Tag Archives: remote jobs

Some responsibilities include:

Review medical record information to identify all appropriate coding based on CMS HCC categories.
Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
Provide support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards.
Provide real time support and coordination with Primary Care Providers and Care Coordinators for MRA coding, HEDIS and STARS.
Coordinate with clinical leadership in the development of provider training plans and for active support in the training process.
Organize and schedule periodic training as indicated from chart review results, and/or as requested by medical leadership or CBO management.
Monitor Coding changes to ensure that most current information is available.
Provides coding support to CBO as requested.
Other duties as may be assigned.

Key Competencies:

Builds Trust: Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one’s actions.
Pursues Excellence: Seeks out learning, strives to develop and expand personally, and continuously helps others upgrade their capability to contribute to Humana.
Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.
Collaborates: Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana’s overall success first

Qualifications

Role Essentials

CPC, CRC.CCS-P Coding Certification
CPC-A with coding experience
18+ months of prior medical coding experience
Strong organization and process management skills
Strong collaboration and relationship building skills
Training and presentation experience
Excellent written verbal and written communication skills
Proficient with Microsoft Word, PowerPoint and Excel
Ability to drive to provider offices and be in the field approximately 75%

Role Desirables

HCC coding experience
Meidcare knowledge
Prior experience in a fast paced insurance or health care setting
Associate or Bachelor’s degree

Some responsibilities include:

Description

Support the HS Net Ops Sr. Analyst role. Below are specific tasks they perform on an ongoing basis:

– Process all new incoming applications & contracts from all locations of market

– Process ACD (Add, Change, Delete) notifications for the large delegated groups that have been assigned on a monthly basis

– Maintain provider contract files (permanent files) and system information on an ongoing basis

– Prepare &/or copy meeting packets, HEDIS/STAR packets, orientation packets, and provider educational memos as needed

– Assist with provider calls for claims questions, enrollment questions, referral questions, etc as needed for the North East Texas market

– Research and resolve provider issues for claims for the market as needed

– Manage the HS Connect email requests, daily

– Update Directory Addendums for all H plans (preferred health plans) on a monthly basis, or as needed

– Assist with any fax notifications for Admits, ER visits, or any other Health Services educational documentation throughout the year.

– Work with HS Net Ops Sr. Analysts team as needed to focus on daily ADK (Admits per Thousand), monthly top 1% membership report, and monthly catastrophic report (all year)

– Assist in the development and mailing of any termination letters for provider network

– Manage the Network Interest Process & participate in QIC (quality improvement committee) meeting monthly

– Review the Credentialing Internal SharePoint site page every week for any newly credentialed provider. Once identified, print out profile and give to appropriate Net Ops Rep for processing

Qualifications

US Candidates Only: Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. If you require a special accommodation, please visit our Careers website or contact us at SeeYourself@cigna.com.

Qualifications

High School Diploma or equivalent

Bachelor’s Degree preferred

Proficient at Microsoft Office products and learning reporting applications

Excellent communication, verbal and written skills

25% local Travel within East Texas/Lufkin service area

Some responsibilities include:

JOB SUMMARY

An Account Executive (AE) establishes, nurtures, and retains business relationships with mortgage brokers and correspondents to facilitate the acquisition of a wide variety of residential mortgage loan products and services through the Company’s extensive business-to-business network of correspondents and brokers. The incumbent is responsible for managing all assigned Client accounts to include educating the clients in every aspect of the business relationship. An AE is typically assigned to a specific geographic area.

ESSENTIAL FUNCTIONS

Identifies and aggressively pursues prospective clients within the assigned geographic territory. Regularly secures new Client relationships, and successfully guides new Clients though the Client approval process. Actively promotes the various features and benefits of establishing/maintaining a business relationship with the Company. Learns, understands, and analyzes the Client’s business model and offers consultation as to what products and services may best meet the client’s business needs. Learns and analyzes assigned Clients’ business model and scorecard rating, focusing on eSign execution, rate lock pull-through performance, deficiency ratios, and other applicable quality or sales performance metrics.

EDUCATION AND EXPERIENCE

Bachelor’s degree in related field or equivalent lending experience in a financial institution. Minimum two years direct sales experience in a mortgage banking environment, preferably in a residential wholesale lending capacity.

KNOWLEDGE, SKILLS AND ABILITIES

Thorough knowledge of and the ability to apply concepts to all aspects of residential mortgage lending, origination’s, operations and delivery. Possesses refined marketing skills that can be applied to the wholesale lending environment. PC literacy; proficiency with Microsoft Office products.

