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Healthfirst is a not-for-profit managed care organization founded in 1993. Based in New York, New York, Healthfirst is supported by some of the state’s most esteemed healthcare s
Doc & Coding Proj Coord-1
Location
United States
Posted
85 days ago
Salary
$42.2K - $66.0K / year
Seniority
Mid Level
Job Description
Doc & Coding Proj Coord-1
Healthfirst
The Documentation & Coding Project Coordinator is responsible for managing and monitoring the activities of the Clinical Documentation and Coding Department, in which they audit provider documentation and educate on coding practices along with other related projects that support Healthfirst’s quality objectives. Duties & Responsibilities: · Responsible for expanding and improving medical records acquisition for RADV risk adjustment program · Manages relationships and effectively communicate with internal and external partners regarding quality objectives and targets as they relate to CMS audits. · Collaborates with key departments on Quality driven initiatives championing process improvement · Analyzes data to identify data-driven opportunities for improvement and determine root causes in areas that need improvement to be successful in our CMS audits. · Ensures a working relationship on internal group projects for process improvements. · Analyzes data to identify trends, issues, and opportunities for performance improvement as it relates to clinical quality · Prepares quality improvement related presentations that accurately summarize complex information, details and data · Assists other departments with clinical documentation and coding initiatives · Provides reporting and summaries on CMS audits in areas, but not limited to, noticeable trends, medical records, and issues. · Ensures accuracy and completeness of medical records and complying with HIPAA guidelines. · Analyzes invoice data to reduce billing errors and ensure billable info is correct for the Clinical Documentation and Coding Department audits. · Additional duties as necessary and as directed Minimum Qualifications: · HS Diploma or GED from an accredited institution · 2-3 years in medical record retrieval in a health plan/ provider setting or administrative experience in lieu of health care setting · Strong writing, time management, critical/creative thinking, communication, and problem-solving skills. · Strong working knowledge of Microsoft Office Suite and Outlook Preferred Qualifications: · Background in health care or managed care. This can include work experience and/or education. · Experience with a health plan's quality improvement/management department · Proficiency in multiple EMR systems (Epic, eCW, Athena, Cerner, etc.). · Understanding of CMS RADV requirements and medical record documentation best practices · Associates degree or higher from an accredited institution · Prior experience in Managed Care/Health Insurance, in a health-related field or environment Compliance & Regulatory Responsibilities: Ensures all work is compliant with relevant regulatory guidelines. WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: - Greater New York City Area (NY, NJ, CT residents): $48,600 - $65,960 - All Other Locations (within approved locations): $42,200 - $62,400 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.
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We anticipate the application window for this opening will close on - 6 Apr 2026 At Medtronic you can begin a life-long career of exploration and innovation, while helping champion healthcare access and equity for all. You’ll lead with purpose, breaking down barriers to innovation in a more connected, compassionate world. A Day in the Life Bring your talents to a leader in medical technology and healthcare solutions. Rooted in our long history of mission-driven innovation, our medical technologies open doors. We support your growth with the training, mentorship, and guidance you need to own your future success. Join us for a career that changes lives. CAS seeks collaborative candidates who are patient-centric, passionate, and who represent the same wide variety of life experiences as our patients. We look for candidates who will meet our customer expectations by striving without reserve for the greatest possible reliability and quality in our products, processes and systems by being accountable, having a voice, and taking action. We are seeking a committed professional to join our team. While this is a remote position not located at a physical Medtronic site, the candidate hired will be required to reside within the territory and drive to multiple accounts throughout the region. A valid driver's license is essential for this role. OPTIONAL: This position posting is location flexible and can be based in any of the following locations (ENTER STATES) Primary Responsibilities - Provide technical, educational, clinical and sales support to assist the Region in meeting Cardiac Ablation Solutions sales and customer service objectives. - Represents Medtronic CAS during ablations procedures to provide troubleshooting and other technical assistance - Receives technical inquiries by customers. Researches solutions to questions or problems (e.g., Catheter, Console, Generator support) - Educational Support - Educates and trains physicians, hospital personnel and office staff on technical matters relating to AFS products and related procedures. - One-on-one training sessions - In-service education programs - Seminars and/or outside symposiums - Assists RM and field training department in educating/training new Clinical Specialists and Account Managers - Provides training and resources for hospital staff to enable them to conduct training for their personnel - Sales Support - Updates sales representatives concerning procedure. Immediately notifies Account Manager regarding issues or problems requiring follow-up - Serves as effective Medtronic CAS representative to physicians and support staff regarding