Jobs
>
Greenville

    Remote Director, Medical Review - Greenville, United States - HealthPRO Heritage

    HealthPRO Heritage
    HealthPRO Heritage Greenville, United States

    2 weeks ago

    Default job background
    Description

    Overview


    The Director, Medical Review will:

    Lead tracking and coordination of all direct bill therapy appeals, ensuring thorough data compilation and analysis. Lead ALJ hearing preparation and maintain professional communication with facility and corporate personnel. Communicate effectively with public and medical personnel promoting clinical excellence. Uphold exceptional customer service standards, fostering positive relationships. Track audit topics and trends for process improvement and participate in or lead presentations/trainings. Responsible for thorough appeal preparation and submission, and to remain adaptable to evolving responsibilities.

    Top of Form

    Reports To: SVP of Clinical Strategies and Consulting

    Supervises: Medical Review Specialists, as needed.

    Salary Range: $75-$85K

    Responsibilities


    Principal Responsibilities and Duties:

    The following is a list of specific duties, which are considered to be essential functions of this job. The list is not exhaustive as all duties are subject to change. This is consistent with our need to be flexible and responsive to the needs of our customers, patients, co-workers and associated policies. The employee who occupies this position is expected to assume any/all duties assigned by management, irrespective of whether such duties are specifically included in this list. While an effort has been made to thoroughly describe the customary manner in which this job is performed, reasonable accommodation will be made upon notification for qualified individuals with disabilities who may not be able to perform the job in the manner indicated.

    • Take the lead in tracking and coordinating all direct bill therapy appeals, overseeing the compilation and analysis of crucial data.
    • Prepare personalized appeal letters for each denied claim, addressing issues like lack of medical necessity or coding errors.
    • Review and refine documentation packets to ensure accurate representation of services being appealed.
    • Ensure the accuracy of information within EMR/tracking systems, verifying that appeals are processed at the correct level and that dollar amounts are entered accurately.
    • Collaborate closely with compliance and billing teams to streamline denials/appeals processing and ensure timely submission of completed appeals. Coordinate completion of required SL clinical claim corrections for billing between AGS, Rev Cycle, RVP and RD
    • Work in conjunction with PMs and clinicians to initiate and oversee ALJ hearing preparation when necessary.
    • Maintain professional and effective communication with personnel at both facility and corporate levels, supporting the denials-appeals processes.
    • Engage in effective communication with both public and medical personnel as required, conveying information about denials, our care philosophy, and the therapy services provided by HPH.
    • Uphold and promote HPH's commitment to exceptional customer service, fostering positive relationships with facility staff, company personnel, and fellow members of the therapy team.
    • Track and analyze audit topics by MAC/State/OIG, contributing insights to improve processes and compliance.
    • Lead or participate in presentations and trainings related to denials and appeals.
    • Responsible for the thorough preparation and submission of appeals.
    • Remain adaptable and responsive to evolving job duties and responsibilities.

    HIPAA & THE MINIMUM NECESSARY STANDARD:

    The Employee shall maintain the confidentiality of all protected health information (PHI) whether electronic, written or oral to which he/she may be exposed either during the course of their duties or the result of an incidental disclosure. In accordance with the minimum necessary standard, the employee may only access PHI to perform the job as a Appeals Specialist. The minimum necessary standard must be applied in all matters and shall continue privacy protection during non-working hours and after employment is no longer with the company.

    This job description does not list all the duties of the job. You may be asked by the supervisors or managers to perform other duties. You will be evaluated in part based upon your performance of the tasks listed in this job description.

