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certified medical coder

Talent Groups

<div>
 
 
 Hybrid Details:
 
 Dallas, TX - Hybrid
 
 
 
 Duration:
 
 3 months to start
 
 
 
 
 
 
 Job Summary:
 
 
 
 Responsible for reviewing clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM/CPT4 codes and modifiers for billing, internal and external reporting, research, and regulatory compliance. Accurately code conditions and procedures as documented in the ICD-10-CM &amp; CPT4 Official Guidelines for Coding and Reporting. Typically reports to Coding Manager
 
 
 
 
 
 
 Minimum Qualifications:
 
 
 <ul>
 <li>
 
 Education:
 
 High School Diploma or GED required
 </li>
 <li>
 Associate Degree in medical area, preferred
 </li>
 </ul>
 
 
 
 
 
 Licenses/Certifications:
 
 
 <ul>
 <li>
 One of the following licenses is required: Certified Coding Specialist (CCS),
 
 or
 
 </li>
 <li>
 Certified Professional Coder (CPC),
 
 or
 
 </li>
 <li>
 Registered Heath Information Technician (RHIT),
 
 or
 
 </li>
 <li>
 Certified Medical Coder (CMC)
 
 or
 
 </li>
 <li>
 Certified Coding Associate (CCA)
 </li>
 </ul>
 
 
 
 
 
 Experience / Knowledge / Skills:
 
 
 <ul>
 <li>
 Two (2) years outpatient Neurosurgery (preferred), Required 2 Years outpatient E/M coding experience required, six (6) months of HCC experience preferred
 </li>
 <li>
 Ability to code Neurology for physicians
 </li>
 <li>
 Effective oral and written communication skills.
 </li>
 <li>
 EPIC Experience Preferred
 </li>
 </ul>
 
 
 
 
 
 Principal Accountabilities:
 
 
 <ul>
 <li>
 Assigns codes for diagnoses, treatments, and procedures according to the appropriate classification system for outpatient encounters.
 </li>
 <li>
 Utilizes technical coding principals and APC reimbursement expertise to assign appropriate ICD-10-CM diagnoses, CPT 4 and modifiers.
 </li>
 <li>
 Reviews documentation to extract and enter data accurately for other abstracting fields.
 </li>
 <li>
 Follow coding compliance policies, official coding guidelines, regulatory requirements and internal policies and procedures affecting the coding process.
 </li>
 <li>
 Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.
 </li>
 <li>
 Ability to communicate with providers, leadership and clinical staff; Query and provide guidance on documentation/coding
 </li>
 <li>
 Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
 </li>
 <li>
 Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
 </li>
 <li>
 Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann&rsquo;s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
 </li>
 <li>
 Other duties as assigned.
 </li>
 </ul>
</div>

Certified Medical Coder

Houston Methodist

<div>At Houston Methodist, the Sr Coding Specialist position is responsible for applying correct coding conventions to patient charge encounters in a clinical environment. This position abstracts diagnosis and procedural services from the physician record and reviews and corrects charge review and claim edit related coding errors in the electronic health record. In addition, the Sr Coding Specialist position is responsible for reviewing, correcting and appealing coding related claim denials and mentoring and cross training Coding Specialists.
<div>FLSA STATUS 
Non-exempt 
 
QUALIFICATIONS 
 
EDUCATION<ul><li>
High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
</li></ul> 
EXPERIENCE<ul><li>
Five years of professional coding experience
</li></ul> 
LICENSES AND CERTIFICATIONS 
Required<ul><li>
Must have one of the following: &bull;CCS - Certified Coding Specialist (AHIMA) &bull;CPC &ndash; Certified Professional Coder (AAPC)
</li></ul> 
SKILLS AND ABILITIES<ul><li>
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations
</li><li>Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
</li><li>Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
</li><li>Knowledge of ICD-9, ICD-10, and CPT codes
</li><li>Working knowledge of medical terminology, anatomy, and physiology
</li><li>Proficiency with Microsoft Office applications such as Word and Excel
</li><li>Must be a self-motivated individual with the ability to think critically and work independently
</li><li>Must have the ability to multi-task in a fast paced rapidly changing healthcare environment
</li><li>Demonstrates a high level of professionalism, customer service, and interpersonal skills and operates under strict confidentiality guidelines
</li>Strong training, leadership, and mentoring skills 
<li>
</li></ul> 
 