Some responsibilities include:

The GDR Group, a stable, dynamic and innovative IT Solutions Provider based in Irvine, CA servicing regionally and nationally – based clients. We provide managed services and business-to-business solutions for today’s technologically dependent businesses.

We are currently seeking …
A Desktop Support Services L2 Technician that possesses a strong customer service orientation, sound technical skills, integrity and a passion for excellence. The right candidate will be extremely detail oriented, able to multi-task in a demanding environment, and possesses exceptional communication and organizational skills. The right candidate will have a “do whatever it takes” attitude and possess great pride in their work.

Essential Functions:

Analyze and resolve moderately complex information system issues for clients. Issues will be related to the desktop computing environment, network applications, production applications, and hardware.
Respond to and resolve client issues concerning systems operation within established Service Level Agreements (SLA).
Closely monitor ticket queue to provide quality assurance of tickets in progress.
Document all end-user requests and interactions in ticketing system.
Resolve, route or escalate service requests to functional teams as necessary.

Qualifications

Minimum 2+ years’ experience in a corporate Helpdesk and/or desktop support environment.
Thorough understanding of Windows 7 and Mac Operating Systems.
Strong Hardware and software troubleshooting skills is a must.
Excellent customer service skills to work effectively with clients
Possess excellent organizational skills
Ability to work well with other people in a team oriented environment.
Must be professional, self-motivated, resourceful, flexible and work with minimal supervision
Must be able to set priorities and be flexible in a fast paced environment.
Understanding and experience with the following Coloration Services – Google Enterprise Apps, BOX, Video, WebEx & Audio Conference
Understanding and experience with Standard Office software & applications (ex: MS Office, Cisco Jabber client & Browsers – Chrome etc)
Must understand and communicate difficult concepts and provide instructions in a clear and straightforward manner.
Ability to troubleshoot client-side MS Exchange problems.
Ability to troubleshoot network port / wireless connectivity issues.
Ability to follow through and document issues and resolutions
Must be able to follow procedures and protocols as outlined by Senior Management.

Some responsibilities include:

Assignment Capsule
Effectively answer inbound calls on the TRICARE program utilizing available resources. Resolve customer service issues in a professional and courteous manner. Effectively communicate information with internal and external customers. Prioritize workload to continuously answer incoming calls and maintain established schedules and deadlines. Utilize information systems for maintenance and reporting issues.

Qualifications

Role Essentials

Our Department of Defense contract requires U.S. Citizenship for this role
High school diploma or equivalent
2 years of customer service experience
Computer literacy with MS Office products
Effective written and verbal communication skills
Analytical and organizational skills

Role Desirables

Experience in healthcare, military or managed care environment

Schedule: Full-time

Primary Location: US-KY-Louisville

Other Locations: US-West Virginia-Charleston, US-Massachusetts-Boston, US-AR-Rogers, US-AL-Birmingham, US-Michigan-Troy, US-South Carolina-Lancaster, US-FL-Tampa, US-New York-Albany, US-New Jersey-Jersey City, US-OH-Cincinnati, US-Texas-San Antonio, US-GA-Atlanta, US-North Carolina-Charlotte, US-TN-Brentwood, US-Mississippi-Ridgeland, US-Maryland-Bethesda, US-IN-Indianapolis, US-Vermont-Montpelier, US-Oklahoma-Tulsa, US-Missouri-Springfield, US-Virginia-Glen Allen

Principal Responsibilities

Act as a liaison between the Client/firm and TSI departments to help ensure that goals are met.
Identify client business needs and expectations to provide solutions to issues or concerns.
Maintain daily contact with assigned clients/firms to ensure appropriate information is provided for the specific needs of each client.
Responsible for responding to daily Client/firm requests, inquiries, and issues through various types of correspondences.
When requested, generate fees and up-sell wherever possible.
Create, maintain, and distribute accurate reports to appropriate parties.
Provide thorough, efficient, and accurate documentation and updates in all required systems for each work event.
Dependent upon position, identify root cause of issues and concerns, determine resolution, and refer to TSI Management.
Dependent upon position, process all payments received, in priority order, on a daily basis at the direction of management and reconcile any discrepancies found in balancing at a batch level or at the end of business.
Dependent upon position input all payments as well as new business efficiently and accurately into record keeping system. When requested, research payments as necessary.
Dependent upon position, maintain and organize all pertinent back up information to substantiate payment postings as necessary.
Knowledge, understanding, and compliance with all applicable Federal, State, and Local laws and regulations relating to job duties.
Knowledge, understanding, and compliance with TSI policies and procedures.
Follow up in a timely manner to ensure customer satisfaction.
Provide feedback to management concerning possible problems or areas of improvement.
Make recommendations to implement improved processes.
Perform other duties as assigned by management.

