Title: Audit Reviewer Location: AL, AR, AZ, FL, GA, ID, IN, KS, ME, MI, MO, MS, NC, NM, OK, PA, SC, TN, TX, VA, WI, WV United States Job Description: The Audit Reviewer works with claims representatives by reviewing and appealing claims when appropriate to overturn clinical validation and coding denials from Medicare, Medicaid, and other third-party payers. What’s Attractive to the Right Candidate? - Knowtion Health is a growing firm in a growing industry. Our status as a leader in this industry means that we have the resources to invest in the business and to innovate. - Our business is intensely competitive and is constantly evolving. We quickly identify new challenges and develop solutions, so you won’t simply be doing what was done last year. Our new employees are frequently pleased and surprised by how quickly we make decisions and adapt to market conditions. - Knowtion Health culture is inviting and competitive, embracing challenge and celebrating accomplishment; dedicated colleagues striving to provide quality results that have lasting impact. The Opportunity: - Reviews medical record documentation to verify clinical indicators and coding issues as related to DRG Validation Audits, Emergency Department Downgrade Audits, Inpatient Level of Care Audits, and Charge Outlier Audits, etc. - Creates detailed appeal letters for denials from payer to support payment of patient claims - Manages Inventory and Follow up on accounts as appropriate - Reviews InterQual/Milliman, coding guidelines and/or payer medical policies related to denied procedures or services and includes criteria in appeals letter as appropriate - Provides feedback to supervisor regarding issues identified for ongoing training to peers and non-clinical staff members - Identifies root causes and trends to share with clients and staff - Works with peers in collaboration of clinical writing situations What you bring: - Current and valid RN License or Coder with 3 years inpatient experience. - Two years of experience in an acute care hospital (Med/Surg) preferred. - Five years of experience in clinical medical record audits or coding preferred. - Experience using InterQual and Milliman healthcare criteria preferred - Experience reviewing CMS LCD/NCD criteria preferred - Knowledge of CMS and payer reimbursement guidelines preferred - Knowledge of DRG, ICD-10, CPT and HCPCS codes preferred - Comfort with productivity standards The above statements are intended to provide the general nature and level of work being performed by most people assigned to the position. They are not intended to be an exhaustive list of all responsibilities, duties and requirements. This position is remote and requires a dedicated, distraction-free work space at home. We offer a competitive benefits package including medical, dental, vision, life insurance, short term disability, long term disability, bonus opportunities, paid holidays, 401k, and a generous PTO policy. Knowtion Health gives priority to applicants located in the following states: AL, AR, AZ, FL, GA, ID, IN, KS, ME, MI, MO, MS, NC, NM, OK, PA, SC, TN, TX, VA, WI, WV

It's more than a career, it's a calling. WI-REMOTE Worker Type: Regular Job Summary: Oversees and manages the daily operations and activities of the regional Clinical Documentation Improvement (CDI) program. Promotes consistent and standardized operations and documentation across the network. Builds and maintains productive inter/intra departmental and vendor work relationships to optimize operations. Job Responsibilities and Requirements: PRIMARY RESPONSIBILITIES - Manages the daily operations and resources of assigned Clinical Documentation Improvement (CDI) team, including the development and monitoring of strategic operating goals, objectives, and data analysis; and report operational performance, justification, and/or corrective action. Provides on-going support of CDI with extensive collaboration with physicians, nursing, coding, quality, and leadership. - Facilitates improvements to clinical documentation through chart review and educational training sessions (with CDI Educator), which could be performed onsite, with physicians and/or other clinical professionals. Initiates corrective actions to resolve any problem areas identified between CDI and any other areas of the organization. - Collaborates with CDI educator for regional education. Provides ongoing clinical documentation management program education for new staff, including new clinical documentation registered nurses, physicians, nurses, and allied health professionals. Participates in the direction and education of all phases of the clinical documentation process. - Supports and implements technologies designed to improve and/or ensure the accurate depiction of clinical services, patient’s severity of illness, and risk of mortality. - Conducts audits on CDI reviews against quality, coding, and mortality. Provides feedback to staff and CDI educator and director. Reports monthly CDI metrics regarding KPIs and staff productivity. Strengthens technical coding practices and clinician documentation by reviewing patient records with flagged complications to ensure coding accurately reflects the patient’s clinical course and complexity to validate accurate risk-adjustment for administrative metrics used in government incentive/penalty