
Maintains confidentiality: adheres to all HIPAA guidelines/regulations.</li><li>
Other duties as assigned from time to time.</li><li>
Attend educational activities and monthly department staff meetings</li><li>
Perform other duties as assigned</li></ul>
Qualifications:
<div><div><ul><li>High School Diploma or GED</li></ul></div><div></div><div><div><br>
<ul><li>
Six months previous experience in clinic registration, billing and collections, financial counseling, or customer service preferred</li></ul></div></div><div></div><div><div><br>
<ul><li>
Knowledge of medical terminology preferred</li></ul><ul><li>
Basic computer proficiency</li></ul><ul><li>
Typing speed: minimum 40 WPM</li></ul><ul><li>
Familiarity with CPT and ICD-9 coding is helpful</li></ul><ul><li>
Good written and verbal communication skills are essential for account follow-up</li></ul></div></div></div></div><div></div>

Clinic Billing Specialist

<div>Overview:
<div>
The Staff Nurse is accountable for interpreting the plan of medical care, assessment of patients clinical decision-making regarding nursing care, assuring nursing care is provided in a safe and competent manner, providing individualized nursing care, and evaluating nursing care for groups of patients.</div><div></div><div><br>
The Staff Nurse provides clinical supervision to LPNs, Nursing Aides, and Nursing Service Clerks where applicable.</div>
Responsibilities:
<div>
MAJOR ACTIVITIES</div><ul><li>Takes report from prior shift and gives report to oncoming shift which includes condition of patients,</li></ul><div>
diagnosis, treatments, procedures given and required and other aspects of the plan of care.</div><ul><li>Performs assessments and reassessments of patients.</li><li>Reviews ancillary service reports, communicates abnormal results to physicians, and notifies</li></ul><div>
supervisor and physician when ancillary services are not completed.</div><ul><li>Interprets plan of medical care, evaluates patients, and devises patient plan of care.</li><li>Maintains proper control of medicine, equipment and supplies specific to the assigned unit.</li><li>Plans for discharge of patient considering all available resources and continuum of care needs.</li><li>Refers patients to chaplain, social worker, and agencies as required.</li><li>Provides a safe and secure environment for the patient.</li><li>Implements the patient plan of care by assigning tasks to nursing and non-nursing personnel, and continuously assessing and evaluating patient care and patient's responses to nursing care.</li><li>Performs nursing treatments and procedures and total patient care which may require expert skill and judgment in accordance with established nursing standards</li><li>May accompany physicians when possible on rounds, communicates pertinent information about patient to the physician, and assists the physician with treatments and procedures or delegate if not possible.</li><li>Performs certain special procedures for which specialized training and supervised experience has been received.</li><li>Plans for and provides effective patient and family education.</li><li>Documents pertinent findings, plan of care and evaluation of care in the medical record.</li><li>Assists patients in performing activities of daily living to meet the basic human needs.</li><li>Prepares and maintains reports, charts, records, and forms as required by hospital, state, and federal regulations.</li><li>May accompany patients who are transferred to another medical facility.</li><li>Notifies supervisor, doctor, and/or family/guardian as appropriate when patient's condition changes.</li><li>Observes and evaluates work performed by LPNs, Nursing Aides, and Clerks to validate that treatments and procedures are being performed in compliance with the plan of care and established hospital guidelines.</li><li>Participates in teaching activities for other hospital personnel and nursing students.</li><li>Participates in the orientation of new employees.</li><li>Participates in interdisciplinary team meetings</li><li>Participates in committee meetings as requested.</li><li>Attends in-service programs per contract.</li><li>Assumes responsibility for personal professional development.</li><li>Assists in the development of review and revision of Nursing policies and procedures.</li><li>Respects the dignity and confidentiality of all matters relating to the patients.</li><li>Operates crucial care equipment such as respirators, temporary pacemakers, defibrillators, and other emergency equipment.</li><li>Set-up, maintains, interprets results of cardiac and hemodynamic monitor required and takes action as indicated by nursing practice and hospital procedure.</li><li>Perform such special procedures as endotracheal and tracheostomy suctioning; tracheostomy care; extubation; cardio-pulmonary resuscitation; arterial punctions; care of chest tubes and plerevac; set-up and assistance with peritoneal dialysis, paracentesis, thoracentesis.</li><li>Performs other related duties as required within the scope of the job classification.</li></ul><div></div><div><br>
SPECIFIC ACCOUNTABILITIES</div><ul><li>Responsible for assessment/reassessment of patients and documentation of nursing intervention.</li><li>Responsible for implementing the patient plan of care.</li><li>Responsible for determining which nursing acts can be delegated and to whom.</li><li>Responsible for providing direction and assistance to those supervised, observes and monitors the activities of those supervised and evaluates the effectiveness of acts performed under supervision.</li><li>Responsible for assuring that the individual performing delegated nursing acts has the necessary educational preparation and validation of competence in order to perform the act in a safe manner.</li><li>Responsible for preparing reports, charts, records, and forms required by hospital, state and federal agencies.</li><li>Responsible for participating in educational programs to further professional growth and development, and assisting in conducting in-service programs.</li><li>Perform other duties as assigned.</li></ul><div></div><div><br>
DEFINITION: SUPERVISION The provision of guidance by a qualified nurse for the accomplishment of a nursing task with periodic observation and evaluation of the performance of the task including validation that the nursing task has been performed according to established standards of practice [ 201 KAR 20:400 Section 1 (7)].</div>
Qualifications:
<div><b>
Education</b></div><div>
&middot; Graduation from a State accredited or approved school of nursing. &middot; Must maintain current licensure in state of practice.</div><div></div><div><b><br>
Required Skills, Knowledge, and Abilities</b></div><div>
Prior to assignment as sole RN provider, the nurse must successfully complete critical care course acceptable to the Director of Nursing and demonstrate mastery of equipment, diagnostic responsibilities, and procedures required of the critical care nurse.</div><div>
Such course work shall include:</div><ul><li>Cardiopulmonary resuscitation and management of an obstructed airway.</li><li>EKG interpretation.</li><li>Drug therapy, including emergency drug therapy via the I.V. route, or routes normally left to the physician.</li><li>Hemodynamic monitoring.</li><li>Critical care procedures.</li></ul><div>
The nurse shall be adequately oriented to policies, procedures and equipment. Orientation shall include safety procedures, infection control practices, and performance improvement activities</div></div>