ESSENTIAL FUNCTIONS 
 
PEOPLE ESSENTIAL FUNCTIONS<ul><li>
Communicates regularly with physicians and Physician Organization Central Business Office (PO CBO) staff on clarification to accurately code diagnosis and procedures.
</li><li>Collaborates with management on coding and diagnosis issues to reduce claims denials by providing verbal and written communication.
</li><li>Assists with knowledge sharing, training Coding Specialists, and department cross training; provides support to other team members as advised by the manager and/or supervisor.
</li></ul> 
SERVICE ESSENTIAL FUNCTIONS<ul><li>
Responds to or clarifies internal requests from all business partners for medical coding information in a timely manner.
</li><li>Participates in coding round tables and in-services for continuing education.
</li><li>Cross trains and provides back up coverage of team members to ensure continuous coding and charge capture activities for PO departments.
</li></ul> 
QUALITY/SAFETY ESSENTIAL FUNCTIONS<ul><li>
Codes and abstracts medical records for reimbursement purposes from patient charts, physician documentation, and medical diagnostic and/or interventional reports using current coding conventions and guidelines and tools such as 3M encoder.
</li><li>Reviews individual medical records to verify and substantiate diagnosis and procedures for charge review, claim edit(s) and/or denied claims and submits clinical appeal or corrected claim.
</li><li>Assists with the creation and review of department specific coding workflows and expectations.
</li></ul> 
FINANCE ESSENTIAL FUNCTIONS<ul><li>
Matches charge documents to charge review &amp; claim edit sessions, billing sheets, operative reports, and medical records to ensure correct codes are applied and billable services are captured.
</li><li>Works charge review and claim edit sessions within two business days of posting to the assigned work queues.
</li><li>Investigates and appeals unpaid, denied and partially paid claims by third party payors.
</li></ul> 
GROWTH/INNOVATION ESSENTIAL FUNCTIONS<ul><li>
Pursues ongoing professional growth and development and participation in team meetings.
</li><li>Provides on-going coding and documentation education to physicians and clinical staff.
</li>Attends, in person, quarterly coding and revenue integrity team meetings. 
<li>
</li></ul> 
 
SUPPLEMENTAL REQUIREMENTS 
<ul>
WORK ATTIRE<li><ul><li>
Uniform: No
</li><li>Scrubs: No
</li><li>Business professional: Yes
</li><li>Other (department approved): No
</li></ul></li> 
ON-CALL* 
<li><ul><li>Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.</li></ul></li><li><ul><li>
On Call* No
</li></ul></li> 
TRAVEL** 
**Travel specifications may vary by department**<li><ul><li>
May require travel within the Houston Metropolitan area Yes
</li><li>May require travel outside Houston Metropolitan area No
</li></ul></li></ul></div>QUALIFICATIONS 
 
EDUCATION<ul><li>
High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
</li></ul> 
EXPERIENCE<ul><li>
Five years of professional coding experience
</li></ul> 
LICENSES AND CERTIFICATIONS 
Required
Must have one of the following: &bull; CCS - Certified Coding Specialist (AHIMA) &bull; CPC &ndash; Certified Professional Coder (AAPC) 
<ul><li>
</li></ul> 
Company Profile:
Houston Methodist Specialty Physician Group is an integral part of Houston Methodist&rsquo;s overall strategy to become one of the nation&rsquo;s leading academic medical centers. Established as a nonprofit corporation certified by the Texas State Board of Medical Examiners, the Specialty Physician Group enables physicians to maintain autonomy with respect to clinical practice while growing their practice within an academic environment.
Houston Methodist is an Equal Opportunity Employer.</div>

Senior Coding Specialist - Remote - Must Reside in TX

CenterWell

<div><h1 class="jobSectionHeader">Become a part of our caring community and help us put health first 
</h1>
The Medical Coding Professional 2 extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Medical Coding Professional 2 confirms appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.<h1 class="jobSectionHeader"> 