programs. - Collaborates with interdisciplinary teams including physicians, nurse practitioners, physicians assistants, and the department managers for revenue integrity, coding and data quality, case management and health information management. Demonstrate leadership and management skills to promote effective and efficient review of physician documentation and the medical record. - Communicates with assigned regional/ministry physician leaders. Participates in monthly medical management meetings to report CDI metrics and act as subject matter expert for inquiries. - Recruits, engages, develops, leads, and manages assigned staff. ​ - Performs other duties as assigned. EDUCATION - Graduate of accredited school of nursing or education equivalency for licensing EXPERIENCE - Two years' acute hospital experience or surgical area as a clinical nurse - Three years' clinical documentation specialist - Two years' demonstrated progressive leadership experience PHYSICAL REQUIREMENTS - Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs. - Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements. - Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors. - Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc. - Frequent keyboard use/data entry. - Occasional bending, stooping, kneeling, squatting, twisting and gripping. - Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs. - Rare climbing. REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS State of Work Location: Illinois - Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri - Registered Nurse (RN) Issued by Compact State - Or - Registered Nurse (RN) - Missouri Division of Professional Registration State of Work Location: Oklahoma - Registered Nurse (RN) Issued by Compact State - Or - Registered Nurse (RN) - Oklahoma Board of Nursing (OBN) State of Work Location: Wisconsin - Registered Nurse (RN) Issued by Compact State - Or - Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services Work Shift: Day Shift (United States of America) Job Type: Employee Department: 8746010033 Sys Clinical Documentation Improvement Scheduled Weekly Hours: 40 Benefits: SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs. - Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). - Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday. - Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members. Explore All Benefits SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.

About PharmaEssentia: It’s not often you get the chance to make a real impact on the lives of others, while expanding your own possibilities. You’ll find that rare opportunity at PharmaEssentia. Join us, and let’s transform lives, together. PharmaEssentia Corporation is a rapidly growing biopharmaceutical innovator. We are leveraging deep expertise and proven scientific principles to deliver effective new biologics for challenging diseases in the areas of hematology and oncology, with one product approved and a diversifying pipeline. We believe in the potential to improve both health and quality of life for patients with limited options today through the combination of rigorous research and innovative thinking. Founded in 2003 by a team of Taiwanese-American executives and renowned scientists from U.S. biotechnology and pharmaceutical companies, today we are listed on the Taiwan Stock Exchange (TWSE: 6446) and are expanding our global presence with operations in the U.S., Japan, Singapore, South Korea, and China, along with a world-class biologics production facility in Taichung. Position Overview: The primary responsibility of a Medical Science Liaison (MSL) is the exchange of medical information with health care professionals (HCPs) involved with the management of myeloproliferative neoplasms (MPNs). As a key member of the Medical Affairs Team, you will facilitate and develop the relationship with the medical/scientific community including physicians and medical centers, by communicating product-related information to investigators and institutions. In addition, you will provide information on research developments, new clinical trials and new concepts in medical treatment, to bring our flagship product to market for the treatment of polycythemia vera (PV). Key Responsibilities: - Establish a respectable PharmaEssentia presence in the medical community. - Identify and develop relationships with the medical community, thought leaders, and treatment advocates. - Liaise and support the development of key and regional opinion leaders within a broad customer segmentation (community clinics, integrated delivery networks (IDNs), academic centers, etc.). - Provide high quality medical and scientific support/communications to internal and external customers (e.g., advisory board meetings, regional training courses/workshops together with KOL/ROL, support of speakers with presentations and literature research) - Lead medical education (disease statement, guidelines, and product information upon FDA approval). - Manage studies and ensure that proposals are aligned with medical objectives within PharmaEssentia locally and globally. Ensure study projects are in line with commercial objectives. - Maintain a high level of scientific and technical expertise in hematology, oncology, and blood disorders. Develop and increase knowledge of medical