Role Description - Review patient insurance policies to determine specific prior authorization requirements based on CPT codes for all upcoming surgical procedures. - Initiate prior authorization requests through provider portals, phone communication, or fax submission. - Track and follow up on submitted authorization requests, ensuring approvals are obtained and properly attached and linked to the patient’s scheduled appointment. - Prepare and submit appeals when authorization requests are denied or require reconsideration. - Communicate with patients when necessary to explain the prior authorization process or request additional required information. - Accurately document all prior authorization activities in patient charts to ensure the care team is informed prior to the patient’s appointment. - Monitor Microsoft Teams chats for questions, clarifications, or appointment updates that may impact prior authorization status in real time. Qualifications - Strong attention to detail and organizational skills. - Effective verbal and written communication skills. - Proficiency with Microsoft Teams, Outlook, and Excel preferred. - Strong problem analysis and resolution skills. - Ability to effectively multitask while working across multiple computer-based information systems. - Capacity to work independently and remain productive in a self-directed environment. Requirements - This is a full time role. - Up to $6/hr. Important Notice By submitting your application, you acknowledge and provide your explicit consent to the collection, processing, storage, and use of the personal information contained in your application. You agree that Remote Raven may contact you using the details provided for recruitment and talent management purposes. You further authorize Remote Raven to retain your information within its database for consideration in current and future employment opportunities, in compliance with applicable data protection and privacy regulations.

About Prep Network Prep Network (www.prepnetwork.com) operates websites -- 100+ in total -- aimed at maximizing visibility and value for high school athletes at all levels. Our scouts provide content, player rankings, and event coverage year-round. Prep Network operates Prep Hoops, Prep Girls Hoops, Prep Redzone, Prep Dig, and Prep Lacrosse. Combined, Prep Network websites have over 300 scouts nationwide that produce 2,500+ articles each month on prep basketball, football, and volleyball. Prep Network also operates 100+ tournaments and showcases that host hundreds of teams and thousands of prospects across the country each year. Job Description As a scout, you will create written and social media content. You will attend high school and club games, watch game film, and publish player-driven analysis on Prep Network's website. You will utilize your existing network with high school and college coaches in your community to grow the Prep Network footprint. We are a rapidly growing sports-focused company where your voice will be heard and you can make a real impact. Aside from helping high school players get recruited, we want someone who fits our culture, work ethic, and, most importantly, our passion for learning and improving. Responsibilities and Duties - Attend high school and club games and publish written and social media content - Promote players at all levels of collegiate recruitment - Work with other Prep Network contributors to maximize the value added to teams, players, and coaches in your state - Network with coaches at all levels to grow the Prep Network brand We Are Looking For Someone Who Is - Entrepreneurial. Help us build the fastest-growing high school sports network in the country - A Great Teammate. No job is too small. We need someone willing to do whatever is needed to build something great - Driven. You are self-motivated and perform without direct supervision - A Strong Communicator. You need excellent interpersonal, verbal, and written skills - Experienced with Microsoft & Google. You are proficient with Microsoft Office (Word, Excel, and PowerPoint), as well as Google Apps (Gmail, Google Calendar, Google Docs) Benefits and Perks - Flexibility. We care more about the quality of your work than your location. - Awesome Co-Workers. Company culture is important to us. We love hiring curious, self-motivated people who work hard and have a blast doing it. - Potential for Growth. Make an impact, and earn the opportunity for an expanded role. Join the Prep Network team, selected as a 2020 recipient of the Best Employers in Sports Award by Front Office Sports as well as 2023 and 2023 Minneapolis St. Paul Best Places to Work.