Use your skills to make an impact 

</h1>NOTE: This is a Hybrid role candidate must reside in Houston
Consultative Coder
The Consultative Coder provides medical coding expertise to support clinical staff (Physicians and Advanced Practice Providers) to ensure the documentation within medical records supports diagnostic and procedural coding.
Relationship/Concierge Services:<ul><li>
Cultivate relationships with clinicians (Physicians and Advanced Practice Providers) to serve as the single point of contact for questions and issues relating to documentation and coding.</li><li>
Based on one-on-one engagement with clinicians, identify documentation improvement areas and partner with clinical and coding education to deliver education related to improvement opportunities</li><li>
Analyze trends, triage, and answer questions in real-time.</li><li>
Research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues.</li></ul>
Post-Visit/Offshore Coding Collaboration:<ul><li>
Perform Quality Assurance on post-visit reviews. (Frequency and sampling methodology to be determined)</li><li>
Review the encounter for potential missed opportunities.</li><li>
Address nonbillable services at the provider level.<ul><li>
Address documentation deficiencies resulting in not billable services in a timely manner (missing chief complaint, missing time for audio only visits, and missing telehealth platform)</li><li>
Serve as liaison to provide timely updates on documentation requirements and process changes.</li></ul></li></ul>
Mergers and Acquisitions:<ul><li>
Responsible for the special handling of Mergers &amp; Acquisitions:<ul><li>
Perform Problem list cleanup (as outlined by compliance)</li><li>
Conduct PCO Process training including but not limited to reporting for open notes and addendums, and gap attestation process and performance expectations.</li><li>
Train acquired providers on PCO documentation requirements and processes.</li></ul></li></ul>
Other Duties:<ul><li>
Lead Special Projects within the Division/Markets<ul><li>
As requested by Market leaders, perform the following duties:<ul><li>
Summarize and analyze AWV completion rates ( what criteria is needed to complete AWV)</li><li>
Analyze EDAPS; report the variances between datahub and eCW.</li><li>
Conduct Chart reviews to identify educational opportunities.</li><li>
Perform individual chart research as requested.</li></ul></li></ul></li><li>
Collaborate with HEDIS leaders and champions to identify HEDIS gaps and deficiencies.
</li><li>Participate in Payer calls/chart reviews.<ul><li>
Compile payer findings and assist with research.</li></ul></li><li>
Participate in payor meetings/discussions to ensure accurate data submission.</li></ul>
Required:<ul><li>
3 or more years of technical Medical Coding experience or similar (including IPA and Offshore coding management)</li><li>
RHIA, RHIT, CCS, or CPC Certification</li><li>
Must reside in the Houston area</li><li>
Must be able to travel to assigned clinics 30% of the time or more depending on market needs</li><li>
Proficient in MS Office Suite (Excel, PowerPoint, etc.), Zoom/Teams</li><li>
Must be comfortable with being on camera and presenting via Zoom/Teams</li></ul>
Preferred:<ul><li>
Passionate about contributing to an organization focused on continuous improvement.</li><li>
Proficient verbal and written communication skills</li><li>
Bilingual (English &amp; Spanish)</li></ul>
Knowledge, Skills, and Abilities:<ul><li>
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint</li><li>
Ability to communicate effectively and sensitively with clinicians and team members in stressful situations.</li><li>
Possess strong business acumen, excellent strategic thinking, and effective critical thinking skills.</li><li>
Excellent verbal and written communications skills with demonstrated ability to communicate, present, and influence both credibly and effectively at all levels of an organization.</li><li>
Ability to work in a rapidly changing, matrixed environment.</li><li>
Has a positive, collaborative mindset to foster partnership within and the Coding, Audit, and Education department, the PCO, and Humana</li></ul>
#LI-MM1
#LI-Hybrid
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. 

$65,200 - $89,000 per year 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, &ldquo;Humana&rdquo;) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.<h1 class="jobSectionHeader"> 
About Us 
</h1>
About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient&rsquo;s well-being.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation&rsquo;s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first &ndash; for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. 
 
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.</div>

Consultative Coding Professional - Houston

Texas Children's Hospital

<div>
 
 Job Description
 
 
 
 We are searching for a Medical Assistant II with our Outpatient BCM OBGYN Clinic in The Medical Center - someone who works well in a fast-paced setting. In this position, you will provide patient care and excellent customer service in a healthcare setting. You will also assist in the coordination of flow and provider schedules to effectively manage patient care.
 
 
 &ldquo;As part of our commitment to maintaining a safe and healthy workplace, all successful candidates will be required to undergo respiratory fit testing in compliance with occupational health and safety standards.&rdquo;
 
 
 Think you&rsquo;ve got what it takes?
 
