• Conduct detailed clinical and coding evaluations to ensure claim payments are accurate. • Review medical records and appeal submissions to assess coding accuracy. • Serve as a subject matter expert for claim payment accuracy including pre-payment claim editing and auditing. • Coordinate with vendors and internal teams to design and implement payment integrity solutions. • Collect, analyze, synthesize, and interpret multiple sources of data. • Lead technology/tool updates, testing, and troubleshooting with IT teams and vendors. • Respond to payment integrity inquiries from providers, internal teams, and vendors. • Manage multiple projects or audits with minimal supervision. • Collaborate with appropriate departments regarding payment integrity issues identified during auditing processes. • Develop and facilitate presentations by analyzing and interpreting data to communicate business issues and findings.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Make a difference from home while supporting patients and providers nationwide. We are seeking experienced Registered Nurses (RNs) to join our growing 24-hour medical call center as a Remote Triage Nurse. In this role, you’ll work collaboratively with providers to deliver timely, high-quality patient care through telephone triage, EHR management, and clinical support across multiple states. This is an excellent opportunity for nurses who thrive in a fast-paced environment, enjoy clinical decision-making, and are looking for flexibility without sacrificing meaningful patient impact. Schedule: - Monday–Friday - Day Shift: 8:00 AM – 5:00 PM EST - Full-Time and Part-Time opportunities available - Occasional overtime or adjusted start times may be required based on business needs What You’ll Do: - Respond to inbound and outbound calls for a multi-state nurse triage service - Utilize Schmitt-Thompson telephone triage protocols to assess and triage patients - Document patient interactions accurately in client EHR systems and/or the Call 4 Health platform - Provide clinical assessments via phone or patient portal based on established protocols - Support providers with administrative and clinical tasks, including: - Medication refill requests per protocol - Provider notification of critical results - Post-discharge and post-operative follow-up coordination - Facilitate referrals and assist with prior authorization requests requiring clinical input - Collaborate with hospitals, nursing homes, funeral homes, and government agencies as needed - Participate in Remote Patient Monitoring (RPM) programs, including: - Monitoring vital signs - Educating patients on chronic disease management (diabetes, hypertension, COPD) - Screen and qualify patients for clinical trials and provide patient education - Take on additional responsibilities to support team success and patient outcomes Qualifications - Associate’s or Bachelor’s Degree in Nursing - 2–4 years of full-time RN clinical experience, preferably in ER/Urgent Care, Adult, Pediatric, Ambulatory Care, or ICU - Prior telephone triage experience using electronic triage systems - Experience working with two or more EHR platforms - Active, unencumbered e-NCL / Enhanced Nurse Licensure Compact license - Willingness to obtain additional state licenses as requested Skills That Set You Apart - Strong teamwork and collaboration skills - Ability to step into a leadership role when needed - Excellent customer service, empathy, and communication skills - High attention to detail and documentation accuracy - Strong organization and time management skills Work From Home Requirements - Private, HIPAA-compliant home workspace - Ability to sit for extended periods and use a headset - Broadband internet access - Ability to house company-issued equipment - Participation in staff meetings via phone or video Work Environment - Fast-paced and collaborative - Adaptable to change and able to manage stress effectively - Occasional overtime or schedule adjustments as needed

