Role Description Klenico Health se consacre au diagnostic visuel en santé mentale. Avec une équipe dévouée, nous nous efforçons d'améliorer l'accès aux soins de santé mentale et leur compréhension. Dans le cadre de nos projets, les personnes souffrant de troubles psychiques peuvent saisir elles-mêmes leurs symptômes. Elles bénéficient ensuite de conseils lors d'appels vidéo avec des thérapeutes agréés. Pour renforcer notre équipe, nous recherchons un(e) psychothérapeute francophone, travaillant à titre libéral, qui partage notre vision et souhaite contribuer à proposer des solutions innovantes dans le domaine de la santé mentale. - Réalisation d'appels vidéo avec des personnes en Suisse, en français - Utilisation de notre outil de diagnostic numérique - Rédaction d'un rapport d'évaluation à l'intention de nos client·e·s Qualifications - Maîtrise du français d'un très haut niveau, assortie de connaissances spécialisées pertinentes - Maîtrise de l'anglais ou de l'allemand pour communiquer par e-mail avec l'équipe - Psychothérapeute reconnu(e) au niveau fédéral dans le domaine de la thérapie comportementale - Disponibilité de 2 à 3 heures par semaine au moins - Volonté de se familiariser avec le produit dès le début - Grande fiabilité et sens de l'organisation autonome Benefits - Utilisation gratuite du système Klenico pour vos propres patients - Honoraires forfaitaires par dossier - Accompagnement complet lors de votre intégration et soutien important de la part de notre équipe - Start-up dynamique dotée d'une équipe talentueuse et engagée Company Description Klenico offers a CE approved web-based diagnostic tool for mental health professionals, as well as digital diagnostics and therapy suggestions for individuals. We enable quick and comprehensive recording of psychological complaints. Our visual symptom map takes into account all disorder areas and serves as a basis for further clinical assessment. Based on symptoms, Klenico system generates diagnostic suggestions according to ICD-10.

• Responsible for independently conducting comprehensive reviews of MS-DRG and APR-DRG coding and clinical documentation to ensure the accuracy of DRG assignment and reimbursement. • Requires advanced expertise in ICD-10-CM/PCS coding and the ability to exercise discretion and professional judgment in assessing complex clinical information, validating diagnosis code assignments, and identifying discrepancies such as coding errors or upcoding. • Operates with significant autonomy in supporting DRG validation reviews and appeals, interpreting regulatory requirements, and making authoritative decisions to ensure compliance with all applicable laws, payer contracts, and organizational policies. • Independently conducts comprehensive MS-DRG and APR-DRG coding and clinical validation reviews, exercising professional judgment to verify ICD-10-CM/PCS assignments, validate clinical diagnoses, identify discrepancies, and apply inpatient reimbursement rules without direct supervision. • Collaborates with the Medical Director on complex cases, providing expert recommendations and influencing review outcomes to ensure clinical accuracy and compliance. • Leads the evaluation of complex cases and proactively identifies opportunities to develop medical policy in the absence of established guidelines, demonstrating discretion and authority in decision-making. • Applies advanced knowledge of coding guidelines and clinical policies throughout the review process, making autonomous determinations regarding coding accuracy and regulatory compliance. • Prepares clear, concise, and well-supported audit findings, referencing authoritative sources such as AHA Coding Clinic and ICD-10 guidelines, approved Centene policies, and adopted clinical guidelines, ensuring recommendations reflect professional expertise. • Evaluates claims and medical records for compliance with state and federal regulations, payer contracts, and company policies, exercising independent judgment in interpreting requirements and resolving ambiguities. • Consistently meets or exceeds established quality and productivity standards while managing priorities and workflow autonomously. • Contributes to strategic initiatives by assisting in the development of audit concepts, identifying new audit opportunities, and selecting claims for review, demonstrating leadership in shaping audit methodologies. • Performs other duties as assigned. Complies with all policies and standards.

• Provide a holistic evaluation for domestic and international applications for undergraduate admission. • Review all application materials and make an admissions recommendation based on extensive training. • Attend and participate in monthly trainings and individual coaching sessions, and other meetings as needed during normal university business hours. • Enter recommendations for completed reviews into the review site on a weekly basis. • Ensure confidentiality and security of the admissions process, files, and university materials.

• Responsible for utilization review calls within BHS, including precertification, continued stay review, discharge reviews, and retrospective reviews and appeals. • Works closely with business office staff, clinical staff, and physicians to advocate for BHS patients with insurance and managed care companies. • Communicates insurance input to physicians and clinical staff making discharge plans for patients. • Assists clinical staff with assessments as needed, primarily as in a back-up capacity. • Communicates daily with Utilization Review Coordinator, and as needed with business office and admissions staff to understand admissions and transfers, patient benefit information, and precertification status. • Understands health care benefit plan provisions and managed care contracting. • Communicates and coordinates efforts at appealing unfavorable utilization review decisions.