 
 
 Qualifications
 
 
 
 
 One of the following certifications are required:
 
 
 
 
 <ul>
 <li>
 CCMA- Certified Clinical Medical Assistant certificate from the National Health career Association required
 </li>
 <li>
 CMA-AAM- Certified Medical Assistant from the American Association of Medical Assistants
 </li>
 <li>
 EMT Certified Emergency Medical Technologist from the Texas Department of State and Health Services required
 </li>
 <li>
 EMT-A Certified Advanced Emergency Medical Technologist from the Texas Department of State and Health Services required
 </li>
 <li>
 EMT-B Certified Emergency Medical Technologist-Basic from the Texas Department of State and Health Services required
 </li>
 <li>
 EMT-I Certified Emergency Medical Technologist-Intermediate from the Texas Department of State and Health Services required
 </li>
 <li>
 EMT-P Certified Emergency Medical Technologist-Paramedic from the Texas Department of State and Health Services required
 </li>
 <li>
 LIC PAR- License Paramedic from the Texas Department of State and Health Services required
 </li>
 <li>
 NCMA- National Medical Assistant Certification from the National Center for Competency Testing required
 </li>
 <li>
 NRCMA - Nationally Registered Certified Medical Assistant from the National Association of Health Professionals required
 </li>
 <li>
 RMA- Registered Medical Assistant from the American Association of Medical Personnel, American Allied Health, American Medical Technologists, or American Registry of Medical Assistants required
 </li>
 <li>
 2 years of related experience required
 
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 
 <ul>
 <li>
 Responds to customer questions with prompt information and/or services related to appointment status, wait time, or unanticipated problems
 </li>
 <li>
 Performs patient registration procedures per clinic process
 </li>
 <li>
 Utilizes the patient management system to mark the arrival of patients and opens accounts
 </li>
 <li>
 Changes status of all non-arrived patients daily to reflect canceled, no-show, or rescheduled status
 </li>
 <li>
 Prioritizes patients to be roomed based on appointment and arrival times and other clinic procedures
 </li>
 <li>
 Assists, as needed, licensed staff with the non-financial aspects of the inpatient admission process
 </li>
 <li>
 Assists with patient escorts and helps with paperwork as needed
 </li>
 <li>
 Assists in the collection and documentation of patient/family data which includes biophysical and psychosocial information according to clinic scope
 </li>
 <li>
 Reports abnormal or out of range data to RN or provider
 </li>
 <li>
 Ensures that requisitions have necessary clinical, demographic, billing, and payor information
 </li>
 <li>
 Monitors patient flow and fills in or assigns staff as necessary to avoid bottleneck and assure minimal patient wait time
 
 
 
 </li>
 </ul>
 
 About Us
 
 
 
 Since 1954, Texas Children&rsquo;s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children&rsquo;s hospital in Texas, and among the top in the nation by U.S. News &amp; World Report as well as recognition from Houston Business Journal as one of this city&rsquo;s Best Places to Work for ten consecutive years.
 
 
 Texas Children&rsquo;s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Tower for pediatric research; Texas Children &rsquo; s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children &rsquo; s Hospital West Campus, a community hospital in suburban West Houston; Texas Children &rsquo; s Hospital The Woodlands, the first hospital devoted to children &rsquo; s care for communities north of Houston; and Texas Children&rsquo;s Hospital North Austin, the new state-of-the-art facility providing world-class pediatric and maternal care to Austin and Central Texas families. We have also created Texas Children &rsquo; s Health Plan, the nation &rsquo; s first HMO focused on children; Texas Children &rsquo; s Pediatrics, the largest pediatric primary care network in the country; Texas Children &rsquo; s Urgent Care clinics that specialize in after-hours care tailored specifically for children; and a global health program that is channeling care to children and women all over the world. Texas Children &rsquo; s Hospital is affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.
 
 
 To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
 
 
 Texas Children&rsquo;s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
</div>

Medical Assistant II - Outpatient OBGYN Clinic

Beamer Urgent Care

Job Summary We are seeking a dedicated and skilled Bilingual (spanish) Certified Medical Assistant to join our healthcare team. The ideal candidate will play a crucial role in providing high-quality patient care in both clinic and hospital settings. This position requires a strong understanding of medical procedures, excellent communication skills, and the ability to work effectively in a fast-paced environment. The Certified Medical Assistant will assist healthcare professionals in delivering outpatient services, ensuring patient comfort, and maintaining accurate medical records.Responsibilities<ul><li>Assist physicians and nursing staff with patient examinations and procedures.</li><li>Administer medications as directed by healthcare providers.</li><li>Perform basic life support (BLS) as necessary.</li><li>Collect and document patient medical histories, vital signs, and other relevant information.</li><li>Prepare patients for examinations by explaining procedures and answering questions.</li><li>Maintain cleanliness and organization of examination rooms and medical equipment.</li><li>Ensure compliance with clinic protocols, including coding for insurance purposes.</li><li>Support the healthcare team in managing patient flow within the clinic or hospital setting.</li><li>Participate in ongoing training to stay current with best practices in patient care.</li></ul>Experience<ul><li>Certification as a Medical Assistant from an accredited program is required.</li><li>Experience working in a clinic</li><li>Previous experience with coding for medical billing is advantageous.</li></ul>Join our team to make a difference in the lives of our patients while advancing your career in the medical field!Job Type: Full-timePay: $15.00 - $17.00 per hourWork Location: In person

