Role Description We made history and now we work to transform the future – for our customers, our communities and our families. You'll see your work on the road every day, helping people move freely and pursue their dreams. At Ford, you can build more than vehicles. Come build what matters. Our Marketing, Sales & Service organization advances the Ford reputation as a visionary vehicle and mobility services company and helps deliver a trusted customer experience. Use your marketing, sales and service expertise to turn data-driven insights into innovative solutions that enhance sales and customer loyalty. Join us and be the eyes, ears and voice of Ford. In this position... - Our Global Dealer Engagement team builds successful partnerships with our 9,500 dealers. - Helps dealers unlock their full potential and increase customer satisfaction. - Focuses on training and productivity, governance, customer sentiment, diversity, community, retail excellence, systems and process modernization, and rewards and recognition. - Aims to help dealers differentiate themselves from the competition and maximize their strengths. Qualifications Requirements Benefits Company Description General company description goes here.

Role Description The Pharmacy Auditor is an integral part of the Pharmacy Audit Team and is responsible for performing and supporting Prescription Drug Claim Audits to validate that the coverage of a prescription drug claim, and the payment of such claim, comply with the contractual, regulatory, and custom plan guidelines. - Project management of Prescription Drug Claim Audits from implementation through closure. - Manage and perform audits of prescription drug claim payment data to validate conformance with contractual requirements and plan specifications as assigned. - Review and evaluate Administrative Services Agreement between the employer and PBM. - Work with dedicated data analytics team to define and translate plan provisions for testing purposes. - Review client-specific documentation to develop the audit test filters. - Complete the contract summary, or assist with completion of contract summaries, as assigned. - Evaluate the results of the initial claim data tests and determine valid audit samples for review and response by the PBM. - Prepare PBM communications regarding test results, response expectations, and clarifications to questions. - Work collaboratively with PBM to resolve exceptions, review supporting documentation, and make final claim error determination. - Ensure audit timeline is adhered to and deliver a high level of service to clients. - Perform Manufacturer Rebate audits as assigned (10-20% travel possible). - Prepare and present detailed audit reports which clearly articulate audit findings and recommendations to PBM and client. - Maintain audit project work papers to support audit findings. - Work collaboratively within the audit team, as well as with internal and external customers. - Participate in team meetings, conference calls, Microsoft Teams meetings, etc. - Assist with claims data analysis and quality assurance as requested. - Interact directly with clients and respond to client requests. Develop strong relationships with clients. - Assist in supporting other auditors, Directors, and Practice Leader as requested. - Perform special projects or assignments, as instructed by Director. Qualifications - College degree (experience may be considered to waive the degree requirement). - 5+ years’ experience in prescription drug claim auditing, consulting, or other applicable pharmacy industry experience. - Previous PBM experience is a plus but not required. - Must demonstrate a high level of pharmacy benefit, claim, or benefit administration knowledge - Medicare benefits experience is a strong plus. - Proficient in the use of Microsoft Office Suite of programs (Word, Excel, PowerPoint, Outlook, Teams). - Excellent oral and written communication skills are required. - Excellent organizational and time management skills. - Personable communication style, positive outlook, and self-confidence. - Ability to multi-task and acclimate to changing priorities without losing focus. - Attention to detail and ability to clearly explain thought process in reaching documented conclusions. - Self-directed individuals who require little supervision and can manage multiple projects effectively to ensure deadlines are met. - Team player with a strong work ethic. Benefits - Medical/dental/vision plans, which start from day one! - Life and accident insurance. - 401(K) and Roth options. - Tax-advantaged accounts (HSA, FSA). - Educational expense reimbursement. - Paid parental leave. - Digital mental health services (Talkspace). - Flexible work hours (availability varies by office and job function). - Training programs. - Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing. - Charitable matching gift program. - And more... Company Description Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength.