    Qualifications


    Knowledge, Skills and Experience Required:

  • Must have exceptional organization and communication skills, ability to prioritize, effectively communicate and execute timely, all tasks related to the denials process.
  • Self-motivated and disciplined with the ability to work remotely.
  • Must be knowledgeable of the general interpretation of remittance advice from Medicare Administrative Contractors and terminology related to Medicare and other payor denials.
  • Must demonstrate the ability to manually enter information into therapy EMR and extract information as directed by QAC, RD, RVP.
  • Fundamental working knowledge of denials and appeals process.
  • Proficient knowledge in Microsoft office (word, excel), Smartsheet, Adobe PDF, job-related internet research.
  • Comfortable with computer and software utilization and expedient in grasping new software applications.
  • 4 years post high school education in a therapy discipline preferred.
  • Familiarity with medical terminology.
  • Must be able to communicate effectively with internal and external customers; facility staff, HPH field management, corporate partners, etc.

    • Physical Demands:

    Someone performing these duties should be in good physical condition and possess the capabilities, with or without reasonable accommodations.

  • Must be able to talk or hear and use hands to touch, handle or feel
  • Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
  • Use of body mechanics and techniques for bearing weight
  • Ability to sit for extended periods of time
  • Ability to work on computer for extended periods of time

    • Recruiter : Email Address

  • MRG Exams

    Nurse Practitioner

    2 weeks ago

    MRG Exams Greenville, United States Full time

    We are looking for the right Nurse Practitioner to perform medical assessments on United States Veterans as part of the VA's disability benefits process. · In performing Disability Assessments, you will review medical records electronically through a web portal and perform a focu ...

  • CVS Health

    Driver Lead

    1 week ago

    CVS Health Greenville, United States

    Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — ...

  • Aggressive Tooling, Inc

    Automation Sales Project Manager

    2 weeks ago

    Aggressive Tooling, Inc Greenville, United States

    Automation Sales Project Manager Position Description · Aggressive Tooling is seeking an Automation Sales Project Manager to manage the coordination and completion of projects. The Automation Sales Project Manager works closely with the design and sales engineer teams to ensure o ...

  • Lockheed Martin

    Mission Planning System Admin

    2 weeks ago

    Lockheed Martin Greenville, United States

    **Job ID**: 664508BR · **Date posted**: Apr. 10, 2024 · **Program**: F-35 Logistics product Operations & Sustainment · **Description**: · **Lockheed Martin Aeronautics. Be More Than You Can Imagine.** · Joining the Lockheed Martin ALIS team immediately opens a world of educationa ...

  • Heart of the Carolinas Home Care

    Private Duty Nurse

    5 days ago

    Heart of the Carolinas Home Care Greenville, United States

    **Job Summary** · **Benefits** · - Flexibility in Scheduling - Create Your Schedule · - Opportunities for Pay Increase · **Responsibilities**- Visit patients in their homes for one-on-one visits.- · - Complete initial and ongoing assessments to identify the physical, psychosocial ...

  • Washington Care Center

    Lpn Full Time

    3 days ago

    Washington Care Center Greenville, United States Full time

    Licensed Practical Nurse Full-Time 2pm-10pm · Job Summary: The Licensed Staff Nurse is responsible for the nursing care of the facility residents. The Licensed Staff Nurse communicates with off going and arriving shifts of personnel to assure the continuum of quality of care. The ...

  • Prisma Health

    Vascular Sonographer

    3 days ago

    Prisma Health Greenville, United States Part time

    **Inspire health. Serve with compassion. Be the difference.** · **Job Summary** · Under the direction of the vascular lab manager and medical director, the Vascular Sonographer performs all vascular lab exams. Provides quality patient care using vascular lab physiological and ult ...

  • Greenville County Schools

    Payroll Analyst

    3 days ago

    Greenville County Schools Greenville, United States

    **Job Title**:Payroll Analyst** · **Qualifications**: · The person in this position should have the following credentials: · - College degree and four years of experience in payroll administration, or any equivalent combination of education and experience which provides the requi ...

  • Corewell Health

    Patient Services Representative

    1 week ago

    Corewell Health Greenville, United States

    Job Summary · Provides clerical support in complex matters to assist in the delivery of quality health care services. · Essential Functions · - Responsible for complex patient/customer problem solving, including high level discernment when registering patients in treatment rooms. ...