Medtronic CAS products, service and support - Promotes the safe and effective use of Medtronic CAS products and related procedures - Understands national, regional and territory sales objectives. Works in partnership with Account Manager to achieve exceed goals The above statements are intended to describe the general nature and level of work being performed by employees assigned to this position, but they are not an exhaustive list of all the required responsibilities and skills of this position. We seek out and hire a diverse workforce at every level: We need fresh ideas and inclusive insights to continue to be an innovative industry leader —that’s why we make it a point to seek out, attract and develop employees who are patient-centric, passionate, and who represent the same wide variety of life experiences as our patients. To learn more about Inclusion & Diversity at Medtronic Click Here Must Have Minimum Requirements To be considered for this role, please ensure these minimum requirements are evident on your resume. - High School diploma or GED PLUS a minimum 11 years of work experience in healthcare within an EP, Cath Lab setting or sales in cardiac field OR - Associate degree PLUS a minimum of 9 years of work experience in healthcare within an EP, Cath Lab setting or sales in cardiac field OR - Bachelor degree PLUS a minimum 7 years work experience in healthcare within an EP, Cath Lab setting or sales in cardiac field - IBHRE or RCIS or RCES Certification required Preferred Qualifications: - Preference will be given to local qualified candidates and candidates with Medtronic experience - B.A./B.S. 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The physical demands described within the Responsibilities section of this job description are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. For Office Roles: While performing the duties of this job, the employee is regularly required to be independently mobile. The employee is also required to interact with a computer, and communicate with peers and co-workers. Contact your manager or local HR to understand the Work Conditions and Physical requirements that may be specific to each role. U.S. Work Authorization & Sponsorship At Medtronic, we are committed to fostering an environment where employees can thrive and make a meaningful impact. 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PR) locations (USD):$110,000.00- $120,000.00 The base salary range is applicable across the United States, excluding Puerto Rico and specific locations in California. The offered rate complies with federal and local regulations and may vary based on factors such as experience, certification/education, market conditions, and location. Compensation and benefits information pertains solely to candidates hired within the United States (local market compensation and benefits will apply for others). In addition to Base Salary, this position is eligible for a Sales Incentive Plan (SIP), which provides the opportunity to earn significant incentive compensation for achieving or exceeding your goals. The following benefits and additional compensation are available to those regular employees who work 20+ hours per week: Health, Dental and vision insurance, Health Savings Account, Healthcare Flexible Spending Account, Life insurance, Long-term disability leave, Dependent daycare spending account, Tuition assistance/reimbursement, and Simple Steps (global well-being program). The following benefits and additional compensation are available to all regular employees: Incentive plans, 401(k) plan plus employer contribution and match, Short-term disability, Paid time off, Paid holidays, Employee Stock Purchase Plan, Employee Assistance Program, Non-qualified Retirement Plan Supplement (subject to IRS earning minimums), and Capital Accumulation Plan (available to Vice Presidents and above, or subject to IRS earning minimums). Regular employees are those who are not temporary, such as interns. Temporary employees are eligible for paid sick time, as required under applicable state law, and the Employee Stock Purchase Plan. Please note some of the above benefits may not apply to workers in Puerto Rico. Further details are available at the link below: Medtronic benefits and compensation plans About Medtronic We lead global healthcare technology and boldly attack the most challenging health problems facing humanity by searching out and finding solutions. Our Mission — to alleviate pain, restore health, and extend life — unites a global team of 95,000+ passionate people. We are engineers at heart— putting ambitious ideas to work to generate real solutions for real people. From the R&D lab, to the factory floor, to the conference room, every one of us experiments, creates, builds, improves and solves. We have the talent, diverse perspectives, and guts to engineer the extraordinary. Learn more about our business, mission, and our commitment to diversity here. 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(“Medtronic”) in any position which will involve performing at least two (2) hours of work on average each week within the unincorporated areas of Los Angeles County, you can find here a list of all material job duties of the specific job position which Medtronic reasonably believes that criminal history may have a direct, adverse and negative relationship potentially resulting in the withdrawal of a conditional offer of employment. Medtronic will consider for employment qualified job applicants with arrest or conviction records in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