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Medicare Outreach & Education Specialist plays a crucial role in our Medicare Program by developing and delivering educational content to the provider community regarding current and upcoming CMS regulations. This specialist creates and develops educational materials, hosts events, and analyzes data to improve provider education and reduce billing errors all while working in a fast-paced, remote environment. - Provides education to Medicare providers, coders, billers, and compliance staff. - Assists providers in developing best practices to avoid coverage and billing errors. - Focuses on ensuring a positive customer experience through relationship building with providers, CMS, and other stakeholders. Qualifications - Bachelor’s Degree in Communications, Health Education, Nursing OR related field OR equivalent combination of education and experience. - 3 or more years of experience in a role supporting Medicare. - 1 or more years specifically in Medicare communications. - Demonstrated experience developing educational materials and presentations. - Extensive knowledge of Medicare Part A, Part B and/or Home Health and Hospice program guidelines and PO&E processes. - Solid knowledge and understanding of medical billing, coding, and insurance processes. - Proficient with Microsoft Office Suite and using various modes of technology to deliver training (i.e., YouTube Channel, WebEx, etc.). - Excellent written and verbal communication skills with the ability to present complex information clearly and effectively to diverse audiences. - Strong interpersonal and relationship-building skills. - Ability to travel for onsite training and education sessions - Travel will be approximately 15% in the future. Requirements - Possess experience working with Medicare. - Thrive in developing and maintaining positive relationships with healthcare providers, clinics, and medical staff. - Enjoy planning, developing, coordinating and delivering educational sessions, workshops, and training materials tailored to provider needs. - Can analyze error data, geographical data, track Medicare regulations, WPS policy guidelines, coverage issues, and keep abreast on upcoming legislation, to determine areas for additional education needs. - Like to conduct outreach activities that increase provider engagement and awareness of organizational services, programs, and initiatives. - Have collaborated with clinical and administrative teams to understand provider challenges and develop targeted solutions. - Would enjoy serving as a resource for providers regarding updates in guidelines, policies, billing procedures and regulatory requirements. - Can coordinate with internal teams (i.e., Claims, Appeals, Systems, Medicare Internal Processes, Provider Enrollment) to ensure identified issues are communicated and shared with Provider Outreach & Education (POE) staff. - Can establish and maintain a POE Advisory Group (POE AG) to assist contractors in creation, implementation, and review of provider education strategies and efforts. Preferred Qualifications - CMS knowledge of the Home Health and Hospice program. - Strong facilitation, presentation and training experience to large groups of people. - MAC contractor experience with FISS, MCS and MAS systems. Benefits - Remote and hybrid work options available. - Performance bonus and/or merit increase opportunities. - 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately). - Competitive paid time off. - Health insurance, dental insurance, and telehealth services start DAY 1. - Professional and Leadership Development Programs.

Role Description - Demonstration, Schulung und Einweisung in das Sentec-Portfolio bei klinischen Anwendern vor Ort - Troubleshooting und First-Level-Support für bestehende Kunden - Positionierung von Schlüsselpublikationen und bewährten Verfahren (Best Practices), um den Einsatz der Geräte bei bestehenden Kunden zu steigern - Entwicklung und Betreuung von Verkaufsprojekten in Zusammenarbeit mit dem regionalen Sales Manager - Präsentation des Sentec-Portfolios, einschließlich der Einsatzmöglichkeiten, auf Messen, Kongressen sowie bei regionalen Produkt- und Applikationstrainings Qualifications - Abgeschlossene Ausbildung als Atmungstherapeut/in oder examinierte/r Fachkrankenpfleger/in - Idealerweise mit Fachweiterbildung im Bereich Intensivmedizin, Pneumologie, Schlafmedizin oder Neugeborenen-Intensivmedizin (oder vergleichbar) - Erfahrung in der Schulung und Ausbildung von Fachkräften im Gesundheitswesen - Fließende Deutschkenntnisse sowie gute Englischkenntnisse Requirements - Ihr Wohnsitz sollte idealerweise in der Nähe von Hannover oder in gut erreichbarer Entfernung liegen, um die Nähe zu unseren Kunden sicherzustellen - Diese Position erfordert zudem eine hohe Reisebereitschaft Benefits - Sinnstiftende Arbeit mit Produkten, die lebensrettend sind oder die Therapie von Patienten wirksam unterstützen - Flache Hierarchien und echte interdisziplinäre Arbeitsgruppen - Die Möglichkeit, Ideen einzubringen, aktiv mitzugestalten und Entscheidungen zu treffen