Job Summary: Clinical Care Reviewer II – Behavioral Health is responsible for processing medical necessity reviews for appropriateness of authorization for behavioral health care services, assisting with discharge planning activities (i.e. outpatient services, home health services) and care coordination for members. Essential Functions: - Complete prospective, concurrent and retrospective review of Behavioral Health services - Identify, document, communication and coordinate care engaging collaborative care partners to facilitation transition to an appropriate level of care - Engage with medical director when additional clinical expertise if needed - Maintain knowledge of state and federal regulations, including State Contracts and Provider Agreements, benefits, and accreditation standards - Identify and refer quality issues to Quality Improvement - Identify and refer appropriate members for Care Management - Provide guidance to non-clinical staff - Provide guidance and support to LPN staff - Attend medical advisement and State Hearing meetings, as requested - Assist Team Leader with special projects or research, as requested - Perform any other job related duties as requested. Education and Experience: - Associates of Science (A.S) in Nursing required or - Bachelor of Science (B.S) in Social Work required - Three (3) years clinical experience required - Utilization Management/Utilization Review experience preferred - Medicaid/Medicare/Commercial experience preferred Competencies, Knowledge and Skills: - Proficient data entry skills and ability to navigate clinical platforms successfully - Working knowledge of Microsoft Outlook, Word, and Excel - Effective oral and written communication skills - Ability to work independently and within a team environment - Attention to detail - Proper grammar usage and phone etiquette - Time management and prioritization skills - Customer service oriented - Decision making/problem solving skills - Strong organizational skills - Change resiliency Licensure and Certification: - Current, unrestricted Registered Nurse (RN) Licensure or Licensed Social Worker (LSW) required - MCG Certification is required or must be obtained within six (6) months of hire required Working Conditions: - General office environment; may be required to sit or stand for extended periods of time - Travel is not typically required Compensation Range: $62,700.00 - $100,400.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Hourly Organization Level Competencies - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-JM1

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description MRTs (Coder) are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings. These coding practitioners analyze and abstract patients' health records, and assign alpha-numeric codes for each diagnosis and procedure. Announcement will close once 50 applicants is reached. Temporarily eligible for Remote work within 50 miles of a VA Medical Center. May fall under the Presidential Memorandum titled "Return to In-Person Work" which will require you to go into the office if the exemption is not approved at the next review. Responsibilities - Responsible for reviewing the overall quality and completeness of clinical documentation. - Inpatient CDI focuses on the concurrent review of patient records with an emphasis on improving documentation while the patient is still in-house. - Outpatient CDI focuses on improving clinical staff documentation of outpatient encounters through retrospective review of outpatient encounters and extensive provider education. - Applies comprehensive knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures, and health services principles. - Reviews clinical documentation and provides education to clinical staff on both inpatient and outpatient episodes of care. - Prepares and conducts provider education on documentation processes in the health record. - Provides education to providers on the need for accurate and complete documentation in the health record. - Adheres to accepted coding practices, guidelines, and conventions. - Reviews VERA input on missed opportunities in provider documentation. - Assists facility staff with documentation requirements to accurately reflect patient care provided. - Searches the patient health record to find documentation justifying code assignment. - Provides advice and guidance on documentation requirements, liability issues, and patient privacy. - Compiles, reviews, abstracts, analyzes, and interprets medical data incidental to patient care activities. - Conducts daily reviews of all new admissions to identify potential documentation improvements. Work Schedule Monday-Friday, 7:30am-4:00pm Mountain Time Qualifications - U.S. Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. - Experience: One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records. - Education: An associate's degree from an accredited college or university recognized by the U.S. Department of Education with a major in health information technology/management, or related degree. - Completion of an AHIMA approved coding program or other intense coding training program. - Certification: Must have either Apprentice/Associate Level Certification, Mastery Level Certification, or Clinical Documentation Improvement Certification through AHIMA or ACDIS. - English Language Proficiency: Must be proficient in spoken & written English. Requirements - Experience equivalent to the journey grade level (GS-8) of a MRT (Coder-Outpatient and Inpatient). - An associate's degree or higher, and three years of experience in clinical documentation improvement. - Mastery level certification through AHIMA or AAPC and two years of experience in clinical documentation improvement. - Clinical experience such as RN, M.D., or DO and one year of experience in clinical documentation improvement. - Demonstrated knowledge of coding and documentation concepts, guidelines, and clinical terminology. - Knowledge of anatomy, physiology, pathophysiology, and pharmacology. - Ability to collect and analyze data and present results. - Knowledge of regulations defining healthcare documentation requirements. - Extensive knowledge of coding rules and regulations. - Knowledge of severity of illness, risk of mortality, and complexity of care for inpatients. - Knowledge of training methods and teaching skills for staff development. Benefits - Competitive salary and regular salary increases. - 37-50 days of annual paid time off per year (13-26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays). - After 12 months of employment, up to 12 weeks of paid parental leave. - Child care subsidy for eligible employees after 60 days of employment. - Traditional federal pension (5 years vesting) and federal 401K with up to 5% contributions by VA. - Federal health/vision/dental/term life/long-term care insurance.