Title: Advice Nurse, Mental Health Work From Home Location: West Valley City United States Job Description: We are so glad you are interested in joining Sutter Health! Organization: SHSO-Population Health Services-Utah Position Overview: The Virtual Behavioral Health Transfer Center RN is a Registered Nurse who provides competent and thorough intake services by conducting initial screening of psychiatric and medical needs of all incoming referrals for psychiatric and chemical dependency admissions. Utilizes virtual assessment skills through phone triage and patient assessments including triaging patients in acute crisis and disposition to correct level of care. Job Description: DISCLAIMER: You must be a resident of one of the following states to be eligible for consideration for this position: Utah, Idaho, Arizona, Montana. EDUCATION - Graduate of an accredited school of nursing CERTIFICATION & LICENSURE - RN-Registered Nurse of California (will need to obtain prior to date of hire) - RN-Registered Nurse in State of Residence PREFERRED EXPERIENCE AS TYPICALLY ACQUIRED IN - 1 year of mental health - 2 years of practical nursing in a hospital, clinic, urgent care, or emergency room/department. SKILLS AND KNOWLEDGE - Professional knowledge of clinical nursing protocols, regulations and institutional standards of care and risk management with an emphasis in the areas of disease processes, emergencies, health sciences and pharmacology. - Advanced clinical knowledge of medical diagnoses, procedures, protocols, treatments, and terminology, including a working knowledge of state and federal regulations and guidelines. - Solid analytical and project management skills, including the ability to analyze problems, situations, practices, and procedures, reach practical conclusions, recognize alternatives, provide solutions, and institute effective changes. - Communication, interpersonal, and interviewing skills, including the ability to build rapport and explain medical lab results or sensitive information clearly and professionally to diverse audiences (patients, staff, and doctors). - Proficient computer skills, including Microsoft Office Suite and experience working electronic medical/health records. - Work independently, as well as part of a multidisciplinary team, while demonstrating exceptional attention to detail and organizational skills. - Manage multiple priorities/projects simultaneously, sometimes with rapidly changing priorities, while maintaining event/project schedules. - Recognize unsafe or emergency situations and respond appropriately and professionally. - Ensure the privacy of each patient's protected health information (phi). - Analyze possible solutions using precedents, existing departmental guidelines and policies, experience and good judgment to identify and solve standard problems. Build collaborative relationships with peers, physicians, nurses, administrators, and public to provide the highest quality of patient care. Job Shift: Nights Schedule: Full Time Shift Hours: 12 Days of the Week: Variable Weekend Requirements: Rotating Weekends Benefits: Yes Unions: No Position Status: Non-Exempt Weekly Hours: 36 Employee Status: Regular Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $37.19 to $48.71 / hour The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate's experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health's comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.

Title: Physician Compliance Auditor II Location Remote, United States Category Shared Services Job Type Full Time Job Id26008035 Job Description: About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: - We serve faithfully by doing what's right with a joyful heart. - We never settle by constantly striving for better. - We are in it together by supporting one another and those we serve. - We make an impact by taking initiative and delivering exceptional experience. Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: - Immediate eligibility for health and welfare benefits - 401(k) savings plan with dollar-for-dollar match up to 5% - Tuition Reimbursement - PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level. Job Summary - The Physician Compliance Auditor II audits and evaluates compliance activities to ensure documentation meets standards. - Establishes audit scope, uses tools, compiles data, reports findings, and provides recommendations and training. - Audits may include documentation and coding accuracy for outpatient, inpatient, and emergency services using ICD-10, CPT, HCPCS, and other guidelines. - Coding across multiple services lines - E/M services - Surgical procedures - Diagnostic procedures - Multiple Specialities including: Cardiology, Orthopedics, Family Medicine, Internal Medicine Work Model & Salary 100% Remote The pay range for this position is $26.66 (entry-level qualifications) - $40.00 (highly experienced). The specific rate will depend upon the successful candidate's specific qualifications and prior experience. Essential Functions of the Role - Performs chart audits and formulates recommendations based upon the audit findings and communicates them to the appropriate personnel. - Implements coding reviews and creates work plans based on them. Ensures compliance issues and risks are identified and addressed. - Develops curriculum for educating providers and staff on medical record documentation guidelines. Educates on diagnostic and procedural coding conventions and methodologies. - Acts as a coding compliance and documentation resource and consultant for all providers, company administrators, and clinical staff. - Assists in developing policies and procedures on coding compliance for clinics and the compliance department. - Prepares and submits compliance reports to the compliance committee. - Cross-trains other Physician Compliance Auditors in their area(s) of expertise to provide more depth and flexibility to the department. Key Success Factors - Advanced knowledge of CPT, ICD-10, and HCPCS. - CHC, AHFI, or CFE certification preferred. - Maintains working knowledge of Federal, State, private payer, and other applicable legal and regulatory requirements for the compliance department. - Ability to research complex topics regarding compliance and coding efficiently and accurately. - Able to explain compliance concerns and resolutions clearly and concisely. Comfortable discussing them with all organization members. - Proficient in Word, Excel, and PowerPoint. - Four years auditing experience. Belonging Statement We believe that all people should feel welcomed, valued and supported. QUALIFICATIONS - EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification - EXPERIENCE - 4 Years of Experience - Auditing experience for Pro-Fee (providers) services with a focus on CPT as well as ICD-10-CM - Coding experience across multiple service lines - E/M services - Surgical procedures - Diagnostic procedures - Multiple Specialities including: Cardiology, Orthopedics, Family Medicine, Internal Medicine - CERTIFICATION/LICENSE/REGISTRATION - Active coding certification: CPC (Verified through AAPC) or CCS-P (Verified through AHIMA) required - Auditing experience for Pro-Fee (providers) services with a focus on CPT as well as ICD-10-CM Cert Coding Spec Physician Bas (CCS-P), Cert Professional Coder (CPC), Cert Prof Coder Physician (CPC-P): Must have one of the following: Cert Coding Spec Physician based (CCS-P), Cert Professional Coder (CPC), or Cert Prof Coder Physician (CPC-P).