Qualifications

High School Diploma or General Educational Development (GED) certificate or equivalent relevant work experience desired.
Previous healthcare/medical billing experience required.
Prior experience with Epic billing software preferred.
Exhibit strong attention to detail.
Dependant upon position, good mathematical and analytical skills required.
Ability to maintain the highest level of confidentiality.
Proficient personal computer skills, including Microsoft Office.
Excellent interpersonal, written, and oral communication skills.
Ability to work in a team fostered environment.
Ability to work in a multi-tasked environment.
Ability to prioritize and organize work.

Work Environment

Work at Home/Office environment.
Ability to lift and/or move 20 pounds with or without accommodation.

We provide Equal Employment Opportunity for all individuals regardless of race, color, religion, gender, age, national origin, marital status, sexual orientation, status as a protected veteran, genetic information, status as a qualified individual with a disability and any other basis protected by federal, state or local laws.

Job Type: Full-time

Salary: $17.00 /hour

Job Location:

Boston, MA

Required education:

High school or equivalent

Required experience:

FACS: 1 year
EPIC: 1 year

Some responsibilities include:

Description

The Knowlede Management Application Support Sr. Specialist position is part of the Operating Effectiveness (OE) team supporting business operations for C-KIT 2.0 and will be an active contributor to the enterprise strategy for Knowledge Management. This position will work closely with OE Knowledge Management (KM) team members, business KM teams, and IT to support C-KIT 2.0 and other KM-related activities for the enterprise, including design, system and process development, implementation and production support.

Responsibilities:

• Responsible for business operations support for C-KIT 2.0.

• Serve as liaison between KM spokes, production support, IT partners, developers and scrum teams

• Collaborate with members of the OEKM team to further the enterprise KM strategy, including leading or participating in KM-related projects.

• Assist with the business assessment and evaluation of system functionality to meet business requests, including requirements gathering, documentation, and design, unit and system testing, as well as provide excellent service and support to internal and external customers

• Assist centralized reporting activities for C-KIT 2.0 and provide analysis support to the business KM teams.

• Analyze and measure the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements.

• Executes business testing, including Production Simulation to ensure the results meet the business needs

• Define quality attributes, external interfaces, constraints, and other nonfunctional requirements

• Proactively identify opportunities for improvement in requirements gathering, documentation, and translation

• Identify potential issues/risks and escalates issues to management and appropriate areas

• Analyzes issues and works closely with the technical team to resolve

• Identify solutions to non-standard requests and problems

• Solve moderately complex problems and/or conducts moderately complex analyses

• Participate in C-KIT governance activities

• Assist with the creation of business data rules to enable data quality checks against production data

• Implement and enforce data policies, processes, procedures, and standards

• Prevent data quality issues by identifying frequent user errors, and working with KM leads/business units to strengthen user competence

• Solid understanding of data needs of the business

• Build and maintain strong relationships with business and IT partners

• Understand application development methodologies and applies knowledge to business interactions

• Provide services to multiple concurrent project, project teams or management

Qualifications

• 6+ years of progressive hands-on experience with data analysis in an MSSQL and/or Oracle, Data Warehouse environment
• Experience with High volume, high transaction Data Warehousing Systems
• Experience in Healthcare insurance highly valued
• Must have working SQL knowledge
• Must have experience in data profiling
• Strong analytical and problem solving skills
• Experience in QA/testing
• Excellent oral and written communication skills – able to clearly convey complex blends of business and technical matters to a range of audiences; ability to articulate points clearly as well as concisely
• Experience interpreting business requirements, recognizing impact on business processes, and making recommendations
• Experience liaising with global business customer groups to drive consensus on approach for program level activities
• Experience working with globally diverse teams
• Flexibility to change course based on business needs; effectively manage and deal with change
• Ability to function in a fast-paced environment and prioritize multiple tasks under tight deadlines
• Ability to work independently and within a team environment
• Strong critical thinking skills
• Strong Office Suite experience: Visio, Word, PowerPoint and Excel
• Ability to influence both technical and business discussions and decisions
• Strong work ethic and sense of urgency