literature. Prepare and present critical reviews of scientific publications and congresses, internally and externally. - Complete necessary documentation in order to ensure knowledge preservation (e.g., CRM reports). Utilize the necessary tools to develop and follow up on strategic measures (project plans). - Write and ensure timely submission of locally relevant abstracts at congresses. - Provide cross-functional support for Market Access and other Medical Affairs activities. - Monitor competitor activities and marketplace changes. Qualifications and Experience: - Advanced Degree Required (PhD, PharmD, or MD) - Experience in the pharmaceutical industry, including 3+ years in a field medical/MSL role - Broad knowledge of general medicine with a focus in hematology, oncology or interferons. - Knowledge in planning and execution of scientific studies and clinical trials - Ability to develop and maintain relationships with key thought-leaders. - Ability to introduce the disease state to the KOL community and articulate complex programs. - Development of product knowledge and knowledge of Company and science - Excellent writing and oral communication skills (including presentations) - Strong networking skills (includes internal teams) - On-time completion of goals with high-quality results - Project planning and execution - Quality of judgment and decision making - Initiative on addressing issues for the team (“roll up your sleeves attitude”) - Ability to maintain collaborative relationships within a dynamic team environment. - Adherence and compliance with all required regulatory and GCP guidelines. The expected base salary range for this position is $170,000 to $230,000. Salary offers are based on a wide range of factors including relevant skills, training, experience, education and geographical location. Market and organizational factors are also considered. In addition to base salary and a competitive benefits package, successful candidates are eligible for short-term and long-term incentives. Benefits of working with our team: PharmaEssentia USA strives every day to improve the lives of patients as well as our employees. As a valued member of PharmaEssentia USA, you will enjoy the following benefits: - Comprehensive medical coverage - Dental and vision coverage - Generous paid time-off - 401(k) retirement plan with competitive company match - Medical & Dependent Care Flexible Spending Account - Monthly cell phone reimbursement - Employee Assistance Program Benefits of working with our team: PharmaEssentia USA strives every day to improve the lives of patients as well as our employees. As a valued member of PharmaEssentia USA, you will enjoy the following benefits: - Comprehensive medical coverage - Dental and vision coverage - Generous paid time-off - 401(k) retirement plan with competitive company match - Medical & Dependent Care Flexible Spending Account - Up to $150 monthly cell phone reimbursement - Employee Assistance Program - Free parking EEO Statement: At PharmaEssentia USA, we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. PharmaEssentia USA believes that diversity and inclusion among our team are critical to our success as a global company, and we seek to recruit, develop and retain the most talented people from a diverse candidate pool. PharmaEssentia does not accept unsolicited agency resumes. Staffing agencies should not send resumes to our HR team or to any PharmaEssentia employees. PharmaEssentia is not responsible for any fees related to unsolicited resumes from staffing agencies. At PharmaEssentia, our goal is to treat as many people with cancer as possible. That means challenging the status quo with better science that leads to better lives. By joining our team, you will not only expand your own possibilities, but you will contribute to expanding options for people with cancer. https://us.pharmaessentia.com/careers/

About PharmaEssentia: It’s not often you get the chance to make a real impact on the lives of others, while expanding your own possibilities. You’ll find that rare opportunity at PharmaEssentia. Join us, and let’s transform lives, together. PharmaEssentia Corporation is a rapidly growing biopharmaceutical innovator. We are leveraging deep expertise and proven scientific principles to deliver effective new biologics for challenging diseases in the areas of hematology and oncology, with one product approved and a diversifying pipeline. We believe in the potential to improve both health and quality of life for patients with limited options today through the combination of rigorous research and innovative thinking. Founded in 2003 by a team of Taiwanese-American executives and renowned scientists from U.S. biotechnology and pharmaceutical companies, today we are listed on the Taiwan Stock Exchange (TWSE: 6446) and are expanding our global presence with operations in the U.S., Japan, Singapore, South Korea, and China, along with a world-class biologics production facility in Taichung. Position Overview: The primary responsibility of a Medical Science Liaison (MSL) is the exchange of medical information with health care professionals (HCPs) involved with the management of myeloproliferative neoplasms (MPNs). As a key member of the Medical Affairs Team, you will facilitate and develop the relationship with the medical/scientific