Role Description We are seeking a highly motivated Coding Quality Auditor with an emphasis in E/M leveling to join our Coding Services team. This job can be performed 100% remotely, and out of state candidates will be considered. The primarily responsible is supporting and leading quality assurance for Coding Services staff through regular auditing of CPT/ICD10/etc selection of all coders, both abstraction and edits. The positions are expected to possess extensive knowledge regarding current rules and usage ICD 10 and CPT and apply those when auditing to their assigned specialties. The position is also expected to be able to assist in trending, coding analysis, coder feedback and providing education either individually or developing and presenting a group presentation. - Serve as a coding expert for assigned specialties. - Maintain records of all audits in database for reference and trending. - Provide auditing of new and existing coders in conjunction with the Coding Services (CS) Department standards. - Using audits, monitor the quality of coding staff work as directed by Coding Services Management and identify areas of education. - Work with leadership and Coding Education Specialist to prepare presentations regarding education to the team for targeted specialty areas and coding groups, based on audit results and trends. - Assist with researching coder questions and provide effective and accurate guidance, and provide supporting documentation for audits. - Identify and research correct coding for new CPT codes, as well as present this information to the team. - Identify provider education opportunities and coordinate with ACE when trends in audits are identified that impact compliance or are the result of provider behavior. - Perform edit analysis to identify educational opportunities and edit modification. - Participate in optimizing work flows to support process improvement and identify additional/ongoing training needs. - Identify trends and work in tandem with management to enhance revenue cycle performance. Qualifications - CPC or AHIMA coding certification required. - CPMA a plus. - 2-4 years of working in a dedicated auditing position. - Strong knowledge of CPT and ICD 10 coding standards. - Skilled in navigating EMR systems and other auditing software. Requirements - All applications MUST be submitted via our website. - You may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation. - You will not be penalized for redacting or removing this information. Benefits - CU Medicine provides generous leave, health plans, and retirement contributions which take your total compensation beyond the number on your paycheck. - Find information about our benefits here .

Role Description The QA Auditor performs audit functions across Client Teams to determine operational efficiency, adherence to internal processes and procedures as well as regulatory requirements, and achievement of quality standards. This role requires an in-depth understanding of the denials management process, a clinical background, attention to detail, and the ability to effectively assess the quality of work completed. The QA Auditor will work closely with internal teams to provide feedback, maintain high standards of quality, and ensure compliance with established processes. - Conduct regular audits of work performed by appeal writers and automated processes to ensure adherence to internal policies and quality standards in the denials management process. - Evaluate how denials are handled, ensuring that all necessary steps are followed, documentation is accurate, and appropriate actions are taken. - Identify defects and improve departmental performance by supporting quality, operational efficiency, and production goals. - Offer constructive feedback to appeal writers based on audit results, identifying areas for improvement and providing guidance on corrective actions. - Provide feedback on automated processes to ensure the highest levels of efficiency in overturning denials. - Maintain accurate records of audit findings and track trends or recurring issues in the denials management process. - Prepare reports to share with management and relevant teams. - Develop strategies for business performance improvement initiatives, including identifying opportunities for improvement, problem prioritization, and creating performance improvement plans for non-compliant audits and/or reports. - Utilize and navigate multiple internal systems (e.g., claims processing systems, communication tools) to review audit data and provide feedback. - Adapt to new systems as necessary. - Work closely with appeal writers, managers, and other stakeholders to foster a collaborative approach to quality improvement and process optimization. - Additional duties as assigned. - Use, protect, and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. - Understand and comply with Information Security and HIPAA policies and procedures at all times. - Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties. Qualifications - State Licensed RN is required. - Experience working in a healthcare or insurance environment, particularly with claims and denials management. - Familiarity with common claims management and denial resolution systems. - Experience in quality auditing or process improvement initiatives. - Familiarity with MCG and Interqual guidelines and processes. - Strong understanding of the denials management process, including common causes of denials and strategies for resolution. - Prior experience with medical records review, claims processing, utilization/case management in a clinical practice or managed care organization, Clinical Appeal Writer, etc. - Advanced knowledge of Microsoft Word, Excel, and Teams for communication, data analysis, and reporting. - Ability to quickly learn and effectively navigate multiple software systems, providing accurate and timely feedback. - Strong analytical skills with the ability to detect issues, inconsistencies, and areas for improvement in the denials management process. - Ability to manage multiple audits simultaneously while maintaining accuracy and efficiency. - Strong interpersonal skills, ability to communicate well at all levels of the organization. - Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses. - High level of integrity and dependability with a strong sense of urgency and results oriented. - Excellent written and verbal communication skills required. - Gracious and welcoming personality for customer service interaction. Working Conditions - Ability to travel to client sites on occasion. - Ability to work outside of normal business hours as needed. Physical Demands - While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals, and telephones; extend arms; kneel; talk and hear. Mental Demands - The employee must be able to follow directions, collaborate with others, and handle stress. Work Environment - The noise level in the work environment is usually minimal.