Certified Medical Assistant

Onco360

<div><div>Are you someone looking for professional career growth? Onco360 Pharmacy is looking for a Lead Medical Benefits Verification Specialist for our Pharmacy located in Houston, TX.</div>
<div></div><div>Work Hours: Monday-Friday 8:30 - 5:00pm CST</div>
<div></div><div>**Starting salary at $23/hr** We also offer quarterly incentive bonuses.</div>
<div></div><div>We offer a variety of benefits including:</div>
<ul><li>Medical, Dental &amp; Vision insurance</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Paid Volunteer Day</li>
<li>Floating Holiday</li>
<li>Referral Incentive</li>
<li>Paid Life, and short &amp; long-term disability insurance</li>
</ul>
<div></div><div>Lead Medical Benefits Verification Specialist Summary:</div>
<div>The Lead Medical Benefits Verification Specialist is responsible to support the Medical Benefits Verification Specialist roles while performing insurance authorization and verification for all patients scheduled for services. The Lead will investigate, review, and load accurate patient insurance for medical coverage, assign coordination of benefits, and investigate/identify authorization requirements needed to obtain medication coverage. Support the department's Manager with the daily workflow and distribution of workload, answer questions as the assigned subject matter experts, assist with mentoring and training new members of the team and report any system or process issues identified.</div>
<div></div><div>Lead Medical Benefits Verification Specialist Major Responsibilities:</div>
<div><ul><li>Support staff in verifying Commercial and Government payer eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profile. This involves contacting Medicare or other relevant government payers to confirm coverage and benefits for specific services. Verify Commercial insurance plans eligibility and benefits utilizing electronic resources to load primary, secondary, tertiary, etc. insurances to patient profiles. Confirming patient eligibility and benefits with various commercial insurance carriers (i.e. Aetna, Humana, Anthem, Cigna, etc.).</li>
<li>Facilitate process for requesting medical authorizations, Single Case Agreements, Letter of Agreements, and Terms of Agreement for applicable commercial, Medicaid, and Medicare, or facility medication claims.</li>
<li>Investigate payer plans: Research and document benefit plan specifics for various payer plans, including cost-share responsibilities and restrictions. Address intricate benefit verification issues, such as those involving high-cost or specialized treatments, denials, and appeals.</li>
<li>Develop expertise: Maintain in-depth knowledge of insurance policies, coverage terms, and complex billing practices. Identify the appropriate clinical records and</li>
<li>submit the authorization request to the insurance company based on plan requirements for approval.</li>
<li>Handle complex cases: Address intricate benefit verification issues, such as those involving high-cost or specialized treatments, denials, and appeals.</li>
<li>Collaborate across departments: Work closely with clinical staff, billing and coding teams, and administrative teams to resolve insurance issues and ensure seamless patient care. Will be the liaison between the ordering physician and insurance company to ensure all requirements to secure approval are identified and communicated.</li>
<li>Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
<li><div>Lead process improvement: Analyze workflows, identify opportunities for improvement, and implement more efficient procedures to reduce turnaround times and improve accuracy. Assist the Medical Verification Specialists in achieving: &gt;95% accuracy/quality while handling accounts, as measured by account audits &gt;95% quality of expected customer service etiquette, as measured by phone call audits Meet or exceed Lower controls of average productivity amongst the team productivity standards assist the manager of the department with escalated issues, tracking system and process issues.</div>
 </li><li><div>Mentor and train staff: Guide and train junior specialists on proper benefit verification and claim processing procedures.</div>
</li><li><div>Ensure compliance: Adhere to all federal and state regulations, including the Health Insurance Portability and Accountability Act (HIPAA), to maintain patient confidentiality.</div>
</li><li><div>Performs other duties as assigned.</div>
</li></ul></div><div>Education/Learning Experience</div>
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification</li>
<li>Desired: Associate degree or equivalent program from a 2-year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience</li>
</ul><div>Work Experience</div>
<ul><li>Required:
<div>3+ years&rsquo; Medicare and Medical benefit verification experience</div>
</li><li><div>Desired: 5+ years Specialty Pharmacy, Medical Verification, and/or Infusion benefit verification experience</div>
</li></ul><div>Skills/Knowledge</div>
<ul><li>Required: Medicare and Medical insurance and benefit verification, medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, coordination of benefits, Understanding Medicare Parts A, B, C, and D, as well as relevant laws and guidelines, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, basic math and analytical skills, Intermediate typing/keyboarding skills.</li>
<li>Desired: Specialty Pharmacy experience, Medicare Billing Experience, Medical Authorization experience</li>
</ul><div>Licenses/Certifications
</div><ul><li>Required: None</li>
<li>Desired: Registration with Board of Pharmacy as required by state law or Certified Pharmacy Technician (PTCB)</li>
<li><div>Certified Revenue Cycle Representative (CRCR)</div>
<div>Certified Medical Insurance Specialist (CMIS)</div>
</li></ul><div></div><div>Behavior Competencies</div>
<ul><li>Required: Independent worker, self-motivated 
Analytical skills: The ability to interpret complex insurance documents and identify potential gaps in coverage is crucial for handling more difficult cases. 
Communication: Excellent verbal and written communication skills are essential for interacting with insurance companies, patients, and other healthcare professionals. 
Problem-solving: Senior specialists must possess strong problem-solving skills to efficiently address and resolve insurance-related issues. 
Technical proficiency: Expertise in electronic health record (EHR) systems, insurance verification software, and payer portals is necessary. 
Leadership abilities: The capacity to mentor junior staff and lead process improvement projects is a key differentiator for a senior role.</li>
</ul>
<div></div><div>Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.</div>
<div></div><div>A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.</div>
<div></div><div>We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.</div></div>