Role Description This position is located in the Health Information Management (HIM) section at the Western NY VA Medical Center. HIMS is responsible for performing qualitative and quantitative record review of patient records, assigning appropriate codes, submission of relevant reports, and various other duties. The Medical Records Technician (Coder) is responsible for abstracting medical record data and assigning codes using current clinical classification systems for the type of care provided. - Applies comprehensive knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures, and health services principles to ensure proper code selection. - Selects and assigns codes from current versions of coding systems including ICD, CPT, and/or HCPCS. - Adheres to accepted coding practices, guidelines, and conventions for accurate and complete coding. - Monitors regulatory and policy requirements affecting coded information for VAMC services. - Assists facility staff with documentation requirements for accurate patient care reflection. - Consults with professional staff for clarification of conflicting clinical data. - Searches patient records to find documentation justifying code assignment. - Uses various applications (Outlook, Excel, Word, Access) and health record applications (VistA and CPRS). - Ensures software applications are updated and functional. - Reviews, analyzes, and reports performance monitors for PTF, PCE, VERA, and Non-VA Medical Care coding. - Provides coding guidance to staff to promote consistency and compliance. - Responsible for performing audits of coded data and communicating results to leadership. - Collaboratively works with coding and clinical staff on coding issues. - Assists in developing guidelines for data quality and compliance monitoring. - Acts as a technical expert in health information coding matters. - Maintains statistical databases to track coding practices and report results. Qualifications - United States Citizenship. - Certification through AHIMA or AAPC (Apprentice/Associate Level, Mastery Level, or Clinical Documentation Improvement Certification). - One year of creditable experience in medical terminology, anatomy, physiology, and medical coding. - Associate's degree in health information technology/management or related field with relevant coursework. - Completion of an AHIMA approved coding program or equivalent intense coding training. - Equivalent combinations of creditable experience and education are qualifying. Requirements - Experience equivalent to the journey grade level of a MRT (Coder). - Mastery level certification required for higher-level positions. - Demonstrated knowledge of current coding classification systems (ICD, CPT, HCPCS). - Ability to research and solve complex coding questions. - Ability to review coded data for adherence to standards and documentation requirements. - Ability to present audit results and provide guidance for accuracy improvement. - Skill in interpersonal relations and conflict resolution. Benefits - Comprehensive health care benefits. - Generous paid time off. - Retirement plans. - Flexible work schedules. Company Description The Western NY VA Medical Center is dedicated to providing high-quality health care services to veterans.

Role Description The Dayton Ohio VA Medical Center's Health Information Management Service is recruiting for a well-qualified Medical Records Technician - Coder Auditor. - Reviews, analyzes and reports performance monitors for PTF, PCE, VERA and Non-VA Medical Care (purchased care) coding. - Audit accurate and complete assignment of: - ICD-10-CM and ICD-10-PCS codes - MS-DRG, POA status, and discharge disposition values for inpatient health records - ICD-10-CM, CPT, and HCPCS codes for outpatient health records - Audit function includes evaluation of clinical documentation to support optimal code assignment. - Reviews coding and assists coders in improving coding accuracy; provides coding guidance to various levels of staff to promote consistency in practice and compliance with coding rules and regulations; initiates various reports and analyzes data. - Facilitates improved overall quality, completeness and accuracy of coded data. - Ensures the accuracy and completeness of clinical information used for measuring and reporting physician and medical center outcomes with continuing education to all members of the patient care team on an ongoing basis. - Responsible for performing audits of coded data, developing criteria, collecting data, graphing and analyzing results, creating reports and communicating in writing and/or in person to appropriate leadership and groups. - Collaboratively works with coding staff and clinical staff to provide support and education on coding issues. - Provides training and education to coding and clinical staff. - Researches complex coding issues and participates in process improvements related to coding. - Assists in the development of guidelines for data quality, consistency, and monitoring for compliance to improve the quality for clinical, financial, and administrative data. - Ensures that all coded data is fully documented and supported to prevent billing denials and fraud. - As a technical expert in health information coding matters, provides advice and guidance on documentation and coding requirements. - Maintains current knowledge to ensure that coding and documentation meets regulatory guidelines and audit standards. - Analyzes audit results and prepares summary feedback for individual coders and/or clinicians, making recommendations for improvement. - Provides coding consultation to coders and/or clinicians related to coding and documentation questions. - Maintains statistical databases to track results and validate the program for identifying patterns and variations in coding practices. Qualifications - United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. - Experience and Education: - One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records. - 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/health information management, or related degree with a minimum of 12 semester hours in health information technology/health information management. - Completion of an AHIMA approved coding program, or other intense coding training program of approximately one year or more. - Equivalent combinations of creditable experience and education are qualifying for meeting the basic requirements. - Certification: - Apprentice/Associate Level Certification through AHIMA or AAPC. - Mastery Level Certification through AHIMA or AAPC. - Clinical Documentation Improvement Certification through AHIMA or ACDIS. - Loss of Credential: Credentials must be maintained through rigorous continuing education. - Grandfathering Provision: All persons employed in VHA as a MRT (Coder) on the effective date of this qualification standard are considered to have met all qualification requirements. Requirements - One year of creditable experience equivalent to the journey grade level of a MRT (Coder). - Employees at this level must have a mastery level certification. - Demonstrated Knowledge, Skills, and Abilities: - Advanced knowledge of current coding classification systems such as ICD, CPT, and HCPCS. - Ability to research and solve complex questions related to coding conventions and guidelines. - Ability to review coded data and supporting documentation for adherence to standards. - Ability to format and present audit results, identify trends, and provide guidance. - Skill in interpersonal relations and conflict resolution. 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). - Parental Leave: Up to 12 weeks of paid parental leave after 12 months of employment. - Child Care Subsidy: Eligible for a childcare subsidy up to 25% of total eligible childcare costs after 60 days of employment. - Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% contributions by VA. - Insurance: Federal health/vision/dental/term life/long-term care insurance options. Company Description The full performance level of this vacancy is GS8. The actual grade at which an applicant may be selected for this vacancy is GS9.