Role Description Responsible for managing the end-to-end credentialing process for physicians and advanced practice providers, ensuring confidentiality, regulatory compliance, and coordination with hospital leadership and committees. Will oversee documentation, resolve issues, and guide files through approval channels, including departmental and board-level reviews. - Plan and organize workload for all new appointments and reappointments. - Identify and resolve issues in the credentialing and privileging process. - Manage committee approval process and meet credentialing deadlines. - Collaborate with CCO and departments to review provider status and red flags. - Maintain confidentiality of provider information and credentialing files. - Ensure compliance with TJC, CMS, URAC, NCQA, and other regulations. - Prepare and present credentialing packets to departmental committees. - Update records post-appointment and respond to regulatory inquiries. - Generate reports and forecast workload to meet regulatory timelines. Qualifications - Bachelor's Degree Related Field of Study preferred - 3-5 years of Credentialing & Privileging, Medical Staff Services required - 3-5 years of experience with MD-Staff preferred - Working knowledge of general office practices and software applications and database management. - Demonstrated understanding of credentialing policies and procedures, as well as accreditation and regulatory requirements relating to the medical staff. - Strong organizational skills. - Ability to manage demanding workload; self-motivated; able to carry out responsibilities with minimum supervision. - Strong analytical skills. - Strong interpersonal skills to effectively communicate with cross-functional teams including staff at all levels of the organization. - Ability to successfully negotiate and collaborate with others of different skill sets, backgrounds and levels within and external to the organization. Requirements - Remote Type: Remote - Work Location: 399 Revolution Drive - Scheduled Weekly Hours: 40 - Employee Type: Regular - Work Shift: Day (United States of America) - Pay Range: $63,648.00 - $90,750.40/Annual - Grade: 6 Benefits At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth.

Role Description The Cardiologist, Virtual Care serves as a virtual health-care provider who specializes in diagnosis, management, and follow-up of patients with any suspected or known heart diseases. The role involves moderately complex to complex issues requiring in-depth evaluation of variable factors. - Specializes in diseases of the heart and blood vessels. - Part of a clinical care team focusing on outpatient medicine, continuity of care, health maintenance, and disease prevention for elderly patients. - Manages complex cardiac conditions such as: - Heart attacks - Abnormal heartbeat rhythms - Congestive heart failure - Provides preventative techniques for potential heart-related illnesses. - Spends 100% of time clinically focused on direct patient virtual care, including patient-facing time and general administrative tasks related to direct patient care. Qualifications - Medical degree and 5+ years of residency and fellowship experience. - Licensure requirements of the state of jurisdiction. - Graduate of accredited MD or DO program of accredited university. - Certified by the American Board of Internal Medicine with a certificate of special qualification in cardiovascular disease. - Certified by the American Board of Nuclear Medicine with a certificate of special qualification in echocardiography. Requirements - This role is considered patient-facing and is part of Humana/Senior Bridge's Tuberculosis (TB) screening program. - If selected for this role, you will be required to be screened for TB. - Occasional travel to Humana's offices for training or meetings may be required. Benefits - Competitive benefits that support whole-person well-being. - Medical, dental, and vision benefits. - 401(k) retirement savings plan. - Time off including: - Paid time off - Company and personal holidays - Volunteer time off - Paid parental and caregiver leave - Short-term and long-term disability. - Life insurance and many other opportunities. Company Description CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment, and more. Our unique care model focuses on personalized experiences, taking time to listen, learn, and address the factors that impact patient well-being. - Integrated care teams spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. - Focus on whole health and addressing the physical, emotional, and social wellness of our patients.

**Account specific roles and responsibilities:** - Review and audit patient charts and clinical documentation. - Verify that ICD-10 diagnosis codes appropriately correspond with documented treatments and services. - Evaluate patient care plans to ensure alignment with diagnoses, prescribed treatments, and documented services. - Complete structured audit reports consisting of 140+ audit questions for each patient chart. - Ensure chart reviews are conducted with a high level of accuracy, consistency, and adherence to documentation standards. - Maintain productivity targets by completing patient chart audits within an average timeframe of approximately 30 minutes per chart. - Identify discrepancies, inconsistencies, or documentation gaps and flag them appropriately through the reporting process. - Follow established workflows, auditing procedures, and quality standards for chart review activities.

Role Description ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Clinical Reviewer to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly skilled professionals, who prioritize employee satisfaction and work-life balance. At ISTA Solutions, we pride ourselves on creating a culture focused on long-term success and life-long learning. We're looking for a team player who is ready to contribute to our mission, just like you! - Review and audit patient charts and clinical documentation. - Verify that ICD-10 diagnosis codes appropriately correspond with documented treatments and services. - Evaluate patient care plans to ensure alignment with diagnoses, prescribed treatments, and documented services. - Complete structured audit reports consisting of 140+ audit questions for each patient chart. - Ensure chart reviews are conducted with a high level of accuracy, consistency, and adherence to documentation standards. - Maintain productivity targets by completing patient chart audits within an average timeframe of approximately 30 minutes per chart. - Identify discrepancies, inconsistencies, or documentation gaps and flag them appropriately through the reporting process. - Follow established workflows, auditing procedures, and quality standards for chart review activities. Qualifications - Must have an active Philippine Registered Nurse (PHRN) license. - Familiarity with ICD-10 diagnosis codes. - Experience reviewing or matching clinical documentation, treatments, and care plans. - Experience with EMR Tools (Kantime). - High level of attention to detail and analytical skills. - Proficient in Microsoft tools and web-based forms. - Good verbal and written English skills. - Must be residing within GMA (Greater Manila Area). - Amenable working night shifts. Benefits - Competitive salary and benefits. - Health Insurance with free dependents. - 10%-night differential. - Attendance Bonus. - Paid time off. - Convertible to cash leave credits. - Performance Appraisal. - Work-life balance. - A focus on growing your career path with us. - We encourage you to follow your passions and learn new skills. Company Description - Strong culture and values-driven leadership. - We create opportunities for you to learn and grow at any stage of your career. - Continuous learning and innovation. - We foster an all-inclusive environment where everyone thrives.