Lead Medical Benefits Verification Specialist

ADVANCED SPECIALTY HOSPITALS

<div>Advanced Houston Specialty Hospital is looking for Lead Patient Care Technician for night shifts to join our team of health care professionals in a newly renovated facility at 205 Hollow Tree Lane, Spring, TX .
Join our team and help us provide top-tier medical services to a justice involved population!
The Lead Patient Care Technician serves as a clinical support leader and provides direct patient care. This role assists nursing and medical staff in delivering safe, efficient, and patient-centered care while supporting daily operations, workflow coordination, and guiding of Patient Care Technicians. The Lead PCT helps maintain compliance with facility policies, security procedures, and applicable healthcare regulations while promoting a professional, respectful, and secure environment for staff and patients.
Essential Functions:
<div><ul><li>Coordinate daily assignments and assist with staffing coverage to maintain operational efficiency.
</li></ul><ul><li>Serve as the primary resource for Patient Care Technicians, offering guidance, support, and workflow coordination.
</li></ul><ul><li>Assist nursing staff with patient assessments, documentation, and preparation for medical procedures or examinations.
</li></ul><ul><li>Monitor completion of assigned tasks such as vital signs, patient observation, specimen collection, ECGs, and mobility assistance.
</li></ul><ul><li>Verify timely response to patient needs and ensure staff remain engaged in the patient care environment.
</li></ul><ul><li>When staffing is limited or patient needs arise, may be assigned to work as a Certified Nursing Assistant (CNA) within their scope of practice.
</li></ul><ul><li>Collaborate with security and medical staff to ensure the safety and security of patients and personnel.
</li></ul><ul><li>Regular and predictable attendance required.
</li></ul></div>Education and Experience Requirements:
High school diploma or equivalent required. Minimum of one year of experience working as a CNA and prior lead, charge, or supervisory experience in a healthcare setting. Certification as a Certified Nursing Assistant (CNA) required. Valid driver&rsquo;s license with an acceptable driving record required, unless waived by management.
Post Hire Requirements:
Must successfully complete annual in-service training requirements to include maintaining licenses, certifications, and passing an annual background check.
Advanced Houston Specialty Hospital (AHSH) is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, sex, disabled status, veteran status, genetic information, national origin, or any other category protected by federal law. AHSH participates in E-Verify. We strive to provide reasonable accommodation for qualified individuals with disabilities, including disabled veterans, in our job application and hiring process. If you are interested in employment opportunities with AHSH and need assistance, please contact our staffing department at 801-693-2702.</div>

Lead Patient Care Technician (Nights)

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