Registered Nurse Tier 1

<div>Overview:
<div>
Provides bedside respiratory care to patients as assigned by supervisors and given on the physician's written order for both in house and out patient care.</div>
Qualifications:
<div><b>
Minimum Education</b></div><div>
Must be a graduate of an approved school of respiratory care</div><div></div><div><b><br>
Required Licenses/Certifications</b></div><div>
Must be registered, or registry eligible, certified or certified eligible
<br>
Must possess current state license<br>
CPR certification
<br>
ACLS certification<br>
PALS certification (optional)<br>
NALS certification (optional)</div><div></div><div><b><br>
Required Skills, Knowledge, and Abilities</b></div><div>
ACLS provider<br>
CPR provider<br>
PALS/NALS provider (optional)</div><div></div><div><b><br>
Required Regulations</b></div><div>
Required to comply with OSHA regulations for the N95 respirator training and fit testing.<br>
Adhere to infection control policies and guidelines appropriate for their work area. Hand hygiene and PPE (job applicable) followed when appropriate.</div></div>

Certified R.T. Tech Non-Union Highlands

<div><h2 class="jobSectionHeader"><b>Overview
</b></h2><div><div><div><div>The Care Coordinator will work with other medical professionals to provide the best healthcare possible to patients. This coordinated, team-based care will be provided to individuals through effective partnerships with patients, caregivers, families, community resources, and their physician with the Care Coordinator serving as the primary contact point, advocate, and resource. The Care Coordinator will work in collaboration and continuous partnership with the patient to ensure that the patient understands every aspect of their care and will promote adherence to a care plan developed in coordination with the patient, primary care provider, and family / caregivers. The Care Coordinator will connect patient to relevant community resources with the goal of enhancing patient health and well-being, increasing patient satisfaction, and reduction health costs by managing relationships with tertiary care providers, transitions-in-care, and referrals. This individual will also work with administration to create policies and make decisions that are in the best interest of patients and will facilitate a shared goal model across settings of care to achieve coordinated high-quality care that is patient and family centered.</div>
</div></div></div><h2 class="jobSectionHeader"><b>Responsibilities
</b></h2><div><div><div><ul><li>Promote timely access to appropriate care</li><li>
Increase utilization of preventative care, reduce emergency room utilization and hospital readmissions</li><li>
Provide medication reconciliation</li><li>
Assess patient&rsquo;s unmet health and social needs</li><li>
Develop a care plan with the patient, family/caregiver, and providers and monitor adherence to these care plans evaluating effectiveness, patient progress, and facilitating change as needed</li></ul><ul><li>
Facilitate patient access to appropriate medical and specialty providers</li><li>
Educate patient and family/caregivers about relevant community resources</li><li>
Cultivate and support primary care and specialty provider co-management with timely communication, inquiry, follow up, and integration of information into the care plan regarding transitions-in-care and referrals</li><li>
Assist in the identification of high-risk patients</li><li>
Implement an effective internal tracking system for identified patients</li><li>
Promote health behaviors in all populations and ensure navigation assistance with community resources</li><li>
Ensure active tracking of test results, medication management, and adherence to follow-up appointments</li></ul>
</div></div></div><h2 class="jobSectionHeader"><b>Qualifications
</b></h2><div><div><div><div><b>Education</b></div><div></div><p><br>
Must be a current licensed Practical or Registered Nurse or Medical Assistant</p><p>
or have obtained a bachelor&rsquo;s or master&rsquo;s degree in Social Work</p><div><b>
Minimum Work </b><b>Experience</b></div><div>
2 + years of experience in a clinic, hospital, or quality management environment</div><div></div><div><b><br>
Required Skills, Knowledge, and Abilities</b></div><br>
<div></div><ul><li>
Ability to identify and implement appropriate patient communication strategies and overcome accessibility barriers</li><li>
Experience in, and sensitivity to, the unique dynamics of an integrated hospital system</li><li>
Exposure to and participation with health IT systems and data reports</li><li>
Demonstrated skills in planning, organizing, decision making, analytical thinking, and communication required</li><li>
Demonstrated skills in Quality Improvement and operational improvements (e.g. &ldquo;Lean&rdquo;) methods.</li></ul></div></div></div></div>

Care Coordinator

Join Appalachian Regional Healthcare and explore 4   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Appalachian Regional Healthcare

About Company

Clinic Billing Specialist

Registered Nurse Tier 1

Certified R.T. Tech Non-Union Highlands

Care Coordinator