  • Dell

    Sr. Manager Financial Systems

    1 week ago

    Dell Simpsonville, United States Full time

    Senior Manager, Financial Systems · Location: The position can be fully remote with a preference of Atlanta, GA based. · Secureworks (NASDAQ: SCWX) is a global cybersecurity leader that secures human progress with Secureworks TaegisTM, a SaaS-based, open XDR platform built on 20 ...

  • DocCafe

    Dermatology Physician

    1 week ago

    DocCafe Greenville, United States

    DocCafe has an immediate opening for the following position: Physician - Dermatology in Greenville, South Carolina. · DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career. · Register now to apply for this job and for access t ...

  • Supplemental Health Care

    Travel Nurse RN

    4 days ago

    Supplemental Health Care Greenville, SC, United States

    Supplemental Health Care is seeking a travel nurse RN Telemetry for a travel nursing job in Greenville, South Carolina. · Job Description & Requirements · Specialty: Telemetry · Discipline: RN · Start Date: ASAP · Duration: 13 weeks · Employment Type: Travel · Job Description: · ...

  • Travel Nurses, Inc.

    RN-Telemetry Travel Nursing

    1 week ago

    Travel Nurses, Inc. Greenville, SC, United States

    Travel Nurses, Inc. is seeking a travel nurse RN Telemetry for a travel nursing job in Greenville, South Carolina. · Job Description & Requirements · ~ Specialty: Telemetry · ~ Discipline: RN · ~ Duration: 13 weeks · ~48 hours per week · ~ Shift: 12 hours, nights · ~ Emplo ...

  • XPO

    Wellford, SC

    2 days ago

    XPO Reidville, United States Full time

    Solutions driven success. · XPO is a top ten global provider of transportation services, with a highly integrated network of people, technology and physical assets. At XPO, we look for employees who like a challenge and can communicate effectively in all situations. We want to le ...

  • Metromont

    Structural Engineer

    2 weeks ago

    Metromont Greenville, United States

    Job Description · Application_instructions:Would you like to be part of a family who loves to take on exciting challenges? Metromont Corporation has been one of the leaders in the construction industry for nearly a century and is currently accepting resumes for Structural Enginee ...

  • Core Civic

    Dentist (Temporary)

    2 weeks ago

    Core Civic Greenville, United States

    Job Description · *Position is full-time but will last 6-8 weeks* · $150,000 200,000 per year · At CoreCivic, we do more than manage inmates, we care for people. CoreCivic is currently seeking Dentist who have a passion for providing the highest quality care in an institutional s ...

  • XPO

    Wellford, SC

    2 days ago

    XPO Startex, United States Full time

    Solutions driven success. · XPO is a top ten global provider of transportation services, with a highly integrated network of people, technology and physical assets. At XPO, we look for employees who like a challenge and can communicate effectively in all situations. We want to le ...

  • Prisma Health

    Professional Billing Quality Coding Auditor, FT, Days,

    1 week ago

    Prisma Health Greenville, United States

    Inspire health. Serve with compassion. Be the difference. · Job Summary · The Professional Billing Quality Coding Auditor will support the Medical Group Coding and Education department by performing routine reviews of coders to ensure accurate coding. This position will also perf ...

  • Core Civic

    Mental Health Therapist

    1 week ago

    Core Civic Greenville, United States Full time

    $65,000 - $75,000 /Year · At CoreCivic, our mental healthteams make lasting changes in the lives of offenders, as we set thestandards of care in the industry. · In our organization, these professionals are placed inthe position of Mental Health Coordinatorto plan and provide cli ...

  • XPO

    Wellford, SC

    2 days ago

    XPO Spartanburg, United States Full time

    Solutions driven success. · XPO is a top ten global provider of transportation services, with a highly integrated network of people, technology and physical assets. At XPO, we look for employees who like a challenge and can communicate effectively in all situations. We want to le ...