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This role will require 25% of travel to enhance collaboration and ensure successful completion of projects.Careers that Change Lives This role will be responsible for creating & leading surgeon education strategies, initiatives, and programs for cranial and spinal therapies, procedures, and technologies, with a specific focus as the Medical Education Lead for the Anterior Lateral Oblique and Posterior Degenerative therapy segments. In this role you will be a critical part of the Training and Education team, responsible for designing and evolving training strategies, planning and executing surgeon training events, creating training materials and curriculum, faculty development / management, and ensuring seamless and holistic educational experiences that increase adoption of CST therapies, procedures, and technologies – driving impact for the Cranial and Spine Technologies (CST) organization and the healthcare providers and patients we serve. 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Content Development & Training Material Management - Partner with HCP Faculty and internal partners to create educational training materials to support educational programs & digital channels. - Manage quality control process for training materials (regulatory, legal, and compliance reviews and approvals) Faculty Selection, Development, and Management - Lead all efforts related to HCP faculty evaluation, selection, onboarding & development through the controlled CST faculty selection process (leveraging your strategic experience to plan faculty utilization and engagement based on needs of business) - Develop, manage, and sustain living HCP faculty roster Must Have: Minimum Requirements High School Diploma or equivalent with 8+ years of relevant experience in a clinical lab setting, clinical training, field sales/support in medical device, healthcare industry or equivalent experience (OR Associate's Degree with 6+ years experience OR Baccalaureate Degree with 4+ years experience). 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The physical demands described within the Responsibilities section of this job description are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. For Office Roles: While performing the duties of this job, the employee is regularly required to be independently mobile. The employee is also required to interact with a computer, and communicate with peers and co-workers. Contact your manager or local HR to understand the Work Conditions and Physical requirements that may be specific to each role. U.S. Work Authorization & Sponsorship At Medtronic, we are committed to fostering an environment where employees can thrive and make a meaningful impact. 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Authorization Specialist II
Centene CorporationTransforming the health of the communities we serve, one person at a time.
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Acts as a resource and supports the prior authorization request process to ensure that all authorization requests are addressed properly in the contractual timeline. Supports utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the members healthcare eligibility and access. - Aids the utilization management team and maintains ongoing tracking and appropriate documentation on authorizations and referrals in accordance with policies and guidelines. - Supports the authorization review process by researching and documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination. - Verifies member insurance coverage and/or service/benefit eligibility via system tools and aligns authorization with the guidelines to ensure a timely adjudication for payment. - Performs data entry to maintain and update various authorization requests into utilization management system. - Supports and processes authorization requests for services in accordance with the insurance prior authorization list and routes to the appropriate clinical reviewer. - Remains up-to-date on healthcare, authorization processes, policies and procedures. - Performs other duties as assigned. - Complies with all policies and standards. Education/Experience: Requires a High School diploma or GED. Requires 1 – 2 years of related experience. Knowledge of medical terminology and insurance preferred. Pay Range: $17.84 - $28.02 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Utilization Specialty Therapist
Centene CorporationTransforming the health of the communities we serve, one person at a time.
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Superior Health Plan - Specialty Therapy Services NOTE: Candidates must reside in the state of Texas Position Purpose: Perform utilization review of authorization requests regarding specialty therapy services for members, including speech language, occupational, and physical therapy across the identified regions and products. Assist with training and network management support for therapy providers. - Perform detailed review of therapy service requests based on evidenced based practice, documentation standards as indicated by the national therapy associations, and organizational policies. - Refer members to case management as appropriate based on service request assessment. - Provide clinical recommendations for any adverse therapy determination. - Provide clinical expertise based on shared practice standards regarding sub-specialty therapy practice to peers. - Provide support for specialty therapy providers, including assistance with clinical trainings, consultation and guidance on matters related to therapy authorization and provision. - Provide clinical expertise to multi-functional areas within organization to support provider relations and operations. - Performs other duties as assigned - Complies with all policies and standards Education/Experience: Master’s degree in area of specialty therapy or equivalent experience. 3+ years of experience providing therapy services in healthcare or home health settings. Pediatric clinical experience preferred. Licenses/Certifications: Current state license in Physical Therapy, Occupational Therapy or Speech-Language Therapy. Speech-Language Therapist must have an active Certificate of Clinical Competence from the American Speech-Language-Hearing Association. Pay Range: $33.71 - $60.67 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act