community including physicians and medical centers, by communicating product-related information to investigators and institutions. In addition, you will provide information on research developments, new clinical trials and new concepts in medical treatment, to bring our flagship product to market for the treatment of polycythemia vera (PV). Key Responsibilities: - Establish a respectable PharmaEssentia presence in the medical community. - Identify and develop relationships with the medical community, thought leaders, and treatment advocates. - Liaise and support the development of key and regional opinion leaders within a broad customer segmentation (community clinics, integrated delivery networks (IDNs), academic centers, etc.). - Provide high quality medical and scientific support/communications to internal and external customers (e.g., advisory board meetings, regional training courses/workshops together with KOL/ROL, support of speakers with presentations and literature research) - Lead medical education (disease statement, guidelines, and product information upon FDA approval). - Manage studies and ensure that proposals are aligned with medical objectives within PharmaEssentia locally and globally. Ensure study projects are in line with commercial objectives. - Maintain a high level of scientific and technical expertise in hematology, oncology, and blood disorders. Develop and increase knowledge of medical literature. Prepare and present critical reviews of scientific publications and congresses, internally and externally. - Complete necessary documentation in order to ensure knowledge preservation (e.g., CRM reports). Utilize the necessary tools to develop and follow up on strategic measures (project plans). - Write and ensure timely submission of locally relevant abstracts at congresses. - Provide cross-functional support for Market Access and other Medical Affairs activities. - Monitor competitor activities and marketplace changes. Qualifications and Experience: - Advanced Degree Required (PhD, PharmD, or MD) - Experience in the pharmaceutical industry, including 3+ years in a field medical/MSL role - Broad knowledge of general medicine with a focus in hematology, oncology or interferons. - Knowledge in planning and execution of scientific studies and clinical trials - Ability to develop and maintain relationships with key thought-leaders. - Ability to introduce the disease state to the KOL community and articulate complex programs. - Development of product knowledge and knowledge of Company and science - Excellent writing and oral communication skills (including presentations) - Strong networking skills (includes internal teams) - On-time completion of goals with high-quality results - Project planning and execution - Quality of judgment and decision making - Initiative on addressing issues for the team (“roll up your sleeves attitude”) - Ability to maintain collaborative relationships within a dynamic team environment. - Adherence and compliance with all required regulatory and GCP guidelines. The expected base salary range for this position is $170,000 to $230,000. Salary offers are based on a wide range of factors including relevant skills, training, experience, education and geographical location. Market and organizational factors are also considered. In addition to base salary and a competitive benefits package, successful candidates are eligible for short-term and long-term incentives. Benefits of working with our team: PharmaEssentia USA strives every day to improve the lives of patients as well as our employees. As a valued member of PharmaEssentia USA, you will enjoy the following benefits: - Comprehensive medical coverage - Dental and vision coverage - Generous paid time-off - 401(k) retirement plan with competitive company match - Medical & Dependent Care Flexible Spending Account - Monthly cell phone reimbursement - Employee Assistance Program Benefits of working with our team: PharmaEssentia USA strives every day to improve the lives of patients as well as our employees. As a valued member of PharmaEssentia USA, you will enjoy the following benefits: - Comprehensive medical coverage - Dental and vision coverage - Generous paid time-off - 401(k) retirement plan with competitive company match - Medical & Dependent Care Flexible Spending Account - Up to $150 monthly cell phone reimbursement - Employee Assistance Program - Free parking EEO Statement: At PharmaEssentia USA, we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. PharmaEssentia USA believes that diversity and inclusion among our team are critical to our success as a global company, and we seek to recruit, develop and retain the most talented people from a diverse candidate pool. PharmaEssentia does not accept unsolicited agency resumes. Staffing agencies should not send resumes to our HR team or to any PharmaEssentia employees. PharmaEssentia is not responsible for any fees related to unsolicited resumes from staffing agencies. At PharmaEssentia, our goal is to treat as many people with cancer as possible. That means challenging the status quo with better science that leads to better lives. By joining our team, you will not only expand your own possibilities, but you will contribute to expanding options for people with cancer. https://us.pharmaessentia.com/careers/